He sees it as a bit of a barrier, but also an opportunity.
Chris Knapp, the new CEO of The Everett Clinic, is a lawyer by training, not a doctor. Does that make it difficult to lead one of the largest medical groups in the state?
Yes, he says, he has much to learn. Even though he has worked for the clinic for nearly 20 years, Knapp has undertaken a listening tour on his first 90 days on the job, visiting all the clinical and non-clinical departments to get out of his “bubble in administration.”
But he’s also committed to spending at least a half-day a week shadowing front-line staff, meeting patients and, if they’re agreeable, joining them on medical exams and even procedures.
“I think that’s an opportunity for me to learn about our business from the patient perspective,” Knapp said. “So I understand how our customers are experiencing The Everett Clinic, and it’s an opportunity for me to walk in the moccasins of our care providers and understand the complexity of their daily work lives, the challenges they face and see how they partner and team together to solve problems.
“But I can do it with fresh eyes.”
Knapp replaces Rick Cooper, who served in the same role for more than 30 years. Cooper is continuing as the Pacific Northwest market president for DaVita HealthCare Partners, the new parent company of The Everett Clinic.
Cooper calls himself a big fan of Knapp.
“I think he’s the right person for the job,” Cooper said. “He’s very passionate about evolving our care model to be even more focused on the patient. I really think under his steady hand we will do a much, much better job for our patients.”
Knapp takes over as CEO at a time change for the clinic, one of the county’s largest employers with 467 medical providers, more than 2,000 employees and 320,000 patients in Snohomish, Island and, now, north King counties.
Perhaps the biggest change is in ownership. The Everett Clinic was a privately held medical group — owned mostly by doctor shareholders — but was sold to Denver-based DaVita earlier this year.
“I think it’s significant that DaVita has made this commitment to continuing local leadership,” Knapp said. “They could have brought in somebody from outside the organization or from another market.”
Cooper echoes the sentiment.
“I am just delighted that he has now, past-tense, moved into the CEO role for me,” Cooper said. “It was a real demonstration of commitment on the part of DaVita in the local leadership team.”
Best business thinkers
Knapp becomes just the third CEO in the more than 90-year history of the clinic. He’s worked for the clinic since 1997 — as a lawyer at Everett’s Anderson Hunter Law Firm and then, in 2012, as in-house counsel.
Knapp, 51, lives in Everett with his wife, Holly. Their two sons, Cal, 22, and Spencer, 19, attend the University of Washington.
Knapp is originally from Minnesota, where he grew up in the small town of Detroit Lakes, about 40 miles east of Fargo. When looking to go to college, he knew he didn’t want to stay in the Midwest. His sister was attending Pacific Lutheran University in Tacoma. On a trip to see her, Knapp toured the University of Washington campus.
“It was on a weekend in November around Thanksgiving, when the sun happened to be shining,” Knapp said. “When you’re out on the University of Washington campus and the sun is shining and Mount Rainier is out and Drumheller Fountain is going, it’s the most beautiful campus in the world.
“I knew that’s where I wanted to be.”
After getting his undergrad degree at UW, Knapp returned to Minnesota for law school. Between his second and third year of law school, Knapp landed a clerkship with Anderson Hunter. After the clerkship, the firm offered him a job. He started practicing law in Everett in 1990.
His time as a lawyer for Anderson Hunter, first as an associate and later as a partner, gave him a chance to meet influential people in the region.
“I just had the great good fortune of being exposed to Snohomish County’s very best business leaders,” Knapp said. “Whether it was in the timber industry or municipal law or banking and real estate and, ultimately, health care, working with people like Rick Cooper, it really gave me exposure to some of the best business thinkers that the north Puget Sound had to offer.
“It was a really fortunate education for me, not just in legal issues, but in how people run a good business and, beyond running a good business, how you give back to your community.”
Bit of good in the world
He spent his first years in Everett working as a litigator, learning about strategy, human nature and the art of negotiation.
