In her large, extended, physician-filled family, the assumption early on was that Sarah Krevans MBA, MPH ’84, would go to medical school. (Krevans’s father is Julius Krevans MD, chancellor emeritus of UCSF.) But after taking time off from college to work in what at the time were “probably the most underfunded and disenfranchised” sectors of health care—a nursing home, a psychiatric hospital, and home health care for Medicaid patients—she realized she needed to take a related but different path.
“I became very passionate about the terrible way the system was put together,” she says. “The biggest problem with U.S. health care was the structure of the system itself.” That, she concluded, was what she needed to address.
To learn more about health administration and policy, Krevans enrolled first in UC Berkeley’s business school and then in the School of Public Health, where she would be deeply influenced by “the emphasis on a multidisciplinary approach.”
Today, as the chief operating officer of Sacramento-based Sutter Health, one of the nation’s leading not-for-profit health care systems, Krevans engages colleagues in every discipline to improve care for patients in 100 communities throughout Northern California.
She oversees operations at Sutter’s 24 hospitals; five physician organizations; and extensive ambulatory care services, long-term care centers, home health and hospice services, and research facilities. To meet the challenge of federal health care reform and reimbursement reductions, she is leading Sutter’s efforts to cut administrative costs by $300 million. She also directs the system’s multi-billion-dollar capital projects, including seismic replacement hospitals like Alta Bates Summit Medical Center in Oakland.
Sutter Health recently announced that Krevans has been tapped to fill the role of CEO beginning January 2016, making her the first woman to lead the organization.
A 14-year veteran of Sutter (with many years at Kaiser Permanente before that), she became COO in January 2012, after serving as president of Sutter’s expansive Sacramento Sierra region, where her team was recognized for its innovations in improving clinical quality and access to care while also making health care more affordable for patients.
As COO, she has partnered with other team members to make a significant impact on how patients access care. For example, the number of patients using My Health Online—the network’s system that connects patients to their doctors and health records—has enjoyed exponential growth, making Sutter Health a leader nationally in the percentage of physicians and patients who are engaged electronically with each other.
Krevans credits Sutter Health’s retiring CEO Pat Fry and the system’s physician leaders, most particularly, Dr. Gordon Hunt Jr., senior vice president and chief medical officer, for quality improvements over the years that have routinely placed the system in the top decile nationally for excellence in patient care.
She is proud that “the ability of our system to spread quality initiatives has improved greatly in the last several years.” For example, she cites Sutter Health’s campaign, in partnership with the March of Dimes, to improve maternal and infant health by educating caregivers and mothers-to-be about the risks of inducing early delivery of babies—a disturbing national trend—and the benefits of permitting pregnancies to go to full term (39 or 40 weeks). The campaign has reduced early elective deliveries in the Sutter Health network by 91 percent since 2010.
In November 2013, Sutter Davis, a hospital with which Krevans has worked closely, became the first Northern California hospital to receive the Malcolm Baldrige National Quality Award, the nation’s highest presidential honor for performance excellence through innovation, improvement, and visionary leadership.
And, as part of federal health care reform, Sutter Health has received one of the largest innovation grants of its kind from the Center for Medicare & Medicaid Innovation to find better ways to care for patients who have advanced illnesses but are not eligible for hospice care. Preliminary results of the Advanced Illness Management (AIM) program, as it is called, are very promising: From July 2012 to December 2013, the program reduced hospitalizations, reduced days in intensive care, garnered high satisfaction ratings from patients, and saved government payers and commercial health plans an estimated $15 million.
“We’re really excited about AIM, its impact on the beneficiaries, and what it can mean from a policy perspective,” Krevans says.
Along with focusing on quality, Krevans and her team “have been working really hard on affordability,” she says, noting that providing high quality care while keeping costs down is especially challenging, given declining reimbursement from government payers and Sutter Health’s sizable commitment to charity care.
“Our hospitals take care of more MediCal patients in Northern California than anyone else,” she says. “That’s a very important part of who we are and what we do. Our ability to sustain this mission is very dependent not just on our generous philanthropic community but also on continuing to be attractive to insured patients. The focus on high quality is important for every patient. It’s a value within the organization, and, fortunately, it is becoming increasingly an external value,” she says.
To achieve clinical goals, Krevans turns to her “talented physician colleagues” and makes sure she has the right nursing leadership involved, along with other specialists. She emphasizes that acting in partnership is not only a “brand promise” to patients but also “an absolute must” in all aspects of her work for empowering everyone to perform “at the top of their license, their capability, their passion.”
The mother of three, Krevans, who was named Woman of the Year in 2011 by Northern California’s Women Healthcare Executives, often hears from young women wondering how she has managed to make a mark in her chosen field while successfully raising a family.
“I tell them they probably have more flexibility than they think, they have a long time to work, and they should learn to say ‘no’ occasionally,” she says. For her part, she aims to create an environment that supports people’s careers, “even when they need to make choices to make their personal life work for them.”
“There’s a lot of tremendous talent in health care, and we have not translated that talent into great care for everyone in the United States. That has to be the goal.”
For students starting out, she advises, “Health care is changing so much. Be open to getting experience, rather than focused on a particular title or a particular career path. Some of the titles I thought I wanted when I started in a particular company didn’t exist at the point where I would have been eligible for them! It’s great to have ambition, but let it be about the impact you want to have on the world and what you want to accomplish! You’ll end up with more opportunity.”
As for building a better structure for health care—her dream starting out and her continuing professional goal—Krevans says, “There’s a lot of tremendous talent in health care, and we have not translated that talent into great care for everyone in the United States. That has to be the goal. I find the visioning work going on now at our academic institutions like UC Berkeley really exciting. Any way we can broaden that conversation to bring together the incredible thinkers at the School of Public Health with people who are responsible for taking care of so much of Northern California has great potential for making a difference in how health care is provided in the future.”