July 1, 2025 • 41 mins
Rob Gerberry, Senior Vice President and Chief Legal Officer, Summa Health, speaks with Angela Brandt, Chief Administrative Officer, ProMedica Health System, and Daryl Tol, Transformation Leader, General Catalyst, about how health care organizations can navigate the continuing transformation of U.S. health care. They discuss some of the headwinds facing the health care industry and issues related to provider partnerships, artificial intelligence, payer mix, consolidation and integration, and the role lawyers can play in health care transformation.
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Episode Transcript
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SPEAKER_00 (00:00):
This episode of AHLA's Speaking of Health Law is
brought to you by AHLA membersand donors like you.
For more information, visitAmericanHealthLaw.org.
SPEAKER_02 (00:17):
Hello, everyone.
Welcome to our latest in ourC-Suite podcast series.
I'm Rob Gerber.
I'm the Chief Legal Officer ofSumma Health and the
President-Elect Designate ofHLA.
I'm excited to welcome twoesteemed guests today to our
podcast, Angela Brandt and DarylTill.
I'm going to start with themproviding introductions.
So Angela.
SPEAKER_01 (00:36):
Hi, well, welcome, or welcome to everyone who's
joining anyway.
I'm Angela Brandt.
I'm the Chief AdministrativeOfficer for ProMedica Health
System.
ProMedica is headquartered inToledo, Ohio, and we're an
integrated healthcare deliverysystem that has 10 hospitals, a
large employed network ofproviders.
And as the Chief AdministrativeOfficer, I oversee all of our
(00:58):
corporate shared services andhelp to lead our strategic
transformation and strategicplanning.
So So looking forward to thediscussion today.
SPEAKER_03 (01:09):
Excellent.
UNKNOWN (01:10):
Daryl.
SPEAKER_03 (01:10):
Hey, hi, everybody.
Daryl Toll.
I'm a recovering health systemCEO.
I've spent years at AdventHealthin Florida, and now I'm leading
our transformation efforts atGeneral Catalyst and with our
new company called HATCO, or theHealth Assurance Transformation
Company.
So we're focusing onaccelerating transformation with
(01:33):
health systems, thinking aboutways to actually drive change in
healthcare that works forsystems in the can be led by a
regional healthcare system.
So excited to join you alltoday.
SPEAKER_02 (01:46):
So in our prior episodes, we've had C-suite
executives across severaldifferent disciplines share a
lot of their challenges, theirproblems.
These two guests were pickedtoday because they're going to
solve all those.
No pressure at all, but they areboth exceptional thought leaders
in the healthcare space.
So looking forward to sharingwith our membership their
thoughts.
And so we're going to start withthe open-ended question of
(02:07):
there's lots of headwinds rightnow in the healthcare industry.
that are further in the need fortransformation and change.
Angela and Daryl, just yourinitial thoughts on not only
some of those macro trends, butwhat are some of the ways that
our membership should start tothink about the need to pivot
from our current model andreally build out a new system
that could best serve ourpatients going
SPEAKER_01 (02:28):
forward?
You wanna go first or I?
That's a loaded
SPEAKER_03 (02:35):
question.
Yeah, you know, it'sinteresting.
I like to think about this ideaanytime I hear someone say
healthcare is broken.
I remember a discussion wheresomeone said, it's not broken,
it was designed this way.
And so in order to improve it,to fix it, to build resilience,
to address the needs of theworkforce, which is burning out
(02:57):
and in short supply, it needs tobe redesigned.
So to me, the invitation oftimes of pressure, times of
challenge.
to dismantle a system that wasbuilt away that led to poorly
aligned incentives, exhaustingworkflows, insecure
environments, overly complexconsumer experiences, and start
(03:23):
to redesign them from the groundup.
The good news is,psychologically, in order to
change a Disappointment isrequired.
Challenge is required.
Burning platforms are required.
So when everyone's fat andhappy, it's very difficult to
create the energy that'srequired to change a poorly
(03:45):
designed system.
And so my view is it's a time ofgreat challenge and also great
opportunity.
SPEAKER_01 (03:53):
I love that you just slipped it on its head because
that's exactly the only placeyou're going to be able to fix
it.
I would...
echo your conversations onheadwinds.
I think workforce challenges aredifficult.
People are burnt out.
I know COVID was five years agofor the rest of the world and
healthcare still feels likeyesterday in many ways, but
workforce shortages, changes inworkforce, all of the workforce
(04:15):
issues are a big deal.
I know we continue to talk aboutcare shifting to ambulatory, but
I think there's also, that'sdisrupting too.
It's not just ambulatory andhealthcare.
We have a lot of healthcareproviders out there that are not
hospitals or healthcare systems.
So thinking about the disruptionthere makes us think about how
(04:35):
we deliver care more efficientlyand more broadly to people.
And it also makes us morevaluable in that inpatient
experience, right?
But we have to deliver a bettercustomer experience.
I love what you said.
I mean, we have to do betterthan that for our consumers and
for our We call them patients,right?
(04:56):
But our patients are really justour friends, our families, our
neighbors, our employees, andmost of our systems.
And so why wouldn't you want todeliver better care to those
people you care about?
I think the other thing I wouldadd is aside of those rising
consumer Expectations, we stillhave all the financial pressures
that you were talking about,kind of the what's broken part,
(05:18):
right?
So the financial pressures frompayer consolidation, inflation,
supply chain disruptions.
So that also allows for us tothink about those headwinds and
ways of how do we innovate?
How do we transform?
SPEAKER_02 (05:32):
So, Ange, to your point, we're coming off four
days of board meetings last weekwith our board, and they are
saying it is five years later.
So why are we still facing thosesame wage inflation issues,
issues with payers arounddenials, this increase in farm
and supply costs?
Is anybody hearing us out therethat we've got these challenges?
So if we were to tell thegovernment, who is right now
having a lot of deliberationsaround health care, let's start
(05:54):
blank.
Let's have a blank sheet ofpaper and rebuild this.
Any thoughts on what you mightshare?
SPEAKER_01 (06:02):
I mean, I can think of a couple of different things
right off the top of my head.
I mean, I do think this is notso much for the government
question you just asked about.
So I will get back to that in amoment.
But I do think, how do wecontinue to prioritize our
employee experience?
Daryl was talking about that.
How do we lean into technologyto make things more efficient
for our staff?
The reason our staff is so burntout, too, is that there are a
(06:24):
lot of demands.
We have technology in a lot ofplaces, but we're still asking
them to work really harder, notalways smarter.
So I think we can leveragetechnology in making things more
efficient, leveraging predictiveanalytics, leveraging AI,
leveraging automation.
And that's true, too, even forthe non-clinical setting.
So healthcare needs to becomemore efficient in our
(06:46):
administrative spaces as well.
So I think that technology couldbe utilized there.
If I were talking to thehealthcare lawyers and everybody
in DC or our advocacy side, Ithink using value-based care
incentives or aligningincentives with our patients,
thinking about care more as aninterdisciplinary team that
(07:08):
could be tech-enabled, how do weget people to buy into that kind
of care just as much as we needto adopt it?
We need our our patients to beexcited about engaging with us
in that way.
So can we set up this incentivesin a different way?
I don't know, Darrell, what doyou think?
SPEAKER_03 (07:25):
Yeah, I think those are all really good points.
I also think we have aninteresting challenge and
opportunity that the currentadministration is unique.
It's unique in a number of ways.
certain leaders in corehealthcare related areas think
differently and respond toevidence differently than in
prior administrations.
(07:46):
So that gives us an interestingchallenge to overcome to ensure
that evidence continues to driveclinical practice and policy at
the federal level But also theadministration is very open and
quick moving in spaces where youcan capture their interests.
Sometimes that's aroundsomething that's unique that
(08:07):
could become a branded changemade in this administration that
could improve certain areas ofstrong support like rural
markets that they're verysensitive to.
So I think we can look at areaswhere this administration can
move a lot more quickly with alot less inertia that can, at
(08:28):
the stroke of a pen almost,change the way healthcare
functions, whereas prioradministrations might move much
more steadily, much more slowly.
So if we can find some of thoseareas, I think we can create a
flywheel effect if we do itthoughtfully as an industry.
The other thing I would say iswe hurt ourselves often.
We hurt ourselves by fragmentedadvocacy.
(08:49):
Every special interest group inhealthcare comes with a
different message.
I would say hospitals and healthsystems largely come with the
message, pay me more and ordon't cut my payments, which
isn't a very creative message.
A creative message is the systemtoday is broken and looks like
this.
We envision a system that'sbetter that looks like this.
(09:11):
That will require the followingthree to five changes in policy
in order to facilitate themovement from this system to
this new system.
