The Future of Care with Dave McFadyen | Ever Onward - Ep. 85

Dave McFadyen believes in the power of local roots. 

As President and CEO of Trinity Health’s West Region — which includes Saint Alphonsus Health System and Saint Agnes Medical Center — this Boise native brings over 25 years of healthcare leadership experience to some of the industry’s most complex challenges.

In this episode, we explore the current realities facing healthcare in Idaho and beyond. From balancing fee-for-service models with value-based care to launching neighborhood care centers that bring services within 15 minutes of every patient’s home, McFadyen shares how St. Al’s is building the future of accessible, community-centered healthcare.

He addresses Idaho’s physician shortage and the promising new Graduate Medical Education program that recently welcomed its first residents — a crucial step in keeping future doctors in the state. We also dig into cutting-edge AI tools like the DAX system that are reshaping both patient care and provider experience.

But innovation isn’t without obstacles. McFadyen explains how recent Medicaid funding changes and Idaho’s transition to a managed care model could jeopardize essential resources for vulnerable populations.

Don’t miss this honest, insightful conversation with one of the key voices shaping the future of healthcare in Idaho.

Guest Bio:

David McFadyen is the President and CEO of Trinity Health’s West Region, which includes Saint Alphonsus Health System and Saint Agnes Medical Center. A proud Boise native and “local kid,” Dave earned his undergraduate degree from Boise State University and an MBA from Northwest Nazarene University. He is also a Fellow with the American College of Healthcare Executives.

With nearly 25 years in healthcare leadership across Southeast Idaho, Dave has held executive roles at West Valley Medical Center, St. Luke’s, and Saint Alphonsus. Throughout his career, he has led the development of new facilities, launched vital healthcare services, and championed provider recruitment — all with the goal of improving access to world-class care close to home.

Dave is an active community leader, serving on the boards of the Idaho Hospital Association, Boise State University Foundation, American Hospital Association’s Regional Policy Board, the Boise Metro Chamber, and various other local organizations.

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Episode Transcript

Speaker 1 (00:00):
Today on the Ever Onward podcast, we have Dave
McFadden.
He's the president and CEO ofTrinity Boise State for his
undergraduate and then has beenin health care for 25 years in

(00:27):
Southwest Idaho 11 years at WestValley Medical Center in
Caldwell, 10 years at St Luke'sand now five years with St Al's.
And now he is the big guytaking over for huge, by the way
, shoes to fill Odette Bolano.
I can't wait to catch up todaywith Dave McFadden, ceo of St
Al's.
Prior to our conversation withDave, I'll do an all-quist

(00:48):
update with my partner, holtHaga.
Holt, we had a little topic totalk about in our all-quist
update today.
Yeah, I think it's important.
It plays on a sensitivity thatI have which, listen, I'm in an
office with all these killersand young guys that are in their
early 40s and I'm pushing 60now and so sometimes I get

(01:10):
sensitive and I poke my head inyour office and I said, man, you
young guys don't listen to usold guys anymore.
But I will tell you, like one ofit's a quick story.
But when I was training inemergency medicine in Tucson
Arizona, one of my attendingphysician was Frank Walter, and
this guy is a legend.

(01:30):
A legend.
He is by far and away the justkind of sheer intelligence, one
of the smartest guys you've everbeen around, and he would
school you on everything.
I mean, every moment was ateaching moment and when you
would go to present a patient tohim because in the ER what you
do is you'd go see two or threepatients and then before, as a
resident, before you could starta treatment plan, you had to go

(01:51):
find Frank, dr Walter, sit himdown and say, hey, this is
patient A, this is this, this iswhat I want to do, and most of
your attendings, like most ofthem, would say great, yeah, go
for it.
They wouldn't even half the timeyou think, are you even
listening to me?
And Frank, every time wouldlook at you and say wisdom comes

(02:12):
from bad experiences and badexperiences come from lack of
wisdom.
Let's go see the patient and,as a resident, it would piss you
off because you'd like, hey,I've got this person in here
that I think has got this easything.
I just want to go treat him.
And hey, I've got this personin here that I think's got this
easy thing, I just want to gotreat him and he would walk in
the room and you'd walk with himand half the time you're
rolling your eyes like, okay,here we go, let's go through it.
And then when he walked in theroom, he'd start off the same
way how are you doing?

(02:33):
And he would kind of do histhing.
And you know what I learned alot.

(02:53):
You learned a lot because I'dlike, oh, I missed that, or I
didn't ask that, or man, why didhe?
Oh, you know what I mean and soyou know, I just think about
that a lot and as I've gottenolder, now I'm saying, hey, what
is there to learn here,Especially as our economy's
changed so quickly andtechnology's changing now is
what can we learn from the pastto help us?
Anyway that was a short way oftelling you that the other day.

Speaker 2 (03:12):
No, I was feeling a little Well and I think you know
, I don't know Younger guys.
I hope I think our generationstill is like you know, we're
students.
Like I can, I've, I'veattributed a lot of my success
just to, like you know learning.
Just, you're always learningRight, but, but, um, but I just
thought it was an interestingcomment because I see it and I

(03:33):
hate to like point the finger atthe generation below me, cause
I'm sure it's you know, mygeneration too, but um, the
value of, of learning from youknow guys like you, tom, you've
been like an incredible mentorto me and everybody else in the
office right, we made a lot ofmistakes, right, when you learn
and they they're deep.

Speaker 1 (03:49):
Yeah, you know we're now.
We went through the greatrecession.
Yeah, you were.
You were still like.

Speaker 2 (03:54):
I was still skiing.
I think I was like skiing amobile run in Park City.

Speaker 1 (03:57):
You were still on the US ski team.
Like you know having to spendyour you.

Speaker 2 (04:02):
You know having to spend your time in Argentina, I
wasn't in the fetal positionunder my desk, so you go through
that one and then you gothrough, you know, this last one
.

Speaker 1 (04:09):
It's been very different, this last kind of
slowdown, but you go throughthose and you learn a lot.

Speaker 2 (04:14):
The message is important, though, like it is,
because it's so easy to sort ofto not understand the value of
the guys who have been doingthis for a very long time, and
I'm more talking to the young,like the crew that's early 20s,
trying to figure out what do Iwant to do.

Speaker 1 (04:31):
Are you starting to feel like an old guy?
Now?
I'm feeling like an old guybecause I'm 42.

Speaker 2 (04:35):
So you know, I think I am one of those old guys now.

Speaker 1 (04:39):
Do you know how mad that makes a guy that's almost
60?
How like you so you're feelingold.

Speaker 2 (04:44):
But I just want to say, because I think it's
important, because I see itevery single day is that when we
look at a lot of projects letme just give an example of this.
So we look at a lot of realestate, right, a ton of real
estate and I was on my GoogleEarth the other day and I was
deleting all of our pins, allthe pins that I had, and I'm
like, well, we didn't do theseprojects, so I deleted them.
I did like 30 pins.

(05:04):
I'm like, wow, that's, welooked at a lot of stuff and
those are things that weactually really looked at.
There's all the other thingsthat we look at and just pass,
pass, pass.
But but when, when you look ata piece of real estate and it's
part of the reason, it's a largereason, part of the napkin say

(05:29):
this project works or it doesn't, there's always the landmines
and the claymores that willhappen, and then all the ones we
think are going to work.

Speaker 1 (05:32):
then you're like okay , now where are the other
landmines?
But you're kind of constantlysaying, okay, what are what are
the?
You're thinking with the end inmind, right?

