Industry Insights: A healthcare podcast presented by Novant Health

Denise Mihal discussed the acceleration of a nationwide nursing shortage in Part 1. Listen here. Interested to learn more on the devastating cost of ignoring workforce burnout? Dr. Thomas Jenike weighs in. 

How an unprecedented pandemic and lucrative incentives from travel agencies have accelerated a nationwide nursing shortage, according to Denise Mihal, EVP and chief nursing and clinical operations officer. And more importantly, how leaders are paving a path forward in the first of this two-part series from Novant Health.

Listen to Part 1 here.Alica Sparling  00:00You have to have innovative positions and you have to bring in a new way of thinking that complements the decision making and focus on economic value.Gina DiPietro  00:14That's Alica Sparling on her innovative role as Novant Health vice president senior healthcare economist. And you're listening to Industry Insights: A healthcare podcast presented by Novant Health. I'm Gina DiPietro, your host, here with part two of our series on healthcare economics. It's often used by government agencies, tech companies like Google and Amazon, and in academia. There's now a growing demand for healthcare data scientists, as you heard in part one. A deeper dive in this episode on using incentives to modify people's behavior, and the role of health economics as organizations navigate a large-scale crisis like a pandemic. Here again is Alica who begins with more on her health disparities research.Alica Sparling  01:02I really like the focus on health equity, and the social impact that I see in the health industry right now. When we think about costs and when we think about effectiveness, you cannot think about the patient population as being one big homogenous group. We have patients with different constraints and different backgrounds, and it's a very diverse, heterogeneous group. And when we make improvements, we need to be paying attention to who is benefiting, and who is being left behind. So, look at how the new drug or how the new implant or how the new service is going to effect not only cost and effectiveness, but also equity. In other words, what is their effect separately on vulnerable populations? Whether we define them by race, ethnicity, or by socioeconomic status (or some kind of combination) versus the majority.Gina DiPietro  01:55When those gaps or disparities are found, you said that it's led by the clinicians as far as figuring out how to solve that. But are you part of the solution, as well? And if so, how do you play a part in helping to close that gap?Alica Sparling  02:10Yes, definitely. We are providers of healthcare. So, any solutions are going to involve providing health care. Closing equity gaps is led by clinicians, and their input is invaluable. But health services scientists and social science studies disparities and health equity issues, as well. So their contribution is very important, as is the contribution of data people. So you have to collaborate on these interventions.Gina DiPietro  02:35Gina here with a quick recap from part one. And there's still time to hit that pause button and listen to our first discussion. So, PhD economists are trained in econometrics - a combination of math, statistics and economic theory. It transforms data and theoretical concepts into useful tools for decision making. Think of Alica as an internal economic consultant. She's a link between the data and people who can influence change. Now, back to Alica who was explaining how data analysis can be used to improve health equity.Alica Sparling  03:08These interventions are usually either some kind of outreach to patients, helping break down barriers for patients to receive care, helping providers provide better care and maybe be more aware of disparities. So, you need to do a data analysis to really understand what are the barriers for vulnerable populations. Maybe it is the fact that they don't have transportation to get there. Maybe it's the fact your office closes too early, and they have to work and they are not able to go somewhere after 5pm. You need to know exactly what's driving the decision making. And if you want to change their decision making, then you have to create an intervention that is focused and enables the patient to change that behavior. Every time you do an intervention like that, immediately think about how you're going to measure the impact of that intervention. Do you have good metrics? How will you know if it's working or not? And so incorporate that, too. Before you spend too many resources on anything, you should know if it's working.Gina DiPietro  04:08People respond to incentives, and you mentioned a few that have worked. Does anything else come to mind?Alica Sparling  04:15Yes, it's interesting. So we talked about patients. So, let's talk about providers a little bit. So for providers, when you think about incentives, the first one that comes to mind, of course, is the economic incentive - payments to physicians or nurses for something that you want them to do or focus on. There are also non-monetary incentives, or behavioral nudges, that work. And that could be, for example, peer comparison. You can just tell people, 'This is what you're doing. This is what other people are doing.' And that works very well, evidence shows. Education always works. People sometimes don't know what's right. So, having evidence-based care and educating people about the proper way to disseminate information. And the last thing is what we call the clinical decision support. With the help of computers, you can also give incentives to providers to do certain things over others. Just simply by how (and what) you position on their screens. If you don't want them to do something, make it difficult to do. Let's say it takes three clicks to do one thing versus something that you want them to do. You can actually position that on top of a pulldown menu and then they're more likely to do that. So, these are the behavioral nudges that are helping with incentives and getting us to modify provider behavior.Gina DiPietro  05:30I'm also curious, what's the impact of a position like a healthcare economist for organizations as they navigate a large-scale crisis like the pandemic? What does that look like? And what's the value both directly and indirectly?Alica Sparling  05:48The effect of the pandemic on the healthcare system (or on a hospital system, a provider or a patient) is definitely a question that economists can address. And they can help think through all of the effects and help leaders. For example, with the pandemic, a question you can ask is what is happening to the population size? If the population size is contracting, then on the macro-level you can expect aggregate demand to fall. You can expect also the labor supply to fall. If people are getting sick, then you can expect an increase in demand for medical care. With COVID-19, we have seen an increase in demand for Emergency Departments and for ICUs. So, we can consider the labor force. Do we have enough people to care for patients? Is the labor force itself changing? And for example, one of the things we have seen is that there has been an increase of traveling nurses, which partially have been needed because we needed more labor force in the ICUs. But maybe partially what is happening is that nurses are changing from being in their traditional roles to the roles of traveling nurses, because maybe the financial incentives are there to make the switch. So, if there is a change in the labor force and how the services are provided, how does that change the product itself? That's going to effect both quality and costs, and patients' wellbeing.Gina DiPietro  07:18What other companies or industries or types of organizations are employing health economists, or alternatively, have not yet gone there, but probably should?Alica Sparling  07:29First of all, health economics has been around for a long time. But traditionally, health economists have been employed in academia, in government agencies like Medicare. The Congressional Budget Office has health economists who are very important. You also have health economists that have been hired at health insurance companies. They have not been that prevalent in health systems like Novant Health. But I can foresee that changing. And I see that there is a lot of work for health economists within health systems. Each health system can tailor the role of the health economist to what is important for them and where they have gaps. I could see that some health economists might be focused only on economic evaluation, especially if their background is in pharmacoeconomics, because it's almost like it's a specialization within health economics. Or maybe some large health systems would have specializations that are focused only on behavioral economics. So, creating these new programs and incentives and figuring out the proper ways to evaulate. You can employ theoretical knowledge from behavioral economics about behavioral nudges. Or you can have economists who are more generalists; that can be brought in to help with brainstorming and questions - doing this kind of internal consulting. And also oversee and help with more sophisticated data analysis. Like, how are these different variables and things related to each other? And that requires more sophisticated techniques. And that can be done through statistics. It can be done through artificial intelligence (AI) and machine learning (ML). And depending on the question, you choose which method is correct. And you see this done a lot outside of healthcare. There has been a lot of hiring of economists, for example, by Google or by Amazon, where they are conducting some really rigorous statistical analysis to better understand the population of their consumers.Gina DiPietro  09:29Novant Health CEO Carl Armato and Dr. Eric Eskioglu - they saw the value in hiring you as a vice president senior healthcare economist. But what would you say to a decision maker at a company who's been fighting to get a position like yours created but hasn't yet been successful?Alica Sparling  09:49Well, of course, go for it! I am very fortunate and I'm very grateful to have this position. And I think it is an important position to have in this world of constant change. You have to innovative and you have to bring in a new way of thinking that complements the decision making. And Novant Health is being innovative by hiring an economist and focusing on economic value.Gina DiPietro  10:12You're just getting started at Novant Health. What are you most excited about as you sort of dig into this work?Alica Sparling  10:20The flexibility of this position. How innovative it is. And how we are targeting things that I really think are the most important ones to target with health economics. We want to eliminate unwarranted clinical variation, improve health equity and social impact, and give incentives to provide value. And I am involved in all of this. And I get to work across the whole organization with leaders and clinicians. And it's work that is ultimately important for patients, and is going to improve the way we provide care. And we will provide it at a lower cost, which is ultimately also good for the patients' access to care.Gina DiPietro  11:05I know you've worked in academia. Is there anything that's surprised you so far about being in this healthcare space?Alica Sparling  11:14When you work with students, you see stars in their eyes. They're very happy and excited and curious and want to learn. Well, I see the same thing with people who are my age peers, who are leaders, who are doctors. They have natural intellectual curiosity, and want to make the world a better place. They want to learn and do new things, and that's everywhere - regardless of age and positions. And that is very encouraging. It's a wonderful thing to see.Gina DiPietro  11:47Thank you for listening to this episode of Industry Insights. Find others, like how AI is improving health outcomes, on the Industry Insights channel of the Novant Health podcast family. Listen on Apple, Google, Spotify, or anywhere you get your podcasts. I'm your host, Gina DiPietro, and hope to see you back here real soon.Listen to Part 1 of our series on healthcare economics here.

Gina DiPietro  0:04  Health economics plays a role across many industries - in government, academia and major tech companies like Google, Amazon and AirBnB. And no surprise healthcare is taking note as health systems face of quickly moving landscape of complex regulations and financial challenges, while also balancing patient care. But despite what the job of a health economist might sound like, it's not just about driving down costs.Alica Sparling  0:32  There's common misunderstanding that it is only about cost effectiveness analysis. Or other people might be thinking about economics only as concerning macroeconomic issues, such as unemployment and inflation. It can be any of the above, or it can be a combination of all. Fundamentally, economics is a study of human behavior. How we - patients, providers, hospital administrators, organizations - make decisions on how to best use our scarce resources. And by that I mean money, time, skill set ... and we want to get the biggest bang for our buck.Gina DiPietro  1:07  Alica Sparling weighs in on her new role at Novant Health as vice president senior healthcare economist. And you're listening to Industry Insights: A healthcare podcast presented by Novant Health. I'm Gina DiPietro, your host. Welcome to part one of a deep dive into healthcare economics - a study of how resources are allocated and what incentives people respond to, with an ultimate goal of increasing the value of care for patients. So what is health economics? It's much more complex than that. It's a question best answered by the expert.Alica Sparling  1:42  So the task of a health economist is to acknowledge that there are multiple decision makers, goals and constraints, and to design incentives accordingly. And my job is to help the healthcare system, Novant Health, to improve efficiency of existing programs and services, identify new opportunities, and design incentives that align the goals of patients, providers, and the organization itself. The ultimate goal, of course, is to increase the value of our care for the patient. So we want to improve the quality of care and lower the costs.Gina DiPietro  2:15  It's interesting because you are a data scientist. So on one hand, health economics can be very analytical. It's data driven. But as you mentioned, it's also a study of human behavior. I just think it's such an interesting intersectionAlica Sparling  2:36  And I love that about it. I love that it's the study of human behavior. But you're really using data to study this behavior. You look for patterns and that's how you support the clinicians. And that's how you support leaders of health systems to provide better healthcare. And this is something that is possible to do only with the introduction of EHRs. And that's probably why you see now an influx of health economists, because we can do the work which was not possible to do before EHRs.Gina DiPietro  3:05  Could you define for me EHR?Alica Sparling  3:09  Electronic health records. There was usually a paper trail behind every visit at a doctor's office or in a hospital. But ever since we started to create electronic health records, we started to input everything that happens during patient visits. And now we have this big system of data and this wealth of information that has been accumulated over many years now. We know about the patient's history, we know about patient's care, and we know about patient's outcomes. We can actually use all this data to discover patterns and to better understand what works and what doesn't.Gina DiPietro  3:46  This reminds me of another recent conversation with Dr. Eric Eskioglu, Novant Health executive vice president and chief medical officer, on how health systems are using artificial intelligence to put all that patient data to good use. Listen to our discussion on how AI is improving health outcomes, and also lowering costs on the Industry Insights podcast channel. Health economics is another piece of that AI puzzle and the new role at Novant Health.Alica Sparling  4:16  I'm so grateful and thrilled that Novant Health CEO Carl Armato and Dr. Eric Eskioglu, who actually hired me, had the vision to create the position. And I have now the opportunity to help mold it and fine tune the scope - something that will work both with Novant Health's culture and also be responsive to the changing world of healthcare. And I view this position as one of these new innovative positions that health systems have and it is really important to have positions like that in this current world of constant change. I hope that this will help us set a standard in the industry and maybe we can become a role model for others and share from our experiences.Gina DiPietro  4:55  While she reports to Dr. Eskioglu, Alica's job requires flexibility and collaboration across the organization - functions like finance, diversity and inclusion, supply chain, payer strategy and consumer engagement. Think of her as an internal economic consultant.Alica Sparling  5:13  A lot of my time is spent in the group that's called the Economic Value Enhancement group. So, this is a group of senior leaders from the organization with a lot of experience. Every person has at least 20 years of experience in the healthcare industry. And all of our initiatives and projects start with the imperative of ensuring safety and quality, and health equity. This group aims to increase value to our patients by improving clinical outcomes and reducing cost of care. And we do this right now by focusing on identification and elimination of unwarranted clinical variation. So, once we identify variation in how our providers order imaging, order drugs, or order labs - what we want to do is to design programs and interventions that align incentives.Gina DiPietro  6:05  This role is complex. So let's pause to clarify. All PhD economists are trained in econometrics, which is basically advanced statistics and data science. Think of Alica as a link between the data people and decision makers, like clinical leaders or administrators. Together, they apply this knowledge, this data, to find solutions that improve patient care.Alica Sparling  6:29  And all of this work, again, is done using data. So we use the data science tools - artificial intellience (AI) and machine learning (ML) - to both identify the variation and also help us design these programs and interventions. The design of interventions is led by the clinicians, and our group supports them. Then, we want to evaluate all of these new interventions. Again, health economists can help step in with the proper methodology, whether it's the budget impact analysis, or cost effectiveness analysis. Ultimately, limiting unwarranted clinical variation improves efficiency of care, and it helps us also drive down the cost of care. That, in turn, improves access to medical care for vulnerable populations, and can help reduce disparities in health. I can help for example, to design health equity metrics for a provider-peer comparison tool, and again, drawing on literature and drawing on evidence. So, in some cases, what's needed is not just a consultation, but actually a data analysis deep dive. Because I am a trained data scientist, and I am trained in econometrics and statistical methods, I can actually roll up my sleeves and I can get the data. And I can conduct the regression analysis that's needed and interpret the data. That kind of work. Even the short time since I've been here, this has been needed both in the area of health equity and in the area of value-based care. So, I have been engaged in a couple of projects where we are actively conducting statistical analysis, regression analysis and interpreting the results.Gina DiPietro  8:07  It's interesting that you mentioned the health equity and disparities research. I think a lot of the focus in the industry has only been on cost effectiveness. And that doesn't take into consideration how diverse the populations that Novant Health serves and provides care for are.Alica Sparling  8:25  You are very correct, Gina. I really like the focus on health equity, and the social impact that I see in the health industry right now. When we think about costs, and when we think about effectiveness, you cannot be thinking about the whole patient population as being one big homogenous group. We have patients with different constraints and different backgrounds. And it's a very diverse, heterogeneous group. And when we make improvements, we need to be paying attention to who is benefiting and who is being left behind. Don't look only at cost effectiveness for the overall patient population, but break it down. So, look at how the new drug, or how the new implant, or how the new service is going to affect not only cost and effectiveness, but also equity. In other words, what is their effect separately on vulnerable populations (whether we define them by race, ethnicity, by socioeconomic status, or some kind of combination) versus the majority.Gina DiPietro  9:29  Thank you for listening to this episode of Industry Insights: A healthcare podcast presented by Novant Health. In part two, Alica and I take a deeper dive into her health disparities research, how incentives can change people's behavior, and the role of health economics as organizations navigate a large-scale crisis like a pandemic. Until then, find other episodes on Apple, Google, Spotify, or anywhere you listen to Novant Health podcasts.