I don't see our advocacy effortsbeing that organized.
I see us being reactive andreimbursement focused.
Now to Angela's point, we doneed to be reimbursed
(09:32):
differently.
We need to be reimbursed forinnovative things that involve
special kinds of virtual care,advanced care at home that
doesn't have to pass anadmission threshold, but might
be a very significant post-acuteopportunity that deals with the
post-acute shortages we seearound the country.
Entirely new ways of structuringour systems of care that include
(09:56):
virtual in-person, AI, humanbeings, and payment mechanisms
that don't require the 14encounters before you can and
say you're doing X, Y, Z.
Those are old constructs.
And so I do think we need to putour heads together and think
about what is the new constructwe want to develop that's in the
(10:17):
interest of consumers andpatients in our workforce.
SPEAKER_02 (10:21):
Yeah, I think that's a great point.
When I hear people talk in theadvocacy world, it's all, we'll
make sure that we all portraythat we're strong.
We're these large employers inour communities, the pillars of
the community.
But at the same time, we've gotto share If we don't get what we
need, there's going to belayoffs.
There's going to be cuts toservices.
It's a real difficult balance,it seems like, right now for a
lot of organizations as theyface a lot of the financial
(10:42):
headwinds.
One of the challenges we alsoface is making sure that we as
administrators bring ourproviders into partnership with
us as we look to make some ofthese transformative changes.
What strategies or techniqueshave you both utilized to make
sure your physicians, yournurses, your physician
assistants all feel a part ofthis change with you?
SPEAKER_03 (11:02):
I think part of the COVID dynamic that really opened
my eyes is at some point Irealized that in healthcare, the
building is on fire.
And it certainly felt like itwas on fire during COVID.
And we were going to our teamsand saying, yes, it's on fire,
(11:23):
but Come on in anyway.
Come in and work here.
And then we really scratched ourheads as an industry.
Why are people always wantingmore money?
And, well, wait a minute.
If you're asking someone to gointo a building that's on fire
and the fire hasn't been putout, the underlying conditions
of the fire have not beenaddressed, the fuel's not been
(11:45):
addressed, then people are goingto say, how much are you going
to pay me to go in there?
It's a very natural set ofreactions.
And I think we have to changethat entire storyline to be
fair.
I think we need to understandwhy is it so difficult?
Going into COVID, in 2019,Deloitte did a study of hundreds
(12:05):
of nurses, critical care nurses.
Over 50% of them rated theirmental health of five or lower
on a scale of one to 10.
And over 60%, rated theirphysical health a five or lower
on a scale of one to 10.
So those are the people webrought into COVID.
And then you can imagine theenergy burn and the fear burn
(12:27):
and the moral injury that hashappened through COVID.
So how do we reset?
I think an important way toreset is one, create highly
collaborative groupings ofspecially trained individuals
that can help us build thesystem of the future.
(12:47):
In a prior organization, wecreated a group of physicians.
Someone told me once the squareroot of N is how you create
change in an organization.
You have to engage and getenthusiasm and energy from the
square root of the populationyou're trying to change.
So if you have thousands ofdoctors, you need hundreds of
(13:08):
doctors to join you.
and they need to be part ofplanning and they need to feel
energetic and they need to feelinspired.
So we created a group called TheCatalysts, 200 doctors, and they
joined in strategic planning andthey came to all leadership
meetings and they were notelected.
They were appointed and selectedbecause they were passionate
(13:28):
physicians who wanted to driveto the future and had a vision
for the future in theirspecialty and for the
organization.
I've never seen change happen sosubstantially than I saw from
that group.
Each physician in that 200 wasgiven an assignment of seven to
10 other doctors that their goalwas to share this with those
(13:52):
physicians and to energize andcreate excitement or at least
talk through with them theirdisenchantment.
And slowly, steadily, theripples grew from that.
We need to do that with doctors.
We need to do that with nurses.
But even so, So even moresubstantively, the way work is
designed in healthcare is veryharmful.
(14:14):
It's very harmful.
The incentives are misaligned.
The structures are poorly set.
We're largely analogorganizations that have glued
technology on withoutredesigning people and processes
to accept that technology.
We've glued our electronichealth records on.
We've glued other technologies.
(14:35):
In most systems, it's hundredsof technologies onto a largely
analog system.
That means we have people wholiterally still today pull
papers off of fax machines andtype in what the paper says into
the computer.
We have those systems all overhealthcare, and it's a very
frustrating career if you thinkabout it.
(14:56):
Moving a paper from a faxmachine and typing it into the
computer is not what you dreamtabout when you were a child.
You want to do something big andpurpose-driven and heroic, and
we're giving people these brokendown jobs to do that over time
really need to be redeveloped.
That's harder than creating agroup of catalysts, but that's
(15:16):
an outcome I think we should allseek.
SPEAKER_01 (15:20):
Yeah, we did something similar at ProMedica.
I totally agree, co-designing itand co-designing it with your
clinicians or your frontlinefolks.
And it's not just frontline.
You've got to be careful abouthow we define frontline.
It's also your security team andyour facilities team and those
other stakeholders.
But you have to co-design it forit to get sticky.
(15:42):
I do think having an engagedworkforce of physician leaders,
future physician leaders, issuper important.
Our group, they named themselvesa transformer.
So you guys had the catalyst andwe had the transformer.
Let's
SPEAKER_03 (15:56):
pull them together.
I love that.
SPEAKER_01 (15:57):
Honestly, that's some power.
And we were also verydeliberate.
We intentionally picked ouryounger providers who we just
recruited.
And I think normally...
folks would go to those seasonedpartners or their seasoned docs
who'd been here for a long time.
And those stakeholders were alsoincluded.
It was still very important.
But we wanted the youngdisruptors who had seen and seen
things differently in otherorganizations who would
(16:20):
challenge us and where it feltpsychologically safe that they
could challenge us.
Otherwise, you don't get thebuy-in because we have to be
just as ready to learn and growas much as we're asking them for
their input in designing.
So if you bring them all in totell them what you're gonna do,
I will guarantee you that wouldbe your first step of failure.
And you're not right anyway.
(16:41):
There's 20 ways to do one thing.
And so to allow yourself to notbe right, to really facilitate
really good conversations andlet the innovation kind of
organically happen, I think thatrequires some thoughtful design
as we're talking about anengagement But it also means
that we need to think aboutleadership development
differently, and we need tothink about succession planning
(17:04):
differently.
And really, what is your whybehind the transformation?
Where are you leading to?
What are you trying?
If you're trying to recreateyour system, everyone wants to
do something that's meaningful,that's valued, and where people
feel useful and needed.
If that's the goal of yourorganization, and I'm sure there
are many different goals in yourorganization, then I guarantee
(17:27):
you that there are people readyto run into that fire.
I mean, I think, you know,different than COVID where I did
feel responsibility and peoplewere running into that fire,
like as an administrator feltreally a high degree of
responsibility for asking peopleto do the hard work that they
did.
I don't feel any differentlyabout asking people to do hard
work today.
It's just not a pandemic, right?
(17:48):
So, um, We have workplaceviolence issues.
We have burnout issues.
We have all kinds of issues.
So that same fire looks a littledifferent today, but the
challenges are still real andpeople want to do meaningful
work.
And I think in healthcareespecially, we allow a platform
for them to do meaningful work.
(18:08):
You really can't ignite thatpassion and keep it.
SPEAKER_02 (18:14):
So often folks refer to AI and tech as the solution
to all this.
As you look out into the future,how quickly do you see the
adoption rate being for AI andtech?
And is it the answer to allthis?
SPEAKER_01 (18:27):
Well, that's like saying EMR is the answer for
every single charting issue, andwe know that's not true.
First of all, you can't ignoreAI.
I think about AI as far asautomation, making work more
efficient, making it smarter,being able to apply it on a
broader network.
I'm learning from some of thepeople who directly report to me
and how efficient I can becomebecause they're using AI more
(18:50):
efficiently than I am at themoment.
At ProMedica, we're using AIprobably more cohesively and
consistently in the clinicalsetting.
But where I can see it havingbroader implications in the
shared services world isautomation with revenue cycle.
So again, think about thatconsumer mindset, right?
I want my bill correct, I wantto reduce overhead, and I want
(19:11):
to keep things efficient forthat consumer as well as for
your internal own expensestructure.
It's a great place to automatewithout really a whole lot of
risk.
In our legal team, they'relooking at ways to look through
forms and with defined criteria,be able to turn contracts over
more quickly.
To not reduce workforce, but toallow the work that our lawyers
(19:35):
are doing to be a higher levelof work using their critical
thinking instead of just pushingpapers.