Speaker 2 (05:45):
Yeah, and you're backing in pretty quickly to
okay, what are all the thingsthat need to make this thing
work?

Speaker 1 (05:47):
Yeah, but the young like, unless you have that
experience, you'll go chase thisdown and what we're
experiencing right now, likethis week, I've probably had
three different people in herethat are young folks that have
gotten into trouble, that havecome in and said, hey, do you
want to take over a project?
Right, yeah, and I sit downwith them and I understand how
it happened.
Yeah, and I sit down with themand I understand how it happened
.

Speaker 2 (06:05):
Yeah, and I get it.
Here's where you.
Yeah, here's where it started.

Speaker 1 (06:08):
I completely understand it.
And you know, some of themmight give us a chance to kind
of partner and help out, andsome of them you're like, hey,
man, it's going to be a toughlesson to learn.
But your point's very welltaken, which is, and you know
what, there is no replacement.
The replacement for developingwisdom, if it's not bad
experience, is listening.

(06:29):
Those are your two options.
Yeah, right, frank would tellyou that, right, right, right,
dr Walter would say either we gohave a bad experience and you
learn, or you learn somethingfrom me.
Yeah, and man, wherever you are, frank, love you man, yeah your
lessons.
It's been great.
Thanks, holt, thanks everybody,thanks for having me.

(06:50):
Dave, thanks for coming on.
You bet this will be fun.

Speaker 3 (07:03):
Yeah, it's been a little while it has been.
It has been.

Speaker 1 (07:06):
How are things out there?

Speaker 3 (07:07):
You know we're moving and shaking.
You know changing the way we'redoing things and trying to
adapt to what's coming at us.

Speaker 1 (07:16):
I honestly can't wait until we've been kind of heads
down and busy in what we do, buthealthcare, healthcare.
I think with the change in theadministration and then
challenges here locally like, isit just?

Speaker 3 (07:30):
crazy right now.
You know, I think healthcare isalways somewhat crazy yeah.
We're adapting to clinicalenvironment, changes in policy,
changes in new technology,reimbursement, but it feels like
it's moving faster than ever.

Speaker 1 (07:47):
Yeah, yeah.
What do you see as the big?
Some of the biggest challengesyou're facing right?

Speaker 3 (07:50):
now, you know, I think adapting to the new
legislation, both at the statelevel and national levels, can
be key.
Most of that won't roll out fortwo, three years, and so we're,
we're in the phase of learning.
You know what does this meanfor Idaho?
What does it mean forhealthcare?

Speaker 1 (08:04):
Can I ask so?
So one of the questions I'vebeen dying to have you on to
talk.

Speaker 3 (08:12):
I just get a couple of questions because if you go
back, I'm old Dave, I've beendoing this a long time and you
know you go back in in.

Speaker 1 (08:18):
You know what I would , as an old guy, call it the
good old days where you know youhad a doctor and a patient
relationship.
It was really prettystraightforward, right.
I mean, in the 90s it waspretty straightforward.
You had very few layers betweenthe provider, the hospital, the
surgery center, wherever you'regetting your care and the

(08:42):
physician, and there was a lotof real accountability Shoot.
I go back to my days.
You had a paper chart and atthe end of the chart you would
lift it up and you would listout the things you're billing
for and the physician.
I would do that and then Iwould turn that in and I was
very tied to billing.

(09:02):
I knew what was going on.
I could have a patient come inand tell me what did happen.
We had professional courtesy,we call it.
So if you had a fellow doctorthat came in with their family,
you could say, hey, I want towrite off my services and I knew
exactly what it was costing,right.
And then there was thistransition to where it got

(09:22):
bigger and it got harder.
And then Obamacare passed andwhen it passed, I remember I
remember having lengthydiscussions that, um, does this
really fix much?
Because it really didn't gosocialized right, where you kind
of had a two tiered systemwhere the government just kind
of came in and then you hadprivate insurance.
And it's a misconception toeveryone that thinks that, like,

(09:44):
if you have socialized medicine, you just have socialized
medicine.
In every country that hassocialized medicine they have
two-tiered system right, theyhave private not.
But when it came in it kind ofdid, it kind of went down the
middle yeah.
So then you had, you know, pbmson the pharmacy side.
You had all these intermediatethings that happen on the
medical side Right, complex,complex yeah.

(10:05):
And so then you had this.
What I would say is thisbloating of kind of like
regulation that kind of came inand so now it got really
complicated.
Then there was this hope for me, because then you had like
value-based care.
So then, shoot, it's probablybeen 10 years for this.
At least yeah, you go back 10,maybe 15 years and then we're

(10:25):
like, hey, we're going to changethe way we do healthcare
Because a long, long time ago,when the blues started, it was
first time insurance wasintroduced, fee for service.
We have this revolutionary ideawhere we're going to have this,
we're going to pay people tokeep people healthy, and that
was the whole new thing.
And it's this value-based carething.

(10:51):
And that was the whole newthing.
And it's this value-based carething.
And it's complicated, but ifyou take care of patients and if
you check all these boxes, thenand their outcomes are good,
and it all sounded great.

Speaker 2 (10:55):
It was really hard to do, though.
I mean it's really really hardto do.

Speaker 1 (10:58):
It sounds good, but but then then it was kind of
like uh, I describe it like yougot your feet in two canoes,
because you still have a wholebunch of people over in this
canoe that are that are fee forservice, and you got a whole
bunch of people over in thiscanoe that are that are
value-based care reimbursement.
And you're trying to figure outhow to do both and and.
But I thought, oh, at somepoint we're going to transition

(11:19):
and get out of that, and then,and then what Cause?
It seems like we're in the,then what?
But we're still there.

Speaker 3 (11:26):
We're still there, yeah, and I think we're trying
to figure it out.
What I'm excited about, though,is, I think, value-based care,
and the premise behind that isstill real.
How do we take really complexpatients that utilize a lot of
healthcare and cost a lot to thewhole system?
How do we keep them out of thatenvironment?
Yeah, and so you know, stAlphonse's, we are standing up
clinics with extra resources andidentifying those patients,

(11:48):
whether they're commercial orMedicare Advantage or Medicaid,
so that we can redirect them tothese clinics where they may be
seen three times a week.

Speaker 1 (11:56):
But your whole goal is, hey, let's keep these guys,
keep them out of the ER, keepthem out of the inpatient
setting.
Because when you look at like apatient like let's say, you
have a 5,000 employee company,at like a patient, like, let's
say, you have a 5,000 employeecompany, at the end of the year
you can get.
I remember when I helped it wasnot West 8th, it was a Meridian
School District back in the daybut Linda Clark and they pulled
up all.
It was blinded to who thepatients were, but they pulled

(12:17):
up the consumption of healthcare.
It was shocking to me.

Speaker 3 (12:34):
It was the first time as a doctor I'd ever looked at
like a very big organization,but it's, it's really five to
ten percent of that panel.

Speaker 1 (12:37):
That eats up 90 of the health care potentially,
yeah, at least 80.
Yeah, it's incredible and so sowe can't stop that.
That is, you keep themhealthier and and and uh, it
helps them right.
In theory, it should be goodfor them.
So what are you?
What are you doing?
So what we're excited about isis we think about, and it's
newer, for In theory, it shouldbe good for them.
So what are you doing.

Speaker 3 (12:46):
So what we're excited about is we think about and
it's newer for St Alphonsus Overthe last couple of years we've
been wading into taking on thatrisk or value-based care models,
and so one of those things ismaking sure as we bring on those
panels of patients,understanding who's in that
5,000 panel group, identifyingthose patients and working with
them to get them into theseclinics.

