Mandatory Episodes, Admin Burden & CEO Priorities with Dr. Christopher Newman ၏ စာသားမှတ်တမ်းအပြည့်အစုံ

That's a lot of things happening in healthcare, along with trying to keep 60 00:04:41,377 --> 00:04:46,069 people alive and delivering a high quality care in the community. 61 00:04:46,069 --> 00:04:46,369 That's right. That's right. 62 00:04:46,369 --> 00:04:50,697 What are sort of, you know, along with these sort of what it feels like left and 63 00:04:50,697 --> 00:04:55,025 right, we're getting cuts, we're getting reimbursement that's being lowered, all 64 00:04:55,025 --> 00:04:59,353 these challenges. Are there any opportunities that are coming down the 65 00:04:59,353 --> 00:05:03,682 pipeline that you're seeing? 66 00:05:03,682 --> 00:05:09,046 And whether your system is engaging with or thinking about right now. 67 00:05:09,046 --> 00:05:13,964 Yeah, you know, there there are opportunities out there. And you know, 68 00:05:13,964 --> 00:05:18,882 when I was in the COO and CMO role, most of the opportunities were around 69 00:05:18,882 --> 00:05:23,800 eliminating waste. so there's a lot of there's a lot of waste and white space in 70 00:05:23,800 --> 00:05:28,718 in any healthcare journey, whether it's, you know, transitions of care within the 71 00:05:28,718 --> 00:05:33,636 hospital, redundant tests being performed. So we did a ton of work. 72 00:05:33,636 --> 00:05:38,201 On r removing the waste within the health system. And you know that was you know as 73 00:05:38,201 --> 00:05:42,767 we annualize it compared to what in you know our cost in 2019 that was somewhere 74 00:05:42,767 --> 00:05:47,333 around a sixty million dollar a year opportunity right on on what at the time 75 00:05:47,333 --> 00:05:51,898 was a a billion dollar health system now we're moving up to one point five billion 76 00:05:51,898 --> 00:05:56,464 dollar health system but so there was a lot of opportunity on that and I'm not 77 00:05:56,464 --> 00:06:01,030 saying 78 00:06:01,030 --> 00:06:06,017 That those opportunities are are gone. they're still ahead of us and we continue 79 00:06:06,017 --> 00:06:11,005 to chip away at that and we have teams that look at that robustly at any given 80 00:06:11,005 --> 00:06:15,992 time. But that's anything from you know you know length of stay, transitions of 81 00:06:15,992 --> 00:06:20,980 care, all those kind of areas. you know, we we've really are people getting the 82 00:06:20,980 --> 00:06:25,967 right test in the right place at the right time for the right reasons. you know, a 83 00:06:25,967 --> 00:06:30,955 lot of that. So we've done a a lot of work in in that regard. 84 00:06:30,955 --> 00:06:34,863 A lot of work on access to our ambulatory. you know, we we have a particular 85 00:06:34,863 --> 00:06:38,772 challenge in our market that we rank only in the second percentile in the nation in 86 00:06:38,772 --> 00:06:42,681 physicians per capita. So physicians per hundred thousand, we are one of the worst 87 00:06:42,681 --> 00:06:46,589 in the nation. And a lot of people may conceive of,

hey, rural South Dakota or 88 00:06:46,589 --> 00:06:50,498 rural Wyoming, you know, that's a that's what people think about a a physician 89 00:06:50,498 --> 00:06:54,407 shortage area where you, you know, you need five primary care doctors and you 90 00:06:54,407 --> 00:06:58,316 only have one. 91 00:06:58,316 --> 00:07:03,118 We have a thousand docs on the staff, but I need 2,000. And our population is 92 00:07:03,118 --> 00:07:07,921 growing very rapidly here. So it's really creating all sorts of access issues in 93 00:07:07,921 --> 00:07:12,724 many different specialties and service lines, but probably most acutely is 94 00:07:12,724 --> 00:07:17,526 primary care. We're short about 195 primary care docs in our immediate market. 95 00:07:17,526 --> 00:07:22,329 And that's just to bring us up to average, and your average community, I think, is 96 00:07:22,329 --> 00:07:27,132 short primary care providers for what is needed. 97 00:07:27,371 --> 00:07:33,021 To keep our populations well. So a lot of that work is how do we take the the 98 00:07:33,021 --> 00:07:38,672 providers we have, create access, make sure the right people are getting seen at 99 00:07:38,672 --> 00:07:44,322 the right times, most efficiently, as we continue to grow our network and grow a 100 00:07:44,322 --> 00:07:49,973 pipeline of providers here in our our market. So a lot of it on the front end 101 00:07:49,973 --> 00:07:55,624 was really that kind of side. And now we're focused on supplies. 102 00:07:55,624 --> 00:08:00,170 You know, we're we're working with with a company right now that's looking at you 103 00:08:00,170 --> 00:08:04,716 know really procurement of non-clinical services. That could be everything from 104 00:08:04,716 --> 00:08:09,262 your your elevator contract, your snow removal, your all those kind of things 105 00:08:09,262 --> 00:08:13,808 that we don't even think about. As a as a healthcare CEO, we're focused on the 106 00:08:13,808 --> 00:08:18,354 patient care-facing things, but there's tens of millions of dollars of cost in the 107 00:08:18,354 --> 00:08:22,901 organization and as nonprofit health providers, 108 00:08:22,901 --> 00:08:27,408 We don't negotiate the best contracts. We're not we're you know, we're competing 109 00:08:27,408 --> 00:08:31,915 against Amazons and the Microsofts of the world, you know, and we don't always get 110 00:08:31,915 --> 00:08:36,423 the best prices. So there's a lot of opportunity to drive you know costs down 111 00:08:36,423 --> 00:08:40,930 in that in that world as well. And then labor is is a huge piece, and that's been 112 00:08:40,930 --> 00:08:45,437 one of the driving things that I've been doing over the last six, seven years since 113 00:08:45,437 --> 00:08:49,945 I've been at Mary Washington is 114 00:08:49,945 --> 00:08:55,104 Creating a robust pipeline of all licensed health healthcare professionals. 115 00:08:55,104 --> 00:08:58,177 That's amazing. That's so much ground to cover there. There's two things 116 00:08:58,177 --> 00:08:58,477 Yeah. 117 00:08:58,477 --> 00:09:04,333 I want to dig into, which is one, if you had to from now the CEO lens, 118 00:09:04,333 --> 00:09:04,633 Yeah. 119 00:09:04,671 --> 00:09:09,170 Think about the ideal external partner, right? Because as a as a healthcare 120 00:09:09,170 --> 00:09:13,669 system, as a hospital exec, like you mentioned, the core piece that you all are 121 00:09:13,669 --> 00:09:18,168 doing is get closer to the patient. And that's irrefutably the thing that you all 122 00:09:18,168 --> 00:09:22,667 can do the best. So a lot of it then ends up falling 123 00:09:22,667 --> 00:09:22,967 Yes. 124 00:09:22,967 --> 00:09:24,140 Towards 125 00:09:24,140 --> 00:09:28,573 Bringing in the right partners at the right stage to take them. And like you 126 00:09:28,573 --> 00:09:33,007 mentioned, there's sometimes a disadvantage on how you negotiate, how 127 00:09:33,007 --> 00:09:37,440 this these contracts are set up. And but you need to kind of keep both your head 128 00:09:37,440 --> 00:09:41,874 above water right now and as well as plan for the future, right? Which can sometimes 129 00:09:41,874 --> 00:09:46,308 feel like it's you're boiling an ocean constantly. But if you 130 00:09:46,308 --> 00:09:46,608 Yeah. 131 00:09:46,608 --> 00:09:49,971 Let's let's imagine a world if we had to set up a new structure of the right ideal 132 00:09:49,971 --> 00:09:53,334 partners to come into healthcare. 