You know, going back to Terrellwhen he said taking that darn...
piece of paper off the faxmachine.
Our poor lawyers, they talkabout living in seas of paper,
my word.
So I think AI is absolutely hereto stay.
It's gonna be faster than we'reall ready for, and I think we
(19:56):
have to lean into it.
And it's gonna be at thecultural pace that you're
comfortable with for yourorganization.
I think some people are gonna befast leaders, Others are going
to be fast followers, and thenthere's going to be the ones
that just kind of wait to seewhat works.
I don't think you can wait tosee what works in this space.
I think that you're going to beway too slow and miss all of the
amazing opportunities to learnand how to apply it in your own
(20:19):
organization.
It can't just work by itself,though.
You still need people.
You still need all of us to makesure we're maximizing it
ethically.
you know, convening it,structure, governance of all of
that, and how you're going touse it in your organization,
there's still a hugeresponsibility.
It's not just a cost savings,but it is going to make us
better faster.
I don't know what you think,Daryl.
SPEAKER_03 (20:40):
Oh, yeah, absolutely.
I think when I hear, well, AIimpact healthcare or the world,
I think, well, did the computerimpact the world?
Did the internet impact theworld?
AI is not a narrow capability.
It's like the internet.
It starts touching everythingvery quickly.
There will not be such a thingas an AI company in the future.
(21:03):
There will be AI in everything.
And so how do we harness that?
A couple of points I would add,and I agree with your comments.
One, for the first time, we havetechnology that can actually
change healthcare.
The old algorithmic kind of codeit, and then the machine runs
(21:24):
across the code andalgorithmically tries to get a
job done that's too complex, hasnot worked well in healthcare.
And that's why healthcare haslagged in technology adoption so
much, because some of our,especially clinical decision
making, is not at all amenableto a coded solution.
Now you have artificialintelligence, which is real
(21:45):
intelligence.
It is able to process and thinkin a way with a very high IQ and
absorbing a massive amount of,can pass all the boards, nursing
boards, pharmacy boards,physician boards.
It can pass at a higher ratethan your medical staff or your
nursing staff.
So then how do you do that?
How do you use it?
How do you start with low riskuse cases as you've described,
(22:07):
Angela?
And then how do you grow towardhigher risk use cases?
And how do you make sure youdon't jump too fast because that
could be dangerous?
Humans in the middle, as yousaid, I think very essential,
but also the ability to augmenthumans in a way in a workforce
shortage environment isessential.
This is part of the answer tohow a physician in the future
(22:28):
can do one and a half times thework at a felt effort of 0.9.
That's transformational.
That starts to mean the shortageisn't what we thought it was
because now we're usingtechnology in more intelligent
ways.
The last point I'll make is thebad guys are going to use it
fast.
We don't have the luxury ofsaying, well, when it's safe,
(22:49):
we'll use it.
Well, guess what?
Our attorney friends here, thetrial bar is using it.
They're gonna get ahold of thechart and they're gonna jam
through that chart and they'regonna point out every single
point where that physician ofwhatever specialty didn't follow
evidence.
And your resistance to AI willmean your organization is unable
to counter.
(23:11):
These are very serious dynamics.
We have to figure out how tomove forward at a reasonable
pace because the adopters outthere, yes, the cyber thieves
and hackers are gonna use it,but legitimate entities like
payers are gonna use it inharmful ways to health systems.
(23:32):
Attorneys that are on the otherside of cases will use it, et
cetera.
So I think we absolutely shouldkeep up with them in health
systems.
We're doing good work.
We deserve to keep up with them.
SPEAKER_01 (23:44):
You know, something you just said before we move on,
sorry, Rob, just made me think,you know, my kids just got, I
got notification from my kids.
Well, actually they got itbecause I'm paying for their
college, but it came to me,right?
But all of their college coursesare requiring them to use AI now
at many of the universities.
And so if you even think aboutthe future workforce of a
physician or a nurse, you know,they're going to be using it and
(24:06):
training with it.
So as an organization, youreally are going to not be able
to even attract top talent ifyou don't have an AI strategy at
some point in time.
SPEAKER_03 (24:14):
So just- Great point.
Same thing happened with the-With the EHR, right?
Remember when the old schoolgrads resisted any kind of
electronic health record and nownew grads would never work in a
place that didn't have aneffective medical record.
SPEAKER_01 (24:27):
You don't have robots to be operating on.
You're not getting thosesurgeons, right?
I mean, that's what AI is rightnow.
That's what we're going to bedealing with from a workforce
employee preference.
It's just amazing.
SPEAKER_02 (24:38):
So we break down some of the barriers that we've
got historically.
We get our physicians and ourproviders to come along with us.
We use technology well.
Do all these things get you tobe that successful health system
of the future without a strongpayer mix?
When we look across the countrynow and the haves and have nots,
if you are still struggling withyour payer mix, how do you
overcome all the otherchallenges?
SPEAKER_03 (25:02):
You know, Rob, I think the concept of a strong
payer mix is decliningeverywhere.
So take a high growth system,Fairly healthy pair mix market,
say, in Texas or Florida, andyou see the commercial insurance
(25:22):
rates dropping in those markets.
Those systems may not notice ityet because they still have
plenty, but those commerciallyinsured rates are dropping.
What are they being replaced by?
Self-pay, Medicaid, Medicare,Medicare Advantage.
As we see that nationally, andthen some markets in the U.S.
are already there.
(25:42):
And it's very, very challenging.
But we've talked for years,maybe decades, about Medicare
breakeven.
Can systems operate at a levelof cost that accommodates a
lower level of reimbursement?
There are two paths, I think,that help with that.
One is using leverage, usingtechnology leverage to reduce
(26:06):
the total cost of our operation,of our production systems.
We've not done that well inhealthcare.
Part of it is we've had enoughbuffers, enough, the
not-for-profit advantage, right?
The ability to not pay taxes andto have a 340B drug program that
brings an extra margin that letsus get by.
And so we don't, actuallyenforce a technology leverage
(26:30):
strategy that starts to bringour cost structures down, like
other industries really had todo because of the narrowness of
their margins.
So I think we really need tothink as an industry about that.
And this AI question from beforeis certainly part of that
answer.
(26:50):
And Value-based care is actuallya strategy that when your
per-click payment rates continueto decline, you start to realize
that if we received paymentdifferently and we could manage
the total cost of care of ahuman being, if we could manage
across a lifetime, if we couldreally feel a sense of ownership
(27:13):
of that human being's thrivingand their experience of health,
not just healthcare, if we canget there as an industry, I
think we can change the paradigmand we all have some strategies
to do that.
I think it's happened much moreslowly than we would have
expected.
but it will be required.
It will be required that we takea more longitudinal view of a
(27:36):
human being, that we have accessto the dollars upfront instead
of so many of them beingessentially filtered away
through middle layers andthrough administrative
structures and massive overheadthat's grown 3,500% plus while
the number of providers havegrown 150% since the 70s.
This is so out of line that inorder to come back to a point of
(27:59):
resilience and stability, Ithink we'll really, really have
to pay attention to this in ourredesign efforts.
SPEAKER_01 (28:06):
It's a wicked problem.
Even as I'm hearing you talkabout it, you know, I think
about the consumer demands forcertain clinical tests that
provider might not even feel asmedically necessary.
And, you know, then there's alitiginous piece of that and
making sure the I is dotted andT is crossed.
It is a wicked trap right nowfor patients.
healthcare providers.
(28:28):
And I do think like a differentpayment methodology and having
that payment up front, I stillthink there has to be something
in it for the patient or theconsumer.
And so whether that's addressedas the employee benefit, or
whether that's addressed on theindividual basis, I don't know
that I have that solution,despite the way you gave us the
add on at the beginning therethat we didn't have all the
(28:48):
solutions.
But I do think that it is awicked problem.
And it's multifactorial.
It's not just a reimbursementproblem.
It is a care design issue aswell.
And we're going to have tofigure out a way.
There are systems figuring out away now.
I don't even know what a goodpayer mix is.
I think we've gone on the whole,we can, well, and all volume is
good volume.
And then it was, I just need theright payer mix.
(29:10):
And now it's like, I just needthe right CMI or whatever.
But ultimately, I think ifyou're documenting the care, you
have the good value incentivesincentivized, or excuse me,
value incentives aligned, thenyou can do a good job, but
you're going to have to embracetechnology, automation, changing
the workforce.
It's all of those factors.
There's not a silver bullethere.
SPEAKER_02 (29:34):
So off that theme, as we look again at that alleged
health, successful health systemof the future, is it going to be
a scale play, which we knowthat's a common strategy where
we're just going to see entitiesget large?