(13:07):
And the first clinic will openup in Caldwell this fall at our
new center out there on thefreeway.
So really excited about thatand Dr Yakeley is going to help
us.
We have pharmacy, casemanagement, social work,
resource managers that can helpthem get the kind of care they
need.
Do they need pharmaceuticals?
Do they need housing support?
What's their access to healthyfoods?

(13:28):
So all those things that we cantry.
Over time go from three visitsa week down to two and
eventually down to one and thenmonthly.
It's amazing, and that's whatwe want to do.

Speaker 1 (13:38):
I think that's good for the community.
That facility is awesome.
It's beautiful.
I hadn't seen it for a fewmonths and I was out there.
We have everything right nextto it there at North Ranch and
I'm like, oh wow, that thing iscoming together.

Speaker 3 (13:52):
It looks so good.
It's a footprint.
We're going to use that samemodel.
So we have urgent care, primarycare, specialty care, imaging
and lab and we're purposely notputting in an ER.
We want urgent care.
How do we develop centers thatare low cost, close to home, so
smart are we want urgent care?
Yeah, how do we develop centersthat are low cost, close to
home, so smart?
And we have this vision ifwe're within 10, no more than 15
minutes where you live, yeah,that's ideal.
So that center is going to goin.

(14:12):
We have another one planned fornorth meridian, out towards
highway 16, that new development.
Another one in south meridianand then really filling in the
community with access to primarycare, because the last thing we
want to do is drive patients toERs, drive patients to
inpatient care.

Speaker 1 (14:29):
We want to close the home and afford it and in theory
, dave, I mean like that'salways been the hopeful model,
right, right, I mean I thinkwhen we started Salter, then
that was kind of like that waskind of when we bought it and
then that was part of the planand it just didn't ever happen.
But that makes a lot of sense,right.
Having accessible healthcare toprimary care, keeping people

(14:56):
healthy the whole idea.
It's become harder.
How hard is it to access careright now?

Speaker 3 (14:58):
Do you know within your system, we have pretty good
access.
I think the challenge is, ifyou want a certain provider in
the primary care side, it may beharder to get into certain ones
because their panels are sofull.
We have enough new providersthat if you want to see a
primary care physician, we canget you in.
Oh good, navigating that isstill a challenge, and one of
the things we're doing iscreating a new navigation system
.
Good, this next year.

(15:19):
You and I are the same way.
You have a friend yeah, I can'tget in.
You call me and I can make afew phone calls, help connect
people and we get them in, andso we want to create that same
experience for any patient inthe Valley.
One number Call this number andwe'll help get you in and we'll
navigate that for you.

Speaker 1 (15:37):
So that's in design and development too, isn't that
one of the you know, I think aswell, we've part of.
It is just dealing with growth,incredible growth.
And you have, you know, if yougo back 20 years, we were
already talking about, 20 yearsago, physician shortages in
Idaho, and then 10 years it wasgetting worse.
And so you think about, you arealready challenged in Idaho for

(15:59):
primary care.
It's just always been a need.
And now you have this explosivegrowth.
But by anyone's prediction, noone ever anticipated this.
And now you just have Micron.
I mean, it wasn't just the firsttime, now it's the second one,
and I think everyone's just likewhat does this mean to us?
It's exciting and a littlescary.
Yeah, it's really exciting, butvery scary.

(16:20):
That's great.
And so I think you've seen Imean I have people call me all
the time hey, can you help meget in here?
I've called, I can't get in, orwhatever, and I think some of
it is navigation, because Ithink if they get pointed in the
right direction then it works.
But it's like sometimes, justso I'm really glad you're doing
that.
Tell me more about that.

Speaker 3 (16:38):
So that's step one.
We're opening up our first GMEclinic.

Speaker 2 (16:48):
Oh great.

Speaker 3 (16:48):
Post medical school going into residency, and so
we're going to have sixresidents starting just started.
July 1 in Napa.
I plan to get to 24 residentsover the next couple of years.
I didn't know that.
That's fantastic, and thereally exciting thing is four of
those six came from ICOM, righthere in the Valley, and so
keeping our students here closeto home, building a pathway.

Speaker 1 (17:07):
Well, and people don't realize that that
residents stay where they train.
So I don't know what thepercentage is nowadays, but it
just makes sense that you fallin love with the community.
If you're already building yourfamily, your life, you have
this known thing so.
So it's critical.

Speaker 3 (17:24):
It always has been, I think we're usually 50th, 49th
in the country for primary care.
Yeah, so we have to do this.

Speaker 2 (17:29):
Yeah, so really excited to get that kicked off.

Speaker 3 (17:32):
Yeah, and it's um, it's good for local kids.
You know, and as we work withthe legislature, we got to make
sure we have a good deal programand a good MD program in the
state and creating the residencyslots.
We can't just have medical.

Speaker 1 (17:43):
How has the legislature been in
receptiveness to medical Well, acouple of different buckets.
I'm going to ask you and I knowwe're going to try not to get,
but but like it do theyunderstand the medical education
, lack of primary care, lack ofaccess, or that they've been
helpful?

Speaker 3 (18:01):
I think we're trying to educate and we're trying.
It's a complex system, yeah,and I think a lot of elected
officials if you don't spendtime there, um, don't quite
understand how how it works.
How is the deal schooldifferent than MD?
How do the slots work?
What does that mean when theygo to residency?
And so I'm you know, I thinkthrough the committees that the
governor has helped stand up andthe right experts, creating the

(18:23):
right documents, the rightwhite papers to help educate is
key.
We have a lot of work, I think,to still do there this next
year to ensure that when theymake a decision around funding
and partners and those things,it it's connected to what's
going to help Idaho retainfuture physicians, cause we
can't just have medical schools.
If we don't have the residencyslots, they'll go to medical

(18:44):
school and, like you just said,they're going to go off to
residency somewhere.

Speaker 1 (18:47):
It's actually more and they won't stay.
It's more important actually.
I mean like if you didn't knowhow it worked, it's actually
like in the level of criticalneed.
It's above it, it totally isyeah, yeah.

Speaker 3 (19:00):
Well, you think how it is right you go to residency,
meet someone, start, start afamily.
Yeah, you like where you're at,you don't move, you don't move.

Speaker 1 (19:07):
Yeah well, that's, that's great.
And so then then, um, I don't,I you know, I don't know if you
know, uh, all of theimplications, but how you know,
with the big beautiful billpassing and and what it did to
medicaid and work requirements,have you guys already drilled
into what that means for idaho?

Speaker 3 (19:25):
we're still assessing , I think, our initial
assessments.
There are different parts tothe bill that we still need to
unpack, but a few key components, one being that our state just
decided to go from a value-basedcare model for Medicaid to a
managed care model over the nextthree years.
Our legislature voted on that.
Couldn't be worse timingbecause with that change those

(19:46):
payment mechanisms from thefederation federal government
changes, uh, between a vco modelversus the medicare I'm just
sitting here thinking about howI mean that is a dramatic.

Speaker 1 (19:58):
That's like taking the titanic and saying go the
other way, go that way.

