These days, people change employers seemingly as often as they change their socks. But Mitch Melfi is a bit of an outlier. For about thirty years, he’s held top legal positions at a single company—albeit one that’s transformed itself several times, through expansion and acquisition.
CommonSpirit Health is the largest Catholic health ministry and among the nation’s largest nonprofit healthcare systems serving 20 million patients across more than 1,000 care sites in 21 states. Melfi’s accountabilities as senior executive vice president and chief legal officer include all legal services (including mergers and acquisitions), enterprise risk management, corporate governance matters, and sponsorship.
Throughout his tenure at CommonSpirit, Melfi has leveraged his legal expertise and institutional knowledge to support the organization’s mission of improving the health of the people it serves, especially those who are vulnerable.
From Pre-Med to Healthcare Law
Melfi’s interest in the medical field dates from at least his junior high days. He was exposed to aspects of healthcare through his dad, who was a dentist, and he had dreams of becoming a surgeon.
“When I was in high school, my dad learned from a colleague that a local hospital was looking for someone to work in the housekeeping department on weekends,” he says. “I got the job and was grateful to be in an actual healthcare setting.”
That interest stayed with Melfi well into college, as a zoology major in the pre-med curriculum at the Ohio State University. But during his sophomore year, he had a revelation. “I was sitting in an organic chemistry lab and realized I didn’t share the same passion for the subject matter as those around me,” he explains. “It occurred to me that I could make a greater impact in the healthcare space, which I was passionate about, in support of clinical services rather than performing clinical services.”
Law school beckoned, and he entered the JD program at Capital University Law School in Columbus, Ohio. His relationship with nearby Children’s Hospital continued during that time, as he worked as a unit administrator during the day and attended classes at night.
In the early 1980s, Paul Greve was serving as the first general counsel at Children’s. “I’d known him since I was in law school,” Melfi says. “When he asked me to serve as staff counsel, I took that job. I cut my teeth in that space, and Paul was an amazing mentor to me.” Just eighteen months later, Greve moved on, and Melfi took over as general counsel.
For the next several years, Melfi and his wife Debbie, a pediatric nurse, worked at Children’s Hospital. During this time, Melfi not only grew professionally but was able to support the healthcare community in other ways as well. Through the hospital’s affiliation with Ohio State, Melfi taught a class at the medical school and served as a guest lecturer on healthcare topics at his law school alma mater.
He later wound up on the short list of candidates for a new position at the Sisters of Charity Health Care System in Cincinnati—one with the combined duties of associate general counsel and the enterprise risk management and self-insurance programs. In healthcare settings, enterprise risk management includes loss prevention, while self-insurance is a common way to protect against professional liability claims.
Melfi saw that as a real growth opportunity. It was a $2 billion, multistate operation, so he and his family moved to Cincinnati in 1992.
“It occurred to me that I could make a greater impact in the healthcare space, which I was passionate about, in support of clinical services rather than performing clinical services.”
Melfi’s perception of growth was on the money. In 1996, the Sisters of Charity Health Care System (along with three other Catholic systems) consolidated their operations to form Catholic Health Initiatives (CHI). “I helped put the merger together,” Melfi says. “At its time, it was the largest provider merger in history with a value of $4 billion.”
Over time, CHI acquired several other healthcare operations. Then, in 2019, CHI merged with Dignity Health to form the $29 billion CommonSpirit Health, which to date, is the largest provider merger in history.
“Our M&A activity is grounded in our mission: improving the health of the people we serve, especially those who are vulnerable, while we advance social justice for all,” Melfi says. “It might entail acquisitions, joint ventures, partnerships, or management services, all to create networks of care across more than one thousand care sites.”
“Most people don’t realize that nonprofit hospitals not only operate on very slim margins, but we must also bring in enough revenue to cover the costs of providing healthcare services,” he continues. “Operating with good business practices, including controlling expenses carefully, enables us to sustain our healthcare services.”
The majority of services for which Melfi is responsible are provided in-house; however, Melfi believes it is necessary to form external partnerships as well. For example, Melfi shifted services that are needed only occasionally to contractors instead of staff positions. This not only enables CommonSpirit to control costs, but also engage the best expert for the specific task at hand.
In addition, as chief legal officer, Melfi sometimes consults with a canon lawyer, a lawyer who has special training in and knowledge of the Catholic Church’s laws.
“Our M&A activity is grounded in our mission: improving the health of the people we serve, especially those who are vulnerable, while we advance social justice for all.”
Communities Across State Lines
CommonSpirit reaches twenty million people across the US, and a platform of that size enables it to be a strong advocate on its own behalf. “Healthcare is one of the most regulated industries,” he says, “and it’s not just one set of rules; there are federal and individual state mandates that we must respond to. And we must also be prepared to deal with changes or expansions to those laws. When necessary, we can offer input to pending legislation, or speak up on topics of concern.”
That immense platform enables CommonSpirit to advocate on behalf of its various communities, addressing pressing issues such as health inequities, social justice, and services for underserved populations. “This gives us a real connection to the mission of the organization, and its values,” he says; those values include compassion, inclusion, integrity, excellence, and collaboration.
“More than being an extraordinary attorney, Mitch is a compassionate leader whose dedication to advancing CommonSpirit’s core mission has made a positive impact on communities across the country,” says CommonSpirit outside counsel Dan Reinberg, a Shareholder of Polsinelli PC.
Melfi continues to support community benefit by serving on the board of directors of several nonprofit healthcare systems in Colorado, Iowa, Ohio, California, and Illinois.
“It’s been an amazing journey for me,” he concludes. “I have never once regretted the decision I made that day sitting in the organic chemistry lab. I started out as acting GC for a $2 billion operation and am now chief legal officer for one that’s nearly fifteen times bigger, but more important to me, I’d like to think I have helped make a positive impact on the health of the communities we serve.”
At Crowe, our approach focuses on achieving a client return on the investment to operate internal audit and compliance functions. The new normal of strategic risk coverage includes achievement a return on risk. We are fortunate to innovating because of the vision of Mitch Melfi and his relentless pursuit of a world class risk program at CommonSpirit Health.