At Hazelden's helm, a man who knows the mission

CENTER CITY, MINN. - Last summer, as the Hazelden Foundation was wrapping up a national search for a new leader, William Moyers got a puzzling phone call. The board, he was told, had a preferred candidate and the candidate wanted to meet him.

Moyers, who is public policy chief for Hazelden, didn't recognize the name of the candidate -- a Mark Mishek.

But as soon as he saw him, Moyers slapped his forehead.

"I said, 'Mark, this is unbelievable,'" Moyers recalled. "'You'd be perfect. Perfect.'"

Until then, Moyers had known the mild-mannered, gray-haired man only as Mark M., a familiar face in the St. Paul recovery community. Now he learned that Mark M. was a top hospital executive, chair of the St. Paul Area Chamber of Commerce and, yes, his future boss.

The convergence of Mark Mishek's two lives and the enthusiasm he has sparked say a lot about what Hazelden has been through as well as the challenges ahead. A string of modern managers have tried to drag the iconic institution into the 21st century, with mixed results. Now Mishek has to put the pieces back together at a time when the economy is squeezing potential clients and health insurers are redefining addiction treatment.

"Mark had the full package," said John Curtiss, president of The Retreat in Wayzata and a Hazelden alum. "He understands the complexities of running a very large health-care organization. But by far the thing that Mark brings to the table is his heart for the mission."

Tradition in transition

Sixty years ago, Hazelden launched a national movement based on the ideals of abstinence and spirituality. Now it is trying to remake itself in a world of anti-addiction pharmaceuticals while competing with luxury spa-like centers on the high end and cheaper outpatient treatment at the low end.

It must also navigate the crosscurrents of health care reform, which will determine which addiction treatments are covered by insurance and which are not.

Mishek's predecessors brought big changes. On Hazelden's lakeside campus an hour's drive from the Twin Cities, there's a new women's center, a graduate school and a thriving publishing business.

But there have also been high-profile failures. In New York, Hazelden closed a residential program after losing money. In Florida, it pulled out of a high-profile partnership in West Palm Beach after business partners alleged mismanagement. Back home, a new corporate headquarters on the Nicollet Mall is now all but deserted after top executives decamped to return to Center City.

Mishek's predecessor

The Minneapolis headquarters had been the baby of Mishek's predecessor, Ellen Breyer. It was emblematic of her efforts to remake Hazelden into a modern health services provider distinct from the addiction recovery movement. Those efforts earned her the Administrator of the Year award in 2006 from the National Association of Addiction Treatment Providers.

But back in Center City, Breyer's lack of personal experience with recovery and her focus on the bottom line divided the institution. After five years she stepped down, just weeks before she was due to move to her downtown office.

For most of 2008, Hazelden functioned with a temporary chief executive, no chief financial officer and no chief medical officer. Donations dropped to about a third of the record $12 million raised in 2007.

Since he arrived in November, Mishek has been "drinking out of a fire hose."

"I love problems and I love problem-solving," he said. "Hazelden has all that."

A family affair

Mark Mishek grew up in St. Paul and White Bear Lake, the second of 11 siblings. His father was a physician and his mother a homemaker.

When he was 11, Mishek began putting out a neighborhood newspaper. For two years, he wrote articles and his older brother Charlie illustrated. "He had a strong desire to do things," recalled Charlie.

The Mishek siblings shared more than family ties. "Chemical dependency is interwoven through our whole family," said Charlie Mishek, who heads the chemical dependency program at Regions Hospital.

Mark Mishek himself sobered up during a weekend at Hazelden. He had his last drink on Feb. 17, 1995.

For about 20 years, Mishek worked for Allina Hospitals and Clinics. As general counsel, he piloted Allina and then sister company Medica through a bruising investigation by Attorney General Mike Hatch over administrative expenses. Later, he was president of United Hospital in St. Paul, where he built a state-of-the-art neurosciences center.

"Mark is very professional and very forthright. He is not swayed by peripheral issues," said Brock Nelson, president of Regions Hospital and an old friend. "A critic might say he is unemotional in his work, but it's not true because he cares deeply."

That objectivity and discretion will be useful at Hazelden, a place where board members -- many of whom had family members treated there -- are very involved.

Years ago, Nelson and Mishek took the day off and took their kids skiing at Afton Alps. While they were on the slopes, Mishek took a phone call. Ten minutes later, Nelson got a call. It dawned on both men that they'd been given the same news in confidence -- a hospital executive was about to be axed. Even then, neither said anything.

"We just went to the ski shop," said Nelson.

Economic squeeze

Mishek's most immediate job is assembling a new team. Over the past three weeks, he announced the departure of three Breyer lieutenants, redistributing their duties and himself taking on Hazelden's biggest business, recovery services. He hopes to have a chief medical officer in place in six weeks and a chief financial officer by summer.

Beyond that, the challenge will be how to stay afloat in a tough economy.

Hazelden's traditional 28-day residential stay costs $27,000 -- steep in a weak economy for clients who pay out of pocket. Even those with insurance coverage are worried about whether their jobs will be there when they get back. Last year, occupancy in Center City dipped to around 85 percent -- far below normal.

Mishek said 2008 revenues were flat at $109 million.

Today Hazelden is pursuing new contracts with insurers. Most of the big national treatment centers are strictly self-pay, but at Hazelden, about 30 percent of revenues now come from Blue Cross and Blue Shield of Minnesota. Just before Mishek came on board, Hazelden signed contracts with HealthPartners and PreferredOne.

Being insurance-friendly "helps us get patients here at times of economic stress," he said. Trouble is, insurers tend not to like paying for costly inpatient care.

Last month, Hazelden introduced a part-time outpatient program in St. Paul, which costs less and requires clients to miss less work. For self-pay patients, the center is reviving an in-house loan program.

Pivotal time

In December, Hazelden invited leaders from the biggest treatment centers around the country to Center City. The topic was how to make sure addiction treatment doesn't get bypassed as Washington grapples with health reform. Leaders from Caron Foundation of Wernersville, Pa., were there. So were people from the Betty Ford Center in Rancho Mirage, Calif.

There was a sense that this is a pivotal time for addiction treatment, which was rocked once before, by the advent of managed care in the 1990s.

"Mark came in at the right time for Hazelden and for the larger field," said Ron Hunsicker, president of the National Association of Addiction Treatment Providers. "If we don't change, we'll become extinct."

Chen May Yee • 612-673-7434