I can remember a conference thatAngela and I were at where Atul
Gawande said in 2010 that everytime you used to have a hardware
store, Every time you used tohave a hospital and that's not
going to be the future, it'sgoing to be big box, Home Depot
(29:56):
and Lowe's.
Is that where health systems aregoing?
Or is it going to be somethingmore vertically integrated where
we're going to see pay riders orother industry segments come
together in a successfulcollaboration?
Are we going to see healthsystems partnered with other
post-acutes or other segments ofthe industry?
What do you both think justabout how you would put those
building blocks together?
SPEAKER_01 (30:17):
Scale always has advantages on some level, right?
So I think there's still goingto be big systems, but I
personally wouldn't be surprisedif you have more regional
systems staying strong andindependent as well as those big
kind of systems.
I don't know that one model isgoing to work.
I think that based on the state,based on the reimbursement,
(30:40):
based on the philosophies, thescale will get you so far.
But at the end of the day, youhave to be nimble enough to be
able to adjust and change andpivot, pilot things, fail fast.
And so sometimes, you know,being large can be a
disadvantage in that regard.
And so I don't know what youthink, Daryl, but I think that
there's advantages in beingprobably strong and regional or
(31:03):
collaborating.
Yeah.
SPEAKER_03 (31:04):
I think scale has been disappointing in
healthcare, largely as systemshave gotten large.
Even the largest systems likeHCA has 5% national market
share.
So there's no such thing as anational American healthcare
system in the way that othercategories of industry might
think of scale.
(31:25):
I do think there's a problem ofsubscale.
capabilities and I think thatthere's this interesting
opportunity ahead where regionalnetworks can be created without
aggregation without acquisitionif your goal isn't to just go
leverage the payer for maximumpayment then you can get more
(31:49):
creative you don't have to ownthe world you don't have to roll
up all the health systems and goto Anthem and say we want the
most we can get out of you butWhat if ProMedica and Summa
Health and Altman created adistribution and supply chain
system together?
What if five systems in threestates that were contiguous
(32:11):
could get together and create asingle workforce company that
would become an outsourced HRdepartment for all of those
systems instead of every systemhaving to replicate that?
I think we have to think And wecan seek scale.
It's legal to do these things.
They have to be appropriatelystructured.
But we have to think about howwe do things differently when
(32:34):
we're underscaled.
And we can achieve, I think, alot of the economies of scale
that a system like HCA mighthave without necessarily...
being sold to a larger system orwithout having to seek the
acquisition of 20 systems inorder to make something
meaningful happen.
(32:56):
Somehow, the way Americanhealthcare works is highly
regional.
It's highly designed for thecities and towns and
stakeholders that exist withinthese circles of care, and it's
very difficult to transmitcapability.
I came from a large system thatoperated in 10 states, and it
(33:20):
was very difficult for us toachieve economies or advantages
of scale across 10 states.
states where we could.
is in the single state where wehad 23 hospitals.
Well, then we could createwarehouses, and we could run a
large HR team, and we could do alot of things that shared
services, but that didn't helpus in Chicago or Colorado.
(33:42):
So I think as we think about thefuture of healthcare, we should
think about how that contiguoussupport system gets created that
reduces the total cost andallows us to hold the steering
wheel instead of outsourcingthose things, which I think is a
hasn't been working well forsystems that have tried it so
far.
SPEAKER_02 (34:04):
So we talked about the role a bunch of different
players may have in thistransformation.
Let's get to the role of ourmembers, lawyers.
As you've looked at lawyers thatyou've worked with throughout
your career journeys, what wouldyou suggest to our audience
about the role that they couldplay in this transformative
change?
SPEAKER_03 (34:20):
It is such a cool question, Rob.
I have loved working with theattorneys that I've gotten to
work with across my career.
And they know that one of thethings we often talk about
together is, in fact, I rememberone time sitting down with our
chief legal officer and saying,I don't need you to be the
(34:43):
goalie.
I need you to be on offense withme.
I need your help making thegoal.
We have to follow the rules ofthe game.
I absolutely accept that.
So we're following the rules ofthe game.
We're skating together.
We have the puck.
We're going to shoot it at thegoal.
You're not the goalie.
You're on offense.
(35:04):
How do we get this done?
When I've had those partnershipswith attorneys that want to
think that way, that want tothink toward an architecture of
the future, a way to get itdone, there are so many more
opportunities to succeedtogether than some twisted
(35:24):
concept that...
I'm probably a crook.
And if you don't stand in thegoal box, then I'm going to get
something by you, right?
Because I'm not.
I'm not a crook.
And most leaders aren't.
Most leaders aren't.
You'll spot them if they are,certainly.
But most leaders aren't.
They're just earnestly trying tobuild something better that
works and that works within theregulatory framework that you
(35:46):
have so well captured in yourtraining.
And that's a really importantaspect of the work.
SPEAKER_01 (35:53):
Yeah, I agree with that wholeheartedly.
The best legal teams I've workedwith have been the, well, not
that, but how about this?
Like there's so many operationalknowledge that lawyers have in
the clinical operations that werespect you all for, but we
just, please use your voicesbecause you can help us reframe
an idea, make it better.
You know, I think additionalinnovation and partnerships or
(36:16):
joint ventures or thosecollaboratives that Daryl was
chatting about, those are hugebecause it's sometimes maybe an
infancy of an idea.
And a lawyer can help us designit in a way that makes it a
better idea.
I think also just continue tohelp us with this regulatory
compliance and the changingregulations.
I mean, that changes every day,right?
But the complexity around thatand in the future, the
(36:37):
complexity around that, as wetalked about with AI or data
privacy or cyber, all of thosethings, you know, we're going to
continue to need to be partnerson.
And that's how I see our legalteam.
They're our partners.
And so the best help that Icould ask is continue to be that
because that's what we need fromall of you is just to continue
to be our partners and help usinnovate.
(37:00):
Look at everything you've done,Rob.
I mean, with the joint venturesand the different arrangements.
I mean, it's helped the systemthat you're part of be an
amazing and better system.
And so that's your trustedpartner.
And that's a huge asset.
SPEAKER_02 (37:17):
So as we wrap up, we've talked about being in
crisis management in thisindustry for an extended period
of time.
One of the things that alwayshelps the workforce in crisis
management is hope.
What are your parting words ofhope to the healthcare workers
out there that may be listeningtoday?
SPEAKER_01 (37:32):
Well, I would think I would like to just say I do
have hope.
I'm really proud to work in thisindustry.
I'm really proud to work withchallenging situations where
people at their most vulnerablemoments come to us for care.
So I don't know if there's anyhigher level of privilege that
you can be afforded.
So if that isn't inspiring anddoesn't elicit hope, then you
(37:53):
probably aren't in the rightindustry.
But nevertheless, what you domatters.
And take a deep breath.
Slow down.
It's gonna be okay.
Yeah, it's crazy.
We all have our days, but thisis actually what change feels
like.
And change is the only thingthat's constant.
So buckle up.
Here we go.
SPEAKER_03 (38:13):
I'm ready.
I'm ready to go.
I love that.
What a rallying cry.
And that recognizes the factthat healthcare is hard work.
It's a difficult, heroic careerchoice.
and it requires people who knowit will be that way their whole
career.
there is nothing that fixes thechallenge of being a police
(38:39):
officer or a paramedic or afirefighter.
The same thing is true inhealthcare.
There's nothing that fixes howhard it is to do heroic,
life-changing work every singleday.
So to me, hope is not defined aswe are going to someday make
this career easy for you.
I think hope is defined exactlyaround the purpose that Angela
(39:02):
described.
We have a purpose.
We run toward the danger, therisk, the challenge.
We run toward the challenge.
Our communities need us.
We are an asset to them.
And every single day, to me,hope is created by fighting for
better, fighting for better.
And that fight will always beincremental.
(39:22):
I will end my career havingfought for better every day and
not accomplish a long list ofthings I wish I would have
accomplished.
The same is true for you, everysingle person listening.
And And you'll hand off themantle and the next person will
take that up and they will fighttheir entire careers.
And every single moment you makeincremental progress or
(39:42):
sometimes transformationalprogress, I think that spark is
created.
And that's where hope is, ourhope to be better.
We are purpose-driven and we aregetting better every day.
And even on those days you can'tsee it, it's still happening.
And I think we need to tellthose stories better and better.
(40:03):
So
SPEAKER_02 (40:04):
sometimes they say right person at the right time.
Thank you, Angela.
Thank you, Darrell, for comingalong at the right time for our
membership.
I know there's been a lot offolks struggling with all this
change, but your words todaywere really inspiring and
appreciate you taking time toshare with our members.