Gina DiPietro  0:04  With the acceleration of remote work, today's job seekers have lots of options. And they're savvy researchers of potential companies; interested, of course, in salary and benefits, but other differentiators like flexibility and company culture. What do people seem to value? Is it inclusive? Would I belong?Carmen Canales  0:27  I'm very focused on inclusion and belonging, because I certainly have been invited to participate in things and it was not lost on me that they needed me for representation. You know, often I had been the only woman in the room, or the only Latin person. Representation matters to allow us to feel safe, to not feel alone, you know, to have a kindred spirit. That's not the only thing that matters, but we can't discount how important it is. Gina DiPietro  0:56  That's Carmen Canales, Novant Health senior vice president and chief people officer, and you're listening to Industry Insights: A healthcare podcast presented by Novant Health. I'm your host, Gina DiPietro. Instead of focusing on personnel management or administrative tasks, today's HR departments increasingly spend their energies on employee engagement and strengthening culture. Listen as Carmen explains a forward-thinking approach that organizations are taking when it comes to ditching traditional views of HR. Thank you for listening. Gina DiPietro  1:31  Carmen, you prompted the renaming of Human Resources at Novant Health to the People and Culture division. What exactly does that mean? And why did it seem like the time to adopt this title? Carmen Canales  1:44  Thank you, Gina. I had the opportunity to come in and to assess the Human Resources team and was asked to do a bit of a turnaround. I had an opportunity to spend time listening. I was able to hear that while folks had good relationships in some cases or good experiences with the then Human Resources team, they weren't consistent. We had operational issues. Things took too long. We weren't transparent about how things were done. And so listening to the people that we serve, and with whom we have the privilege to work, really informed that people want a People and Culture team to be at the table. It was the time to say you know what, 'We are not a traditional HR team. We are not old fashioned. We are not here to have red tape. We are here for you. We share the same goals that you have. We understand your concerns.' Nothing about us is intended to be negative or punitive. Gina DiPietro  2:41  I think that's great because historically, I do think a lot of employees have a negative connotation about HR. Carmen Canales  2:49  You know, there are TV shows about it. There are memes about it. There's everything out there about how HR is the HR police or how you're in trouble with HR. And I would just say, that cannot be further from the truth. We are here to understand the strategy, to inform the strategy and to solve problems. So, we are all about the people and all about the culture that we're creating. Additionally, it really speaks to our desire and our focus on ensuring that we are an inclusive place where everyone can thrive, where everyone can belong. From somebody who was raised in the Midwest, in Michigan, I'm a Detroiter, proudly. So, how can I use that to inform what I do to, you know, bring that lens? And so that informs my empathy. And to think about what good can I do. What difference can I make? And it may be up to me to get the conversation started. I find that so invigorating and so rewarding. Gina DiPietro  3:41  Some say the health care industry - and I'm sure other industries experience this, as well - but it's known to be slow when it comes to cultivating change. How do you begin to break down that mindset of 'Well, that's how we've always done it.' And move past that status quo? Because I imagine when you came to Novant Health, as you were reassessing what this now People and Culture division would look like, that you encountered some of that. Carmen Canales  4:08  So, a couple of things come to mind. One is focusing on brand identity. How does what we do as HR professionals align with the brand? Which requires frequent communication. Communicating things three times in three ways. Additionally, it's attracting talent who come from all walks of life. Having a diverse talent pool at every level of the organization that reflects the communities we serve. Just by doing that, the ideation, the innovation is going to increase. This requires courage to go beyond what we used to do. What we used to do may have been lovely and may have served the need at the time. However, that's not going to get us there now. The world is forever changed. It's our opportunity to not just to keep up with it, but to get ahead of it. We can do that by harnessing the talent and the wonderful ideas a diverse group of committed individuals can bring to the table.Gina DiPietro  5:00  I'd like to dive into that concept you mentioned of a diverse talent pool. Traditionally, Novant Health has hired people who work in a state where there's a healthcare facility. So the Carolinas, Virginia, Georgia, but it's my understanding that you've been working to move away from that and instead, find the best talent for the role - no matter where they live. Explain your philosophy on this and how you went about it.Carmen Canales  5:28  I find this so exciting. At heart, I'm a recruiter. And the world is our talent marketplace. And it's such a great opportunity. Why limit ourselves to just where we have had a geographic footprint? Certainly, I'm mindful of the tax implications and legalities and continue to work with wonderful individuals who will help us sort through those things. But we really should not use that as a barrier. Again, for our clinicians, the people closest to the bedside, well, then certainly, we'll need folks in a particular location so that they can treat people as needed. However, with all of the wonderful progress that's been made in terms of remote visits, video visits - that is the result of people thinking really creatively, and really having a solution orientation. The best talent for the opportunity that you have in front of you might be in another country, maybe in another state. So, why not figure it out? It is so worth it. Gina DiPietro  6:21  We're having our conversation today remotely. The 9-5 in a traditional office setting is becoming a thing of the past, right? COVID-19 changed people's expectations around balance and flexibility. Explain what you've seen. And what your approach will be to meeting the expectations of today's workforce, especially younger generations who may have different expectations.Carmen Canales  6:46  Much of our workforce can be remote, and will be primarily remote. But we also need to bring people to the office occassionally to do things like purposeful innovation days. Use that time not just to be in a cubicle or to be on more zooms, but use that time to brainstorm, to collaborate. Also, to check on each other. Keep building community. Doing all of that in person on some occasions - certainly masked and distanced - is imporant. Additionally, I'll go back to communication. Gina, high communication is key. Especially if the only way that we're talking to somebody is by Zoom or by phone or whatever it may be. You know, chit chat as you would if you were in person. And we have other things in place, too, like our weekly system calls. Any of our 37,000 team members who are interested can join for a full hour or for a few minutes, as schedules permit, to have access to leaders and access to clinicians. They ask questions, learn about updates and hear about all the things that we're celebrating. Things we're doing well during the pandemic. It keeps everyone on the same page. Also, to rally and to keep inspiring each other to keep going. Gina DiPietro  7:51  What other ways can companies keep a remote workforce engaged and kind of deliver that "high communication," as you put it? Carmen Canales  8:00  For example, we have Business Resource Groups (also known as affinity groups or employee resource groups). It's an opportunity for folks with similar interests to come together and meet via Zoom or in-person, whatever the case may be, with some cadence. It helps with community building and to talk about things outside of your particular role. I also started something called Coffee with Carmen. Again, an opportunity for anybody in the organization who would like to talk to me. They share ideas or ask questions. Those are one-on-one conversations. We have 10 minutes slots and people can sign up. We talk about whatever they'd like. I can advocate for them or look into something and help them resolve it. So, I'm really excited about the changes that we've made in the past year and about more that are coming. Gina DiPietro  8:44  Is there anything else that you would add? Anything that you would share with people - possibly someone whose company is going through a similar culture change? Carmen Canales  8:55  Yeah, absolutely. I would just recognize that this is a really difficult time for all of us. But don't give up hope. I believe in the goodness of all of us wanting to solve this world situation together. As a human capital professional, this is where it's at. We should pause and think about all of the good things that we can do to serve the people with whom we work. You know, we certainly balance that with operational needs of the organization. We may not be able to do everything all at once. But there are lots of things that we can do that aren't even monetary to make people feel heard. Take some time and reflect. Think about how you can make a difference today. It starts with you, so I challenge and invite everyone do something today that really fosters the special culture of your own organization. It really matters and people are looking to you.Gina DiPietro  9:51  Thank you for listening to this episode of Industry Insights: A healthcare podcast presented by Novant Health. I invite you to listen to another conversation I had with Tanya Blackmon where we talked about the organization's approach to fostering inclusion and belonging. As Novant Health executive vice president and chief diversity, inclusion and equity officer, Tanya has great insight into how the organization has approach this not as a program, but a culture change strategy. You can find it on Apple, Google, Spotify or anywhere you listen to Novant Health podcasts.

Gina DiPietro  0:04  Retaining physicians and attracting new talent looks different since COVID-19, prompting healthcare systems to pivot and embrace a new normal. Welcome to Industry insights: A healthcare podcast presented by Novant Health. I'm your host, Gina DiPietro. Physician engagement and workforce burnout aren't new concepts in health care, but how leaders are tackling this is evolving. The pandemic changed the way people work and physicians, like everyone else, have new expectations. Here to dive into the strategy is Novant Health's Dr. Pam Oliver. In her role as executive vice president and president of Novant Health Physician Network, Dr. Oliver oversees hundreds of clinics and nearly 2,400 physicians. Listen as she explains why younger generations are prompting healthcare leaders to think outside the box, how healthcare systems are attracting physicians in a competitive market, and retaining the ones they have. More on that and her thoughts on what she calls the "secret sauce." Thank you for listening.Dr. Pam Oliver  1:10  We as physicians are blessed to be part of a profession where we have a sense of purpose and all that we do. And that purpose is to help take care of our patients, right? And to heal our communities. Value-based care is about outcomes. It's about providing high-quality care. It's about being conscientious and containing costs. And it's also about engaging the patient. We know that when patients are engaged, that they are more likely to follow recommendations and to follow through. It builds trust. And we know that physician engagement leads to better outcomes in all those areas. When our physicians are engaged, they feel like they're part of a team. They are always looking at ways to do better, about how we take care patients, listen to our patients needs. We then see that our patient experience is better and outcomes are better, right? So, it all is intertwined because we cannot be successful without a high level of physician engagement. Gina DiPietro  2:14  Right now, doctors are leveraging a competitive market. It kind of makes me think of that term "buyers market." So, how are health systems pivoting to stay competitive, and attract physicians and possibly their referral networks, too?Dr. Pam Oliver  2:28  We see the pendulum swing a lot in healthcare, where three decades ago, it was probably much more uncommon to be a part of a health system. We had more independent practices then. I came out of residency into an independent practice that then became part of Novant Health, so I recognize this journey. What we have to make sure we continue to do, and we work on this every day, is we try to make sure that we are investing in resources to help make it easier to take care of patients. It is incredibly hard today in patient care - whether it's EMRs that are necessary evils. Some people would say our EMR is top-rated amongst our physicians for ease of use and satisfaction. So we invest in it every day to make sure that it is an enabler and not an impediment to taking care patients. We are investing in teams to wrap around our positions to make sure that they have support to take care of our patients. So we bring physicians to the table to help figure out what are those things that can help you so we make the right investments. We also try to balance safety and compliance and legal matters with autonomy - the things that you know, physicians want. We're professionals and we want to make sure that we have autonomy to take care of the patient the way we feel like it is best. So autonomy where it matters is what we continue to strive for. And make sure we live up to that to stay competitive.Gina DiPietro  3:57  Your answer there, you touched on something else that I wanted to speak with you about. What's the value to physicians in being part of a medical group versus being independent?Dr. Pam Oliver  4:07  When you're independent you probably feel like you have the ability to make lots of decisions. Not all those decisions are wanted. As physicians, I don't think we want to make some of those business decisions. We try to make sure we can have physicians engaged at the clinic level and as much as we can in the market or system to be part of that - even if they're not individually making every decision about parts of their team. But what we are saying is you know it is about being part of a bigger team. That is incredible today, right? To be part of a family where we are all engaged. I have cardiologists who help take care of my patients. I have you know, neurologists, all these specialties that we jointly are aligned and we all are marching in the same direction in service of our patients to take care of our communities. Some of it is about security. And I don't want to make that feel like it's false security. But I'll say as we pondered the decision of staying independent versus joining a health system, you know, one of the things that we looked at was, it was incredibly stressful with all the ebbs and flows. And I think the pandemic has highlighted that even more. There's so much that can change with regulations with laws that we are challenged with as a system. And it's even more difficult if you are smaller and independent, and you don't have those resources or access. And so for some people, that's a trade off that they are okay, you know, making. For us, it is really about how to provide the most security for our physicians so that they can focus on taking care of our patients, because that's what we value is that they are there to help us heal our communities, and not having to sweat it out, because of some toher change that's made elsewhere. Gina DiPietro  5:53  Going back to this idea of attracting talent.. Besides salary, which is kind of a given, what incentives are you finding that physicians want? What messages are really resonating right now?Dr. Pam Oliver  6:06  There's a plethora of options that we feel we need to offer. Because I always tell people, if you've met one physician, you've met one physician. What matters to one may not even resonate with another. And so we really try to come at this from a holistic approach of, 'What are all the areas when it come to security or empowerment that we can look at?' So, some things come down to benefits, right? So the basics of safety is, 'I feel like I can feed my family.' So, we want to be competitive with salaries. We want to be competitive with our benefits. You know, we've extended our paid maternity leave and paternity leave. And added a week of paid caregiver leave for our physicians to try to ease some of that stress when life happens. And then it goes all the way up to what are the things that we could do to make sure they have opportunities for being engaged in other areas, right? So we have a strong physician leadership within our medical group, within our system. Lots of our physicians want to do something outside of clinical care. We provide those opportunities for them to either grow for us to include them in leadership programs or at the table so they can continue to seek opportunities for leadership if they want to. Or be engaged with teaching, from our residency program, to the new UNC Medical School campuses that will be in Charlotte and exist and Wilmington - to involvement and research. So, all those types of things are important. And then I think it's the support, you know. Some of the incentives are not like transactional in the traditional way. But they're more around, we have a resilience program that our physicians don't have to pay for. It's about investing in their mental and emotional well-being. And, you know, trying to prevent burnout and boost their resilience. Looking comprehensively at what our physicians need to stay healthy in these challenging times. Gina DiPietro  7:57  You mentioned that concept of dyad leadership.Dr. Pam Oliver  8:00  We tell that our secret sauce as a system is that we have physicians engaged in decisions throughout the medical group, throughout the system, really top to bottom. So whether it's Dr. Eric Eskioglu and myself representing our physicians and clinical services at the executive team level, all the way to our physicians who are working in practice full-time. We call those frontline positions. They can see patients and run their clinics to be involved in leadership at the market to determine growth and our protocols for safety. When that works well, it is phenomenal. And I say we get it right, the majority of the time. The administrative leaders have their own skill sets and come with their own expertise and skill sets. We all come to the table in alignment about what we want to achieve. And we work through it together to come up with something that makes sense for and can help us excel at patient care and safety.Gina DiPietro  9:02  Burnout was a concern pre pandemic, and in a lot of ways, COVID-19 exacerbated that. Life is different now ... more people are working remote and physicians, like everyone else, want and expect a new balance in their lives. So how can healthcare systems now and in the future, work with their physician partners to achieve this?Dr. Pam Oliver  9:25  We have as physicians have the same stressors on us from a work life perspective as others might. We are starting to see, whether it's generational changes, what people value. Our younger generations are really forcing (in a good way) for us to consider how we start to work differently to achieve balance or integration. Personally, what we've started looking at is challenging ourselves and our teams to think outside of the normal work routines. So, telehealth brought forth options for physicians to balance out in-person versus telehealth. Not to say these virtual visits are easier, but it provides a balance of the way that we work. Some people value that, and it gives them a little bit more flexibility. We started to really look at how we can incorporate that into the traditional way we do business. So if I want to drop my kids off, can I do that ... without having to like sacrifice being full-time? Like how can we work with the clinics on staffing? How can we work through all those things? Those are the types of things that we really have started to look at when it comes to, you know, post-pandemic. Work smarter, not harder. How do we leverage the team? I feel we can still do that and balance out patient demand and needs. We really have focus a lot on our teams working together. So, if one clinic or one team is having a difficult time figuring their way through - that's part of belonging to a health system. You have a team, usually nearby, that can help you and dive in. And you all work through it together. That 'not feeling alone' is priceless.Gina DiPietro  11:00  Your answer to that question reminds me of the phrase change is the only constant. Dr. Pam Oliver  11:05  So true. We don't want change for change sake. But I think the world around us is changing so quickly. This pandemic has really shown us that we can do that. W can experience significant change. We can get through it. Because we have to evolve. I don't think that what worked for us in 2019 is going to work for us post-pandemic. There's a new norm. We have to embrace it and figure out how to thrive in that if we're going to be successful.Gina DiPietro  11:33  Dr. Thomas Jenike, Novant Health Senior Vice President and Chief Well-being Officer, recently said in another Industry Insights podcast that when a physician leaves an organization, it costs about two to three times their salary to replace them. So keeping talent is also really paramount. I'm curious how you go about doing this? Does it start with intentional listening? Or where can people really start to wrap their brains around this?Dr. Pam Oliver  12:01  We say that around patients, too. To retain a patient versus to go seek a new patient - it's much better to retain the patient. We may not get to a point where it's zero, but we want to make sure that we do everything we can to retain our patients and physicians. And that's through engagement in lots of ways. As president of the medical group, I walk into clinics every day. I see various cultures. I see where things are being done well, I see where people have resources. I also see where we have opportunities. And so I personally have to depend on a slew of teams to help us keep our physicians engaged and retain our physicians ... from the clinic administrators who are really side-by-side with our physicians. They hear and seeing their needs, and they're elevating those needs to the managers above them who are helping to remove barriers and to put things in place. Ultimately, I'm accountable for that. But I have to do that through empowering and using teams to listen to our physicians. And I think a lot of it is around communication, right? 'Tell me what it is that you need. Let's talk through what we can do and what we can't do.' Even if we can't do something a physician asks us for having the conversation and explaining it and listening is important. It's all the other stuff I told you, like we want to be competitive, and we want to make sure we have benefits, etc. But we'll never be exactly like any other system. We have to do what works for our markets and for Novant Health, and for our patients. But we have to engage the physicians. And that in itself, I think is the most important thing for retention.Gina DiPietro  13:34  Anything else that you'd add on this topic before I let you go, Dr. Oliver? Dr. Pam Oliver  13:39  I appreciate you doing the segment. As a physician working at Novant Health, working in our communities, it is a pleasure for me to be able to work as hard as I do. I love working for our patients. And I love working for our teams that are physicians. And so I hope that all of our physicians understand the important role they play. They are leaders. We have 1,800 physician leaders now, whether they are named or unamed, in all of our spaces, and we truly appreciate it on behalf of our community, on behalf of our nation. We thank them for all that they're doing.Gina DiPietro  14:13  Definitely a blessing to enjoy what you do. Dr. Pam Oliver  14:15  Yes, it is. Gina DiPietro  14:21  Gina DiPietro here and thank you for listening to this episode of Industry Insights. You can find the podcast I mentioned with Dr. Thomas Jenike on workforce burnout, and many others, under the Industry Insights channel of the Novant Health podcast family. We're on Apple, Google, Spotify or anywhere you listen to podcasts.