Speaker 3 (20:01):
Yeah, so, because you've been planning forever the
value-based model for thatpatient population, which is a
high cost pay, and there'sseveral hundred million dollars
that comes to the state of Idahofrom the federal federal
government to help offset thelosses of Medicaid here in the
state and that gets dispersedacross rural hospitals to
hospitals like San Alphonsus Inthe new model under managed care

(20:21):
, insurance companies will takeaccountability for managing
those lives and then workingwith us.
But the payment mechanism fromthe federal government will
change under this new bill andIdaho, I think, will lose more
than any other state in thecountry that we can tell based
on what happened there, and sounfortunately they didn't at
this point address that forIdaho, so I'm not sure where

(20:43):
that's going to yet we have tosee.
Based on just today's model, weexpect San Alphonsus could lose
$35 million a year and fundingthat comes in to offset Medicaid
Just because of a fundingmechanism change.
Yeah, and, like I said, that's areally early number.
We've got a lot to unpack.

Speaker 1 (21:01):
But whatever it is, the point is that these
decisions make huge impactsdownstream and you're clipping
along just trying to take careof people.

Speaker 3 (21:09):
Right, it doesn't change how many sick people are
coming to you and people thinkthat's just money coming to the
hospital through a check.
That $35 million is not justthat.
What it is is those patients onMedicaid expansion that won't
have coverage in the future.
So what's going to happen isthey're not going to see their
primary care doctor.
They're going to wait longer,eventually end up in the ER, be
really sick, don't have accessto meds, and so then there's

(21:35):
going to be this really big costof care for an inpatient stay,
er stays, and we're going tohave to just write that off.
It's a bad debt, and so that'swhere that loss comes in.

Speaker 1 (21:40):
It's not like it's just a check coming from the
federal government for Medicaidreimbursement, right.
And the other thing that'salways been interesting to me
with, like indigent care orwhatever it's like, you pay for
it now or you pay for it later.
You're never eliminating theneed to pay for it, it's just
how you're going to pay for itand the sooner the better.
I mean you would think.

(22:01):
The other thing you know Ihaven't listened.
Well, the Robert F Kennedy thinghas been interesting for me
because I'm like a Western youare right, neanderthal and a lot
of the stuff.
When you first hear some ofeven the medical stuff he talks
about, I think still some of itis kind of out there, but a lot
of it and then you go back tohis thing on wellness and all

(22:22):
this.
So I think, going in, I'm likeI'm hopeful that someone might
be able to go back there.
But the issue is you've gotthis machine right, this thing
that is just cranking along.
Changes have deep implicationsthat affect people's lives today
, right.
Have deep implications thataffect people's lives today,
right.
And how do you make adjustmentsthat don't have unintended

(22:42):
consequences or unforced errorsthat are potentially very
difficult?

Speaker 3 (22:45):
to overcome.
Yeah, I think really what'shappened with this bill is it's
pushing all that back to thestate level.
The federal government's prettymuch saying we're out of
funding Medicaid for theexpansion population for the
most part, right, those thatreally need Medicaid are still
going to have Medicaid, and sothe states are going to each
have to figure out what to do.
What do we do?
And in the past, even here inIdaho, before Medicaid expansion
, the counties had County funds,indigent funds, those all

(23:07):
sunset right as we went toMedicaid expansion.

Speaker 1 (23:09):
So let's talk a little bit about that the way it
always worked is counties hadsome funding that came from the
state, multiple levels offunding.
Yeah, and it was just.
You know they and, by the way,there was a ton of pressure on
that.

Speaker 2 (23:21):
I don't want anyone to think like these excess funds
?

Speaker 3 (23:23):
That wasn't easy either, but at the county level.

Speaker 1 (23:25):
They were making decisions.
Okay, how are we going to usethese indigent funds to help our
little community hospitals?
I mean it was I would sit inthose meetings like with those
rural hospitals and go, oh mygosh, how do you make this work?
So it was not like you hadexcess dollars, but those funds
are now gone because theMedicaid dollars came in that
said, hey, now this is how we'regoing to take again.
You're just shifting the wayyou're taking care of the same

(23:47):
patient population, absolutely.

Speaker 3 (23:49):
Wow, yeah, so you know a lot of work to do the
next couple of years.
I do believe, though and at StAlphonse's we're committed to
this If we focus on the rightthings, we'll figure that stuff
out as we go.
What I mean by that is we havehigh-acuity specialty care for
when you really really need it,so you don't have to travel to
the University of Utah or UW.
That keeps people close to home, that lowers the cost for the
insurance companies, right, andso we're focused on that.

(24:12):
And then these access pointswe're talking about.
That's going to be key tocreating that right care
continuum with the right coststructure.
And then I think, as we partnerwith the state, we have to
partner to solve this.
It can't just be us againstthem, it has to be us getting
creative and finding solutions.
So I do worry for criticalaccess hospitals.
I think you know the largesystems have more ways to help

(24:34):
manage some of that risk.
It's going to hurt and it'sgoing to slow down new services
or investments in certain areas,but critical access hospitals
are already just right on theedge.

Speaker 1 (24:45):
Let's talk a little bit about that.
So within well, if you go backto the way hospitals are funded,
they get reimbursement ratesfor Medicareare and medicaid
that are federally, and thenthere's these fee schedules that
it's supposed to help pricefixing, but ultimately you end

(25:06):
up with these master feeschedules that have to be driven
by something, and they're oftendriven by these federal rates.
That's a probably yeah, youtell me when I say something
that's completely off.
And then what happened is, um,in critical access hospitals or
rural hospitals, they alreadyhave a hard enough time keeping
their doors open and they arecritical.
They're critical in a lot ofways.
The name is I mean, you've gotthese little hospitals that feed

(25:30):
healthcare to a lot of people.
The one I'm most familiar withwhen I started going part-time
from the ER, I would go toWeezer Memorial.
Oh yeah, and I worked there forthree years.
I'd do a 24-hour shift onFridays, yep, and I thought I
could do this forever and then Irealized I couldn't, but I
loved it.
But that's a critical accesshospital, so I know a lot about
that one.
But they would get reimbursedat 100% right, that was their

(25:58):
deal, right structure of coststructure, and so that was
helpful to them.
But even with that, it wasalways hard right.
It was always just right there,right there, like they're on
the edge always of how do westay open and how do we provide
these services.
And and so your point is, likeany change, it's a big problem
for you because changes are hard, but for if you're a critical
access possible that was alreadyon the edge it does not take

(26:18):
much to Not much 1%, half apercent, Absolutely, I mean.

Speaker 3 (26:27):
So we have a Baker city is critical access hospital
in our system and same thing Imean we usually are either right
at break even or losing alittle bit, and you know we've
made tough decisions out therearound closing services OB was
one of those, you know, a coupleof years ago and especially as
we came out of the pandemic, andI'm committed to trying to find
a way to try to bring backthose services.
I think if you live in thesesmall communities and you're two
hours away from a Boise or fivehours away to a Portland, I

(26:50):
can't imagine not having accessto basic services, and so we're
committed to trying to figurethat out.

Speaker 1 (26:55):
And, to be clear, one of the things that I sometimes
I get in conversations withpeople and I'm like, well, you
wouldn't know this, but we'retalking basic services, right,
because the system's already setup from Baker.
If you come in and you have aheart attack, you have a stroke,
you have something that'sserious, you pretty much get
stabilized and get airtransported to a higher level of

(27:16):
service.
So that's already built intothe system.
We're talking just basic stuffthat you Basic general surgery,
basic general surgery,delivering babies, delivering
yeah, just basic, basic stuff.
And I would say from the likeall my years there at Weezer I'm
guessing a little bit here, butyou know, probably once every
other shift I would have to flysomeone out from the thing, but

(27:38):
most of the time we took care ofwith that little community,
almost everything that came insomehow some way.
So you go back to cost, and whyI like bringing it up is think
about that.
It was just a little teeny ERwith a little teeny community of
physicians, but you were takingmost of the problems that
happened in that catchment areaand saying, hey, we're going to

(28:00):
figure out how to take care ofthese patients and do it amongst
ourselves.
That's very different than ifyou don't have those things and
now, well, one people are notgoing to get care.
So those things that they justget, you know, they're going to
wait too long.
Most healthcare problems, likea urinary tract infection in an
older person, a skin infectionin an older person, the longer

(28:25):
you let it go, the harder it isto treat and the sicker you get
right.
So we'll take diabetes, I meanany illness.
There is hypertension, it isprimary care, it is prevention,
and then it is having earlyaccess to early treatment that
ends up dramatically reducingcosts, reducing the cost.