SPEAKER_03 (40:18):
Thanks
SPEAKER_02 (40:18):
for that.
Thank you, Rob.
SPEAKER_00 (40:24):
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(40:44):
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SPEAKER_02 (00:17):
Hello, everyone.
Welcome to our latest in ourC-Suite podcast series.
I'm Rob Gerber.
I'm the Chief Legal Officer ofSumma Health and the
President-Elect Designate ofHLA.
I'm excited to welcome twoesteemed guests today to our
podcast, Angela Brandt and DarylTill.
I'm going to start with themproviding introductions.
So Angela.
SPEAKER_01 (00:36):
Hi, well, welcome, or welcome to everyone who's
joining anyway.
I'm Angela Brandt.
I'm the Chief AdministrativeOfficer for ProMedica Health
System.
ProMedica is headquartered inToledo, Ohio, and we're an
integrated healthcare deliverysystem that has 10 hospitals, a
large employed network ofproviders.
And as the Chief AdministrativeOfficer, I oversee all of our
(00:58):
corporate shared services andhelp to lead our strategic
transformation and strategicplanning.
So So looking forward to thediscussion today.
SPEAKER_03 (01:09):
Excellent.
UNKNOWN (01:10):
Daryl.
SPEAKER_03 (01:10):
Hey, hi, everybody.
Daryl Toll.
I'm a recovering health systemCEO.
I've spent years at AdventHealthin Florida, and now I'm leading
our transformation efforts atGeneral Catalyst and with our
new company called HATCO, or theHealth Assurance Transformation
Company.
So we're focusing onaccelerating transformation with
(01:33):
health systems, thinking aboutways to actually drive change in
healthcare that works forsystems in the can be led by a
regional healthcare system.
So excited to join you alltoday.
SPEAKER_02 (01:46):
So in our prior episodes, we've had C-suite
executives across severaldifferent disciplines share a
lot of their challenges, theirproblems.
These two guests were pickedtoday because they're going to
solve all those.
No pressure at all, but they areboth exceptional thought leaders
in the healthcare space.
So looking forward to sharingwith our membership their
thoughts.
And so we're going to start withthe open-ended question of
(02:07):
there's lots of headwinds rightnow in the healthcare industry.
that are further in the need fortransformation and change.
Angela and Daryl, just yourinitial thoughts on not only
some of those macro trends, butwhat are some of the ways that
our membership should start tothink about the need to pivot
from our current model andreally build out a new system
that could best serve ourpatients going
SPEAKER_01 (02:28):
forward?
You wanna go first or I?
That's a loaded
SPEAKER_03 (02:35):
question.
Yeah, you know, it'sinteresting.
I like to think about this ideaanytime I hear someone say
healthcare is broken.
I remember a discussion wheresomeone said, it's not broken,
it was designed this way.
And so in order to improve it,to fix it, to build resilience,
to address the needs of theworkforce, which is burning out
(02:57):
and in short supply, it needs tobe redesigned.
So to me, the invitation oftimes of pressure, times of
challenge.
to dismantle a system that wasbuilt away that led to poorly
aligned incentives, exhaustingworkflows, insecure
environments, overly complexconsumer experiences, and start
(03:23):
to redesign them from the groundup.
The good news is,psychologically, in order to
change a Disappointment isrequired.
Challenge is required.
Burning platforms are required.
So when everyone's fat andhappy, it's very difficult to
create the energy that'srequired to change a poorly
(03:45):
designed system.
And so my view is it's a time ofgreat challenge and also great
opportunity.
SPEAKER_01 (03:53):
I love that you just slipped it on its head because
that's exactly the only placeyou're going to be able to fix
it.
I would...
echo your conversations onheadwinds.
I think workforce challenges aredifficult.
People are burnt out.
I know COVID was five years agofor the rest of the world and
healthcare still feels likeyesterday in many ways, but
workforce shortages, changes inworkforce, all of the workforce
(04:15):
issues are a big deal.
I know we continue to talk aboutcare shifting to ambulatory, but
I think there's also, that'sdisrupting too.
It's not just ambulatory andhealthcare.
We have a lot of healthcareproviders out there that are not
hospitals or healthcare systems.
So thinking about the disruptionthere makes us think about how
(04:35):
we deliver care more efficientlyand more broadly to people.
And it also makes us morevaluable in that inpatient
experience, right?
But we have to deliver a bettercustomer experience.
I love what you said.
I mean, we have to do betterthan that for our consumers and
for our We call them patients,right?
(04:56):
But our patients are really justour friends, our families, our
neighbors, our employees, andmost of our systems.
And so why wouldn't you want todeliver better care to those
people you care about?
I think the other thing I wouldadd is aside of those rising
consumer Expectations, we stillhave all the financial pressures
that you were talking about,kind of the what's broken part,
(05:18):
right?
So the financial pressures frompayer consolidation, inflation,
supply chain disruptions.
So that also allows for us tothink about those headwinds and
ways of how do we innovate?
How do we transform?
SPEAKER_02 (05:32):
So, Ange, to your point, we're coming off four
days of board meetings last weekwith our board, and they are
saying it is five years later.
So why are we still facing thosesame wage inflation issues,
issues with payers arounddenials, this increase in farm
and supply costs?
Is anybody hearing us out therethat we've got these challenges?
So if we were to tell thegovernment, who is right now
having a lot of deliberationsaround health care, let's start
(05:54):
blank.
Let's have a blank sheet ofpaper and rebuild this.
Any thoughts on what you mightshare?
SPEAKER_01 (06:02):
I mean, I can think of a couple of different things
right off the top of my head.
I mean, I do think this is notso much for the government
question you just asked about.
So I will get back to that in amoment.
But I do think, how do wecontinue to prioritize our
employee experience?
Daryl was talking about that.
How do we lean into technologyto make things more efficient
for our staff?
The reason our staff is so burntout, too, is that there are a
(06:24):
lot of demands.
We have technology in a lot ofplaces, but we're still asking
them to work really harder, notalways smarter.
So I think we can leveragetechnology in making things more
efficient, leveraging predictiveanalytics, leveraging AI,
leveraging automation.
And that's true, too, even forthe non-clinical setting.
So healthcare needs to becomemore efficient in our
(06:46):
administrative spaces as well.
So I think that technology couldbe utilized there.
If I were talking to thehealthcare lawyers and everybody
in DC or our advocacy side, Ithink using value-based care
incentives or aligningincentives with our patients,
thinking about care more as aninterdisciplinary team that
(07:08):
could be tech-enabled, how do weget people to buy into that kind
of care just as much as we needto adopt it?
We need our our patients to beexcited about engaging with us
in that way.
So can we set up this incentivesin a different way?
I don't know, Darrell, what doyou think?
SPEAKER_03 (07:25):
Yeah, I think those are all really good points.
I also think we have aninteresting challenge and
opportunity that the currentadministration is unique.
It's unique in a number of ways.
certain leaders in corehealthcare related areas think
differently and respond toevidence differently than in
prior administrations.
(07:46):
So that gives us an interestingchallenge to overcome to ensure
that evidence continues to driveclinical practice and policy at
the federal level But also theadministration is very open and
quick moving in spaces where youcan capture their interests.
Sometimes that's aroundsomething that's unique that
(08:07):
could become a branded changemade in this administration that
could improve certain areas ofstrong support like rural
markets that they're verysensitive to.
So I think we can look at areaswhere this administration can
move a lot more quickly with alot less inertia that can, at
(08:28):
the stroke of a pen almost,change the way healthcare
functions, whereas prioradministrations might move much
more steadily, much more slowly.
So if we can find some of thoseareas, I think we can create a
flywheel effect if we do itthoughtfully as an industry.
The other thing I would say iswe hurt ourselves often.
We hurt ourselves by fragmentedadvocacy.
(08:49):
Every special interest group inhealthcare comes with a
different message.
I would say hospitals and healthsystems largely come with the
message, pay me more and ordon't cut my payments, which
isn't a very creative message.
A creative message is the systemtoday is broken and looks like
this.
We envision a system that'sbetter that looks like this.
(09:11):
That will require the followingthree to five changes in policy
in order to facilitate themovement from this system to
this new system.
I don't see our advocacy effortsbeing that organized.
I see us being reactive andreimbursement focused.
Now to Angela's point, we doneed to be reimbursed
(09:32):
differently.
We need to be reimbursed forinnovative things that involve
special kinds of virtual care,advanced care at home that
doesn't have to pass anadmission threshold, but might
be a very significant post-acuteopportunity that deals with the
post-acute shortages we seearound the country.
Entirely new ways of structuringour systems of care that include
(09:56):
virtual in-person, AI, humanbeings, and payment mechanisms
that don't require the 14encounters before you can and
say you're doing X, Y, Z.