Dr. Eric Eskioglu  0:00  AI is already in our lives, whether or not we know about it or believe it. You know, when you talk about your cars, those are all sensors that give you information. You use that pretty accurately. Now, do you question, is my beeper if I'm making lane change accurate or not? Maybe the first time you drive the new car, but once you get used to it, you can trust it almost all the time. You're still vigilant, you're still making sure that it's okay. But after a while, once you notice that it's almost 100%, correct. You don't think about anymore, and it becomes almost like an extra sensory organ that you don't have.Gina DiPietro  0:39  That's Dr. Eric Eskioglu, Novant Health executive vice president and chief medical officer, on how artificial intelligence brings together vast amounts of data to quickly find insights and efficiencies. You're listening to Industry Insights: A healthcare podcast presented by Novant Health. I'm your host, Gina DiPietro. In this episode, we explore how healthcare is using AI to solve real problems like health equity, cost of care, and better patient outcomes. More on that to come. But let's take a step back and start with what is data? And how is it used to get artificial intelligence? Here again is Dr. Eskioglu.Dr. Eric Eskioglu  1:20  So the data portion is your anything a patient generates throughout their lifetime. Whether it be regular physical checkups, regular care, or unfortunately have to end up in a hospital if they get labs if they had xX rays, MRIs. So this is all data. But as we started growing as a nation, and you know, our medical knowledge actually scientifically has increased tremendously. 50 years ago, our medical knowledge was doubling every 100 years. And currently, it's doubling every 72 days. And it is expected to double every 30 days in the next two to three years. So you can imagine the amount of medical knowledge and the data. We're going to be overwhelmed with all of this. We need to put it to good use. And from this data, you can get predictive analytics, which is the initial step to get into artificial intelligence. And that predicts, you know, things that could happen to a patient before it happens, which is very helpful. Then you can do what's called machine learning. And that's more getting structured data in an area where you can start not only predicting things, but also expecting things and also working with things that we can prevent. The final stage is artificial intelligence. And this one has two components. It's got recurrent neural networks, which is data that's dynamic that is streaming. So you can think of a heart monitoring for EKG, that is a data that's continuously streaming, you have to make decisions on the spot. And then there's also a convolutional neural network, which is the static data such as if you look at an MRI of a liver. That data statically, you have to turn it into an artificial intelligence. Now, what's exciting to me is artificial intelligence, we already have it around us. Whether or not you drive a Tesla car. Tesla cars are equipped with it. Whether or not you have an Alexa, if you're an Amazon Prime member. They not only when you log in, they can tell you what you have bought in the past, but what you may like from your profile. Artificial intelligence is going to be the fourth industrial revolution. I truly believe in that. In healthcare, if we don't adopt it, with the increasing complexity of patients, increasing amount of data, doubling of the medical knowledge every 72 days, which is going to decrease to every 30 days. We are not going to be effective and efficient and we're not going to have good outcomes. So it is imperative that all of us get into this field. Gina DiPietro  3:37  Keep in mind here that AI will not replace people in healthcare. Machines will never replace human qualities like empathy, intuition, or compassion. But it's important that people like physicians and nurses adopt AI to better care for patients. Dr. Eskioglu weighs in on where he thinks it will have the most impact.Dr. Eric Eskioglu  3:57  Physicians and nurses who use AI are sure to replace the physicians and nurse who refused AI. They are going to be much more effective, much more efficient. You know, I'm a vascular neurosurgeon, so people are surprised to hear me say that AI is going to have the biggest impact on primary care. I've said it for many years. You know, when you want to get a heart care, you think about several institutions around the country. When you want to get cancer care, you think about several institutions. But when you think about primary care, you don't hear somebody say, I'm going to get go to Cleveland Clinic and get my primary care or I'm going to go to MD Anderson to get my primary care. The reason it's going to change primary care. Those are the physicians that have the longest tenure with the patients. They have data, maybe q&a with a patient, you know, 20 to 30, sometimes 40 years of data. Because when you're with a primary care, you're you're with that person for a long time. With that data comes a lot of treasure trove of things we can predict. So, you know, we're going to be able to use artificial intelligence to predict trends from that data. Whether it be labs, whether it be MRIs, whether it be from natural language processing, your notes you wrote 20 years ago or 15 years ago. Next time you go to your primary care physician, ask them how many notes they go back to. And how many labs or x rays do they go back to see what went on. I can guarantee it's no more than one or two. So there's a lot of trends that were missing. AI is going to come into that space where it's going to get the physician or the nurses' or nurse practitioners' attention saying, 'We see a trend here from the last 15 years. And you may want to look into that.'Gina DiPietro  5:31  Here's the bottom line. Physicians and nurses can use that data to precisely diagnose and even predict health outcomes before they happen. Here again is Dr. Eskioglu with more on the potential of AI to reduce the cost of care, and why it could be a great equalizer for health equity.Dr. Eric Eskioglu  5:49  There's two things to AI that's really going to help us out on. We're going to be able to lower cost, because we're going to lower the covariation channel in the treatment modalities by using AI. What I mean by that is we've been looking at pneumonia, uncomplicated pneumonia admissions. And you know, before that homogeneous patient population, the outcomes are pretty similar, they're good. But we're noticing that some physicians order what we call the kitchen sink or the Cadillac workup. They order labs every day, x rays every day, consults. Some of them order only every other day, or every three days. So with AI, we're going to be able to predict after how many labs you've had normal do you need to stop ordering labs? Is one lab or two labs enough? So that's going to help with clinical variation. What we call economic value enhancement. And by doing that, we're going to be able to lower the healthcare costs, thereby increasing the access to underserved communities and people who have less or no access today. The other part of AI is we're going to help with social determinants of health, but also it's going to provide health equity. And what I mean by that is I'll give an example. In our stroke care, we've been very successful working with a startup company called Viz.ai. We were one of the first in the country to adopt them. when they were just at the beginning stages. It has proven to be a complete hit with us and our patients have been the true winners. This is an artificial intelligence layered on top of our telemedicine and we're able to detect a stroke on a CT scanner before the patient's out of a CT scan. On average, we've been able to save about 10 minutes per stroke patient, which equates about 19 million brain cells. Quality of life has increased. They don't die and this has had a tremendous improvement on the length of stay. But by doing that, we've provided health equity because you know, if you're a patient in Elkin, North Carolina, which is one of our affiliated hospitals that works with us. Or if you're a patient in uptown Charlotte, guess what? You get the same standard great care for stroke. There's no variation. You get the same care. So you don't have to be in a metro area to survive a stroke. And you know, that I'm proud of. So it will be the great equalizer. AI will be the great equalizer for health equity. And I truly believe that. Now, a couple of caution points. One of them is we have to make sure that we don't get bias entered into AI algorithms. And to prevent that, we need to make sure all populations data are entered not just a certain segment of a population. So we need to make sure Caucasian, African American, Asian American, Latino as well as any Native American, these populations have to be entered into the AI databases, because then you can get a true picture of what you need to do, rather than having a bias. So those are areas that we have to be cautious about. Gina DiPietro  8:42  As Dr Eskioglu put it, healthcare systems should approach AI with three pillars. I'll let him explain.Dr. Eric Eskioglu  8:48  First of all, from safety and quality. You know, we want to make sure whatever AI project we do is going to improve the safety and quality. So there may be an operation where somebody may be diagnosing the patient, but it has to improve the safety and quality. The second one is it has to lower the cost by unifying the protocols. The third one is it has to provide access to health equity. So those three pillars have kept us really in check. I always said, if you provide the highest quality clinical care with the help of AI, if you lower the cost, you are going to have quite a bit of money coming back in to be able to put for your mission, in not for profits. You will be able to invest in further things. And these things are not cheap. But you know, if you save more lives, if you prevent hospital acquired infections, if you provide serious safety issues in the hospitals - you'll be able to get to a point where you know you're one of the best in the country. And people will seek you out.Gina DiPietro  9:45  Looking ahead, he's especially excited about a few other things as well. I'll let him wrap up our conversation.Dr. Eric Eskioglu  9:51  The other things that's going to speed up AI is the quantum computing. It's here. It started last year. Google was the first company to be able to achieve that. So that's going to rapidly increase. The other thing that excites me is the fact that we can provide health care equity, using AI for all the populations we serve. I think that's going to be tremendous. I've always said it, the basic promise of democracy is health care access to everyone. And if you don't have your health, you can't have your economic upward mobility. So health is the most important asset you have. Forget about your house, forget about your car, forget about your bank account. The most important asset in your life that you will have is your health. The other thing I'm really interested excited what we call ambient intelligence. So artificial intelligence is your data, what we do with your data and how we make it work for you. Ambient intelligence is the data surrounding how does that affect your health? That's going to take more and more center stage since the environmental factors. We're going to be able to notice that if you're getting out of a bed, are you more likely to fall? We're going to be able to notice that. And that's what you know, a lot of our lives revolve around right now with our cars. What the sensors they have is AI, but what we call ambient intelligence, it gathers the data around your environment, and feeds it to you. So there's going to be two components -the AI, which is going to be your own personal medical healthcare data, that's going to affect how you get treated, but also the ambient intelligence, which includes social determinants of health. And those two combined with astute physicians who really utilize AI and again, I program in Python, you don't have to be a programmer in Python, you just have to have a basic understanding of AI and how it's going to help your patients. So I'd like to think people to think outside the box when we get to that point.Gina DiPietro  11:45  Gina DiPietro here and thank you for listening to this episode of Industry Insights: A healthcare podcast presented by Novant Health. You can find more episodes in our Industry Insights library. We've touched on healthcare supply chain, orthopedic trends, and even workforce burnout. There's tons of great content there. So feel free to browse around on Apple, Google, Spotify, or anywhere you listen to podcasts.

