The two could understandably have been archenemies for life: Kitty Westin had just lost her daughter Anna to anorexia, and was locked in a battle with her insurance company over the patchy coverage it had offered. MaryAnn Stump was an executive at that very same insurance company – Blue Cross and Blue Shield of Minnesota – which had been sued by the state for withholding and delaying care for people like Anna Westin.

Instead of squaring off as adversaries, Stump and Westin became “fellow travelers” in a years-long effort to create a new model of care in Minnesota for those with eating disorders.

They recounted their almost 14-year-long journey together during a recent interview – talking over each other, finishing each other’s sentences, and affectionately filling in the blanks of the other’s memory.

A pivotal lunch

It started with an invitation to lunch at the Sofitel in Bloomington in the fall of 2000, just nine months after Anna Westin had died. Mark Banks, then-president and CEO of Blue Cross and Blue Shield, invited Kitty and her husband, Mark Westin, and asked Stump to come along. His company had paid the Westins $1 million in an extrajudicial “settlement,” to compensate for their losses, not the least of which was 21-year-old Anna. Now he was going to face them in person.

Stump was willing to accompany her boss, but admits she was nervous and didn’t know what to expect. She had been a critical-care nurse in cardiology when she joined Blue Cross and Blue Shield as chief strategy and innovation officer, and didn’t know anything about eating disorders.

“I was just an accidental tourist,” she said. Banks said he didn’t know what to expect either, Stump said, and warned her that the lunch might be ambushed by media. Of this much Stump was sure: She and Banks were there to extend their condolences and see what could be done, wearing their “different hats” – he as a physician and she as a nurse.

Kitty Westin was ferociously opposed to sitting down with anyone from Blue Cross and Blue Shield of Minnesota. She was “angry” and weighted with grief. She wanted to take cover “and never think about eating disorders again.” In a move worthy of Richard Holbrooke or Nelson Mandela, her husband made the case for rapprochement: “Anger is not going to get us anywhere,” Kitty remembers him telling her. “We can’t bring Anna back, but maybe if we can get somebody to listen to us, it can help make change happen. Other people will live. And that’s what it’s all about.”

A tall order

A lot depended on those first few seconds after arriving for lunch, Westin said. If she detected “anything phony,” she’d turn on her heel. But Banks’ gracious apology and Stump’s genuine condolences caught her off guard.

She doesn’t remember consciously preparing an agenda, but suddenly it was out on the table: She was going to take that $1 million and open a residential home for young women with eating disorders – she wanted to do it fast, and she wanted it covered by insurance. Banks told Westin that he couldn’t give her carte blanche but that he could give her Stump – a known problem-solver who loved a blank page and had a reputation for “turning straw into gold.”

The luncheon meeting broke up, with a promise to continue working together, and Westin and her husband “walked out of there feeling a sense of hope,” she said. “I just remember, finally, thinking that maybe something can change. Maybe there can be a legacy for Anna. And maybe that’s what I wanted so bad. I didn’t want anyone to forget her. I didn’t want her to be just another 21-one-year old who died. She was our daughter. She had so much potential, and she needed to live on.”

‘Learners vs. knowers’

Westin and Stump began by creating an advisory council of interested parties and experts. Besides Westin and Stump, the members included Lindsay Brown, Dirk Miller and Jillian Croll of the Emily Program; Scott Crow and Nancy Raymond of the University of Minnesota’s psychiatry department; MaryJo Kreitzer of the university’s Center for Spirituality and Healing; attorney Bob Lindall; Mayo clinic psychologist Christine Sadowski; and Mary Welch of the Chaska Community Land Trust.

The group met monthly, then weekly, then twice weekly, calling on input from others in the treatment field, representatives of the insurance industry, and those who suffered from eating disorders and their loved ones.