Those are old constructs.
And so I do think we need to putour heads together and think
about what is the new constructwe want to develop that's in the
(10:17):
interest of consumers andpatients in our workforce.
SPEAKER_02 (10:21):
Yeah, I think that's a great point.
When I hear people talk in theadvocacy world, it's all, we'll
make sure that we all portraythat we're strong.
We're these large employers inour communities, the pillars of
the community.
But at the same time, we've gotto share If we don't get what we
need, there's going to belayoffs.
There's going to be cuts toservices.
It's a real difficult balance,it seems like, right now for a
lot of organizations as theyface a lot of the financial
(10:42):
headwinds.
One of the challenges we alsoface is making sure that we as
administrators bring ourproviders into partnership with
us as we look to make some ofthese transformative changes.
What strategies or techniqueshave you both utilized to make
sure your physicians, yournurses, your physician
assistants all feel a part ofthis change with you?
SPEAKER_03 (11:02):
I think part of the COVID dynamic that really opened
my eyes is at some point Irealized that in healthcare, the
building is on fire.
And it certainly felt like itwas on fire during COVID.
And we were going to our teamsand saying, yes, it's on fire,
(11:23):
but Come on in anyway.
Come in and work here.
And then we really scratched ourheads as an industry.
Why are people always wantingmore money?
And, well, wait a minute.
If you're asking someone to gointo a building that's on fire
and the fire hasn't been putout, the underlying conditions
of the fire have not beenaddressed, the fuel's not been
(11:45):
addressed, then people are goingto say, how much are you going
to pay me to go in there?
It's a very natural set ofreactions.
And I think we have to changethat entire storyline to be
fair.
I think we need to understandwhy is it so difficult?
Going into COVID, in 2019,Deloitte did a study of hundreds
(12:05):
of nurses, critical care nurses.
Over 50% of them rated theirmental health of five or lower
on a scale of one to 10.
And over 60%, rated theirphysical health a five or lower
on a scale of one to 10.
So those are the people webrought into COVID.
And then you can imagine theenergy burn and the fear burn
(12:27):
and the moral injury that hashappened through COVID.
So how do we reset?
I think an important way toreset is one, create highly
collaborative groupings ofspecially trained individuals
that can help us build thesystem of the future.
(12:47):
In a prior organization, wecreated a group of physicians.
Someone told me once the squareroot of N is how you create
change in an organization.
You have to engage and getenthusiasm and energy from the
square root of the populationyou're trying to change.
So if you have thousands ofdoctors, you need hundreds of
(13:08):
doctors to join you.
and they need to be part ofplanning and they need to feel
energetic and they need to feelinspired.
So we created a group called TheCatalysts, 200 doctors, and they
joined in strategic planning andthey came to all leadership
meetings and they were notelected.
They were appointed and selectedbecause they were passionate
(13:28):
physicians who wanted to driveto the future and had a vision
for the future in theirspecialty and for the
organization.
I've never seen change happen sosubstantially than I saw from
that group.
Each physician in that 200 wasgiven an assignment of seven to
10 other doctors that their goalwas to share this with those
(13:52):
physicians and to energize andcreate excitement or at least
talk through with them theirdisenchantment.
And slowly, steadily, theripples grew from that.
We need to do that with doctors.
We need to do that with nurses.
But even so, So even moresubstantively, the way work is
designed in healthcare is veryharmful.
(14:14):
It's very harmful.
The incentives are misaligned.
The structures are poorly set.
We're largely analogorganizations that have glued
technology on withoutredesigning people and processes
to accept that technology.
We've glued our electronichealth records on.
We've glued other technologies.
(14:35):
In most systems, it's hundredsof technologies onto a largely
analog system.
That means we have people wholiterally still today pull
papers off of fax machines andtype in what the paper says into
the computer.
We have those systems all overhealthcare, and it's a very
frustrating career if you thinkabout it.
(14:56):
Moving a paper from a faxmachine and typing it into the
computer is not what you dreamtabout when you were a child.
You want to do something big andpurpose-driven and heroic, and
we're giving people these brokendown jobs to do that over time
really need to be redeveloped.
That's harder than creating agroup of catalysts, but that's
(15:16):
an outcome I think we should allseek.
SPEAKER_01 (15:20):
Yeah, we did something similar at ProMedica.
I totally agree, co-designing itand co-designing it with your
clinicians or your frontlinefolks.
And it's not just frontline.
You've got to be careful abouthow we define frontline.
It's also your security team andyour facilities team and those
other stakeholders.
But you have to co-design it forit to get sticky.
(15:42):
I do think having an engagedworkforce of physician leaders,
future physician leaders, issuper important.
Our group, they named themselvesa transformer.
So you guys had the catalyst andwe had the transformer.
Let's
SPEAKER_03 (15:56):
pull them together.
I love that.
SPEAKER_01 (15:57):
Honestly, that's some power.
And we were also verydeliberate.
We intentionally picked ouryounger providers who we just
recruited.
And I think normally...
folks would go to those seasonedpartners or their seasoned docs
who'd been here for a long time.
And those stakeholders were alsoincluded.
It was still very important.
But we wanted the youngdisruptors who had seen and seen
things differently in otherorganizations who would
(16:20):
challenge us and where it feltpsychologically safe that they
could challenge us.
Otherwise, you don't get thebuy-in because we have to be
just as ready to learn and growas much as we're asking them for
their input in designing.
So if you bring them all in totell them what you're gonna do,
I will guarantee you that wouldbe your first step of failure.
And you're not right anyway.
(16:41):
There's 20 ways to do one thing.
And so to allow yourself to notbe right, to really facilitate
really good conversations andlet the innovation kind of
organically happen, I think thatrequires some thoughtful design
as we're talking about anengagement But it also means
that we need to think aboutleadership development
differently, and we need tothink about succession planning
(17:04):
differently.
And really, what is your whybehind the transformation?
Where are you leading to?
What are you trying?
If you're trying to recreateyour system, everyone wants to
do something that's meaningful,that's valued, and where people
feel useful and needed.
If that's the goal of yourorganization, and I'm sure there
are many different goals in yourorganization, then I guarantee
(17:27):
you that there are people readyto run into that fire.
I mean, I think, you know,different than COVID where I did
feel responsibility and peoplewere running into that fire,
like as an administrator feltreally a high degree of
responsibility for asking peopleto do the hard work that they
did.
I don't feel any differentlyabout asking people to do hard
work today.
It's just not a pandemic, right?
(17:48):
So, um, We have workplaceviolence issues.
We have burnout issues.
We have all kinds of issues.
So that same fire looks a littledifferent today, but the
challenges are still real andpeople want to do meaningful
work.
And I think in healthcareespecially, we allow a platform
for them to do meaningful work.
(18:08):
You really can't ignite thatpassion and keep it.
SPEAKER_02 (18:14):
So often folks refer to AI and tech as the solution
to all this.
As you look out into the future,how quickly do you see the
adoption rate being for AI andtech?
And is it the answer to allthis?
SPEAKER_01 (18:27):
Well, that's like saying EMR is the answer for
every single charting issue, andwe know that's not true.
First of all, you can't ignoreAI.
I think about AI as far asautomation, making work more
efficient, making it smarter,being able to apply it on a
broader network.
I'm learning from some of thepeople who directly report to me
and how efficient I can becomebecause they're using AI more
(18:50):
efficiently than I am at themoment.
At ProMedica, we're using AIprobably more cohesively and
consistently in the clinicalsetting.
But where I can see it havingbroader implications in the
shared services world isautomation with revenue cycle.
So again, think about thatconsumer mindset, right?
I want my bill correct, I wantto reduce overhead, and I want
(19:11):
to keep things efficient forthat consumer as well as for
your internal own expensestructure.
It's a great place to automatewithout really a whole lot of
risk.
In our legal team, they'relooking at ways to look through
forms and with defined criteria,be able to turn contracts over
more quickly.
To not reduce workforce, but toallow the work that our lawyers
(19:35):
are doing to be a higher levelof work using their critical
thinking instead of just pushingpapers.
You know, going back to Terrellwhen he said taking that darn...
piece of paper off the faxmachine.
Our poor lawyers, they talkabout living in seas of paper,
my word.
So I think AI is absolutely hereto stay.
It's gonna be faster than we'reall ready for, and I think we
(19:56):
have to lean into it.
And it's gonna be at thecultural pace that you're
comfortable with for yourorganization.
I think some people are gonna befast leaders, Others are going
to be fast followers, and thenthere's going to be the ones
that just kind of wait to seewhat works.
I don't think you can wait tosee what works in this space.