Gina DiPietro  0:04  COVID-19 forced a sudden and significant leap in responsibility for healthcare supply chains across the world. When hospitals, clinics, long term care facilities and even physician offices found themselves on the frontlines of the pandemic. You're listening to Industry Insights: A healthcare podcast presented by Novant Health. I'm your host, Gina DiPietro. Healthcare supply chains, which often operate behind the scenes, were catapulted into the spotlight in early 2020. As communities around the world faced patient surges, demand for personal protective equipment, and other supplies. Mark Welch, Novant Health Senior Vice President of supply chain, explains in this podcast what they learned from the experience, and what best practices they'll carry forward. Gina DiPietro  0:55  Mark, I've heard you refer to the supply chain as a bunch of problem solvers in a lot of ways they were ready for COVID-19. It's what they do every day. But what did change was the urgency and the volumes of what supply chain needed to source. Explain kind of what you observed in the early days of the pandemic.Mark Welch  1:16  So we started putting together what would be the critical supplies? So what do we need to battle to prevent from getting COVID? And so we did that. And that's a lot of the PP stuff that you've heard so much about, we actually got into a good cadence of what we were doing. And once we got that cadence gone, it was just more of how soon How fast, how much, and then we just continued down that road.Gina DiPietro  1:40  Yeah, let's dive into that a little bit more. You mentioned PPE. So we'll take personal protective equipment as an example. You know, supply chain needs to have a strong understanding of who is using what and how much. So tell us a little bit more about the importance of having had those trusted partners across the clinics, whether it's physicians, nurses or other team members, as you work to figure out who needed what and when.Mark Welch  2:05  Especially when you look at some protective equipment, when's the right time to use a gown? When's the right time to use it, and N95 respirator masks, and we teamed up with Dr. David Priest's team. And his whole team was remarkable. They started drawing up protocols when it was properly to have and N95 masks who had and N95 masks, who should be going into the rooms. And that utilization of product really helped instead of just masking everybody and gown and everybody, we really went into a conservative state, and really thoughtfully put together who needed what, and through their protocols, we were able to do that. And another thing, as you know, you may or may not know, we have a lot of contracts. And we do a lot of standardization. So when we do a change in our system, we have to education throughout the whole system. So this new way of sourcing that we had to do during this time period, when our current suppliers can supply us enough product, we had to go get other products. So we had to use a lot of inserting of new products who could use what how they would use them. And N95 is a really unique piece of protection because you've got to be fitted for it. So it's not just like putting over here, look, you're good to go. You actually have to be fitted for it yet to be tested. And then what causes a problem for us, they're more we're buying different brands of N 95 masks, you got to be fitted for each one, the supply chain team worked with the conditions did a great job and saying, Okay, so we have four different and N95 resources at this time. And because of that, what we're going to do is we're going to segment what type of ni five goes to what area that way, there's only testing for that and N95 in that particular area. And it remained consistent throughout the process. And so we didn't have to have a lot of tests, you know, there's some master didn't fit everybody's face. So we had to do some exceptions for that. Whether it be size, you know, small, medium, and large. There's some that we had to do some pretty detailed manual delivery of product just to make sure the right people got the right product. But for the most part, we were able to segment to different areas of our system, the different mask, and that in itself helps maintain consistency and safety for our patients as well.Gina DiPietro  4:22  You mentioned Dr. David Priest, Novant Health chief safety quality and Epidemiology officer, and how he and the infection prevention team were able to implement those new protocols to help maintain those resources when they were becoming scarse. Do you think that this helped avoid maybe the hoarding or hiding of supplies when people just weren't sure how long they would last?Mark Welch  4:47  Oh, absolutely. And I think everybody just felt comfortable. We didn't have to feel insecure and we didn't have to hoard things. I mean, if our system would have started hoarding things, we probably would have spent three or four times as much right product when it got to the right people. And there probably would have been some safety issues, the fact that we have so much trust in each other and the transparency that Novant has with our vendors, as well as with our teammates, and our patient. I mean, that's the only way to go. If this happens again, and it probably will in our lifetime, something like this will happen again, we'll be prepared. And the trust that we built to the COVID process will lend us well in the future.Gina DiPietro  5:28  How did supply chain go about sourcing from new vendors, when existing vendors just didn't have the supplies or whatever else was needed at the time?Mark Welch  5:38  We had a lot of community help. We set up donation line, we set up emails for donation, we had a team did a great job of sorting that out. But we also had a lot of people that they had resources that they were importing from other countries, and they had connections and they could help us with different things. And you know, honestly, it was a situation that we vetted them all. We did end up buying some from areas that when we got the product was a little bit questionable. So we sequestered it, we didn't use it, we had a tested in the stuff that did not meet our quality or did not meet specs we did get rid of we weren't randomly just putting things in the hospital. So that took a lot of effort. And probably the most uncomfortable thing we had to do was to buy from some of these companies that we've never done business with before. And now we're sourcing with them. And we're standing in line trying to get product.Gina DiPietro  6:34  What did you learn from that experience? Kind of having to get out of the comfort zone a little bit and maybe source from companies, like you said that Novant Health had not previously worked with.Mark Welch  6:44  Whether it's offshore, nearshore or onshore, we're looking at try to balance it. That doesn't mean we want to have a lot of different products. We don't want to go away from standardization and everything else. Because standardization is so important. And so, so critical to quality and different things. We're being very proactive about where we're getting product and how we're getting product, and then how we can ramp up or slow down wherever the case may be. So it's a constant study. I mean, we're studying our numbers all the time.Gina DiPietro  7:15  You mentioned that the beginning of the pandemic, you were getting emails about, 'Hey, I know a guy who knows a guy who can get this.' What does the process look like when you begin to vet new vendors or new companies?Mark Welch  7:27  When they deemed some stuff emergency use, you know, it kind of opened the floodgates a little bit on some things that allows you to buy products, maybe from people that you normally wouldn't buy it from. But when we got those products, like I said, we still work with Dr. David Priest's team and make sure that the quality was there that the product was doing was supposed to be doing. Because the worst thing we could have done is put a mask on somebody that thought they was being protected. And they really were not being protected. We were very concerned about that. So that's what we did a lot of different testing and, and just quality checks.Gina DiPietro  8:00  What is the benefit of hiring and retaining employees who have a background, not just in sourcing, but in healthcare sourcing, in particular? What would be the benefit in that?Mark Welch  8:14  Product knowledge. And I'm not saying healthcare is that much different. But there's a lot of moving parts, a lot of variables, you know, the human body and specifications. Everybody's different. The willingness of our clinicians to teach us and explain to us because we've been around long enough what their products they need and how they use them. And what's different about this product compared to this product really helped us out if COVID would have started. And I wouldn't have had to go introduce myself to Dr. David Priest for the first time. He would have said, 'Who are you, you know what's going on? You know, I've got all these other things to worry about.' But since we have a relationship now, he me but my entire team is a phone call. Here's what we see, I have this many masks, if we continue on the route that we're going, we'll be out of mask in 45 days. She would say, Well, what do we need to do? We're using a lot more mask and this area compared to this area. It would be a phone call, what are we doing? And maybe somebody was starting thinking that moment, we got to order up on these that relationship in itself. It just squashes any type of fear.Gina DiPietro  9:20  What other lessons learned could you share about how supply chain leaders can develop and implement preparedness plans? Perhaps any helpful technologies or resources that you shared with others or just things that you found that really worked?Mark Welch  9:36  It's just about people and process and relationships. We can buy the fanciest computer. We can buy the fanciest software. And that's great because you need information you need data and we have unbelievably strong data at Novant Health. So I mean, that made our process easier. But at every level of supply chain, whether it's my role, whether it's a vice presidents role, whether it's as a director role, whether it's a manager's role, whether it is a frontline worker talking directly with other frontline workers, it's about that relationship. And I would say that our relationship and our reputation, our hospital system was strong before COVID. And I think that helped us in our response to COVID anyway, and I think it's just gotten stronger. I hope that we can continue to have those open conversations. And if something breaks, honestly, if we mistakenly put something in the wrong area or somebody out of something else, we're not getting calls from the market president. That person on the front line is calling the people they work with every day, and they're solving those problems again, every day. And that happens. I know it happens, but it's how we react to a crisis versus how we don't react to a crisis.Gina DiPietro  10:52  Gina here and thank you for listening to this episode of Industry Insights. You can find more episodes under the Industry Insights channel of the Novant Health podcast family. There's tons of great content there around workforce burnout, creating a culture of diversity and inclusion, price transparency, and even a deep dive into the shift in orthopedics from inpatient to mostly outpatient procedures. Feel free to browse around. We're on Apple, Google, Spotify, or anywhere you listen to podcasts.

Gina DiPietro  0:04  Half a million common elective procedures like hip, knee and shoulder replacements are performed every year in the United States. Most, outside of the hospital - with a one night stay or less. Welcome to Industry Insights: a healthcare podcast presented by Novant Health. I'm your host, Gina DiPietro. Regulatory changes over the past few years have made it increasingly easier to perform orthopedic procedures in an outpatient setting. This shift was driven by the Centers for Medicare and Medicaid Services, or CMS, with a goal of reducing the national spend on health care and creating access at lower cost sites. Here to explain it all is Dr. Bryan Edwards, system physician executive at Novant Health Orthopedics and Sports Medicine Institute, and Zack Landry, system administrative executive for that same institute. You'll hear Zack Landry jump in first. Thanks for listening.Zack Landry  1:03  What we are seeing both nationally and at a local level for Novant Health is that many orthopedic procedures that were once exclusively performed within inpatient hospitals are now actively moving to ambulatory sites of care. So you mentioned common elective procedures like hip knee and shoulder replacement, those are increasingly being performed at outpatient surgery center. So nationally, the impact of that is there's a lot of really value to be gained, you look at close to half a million hip and knee replacements that are performed a year in the US several billion in spend on those procedures a year. So we hear all the time about growth of healthcare spending as a percentage of GDP, we have an aging population, so that we know, you know, those hip and knee replacements aren't going away, there's gonna be more of them. So I think there's a real interest in how can we reduce the cost of care? How can we create more value? How do we make them more cost effective. And so I think that then this you know, confluence of factors that are driving cases to the outpatient space has really put the spotlight on orthopedics, I'd say probably over the last couple of years, especially this year.Dr. Bryan Edwards  2:05  Gina, this started back probably 2014 or 2015. When Medicare (CMS) came up with a program, it was basically the Bundle Care Initiative. So it was a program where Medicare looked at their spend every year, and the highest spend they have on a procedural DRG is hip and knee replacement. So obviously, if you're at the top of their list, there are going to be more eyes upon you. And at that point, they created a program called BPCI, which basically was a bundled program, where the government Medicare was going to pay you a set amount of money for that bundle, and you had to manage it the best way possible. And so that led to a lot of changes and how the patient's journey was mapped out. So focus has got placed on preoperative optimization of patients, better pain control techniques, better mobility, removing skilled nursing facilities from the discharge planning, moving to home with home PT. And to this day, it's the only bundle program for Medicare that's actually done what it wanted to do it actually improved quality could decrease length of stays, decrease readmissions and a decreased cost. And when that was happening, what they also noticed is how many patients that we treat with hip and knee replacements they were being discharged with just one night stays. They also noticed that we were discharging patients same days, I think when the light went off with CMS and said, Well, obviously, the site of service that we're delivering is hip and knee replacements. And if patients are only staying one night, well, that's truly outpatient, that's not really an inpatient resource consumer. And so you started to see things such as knee replacements got taken off the inpatient only list and placed on an outpatient list. And then once the government or Medicare, a Medicare makes a move like that, than the insurers follow. And so over the last several years, that's what's happened. And that was kind of the market forces that pushed all of us to take a hard look, because not everybody is going to go home the same day and certain criteria that we've come up with national criteria, not everybody's going to stay just one night. So is a select group of patients. But this select group of patients are what we're talking about in this shift. Gina DiPietro  4:19  What prompted this shift? Is it revenue driven? Does it improve patient outcomes? Perhaps the combination of both?Zack Landry  4:27  Yeah, I'd say there's a couple things that collectively are both prompting the shift and accelerating the shift. And our partners at SG2, a healthcare consulting firm, they even refer to it as the perfect storm for surgical migration. And so Bryan mentioned some of the regulatory perspective. That's the first one and it really starts with CMS, some of the rule changes that they've had over the last couple of years. They make it easier to perform cases outside of the hospital. So hip, knee and shoulder replacement are those high volume big spend items for Medicare, but there's about 300 procedures that CMS actually is removed from the inpatient only list with those goal of reducing the national spend on healthcare creating access at lower cost sites. The second is clinical perspective. Brian mentioned a lot of those. It's easier and safer now to perform procedures and outpatient surgery centers than it was say 10 years ago, you have advancements in medicine, clinical pathways, technology, and equipment allows our surgeons to provide safer procedures and faster recovery. And so you don't need that long hospital stay, it's now become unnecessary, you have the consumer perspective. Third, there's growing interest by patients and insurers to operate at lower cost. And so they're actually incentivizing payers, our physicians and patients to choose the lower cost settings and sometimes pass those savings along to the patients as well to eliminate out of pocket expense. And then lastly, I'd say you have the impact of the pandemic that we've seen over the last 12 months where in the state of North Carolina elective procedures shut down for about six weeks during the height of the pandemic. And beyond that it's really kind of changed the way that people access care. When you think of elective procedures, especially a lot of people thought it was best to wait it out until the pandemic had clear they had concerns about receiving care in a hospital during COVID. We saw the impact of people who lost access to employer sponsored insurance all together. Those are the ones I'd say that SG2 refers to as the perfect storm for orthopedic migration. So you could say that makes Dr. Edwards and George Clooney and Mark Wahlberg and a lot of ways just as we navigate these rough seas for outpatient migration.Gina DiPietro  6:23  Dr. Edwards, would you agree with that - George Clooney? Dr. Bryan Edwards  6:26  I'm definitely George Clooney, in my mind. Gina DiPietro  6:30  You have to love their sense of humor. You'll notice Zack mentioned faster recovery times. Another practice in orthopedics is something known as enhanced recovery after surgery, or ERAS. It's an evidence based approach to shorten both hospital stays and recovery times and decrease the risk of complications. It starts with making sure that person is ready for surgery. So do they smoke? Are they at a healthy weight, if it's a diabetic is their blood sugar controlled? Here's Dr. Edwards.Dr. Bryan Edwards  7:01  You're making sure that the patient before surgery is medically optimized. Then, in that group of patients, you're also doing a lot of messaging to them that we expect you to go home after one night. So you want the whole team to be kind of in a consistent message you know you're going to gray or take good care of you. It's not like we're rushing patients out the doors just we know that they only need a certain amount of resources to succeed. During the surgical period, we've taken a lot of steps to decrease the patient's pain and discomfort we use an agent called TXA. It's an IV medication given a patient's before HIPAA near procedures, and it substantially decreases the amount of bleeding that they have at the time of surgery. So we've seen significant reductions in post operative pain and swelling from the use of TXA. We have anesthesiologist here that perform peripheral nerve blocks and spinals to patients are avoiding generally anesthesia. So they avoid potential complications from that with the peripheral nerve blocks as well. They're taking far less opioids, so they're not as nauseated and some of our surgical techniques become more minimally invasive. And all of that just came together to, I think, give the patient a experience where they're not in as much discomfort as they were in patients procedures are pretty seamless to just take it to the you know, kind of a neat level. One of Dr. Holmes' hip replacement patients came in went home the next day and play golf six weeks after the hip replacement and got a hole in one on the fourth hole of his route. That's unheard of, you know, playing golf at six weeks wouldn't be thought of two or three years ago, but that shows you the minimally invasive techniques that can be done to get people back to what they want to do.Gina DiPietro  8:41  You talked about the difference between surgeries performed in the hospital versus in ambulatory surgery center. But how does this impact reimbursement?Dr. Bryan Edwards  8:51  Well, that's the main headache for a hospital chief financial officers is that it's significantly less reimbursement. There's three kinds of sites of service we have. We have inpatient hospital with HPD outpatient procedures done in the inpatient setting, if you will, and then you have a freestanding type of Center, which is a totally detached ASC. And as you move from inpatient to hospital outpatient to amatory surgery freestanding, there are significant decreases along the way. So obviously, that is less margin for Novant Health, which then requires the entire organization to sit back and say, Well, okay, well, orthopedics can't do anything about this. This is a market trend. It's what the patients and insurers want. Oh, but yes, we've got this decreasing potential margin head coming. So that's when you have to kind of say, Well, what can we do to mitigate that decrease in margin? Well, obviously, I think there's things that you can do that other systems are, you know, for us in orthopedics. We spent a significant amount of time in Charlotte and in Winston building out our trauma programs inside of Forsyth Medical Center and Presbyterian Medical Center. We're also putting in huge focus with neurosurgery on spine, then there's a point where, you know, orthopedics can only I would say, probably next year, about 95% of what we're going to be doing is outpatient. So