The work was intense, and the experts could sometimes get bull-headed, Stump recalls. But a spirit of inquiry and a culture of “learners vs. knowers” began to develop, helped along by an agreed-upon set of principles that the group turned to time after time to resolve their differences:

• All those who are eligible will receive needed care. No one will be excluded from program participation because of financial barriers or constraints.
• Care will be based on the best available scientific knowledge. Where no evidence is available, research designed to provide that evidence will be a priority.
• Treatment will be interdisciplinary. Cooperation among clinicians and professional disciplines will be a system attribute designed to assure optimal patient outcome.
• Care will be customized according to patient needs as determined by the treatment team, stratified by patient symptoms and condition. The team treatment approach will be designed accordingly.
• The Demonstration Project model will be developed with the intent that it can be replicable in other settings, statewide and nationally. Any evaluation/research design that is part of this Demonstration Project will be, as appropriate, expanded to include these settings.
• Given the changing health-care environment, the intent of the Demonstration Project is to develop a therapeutic delivery model that will be effective, replicable, adaptable, and sustainable today and in the future.

Westin was a merciless driver, setting a pace that did not always fit with the “timelines” of the many parties involved. Her grief was raw, and team members had to tread carefully.

And Stump didn’t always get a ready reception back at the office. When Westin insisted that the portfolio of services include alternative and complementary care (acupuncture, acupressure, yoga, dance therapy, massage, music and art therapy), Stump’s colleagues in the finance department were incredulous. “You want to do what?” they said.

A home in Chaska

Westin wanted her facility to be in a homelike, not a hospital, setting, and it wasn’t long before an appropriate place was located in Chaska. It was where Anna had grown up and where she died, and so it felt just right to the Westins.

The advisory council pushed forward, detangling the myriad issues: insurance coverage, length of stay, patient aid, nutritional needs, treatment protocols, per diem caps – $1,300 per day per patient, as it turns out, minus the physician costs.

“It sounds expensive, but it’s cost-effective,” said Westin. “We are treating this population that absolutely can recover. And that recovery – whether it takes two months or six months or nine months— means that this person absolutely can return to a very productive life of working, contributing to society, and paying taxes.”

Opening ceremonies for the eight-bed, fully staffed Anna Westin House were set for Sept. 29, 2002. Kitty had been uncompromising about the date. Among the VIPs was U.S. Sen. Paul Wellstone, who told the assembled:

“I feel today at this celebration as if the strength and the courage and the beauty of the Westin family and the indomitable spirit of Anna will always be here at this house. And it will spread out and it will help so many young men and women and make all the difference in the world.”

Westin and Wellstone had joined forces after Anna’s death on the issue of parity for mental-health and substance-use disorders. He gave her a platform from which to tell the family’s story; she gave him a powerful case in point. If Kitty Westin had delayed her Anna Westin House opening ceremonies by even a few weeks, she would not have had the pleasure of watching Wellstone “running through the house, checking out every room.”

Then and now

A lot has happened since then: The Emily Program now runs the Anna Westin House(s), which offer 24/7 care for teens and adults (both men and women) in two separate “homelike” facilities in the St. Anthony neighborhood of St. Paul. Eight beds have multiplied into 26 beds. And outpatient services are offered in Woodbury and Duluth, and Spokane and Seattle, Wash. The Emily Program serves 1,300 new clients each year.

Westin and Stump have sustained their collaboration for nearly 14 years, with Stump just now rotating off a term on the Emily Program board of directors.

Westin is now advocacy director of the Emily Program Foundation, and Stump works independently as a health-care innovation expert.

For two such women, a lot remains to be done, especially in the “messy middle” of health-care reform.

“We’re first in cost, 38th in outcomes [as a nation] – so what we’re doing isn’t working,” Stump said. “Although I was an accidental tourist in this eating-disorder space, can what we do together translate into effective ways of treating other conditions? That is always in the backs of our minds.”

Westin notes that just a fraction of the 240,000 Minnesotans who have an eating disorder will receive care. “We need to work together,” she said. “The insurance companies, the providers, the families, the clients, the community at large – and that’s how we’re going to solve this, that’s how we’re going to move forward, that’s how we’re going to ‘make it OK,’ to have a mental illness.”

The two remain friends, able to laugh at their own and each other’s foibles.

Says MaryAnn: “Kitty was a bulldog.”

Says Kitty: “More like a shih-tzu, biting at the heels.”