133 00:09:53,579 --> 00:09:59,024 Whether they're coming from the tech side or from services side, how would we align 134 00:09:59,024 --> 00:10:04,469 incentives from your perspective with the health system and then the partners that 135 00:10:04,469 --> 00:10:09,914 are coming in who are feasibly trying to aim for the same goals or at least should 136 00:10:09,914 --> 00:10:15,360 be, which is better patient quality and outcomes at a sustainable rate. 137 00:10:15,360 --> 00:10:20,295 Yeah, I think to start right off the bat, there's a lot of great companies and 138 00:10:20,295 --> 00:10:25,230 partners out there that have solutions in search of a problem, right? so they think 139 00:10:25,230 --> 00:10:30,165 you have the problem that they have the solution for, but it it doesn't always 140 00:10:30,165 --> 00:10:35,100 pair up exactly. So on our side, it then it takes a lot of time for people like 141 00:10:35,100 --> 00:10:40,035 myself, our chief technology officer or chief strategy officer who are out there 142 00:10:40,035 --> 00:10:44,970 kind of combing through solutions, meeting folks and trying to find what's you know 143 00:10:45,120 --> 00:10:49,218 May be beneficial. It would a little reverse would be helpful. And this is 144 00:10:49,218 --> 00:10:53,317 something we're implementing. We're v implementing a venture arm in the health 145 00:10:53,317 --> 00:10:57,416 system right now, where we actually have innovators embedded now

into our teams and 146 00:10:57,416 --> 00:11:01,515 they're looking for our problems and they're pairing it up with solutions that 147 00:11:01,515 --> 00:11:05,614 already exist out there. And we can partner and often these companies are at 148 00:11:05,614 --> 00:11:09,713 an early stage that you know they have some initial investments, they've got 149 00:11:09,713 --> 00:11:13,812 great ideas. 150 00:11:13,812 --> 00:11:17,657 But they need a proof of concept. So this is where it pairs in. We have we have a 151 00:11:17,657 --> 00:11:21,502 problem, they have the solution, and we can co-develop it together. and we both 152 00:11:21,502 --> 00:11:25,348 benefit, right? If if this company becomes 153 00:11:25,348 --> 00:11:29,193 wildly successful, maybe there's an equity 154 00:11:29,193 --> 00:11:33,039 stake, but that's not always the way we're doing it. We're doing it to drive 155 00:11:33,039 --> 00:11:36,884 immediate operational value and efficiencies. And and that's good enough 156 00:11:36,884 --> 00:11:40,730 if that's all it it it turns it turns out to be. 157 00:11:40,730 --> 00:11:45,462 But rather than paying an enormous amount for established companies that have 158 00:11:45,462 --> 00:11:50,194 established solutions that don't quite pair up, and there's generally not an ROI, 159 00:11:50,194 --> 00:11:54,926 hence a lot of the like Epic, I should well shall I say it, you know, and some of 160 00:11:54,926 --> 00:11:59,658 the other big the vendors that are great companies, but not really providing that 161 00:11:59,658 --> 00:12:04,390 ROI. this is a way that we we can maybe pair up ROI and solutions that are more 162 00:12:04,390 --> 00:12:09,122 tailor-made for our health system. 163 00:12:09,122 --> 00:12:14,011 But outside of that, I find networking is the best way to for me to to find value or 164 00:12:14,011 --> 00:12:18,901 things that would be value add. And that's peer networking, talking to other 165 00:12:18,901 --> 00:12:23,791 healthcare CEOs, COOs, what worked, what didn't. And I always try to be available 166 00:12:23,791 --> 00:12:28,680 for other health systems. If I've got something, this was a home run, this 167 00:12:28,680 --> 00:12:33,570 worked well, this had an eight, ten, you know, eight figure value or ROI, I'm gonna 168 00:12:33,570 --> 00:12:38,460 be sharing that with my peers and and then they can they can kind of hear. 169 00:12:38,572 --> 00:12:44,005 Those endorsements from other operators that use products that really go a long 170 00:12:44,005 --> 00:12:49,439 way. And then sometimes you you just meet particular companies or vendors out on the 171 00:12:49,439 --> 00:12:54,873 road that have an intriguing idea and and sometimes those have worked out extremely 172 00:12:54,873 --> 00:13:00,307 well as as well. And if they don't, you gotta fail fast and and move on. 173 00:13:00,307 --> 00:13:07,312 Exactly. Couldn't say that better. That's very, tech tech forward of

you. 174 00:13:07,312 --> 00:13:07,612 Yeah. 175 00:13:07,612 --> 00:13:11,898 One of the things you brought up I thought that was so interesting, which was again 176 00:13:11,898 --> 00:13:16,185 on where you've been, right? Where those operational models, cost savings, 177 00:13:16,185 --> 00:13:20,471 productivity improvements, things that are 178 00:13:20,471 --> 00:13:24,758 incredibly powerful, incredibly important, strategic. However, they're not the same 179 00:13:24,758 --> 00:13:29,045 thing as revenue generation. And I would almost say that we're 180 00:13:29,045 --> 00:13:33,864 Technology landscape has been is actually following the trajectory of your career 181 00:13:33,864 --> 00:13:38,683 because operate operations officers, medical officers are more focused on the 182 00:13:38,683 --> 00:13:43,503 cost savings productivity improvement side of the equation. But now in the CEO seat, 183 00:13:43,503 --> 00:13:48,322 and I think sometimes the CFO or the chief strategy officers, there's only three 184 00:13:48,322 --> 00:13:53,141 roles in charge of revenue generation, top 185 00:13:53,141 --> 00:13:57,961 line. How do you think about those two and 186 00:13:57,961 --> 00:14:05,792 Opportunities as you weigh them and how you balance between between those as well. 187 00:14:05,792 --> 00:14:10,304 Yeah, it it's hard. at this point we've done a lot of the cost savings work and 188 00:14:10,304 --> 00:14:14,816 we've had great success in that. And my challenge for the team now is we really 189 00:14:14,816 --> 00:14:19,328 need things that actually drive revenue and drive performance in a in a in a 190 00:14:19,328 --> 00:14:23,840 different way. So we did a five year strategic plan and we're looking at you 191 00:14:23,840 --> 00:14:28,352 know which growth you know service lines have that kind of value, where can we 192 00:14:28,352 --> 00:14:32,865 drive 193 00:14:32,865 --> 00:14:37,670 Revenue, where can we drive EBITDA? Where can we drive margin? and that will allow 194 00:14:37,670 --> 00:14:42,475 if we are successful in those arenas, that that margin allows us to invest in other 195 00:14:42,475 --> 00:14:47,280 things our community need that maybe lower margin value, but are our mission and 196 00:14:47,280 --> 00:14:52,085 really the focus of our mission. So we've made major investments in oncology and in 197 00:14:52,085 --> 00:14:56,890 neurosurgery and neurosciences, cardiovascular Orthopaedics, and those 198 00:14:56,890 --> 00:15:01,696 kind of things allow us to drive 199 00:15:01,696 --> 00:15:06,504 You know, revenue that we can deploy to behavioral health and and primary care and 200 00:15:06,504 --> 00:15:11,312 women's health, which are just as equally important in our community, but may not 201 00:15:11,312 --> 00:15:16,121 have the margin where we can invest without other revenue elsewhere. So it's 202 00:15:16,121 --> 00:15:20,929 it's a balancing act. You know, we we we look at the