then you have to really look at your colleagues and surgical oncology, Heart and Vascular, and really look at your product lines to see, okay, well, where else could we grow on the inpatient side?Zack Landry  10:21  I think that's well stated. I would say kind of at a high level, there's opportunities and risk with the shift out of the hospital. And I think you had the chance to speak with Jesse Cureton, and Melanie O'Connell not so long ago about patient affordability and pricing transparency. And so we know that there's the financial impact of moving and that's a risk for us that we need to manage. But there's also the opportunity to bring lower cost care to patients and the process of going through their clinical steps, the operational steps, workflows of moving a case out of the hospital into a surgery center, it helps us to learn a lot about ourselves. And it helps us to better connect with our consumers. And the reality is that our surgeons, too, are getting a lot of pressure from patients. Well, if we can't do it in a surgery center here, then I'm going to go see another surgeon. So it's always our goal to reduce clinical variation to cut out waste and bring affordable products to our patients. And so we keep that in mind too, as we try and balance the impact to hospital financial margin to with the opportunity to deliver lower cost care.Gina DiPietro  11:20  You are both familiar with this idea, this concept of value-based care where people are shifting away from the quantity of care they provide a patient with the quality of care you provide patients. So it's much more outcomes driven. Would you say that this shift that you're seeing is something that supports that shift in healthcare to make it a more value based approach for folks?Dr. Bryan Edwards  11:44  It definitely what we're seeing is. You know, number one, Zack mentioned earlier for our own company, for Novant Health team members, we launched a bundle over a year and a half ago. Our own team members were able to have their joint replacement in a Novant Health facility and minimal out of pocket for them a tailored experience. Obviously, it's a little complicated because no one's self insured. But we proved that the product work, people liked the fact that they had limited out of pocket. They like the connectivity of the bundle with the digital engagement tools that we had to engage them. So there's no question on quality thinking the competitive marketplace for insurers, especially the self insured employers, they're looking for a great result for their team members at the best price of the company. So we've got that in our bundle division, we've created that product with Novant Health team members, and we're ready to use that product to go after the self insured employers.Zack Landry  12:43  I think that's part of the value of having a diad leadership structure, as well and having Dr. Edwards as the traditional clinical expert, and visionary for orthopedic services, and then, you know, our team of leaders who are more focused on the business side and the financial outcome. I go back as a traditional MBA to the Porter's value equation, how do we improve quality? And how do we do it at lower costs. So value is something that we talk about quite a bit. I think that we're really lucky that we have a couple of things that are unique for us. We have expert Surgeons of every nearly every sub specialty throughout our markets. And then we have orthopedic focused hospitals as well. So when you talk about Charlotte orthopedic hospital, you talk about Clements Medical Center being a mostly orthopedic hospital, we have ASC's that are within close proximity to both of those sites. Now, New Hanover having an orthopedic hospital as part of our organization as well. We really have a lot of opportunities to create Center of Excellence around specialized fellowship trained total joint surgeons, for instance, where we can bring the experts to the table, we can bring experts in inpatient nursing care, we have outpatient facilities that can deliver great low cost care and that same remarkable care that we do in the hospital on an outpatient setting, we look at value in a lot of different ways. And we've been able to successfully attack that in a number of ways, whether that's through cost reduction, whether that's through our readmission rates, which are less than half of the Medicare national average, having that diad leadership and having the clinical experts that can lead that across our institute is something that's helped us be successful in delivering value.Gina DiPietro  14:16  Do you know it healthcare systems are seeing this shift from inpatient to outpatient procedures in other programs outside of orthopedics?Dr. Bryan Edwards  14:24  Yes, with Heart and Vascular. There's been also a push for simple cervical lumbar procedures to be done an outpatient setting. So those are two service lines in addition to us that will feel some of these pressures.Gina DiPietro  14:37  It might be nice to sort of wrap up our discussion with lessons learned. So if you could, what have you experienced as the benefits to this approach that maybe you could recommend as best practice to others as they kind of delve into this?Dr. Bryan Edwards  14:53  I think the things you have to do in this business is you got to listen to the customer and listen to the surgeon. So talking to the patients about what worked, what didn't work, you know how they felt like they move through the journey, you learn a lot about where there's educational gaps, you learn a lot about a quote unquote phone call wasn't answered on the answering service. So how do you kind of streamline and package it, we got a lot of great patient feedback from our employer bundles with Novant Health. That was one of the advantages when that was put together, I get a classic example Gina, is that we saw this little blip in readmission, I believe it was around the 10th or 12th day. For some reason, that was a day where people are going to the emergency room for some issue after their hip and knee replacement. It wasn't a lot, but it was statistically it's why is this and it had to do with how you know several things. But what we figured out is, you know, patient being discharged, we were calling him at like two days or three days after they got home, they were calling him at 14 days. So what we did is we adjusted the calls to start calling them around seven to 10 days, and so we could get ahead of you know, they're constipated a question about their wound. You know, frequently, a lot of after surgery, people have a lot of extremity swelling, and they always think they have a blood clot. So they always want to go to the ER and always want to get an ultrasound. And it's really rare that happens, it does happen, but it's not calm. And so we were able to kind of intercept a lot of those patients, and direct them on an outpatient basis to get you know, we would number one, adjust medications work on the GI issues and then you know, get an outpatient based ultrasound. So that way listening to the consumer, you can keep them out of the ER, you don't have any expenses, keep them healthy. And so once a month, we're always hashing out flows and what worked and what didn't work. So I'd say the key for anyone is listen to your patients and listen to the surgeons. And part of that too is we have a lot of input from our nursing staff and physical therapists. Because, you know, nurses see a lot of what's happening on the floor, Zack sits on a team called a best practices team. And in the best practices team, once every two months, we sit down with nursing leaders, therapy leaders across the company. And we find out a lot about the clinical care delivery on how we can improve.Zack Landry  17:06  I would definitely echo that. I think it's very important to listen to our surgeons and our patients and get the insights from them as to how we're delivering value. The one other thing I'd mentioned is taking the time when you're really looking at value to do some patient journey mapping and really trying to understand what's the perspective of the patient? And what's the experience that they're going through, not just for procedure, not just date of surgery, and a day or two of recovery. But what is their entire journey look like? Starting with the first physician office visit when they're first experiencing knee pain or shoulder pain? What's the education look like leading up to that surgical procedure? The surgical wellness visit the optimization steps, are they getting a full packet of 2000 pages that they have to sort through are they getting education in little bite sized bits that they can understand and be fully prepared to take on that surgery to take on their recovery. And I think as we started to do that, as we pulled together all the frontline team members from every part, whether that was the clinics, the hospitals or home health agencies, partner skilled nursing facilities, as we did that, we started to realize little gaps that might occur 30 days pre op that might affect the readmission on the backside. And so I think taking the time, and it was really time intensive for us to be able to build that for our total joint episodes. But since we did that for our team member total joint replacement, which we started about two years ago, and we've seen that performed extremely well, we've actually seen our patients, on average, save about $3,000 out of pocket, because we've been able to eliminate a lot of the waste. And then also too we've had no readmissions over the last year for anybody that's gone through one of those procedures. So we're really proud of the results. And we want to continue to learn and grow from there.Gina DiPietro  18:50  That's fantastic. And I really liked that point that you made around, you know, someone doesn't want to go home with 2000 pages to read through. So really, you know, breaking it down into bite size info. And I think to making sure it's written in a way that people understand it because medical jargon can be tricky and sometimes go over people's heads.Dr. Bryan Edwards  19:10  You have to also understand that every patient wants to receive information like every other patient, right? So you kind of have to figure out millennials that it's really a Gen Z millennial thing, you know, what do people want and you can't have one delivery mechanism.Gina DiPietro  19:28  Thank you for listening to this episode of Industry Insights. You can find more episodes under the Industry Insights channel of the Novant Health podcast family. There's tons of great content there around creating a culture of diversity and inclusion, using technology to transform care delivery, price transparency, and workforce burnout. So feel free to browse around. We're on Apple, Google, Spotify or anywhere you listen to podcasts.

Gina DiPietro  0:04  Turns out there's a playbook for starting programs that drive employee retention, engagement and performance, and Dr. Thomas Jenike has the answer key. I'm Gina DiPietro with Industry Insights, a healthcare podcast presented by Novant Health. In this episode, I sit down with Dr. Jenike, Novant Health Senior Vice President and Chief Well-being Officer, to learn why it's so important for companies to invest in their employees well being. Something on the forefront of many minds after a year of loss from COVID-19. Join us as we unravel the ways companies can engage their workforce and promote wellness.Gina DiPietro  0:45  As chief well-being officer, workforce burnout and trauma are some of the things you're really tuned into. Was there's something on a personal level that endeared you to this field or what initially captured your interest? Dr. Thomas Jenike  0:59  I think for me, the fact that I'm trained as a physician, and work around people that are called to do work that is in service of others. What I saw for my whole career is that people are so committed to helping others that oftentimes they put themselves on the back burner, if there's a group of people that deserve to have meaningful lives, great relationships, create experiences, and get fulfillment out of their work as people that are so committed to help others. And oftentimes, if we don't nudge them towards that, that just does not seem to be what happens by default. So, for me, it's just to help investment people who are so committed to helping others.Gina DiPietro  1:34  With COVID-19, last year was especially tough. You know, in April of 2020, just a short time after the pandemic began, an emergency room doctor in New York City who treated a lot of Coronavirus patients died by suicide. And at the time, her father said that she had been describing some of the devastating scenes that the pandemic took on patients. How does it feel to know that a physician, and I'm sure others too, got to that point? And how are you doing amidst everything? Dr. Thomas Jenike  2:07  That was one of the stories that as heartbreaking as it was as shocking as it was, at the time wasn't at all surprising to me, this type of emotional toll has been in a place well before COVID. So this has always been part of the water that we swim in as healthcare workers is this emotional outpouring for the people that we take care of, of course, like many things, COVID was an accelerant to that. So the amount of trauma, the amount of death that came in such a short period of time, and for many of my colleagues, not being able to really do something about it, many things that we treat, we actually can treat. So this is just something that was unique. So I think the fact that it's been so hard to actually get our hands around how we can help people has been even more emotionally draining. So I'm not surprised by that incident. Of course, it's devastating. And it's something that we just have to keep talking about, I think the most important thing that we need to do is just to be honest, that these things are having impact on us. And not to be afraid to say that we're struggling, that we are suffering, I think historically speaking, that has not been the mindset of my colleagues is typically don't show any weakness, grin and bear it. And if you're struggling, keep it to yourself. So I think the most important thing we can do, and that even I've been doing is being in conversation around the impact of this and being honest with ourselves and each other. Gina DiPietro  3:28  It's interesting to me how you say healthcare workers often think about others before helping themselves. And your answer to that question kind of drives home that point. You know, I also asked how you are doing. Dr. Thomas Jenike  3:41  I imagine the mindset is, I shouldn't say that I'm doing well. But I really am. And I think part of the reason I'm doing well, is because I'm in this work all the time, I'm constantly in conversations around, how are people doing, and that allows me to share how I'm doing. So I'm allowed to grow. And I'm allowed to emote, how I emote. And that doesn't mean I don't have bad days. That doesn't mean I don't have times where I feel unsettled or fearful. But in general, the fact that I get to talk about a lot in my work allows me to have a sense of peace and calm about it. So I'm actually doing really well. And part of it is I do practice what I preach in terms of taking care of myself so that I can take care of others. And I guess the bottom line is it doesn't mean that I don't feel stress or worry or anger or fear. I just don't let them stay with me as long as I might have. Gina DiPietro  4:33  Historically, healthcare workers may have never seen this much death in this short of time in their careers. And I know what Novant Health a lot of employees assisted with Operation All In, stepping into roles that they don't traditionally work in perhaps they're even more traumatized because they don't typically see depth up close. So how can leadership not only recognize where people are in stages of grief, but also help people begin to emotionally recover from a year of loss? Dr. Thomas Jenike  5:07  Yeah, it's a great question because you know, one mantra is just do it and move on. And it seems if you just do it and move on to the next new normal that sometimes you don't heal along the way, I think there's a number of steps that people can do. One is just to honor the lives that are lost both in the nation and the country, in our communities, and even amongst our family, the lives that are lost, honor, the sacrifices that people have made. This has impacted people beyond just their well being from a socio economic standpoint, from a relationship standpoint, or societal standpoint, it's just had impacts I think, give me the honor that, and then really appreciate what we've done. I think all the things you talked about us stepping up, and really being at the very pointy end of the sword of dealing with this pandemic. It's, it's amazing. So I think this is gonna sound weird, but celebrating the fact that we've made such great strides in a year, it was really hard. And we did it. And then as you said, I think we just have to be honest about how we're feeling. And that starts with asking people you don't ask, they're not going to volunteer, typically. So getting out in front of people and saying, Well, how are you doing? What is your level of stress, grief, or whatever. And then the last thing is just showing compassion for the healing process, knowing that everyone's on their own journey. That's a really a cultural sort of way that you run your business. And I think for us, that's been part of the success of starting to come out of this stronger rather than weaker. Gina DiPietro  6:30  I think a lot of times, the initial question might be asked, so for example, how are you doing? But if that person isn't doing well, or maybe needs support, what do you do at that point? Dr. Thomas Jenike  6:43  I think part of it is getting people connected to the resources that are in place. And, you know, the ''How are you doing? Question is one that, you know, society speaking, we ask that all the time. What we might want to get to is, well, how are you doing -really? And get beyond the typical platitudes of I'm fine, but really, how are you doing? Sometimes that comes in a conversation, sometimes that may come in a more of a survey like thing where it's, it's more anonymous, and then it's to give people the menu of support services that are available and make sure that's front and center, easy to access. So some of it can be individual linking people to support services, others it can be making sure that people know where to find them and make it easy for them to access them. Gina DiPietro  7:27  You alluded to some of the resources in place. Are you able to discuss the How We H.E.A.L. program and how that's being utilized right now at Novant Health? Dr. Thomas Jenike  7:36  How We H.E.A.L. is going back to - what do we do coming out of the pandemic? What is the new normal? And how do we acknowledge all the sacrifices we made? How We H.E.A.L. is an acronym. So H is for honor. So this goes back to honoring the sacrifices people have made, honoring the losses that we had even honoring the feelings that people have, he is for empathy. So showing empathy for those that are impacted and not trying to make them feel like they need to be in a certain place where they need to get better, faster, just being empathetic. And then the A is for appreciate. So appreciating the hard work that people have done, and Alice for loving and supporting each other. And what we've done as we put into place workstreams under each of those acronyms. So honoring, we have memorial services, ways that team members can honor people that they've met and lost part of closure when a health care provider loses a patient is just to talk about them and honor them. So creating a space where they can do that creating a way for people to really share how they're feeling and have forums peer support, which is under the empathy part. And then having celebrations around, you know what we've done and made sure we say thank you as part of the appreciate and then also giving more resources for team members around their own personal development. We have numerous programs that allow team members to turn to build on their personal wellbeing journey. So that's another way we want to appreciate and love and support them. Gina DiPietro  8:59  COVID didn't just impact the healthcare industry. Some may be grieving the loss time spent with elderly family members or others may have lost their jobs picked up new side hustles like driving for Uber just to pay bills and a lot of kids were home more often with virtual schooling. What is the process people can go through to grieve or cope in a healthy way? Where can they start? Dr. Thomas Jenike  9:25  In my experience for myself and for the people that we work with, I think it is all about communication and connection. People suffer worse when they're in silence when they're by themselves, just creating a dialogue around how they're really feeling like really like you talked about. I think that's a great place to start that can be done on a corporate level. And it can be done individually, however you are feeling along this journey because as you said, everyone's been impacted by this pandemic in some way. I can assure you that there's other people who are feeling the same way our minds might suggest to us I'm the only one suffering or I'm the only one feeling this way, I can assure you that other people feel that way. So just being able to support whether it's your family, your friends, your work colleagues, being able to talk about the struggles, and just name them is a great place to start. And again, that can be done just on an individual level or can become part of a corporate culture. Gina DiPietro  10:20  I'd like to transition to this concept of workforce burnout, which was likely exacerbated by COVID. How else can organizations approach team member resiliency and wellness? Dr. Thomas Jenike  10:33  Yeah, as you said, this is something that's always been in play. And I think COVID has been an accelerant to many things, and this is one of them is accelerated, the need to really highlight this, because of the constant give, it can start to wear people out even more. So I think one of the things that we have found to be most important, is to really start to tether the performance of the organization to the well being of the people that are taking care of the organization. Meaning that we don't want to do this, because this is the right thing to do, we want to do it because of that. And that for a company, whether it be a healthcare organization or some other industry, they know that from a business standpoint, they can't be the type of organization they want to be, and sustain that level. If they're not taking care of the people who are making up the organization, what I've learned is that if you can get the most senior leaders talking about, the only way for us to maintain our high level performance or be the type of organization we want to be, is if we invest in our people. And that becomes how they run the business that really starts to work. And I know at Novant Health, our CEO Carl Armato knows that this is a human industry. And if we aren't investing in humans, we can't take care of others. So I think what you get that mindset to be high performing on a consistent basis, you have to build this into the organizational fabric and make it part of the thing we talked about regularly, and offer things that are in support of human being growth and development. Otherwise, you're just going to lose people from burnout and have to keep replacing them. Rather than keeping together the team and having them come together through this to stronger. Gina DiPietro  12:11  How has that mindset proved successful? What sort of results have you seen from some of those tactics that you've put in place?Dr. Thomas Jenike  12:18  What we've noticed is that when a person feels that their company cares about them, not just as cares about them, and the role they played, but cares about them as a human being as an individual, as a father, son, mother, friend, as they care about all those aspects of their lives, that person cares back about the company. So the company cares about the person. And through our research and through our data, the person cares back about the company, meaning they're more engaged. And this is like any human relationship. If I know you care about me, from a personal basis, I'm going to care more about you. And the same thing works corporately as well. So when we put processes into place programs in place, that is for the sole benefit of personal growth, or personal well being, that people who go through those processes, those programs, they become much more engaged with the organization, they become much more aligned with the organizational mission, and they take greater pride in the outcomes of the organization, they feel more of a sense of we. And when you have that engagement, drives, performance drives retention. And it's a very simple formula. But it takes commitment, and it takes persistence. You don't just talk about we care about you, but you have to keep putting into place. things that make people feel that we care about you that it's really driven engagement, alignment and performance. Gina DiPietro  13:40  You mentioned engagement and retention, as key strategic initiatives. How do you quantify the business value of employee satisfaction and retention because this costs money for organizations to implement?  