Growing up in Dayton, Jim Pancoast figured after college he’d move away, but after a brief stint in public accounting he found himself working as controller for Miami Valley Hospital, drawn by its mission.

“The former chairman of the board said he wanted [the hospital] to be a charity run on sound business principles. That resonated with me,” says Pancoast, a CPA with an MBA from Michigan State.

“In accounting, you are always reporting on what happened,” he says. “I like to be where we’re going, helping get a vision of the future. It’s more rewarding.”

It was the start of a 36-year career that culminated four years ago when he was named president and CEO of Premier, the largest health system in southwest Ohio and, with 14,000 employees, Dayton’s second largest employer after Wright-Patterson Air Force Base.

Premier, formed in 1995 with the merger of Miami Valley and Good Samaritan Hospitals, today includes Miami Valley South Hospital, Upper Valley Medical Center in Troy and Atrium Medical Center in Middletown and more than 2,300 physicians in more than 100 locations throughout a nine-county region.

As Premier charts its way through the choppy seas of the U.S. health care system, Pancoast says it remains focused on its mission. 

“We want to work with others who want to work on improving the health of the communities we serve,” Pancoast says.

Several years ago, reflecting the changing approach to health care, Premier rewrote its mission statement to focus on how to keep people healthy rather than just providing acute care.

“Our theory used to be: We’re in sick care and when you need us we’re there. We’ll fix you up and put you back into the community,” he says. “The feeling is that’s caused us to go after a whole lot of [patient] volume and it got expensive, in my opinion.”

Instead, today Premier is focused on establishing a long-term relationship with those it serves through its physicians and other health professionals, helping patients be healthy and avoid illness.

The transition has accelerated with the federal Patient Protection and Affordable Care Act and continuing concerns about the cost of health care.

“We’re going through transformational change because the [U.S. health care] system we’ve built is pretty expensive, really too expensive,” he says.

Part of what Premier is doing is learning to integrate its hospitals and other facilities as a single system.

“We believe no matter where you arrive in any our facilities, outpatient centers or physician offices, you should have the exact same quality and service throughout,” he says.

“We are trying to do things one way instead of four different ways. That’s been a major part of it, and that takes some getting used to.”

Premier also has created an innovation team to look at how to reduce costs and purchase things more efficiently.

“We’ve probably taken out $150 million in costs, about 7 percent of our cost base, over three years.”

To facilitate the new approach, Premier has established a network of providers, everything from physicians to pharmacies. 

“If we’re going to do real population health, we have to be involved in all of it,” he says. “What we’re really trying to learn is how to improve the handoffs and keep people out of the hospital and exacerbating their conditions.” 

One difference is that Premier doesn’t feel it has to own and operate all the services it offers. It is willing to partner with other providers.

For example, last fall it signed an agreement with CVS Health so its patients can have clinical support, medication advice, disease monitoring and wellness services through CVS Health’s MinuteClinics seven days a week without appointments.

Earlier this year, Premier signed an agreement with Doctor’s Urgent Care in the Dayton area to provide urgent care and occupational health services.

“Some systems put up their own [urgent care offices],” he says. “Our view was if they’re good providers why not sign agreements?” 

Premier also has introduced insurance products as part of its services.

It began insuring its own employees and their dependents in 2014 and had success managing their care.

“We’ve brought down admissions and emergency room visits. We have some really good programs helping people with wellness and providing care managers based in primary care offices,” he says. 

This year it expanded the program to offer a Medicare Advantage plan and insurance plans for individuals and employers.

“Our theory is we want to be a population health company,” he says. “If we can’t get access to populations other than through insurance, then we will do it. That’s the best way to help them manage their health. If we can do it through existing insurance companies, we’ll do it through them also.”

Despite the political controversy over the Affordable Care Act, Pancoast says including everybody in health coverage and allowing them to buy coverage through an insurance exchange is the best way to manage care and reduce hospital utilization.

“I think the exchanges are a good thing, although not everybody agrees,” he says.

“It’s just my personal opinion, but I wouldn’t be surprised if some day everybody buys their insurance on an exchange and employers get out of providing health insurance entirely.”

He points out some big companies already provide their employees with an insurance allowance and let them pick their coverage.

“I think that’s not bad way to go. People understand their own needs.”

And despite the controversy over the Affordable Care Act, Pancoast remains optimistic it will be resolved.

“We start and stop, but ultimately America figures it out,” he says. “We figure out ways to feed people, through food stamps and food banks. That’s a basic need. There are ways to do it. I think we can figure out how to get people basic care.”