mission. At this point, our 203 00:15:20,929 --> 00:15:25,737 mission is to serve our entire community, regardless of ability to pay. I mean we're 204 00:15:25,737 --> 00:15:30,546 the safety net provider. We take that very seriously, but 205 00:15:30,546 --> 00:15:34,343 As our revenue, our traditional revenue is 206 00:15:34,343 --> 00:15:38,141 eroded, we have to look where we can drive 207 00:15:38,141 --> 00:15:41,939 margins so that we can continue to support our mission. but I think at some point 208 00:15:41,939 --> 00:15:45,736 we're gonna have to look at diversification. there's gonna have to be 209 00:15:45,736 --> 00:15:49,534 diverse revenue streams. It can't all be the traditional payers for fee-for-service 210 00:15:49,534 --> 00:15:53,332 or even value-based payments for care. we're gonna have to look at how, as 211 00:15:53,332 --> 00:15:57,130 healthcare, we can view ourselves as a healthcare 212 00:15:57,271 --> 00:16:01,904 Company and really look at is there other sources of revenue, whether it be tech or 213 00:16:01,904 --> 00:16:06,537 other sort of thing, areas where we can pharmaceuticals, et cetera, and drive 214 00:16:06,537 --> 00:16:11,170 value and drive margin for the health system. 215 00:16:11,170 --> 00:16:16,627 Very insightful. I'm curious, again, we've been talking a little bit about Mary 216 00:16:16,627 --> 00:16:22,085 Washington as a nonprofit health system. Do you think there are certain challenges 217 00:16:22,085 --> 00:16:27,543 that are different for nonprofit systems versus for profit systems? 218 00:16:27,543 --> 00:16:32,902 Yeah, definitely. you know, our our competitor in town, and not to disparage 219 00:16:32,902 --> 00:16:38,261 them, is HCA. So I see it v every day. you know, we we they are able to focus on the 220 00:16:38,261 --> 00:16:43,620 on the margin producing care. Yes, they'll say, hey, we have to see everything that 221 00:16:43,620 --> 00:16:48,979 CMS in through their ED ER, but they only choose markets with certain demographics, 222 00:16:48,979 --> 00:16:54,338 with certain payer mixes. you know, they they're able to secure the risk. 223 00:16:54,338 --> 00:16:59,359 There are nonprofit health systems, we're we're in a fairly affluent area, although 224 00:16:59,359 --> 00:17:04,381 we do have challenges in pockets of our market as well. but there are nonprofit 225 00:17:04,381 --> 00:17:09,402 health systems that are in areas that are in much greater need with much lower 226 00:17:09,402 --> 00:17:14,424 parameters than we have, including here in in Virginia. And but they stand in every 227 00:17:14,424 --> 00:17:19,446 day to serve everyone in their communities. and 228 00:17:19,446 --> 00:17:24,109 Sometimes now that has to be done with partnership with commun other community 229 00:17:24,109 --> 00:17:28,772 nonprofits, whether that's around housing, food insecurities, safety, a lot of 230 00:17:28,772 --> 00:17:33,436 different things that can

affect the social determinants of of health for our 231 00:17:33,436 --> 00:17:38,099 patients that are not really in our wheelhouse but are important to the 232 00:17:38,099 --> 00:17:42,762 overall health of the patient and can drive costs ultimately for that patient 233 00:17:42,762 --> 00:17:47,426 and their care. So you know, we have a pro 234 00:17:47,639 --> 00:17:52,382 Pretty robust group of community partners and we support financially support those 235 00:17:52,382 --> 00:17:57,125 nonprofits through our foundation. So we have a amount of money that we are donate 236 00:17:57,125 --> 00:18:01,868 every single year to local community nonprofits that partner with us to really 237 00:18:01,868 --> 00:18:06,611 provide that entire safety net across our communities. But you know they're the 238 00:18:06,611 --> 00:18:11,354 for-profit players are focused on only the high margin things, right? And they are 239 00:18:11,354 --> 00:18:16,098 they have they're at liberty 240 00:18:16,098 --> 00:18:21,017 To allow us to do all the other stuff that doesn't have 241 00:18:21,017 --> 00:18:26,781 Absolutely. Well, this is where, your investment in the community. I'm 242 00:18:26,781 --> 00:18:32,546 wondering, is that something that is going to pay dividends now that Medicare is 243 00:18:32,546 --> 00:18:38,311 moving towards mandatory episode management, where majority of the care and 244 00:18:38,311 --> 00:18:44,076 cost is going to happen in the community outside of the acute care setting. So 245 00:18:44,076 --> 00:18:49,841 curious from both lenses where, you know, as that 246 00:18:49,841 --> 00:18:54,548 Leader in the community that's supporting the community, th is that a secret weapon? 247 00:18:54,548 --> 00:18:59,255 Is it an ace of cards you all hold? And also from your personal experience in the 248 00:18:59,255 --> 00:19:03,962 post-acute care space where you've been, is is that the right incentives that are 249 00:19:03,962 --> 00:19:08,669 gonna allow for that stronger system rather than, these disparate points of 250 00:19:08,669 --> 00:19:13,376 care? 251 00:19:13,376 --> 00:19:18,788 Yeah, so a a a lot to unpack there. I I don't know that there's an ROI with the 252 00:19:18,788 --> 00:19:24,201 partnerships. I do think it's a benefit. We we need them. They're s they're 253 00:19:24,201 --> 00:19:29,614 essential. but you know, this is just really a a cost and and risk shifting, 254 00:19:29,614 --> 00:19:35,027 right? You know, this is what this is. It's shifting cost and risk and and 255 00:19:35,027 --> 00:19:40,440 administrative burden from the payer to to to the health system. 256 00:19:40,440 --> 00:19:45,368 And it's not really necessarily our wheelhouse, although we certainly have 257 00:19:45,368 --> 00:19:50,297 ability to focus on some of the value there in that squeezing out the waste, the 258 00:19:50,297 --> 00:19:55,226 noise, et cetera. But even when I look at the bundles, the largest portion of the 259 00:19:55,226 --> 00:20:00,154 cost is is in that post-acute setting, which we don't even own, but we're at risk 260 00:20:00,154 --> 00:20:05,083 for it, right? So you know, so a lot of the work becomes us really spending a lot 261 00:20:05,083 --> 00:20:10,012 of effort on making sure the patient gets to the right post-acute. 