Dr. Thomas Jenike  13:56  I think there's a couple ways to think of this one is certainly you can do a very detailed analysis on the business case of investing into people. We know that for example, when a physician leaves the organization has replaced a typically costs two to three times their salary to replace them. So just on that fact alone, if you can save one physician from leaving the organization, you more than make up for the investment. So we know that. And then there's the what's the cost if you don't do it conversation, which is really the one that probably resonated most with our leadership and may resonate most with a lot of other leaders is that if we don't do this, what's the cost on the performance of our team? What's the cost on the engagement of our team, we know that engagement equals performance. There's plenty of data to suggest that so in healthcare, for example, we get paid now on quality. So if a physician a nurse is less engaged or less well, there is a direct correlation to quality, which will then correlate to the bottom line. So the business case is pretty simple to make, you can get really down into the details of the numbers. But the bottom line is, when you invest in people, it typically returns about three fold. And if you ask our CEO, what's the single best investment he made as a CEO, time and time again, talk about the investment he makes into his people.Gina DiPietro  15:25  For organizations who are thinking critically about this concept of wellness, how do they parlay that into a program that an entire workforce can benefit from? Dr. Thomas Jenike  15:37  Well, you know, I don't think there's a one size fits all, I think it is starting to understand your workforce, what are the needs of your workforce, even inside of Novant Health, we need to get very specific about who needs what, not everyone has the same needs. So it starts first with the decision that we're going to care about you, we're going to care about you holistically, not just so you can show up at work and be productive, but we're going to care about you. From an emotional standpoint, from a physical standpoint, financial social standpoint, we're going to care about you. And then you have to start to understand well, what are the needs of the different subsets of our employees? Who are team members? And then having a commitment to start to tactically look at? How do we solve for the financial needs that some people may have? But others don't? How do we solve for the emotional needs that some job families or people might have, and others may not? So it becomes a first decision than a commitment. And then you start to look at what are the needs we have and start to tackle them one at a time. And my advice would be don't get overwhelmed. Don't feel like you have to boil the ocean, but just start to show something that is tangible. And then just stay in the game and keep asking what people need and ask them well, how did this program or this benefit impact your life? Gina DiPietro  16:54  That's an interesting point that you made about one size not fitting all I think, you know, even personally, just as an employee with different companies over the years, sometimes I think the tendency is just sort of slap a band aid on it and say, Hey, here's a pizza party. Dr. Thomas Jenike  17:10  Yeah, I agree with you. I think some of those things are nice, right? And then they make you feel better in the moment. If that's not really what speaks to me, it's not going to give that lasting effect. So this is why organizations that are on the cutting edge have a department of wellbeing resiliency or a human resources department that don't just look at, you know, how do we tear language, throw a band aid over this, but really have solutions for all of our team members and really understand them better. So I think that's critically important. If you're going to play this game, in the highest level for the longest time.Gina DiPietro  17:42  Is there anything else that you would add that you think folks could benefit from?Dr. Thomas Jenike  17:46  I think that's the take home point is that if you aren't talking about this, you're missing the boat. If you aren't talking about it, honestly, and from a place of true authenticity and vulnerability, it's a risk point. Not only to the individuals that are struggling, his risk point to the organization, just like wounds that are not covered, they will fester. Addressing them head on is really important. What do we talk about most consistently? What do we do behaviorally, what seems to be valued here, that really starts to set your culture. And it starts with just the honest acknowledgement that this is an important topic, and one that our company and the mission that we are striving to achieve dependent upon. So I think that's really the most important take home point. Gina DiPietro  18:31  If you're really creating a culture, it's not just a one-time conversation, or a two-time conversation, it's really embedded into what you're doing month after month. Dr. Thomas Jenike  18:42  Even more importantly, it's what you're talking about. If the messaging to the team members is strictly about the bottom line, for example, like this week, we're gonna talk about the bottom line. Next week, we're talking about where the gap is on our budget. And then the next week we talk about the next year's budget, well, it becomes very clear to the people that what's valued here is certainly the bottom line. And of course, that's important. But if you're going to create a culture, you have to talk about the things that are most important. So I promise you every time our CEO gets in front of our people, he is talking about performance, but he's also talking about well being. And when the most senior leaders start talking about this regularly, people start to get an idea of like, Wow, that's really valued here. As a leader, I better make sure that I take care of myself and I take care of my team because that's valued in this organization. So you're right. It's a constant drumbeat. It can't just be a campaign. It has to be part of the normal conversation. And behaviorally, we have to walk the talk.Gina DiPietro  19:48  Gina DiPietro again. And a great takeaway there from Dr. Jenike that when a person feels their company cares about them, and not just as an employee, but as a human being, it drives alignment, performance, engagement and employee retention. And next time you see a co-worker, you might ask them, 'How are you? Really?' Thank you for listening to this episode of Industry Insights. You can find more episodes under the Industry Insights channel of the Novant Health podcast family. There's tons of great content there. So feel free to browse around. We're on Apple, Google, Spotify, or anywhere you listen to podcasts. 

Gina DiPietro  0:04  Expanding access to care and improving health outcomes requires innovative digital solutions that, in some cases, no one else has access to. I'm Gina DiPietro with Industry Insights, a healthcare podcast presented by Novant Health. In this episode, Angela Yochem, Novant Health Executive Vice President and Chief transformation and digital officer, explores why it's more important than ever for organizations to invest in programs ranging from artificial intelligence to drones. More on that, and what else she's excited about on the digital horizon.Gina DiPietro  0:42  One of your biggest priorities is expanding access to care. How do you go about uncovering what new and different tools are out there to help your team accomplish that?Angela Yochem  0:54  I'd like to answer that in a couple of different ways. First, I'd like to talk about the sorts of things for which we look when we think about what we need to expand access to care. One sort of thing that we look for would be enhancements to or expansions of digital channels. In the past, when we think about a video visit, we would think almost exclusively about the capability set that exists on one's phone or on one's laptop. But as you know, in the last couple of years, we've extended that by partnering with a company called title care. So Tyto Care has a series of devices, one of them's called Tyto, home that a consumer can have in hand to allow an advanced practitioner or a physician on the other end of their line to look in their ears or look down their throats or listen to their breathing, listen to their heartbeats take a temperature look at their skin. These sorts of advanced technologies, advanced sensor capabilities, along with the connectivity that we provide back into the patient's record and or direct connectivity back to the advanced practitioner gives us a much more robust and meaningful exam for that patient at home. So that's an example of a solution set that we'd want to incorporate to extend that sort of digital channel of care. We also look at what I would consider to be a hybrid sort of approach. So there is care that we provide that we extend to our communities that is not delivered in the patient's home. But nor is it delivered in a traditional venue of care. An example of this would be a kiosk in a retail facility, for example. Or it could be you know, a nurse guided kiosk type device that exists in schools in the school nurse office, or in some other you know, even in a corporate facility for their employees. These are those sorts of expanded access locations that have a physical component, but don't require the patient to have any sort of special technology or toolset. And then lastly, when I think about expanding access to care, I think about care that is traditionally delivered, and is still delivered inside one of our traditional locations, but through some digital enhancement that provides a greater access at all of our locations instead of just certain specialized locations. So examples would be the tele ICU capability that we have that allows us to turn your any normal hospital room into an intensive care unit style bed with remote monitors and advanced sensors in the room and that sort of thing. I also think about things like our visit AI solution set that you've heard me discussed many times before, that allows us to very, very quickly diagnose a stroke patient with an operable occlusion, if that's in fact, what they have. And do that regardless of the relative location of the patient sitting in a CT scanner, to the neurosurgeon, who is you know, who gets the results of that scan, even before the scan is complete? So these are the sorts of enhancements are constantly an earthing. So that's the first half of my answer, what are we looking for, we think about expanding access to care. But you know, how we go about doing it is I think, where the magic really lies. So we look not just in the traditional vendor community for these sorts of solutions, we don't just pull our traditional software partners, although there's certainly a rich source of those solutions. They're not the only source what we believe is if we were to wait on the vendors roadmap to provide to us something that our patients need, then you know, we will a perhaps not get that capability as quickly as we'd like to have it and be what we get at the same time. All of our competitors get it you know, we we like to differentiate by having the most up to date and oftentimes uniquely available solutions to help get to a faster diagnosis and a more appropriate response to that diagnosis. So instead of just relying on those sorts of traditional relationships, we've cultivated relationships with a variety of different entity types. So we've created relationships with a variety of investment groups. Certainly, we're very active in the startup community across not just those startups that we think about as healthcare startups, but a number of startups that are industry agnostic to which we can use solutions, we're able to apply to some of our toughest problems were very active and engaging individual inventors, the tinkers that exist inside of our own organizations, and providing constructs that allow them to very quickly bring forward their ideas and inventions so that we can incorporate them into solutions that we bring forward. And of course, universities and university labs, we're able to work closely with those entities and with individuals and those entities to bring forward things that otherwise, no one else has access to them to their solutions or their inventions, because they're just not commercially available. So those are the ways in which we think about expanding access and discovering differentiating ways to achieve that expansion. Gina DiPietro  5:59  You talked through some of the solutions to expanding access to care. I'm curious, what do you think some of the biggest care delivery challenges are right now for healthcare systems and the industry as a whole? Angela Yochem  6:12  Well, the COVID-19 pandemic has really shined a spotlight on health inequities. We know the impact of the virus was disproportionately felt by our communities of color. And what was true before COVID-19 is certainly true now, in that certain communities lack equitable access to health care. Many of the things that we described that that I just described are things that we are applying to this inequity. Even before the pandemic, we were working to increase access and improve equity through digital means or otherwise, it's become increasingly clear that our practice of seeing the person behind the patient is more important than ever before. So what does that mean? That means that where people live, whether they held multiple jobs, what kind of family support they have, what they eat? are they safe? These are all key social factors that influence health. So we're focused on ensuring that each of our patients receives care that is tailored to their specific needs. Gina DiPietro  7:14  How can technology be used to increase health equity? How might it benefit some of those underserved populations? Angela Yochem  7:22  So, when I think about the sorts of things that we focus on, and the ways in which they can be applied to this equity issue that is so pervasive, you know, I think about it in terms of access, and we've discussed that I also think about it in terms of quality of care. So many of the things that we apply to all of our communities are key accelerators of some of the work we're doing to address those health inequities, the access that we're providing through non traditional physical locations that are either roving, or you know, the mobile mammography unit, for example, or clinics that we're setting up in underserved communities that look more like community centers than traditional clinics, where there are food pharmacies, and you know, the most advanced diagnostics, those are some of the Michael Jordan clinics in our area that you're familiar with. Those are great examples of such locations. And of course, the digital divide is real and plays a part in inequities in education, and equities and health. So it's not always reasonable that we can rely on traditional virtual venues, virtual channels to just immediately reach those who otherwise don't have easy access to care. So it's important to have those hybrid locations. So people can can use digital capabilities to get better access, either in a walk in sort of urgent care style, or part of their visits to their physician. So for example, if someone has taken time off work, so they forgone getting paid for the day. And they've taken six buses, you know, to get to see a physician. And they get to see that physician only to discover that they need to consult with two other specialists, if we're able to allow for virtual consults from that physician's office. And that person can go ahead and have those consoles that day, from the physician's office where they are, that's a huge help, right? Because then we're not putting undue stress on that person who then has to go back, take six buses to get back and take another day off work or maybe two other days off work to see to other specialists. So because of this sort of extension of the physical locations through digital means we're able to help address some of those inequities. Other examples relate to the moves that we're making to improve the quality of care. So for example, we have an unprecedented amount of data available to us. It's not just the data that streams in from wearable devices. It's clinical data that has either been collected as part of our own engagements for the patient or clinical data that may have been shared at the patient's request from other systems. And we have behavioral data and information about the whether we understand what's going on, you know, what sort of social issues are happening in a given geography that may impact the patient. And then all of this data that could be used to help us better understand an individual patient's health is the same sort of data that helps us predict major health events before they happen. And if we're to the point where we're able to make predictions about the likelihood of certain health events, then it changes the way we are able to proactively and effectively engage with patients, before they find themselves with a significant health issue with which they have to deal. So those quality plays that we make that serve every single patient, this quality plays are the same sorts of capabilities that will allow us to address the inequities. Gina DiPietro  10:57  What's the benefit of investing in programs ranging from artificial intelligence to drones? Things that you may not think, really play a role in the healthcare space. But I'm curious, what's the ROI from utilizing some of those advanced technologies?Angela Yochem  11:15  We pay attention to ROI with every investment that we make. AI is everywhere. So the things I just described related to predicting major health events, that is largely based on models that we've built in our cognitive computing team, that allow us to use learning algorithms to make those predictions, you know, AI is essential, and it is part of every solution, I think that that you can buy off the shelf these days, no matter how pragmatic and boring, a solution might be, there will be an AI aspect to it, that's just the nature of technology advanced and where we are. So I don't think that we would invest in AI for AI sake, we would invest in solution sets. And that will allow us to bring differentiating care to our patients and our communities and or solution sets that allow us to run a more efficient operation, or allow us to create a world class consumer engagement. These are the sorts of things that every company worries about and you know, every company is applying AI based solutions to those problems. Like I said, we cognitive computing team. So we do have invested in skill sets around AI. And we do have, you know, PhD data scientists on staff and it's the right thing to do for any company that again, does not rely on just what they can purchase off the shelf from a vendor for every single one of IT solutions. If it's reasonable to expect that you will, at the very least co create solutions with third parties, and perhaps even entirely create in house solutions as needed, then it is also reasonable to build one's own capacity for that sort of creation. So there is some investment in people and teams that have that capability set. That's fairly straightforward. It's best practice across pretty much every industry these days. On the drone