Speaker 3 (28:42):
Even in small communities, even in small
communities, if not moreimportant, yeah, if not more
important.
So we're committed to that.
But we got to have partnerswith our physicians as well.
You know there's a lot of workhappening out there in Baker
city with our family physicians,because family doctors, they
Family doctors.
They practice inpatientmedicine, they practice in the
clinic, sometimes in the ER,sometimes they do endoscopy.
And if you don't have them thenyou've got to fly in a

(29:02):
hospitalist internal medicinedoctor that's just there for a
12-hour, 24-hour shift andthat's expensive and that's not
somebody that lives in thecommunity.
I love the family physicians inour rural communities.
Many of them grew up there.
They're part of the community.
You see them at church.
You see them they're outplaying soccer with your kids.

Speaker 1 (29:18):
I will, I will tell you like and this is gonna sound
like another old guy thing, Idon't know why like I'm on this
old guy kick maybe.
So I'm almost 60 days, yeah,but it's like I, I remember like
when I came out of residency inthe 90s, right and and and we
would well.
First of all I would moonlighta lot because when you're you're
so poor and you're just likesomeone will pay me 50 bucks an

(29:38):
hour to go.
You'd go, I work my tail off.
But these grizzled family docs,male and female, that just did
everything you would go from.
You're just these people thatthat was their life.
They took care of people andcome what may time of day, and
it just always blew me away.
You know, you're just thesepeople that that was their life.

(29:58):
They took care of people and income what may time of day, and
it just always blew me away.
I was like very humbling, likeyou know, doc, so and so it just
does everything for everybody.
Yeah, you, you don't realize,as they age out, you get a new
breed of doctor coming in with aseparate like one.
They probably weren't from thecommunity.
Two, they're not signing up for80 hour weeks, 60 hour weeks,

(30:24):
and so it's not a one-to-onereplacement for those folks.

Speaker 3 (30:28):
No, I'll go back to the residency then.
Yeah, it's so important that wehave residencies in the West.
So think about this yeah, withindividuals that want to live
that lifestyle, especially inthe real setting, and we keep
our own and keep our own.

Speaker 1 (30:40):
You're more likely to have an Idaho resident that
goes to an Idaho school and then, most importantly, an Idaho
residency that then stays in anIdaho community.
That is that's irreplaceable.
Irreplaceable that havingsomeone come in from outside
that's here for two or threeyears and leave and kind of
bounces around.
It's recruitment and retention.

Speaker 3 (31:01):
It totally is.
And in Baker City, I think halfthe doctors out there either
lived there or grew up there andthey came back, yeah, took care
of that community, and so youknow.
You're so right.
In the larger settings we'rehaving to go to shift work
because the doctors don't wantto work those long shifts, they
don't want to be on call at theend of a long clinic day, and so
that's adding cost to us.
We're having to adapt to thenew physician models and it's

(31:24):
also creating shortages.
Oh yeah, because in the pastJust a numbers game.
It's a numbers game.

Speaker 1 (31:29):
Yeah, gosh, we jumped right into it.

Speaker 2 (31:33):
We did.

Speaker 1 (31:34):
Which is fine.
You're a local guy man, yeah.
Yeah, Grew up here, stuckaround and I know you spent.
So you spent like 10 years atWest Valley, is that right?

Speaker 3 (31:47):
11 years, 11 years at West.

Speaker 1 (31:49):
Valley.
And then some time at St Luke'sAbout 10 years almost, yeah,
and that's where I got to knowyou pretty well there.
And then when you went to StAl's, you've like been pretty
well there.
And then when you went to StAl's, you've been Dave, let's be
honest man you've been likethis rising star that everyone's
like I wonder where this guy'sgoing to end up.
And then you end up going overto St Al's and working with
Odette and then trying to fillthose shoes, following those
small shoes.

Speaker 3 (32:10):
Big, small shoes.

Speaker 1 (32:12):
Yeah, I had the total privilege and honor to getting
pretty close to her and considerher a dear friend and mentor,
and you get to come in and takeover for her.
So how's that been?

Speaker 3 (32:25):
It's been incredible and just backing up for a minute
, it's been such an honor and aprivilege to get to serve in a
community and I've always hadthis passion for health care.
My dad was in the hospital alot as a young kid so I feel
comfortable in the hospital so Iwanted to somehow end up in
healthcare.
I thought I was going to go theclinical route.
It wasn't the right fit for me.
My brother's a NP for apulmonary group over in Bend,

(32:45):
oregon, so we both have kind ofthat passion.
Never thought I could do ithere locally.
You know it was at West Valleyand an incredible learning
experience.
They're part HCA, they know howto operate hospitals and
thought I'd have to move aroundthe country and had this
opportunity to go over to StLuke's at one point, which was a
great experience too.
I've got a lot of friends overthere, done a lot of good work.
Thought I was leaving thecommunity again right before the

(33:06):
pandemic and I love telling thestory.
When were you at St Luke's?
So I was there.
I think I started right around2010, 2011 through 2020.
So you still had Jeff Taylor.
Oh yeah, gary.

Speaker 1 (33:19):
Fletcher Jeff Taylor John Key.
Was Gary still there?

Speaker 2 (33:22):
Gary's still there yeah, yeah, man, I have such
fond memories of you.

Speaker 1 (33:25):
Know how it might be too nostalgic.
They may not be as awesome as Ithink they are, but I think
back to you know you got GaryFletcher, icon, icon, dahlberg
and then Jeff Taylor.
Jeff Taylor is kind of like theWizard of Oz, absolutely.
Yeah, he really kind of is.
He's not your typical CFO andhe's super humble behind the

(33:48):
scenes, but you think of allthis stuff and you got to work
with all of them.
By the way, I've tried to gethim on this podcast.

Speaker 2 (33:56):
Get him over here.
He's like, I'm not, I'm like.
I can't do that, I'm like, soyou're going to have to twist
his arm, so you're with thoseguys.

Speaker 1 (34:01):
Yeah, and then Learned a lot.

Speaker 3 (34:04):
And we built a lot of amazing things yeah, good
things for this community.
And so I thought I was leavingyou know it's been 10 and
thought I was going to leaveagain, and my wife didn't want
to leave, right, she's got rootshere.
I got roots here.
Both went to high schooltogether.
That's how we met.

Speaker 1 (34:20):
She went to high school too, yeah.

Speaker 3 (34:21):
So we went to Boise State and we've been all through
the Valley and we love thisarea.
Yeah, but it's tough whenyou're trying to grow a.
If you'll leave me alone, I'llcall Odette, so I called her and
Andy Costantino, who had onlybeen there a year running.

