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How do we create a hub model where patients can come and get everything they need in one space? They can get their radiology, they can do pharmacy, they can get their outpatient visits, and even maybe cross coordinate care. So maybe they do see their primary care doc. And we've actually put orthopedics folks in the primary care practices, so they're seeing their doctor for their annual visit, and they're like, you know, my knee's really been bothering me. Great, let's go see our physician down the hall. We can get you right in.
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Now.
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Let's make it really easy. So almost shrinking our footprint, but to expand. So when we do take that step, it's a much bigger step.
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Welcome to A and M Healthcare Industry Group's what's yous Moonshot? Podcast series, where leaders seek to solve big problems and transform healthcare. Join us for conversations to hear how their vision and bold moonshots are becoming reality.
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Welcome to A and M's what's yous Moonshot Podcast. I'm Aaron Binowski. I'm managing director in A and M's Health Industry Group. I'm joined by my co host, Dr. David Shulkin, the former 9th Secretary of the US Department of Veterans Affairs. We're also joined by Alison Rodidi, who's the vice president of orthopedic services at Catholic Health. Welcome. We're to have you here with us today.
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I'm super excited to be here as well.
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So your moonshot is really interesting. It's not just about growing orthopedics. It's really about scaling it. Right. So talk to me a little bit how you got there and why you're doing that.
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Sure, sure. So we are a six hospital system on Long island in New York, and so we are on a literal island. And so what we are trying to do is really create a place and an environment and a culture that is sustainable so that we can continue to grow, even though we are very geographically constrained. And we are also in probably one of the most competitive healthcare markets in the country. We have got lots of big players there, and so our goal is really maybe not be the biggest, but we will definitely be the best.
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Now, you're one of several that you're trying to grow, but I think you're a little ahead of the other service lines. Is that right?
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Yes. So I came in about three years ago. We had a faculty of about eight, and there were about three large orthopedic groups that we partnered with. And my charge was to grow and develop an orthopedic musculoskeletal service line. So not only do I have orthopedics, but I cover a few of the ancillary and related services, such as PT and rehab, radio, rheumatology, primary sports medicine, and a few others. And so we are really looking to create an environment where we are partnering with the large groups in the area. We have built our faculty to a point where I think we've got a really good subset of all the different subspecialties of orthopedics, and we've done that regionally. So if you've ever been to Long island, you can know it can take about three hours to get from sort of the border of Queens all the way out to Montauk. So. So that is a large geography. So we have to make sure we're being smart about how we cover it and that patients can access our services as well. So we're really trying to think differently about how do we create this ecosystem where patients don't have to go to the city or even into Queens sometimes to get the care that they need. They can get it all right in their backyard.
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And maybe one of the unique things about orthopedics is that it's not just an inpatient question. There's a significant amount of procedures and other things that happen in the ambulatory and outpatient environment. How do you think about managing across that entire continuum of care?
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Yeah, so it's been really interesting, too. We have to involve school, many different people, from finance to IT to our clinicians even. And so the very traditional way of looking at things is hospital centric, at least from our perspective in our health system. And we're really challenging those assumptions. So we recently had a leadership summit and said, okay, we need to start looking at finance on a service line level. How do we look at a P and L that rolls up across our entire system? We can still break out across the inpatient, but when you do that, it allows you to be more creative about where do the doctors go. If it's just your hospital and you cover the deficit of some of your physicians, they're like, oh, the doctor has to operate here. We can't do that anymore. We need to really be smart about where are we putting in our capital resources and where are we looking. And especially in orthopedics, even joint replacements are being done outpatient, which was something even 10 years ago nobody really thought was going to happen. And so it's using what we have in terms of structure, buildings, real estate, to develop those sites and say okay, maybe one of our hospitals is really well suited to be an ambulatory hub for all of our orthopedic procedures. So let's think about who does that, how far away are those doctors, where are those patients coming from, and who can we funnel over there. When we do that, we're taking cases out of the hospitals. So then what do we think about backfilling? Some of it may be high level orthopedics, it may be oncology, it may be cardiac, thoracic, other things. And so we really have to start branching out even to our other service lines, because that's the only way we are going to sustain growth as a health system.