262 00:20:10,191 --> 00:20:14,301 Setting for for them for the best healthcare journey. And that's, best, 263 00:20:14,301 --> 00:20:18,412 lowest cost, et cetera. But that becomes a large portion of it. But you know, it's 264 00:20:18,412 --> 00:20:22,523 it's just shifting. There's been a heavy shift for many, many years to the health 265 00:20:22,523 --> 00:20:26,634 system. And I would say this, I don't know if you know the the it was really a 266 00:20:26,634 --> 00:20:30,745 seminal article by Atul Gawande, which really opened my eyes to population health 267 00:20:30,745 --> 00:20:34,856 way back in the day. And it was called the cost conundrum, I believe. And it was 268 00:20:34,856 --> 00:20:38,967 like, 269 00:20:38,967 --> 00:20:43,543 McAllen, Texas versus El Paso, Texas, and the cost was twice in El in McAllen that 270 00:20:43,543 --> 00:20:48,119 it was in El Paso, like literally twice and why and all the perverse incentives 271 00:20:48,119 --> 00:20:52,695 for providers and volume over value, et cetera. I think in you know, two thousand 272 00:20:52,695 --> 00:20:57,271 nine wasn't all that long ago. I think we've done a very good job as an industry 273 00:20:57,271 --> 00:21:01,847 squeezing a lot of that out. Some of that's been done by the health systems, 274 00:21:01,847 --> 00:21:06,424 but you know, 275 00:21:06,424 --> 00:21:10,987 Proactively and population health metrics, but some of that's just been done by 276 00:21:10,987 --> 00:21:15,550 limited access, right? We you know, it's very different day where you're looking 277 00:21:15,550 --> 00:21:20,114 for volume. Most health systems are looking at how do I care for everybody 278 00:21:20,114 --> 00:21:24,677 that actually even needs it, right? So it's it's it's a different you know, 279 00:21:24,677 --> 00:21:29,240 perspective. And I think some of that's forced some of the value as well and 280 00:21:29,240 --> 00:21:33,804 removed a lot of the waste that was just out of necessity. 281 00:21:33,804 --> 00:21:38,810 But I wonder how much value there's gonna be in few future episodes like these, the 282 00:21:38,810 --> 00:21:43,816 a lot of the population health things coming out of CMS. And is there gonna be 283 00:21:43,816 --> 00:21:48,822 more value in like supply, demand, and labor or or technology to improve people's 284 00:21:48,822 --> 00:21:53,828 productivity without burning them out? I or cures such that people don't need the 285 00:21:53,828 --> 00:21:58,834 care in the first place, right? you know, that's what makes me optimistic about the 286 00:21:58,834 --> 00:22:03,840

future. I I think in 287 00:22:03,840 --> 00:22:07,406 My lifetime, it's hard to believe, but there may be cures for MS and Parkinson's 288 00:22:07,406 --> 00:22:10,973 and diabetes, all these things that have enormous cost. So I think as we look at 289 00:22:10,973 --> 00:22:14,540 the lens of healthcare going forward, we're looking at today's problems, not 290 00:22:14,540 --> 00:22:18,107 really realizing the world five, ten years 291 00:22:18,107 --> 00:22:21,673 from now may look very, very different. So 292 00:22:21,673 --> 00:22:25,240 so I try to be an optimist and we you know 293 00:22:25,240 --> 00:22:28,807 we always are looking for opportunities in the sh in the short term and trying to be 294 00:22:28,807 --> 00:22:32,374 optimistic towards the vision of where we're heading. but I I do see 295 00:22:32,554 --> 00:22:36,851 A lot people with a pessimistic view, but I think, we may not need as many hospital 296 00:22:36,851 --> 00:22:41,148 beds. I've been hearing that for years and the demand has been increasing instead of 297 00:22:41,148 --> 00:22:45,445 going the other way. But we l we literally with AI and some of the, gene therapies 298 00:22:45,445 --> 00:22:49,742 and some of the stuff coming through, it may be a very different world in five to 299 00:22:49,742 --> 00:22:54,040 ten years, a much better world for our health. 300 00:22:54,040 --> 00:22:55,851 So this is where I usually end these episodes, but you're leading me there 301 00:22:55,851 --> 00:22:57,662 already. 302 00:22:57,662 --> 00:22:57,962 I think 303 00:22:57,962 --> 00:23:03,085 So we're just gonna jump in, which is so what are the things you're most optimistic 304 00:23:03,085 --> 00:23:08,208 about in the next five years? Is it preventative care? Is it these you know, 305 00:23:08,208 --> 00:23:13,331 more on the life sciences, the the therapies? What is it that gets you most 306 00:23:13,331 --> 00:23:18,454 excited about where we're headed in the next, let's say five years horizon? 307 00:23:18,454 --> 00:23:23,084 Yeah, I I think it's the therapies. you just look at at GLP-1s and and I I d I've 308 00:23:23,084 --> 00:23:27,715 just seen people, people I work with, people I are friends with, family members 309 00:23:27,715 --> 00:23:32,346 who've taken those medications and they've changed their lives just in a matter of a 310 00:23:32,346 --> 00:23:36,976 year of being on on the medication. I know 311 00:23:36,976 --> 00:23:41,607 those medications are extraordinarily high cost at this point, but I think the cost 312 00:23:41,607 --> 00:23:46,238 will come down and the long term benefits of those drugs may be profound. 313 00:23:46,421 --> 00:23:50,620 Right, there may be really a a profound improvement in people's overall health. So 314 00:23:50,620 --> 00:23:54,820 that's just one example. And as I've, you know, seen some of the, you know, and the 315 00:23:54,820 --> 00:23:59,020 same sort of thing with the gene therapies where you look at like these are million 316 00:23:59,020 --> 00:24:03,220 dollar drugs and how are we going to be able to afford those? But when you look at 317 00:24:03,220 --> 00:24:07,420 a cure for type one diabetes, I mean that's a that's amazing. that that is 318 00:24:07,420 --> 00:24:11,620 truly amazing. So I think I'm I'm more of an optimist by nature, and I and I think, 319 00:24:11,620 --> 00:24:15,820 you know, yes, we've got 320 00:24:15,820 --> 00:24:20,303 More challenges now than I've ever seen in my career, but I also think there's a lot 321 00:24:20,303 --> 00:24:24,787 of opportunities out there. And then I look at we have over the last 20, 25 322 00:24:24,787 --> 00:24:29,270 years, just put tons of administrative burden on our bedside caregivers. Tons and 323 00:24:29,270 --> 00:24:33,754 tons and tons. I look at how I practiced medicine in 2001 versus when I left 324 00:24:33,754 --> 00:24:38,237 practice in 2015. And it was like I was doing probably 40% of my day on 325 00:24:38,237 --> 00:24:42,721 administrative. 326 00:24:42,721 --> 00:24:47,943 In 2015 and almost zero percent in two thousand one, right? So you know, all 327 00:24:47,943 --> 00:24:53,165 these things just add a burden. And I think technology, I'm hopeful, in a very 328 00:24:53,165 --> 00:24:58,387 short order, is going to be able to remove burdens from our caregivers so they can 329 00:24:58,387 --> 00:25:03,609 get back focused on what they're trained to do, which is take care of people, and 330 00:25:03,609 --> 00:25:08,832 not fill out EMRs for two hours every night. Right. So not 331 00:25:08,832 --> 00:25:13,952 Do prior authorizations and all the stuff that we've we've stuck on our clinicians. 