side of things, you know, we did make a big splash this past year when we partnered with a company called zip line to run some experiments in moving PP from our distribution center to a couple of our locations. And the reason it was such a splash is that we worked with the FAA to get the first ever waiver in advance of you know, any other company getting such a waiver, emergency waiver for flying drones over long distances over populated areas. And that didn't require a full line of sight as the drone was flying. So in other words, you'd have to have human eyeballs on the drone as it flew. So this is a fairly big deal in the drone community. We learned a lot from it when we think about expanding access, taking advantages of all modalities of delivery for things like PPP, or medicines, or any sort of medical or clinical supply. Understanding what it means to use drones as a modality of delivery is important information for us to have it for every company to have, particularly when we started to see the surges back at the beginning of the pandemic, we started to see the horrific surges in other large metropolitan areas like New York City was awesome things happening in California saw some things happening sound all this awesome things happening in Boston. And we wanted to ensure that for our 700 plus locations, there was never a time when that location could not get on demand exactly what it needed to serve the patients that it was treating at that moment in time. And the great thing about drone based distribution of supplies is it allows you to be very precise in the nature of the delivery and the timing of the delivery because of that we invested in. And then drone modality, where that takes us in the coming year, it's likely to include home delivery of medicines. So specialty pharmacy, Home Delivery through drones, that's pretty exciting, because that means that you can specify, I would like this delivered in a 10 minute window, and you will get it in that 10 minute window. How exciting is that. But we'll also be investigating movement of very, very large payloads using a different type of aircraft that, of course, will come in handy when we think about shifting big, you know, pallets of supplies, back and forth between our locations. So there are a number of things that are just part of the natural evolution of business that require us to not rely on what's normal, and try to look ahead at what the future is likely to be and prepare for that future. Gina DiPietro  15:44  Rapid advances in technology require constant evolution, just like you alluded to, and I know you mentioned, you know, one example was the home delivery of medication that we can look forward to. But what other new things on the horizon are you excited about? Angela Yochem  16:01  I'm excited about the evolution of the in the advances that we're seeing in devices, because sensor capability is becoming so much more sophisticated in the physical footprint that it requires continues to shrink, I think it's reasonable to expect that a lot of the things that for which we normally would have to go into a hospital, retested inside of a hospital will be things that are or things we could even have just have in the home, you know, and the small handheld things that could revolutionize how we think about continuous monitoring of patients, or monitoring of patients with chronic conditions, who wouldn't be at the level of acuity to be in a hospital, but need to have a closer eye kept on their condition on a regular basis, really excited about that the device world is exploding right now. And I just can't i can't wait to see how that continues. We've already talked about the proliferation of data and how, you know, extreme conductivity advances that have happened in computing power. And you know, I don't even get me started talking about quantum, you know, these are things that are going to enable us to practically tell the future I mean, you know, it's, it's really extraordinary to predict where we're likely to be this time, five years from now related to understanding health conditions in a way we never have before with the precision we never have before. And by we I mean, you know, I mean, everybody. And that's very, very exciting. And then also getting to a more personalized treatment plan for whatever health condition is found is also very, very exciting. So I'm excited about that as well. Gina DiPietro  17:33  It sounds like patients will really benefit from some of the things that you just mentioned. Angela Yochem  17:39  That's exactly right. All of the things we've talked about today are all in support of our mission, which is to ensure that our communities are healthy, and we address the community's health one patient at a time. And the way we do that is to reach more patients, to reach them in a more personalized fashion. To understand more about that patient's condition, whether they're healthy patients today, do we want to keep them healthy, and if they have health challenges, we want to get them healthy, and then keep them healthy. That is our mission. That is why we exist. So that is something that we pursue with a tremendous amount of energy. Gina DiPietro  18:14  You mentioned earlier in our discussion, that part of your role as a tech leader is to provide a platform for ideas, allowing people to sort of learn, tinker and experiment - has this mindset proved successful? Angela Yochem  18:29  Absolutely. We have ideas coming in from all over. We have ideas coming in from our staff members, we have ideas coming in from physicians and nurses and advanced practitioners and other clinicians, who every single day have a lot of time to think about ways in which they wish things works differently. And so they these are smart people, these are people who are used to tackling some of the most difficult problems there are related to the human health condition to create a facility that allows us to bring in those ideas, and to run experiments, pressure testing some of those ideas, and then ultimately using the data from those experiments to make great decisions about future investment to solve some of these problems either directly for patients or operational issues or any number of other solution sets. It's been great. And it's also these constructs that we've put in place that allow us to quickly engage with a variety of third party types without crushing, you know, a startup with our big enterprise processes. It's these sort of processes that have allowed us to do all the things that we've talked about so far today, doing things unconventionally requires sometimes an unconventional path. And if we want to do that safely, and with speed, we have to make sure we're very clear and very crisp in how we define those pathways. Gina DiPietro  19:46  As we look to the rest of 2021, what role will your team play in Novant Health effort to vaccinate its communities against COVID-19, as well as integrating a recently-acquired major hospital system on the North Carolina coast? Angela Yochem  20:00  Oh, well, our team is busy with both of those things. First of all, in the vaccination effort, we have many clinicians, dozens and dozens and dozens of clinicians are on my team, and they were actually putting needles in people's arms. So, so they are physically vaccinating the communities in many cases. But in their traditional roles, we're also trying to make it as easy as possible for our patients and our communities to get appointments to find a location to be vaccinated to request a vaccination. All of that is top of mind for us, we want to make it as easy as possible for our operational teams to set up those vaccination locations. We want to make sure it's easy as possible for our pharmacy teams and our supply chain teams to get the medicines to where they need to be at the right time. So you know, our teams are involved in every aspect of our business and every aspect of our operations and every aspect of our clinical work. So there's nothing that they're not involved in is as it relates to the COVID-19 vaccination efforts, you know, integrating the major hospital system on the coast, that as you know, is for any industry, a fairly heavy lift, the nature of the integration is being very carefully defined, so that we bring the best of each system to the whole with the least amount of disruption to our operations as possible. So that's been just delightful. Gina DiPietro  21:25  Lots to look forward to.Angela Yochem  21:27  Indeed.Gina DiPietro  21:32  Gina DiPietro again. Thank you for listening to this episode of Industry Insights. We hope you'll join us next month for discussions about addressing workforce burnout and trauma, as well as the shift in the orthopedic industry from inpatient to outpatient procedures. If you enjoyed this podcast, please take a moment to rate and review it. And subscribe to this and all the Novant Health podcasts We post new episodes all the time. Most are just 15 minutes.

Gina DiPietro  0:04  After an emotionally charged year, conversations about diversity, inclusion and equity have taken center stage. But how can organizations embed this in their culture? Where do you start? I'm Gina DiPietro with Industry Insights: a healthcare podcast presented by Novant Health. This episode is packed full of interesting ideas from Novant Health's thought leader on the subject. First and foremost, Tanya Blackmon - Novant Health Executive Vice President and Chief Diversity, Inclusion and Equity Officer - explains why approaching this as a culture change strategy instead of a program can be key to its success. Thank you for listening. Diversity, inclusion and equity are really the buzzwords of today. And I think most large organizations have realized the value of embedding this into their culture. But it also sounds like such a monumental task. So I'm curious, where can people start? For example, what did you do on day one, and even over the first few months?Tanya Blackmon  1:10  It is large. And I think, the way you approach embedding diversity, inclusion and equity depends on what your company, or what you as an organization believe it is. I do believe that it starts at the top of the organization. So in Novant Health's case, our president and CEO really wanted us to operationalize our core value's of diversity and inclusion. And so as we talked about doing that, we talked about it being a culture change strategy that we were going to leverage in our business, versus it being a program. One of the big differences in my experience in my work is that when it's a program, it's a check-the-box kind of thing. And it goes up when you're committed at that moment, and you really have passion about it. And then when that goes away, or funding goes away, it's put in a drawer. That's a program. But when it really is a part of who you are, and a part of your culture. And it's our core value after thinking of it as differently in a much more holistic way. Gina DiPietro  2:12  That's interesting. Tanya Blackmon  2:13  I'm a social worker by profession. I have my MBA, but I'm also a social worker. And in social work, you are taught about systems and systems theory. But you're also taught to start where the client is. And even though I had been with Novant Health for over 20 years, and we had this core value, diversity inclusion, we weren't really operationalizing it said, I didn't really know what people thought about it. And so I embarked upon a listening tour that lasted several months across the organization, I listened to the voices of 700 people. And you can imagine, if you're listening to 700 people, that's a lot of listening. And it was very methodical in that we had questions that we asked everyone that we met, and it was people of all levels of authority across the organization. So environmental services, nursing, the executive team, senior leaders, physicians, I did focus groups of people, I did every role in this organization on different shifts, to really get an understanding of what diversity and inclusion meant to them. And that was really important as we developed our definitions, because I will tell you, when you say the word diversity, if you leave it to chance in people's heads, usually they're thinking about race, and usually black and white, only, and then sometimes gender. So we had to be really clear and expansive on what diversity meant for Novant Health that encompasses many dimensions of diversity and things that are visible and things that are less visible. And so we did that to help with alignment. And then we looked at inclusion, we didn't feel like diversity, took it far enough, took the work far enough, because diversity without people feeling valued, and like they belong, you just have diversity and no inclusion. So we also defined inclusion, which means that we look at each other's differences as strengths so that we can value others understand others and respect and care about others.Gina DiPietro  4:12  Can you help me understand why this effort is so important to you? Is there a personal anecdote you'd be willing to share or an experience you've had that drives the way you approach your job?Tanya Blackmon  4:23  I grew up as a military dependent. My father was in the Marine Corps. And so we moved some around the country. And one of the things that I learned it's one of the best gifts for me in my life, I believe it helped me to deal with change. And that was we would go from different bases, and you are a military and go to a base. No one is from the base. So everyone is transplanted him or transferred. And so you actually learn how to live with people, different backgrounds and cultures, so that you can make the family work you can make the time on that base really work. So that's kind of been ingrained. me all of my life, because that's how I was brought up by my mom and dad. So I see people as being valued as human beings. So I do have a real passion about people. And I'm living that passion in my work now as the chief diversity inclusion equity officer, and I live that passion when I was the leader of two different hospitals and other departments, because I really do believe that we are here I am here, I should say, to add value to the lives of the people that I touch and serve. And so right now in this role, I see that we are in a healthcare organization. And so that's our business is healthcare. Well, people need health care. So it is my job to create an environment where people come to our organization, they want to be here to get their health care needs met, and that we provide them the remarkable patient experience, but in different ways in a culturally competent way, that we understand their unique needs, culturally, their dimensions of diversity, and what their unique needs would be or their fears or concerns. And we alleviate those and provide the best care possible work with our providers and understanding cultural competency, understanding the medical needs, that people have, from their own perspective, their own culture. You know, years ago, there was not a lot of research done on women that had heart attacks, most of the research was done on men westcombe, performed or completed with men. So when women came in with symptoms of heart attack, they look very different. Because we've learned a lot over the years, we now look at different symptoms for women who may be having a heart attack. And so I think that's what we do. That's what my goal was, is that we would look at everyone, yes, as an individual and do things that meet their needs, but also look at populations of people to see if there were any kinds of historically marginalized people or populations, that we need to make sure that we're putting a putting that health equity lens on to make sure they receive access to care, and the resources and treatments that they need to receive.Gina DiPietro  7:07  The word passion is really resonating with me. And I know you're also passionate about having what you refer to as courageous conversations. And this dialogue, I imagine can be pretty uncomfortable. And it's around topics that maybe 10 or 15 years ago wouldn't have even been approached in the workplace. So can you explain what these courageous conversations are and why you chose this practice as a way of implementing D&I and equity?Tanya Blackmon  7:34  One of the things that we heard on the listening tour and the listening to a really did serve as the foundation for every single thing we're doing and no one else, one of the things that we heard is that people want to be able to have dialogue in a safe space about topics related to diversity and inclusion. And at one point, Novant Health, we really weren't doing that. I mean, we had that core value, but there was really not a lot of dialogue. And so we decided we would start having zoom chats and web chats before zoom was was prevalent. But we had web chats and zoom chats to talk about topics related to diversity, inclusion, equity. And we did that so that people would have a safe space to be able to share their thoughts and feelings. But not only that, to be able to understand and listen to the perspectives of others, because we found that was the challenge that people wanted to be able to say what they wanted to say, but they didn't really have the patience to listen and seek understanding of a different perspective. And so these zoom chats have been wonderful to be able to do that. And we've done them for a variety of things, Carl Armato, our President and CEO, and I have done them together on some occasions. But we've had some people talk to courageous conversations across differences that when you don't agree, how do you have that conversation? So we've had some role playing on the virtual stage. And we've given people tips for knowing how to do that. We've had courageous conversations about the death of George Floyd, and what that felt like to team members in Novant Health. And so they were able to share their feelings and thoughts related to that. We've had web chats about this pandemic, and the anxiety and fears and concerns that people have had, you don't always take the time to think about the grief that has happened in this year. But through our web chats or zoom chats, we're able to do that we really stop and talk about that and provide resources for people through EAP through spiritual care, whatever resources they need through the Office of diversity, inclusion, equity. We've been able to do that and so are courageous conversations. We were doing them before some of the social and justices that were unraveled in the country. We were doing them before that and we will continue to do that. We were doing that when it happened. And we'll continue to do that. We've had another one that I mentioned is stereo types, and also the multiple I think there were five generations in the workforce now, that can pose challenges for all the generations. So we've been able to talk about that as well.Gina DiPietro  10:11  How can organizations create a culture where people are engaged and empowered to have vulnerable conversations? What could leadership do to foster a culture where people can participate constructively?Tanya Blackmon  10:24  You have to have an intention, you know, think about what your intention is for the conversations. And if there were actually do do a lot of thinking and planning and what do we really want the audience to hear? How do we really want to engage the audience? So I think that as an organization, you want to first think about? What's your intention for the conversation? Is it a one time conversation? Is it something that's a part of your vision and your strategy to embed diversity, inclusion and equity, so I think you have to decide what it is first. But after you decide that you are interested in having conversations, or courageous conversations across your system or your organization, then I think you come up with a plan to do that. And the topics for that. One of the things that we first started doing this is that Carl Amato and I sent an email out to the team, the whole company, 30,000 people saying, we're going to start this, we're going to start having courageous conversations, as we heard you during the listening tour. And so we said in the email, that these are not debate sessions, and they're not problem solving sessions. But there are sessions for us to hear your voice, and for you to hear the voices and experiences and perspectives of others. So from the very beginning, we set the tone for what this was, and what it wasn't. And that really has worked that people have been able to engage. I think with all the zoom chats that we've done related to diversity, inclusion equity, we've had about 13,000 participants either actively participating and are gone back and listen to them later, or viewed the information later.Gina DiPietro  12:00  It's no secret that 2020 was such an emotionally charged year. I know Novant Health publicly came out and supported Black Lives Matter. The organization also publicly stood with Asian Americans following the shootings in Atlanta. How do you approach leadership and get support for these messages that perhaps not everyone agrees with?Tanya Blackmon  12:22  We have been on this journey of having dialogue about diversity, inclusion and equity for about five years now. So we've been on a journey together, and we don't stop. And I think one of the important things is that you're not going to get it perfectly right the time the first time. But that doesn't mean you stop and go backwards. You just keep moving, you keep listening, and you keep adjusting and keep tweaking in terms of black lives matter. It was really a natural evolution in our journey for embedding diversity inclusion, if you really believe in our mission to improve the health of our communities, our vision to deliver on their market patient experience, that means for everyone, so what we look at not organization is who are the groups of people that are hurting. And in the situation with George Floyd, black people were hurting. Other people were too but it was really impacting the black community. So black lives do matter. They do. When the Asian group was hurting, and they were the killings, shootings and Georgia, Asian people were hurting. I get chills talking about that. So as a healthcare organization, we want everyone to have the best health. If you have people dying, or have people who don't have their needs met, it is our job to take a position on that and to figure out as a