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Well, let me ask you this question. Back to the question of scale versus growth. What
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are the unique challenges you're trying to overcome in the scale factor across all of those assets?
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So there's a couple of things. Recruitment is a huge challenge for us on Long Island. We really try to get very smart about who we're recruiting. We have recruited, I think in the last two years, some amazing clinicians, but they all have ties to Long Island. So we found, I tried to recruit someone from my former place, Hospital for Special Surgery, but didn't want to stay in Long island, wasn't from there. And so we really think about who is from there, who has family there, who may be trained there and wants to come home. And that's where we've been really successful. So we have people graduating from top programs, other markets, they maybe want to come back and be with their parents as they have children and the grandparents are close. So recruitment and finding people that want to be there is one trick. The other thing in terms of scalability is really thinking about how do we bundle services and programs. So we have a lot of sort of mom and pop onesie, twosie setups in terms of real estate as well across Long Island. So what we've been doing in recent years is looking at how do we create a hub model where patients can come and get everything they need in one space. They can get their radiology, they can do pharmacy, they can get their outpatient visits, and even maybe cross coordinate care. So maybe they do see their primary care doc. And we've actually put orthopedics folks in the primary care practices, so they're seeing their doctor for their annual visit. And like, you know, my knee's really been bothering me. Great, let's go see our physician down the hall. We can get you right in.
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Now.
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Let's make it really easy. So almost shrinking our footprint but to expand. So when we do take that step, it's a much bigger step.
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So getting small to get big.
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Exactly.
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Very interesting.
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Are you seeing this as a fee for service model or are you seeing this as a different type of reimbursement system in the future?
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I would love to say I'm seeing this as a fee for service, but no, I think we are going to be working still in the people are insured and especially in our environment, people are uninsured sometimes and they still need care. Because we're a faith based organization, we have a mission to take care of our entire population. So it's really going to be being smart about who do we bring in, how do we retain patients to be able to provide care for those that maybe can't afford care but still desperately need that care. And how do we be smart about maybe bringing care to the patients so that they don't have to continually come to us. So more of like a push than a pull so that we're, you know, oh, you have to come and drive and get in a car and figure out a cab. Well, maybe there's things we can bring to them that they won't have to be able then to have to come to us to get all those services. But I think the payment environment right now is such a challenge. We're continually being asked to do more with less and so it is tricky and I think we have to just be really smart about that. And I think we also have to align what we're trying to do with how we're getting paid. So stronger relationships with post acute care, for example. So really partnering with those facilities that get it, that want to engage in our clinical quality and be part of a bigger program versus standalone, do what you want. When our patients go there, they're sort of lost to us and we don't know what happens.
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So truly integrating across, truly integrating. So I think it's fascinating that you actually, because you're a mission based and a faith based organization, you have an eye, a very keen eye towards the patient and to patient experience. With that new model where you're saying you have a one stop shop, what are some of the early returns? Are you starting to see the positive feedback from your patients and then what are your plans are to continue to get that positive feedback?
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So where we, we are obviously still in our infancy of building this, but where we are starting to do this, we are seeing positive returns. We are seeing much higher patient retention rates. We're seeing people bring their family, their friends, their children to us. So my hope is that it continues to expand from there. We're also doing a lot of work. We have a whole dedicated team that looks at our in network utilization. And what we realized is we had clinicians that were employed by us that were not sending patients back to us. So we said why? So we, we literally identified all of those doctors. We went out and we asked them the question, why are you not sending us your orthopedic referrals? Why are our patients not coming here? In some cases it's too hard, you're too far away, it's not easy to get an appointment. And so what we started to do is strategically attack those reasons so that the reason doesn't exist anymore. And we make it really easy. We've also done things within our medical record system so that we have EPIC and so making sure that providers have preference list of who they want to refer to. And it's super easy. One of them said to me, well, I can't find a spine surgeon to send to. And I was like, well, who do you normally send to? Oh, these five people who I really like to refer to. Great. Set my project manager in. We're building the preference list for them just to make things easy. And I think one of the things we always focus on is patient experience. We also need to change our lens a little bit and think about our physician, nurse, ats, physical therapy, our provider experience. So if you don't take
care of your providers, you're not going to be able to take care of your patients. And I think that is also really key. So I think talking to your providers, I'm in the middle of doing one to ones with every single one of my physicians that we employ, as well as a few key leaders that are in the other large groups to get feedback. And it's really interesting what you find out and that's sort of how you are able to scale and get to some of these other great places where you are handing patients off seamlessly and able to keep the patients in your system.