332 00:25:13,952 --> 00:25:19,072 So I'm hopeful I'm hopeful in that regard as well. 333 00:25:19,072 --> 00:25:24,074 No, that's that's such a great point about administrative burden and actually the 334 00:25:24,074 --> 00:25:29,077 cost of it too, right? Like it's not just in the the time that it takes. There's an 335 00:25:29,077 --> 00:25:34,080 actual financial cost. There is a cost to how many patients you're able to actually 336 00:25:34,080 --> 00:25:39,082 get to, and then also the level of effort and time you can spend with those 337 00:25:39,082 --> 00:25:44,085 patients. From a technology lens, you know, where we spend a lot of time as 338 00:25:44,085 --> 00:25:49,088 rainfall, I'm curious as to your perspective. 339 00:25:49,088 --> 00:25:54,413 Which is technology right now most impactful in trying to figure out where 340 00:25:54,413 --> 00:25:59,739 the right effort is spent by the clinicians? Because ultimately I I'm I'm a 341 00:25:59,739 --> 00:26:05,064 big believer that clinician has to be in the loop. They have to always be the 342 00:26:05,064 --> 00:26:10,390 quarterback. Technology might be able to figure out 343 00:26:10,390 --> 00:26:15,294 Where their time is best spent, such as finding

higher acuity patients to spend 344 00:26:15,294 --> 00:26:20,198 more time with versus lower acuity patients that may need less oversight. Or 345 00:26:20,198 --> 00:26:25,102 are there other places that you find that overlap and time savings in the now, even 346 00:26:25,102 --> 00:26:30,007 as we aim for the a future state? 347 00:26:30,007 --> 00:26:34,394 Yeah, I I'm a big believer in, analytics and you know using data for action. you 348 00:26:34,394 --> 00:26:38,782 know, I think the challenge we have, and it was my responsibility as CMO, COO, 349 00:26:38,782 --> 00:26:43,169 because we've got, you know, thousands of data points, right? And thousands of 350 00:26:43,169 --> 00:26:47,557 dashboards blinking red and yellow and and it can be overwhelming. So it's really my 351 00:26:47,557 --> 00:26:51,944 it was my job, I felt, and and the administrative team to say, the prioritize 352 00:26:51,944 --> 00:26:56,332 those. 353 00:26:56,481 --> 00:27:01,268 Okay, these are the ones we're gonna focus on right now, and these are the drivers, 354 00:27:01,268 --> 00:27:06,056 and these are what how we're gonna focus our our docs and nurses to to drive value 355 00:27:06,056 --> 00:27:10,844 and improve what they're working on and remove inefficiencies. So I think huge 356 00:27:10,844 --> 00:27:15,632 value right now in that. What I'm what I'm hopeful is that through AI or through 357 00:27:15,632 --> 00:27:20,420 companies, we not only see what's wrong and where we can focus, but also have 358 00:27:20,420 --> 00:27:25,208 presented a solution, right? Or be nudged. 359 00:27:25,208 --> 00:27:29,924 Towards towards the solution because it can be a a bit overwhelming. I have a lot 360 00:27:29,924 --> 00:27:34,640 of companies say, hey, we can find this, we can find that, we can find this, we can 361 00:27:34,640 --> 00:27:39,357 find that. But I don't have a shortage right now of dashboards blinking red, 362 00:27:39,357 --> 00:27:44,073 right? You know, I've it's when I have a shortage of his time to figure out the 363 00:27:44,073 --> 00:27:48,789 solutions to fix those those kind of things or to really deploy resources in 364 00:27:48,789 --> 00:27:53,506 the right areas or see you know even triage which is the bigger opportunity. 365 00:27:53,506 --> 00:27:59,232 So so I I think that's where the focus will be going forward. But Yeah, in 366 00:27:59,232 --> 00:28:04,958 today's day you just can't move an organization forward successfully without 367 00:28:04,958 --> 00:28:10,684 robust data analytics and point people in the right direction. 368 00:28:10,684 --> 00:28:10,984 See, I'm gonna switch gears with you here because I think that's so 369 00:28:10,984 --> 00:28:14,693 Powerful. Because there are all these technology companies, well-meaning 370 00:28:14,693 --> 00:28:18,402 technology companies, that want to help executives 371 00:28:18,402 --> 00:28:18,702 Yeah. Yeah. 372 00:28:18,702 --> 00:28:22,890 Like

you. You're absolutely right, where there's this aspect of solving almost not 373 00:28:22,890 --> 00:28:27,079 the right problem, or not the greatest you're you're not solving the bottleneck 374 00:28:27,079 --> 00:28:31,268 here, right? 375 00:28:31,268 --> 00:28:31,568 Yes. 376 00:28:31,568 --> 00:28:34,540 You're handing off one more thing for now, a limited team with still limited 377 00:28:34,540 --> 00:28:37,512 resources. 378 00:28:37,611 --> 00:28:41,609 That's right. That's right. Yes. 379 00:28:41,609 --> 00:28:41,909 To figure out. And it's data overload. So 380 00:28:41,909 --> 00:28:47,181 The the so what issue here is as a mentor of mine would say, like, okay, 381 00:28:47,181 --> 00:28:47,481 Mm-hmm. 382 00:28:47,481 --> 00:28:53,672 Great, we have the data now. So what are you helping me to actually solve it? how 383 00:28:53,672 --> 00:28:59,864 do you how do you start to think about that sort of overlap, that sort of you 384 00:28:59,864 --> 00:29:06,056 know amplifying the existing resources to where they need to be is it 385 00:29:06,056 --> 00:29:12,229 As much as you can be as part a part of existing workflows, is it bringing in 386 00:29:12,229 --> 00:29:18,402 entirely new sort of ways to think about it? What is what is sort of the way to 387 00:29:18,402 --> 00:29:24,576 kind of get in there, embed and start providing value now to to systems? 388 00:29:24,576 --> 00:29:29,858 Yeah, I I think one example, you know, where we worked on the length of stay. And 389 00:29:29,858 --> 00:29:35,140 when I got to Mary Washington, we were bottom decile length of stay. And really 390 00:29:35,140 --> 00:29:40,422 no coordination of of the care well in the hospital. It was the Wild West a little 391 00:29:40,422 --> 00:29:45,704 bit, you know, kind you know, and we had the analytic we so we partnered with a 392 00:29:45,704 --> 00:29:50,986 company that provided the analytics and provided the 393 00:29:50,986 --> 00:29:55,931 The dashboards and all the visibility of the bottlenecks in real time. But they 394 00:29:55,931 --> 00:30:00,876 also paired that with boots on the ground, kind of process engineers that worked at 395 00:30:00,876 --> 00:30:05,821 the elbow with our docs and nurses in real 396 00:30:05,821 --> 00:30:10,766 time on on what to do then, right? And and so that was you know an engagement of you 397 00:30:10,766 --> 00:30:15,712 know approximately 15 months that that went out. 398 00:30:15,712 --> 00:30:20,380 And then now they come back quarterly, right? But but my team, it is so 399 00:30:20,380 --> 00:30:25,049 hardwired. I would say if I told my team to go back to long length to stay and 400 00:30:25,049 --> 00:30:29,718 inefficient care they they wouldn't know how to do it, right? Because it's just 401 00:30:29,718 --> 00:30:34,386 becomes a a habit. So I think pairing the technology with true operational chops or 402 00:30:34,386 --> 00:30:39,055 experience, where you can kind of teach the teams almost like a coach or a you 403 00:30:39,055 --> 00:30:43,724 know or teacher that once the people get into the new habit. 