When Advocate Health co-CEO Jim Skogsbergh began planning his departure, he knew he wanted to leave the health system better than he found it, avoid overstaying his welcome and exit at the top of his game.
Mr. Skogsbergh steps down May 31 from a system he's been with for 23 years.
He joined Advocate Health Care, then headquartered in Oak Brook, Ill., in 2001, assuming the role of president and CEO a year later. At the time, the organization was a $2.5 billion, eight-hospital nonprofit system with 24,500 employees. Under his leadership, it underwent several transformations and navigated two significant mergers, including its 2022 combination with Charlotte, N.C.-based Atrium Health that culminated in the $31.7 billion system it is today.
"It's not about being big," Mr. Skogsbergh told Becker's. "It's about being better and stronger. And if scale can bring you strength so that you can better serve the community, then that's a good thing."
Mr. Skogsbergh's departure is meticulously planned. A timeline was established for him to serve as co-CEO alongside Eugene A. Woods for 18 months following the merger of Atrium and Advocate Aurora in 2022. In conversation with Mr. Woods and other colleagues who have worked with Mr. Skogsbergh for one to two decades, a portrait emerges of a leader who may surprise some as an unexpected figure behind a system that has grown tenfold in size.
"He walks into a room and you can't help but notice his warmth," said Michele Baker Richardson, chair of the Advocate Health board of directors and president and CEO of Higher Education Associates, who has known Mr. Skogsbergh for 20 years.
Rapid growth is frequently associated with outspoken or aggressive leadership styles. Mr. Skogsbergh defies the stereotype. Hailing from Cedar Rapids, Iowa, he is recognized for his deeply inquisitive nature, straightforward communication, composure, humility and visionary thinking.
Effectively Mr. Skogsbergh's boss, Ms. Richardson as board chair describes him as the consummate communicator. He lets his work speak for itself, but is also known to speak up to the board about good and bad news, early and often. "I never worried that I was going to hear about something before I heard it from Jim," she said.
As the system grew larger throughout their working relationship, Ms. Richardson said her best memories of Mr. Skogsbergh are what became a routine event: board meetings where he would openly invite his team to challenge his perspective and correct him if necessary.
"You see very few CEOs who invite active dissent in front of their board, and he got it sometimes," Ms. Richardson said. This aligns with other anecdotes about Mr. Skogsbergh, whose trust in his leadership team would take center stage at live events as he scanned the audience and invited fellow executives on stage to answer questions on specific topics, trusting their ability to provide more nuanced answers than he could offer himself.
Mr. Woods, who knew Mr. Skogsbergh for more than a decade before they became co-CEOs in 2022, described his counterpart as an authentic, transparent leader with a distinct work ethic who makes the most of the people around him. Rather than priding himself on having all the answers, Mr. Skogsbergh makes an impression on others through his questions.
"I don't think I've come across a leader that asks as penetrating, good questions as Jim does," Mr. Woods said. "He's never tried to ask the question to be the smartest person. He's always asking questions to bring out the best in others, that's always his intention."
(Mr. Skogsbergh admits to this: "There's probably nothing I won't ask rather than hold my tongue and assume that I know or assume that I understand.")
Ken Kaufman, managing director and chair of healthcare consulting firm Kaufman Hall, has known Mr. Skogsbergh for 22 years and characterizes him as one of the leading visionaries for scale in the hospital industry. When Advocate Health Care merged with Aurora Health Care in Milwaukee in 2018, the system grew to 27 hospitals, 70,000 employees and $12 billion in revenue in its first year as a combined enterprise.
"Jim's response to that was, well, that was well and good, but that still hasn't created an organization with enough scale to deal with what's going on in the greater healthcare marketplace," Mr. Kaufman recounted to Becker's about his experience consulting Mr. Skogsbergh. Health insurers were either attempting or achieving significant growth around this time. For instance, in 2018, CVS acquired Aetna for $69 billion, representing the largest healthcare merger of its time.
Mr. Skogsbergh's pursuit for growth — in cash flow, capital capacity and intellectual capital — persisted.
"He saw the value of systemness, and how systems presented a whole series of opportunities that you could not achieve without scale," Rick Pollack, president and CEO of the American Hospital Association, told Becker's. Having known Mr. Skogsbergh for over 20 years, Mr. Pollack pointed out his personable nature as one of the first qualities that left an impression on him.
