Our vision is a world where everyone embraces health. In our Remarkable Leadership series, we talk with people who are making that vision a reality by leading the work to create a new system of health, empower our customers and communities, and better support every individual’s health journey.
Public service runs throughout Dan Onorato’s career. A two-term Allegheny County Executive, he told a Post-Gazette reporter that one of his most fulfilling times in office was helping to lead the response after Hurricane Ivan: “We rolled up our sleeves and helped people and worked as hard as we could to make sure they're OK. That's what government is for.”
When he returned to the private sector in 2012, he chose Highmark Inc., a nonprofit with a strong social mission. Now Highmark Health’s chief corporate affairs officer, impacting the community and public policy continue to be central concerns, including coordinating responses to COVID-19 and the opioid crisis, launching an enterprise social determinants of health program, and much more. Sharing insights on his work during our interview, he also reflected on the dynamic transformation into a national blended health organization during his time here.
Don Bertschman (DB): Tracing your career from CPA, to publicly elected official, to health industry leader, what ties it all together?
Dan Onorato (DO): Graduating from Penn State with an accounting degree, my plan was to start a career with skills that could be used later in life, and I became a CPA with a national accounting firm. The next step was law I thought the CPA and law background was a strong combination for any profession I would choose. So I got my law degree from the University of Pittsburgh, and joined a law firm in Pittsburgh.
I’d always had an interest in political life, believing that elected officials can impact people's lives. I decided to run for a Pittsburgh city council seat in the neighborhood I grew up in, the North Side, against a well-known incumbent with 30 years of political experience. I did not have money compared to him, but I did have the energy and youth to door-knock for six months. I won, and that launched a 20-year career as a public official.
After two terms on city council, and one term as Allegheny County controller, I decided to challenge the incumbent county executive, Jim Roddey, another big name in this region. He and I are good friends today, by the way, but I ended up winning big. During my second term, I ran for governor and won a four-person primary to become the Democratic nominee in 2010. Ironically, considering where I am today, it was probably the Democrats passing the Affordable Care Act (ACA) that changed my fortunes. Today, the views on the ACA, or Obamacare, are much more favorable, but when it passed there was a negative backlash, Democrats got swept across the country, and I lost my race.
I realized at that point that once I finished my term as county executive, I wanted to return to the private sector in a role where I could pull together all those skillsets, everything I'd learned and experienced, especially during eight years as county executive, which was essentially like being CEO of a $2 billion operation. At the time, Highmark Inc. had an executive nearing retirement, and the role included government and regulatory affairs, corporate communications, community affairs, community investments it’s been a good, long-term fit, for both me and the organization. I've loved it.
DB: Is one motivation throughout that journey something around public service? You could have gone many places in the private sector, but you chose a nonprofit that, by its nature, has a strong tie to community work and policy issues impacting public health.
DO: Great point. Coming here allowed me to use all my skills and experience, while staying very much involved in the community, and continuing to lead efforts to make a positive impact. As two quick examples, I oversee Community Affairs, which invests $25 million to $28 million every year to support community improvements, and I also head up Government Affairs, which works to influence public policy at the federal and state levels. It’s a perfect spot for me to represent our organization in strengthening our communities and doing what's right for our communities. The number of lives our organization touches is rewarding for me, and for all of us who work here.
DB: I've heard both you and David Holmberg emphasize that corporate giving should make a measurable difference it shouldn’t be giving just to say we gave. Can you talk about that mindset?
DO: My predecessors had done great things in the community, supporting many great causes and organizations, as we still do. But coming in new, I had a chance to suggest some changes based on my experiences. When I looked at the total budget of giving, one suggestion was to scale back the number of separate grants so we could increase grant amounts and achieve greater impact.
So, instead all those $500 or $1,000 grants, let’s focus on 200 to 300 groups so we can give more grants in the $10,000 to $50,000 range. As you can imagine, you can do a lot more with $25,000 than you can with $1,000. That also means we ask groups to show us what they can achieve with that level of investment how are they going to help people? We want organizations to be creative, do something they maybe couldn’t have done without that grant, and then, as with all of our corporate giving, we want to make sure our communities get the intended results. That’s our approach, and it’s been very successful.
DB: Your role here often includes bringing together different stakeholders for a common purpose. Can you talk about finding the intersections between community giving, public policy, and business interests?
DO: If you look at what I oversee Community Affairs, Government Affairs, Strategic Partnerships, Corporate Communications, Social Determinants, Highmark Caring Place our social mission is very strong in each area, and at the same time aligned to our business strategy. They're not in conflict. We have aligned them so that good social responsibility can also be good business.
As an example, our health plan business serves three states that have been hit hard by the opioid crisis. A couple years ago, we shifted some of our corporate giving to focus on the problem, but we also coordinated with nonprofits and our own experts and clinicians, and came up with a three-pronged strategy to really attack the opioid problem. Why do I say that is also good business? These are our customers, and they have a need. Meeting that need means helping them be healthier and minimizing the people getting addicted, and that can help lower the total cost of health care. So it’s a good social response, it’s our social responsibility, and it also makes good business sense.