“You’re also dealing with people always in very difficult circumstance,” he said. “Litigation is time-consuming, it’s costly, it’s emotionally draining and you don’t always see people on their best behavior, so I started looking for opportunities outside of litigation to look for clients who I enjoyed working with who maybe were doing a little bit of good in the world.”
That led him to taking more work with The Everett Clinic, where he said he found smart, hardworking, dedicated clinicians and business people who were always seeking to do things better.
Knapp earned the confidence of The Everett Clinic board, said Doug Ferguson, senior counsel at Anderson Hunter. He said Knapp is intelligent, has high integrity and is one of the most organized lawyers he’s ever met.
Ferguson thinks those traits will serve Knapp well in the new role.
“I think he was a natural choice and it’s an excellent fit for him,” Ferguson said. “I think he’ll do very well — obviously his role has expanded significantly. In my judgment, he has big shoes to fill in following Rick Cooper. I’ve worked with a lot of business leaders and Rick Cooper is right at the top of the list.
“But he’s worked with Rick Cooper for quite some time, and he’ll have the benefit of continuing to work with Rick.”
Knapp’s time at The Everett Clinic has come while the clinic was growing rapidly and while the regulatory environment of health care was becoming more and more complicated. Since he became in-house lawyer, Knapp has worked on more business issues.
“I had the opportunity to move into some areas that were not really traditional legal work, but were fascinating to me, around business development, strategy and developing our long-range business plans and, ultimately, the work that led to our partnering process and the decision to align with DaVita,” Knapp said.
Eyes on the merger
The ability to grow was one of the key factors in the decision to merge with DaVita, Knapp and Cooper said. The clinic in late September opened a 40,000-square-foot clinic in Shoreline, its first clinic in King County. The clinic is also in the next few months planning to open an ambulatory surgical center in Edmonds and a smaller office near Mill Creek.
Part of Cooper’s role will be to help guide growth, either by opening new clinics or partnering with existing medical groups.
“Our business plan calls for us to double in size over five years,” Cooper said.
That will include growing more in King County and expanding elsewhere, Knapp said.
“In the near term, I think we’re kind of focused on King and Pierce counties,” Knapp said. “In the long term, we really view the Northwest as a region where we can grow, and that extends from the greater Portland area to the Canadian border.”
For now, Knapp’s new role with the company will be joining the cultures of The Everett Clinic with the new corporate ownership.
“We do know that a lot of folks are watching this transaction, wondering if The Everett Clinic is going to change,” Knapp said. “I would say the only thing that’s constant in life is change. We’re always looking to evolve and improve and, in the classic words of a former board president, how can we do this better?”
Challenges to face
During DaVita’s first earnings conference call after the acquisition, company officials, responding to an analyst’s question about disappointing fee-for-service revenue growth, pointed to The Everett Clinic as the single biggest source. The officials said it was an uncharacteristic stumble.
“Well, first it’s kind of unusual to get market-specific in an earnings call, but that did come up,” Knapp said. “We have known for a long time that in fee-for-service medicine there is a significant business challenge.”
Fee-for-service is a payment model where services are paid for separately. There’s a concern that it gives an incentive for doctors to provide more treatments because payment is dependent on the quantity of care, rather than quality.
Knapp said the clinic has known over the past six or seven years that the cost of paying for medical treatments has been rising faster than revenue growth, which has stayed relatively flat.
He said that is another of the reasons the clinic has aligned with DaVita, which has been able to grow revenues year over year.
Knapp said that doesn’t necessarily mean the clinic will raise prices. There may be ways to perform more efficiently.
That’s something that needs to be explored, he said, pointing out that health care costs have risen to a little more than 18 percent of the gross domestic product of the country.
One of Knapp’s jobs will be to help his staff — doctors, nurses and others — keep up with increasing demands, from electronic records to administrative burdens. Burnout is a concern among health care providers.
With an aging population, many people don’t come in with a single problem but a “constellation of issues that are all interrelated in very complex ways.”
“The ability to meet the patient where they are, provide the empathy and communication that the patient needs and then partner with them in improving their own health care is a very challenging thing to do,” Knapp said. “I think it’s one of the most complicated things that humans do is the practice of medicine.”