In 2020, Mr. Skogsbergh made local headlines for openly soliciting partners to enhance Advocate Aurora Health's growth. "After methodically expanding Advocate Aurora Health into a regional hospital power over two decades, Jim Skogsbergh is hitting the gas," Crain's Chicago Business noted at the time, citing his "ambitious" plan to more than double the health system's revenue by 2025.
"We had individuals who thought we were on the right track. We had quite a few who thought we weren't on the right track," Mr. Kaufman said. "But the one thing that Jim did was never give up on the idea, which really shows what kind of executive and how good a thinker he was and how capable he was in executing on his thought process."
"People say big is bad," Mr. Skogsbergh told me. "I say inefficient is bad. Ineffective is bad. Being big — in and of itself — is not." He points out what he sees as a conundrum: U.S. health insurers have expanded in size and dominance, persistently absorbing health systems in their wake, providing yet another rationale for the scale and integration he consistently advocated for at Advocate.
The growth did not happen without setbacks. Advocate lost to the FTC in 2017 when it tried to merge with NorthShore University Health System in Chicago's northwest suburbs. ("I still think it was a terrible decision," Mr. Skogsbergh said.) In October 2020, it scrapped plans for a proposed merger with Beaumont Health, headquartered in Royal Oak, Mich., which would have formed a $17 billion health system.
The false starts left Mr. Skogsbergh with a sharper understanding of what makes strong partnerships. He cites "worldview" as the most critical determinant of a health system match. Patient safety and clinical quality made up priority number one. "Everything else is in second place," Mr. Skogsbergh said. "Everything else."
Close seconds include commitments to community citizenship, financial health, and diversity, equity and inclusion. Having a defined sense of direction, particularly toward value-based care, was also essential in selecting a health system partner. "I laugh when I hear '10-year strategic plan,'" Mr. Skogsbergh said. "I just don't think the world works that way. But the notion of being clear about where you want to go I think is critical, and how you get there is the flexible part."
Charlotte, N.C.-based Atrium Health turned out to fit the bill.
Initially, the pairing seemed unlikely, resulting in a geographic footprint reminiscent of a crooked semicolon, with care facilities spanning Illinois, Wisconsin, North Carolina, South Carolina, Georgia and Alabama. However, it swiftly advanced from its announcement in May 2022 to its completion in December, following successful clearance by state regulatory agencies and approval from the FTC.
Mr. Skogsbergh insisted that the timeline for his departure be communicated when news of the deal was made.
Mr. Skogsbergh said he told Mr. Woods, "'Let's announce my timeframe when we announce the deal, because that immediately puts you in the driver's seat. I'm not the least bit concerned about being a lame duck,'" Mr. Skogsbergh said. "That's not me. That's not my style. So, that's something that I think served the organization well right away."
The health system, now the third largest nonprofit of its kind in the U.S., will solely be led by Mr. Woods with Mr. Skogsbergh's departure. The two seem to have performed as well as possible in an unusual and challenging shared leadership role.
"We knew that there is a long history of co-CEOs in healthcare and other sectors that just don't work," Mr. Woods said. "So we endeavored from the beginning to do it well. The commitment we made on the front end is that we'd be better friends and better colleagues at the end of 18 months."
Mr. Woods describes his co-pilot as having Midwestern values, a concept that Mr. Skogsbergh argues is more shared than confined to any particular region.
"They're the same values that Gene has — honesty and integrity and work hard and care about others and do the right thing," Mr. Skogsbergh said. "Gene's got the very same values, which is why I care deeply about him and want him to be wildly successful at Advocate Health."
Industry leaders regard Mr. Skogsbergh as both a servant leader and the architect of a model that health system decision-makers will study for years to come. His strategy has underscored the importance of scale and systemness in managing financial risks in healthcare, addressing practice variation and improving quality, accessing capital for investments, and providing coordinated specialized services, Mr. Pollack said.
Mr. Kaufman pointed to the combined Advocate Aurora-Atrium enterprise and Mr. Skogsbergh's strategy, collaboration and expansion efforts as lessons for the books. "It made a very, very significant contribution to the hospital industry," Mr. Kaufman said. "I think there are now quite a few people out there following [Jim's] lead, but he was really the thought leader for all of that."
What's next for Mr. Skogsbergh? "Redeployment," as he calls it. "I still want to make a contribution."
Stepping away from around-the-clock demands as CEO, he will return this fall and again next spring to coach emerging leaders within the Advocate Health system. Mr. Skogsbergh aims to help up-and-comers in the organization become a little better and make their way a little bit faster than they otherwise would, he said.
"I love the organization deeply, and I want it to be successful — wildly successful — long after I'm gone."