With COVID, we have already made several hundred million dollars of related community giving and business investment, but my team is also working with governors and other elected or appointed officials to inform policy related to testing, equipment and PPE, closures all the things you're reading about. We opened four testing centers pretty quickly, but when we heard from the African American community and saw they were not getting the same level of testing, we opened two more, one in Braddock, another on the North Side. Seeing that we still had underserved communities, we put together two mobile units to go where they were needed to provide testing and other resources. More recently, we partnered with the Department of Health in Pennsylvania on another mobile unit that’s going into 16 counties to service the Latino community. So giving, public policy, clinical support, community outreach it all comes together to meet the needs of our communities.
DB: You mentioned public policy. People ask about that sometimes what involvement do we have in lobbying and advocacy, and why?
DO: Our entire organization operates in a highly regulated environment. For example, we’re regulated by federal agencies, by state governments, including insurance and health departments, and others, down to the local level. All of these entities and agencies have a direct impact on our business and influence what we can do for our customers. So we want to ensure any public policy that affects us is shaped to make quality health care more affordable and accessible.
DB: Different parts of the organization have had programs involving social determinants of health for years, including the AHN Center for Inclusion Health. What is the significance of making social determinants an enterprise-level department with its own executive leader?
DO: It’s true that many things we did in the past could be classified under social determinants of health, but our approach is saying, let’s take our resources and expertise across all of Highmark Health providers, insurance, community affairs, public policy, everybody and figure out how to go to underserved communities and intervene on the front end. A great example is a pilot program on the North Side, where we work with an African American church to hire people to door knock and find out what concerns people have, what’s impacting their health, and see if there's anything we can do to help them earlier and stop problems from becoming worse.
Now, take that philosophy, it’s good for the community and good for our business, and apply it to, say, all health insurance members. It’s like a case management program on steroids. Let's find out what customers need, and what we can provide to intervene earlier. If it works, our customers are healthier, they’ll have a better experience, and it's less expensive because we're taking action before they’re coming in with bigger problems. We believe that if we focus on social determinants of health as a real part of the business strategy and model, the results are win-win-win.
The biggest challenge across the industry is to prove that you can make that approach work and scale it up. Getting back to your question, for us, scaling it up meant having something at the parent company level, under Barb Gray, one of my direct reports. If you look at what we do, we collaborate with Karen Hanlon’s management committee in the blended health organization, we collaborate with the AHN Center for Inclusion Health, we work with Deb Rice-Johnson’s team on case management for health plan members, we work with corporate giving to fund organizations that help with social determinants. That’s why it sits with me it allows me, and Barb and her team, to help coordinate all those functions.
DB: What about the role of public-private partnerships in this work, and in the U.S. health system in general?
DO: There are certain areas where public-private partnership works better than others. As an example, we are part of a public-private response to the problem of homelessness in downtown Pittsburgh and our region. People are on the streets for a lot of reasons mental health, housing insecurity, food insecurity so wouldn't it be good if we could bring them to a high-quality facility that surrounds them with the services they need? Well, Highmark Health and PNC Bank invested $5 million each, UPMC is putting in $5 million of services, the city donated land, the county has the department of human services involved, several foundations stepped up, and we are building a new facility that will have all the services to help people on the streets get what they need. That is one of your best examples of how public-private partnerships can make a difference.
Nationally, the debate about where health care should go we have our own answer to that, which is the Living Health model that’s central to our 2025 strategy. But another example of public-private partnership within the larger system is Medicare Advantage. The federal government is the payor, but the private sector implements it, and provides competition and creativity to make it a better program for customers.
DB: In the nine years you’ve been here, the organization has gone through a remarkable transformation. Reflecting on all that change, what has you revved up about the future?
DO: I came here at a unique time. I got a taste of the original Highmark, a dominant regional insurance company, but this was also when we were acquiring what is now the Allegheny Health Network. I got to be part of the team that expanded Highmark Inc. to Highmark Health, and took a provider system on the verge of bankruptcy and helped it become a thriving system that’s competing head to head and winning across western Pennsylvania. Add to that our partnership interest with Penn State Health, relationships with other big systems, a diversified book of business with dental, stop-loss, and technology solutions companies, and we are positioned to be a national player and leader on health issues.
Going to the next level, we’re taking all that expertise, those different parts of the health experience, and blending it together around a very strong customer-clinician relationship. We’re creating a health experience model we call Living Health that we believe will be the winning solution to what customers will want, and at the same time will help lower overall costs. Working for Highmark Health, we are fortunate to have the opportunity to take what we built so far and now expand it, accelerate it. It’s an exciting time to be here.