404 00:30:43,924 --> 00:30:47,572 It it's it it becomes a habit, right? And they and they can follow that. But often 405 00:30:47,572 --> 00:30:51,220 we get, well, this is where you're wrong. And everybody's like, Yeah, I'm just gonna 406 00:30:51,220 --> 00:30:54,868 keep doing things the way I'm doing it. Right. And so I really think that 407 00:30:54,868 --> 00:30:58,517 partnership was not a consulting engagement. We get this with consultants 408 00:30:58,517 --> 00:31:02,165 too. They're like, here's your problems, here's the solutions, good luck, you know, 409 00:31:02,165 --> 00:31:05,813 and they're out the door, versus here's the problems, here's the solution, we're 410 00:31:05,813 --> 00:31:09,461 gonna be at the elbow with you to solve it over time and eventually train you how to 411 00:31:09,461 --> 00:31:13,110 do this by yourself. 412 00:31:13,110 --> 00:31:18,646 Right. That's that's what I think. And hopefully even have AI nudges built in 413 00:31:18,646 --> 00:31:24,182 over time that really allows the technology to drive some of the processes. 414 00:31:24,182 --> 00:31:26,513 No, that that's so insightful 415 00:31:26,513 --> 00:31:26,813 Yeah. 416 00:31:26,813 --> 00:31:30,575 Because some of these issues are scaled with technology, but they are 417 00:31:30,575 --> 00:31:34,338 fundamentally human and behavioral changes that we're dealing with at the 418 00:31:34,338 --> 00:31:34,638 Human That's right. 419 00:31:34,638 --> 00:31:39,250 Same time. Which is doesn't sound as exciting as saying I have AI, but really 420 00:31:39,250 --> 00:31:43,863 it is. It's it's peop people are messier and a lot less 421 00:31:43,863 --> 00:31:44,163 It's hard. That's the hard part, right? Yeah. 422 00:31:44,163 --> 00:31:46,044 Predictable than AI. 423 00:31:46,044 --> 00:31:50,644 That's Right. That's right. So Yeah, it's the people and processes that overlay the 424 00:31:50,644 --> 00:31:54,944 technology that I think has to be looked at a little closer. 425 00:31:54,944 --> 00:31:59,915 No, absolutely. we were at a conference together just a few weeks ago, and one of 426 00:31:59,915 --> 00:32:04,886 the things that did come up was how do you align incentives properly for an 427 00:32:04,886 --> 00:32:09,858 engagement like this, right? Like you were mentioning you had this this this partner 428 00:32:09,858 --> 00:32:14,829 that came in and they were on in there for the long haul versus you know 429 00:32:14,829 --> 00:32:19,801 consultancies 430 00:32:19,801 --> 00:32:20,101 Yeah. 431 00:32:20,101 --> 00:32:22,007 Where you're paying for 432 00:32:22,007 --> 00:32:24,428 Somebody to point out problems and then leave. They have 433 00:32:24,428 --> 00:32:24,728 Mm-hmm. 434 00:32:24,728 --> 00:32:31,250 No vested interest in helping you figure it out at the at the

end. Do you 435 00:32:31,250 --> 00:32:31,550 Right. Right. 436 00:32:31,550 --> 00:32:36,609 Think, you know, and and you know, I have have my opinions here on this side of the 437 00:32:36,609 --> 00:32:41,668 table in many ways, which is how do you align incentives so that a win for the 438 00:32:41,668 --> 00:32:46,727 system is the same as the win for the patient, which is the same as a win for 439 00:32:46,727 --> 00:32:51,786 the partner in this instance? Do you think it's fundamentally, again, not just 440 00:32:51,786 --> 00:32:56,660 It's not for a lack of technologies or AI companies that we're dealing with, 441 00:32:56,660 --> 00:32:56,960 Yeah. 442 00:32:56,960 --> 00:33:02,606 But a lack of how to engage with people scalably so we can drive the outcomes, not 443 00:33:02,606 --> 00:33:08,253 just create more things to look at and problems that nobody's actually vested in 444 00:33:08,253 --> 00:33:13,900 figuring out the solutions to. 445 00:33:13,900 --> 00:33:18,400 Yeah. Well I I think it is that partnership versus consult a consulting 446 00:33:18,400 --> 00:33:22,900 engagement and and we use consultants and and the consultants are great and they're 447 00:33:22,900 --> 00:33:27,400 useful if that you have an issue or you need you need something big s helps 448 00:33:27,400 --> 00:33:31,900 solved. But what I think in the first case 449 00:33:31,900 --> 00:33:36,400 where it worked is that it was truly a a a partnership, a longstanding model. It 450 00:33:36,400 --> 00:33:40,900 wasn't like paid, here's the playbook, good luck. 451 00:33:40,900 --> 00:33:45,812 I felt like they were invested in our success, right? And and it's all since 452 00:33:45,812 --> 00:33:50,724 it's a longstanding partnership, you know, in order to keep our business, that we 453 00:33:50,724 --> 00:33:55,636 need to have results in an ROI, right? So, and you know, we even factored in things 454 00:33:55,636 --> 00:34:00,548 like, and this is I'm always willing to do these things because I think the industry 455 00:34:00,548 --> 00:34:05,460 needs to to learn is like if you're you know, we'll give you a better pricing if 456 00:34:05,460 --> 00:34:10,372 we if we hit a home run here, would you go tell your peers, right? You know, and and 457 00:34:10,372 --> 00:34:14,419 And the answer is yes. so those those are the kind of things and and I'm always 458 00:34:14,419 --> 00:34:18,467 willing to when we have a great partner that's really doing value, we're a 459 00:34:18,467 --> 00:34:22,515 nonprofit healthcare. I why would I why would I hold that close to the best? You 460 00:34:22,515 --> 00:34:26,562 know, I want a community in, you know, Nebraska to to benefit from this or 461 00:34:26,562 --> 00:34:30,610 Pennsylvania or wherever else as well, right? So because we're all in this for 462 00:34:30,610 --> 00:34:34,658 the right reasons. So I I think that's that's important. It's really hard to get 463 00:34:34,658 --> 00:34:38,706 incentives correct. 464 00:34:38,838 --> 00:34:42,937 Even even with the best intentions, there's always perverse things that happen 465 00:34:42,937 --> 00:34:47,036 it with incentives. you know, as I was talking about, I I'm sure CMS has the best 466 00:34:47,036 --> 00:34:51,135 intentions in place, right? They want to bend the cost curve down, they want higher 467 00:34:51,135 --> 00:34:55,234 quality care for patients as that they pay for, but there there are perverse there's 468 00:34:55,234 --> 00:34:59,333 always gaming of the of of these you know, 469 00:34:59,333 --> 00:35:03,432 population health things. There's th so so it there just are always perverse 470 00:35:03,432 --> 00:35:07,532 incentives. So 471 00:35:07,532 --> 00:35:11,157 You just have to go into it eyes wide open and and understand what you're mutually 472 00:35:11,157 --> 00:35:14,782 trying to acc accomplish. 