(34:42):
The Boise Hospital for them hadjust given notice and it worked
out great.
It was a God thing in a lot ofways, because had I left in
February, march of 2020, goinginto the pandemic which I had no
idea was going to happen wouldhave been awful for my family,
and so getting to stay local andwork with Odette was just an
incredible opportunity.
And you know, odette and Chrishad a great relationship.

(35:03):
Yeah, they did, you know, and Ithink me, coming over to, I've
known Chris and that team overthere a long time.
I feel like really goodrelationships and throughout the
pandemic, that was key, that wepartnered and took care of this
community.

Speaker 1 (35:13):
To be clear, it wasn't always that way.
I mean there was some seriousrivalries.
I remember when I got here inthe 90s and shortly after I got
here all the neonatal docs allpicked up and left and went over
to St Al's at one time.

Speaker 3 (35:31):
There's been some shifts there's already
cardiology stuff going on.

Speaker 1 (35:33):
So it's nice that in a community like ours with only
really two major well, hha hasbeen very important in Kane
County, but but it's the two,it's the two of you that there
is a relationship.

Speaker 3 (35:44):
Yeah, and it's important and that was great
Like during the pandemic.

Speaker 1 (35:48):
The collaboration was really impressive and that's
what we need.

Speaker 3 (35:52):
You know we have to compete.
Yeah, that's important, but weneed two healthy health systems
to care for this community.
So that's in a good spot, butwouldn't an opportunity, though,
to work for Odette?
You know, um, she's an operatorthrough and through and she was
the right fit for St Al's, forthis community during the
pandemic and, um, for all of us.
You know, we worked good 18months without taking a day off,

(36:12):
whether you're administrativeor physicians, um, an incredible
time.
But I saw her, I saw so manyaround us rise to the occasion
and just do what was needed.
So, yeah, like you said, greatopportunity to work for Odette.
I wasn't sure I was going tostep into the role or wanted to
even apply for it.
Tell me about that.

Speaker 1 (36:30):
So, before we leave her tenaciously, her Absolutely
A lot of drive.
It was super awesome.
You know, just, uh, you know,cause you, you, you meet all
sorts of people that you look upto that end up being your
mentors, and they all havedifferent qualities, but, but,
but, like I learned a lot fromOdette, yeah, yeah, and mostly
just kind of this fearlessconfidence of just hey, I'm

(36:53):
going to do the right thing, sheknew how to cut through it, I'm
going to cut through the BS andI'm going to do the right thing
.
She knew how to cut through it,I'm going to cut through the BS
and I'm going to do the rightthing all the time.

Speaker 3 (37:00):
And not just in the hospital.
She was on various boardsserved in the community and same
thing, yeah, made an impact.

Speaker 1 (37:07):
And humbly confident.
It's kind of like one of thoselead, always use words when
needed, just really reallylearned a lot, so that had to be
incredible.
But then she's leaving and youapply yeah, how's it?

Speaker 3 (37:24):
been.
It's been great.
You know we're very differentleaders.
Yeah, the things her and Ireally aligned on and connected
on was operations, you know,running really efficient, high
quality operations in thehospital.
So that was fun to worktogether with her, with her on
those things and and we did thatand we have that base already.
You know me being a kid growingup in the community, my focus is

(37:45):
shifting a little bit.
We got those operations.
We have high, high Q to care,but it's all that stuff I just
spoke to earlier around reallycreating access at a low cost
point for our community andpartnering with payers and
businesses to figure out how dowe do that for this Valley
Because, as you know, I mean thecost of living is just going
through the roof and so ifyou're in that middle income to
lower income, it's hard just tohave housing, put food on the

(38:08):
table, let alone figure out yourhealthcare, and so I want to
try and help figure out how tosolve that.
You know there's lots offactors besides just government
payers.
We've got rising costs, tariffs, inflation, wage cost pressures
, but I'm committed to thepressure.
How do we do that Everywhere?

Speaker 1 (38:21):
Yeah, yeah, well, I commend you.
I mean that's if you thinkabout, if you think about a
family budget, right, and justwhere.
Well, I, here's a story fromyesterday.
We started a little thing withoperation military blessings.
We do a lot with them and andTom Wessel is an unbelievable
guy but he found out that theywere very short on diapers and

(38:43):
formula for the L1, the levelone military families, who are
39% of them are food insecure,think about that.
So we had this little pressconference here yesterday, like,
think about that.
But so we had this little pressconference here yesterday and I
told alex I said, hey, run overand grab for, go over and grab,
um, some diapers and someformula for the table.

(39:04):
And she came back and I saidhow much was that?
It had to be like she's like itwas 400 bucks.
So so my point is like and youthink about, yeah, diapers,
formula, car, just the inflationwe've had, and then on top of
that you put healthcare costs,however you're trying to figure
it out as a family there are alot of pressures when you think

(39:28):
about that young family the kidsout at the baseball field falls
down whatever happens.

Speaker 3 (39:33):
Whatever happens, you end up in the ER.
That's a $2,500 to $3,000's a2500 to 3000 3500 bill.
Urgent care at least is maybeless than 300.

Speaker 1 (39:41):
yeah, right, so that's why those helping create
the right access it's awesome wecan't change all the costs
right, we can't change no, butyou can't get them to the right
level of care, right spot andand it should help the ers, by
the way, too where, where you'vegot an aging, the other thing
that's happening.
You know this better name whatanyone is you have an aging
population.
You have sicker people.
I talk to my old partners nowand it's like how are you doing?

(40:01):
And they're like good, butremember the good old days where
you would have one or tworeally sick people and then
you'd have this big populationof kind of healthy people that
are coming in for it.

Speaker 3 (40:11):
It's now just sick people, sick people, and we're
seeing that in the hospital postpandemic.
You know we took a lot ofsurgeries out of the hospitals
during the pandemic and we triedto figure out how to do them
out patient, which that wasalways a trend, yeah, for years.
But the pandemic sped that upso we had to reshape our boise
hospitals inpatient beds so wehave very little inpatient
orthopedics now.
We had a whole floor oforthopedics before, 30 some beds

(40:32):
.
They're sending people homelike same day.
Same day you go have a hip andyou're like hey yeah, it's
incredible but it's also it'sadvanced technology
right, very much.
High acuity centers.
Yeah, I mean, I don't doubt inthe near future you're hardly
going to have a general medicalsurgical for bed.

Speaker 1 (40:48):
It's all going to be high acuity, critical care,
telemetry, step down how are wedoing demographically here with
our aging population and and doyou worry?
I mean you know it's funnybecause you heard a lot about it
like 15 years ago Everyone wasworried about, hey, the boomers
and the demographics, and hey,here it's coming and I think the
pandemic hit and it sucked upall the oxygen and then there's

(41:11):
just all this other stuff that.
But I was actually thinking theother day I'm like it's been,
you know, or we're gettingcloser, and if you look at those
curves, it happens, we'reexperiencing it.

Speaker 3 (41:22):
Is it?
Is it happening?
Already there's a few thingsthat are happening in the Valley
.
One we have that agingdemographic.
That's also who's moving intothe Valley, yeah, and it's
interesting kind of that 55 to65, fairly well-off individual.
They're needing lots of kneebecause they're active.
Yeah, knees, spine surgeries,pts.
So we have that kind ofpopulation.
I am that type of guy.