I think that you're going to beway too slow and miss all of the
amazing opportunities to learnand how to apply it in your own
(20:19):
organization.
It can't just work by itself,though.
You still need people.
You still need all of us to makesure we're maximizing it
ethically.
you know, convening it,structure, governance of all of
that, and how you're going touse it in your organization,
there's still a hugeresponsibility.
It's not just a cost savings,but it is going to make us
better faster.
I don't know what you think,Daryl.
SPEAKER_03 (20:40):
Oh, yeah, absolutely.
I think when I hear, well, AIimpact healthcare or the world,
I think, well, did the computerimpact the world?
Did the internet impact theworld?
AI is not a narrow capability.
It's like the internet.
It starts touching everythingvery quickly.
There will not be such a thingas an AI company in the future.
(21:03):
There will be AI in everything.
And so how do we harness that?
A couple of points I would add,and I agree with your comments.
One, for the first time, we havetechnology that can actually
change healthcare.
The old algorithmic kind of codeit, and then the machine runs
(21:24):
across the code andalgorithmically tries to get a
job done that's too complex, hasnot worked well in healthcare.
And that's why healthcare haslagged in technology adoption so
much, because some of our,especially clinical decision
making, is not at all amenableto a coded solution.
Now you have artificialintelligence, which is real
(21:45):
intelligence.
It is able to process and thinkin a way with a very high IQ and
absorbing a massive amount of,can pass all the boards, nursing
boards, pharmacy boards,physician boards.
It can pass at a higher ratethan your medical staff or your
nursing staff.
So then how do you do that?
How do you use it?
How do you start with low riskuse cases as you've described,
(22:07):
Angela?
And then how do you grow towardhigher risk use cases?
And how do you make sure youdon't jump too fast because that
could be dangerous?
Humans in the middle, as yousaid, I think very essential,
but also the ability to augmenthumans in a way in a workforce
shortage environment isessential.
This is part of the answer tohow a physician in the future
(22:28):
can do one and a half times thework at a felt effort of 0.9.
That's transformational.
That starts to mean the shortageisn't what we thought it was
because now we're usingtechnology in more intelligent
ways.
The last point I'll make is thebad guys are going to use it
fast.
We don't have the luxury ofsaying, well, when it's safe,
(22:49):
we'll use it.
Well, guess what?
Our attorney friends here, thetrial bar is using it.
They're gonna get ahold of thechart and they're gonna jam
through that chart and they'regonna point out every single
point where that physician ofwhatever specialty didn't follow
evidence.
And your resistance to AI willmean your organization is unable
to counter.
(23:11):
These are very serious dynamics.
We have to figure out how tomove forward at a reasonable
pace because the adopters outthere, yes, the cyber thieves
and hackers are gonna use it,but legitimate entities like
payers are gonna use it inharmful ways to health systems.
(23:32):
Attorneys that are on the otherside of cases will use it, et
cetera.
So I think we absolutely shouldkeep up with them in health
systems.
We're doing good work.
We deserve to keep up with them.
SPEAKER_01 (23:44):
You know, something you just said before we move on,
sorry, Rob, just made me think,you know, my kids just got, I
got notification from my kids.
Well, actually they got itbecause I'm paying for their
college, but it came to me,right?
But all of their college coursesare requiring them to use AI now
at many of the universities.
And so if you even think aboutthe future workforce of a
physician or a nurse, you know,they're going to be using it and
(24:06):
training with it.
So as an organization, youreally are going to not be able
to even attract top talent ifyou don't have an AI strategy at
some point in time.
SPEAKER_03 (24:14):
So just- Great point.
Same thing happened with the-With the EHR, right?
Remember when the old schoolgrads resisted any kind of
electronic health record and nownew grads would never work in a
place that didn't have aneffective medical record.
SPEAKER_01 (24:27):
You don't have robots to be operating on.
You're not getting thosesurgeons, right?
I mean, that's what AI is rightnow.
That's what we're going to bedealing with from a workforce
employee preference.
It's just amazing.
SPEAKER_02 (24:38):
So we break down some of the barriers that we've
got historically.
We get our physicians and ourproviders to come along with us.
We use technology well.
Do all these things get you tobe that successful health system
of the future without a strongpayer mix?
When we look across the countrynow and the haves and have nots,
if you are still struggling withyour payer mix, how do you
overcome all the otherchallenges?
SPEAKER_03 (25:02):
You know, Rob, I think the concept of a strong
payer mix is decliningeverywhere.
So take a high growth system,Fairly healthy pair mix market,
say, in Texas or Florida, andyou see the commercial insurance
(25:22):
rates dropping in those markets.
Those systems may not notice ityet because they still have
plenty, but those commerciallyinsured rates are dropping.
What are they being replaced by?
Self-pay, Medicaid, Medicare,Medicare Advantage.
As we see that nationally, andthen some markets in the U.S.
are already there.
(25:42):
And it's very, very challenging.
But we've talked for years,maybe decades, about Medicare
breakeven.
Can systems operate at a levelof cost that accommodates a
lower level of reimbursement?
There are two paths, I think,that help with that.
One is using leverage, usingtechnology leverage to reduce
(26:06):
the total cost of our operation,of our production systems.
We've not done that well inhealthcare.
Part of it is we've had enoughbuffers, enough, the
not-for-profit advantage, right?
The ability to not pay taxes andto have a 340B drug program that
brings an extra margin that letsus get by.
And so we don't, actuallyenforce a technology leverage
(26:30):
strategy that starts to bringour cost structures down, like
other industries really had todo because of the narrowness of
their margins.
So I think we really need tothink as an industry about that.
And this AI question from beforeis certainly part of that
answer.
(26:50):
And Value-based care is actuallya strategy that when your
per-click payment rates continueto decline, you start to realize
that if we received paymentdifferently and we could manage
the total cost of care of ahuman being, if we could manage
across a lifetime, if we couldreally feel a sense of ownership
(27:13):
of that human being's thrivingand their experience of health,
not just healthcare, if we canget there as an industry, I
think we can change the paradigmand we all have some strategies
to do that.
I think it's happened much moreslowly than we would have
expected.
but it will be required.
It will be required that we takea more longitudinal view of a
(27:36):
human being, that we have accessto the dollars upfront instead
of so many of them beingessentially filtered away
through middle layers andthrough administrative
structures and massive overheadthat's grown 3,500% plus while
the number of providers havegrown 150% since the 70s.
This is so out of line that inorder to come back to a point of
(27:59):
resilience and stability, Ithink we'll really, really have
to pay attention to this in ourredesign efforts.
SPEAKER_01 (28:06):
It's a wicked problem.
Even as I'm hearing you talkabout it, you know, I think
about the consumer demands forcertain clinical tests that
provider might not even feel asmedically necessary.
And, you know, then there's alitiginous piece of that and
making sure the I is dotted andT is crossed.
It is a wicked trap right nowfor patients.
healthcare providers.
(28:28):
And I do think like a differentpayment methodology and having
that payment up front, I stillthink there has to be something
in it for the patient or theconsumer.
And so whether that's addressedas the employee benefit, or
whether that's addressed on theindividual basis, I don't know
that I have that solution,despite the way you gave us the
add on at the beginning therethat we didn't have all the
(28:48):
solutions.
But I do think that it is awicked problem.
And it's multifactorial.
It's not just a reimbursementproblem.
It is a care design issue aswell.
And we're going to have tofigure out a way.
There are systems figuring out away now.
I don't even know what a goodpayer mix is.
I think we've gone on the whole,we can, well, and all volume is
good volume.
And then it was, I just need theright payer mix.
(29:10):
And now it's like, I just needthe right CMI or whatever.
But ultimately, I think ifyou're documenting the care, you
have the good value incentivesincentivized, or excuse me,
value incentives aligned, thenyou can do a good job, but
you're going to have to embracetechnology, automation, changing
the workforce.
It's all of those factors.
There's not a silver bullethere.
SPEAKER_02 (29:34):
So off that theme, as we look again at that alleged
health, successful health systemof the future, is it going to be
a scale play, which we knowthat's a common strategy where
we're just going to see entitiesget large?
I can remember a conference thatAngela and I were at where Atul
Gawande said in 2010 that everytime you used to have a hardware
store, Every time you used tohave a hospital and that's not
going to be the future, it'sgoing to be big box, Home Depot
(29:56):
and Lowe's.
Is that where health systems aregoing?
Or is it going to be somethingmore vertically integrated where
we're going to see pay riders orother industry segments come
together in a successfulcollaboration?
Are we going to see healthsystems partnered with other
post-acutes or other segments ofthe industry?
What do you both think justabout how you would put those
building blocks together?
SPEAKER_01 (30:17):
Scale always has advantages on some level, right?