473 00:35:14,782 --> 00:35:19,673 Absolutely. Couldn't agree more. And I always think of what Medicare does as more 474 00:35:19,673 --> 00:35:24,564 of a wish list, which is not again what you want to hear as a health system that's 475 00:35:24,564 --> 00:35:29,456 been assigned one of the most rigorous and most burdensome episode management in the 476 00:35:29,456 --> 00:35:34,347 history of you as healthcare, and you happen to be the CEO as this is happening, 477 00:35:34,347 --> 00:35:39,239 exciting for you. but 478 00:35:39,239 --> 00:35:39,539 Yes. 479 00:35:39,539 --> 00:35:41,524 You know, it is, you know, it's sort of a wish list component. You're absolutely 480 00:35:41,524 --> 00:35:43,510 right. 481 00:35:43,649 --> 00:35:48,314 But then somebody needs to operationalize it, somebody needs to scale it, and 482 00:35:48,314 --> 00:35:52,979 somebody needs to make sure that those incentives and the reporting is happening 483 00:35:52,979 --> 00:35:57,644 and have do it in a sustainable way. Because there was a univers Brown 484 00:35:57,644 --> 00:36:02,309 University article that came out that said the burden to just report on these models 485 00:36:02,309 --> 00:36:06,974 sometimes can be upwards of six hundred and fifty thousand dollars up to 486 00:36:06,974 --> 00:36:07,274 Yeah. 487 00:36:07,274 --> 00:36:11,288 One point four million per hospital per year. 488 00:36:11,288 --> 00:36:11,619 Yes. 489 00:36:11,829 --> 00:36:15,562 Which is huge for any system, 490 00:36:15,562 --> 00:36:15,862 Yeah. 491 00:36:15,862 --> 00:36:18,643 Let alone a regional system. So 492 00:36:18,643 --> 00:36:19,183 Yes. 493 00:36:19,183 --> 00:36:24,526 Is it partially, figuring out those sustainable and operational tricks and is 494 00:36:24,526 --> 00:36:29,869 it also to figure out those right incentive partners to make sure that, 495 00:36:29,869 --> 00:36:35,212 everybody's doing what they do best rather 496 00:36:35,212 --> 00:36:40,555 than everybody trying to reinvent the same solution in-house? 497 00:36:40,555

--> 00:36:44,887 Yeah, there Yeah, you're you're exactly right. There's a lot of cost in this, but 498 00:36:44,887 --> 00:36:49,220 the first is in finding a partner to help you at least get the the data analytics 499 00:36:49,220 --> 00:36:53,553 pointing you in the right direction so you can drive this and it's not like, 500 00:36:53,553 --> 00:36:57,886 surprise, surprise at the end, you you lost. So you do need to stay on top of it. 501 00:36:57,886 --> 00:37:02,219 But you know, there's often gain sharing with private docs, right? They're not 502 00:37:02,219 --> 00:37:06,552 gonna you know, they they don't have any skin in the game, honestly. So, you know 503 00:37:06,552 --> 00:37:11,479 So in order to drive change on your medical groups, you really need to focus 504 00:37:11,479 --> 00:37:16,406 on that. really partnering closely with your post-acute, right? we we've got 505 00:37:16,406 --> 00:37:21,334 fantastic IRFs here in our community that would love to take the business, and I'm 506 00:37:21,334 --> 00:37:26,261 now I'm having to steer patients in a different direction, right? so so there's 507 00:37:26,261 --> 00:37:31,188 a lot that needs to be done to succeed in these in these programs, and that all is 508 00:37:31,188 --> 00:37:36,116 cost, right? And and it's not like if you do well, you're here's your reward. 509 00:37:36,116 --> 00:37:41,952 It's like if you do well, we you won't get penalized. that's generally how these all 510 00:37:41,952 --> 00:37:47,789 all all work. so it it it does become difficult as these the juice continues to 511 00:37:47,789 --> 00:37:53,626 get squeezed out of this orange that is value-based care. so you know, there's 512 00:37:53,626 --> 00:37:59,463 just there's only so many inefficiencies of care and a lot of the administrative 513 00:37:59,463 --> 00:38:05,300 burden is placed on the health system that actually is belongs elsewhere. 514 00:38:05,300 --> 00:38:10,118 So, in the in the value chain of healthcare. So it's it's it's difficult. 515 00:38:10,118 --> 00:38:14,936 But we we've learned to stop complaining long ago and just try to do the best we 516 00:38:14,936 --> 00:38:19,754 can. honestly. You know, we try to focus on what we what we can control and what we 517 00:38:19,754 --> 00:38:24,572 can do. I'm lucky that we've had robust population health and ACOs. We've been at 518 00:38:24,572 --> 00:38:29,390 risk for quite a long time, long before I got to the health system. We were we 519 00:38:29,390 --> 00:38:34,209 voluntarily participated in in the bundle payment programs. 520 00:38:34,209 --> 00:38:38,334 In the past and and succeeded. So we have that muscle memory and we have a lot of 521 00:38:38,334 --> 00:38:42,460 those things in place already. So we're not quite in panic mode like other other 522 00:38:42,460 --> 00:38:46,585 health systems, but it still costs us. It it's still gonna cost to manage these 523 00:38:46,585 --> 00:38:50,711 programs

have a cost of the health system. 524 00:38:50,711 --> 00:38:55,649 We end up talking as Rainfall Health to quite a few leaders on the CMMI side and 525 00:38:55,649 --> 00:39:00,588 how they think about these these innovative bundles that they're coming out 526 00:39:00,588 --> 00:39:05,527 with. And one of the things that they put up the table is they learned a lot in the 527 00:39:05,527 --> 00:39:10,466 last sort of generation of these bundle payments, right? BIPC came out, CJR, and 528 00:39:10,466 --> 00:39:15,405 now we have the new generation team transforming episode accountability model 529 00:39:15,405 --> 00:39:20,344 and CJRX, which is comprehensive joint replacement expanded. 530 00:39:20,344 --> 00:39:25,335 And you know, the way we've heard them describe it is it's less about just 531 00:39:25,335 --> 00:39:30,326 cutting down on those cost savings productivity improvements and trying to 532 00:39:30,326 --> 00:39:35,317 create new opportunities for revenue for systems, not just for what they're doing 533 00:39:35,317 --> 00:39:40,308 internally, but also as the episode goes outside of the four walls, being again 534 00:39:40,308 --> 00:39:45,299 that quarterback and then having sort of a 535 00:39:45,299 --> 00:39:50,290 a a new bonus essentially that CMS out of. 536 00:39:50,290 --> 00:39:54,781 A payment so it feels actually like revenue that you can invest and you can't 537 00:39:54,781 --> 00:39:59,272 build build in better infrastructure. Does that shift at all how you view these 538 00:39:59,272 --> 00:40:03,763 models from, you know, sort of where they've been, which has been much more 539 00:40:03,763 --> 00:40:08,254 about a race to the bottom. The problem with the race to the bottom is there's 540 00:40:08,254 --> 00:40:12,746 always a bottom, right? Yeah. 541 00:40:12,746 --> 00:40:13,566 That was the bottom up. 542 00:40:13,566 --> 00:40:17,408 Yeah, I mean it it's it's hard to answer that because there's so many variables 543 00:40:17,408 --> 00:40:21,250 that that all go into this and that's so much changes over time. But I guess if I 544 00:40:21,250 --> 00:40:25,092 look at your traditional hip and knee, when I was practicing in, you know, two 545 00:40:25,092 --> 00:40:28,934 thousand fourteen, twenty fifteen, people would stay in the hospital three, four 546 00:40:28,934 --> 00:40:32,776 days after a a hip or knee. And, you know, my my dad had his you know, recently and 547 00:40:32,776 --> 00:40:36,618 he was out within, you know 548 00:40:36,778 --> 00:40:42,282 18 hours and he's older and some come out immediately, right? Most I would say. Most 549 00:40:42,282 --> 00:40:47,786 of the hip don't even get admitted. So there certainly is, you know, con 550 00:40:47,786 --> 00:40:53,291 continuous evolution. you know, and all this drives drives cost down over time. 551 00:40:53,291 --> 00:40:58,795 But I think as I look to the future, my biggest concerns go back on, you know, the 552