(41:42):
We'd like to have fun.
We're out mountain biking.
We're horseback riding, atvs,whatever it is, but they have a
pretty high utilization ofhealthcare.
So that's one population.
Then that's right.
When you get into Medicare agethey're still just as active.
And so I know for both healthsystems speaking for ours we're
seeing a shift from thatcommercial age group into more

(42:03):
of a Medicare age group, whichalso has impacts because that
reimbursement rate is sodifferent.
Oh, I hadn't ever thought ofthat.
That's occurring.
And at the same time you haveand I get why you have, you know
, the physician-owned surgerycenters and some.
So those centers pulling outthat commercial population.
So the hospitals are trying toreally figure out how do we
manage that.
And you know, for us we didopen up our own surgery center

(42:25):
that is an ASC, that isreimbursed at an ASC level
versus a hospital based level.
And I think that's key as wekeep thinking about that cost
structure.
But with the demographicchanges we got to keep adjusting
for that and figure out how dowe, how do we come around,
because it is changing.
And then you look at our birthrates in the valley the rates

(42:45):
are staying, are actuallydecreasing, but the number's
pretty flat.
So you'd think with all thispopulation growth we should have
a lot more babies coming in.
There's a lot, not a lot morebabies because of that people
aren't making babies like theydid no, and so we have to keep
adapting.
What type of services do weneed?
So we need more nephrology,urology, pulmonary medicine to
help with an aging population.

Speaker 1 (43:06):
Talk a little bit about physician recruitment in
the different specialties whereyou see some of the greatest
needs or the hardest specialtiesto recruit.

Speaker 3 (43:16):
It's really primary care, is it?
We've done pretty good withmost specialties.
The one specialty would beneurology.
That's been a tough one hereand nationally.
I mean a lot of organizationslook into J-1s or some other way
to bring in some out-of-countryexperience.
Outside of that, we've donefairly well.
Sometimes it takes a while, butprimary care is a national

(43:38):
problem, but here especially so.
That's why that GME program wetalked about is important.
You don't want to dive too deepinto the women's health topic,
right, there's a lot to unpackthere, but OB and women's health
is a big problem for the stateto ensure we have that access.
So we've got to keep working onthat one to try and get us to a
point that we can ensure accessto care there.

Speaker 1 (43:58):
Yeah, I mean it's probably a whole episode because
there's just so much going onwith it.
And go back to the primary carething.
Is there anything like peoplelistening to this should know or
could help with, becauseultimately that becomes a
problem?
And, by the way, we got the CEOof the largest or second

(44:20):
largest you know hospital herein the Valley here.
Can you imagine if we weretalking to anyone in rural ish
Idaho, like don't even takerural, but like if you just go
that next tier down, they gottabe just you know, really hurting
for me.

Speaker 3 (44:35):
Yeah, you know, um, support from the state's always
important.
Think about if you're a familydoctor.
Though you come out, you havedebt, several hundred thousand
dollars, and those physiciansdon't make what a specialist
makes.
Got young families and sothey're trying to figure out
where do I go and how do I makethat happen.
And then you come to Boise, whoused to have a low cost of

(44:57):
living, so it made it eveneasier to bring in these primary
care doctors.

Speaker 1 (45:00):
Man.
It used to be so easy torecruit.

Speaker 3 (45:01):
So much easier.

Speaker 1 (45:02):
We'd interview our groups and they'd come here and
wherever they came from, they'relike, oh great, you have the
outdoors, you have the culture,you have the river, you have
this heritage, family,everything you have here.
And then it's like was itinexpensive to buy a house?
And now it's like, not, it'snot.
You're on the other end of it.

Speaker 3 (45:20):
We've had to create housing stipend programs for
nursing and physicians I meaneven specialists who make very
good incomes come to Valley andlike this is incredible for what
I have to pay for a houseversus even other parts of the
country now.
So it's a new dynamic we'redealing with.
When we recruit here, it'speople that want to be here or
used to live here, so we havethe primary care investment we

(45:42):
just can't stop.
Or used to live here, so wehave the primary care investment
.
We just can't stop.
We have some pretty big, boldgoals at Al's to recruit into
the Valley and retain for sureany of the ones coming out of
residency, because our localresidents are incredible and we
can't lose one.

Speaker 1 (45:56):
I have a couple other .
I just looked down and it's1043 already AI.
So if you could tell a quickstory, and then I'm'm gonna ask
you because I I have a.
I have a friend of mine who'sbrilliant, uh, his name's fahim
rahim and he's a.
He's a nephrologist over inpocatello.
Incredible story because hecomes over to america, him and
his brother, nahim rahim, andthey have like a few hundred

(46:18):
bucks.
They land in new york and thestory it's a true story.
They look at a map saying wheredon't we have any nephrologists
?
And this was like 25 years agoand the, the place in the
country 25 years ago with thefewest and with the largest
encampment area and nonephrologist was pocatello.
So they come to pocatello andthey set up their life, so and
they're incredible human beings,entrepreneurs.

(46:40):
But he calls me a year and ahalf ago and he's like I have
got this company I'm starting asthe next big thing and he
talked about he's doing an AIcompany for nephrologists, so
pretty tied down.
But I want to get there and I'mlike, well, hey, I'm like I
don't even know.
I better know how to spell AI.
So I'm just like, tell me moreabout this.

(47:03):
But it uses.
So his technology it's nowlaunching.
Now Nephrolytics is the name ofthe company, but it uses three
forms of AI.
So the first one and this hasbeen in development for years,
but first one is you walk intothe room, the physician lets the
patient know, hey, I'm going tobe recording our conversation,

(47:27):
and then they're pretty goodabout knowing that they're.
This is normal.
The one thing that you don'trealize is there's when you walk
into a room, because you'realready thinking this way
history of present illness.
You have to ask all thesequestions anyway.
So then they ask the questions.
The recorder is catching it all.
It's auto charting the entireinteraction with the patient.
So then that's done so thatwhen he, when, when you go to uh
chart, that in theory is alldone already.

(47:49):
The second part of the ai isbecause nephrology is so uh data
driven you know what are yourlabs doing, you know how are
they compared to your last labsas they track your creatinine
and all the other stuff thatthat's been done before the
visit so that all auto uploadsinto the, into the chart, and
gives a big giant summary notethat's already written of hey,

(48:11):
mrs jones has been had a.
You know this is what'shappening with her and this is
so, that's done.
Yep, and then the third thingwhich is like blew my mind is
now.
It says okay, mrs jones has allthis stuff, this history has
been loaded.
Here's where her new thing is.
It takes in what.
What's happening with her now,all the vital signs, everything
here is the treatmentrecommendations for mrs jones,

(48:32):
based on all of the data and man.
I'm like this is cool, amazing,yeah, so are you seeing kind of
similar things on all fronts?

Speaker 3 (48:41):
absolutely, absolutely.
So.
We use a program called DAX.
We've been piloting herelocally DAX it's called DAX
D-A-X-E, okay, and basicallyit's the same thing Active
listening While the physicianwe've been trying it with our
primary care doctors listens,does the same, creates the note.
Doc can go into a quick summary.
We think providers can.
What we're seeing is anywherefrom about three patients more

(49:03):
per day, or it takes care oftheir pillow time at night.
We call it right.
You're close for the day,taking away those two hours of
documentation.
So that's working amazing andwe're rolling that out through
the whole group.
We've used AI for a couple ofyears now on imaging studies to,
because as you come in forwhatever study, it may be for a
certain purpose, you know theradiologist tries to check for

(49:24):
anything, but they're movingthrough hundreds of images.
So the ai technology basicallyscans through every image and if
something flags, it sends itback to the radiologist to look
at it, typically looking forcancers or those types of things
and then if they see example isyou?

