The Journey: Stu Clark

Stu Clark is CEO of Brentwood-based Premise, an onsite health and patient engagement company created by the 2014 merger of CHS Health Services and Take Care Employer Solutions. The deal came with an integration and repositioning effort that Clark says is now truly bearing fruit for the company, which runs more than 550 health centers across the country for a client list that includes more than 200 of the nation’s largest employers. Here, he talks about the process that laid the foundation for its latest growth spurt.


Over the past 25 years, I have come to appreciate the importance of culture. But even with that appreciation, I underestimated its role in a company of this size. Ninety percent of our team members are dispersed across 45 states, Guam and Puerto Rico. It is paramount that they associate themselves with our brand, our values and that they feel engaged. The Premise Health culture has created an environment where trust can exist and grow — so that innovation quickens and decision-making and execution occur. Absent a strong culture, trust struggles to exist.

We have made the creation of our culture, the engagement of our workforce and the alignment of senior management our top priorities since the formation of Premise. When the merger occurred in 2014, we were given an opportunity by our lead investor — Water Street Healthcare Partners — to hit the reset button with our identity, both internally and externally. We rebranded the company with a new name and a new mission. But we also needed to reset the company’s culture and priorities.

We figured we had one chance to get it right and it had to count. My first priority was for my team to understand that change was necessary and that alignment was an absolute requirement. The team quickly began walking the talk.

To set the proper cultural and alignment standards for the company, we knew it was all about how we treat each other, hold one another accountable and how we find ways to succeed when circumstances interfere with the best-laid plans. Our team knew that the rest of the company models their behavior, and if that behavior is inconsistent with our values, we have a problem. Integrity and accountability are not situational attributes — they must exist even when others aren’t watching.

When the Affordable Care Act was passed in 2010, it brought health care access to 30 million people across the United States. But it also made it harder for people to actually get an appointment in a system already stressed by a lack of primary care physicians and a rise in chronic diseases. Those trends spelled trouble for employers. If their employees couldn’t access care, they would continue to get sicker, affecting both their ability to excel at work and the cost of their health care. For many large employers, the best solution was to partner with an organization like ours to bring health care services to (or near) the workplace.

Being focused on one or a just few employers within a community offers us many advantages over the local providers. Because it’s convenient to visit our health centers, employees tend to go sooner, and for those who are reluctant to visit our provider, we reach out to them. We also have the ability to spend more time with patients, which allows us to address family history and lifestyle issues and then drive positive behavior change. For our health care professionals to accomplish all of this, they must feel engaged and must believe in our mission.

The word “alignment” has become popular recently, maybe even overused. I’m certainly no expert on the concept, but I have watched from the front row the importance of alignment to a company’s success. Well-intentioned, talented executives within the same company can get misaligned in a nanosecond, and it’s the CEO’s obligation to be on the lookout for this. There is natural and healthy tension between many departments within an organization, but this healthy tension can devolve into misalignment quickly. Misalignment is a death sentence if it is not addressed early and aggressively. Efficiency, morale, commitment and innovation all begin to disappear if misalignment takes hold.

We have utilized several strategies to establish and maintain alignment at Premise. My first step was to get some expert support, and we did that immediately after the merger in 2014. I hired The Table Group to start up a process whereby the executive team goes off-site and, in an uninterrupted fashion, talks about the tough issues, addresses interpersonal challenges and commits to a way through these obstacles. Strategy and communication tactics are established in these off-sites and we leave the session aligned and ready to lead the company.

This alignment can last two weeks or two hours but it does not establish itself with any permanence, and that is why maintaining alignment is one of the most important jobs of a CEO. We have daily, weekly and monthly tactics to ensure alignment at Premise.

Great culture and alignment do not happen quickly. With us, it took more than a year to start seeing a difference in how team members viewed our culture, which we measured through Gallup engagement surveys and also internal surveys. But the cultural groundwork we laid at the beginning is paying off now. We have a united leadership team in place with the confidence to speak up when they see an opportunity or need to pivot. And our team members are willing to commit to projects and see them through because they understand our vision — and they trust us. We have achieved a solid level of alignment, though there is always room for improvement.

The trust that we’ve built within our teams is helping us move faster and work more efficiently. For example, we’ve decreased the amount of time it takes to implement a new health center. We are seeing great clinical and financial outcomes within our patient base. We’re also bringing new ideas and innovations to market more quickly. We just opened our largest and most innovative health center ever. It offers employees incredible resources to change their lifestyles, from plant-based cooking classes to personal trainers. Its programs are integrated into the community, so there is an impact to the patient beyond the worksite. There is no way we could have done this two years ago without a cultural and alignment reset.

With integration behind us, we’re looking forward to seizing the opportunities that spurred us to come together in the first place. Our model is proven to help people get healthier — and we believe it has an important role to play in the new value-based reimbursement world. We see a future where we partner not only with employers, but also with health plans and other providers.

That’s a big goal, one that requires us to create new markets.

As we step up to this new challenge, we know that trust is more important than ever. We must — and will — remain focused on our culture and alignment in order to achieve the vision that we’ve set forth.

We’ve said it from the beginning: This is our opportunity to change an industry. And we will do that with our culture and with alignment throughout the organization.

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