00:40:58,795 --> 00:41:04,300 supply-demand and labor, right? So you know, we we 553 00:41:04,300 --> 00:41:08,309 If I have an opportunity, I can't you know, capitalize on it because I don't 554 00:41:08,309 --> 00:41:12,319 have the providers to grow with with that opportunity, right? Or even the status quo 555 00:41:12,319 --> 00:41:16,329 stuff that I have to have, any person we're hiring in, you know, you're having 556 00:41:16,329 --> 00:41:20,338 to say, Yeah, I'll go up on the sign and bonus when you don't want to work Thursday 557 00:41:20,338 --> 00:41:24,348 nights and Tuesdays you need off for three hours and Yeah, that's all fine, right? 558 00:41:24,348 --> 00:41:28,358 You know, like it's just like you're desperate to get anybody who's willing to 559 00:41:28,358 --> 00:41:32,368 care for people and 560 00:41:32,368 --> 00:41:36,927 And it's really creating a lot of just perversity and in in how how things are 561 00:41:36,927 --> 00:41:41,486 done. You're just beg, borrowing, and stealing to to get actual people to do the 562 00:41:41,486 --> 00:41:46,046 work and care for our communities. and so and it and on the provider side I see more 563 00:41:46,046 --> 00:41:50,605 of a transactional mindset, which is actually not great for healthcare. You 564 00:41:50,605 --> 00:41:55,164 want it it it should be purpose driven. And I I know most people get into it for 565 00:41:55,164 --> 00:41:59,724 purpose, but they start 566 00:41:59,724 --> 00:42:03,842 Moving to transactional. When transactional happens, quality of care, 567 00:42:03,842 --> 00:42:07,961 the viewing the the patients as people, all that starts to fall back a little bit. 568 00:42:07,961 --> 00:42:12,080 And I and th those are the things that culturally I'm always sort of driving is 569 00:42:12,080 --> 00:42:16,198 let's all focus on why we do why we're doing this, right? And Yeah, you want to 570 00:42:16,198 --> 00:42:20,317 have more money and Yeah you want to have less time and this and that and the other 571 00:42:20,317 --> 00:42:24,436 thing. But let's focus on our community and our patients. You know, bring that 572 00:42:24,436 --> 00:42:28,555 into to to center. But 573 00:42:28,555 --> 00:42:33,066 It's it again, it's a it's a difficult question to answer because so many 574 00:42:33,066 --> 00:42:37,578 variables, so much so many things change. is it an opportunity? I'm not so sure I'm 575 00:42:37,578 --> 00:42:42,089 viewing it as an opportunity, but but it it is something we're we're participating 576 00:42:42,089 --> 00:42:46,601 in mandatorily now. but we did volunteer previously, and I think there has been 577 00:42:46,601 --> 00:42:51,112 value in these programs over time, but I do worry that it's not a quite race to the 578 00:42:51,112 --> 00:42:55,624 bottom, but we're getting towards the bottom. 579 00:42:55,624 --> 00:42:59,947 And there have to be other solutions going forward to really bend the cost curve 580 00:42:59,947 --> 00:43:04,270 down. And that's gonna be technology cures healthier populations for other reasons 581 00:43:04,270 --> 00:43:08,594 than just saying it's because the health system didn't do a good job. 582 00:43:08,594 --> 00:43:11,607 Absolutely. Well, this has been such a great 583 00:43:11,607 --> 00:43:11,907 Really I will turn. 584 00:43:11,907 --> 00:43:14,449 Conversation. I have one last thing for you because we got to the 585 00:43:14,449 --> 00:43:14,749 Yeah. 586 00:43:14,749 --> 00:43:20,440 Optimism question early, which is, it came up this this theme of making strategic 587 00:43:20,440 --> 00:43:26,131 calls, getting ahead of it, and being there for the right reasons. Again, this 588 00:43:26,131 --> 00:43:31,822 was part of this conference that you and I were both at, which is it requires bold 589 00:43:31,822 --> 00:43:37,514 thinking, bold moves, and in a time where so much is uncertain. 590 00:43:37,514 --> 00:43:40,847 It can feel very paralyzing. What is your 591 00:43:40,847 --> 00:43:41,147 Yeah. 592 00:43:41,147 --> 00:43:45,490 Mindset when you try to make decisions that don't have a clear right or wrong 593 00:43:45,490 --> 00:43:49,834 answer, but you need to make the right call that you think will best benefit your 594 00:43:49,834 --> 00:43:54,178 patients, your system, your community? How do you reconcile with imperfect 595 00:43:54,178 --> 00:43:58,522 information 596 00:43:58,522 --> 00:43:58,822 Yeah. 597 00:43:58,822 --> 00:44:06,592 And sometimes just making a call that may not prove dividends for a long time? 598 00:44:06,592 --> 00:44:10,350 Yeah. Well I think that's the the you know, get back to why you know what was 599 00:44:10,350 --> 00:44:14,109 the difference between COO and CEO is that I need a lot more heads up time as the 600 00:44:14,109 --> 00:44:17,867 CEO. I have to have that time to kind of not look at three steps ahead of me, but 601 00:44:17,867 --> 00:44:21,626 like where could we be in a year, two years, four years, five years down the 602 00:44:21,626 --> 00:44:25,384 road. And nobody has a crystal ball. And I think we're all gonna be wrong. I think 603 00:44:25,384 --> 00:44:29,143 things are changing so quickly that we're all gonna be wrong of where we're gonna be 604 00:44:29,143 --> 00:44:32,901 in five years. But I think if you're at least thinking about it and mitigating 605 00:44:32,901 --> 00:44:36,660 risk and 606 00:44:36,660 --> 00:44:41,528 Leaving your organization more flexible and ability to pivot with the time. So 607 00:44:41,528 --> 00:44:46,396 when I look at solutions now it's it they're more like flexible solutions, 608 00:44:46,396 --> 00:44:51,264 things that we can turn off, turn on, pivot without major, major investments. I 609 00:44:51,264 --> 00:44:56,132 think that's how I I look at it. And again, I always put the community front 610 00:44:56,132 --> 00:45:01,000 and center. Every decision we make is what is best for the health of this community, 611 00:45:01,000 --> 00:45:05,868 how can we serve this community? 612 00:45:05,868 --> 00:45:11,844 The best and you know that it has to you know pass that test first before we're 613 00:45:11,844 --> 00:45:17,820 gonna move forward with something maybe you can 614 00:45:17,820 --> 00:45:18,120 Amazing. Thank you, Chris, for joining me on the 615 00:45:18,120 --> 00:45:21,164 Podcast. It was great to get your insights. Thanks so much. 616 00:45:21,164 --> 00:45:23,297 Yeah, no, this was Great. Good seeing you again. 617 00:45:24,214 --> 00:45:24,813 Likewise.