Speaker 1 (49:38):
you come in because you think you broke your rib.
I shoot a checks x-ray and Iand say, oh, you didn't break
your rib, or you did break yourrib.
That chest x-ray has all theother data of oh, there's a
nodule in the left upper lobe CTscans, x-rays.
Oh, wow, that's cool.

Speaker 3 (49:51):
So then that way at least somebody can make an
informed decision.
Do they want to seek additionalcare?
And so that's amazingtechnology, because then are
putting the power back to thepatient and the provider, and
they may not have known orcaught things.
So that's amazing technology.
You know, on the inpatient sidewe're going to start testing it
the same way with nurses,because think how much time
nurses spend documenting,actually caring for their

(50:11):
patients at the bedside, and soif that active listening
technology can be used to getthem back to the bedside and
just being, you want to?

Speaker 1 (50:18):
know what I love more about it, because the old guy
thing again, like there was adramatic change.
So we used to have liketraining, like for all the new
docs, like hey, grab a stool,sit down, scooch up to the
patient, like, look them in theeye, have a conversation with
them, right.
And then you had all of asudden this change where you
would wheel in a cart, right,and you went from hey, dave, I'm

(50:41):
here to take care of you toLooking at the computer right,
and you went from hey, hey, dave, I'm here to take care of you
to looking at the computer.
Hey, when was the last time youwere in?
Yeah, and it just changedeverything.
So the one thing that thatfahim was saying is the nice
thing about this is now you'reback to engaging.
I mean, think about this.
You're now back to talking to apatient again.
So it's, it's awesome, awesometechnology yeah, how much do you
think it's going to save if youguys you guys have to know this

(51:02):
because you're so smart as youget through this FTE crunch and
kind of the future of medicine.
Has anyone done studies on theefficiencies and what it may
mean to the overall cost of care?

Speaker 3 (51:14):
I think it's cost of care and it's staffing, because
we're all struggling withstaffing, so it's both being
more effective, more efficientwith our time.
So we need less physicians,less nurses, to fill the future
need because, as that agingpopulation, we're going to need
more care, so that's going tohelp, I think, adjust for some
of that.
I don't know the numbers offthe top of my head, but
absolutely.
But I'd say it is better,absolutely better.
The other thing that I think ispretty exciting is so much of

(51:37):
the healthcare cost is inbilling and all that back-end
process work too, and AI shouldbe able to help automate the
vast majority of all that codingdocumentation, versus having
individuals have to scrub charts, figure out how to code it, and
it should be more accurate, too, as it flows right out the
system, and then there's just areview audit process.

(51:57):
I'm excited about that to reducethat cost as well just so we
can help streamline that processin the future.
That's great.
A dream would be the pairs dothe same thing, we actually
collaborate.
It's a really nice processinstead of the back and forth
that can occur, right.

Speaker 1 (52:11):
But pipe dreams pipe dreams, yeah that, that that
layer, that tension, thathealthy tension, that, whatever
you want to call it, is, uh, youknow it's always been part of
it, but uh, ever, uh, everchanging, right, ever changing.
Yeah, yeah, um, how has thisbeen working for Trinity?

Speaker 3 (52:29):
You know, um, people say all the time you kind of
hate working for a largenational company.
Um, trinity is not that way.
Um, if you ever get the chanceto sit down with the senior
leadership at Trinity, we'rebased out of Michigan, just just
outside of detroit and livonia.
Um, you know, we're catholicbased, faith-based organization
and salt of the earth justincredible people.

Speaker 1 (52:50):
So I'll tell you a quick story.
I got to go there with odette,did you okay?
So we went back and met withtheir top brass and went into
the conference room and and, um,very nice people, um.
The one negative for them isthey were all Detroit baseball
fans.

Speaker 2 (53:07):
It was like the start of the season.

Speaker 3 (53:08):
They'd already lost all their mojo right.
They're pretty proud back therewith their sports teams Sports
teams.

Speaker 1 (53:13):
But we get in there and we sit down and the first
thing they said was who wants totake a mission minute?
And I wasn't ready for that.
And what was cool about it isI'm trying to remember the name
of the the ceo, but veryimpressive, um, very impressive,
yeah, mike.
But he looked at us and said,hey, would one of you like to do
the mission minute today?

(53:34):
And by sheer luck, sheer luckthat morning was the meridian
mayor's prayer breakfast and Igave, I gave the thought there,
so I'm like you, like polishedit off.
He was impressed, but I didn'tever tell him.
It's just because I just did itthis morning.
Anyway, it was really cool.
It was awesome that the first15 minutes of that meeting was
talking about patient care,talking about why we do this,

(53:55):
talking about, hey, this isservice-based.
It was really I mean, I'm notjust we walked out of there and
I'm like, oh yeah, just genuine,I mean we're going in and
there's no reason that thatcould have been part of the
meeting and we spent the first15 minutes kind of level,
setting on why we're doing whatwe do, absolutely.

Speaker 3 (54:11):
I was blown away.
You meet with our teams herelocally.
You'll get that sense right.
That's who we are, that's ourpassion, our mission, um.
But when you have that at thehome office team, the system
office team, it penetrates allthe work that we do and how we
make decisions.
And when we're making toughdecisions, you know, we, we, we
call it discernment process andwe, we look at it from all
angles, not just financial.
What's it mean for ourcommunities?

(54:32):
And so to have that supportfrom them is incredible, um, and
to have a national presence wehave over a hundred hospitals
nationally, so I can pick up thephone, talk to a friend in New
York or Florida and say, hey,I'm dealing with this problem,
you have any ideas?
And we get together as a CEOteam.
There's 12 of us that report upinto the system office every
two weeks.
Uh, we get together four to sixtimes a year in person, uh,

(54:53):
spend several days together justbrainstorming what's happening
across the country and how canwe bring that back to our local
markets to help makeimprovements and, uh,
investments, and so that's,that's unique and special and
we're all aligned.
I mean you can go to ourFlorida hospitals and you'd
experience the same type ofculture and passion, which is
pretty cool.

Speaker 1 (55:11):
And then as a consumer of healthcare here with
you guys, I mean what greatexperiences.
Yeah, I've had incredibleclinicians, some heart stuff
going on for the last few yearsand man, it's been great.
It's been the highest qualitycare.
We're really blessed, aren't we?
Dave, very blessed For our sizecommunity.
We're done for our sizecommunity.

Speaker 3 (55:31):
Man, we're blessed.
Well, and, as you know, youdraw that circle around Boise.
We're one of the most remotecommunities in the country,
especially in health care, as itrelates to how far do I have to
get to get to an academiccenter and we are the most
remote and so you know St Alicehas been committed over the last
decade to really bringing inthose specialists so you don't
have to go to Utah and we havethem and they love being here

(55:52):
and they're part of thecommunity and we don't want to
ever have to use them.
But to know they're there andwe have that backstop is well
hey, buddy, you're a tremendousleader.

Speaker 1 (56:02):
they're lucky to have you and it's going to be
wonderful to watch you shapehealthcare here, and we're lucky
that a local kid is passionatehere in your own community to be
the CEO of a giant organization.
How many employees do you have?

Speaker 3 (56:16):
here, so between here and our Fresno hospital about
9,000.
Yeah, 7,500 here locally.

Speaker 1 (56:20):
Wow, 7,500.
Well, we're in good hands,thank you.
Thank you for what you do andwe wanted to have you on, since
you took over, to just talkhealthcare and this was good and
I just really appreciate you,man.
Yeah.

Speaker 3 (56:34):
Thank you, thanks for the opportunity.
Thanks, good to see you.
Thanks everybody.