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Do you think this will be a model for other service lines within the system?
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I do, I do. So I think that what's great is all of our service lines are in varying degrees of development and so we have a really awesome team and we learn from each other and we meet regularly and so we're always talking about like, hey, what did you try? Hey, what did you try? And again, because orthopedics is so tied to primary care, radiology, neurosurgery, we cross over spine. So we were trying to create this integrated spine system with neuro and ortho. We can't be successful if the other service lines aren't partnering with us. And then when we have a success, it's great because then they can learn from that. You can take the same tools, you may have to tweak them a little bit for the nuances of that subspecialty, but really you can do something that repeats over and over again.
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What are the barriers that you're finding to doing this?
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So I think people don't like change and people are afraid of failure. So I think one of the things we're really, over the next year to three years we're going to have to try to do is really create this culture where failure is not feared, but it's used as a tool to learn and resistance. So you got doctors? Oh, I've been practicing 30 years and this is how we've done it. And I don't want to change. Well, don't use those people as resistance, as an obstacle. Use it as a learning experience. How do you engage them really early on? So when I've over my career, when we've done change implementation, I found you always pick like your biggest naysayer. You pick somebody who's really into it and then you pick somebody who's in the middle who's like, let me wait and see how it happens. If you get them engaged, especially on the clinicians early on, and they help not only design, I think we limit them sometimes to like, clinical workflows. Engage them in ops, engage them in finance, engage them in learning from failure and bring them in as really part of this actionable team. I think that's how you're going to be really successful going forward in creating what we want to create. So just because they're not into it in the beginning doesn't mean that you can't learn from that. And you have to listen. What are you picking up on? Is it fear? Is it change? Is it when we think about how patients get into our system, it used to be you'd have one person who would kind of get all the referrals and parse it out to other people. That's changing. We have call centers, we can schedule our appointments online. So that control over, like, where am I sending everybody? Is gone. And so we've got to get people on board with there's a new way of doing things, but it doesn't mean that you can't still be successful in that new environment.
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So there'll be people who are watching this that will get motivated by what you're doing. What suggestions would you give to other health systems who are looking to take this on and maybe adopt some of the things you're trying to do?
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Of course, I think one is being willing to listen. I think you really have to be cognizant of who this is going to impact and where the changes need to happen. So you need to engage people from a bottom up perspective. I think too often we come in as leaders and I'm guilty of it too, and you have this great idea and you're ready to go and then it just falls completely flat because you started in the wrong place. You have to start with the people that are doing the work. So engage your clinicians, listen and really start to create a place of psychosocial safety so that you can fail and learn from that failure. And I think start small. I love pilot projects. That's like my favorite way to get stuff done. Because too often we were like, we're like, oh, we're going to bring this thing into the whole system and it's an IT effort and millions of dollars later and then it flops and you're like, oh, that was terrible. Right? So find ways to partner with some of the great new innovators and bring in tech, but do it in a way where the financial burden isn't so high and do it in a way that if you do fail or need to pivot, you can do that and you can be nimble about it. The other thing I would say to other leaders is make sure you can measure your data and be very clear about what success looks like and know how to get there. So what are the metrics that way? Again, things aren't really going great. Before things get totally off the rails, you can bring it back and know when to sunset something. So sometimes this thing you want to do or this great idea just isn't going to work. And that's okay. It just, you're going to have to think of something else.
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Well, thanks so much for sharing this vision with us and we wish you the best of luck. It's an important work you're doing. Thanks for being on the what's yous Moonshot podcast.
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Great.
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Thanks for having me.
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Thanks for being here.
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Thanks. Alvarez and Marsal Leadership action results.