So I think there's still goingto be big systems, but I
personally wouldn't be surprisedif you have more regional
systems staying strong andindependent as well as those big
kind of systems.
I don't know that one model isgoing to work.
I think that based on the state,based on the reimbursement,
(30:40):
based on the philosophies, thescale will get you so far.
But at the end of the day, youhave to be nimble enough to be
able to adjust and change andpivot, pilot things, fail fast.
And so sometimes, you know,being large can be a
disadvantage in that regard.
And so I don't know what youthink, Daryl, but I think that
there's advantages in beingprobably strong and regional or
(31:03):
collaborating.
Yeah.
SPEAKER_03 (31:04):
I think scale has been disappointing in
healthcare, largely as systemshave gotten large.
Even the largest systems likeHCA has 5% national market
share.
So there's no such thing as anational American healthcare
system in the way that othercategories of industry might
think of scale.
(31:25):
I do think there's a problem ofsubscale.
capabilities and I think thatthere's this interesting
opportunity ahead where regionalnetworks can be created without
aggregation without acquisitionif your goal isn't to just go
leverage the payer for maximumpayment then you can get more
(31:49):
creative you don't have to ownthe world you don't have to roll
up all the health systems and goto Anthem and say we want the
most we can get out of you butWhat if ProMedica and Summa
Health and Altman created adistribution and supply chain
system together?
What if five systems in threestates that were contiguous
(32:11):
could get together and create asingle workforce company that
would become an outsourced HRdepartment for all of those
systems instead of every systemhaving to replicate that?
I think we have to think And wecan seek scale.
It's legal to do these things.
They have to be appropriatelystructured.
But we have to think about howwe do things differently when
(32:34):
we're underscaled.
And we can achieve, I think, alot of the economies of scale
that a system like HCA mighthave without necessarily...
being sold to a larger system orwithout having to seek the
acquisition of 20 systems inorder to make something
meaningful happen.
(32:56):
Somehow, the way Americanhealthcare works is highly
regional.
It's highly designed for thecities and towns and
stakeholders that exist withinthese circles of care, and it's
very difficult to transmitcapability.
I came from a large system thatoperated in 10 states, and it
(33:20):
was very difficult for us toachieve economies or advantages
of scale across 10 states.
states where we could.
is in the single state where wehad 23 hospitals.
Well, then we could createwarehouses, and we could run a
large HR team, and we could do alot of things that shared
services, but that didn't helpus in Chicago or Colorado.
(33:42):
So I think as we think about thefuture of healthcare, we should
think about how that contiguoussupport system gets created that
reduces the total cost andallows us to hold the steering
wheel instead of outsourcingthose things, which I think is a
hasn't been working well forsystems that have tried it so
far.
SPEAKER_02 (34:04):
So we talked about the role a bunch of different
players may have in thistransformation.
Let's get to the role of ourmembers, lawyers.
As you've looked at lawyers thatyou've worked with throughout
your career journeys, what wouldyou suggest to our audience
about the role that they couldplay in this transformative
change?
SPEAKER_03 (34:20):
It is such a cool question, Rob.
I have loved working with theattorneys that I've gotten to
work with across my career.
And they know that one of thethings we often talk about
together is, in fact, I rememberone time sitting down with our
chief legal officer and saying,I don't need you to be the
(34:43):
goalie.
I need you to be on offense withme.
I need your help making thegoal.
We have to follow the rules ofthe game.
I absolutely accept that.
So we're following the rules ofthe game.
We're skating together.
We have the puck.
We're going to shoot it at thegoal.
You're not the goalie.
You're on offense.
(35:04):
How do we get this done?
When I've had those partnershipswith attorneys that want to
think that way, that want tothink toward an architecture of
the future, a way to get itdone, there are so many more
opportunities to succeedtogether than some twisted
(35:24):
concept that...
I'm probably a crook.
And if you don't stand in thegoal box, then I'm going to get
something by you, right?
Because I'm not.
I'm not a crook.
And most leaders aren't.
Most leaders aren't.
You'll spot them if they are,certainly.
But most leaders aren't.
They're just earnestly trying tobuild something better that
works and that works within theregulatory framework that you
(35:46):
have so well captured in yourtraining.
And that's a really importantaspect of the work.
SPEAKER_01 (35:53):
Yeah, I agree with that wholeheartedly.
The best legal teams I've workedwith have been the, well, not
that, but how about this?
Like there's so many operationalknowledge that lawyers have in
the clinical operations that werespect you all for, but we
just, please use your voicesbecause you can help us reframe
an idea, make it better.
You know, I think additionalinnovation and partnerships or
(36:16):
joint ventures or thosecollaboratives that Daryl was
chatting about, those are hugebecause it's sometimes maybe an
infancy of an idea.
And a lawyer can help us designit in a way that makes it a
better idea.
I think also just continue tohelp us with this regulatory
compliance and the changingregulations.
I mean, that changes every day,right?
But the complexity around thatand in the future, the
(36:37):
complexity around that, as wetalked about with AI or data
privacy or cyber, all of thosethings, you know, we're going to
continue to need to be partnerson.
And that's how I see our legalteam.
They're our partners.
And so the best help that Icould ask is continue to be that
because that's what we need fromall of you is just to continue
to be our partners and help usinnovate.
(37:00):
Look at everything you've done,Rob.
I mean, with the joint venturesand the different arrangements.
I mean, it's helped the systemthat you're part of be an
amazing and better system.
And so that's your trustedpartner.
And that's a huge asset.
SPEAKER_02 (37:17):
So as we wrap up, we've talked about being in
crisis management in thisindustry for an extended period
of time.
One of the things that alwayshelps the workforce in crisis
management is hope.
What are your parting words ofhope to the healthcare workers
out there that may be listeningtoday?
SPEAKER_01 (37:32):
Well, I would think I would like to just say I do
have hope.
I'm really proud to work in thisindustry.
I'm really proud to work withchallenging situations where
people at their most vulnerablemoments come to us for care.
So I don't know if there's anyhigher level of privilege that
you can be afforded.
So if that isn't inspiring anddoesn't elicit hope, then you
(37:53):
probably aren't in the rightindustry.
But nevertheless, what you domatters.
And take a deep breath.
Slow down.
It's gonna be okay.
Yeah, it's crazy.
We all have our days, but thisis actually what change feels
like.
And change is the only thingthat's constant.
So buckle up.
Here we go.
SPEAKER_03 (38:13):
I'm ready.
I'm ready to go.
I love that.
What a rallying cry.
And that recognizes the factthat healthcare is hard work.
It's a difficult, heroic careerchoice.
and it requires people who knowit will be that way their whole
career.
there is nothing that fixes thechallenge of being a police
(38:39):
officer or a paramedic or afirefighter.
The same thing is true inhealthcare.
There's nothing that fixes howhard it is to do heroic,
life-changing work every singleday.
So to me, hope is not defined aswe are going to someday make
this career easy for you.
I think hope is defined exactlyaround the purpose that Angela
(39:02):
described.
We have a purpose.
We run toward the danger, therisk, the challenge.
We run toward the challenge.
Our communities need us.
We are an asset to them.
And every single day, to me,hope is created by fighting for
better, fighting for better.
And that fight will always beincremental.
(39:22):
I will end my career havingfought for better every day and
not accomplish a long list ofthings I wish I would have
accomplished.
The same is true for you, everysingle person listening.
And And you'll hand off themantle and the next person will
take that up and they will fighttheir entire careers.
And every single moment you makeincremental progress or
(39:42):
sometimes transformationalprogress, I think that spark is
created.
And that's where hope is, ourhope to be better.
We are purpose-driven and we aregetting better every day.
And even on those days you can'tsee it, it's still happening.
And I think we need to tellthose stories better and better.
(40:03):
So
SPEAKER_02 (40:04):
sometimes they say right person at the right time.
Thank you, Angela.
Thank you, Darrell, for comingalong at the right time for our
membership.
I know there's been a lot offolks struggling with all this
change, but your words todaywere really inspiring and
appreciate you taking time toshare with our members.
SPEAKER_03 (40:18):
Thanks
SPEAKER_02 (40:18):
for that.
Thank you, Rob.
SPEAKER_00 (40:24):
If you enjoyed this episode, be sure to subscribe to
AHLA's Speaking of Health Lawwherever you get your podcasts.
For more information about AHLAand the educational resources
available to the health lawcommunity, visit
AmericanHealthLaw.org.
And stay updated on breakinghealthcare industry news from
the major media outlets withAHLA's Health Law Daily Podcast,
(40:44):
exclusively for AHLA Premiummembers.
To subscribe and add thisprivate podcast feed to your
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