healthcare organization, how do we help populations of people? Sometimes it's taking a statement or making a statement, sometimes is as we've done, we've had zoom chats with our Asian Business Resource Group, with our African American business resource groups, all the resource groups together. Sometimes it's doing that when the host club shootings happened in Orlando several years ago, we really met with our pride BRG and and sent a memo out to the team about the LGBTQ population. So I believe you have to go where the people are hurting. And if you're true to who you say you are, then I believe you have to you have to meet those needs at that time.Gina DiPietro  14:28  Some of our listeners may not be familiar with that acronym BRG. Could you just quickly explain what that is?Tanya Blackmon  14:34  Yeah, thank you for doing that. You know, he's a lot of acronyms, and Novant Health we call these groups, Business Resource Groups, and some organizations they call them er, G's, employee resource groups. And some organizations will say affinity groups. These are voluntary groups of team members who identify in a particular identity dimension of diversity. You don't have to identify to be in that Group, but these groups and we call them Business Resource Groups because they help us do several things. Number one, they help us understand our patients. So for example, we have a veteran's BRG. We have a we have about 14 of them. We have a black Latino, Asian, a women's Native American 14 brgs, engaging white men's BRG, so they want to help us understand the needs of our patients so that we can meet them. They help us understand our team members so they can be better engaged in our organization and caring for our patients, and helping us understand what they need to help be recognized and developed in the organization. They also connect us to our community. We want to be the healthcare provider of choice, and we believe that we are delivering on a remarkable patient experience. So they help us to be their ambassadors in our communities about Novant Health and the help that we are providing. And if we don't aren't providing it in a remarkable way, those groups of people help us understand the BRG say, help us understand, for example, that Latina BRG helped us to create our Novant Health website, and espanol. If you look at it, it's very different from the one in English. And we trans created it, which means we didn't go to Google and translate it, we truly made it meet the needs of the culture, the Latino culture, we actually went to the community and talk to them, and said, what would you want to see on a website, and they helped us design the website. They also help us from a business perspective, doing all those things, helps us to grow our market share in the company, which ultimately helps us grow our revenue. So they are weight groups for us console groups on helping us to be the best we can be in many different ways.Gina DiPietro  16:45  Thank you for clarifying that. What is your opinion when it comes to the leaders of diversity and inclusion in large companies? Are there greater opportunities to have an authentic voice at the table when people of color or minorities are leading this work?Tanya Blackmon  17:00  I do think there's a great opportunity to have the chief diversity inclusion, and in my case equity officer's, voice at the table. Our president and CEO was really very visionary in that when I first started in this role, I was a senior vice president. And what he said was, you know, I think you can be a bigger influence and do what you've done for your hospitals that you've been over with working closely with me on the executive team. And he was right. And I think that's happening in the country, more Chief Diversity Inclusion officers are at the table at the executive team level. And that really has made a big difference for us. I think, Carl, we're here and our other executive team members, they would say the same thing. Because I am at the table when we're making decisions. When we're having dialogue about decisions or behaviors of the organization and behaviors that people I am at the table helping to influence some of that I'm not the only one at the table doing that all of us are but I'll have a voice at the table looking at our organization in totality with that diversity, inclusion and equity lens. More and more organizations are doing that. I have found that and I said this to Carl, when I took the role, that if the chief diversity inclusion equity officer is too far down and the organization, it's hard to get their voices heard. And if you really are serious about this and you're committed to embedding diversity, inclusion and equity, you really have to raise the level of that person to the to where their voice can be heard, where decisions are being made. A great point.Gina DiPietro  18:37  As you know, Novant Health recently acquired New Hanover Regional Medical Center also referred to as NHRMC. But with 700 beds on its main campus in Wilmington. NHRMC is now the second biggest Hospital in the Novant Health system. And it also serves a total of seven counties, making it the primary location for emergency and specialized services for people in rural North Carolina counties. What is the strategy to expand awareness and understanding in communities that may not have the same culture that we experience?Tanya Blackmon  19:14  We are working very closely with our new team members at New Hanover Regional Medical Center. It's been a wonderful thing they've really embraced where we are on our journey in Novant Health as it relates to diversity, inclusion and equity. And so our first step was starting a listening tour there in this space, we are doing a listening tour with the team members. And at the same time, we're doing a listening tour with the community at large because there's a lot of history, a lot of things are in the ground and the massacre in 1898 is still in the ground in Wilmington. And so we are doing a listening tour with the community members to understand where do they see New Hanover Regional Medical Center's role in the community as it relates to health equity as It relates to diversity and inclusion, we want to hear all of their voices. And it's been really exciting. So many people have already signed up for the listening tour. And so we will be listening to their voices, we have questions to ask them that will help us build a strategic plan for that area to embed diversity, inclusion, equity.Gina DiPietro  20:19  That's great. What opportunities do healthcare workers have to consider health equity or use this lens in their everyday work?Tanya Blackmon  20:28  Every opportunity, which is part of the change in culture, one of the things that your if you talk to people in Novant Health, when we look at data, you'll hear them talking about well, did we put the health equity lens on it? Do we look at the real gaps, it's really easy to say, my satisfaction scores or this or my quality scores or this, but really, you don't know what they are until you apply the real gaps lens. So American Hospital coined the term real, and I'll tell you what that means. We added the gaps portion to it because we're expanding our knowledge in the space. But real stands for looking at your data by race, ethnicity, and language. And then the gaps pieces gender, age payer, sexual orientation, gender identity. So you'll hear people talking about that people want to see what the real gaps lens looks like, for the data. And team members are beginning to say that as well. Team members are also beginning to see their patients and if they're from a different background or different culture, to ask them questions on how can we have make this a better experience for you? Are there any particular beliefs that we need to know about so that we can meet your needs and provide care? So we're seeing people really start talking about the lens and placing the lens on all of the work that we do?Gina DiPietro  21:47  Is there anything else that you'd like to add?Tanya Blackmon  21:49  I would say that the key to embedding diversity inclusion is not perfection, it's really progress. I have found a lot of leaders have to decide CEOs can be one or the other, or can be both and for us both, is it about your mission? Or is it good for your business and for us, they go hand in hand. Our mission is good for our business and diversity. Inclusion, equity is good for our business. So I really encourage people to think about the why, why now what they want to embed diversity inclusion, and I think if you can answer the Y, it will help you get to the plan or the interventions that you want. Fantastic.Gina DiPietro  22:29  Well, thank you so much. I really enjoyed our chat.Tanya Blackmon  22:32  Oh, thank you.Gina DiPietro  22:37  Gina DiPietro again. Some really interesting ideas there from Tanya Blackmon Novant Health Executive Vice President and Chief Diversity Inclusion and equity officer. Bottom line is diversity is not black and white. It's a whole host of things that make up a person both seen and unseen. Thank you for listening to this episode of industry insights. If you enjoyed this podcast, please take a moment to rate and review it. And subscribe to this and all the Novant Health podcasts. We post new episodes all the time, most are just 15 minutes.

Gina DiPietro: Everyone talks about price transparency, but when a consumer wants that, what exactly does that mean? I'm Gina DiPietro with Industry Insights: a healthcare podcast presented by Novant Health. In this episode, we dive into what makes healthcare billing so complicated, explore the new pricing expectations in healthcare, and why those rules aren't as effective as they could be. For answers, we look to Jesse Cureton, executive vice president and chief consumer officer at Novant Health. You'll also hear from Melonie O'Connell, vice president of pricing strategy. Thank you for listening.  Jesse, I'm curious. How is Novant Health meeting consumer need for affordable care when and where they need it? Jesse Cureton: Novant Health exists to improve the health of communities, one person at a time. We're tackling the challenge to provide access to higher-quality, more effective care at a lower cost with a unique, innovative approach that identifies, then meets, consumer expectations and needs. We empower physicians and nurses to be partners and decision-makers, not just service providers in this transformation. And we embrace disruptive innovations that have the potential to fundamentally change the nature of healthcare in the U.S.  Gina DiPietro:Explain what took effect in January as it relates to price transparency in healthcare.   Melonie O'Connell: Starting January 1, 2021, a new rule from the Centers for Medicare and Medicaid Services (CMS) requires all U.S. hospitals to offer patients access to a price estimator tool and a public list of prices for all procedures and services. The rule is intended to improve price transparency and increase access to pricing information for patients.  Gina DiPietro:Everyone talks about price transparency. When a consumer wants that, what does that mean? Melonie O'Connell: What consumers really want to know is how much they will be expected to pay out of their own pocket. At a high level, this amount will vary based on a consumer's insurance provider and where they are in their benefit year – so how much of their deductible or out of pocket maximum has been met.  Gina DiPietro: Why is healthcare billing so complicated?  Melonie O'Connell:Healthcare billing is built on decades of policy and regulation requirements to accurately account for all the resources used in providing care to a patient and ensure purchasers aren't over or underpaying for care. Healthcare is also extremely personal, which adds a layer of complexity on to that policy and regulation. Each patient's care is designed for the exact needs of that patient. And while we can, and do, provide estimates of how much that care should cost, there's also a level of variability to it. There's no way we can fully predict what care is necessary because no patient is the same. Our providers are specially trained to determine what a patient needs in the moment, which may or may not be reflected in a cost estimate a patient receives before the procedure.  Gina DiPietro: It's my understanding that Novant Health doesn't believe this new rule is as effective as it could be. Can you explain why?  Melonie O'Connell: While this rule is meant to make healthcare costs easier for patients to understand, some components of the rule actually make it more confusing. For example, the files required by CMS include negotiated rates with insurers for services, however, it does not provide the consumer information about their specific insurance coverage. The information isn't valuable to the patient because it doesn't take their insurance coverage, benefits and out of pocket costs into consideration. This may give patients a false sense of what their healthcare costs could be.  Gina DiPietro: It sounds like providers can check the box on this rule by taking a wealth of information and posting it on their website in a spreadsheet. That's a lot of information for people to comb through. What's out there and how can it be overwhelming for people?  Melonie O'Connell: That's right. It's a lot of data, and data that isn't especially helpful for patients. If you used the file required by CMS to search for a common procedure, you'd find data that breaks it down by CPT code and charge by payor. But none of that information is what a patient will actually pay to receive care. There are so many factors involved, none of which are taken into consideration on this “price list.”  For example, a patient may search for knee replacement with Cigna insurance and find a few results. However, the search tool doesn't take into account that patient's specific Cigna benefits. Employers have their own benefit plans with insurance providers and those details aren't reflected in this list. This list also doesn't take into account where a patient is during their plan year, whether or not they've met their deductible, and what their out-of-pocket maximum is.  Gina DiPietro: At a basic level, people just want to know how much something will cost. It's my understanding that we tried to be a bit more helpful than the bare minimum of what was required. What did Novant Health do and why?  Melonie O'Connell: We want to make sure our patients have access to information that is helpful and uniquely tailored to them. In keeping with the CMS rule change, we are providing easy access to the out of pocket costs of common procedures through an online price estimator tool on our website. This online price estimator tool provides a Real Time Eligibility check, which means it uses the patient's member information to make a customized out of pocket price quote based on the member's specific benefits at that point in time. This tool doesn't require patients to comb through rows and rows of data. Our goal is to make receiving a price estimate for our services a simple and convenient process, so patients can make the most informed healthcare choices possible. Gina DiPietro:Where does Novant Health direct its patients to comparison shop and what is the organization doing to ensure patients have the tools they need to help them in that?  Melonie O'Connell: Online price estimator- Our online price estimator tool is a simple, convenient way to find out-of-pocket facility prices for common procedures. Still, the price provided is only an estimate. It's important to know that out-of-pocket costs may look different for each individual patient based on insurance coverage and other factors. This tool does not provide an estimate for physician and ancillary fees – like anesthesia. Financial navigators- The best way for patients to understand the total out-of-pocket costs for care is to work with their insurer or speak with our financial navigator team. This expert team is on standby to support our patients and help them understand pricing estimates. Our financial navigators are often able to provide the patient a more robust view of the services they may need, helping patients understand what other services may go along with the care for which they're looking to receive quote.Our online price estimator tool is a great place to start, and our financial navigators can help patients think through the whole continuum of care and what services may be needed.  Gina DiPietro: Do you view it as our responsibility as a healthcare organization to go beyond the federal requirements for price transparency?  Jesse Cureton: In order to build trust with our patients and meet their needs, we have to do more. We've said for years that as our patients increasingly become savvy consumers of healthcare, they are looking for us, their healthcare provider, to meet their needs when and where they want it and at a price they can afford. We are constantly working to meet and exceed those needs by shaping new services and experiences that resonate most with our customers. Think about it – our patients today expect a level of predictability and convenience from healthcare that they experience in other industries. My background is in banking where most people do their transactions online. By using consumer research, we know that our patients expect the same from healthcare. We clearly know what our patients want for price transparency. They expect the ability to access information when it's convenient for them and that's what we're working to provide through our online price estimator tool. Melonie has already mentioned that healthcare billing is complicated. We may not ever be able to fully guarantee a price because of the way care is tailored for each unique patient. But we need to provide our patients an estimate so they can prepare for it. This level of predictability builds trust. We consider it a privilege and a great responsibility to ensure that every patient has access to the care and information they need and deserve. We are actively working to design a human-centered patient experience and we look forward to engaging with our patients and their families in new ways around this important piece of their care journey. Gina DiPietro: What is your hope for the future of price transparency as it relates to healthcare? What would make this process more effective?  Melonie O'Connell: I know I mentioned previously, but Healthcare is a complicated industry. It took many years for us to get to this point, and we know it will take many years to get to where we want to be. We're actively working to make sure patients fully understand every aspect of their care so we can help them make the most informed healthcare choices possible.  Gina DiPietro: Price transparency beyond the federal requirements is a way of meeting the consumer needs. Another way we do that is through affordability and accessibility– providing the right care, at the right location, at the right time. Can you explain Novant Health's value-based care concept?  Melonie O'Connell: For more than a decade, Novant Health has delivered innovative, value-based care, building on its commitment to meet the needs of patients and their families wherever they are in their health care journey at a price they can afford.   We have taken a multipronged approach to make health care more affordable and accessible while getting people well and keeping them healthy. From our perspective, a health care system where value is defined by quality, cost and patient experience more closely aligns with our mission to improve the health of our communities, one person at a time. We participate in value-based care programs covering over 450,000 attributed lives with multiple payors. In one of those programs for over 80,000 members, including our own team members, we have demonstrated significant reductions in the cost of their care compared to the market – over $17 million in savings in a single year. Likewise, our Medicare Shared Saving Program (MSSP) accountable care organization has delivered top decile national performance on the cost per patient. In addition to innovative, strategic value-based care programs, our providers are focused on helping patients be more proactive in their health care, whether online through MyChart with over 1 million patients, or connecting with people who are at higher risk of developing complications from chronic conditions. Some of these initiatives include:Developing a dedicated diabetes service line with resources to provide nation-leading diabetes care in both primary and specialty care settings. Offering an episodes of care benefit option for team members, including total joint replacement and maternity care. This option includes coordinated and clearly defined care paths with a single point of contact and a single bill with upfront cost information. Partnering with TytoCare to provide virtual physical exams for team members and consumers in North Carolina. Patients have the ability to perform their own guided medical exams with a health care provider – all from the comfort of their home. Offering Novant Health Care Connections, which offers interventions to manage health for a wide range of patients, from those who are healthy to those managing chronic conditions. Our Care Connections team handles millions of inbound and outbound calls a year, connecting with patients and coordinating referrals Jesse Cureton: I want to highlight what Melonie said again – that a health care system where value is defined by quality, cost and patient experience more closely aligns with our mission to improve the health of our communities, one person at a time. This dedication to quality and patient experience is for all of our patients, in all of the communities we serve. We have demonstrated a long-standing commitment to improving access to quality, affordable health care for communities that need it most. We have been investing in community clinics, mobile health units and innovative wellness initiatives with the help of our community partners. This is to ensure vital access to primary and preventative care services are available where and when our communities need us. Together, we are removing barriers to health care, closing health equity gaps and improving the overall health and wellness of all of our communities.   As we think about healthcare costs, I do think it's important to highlight our financial assistance policy, which I'm proud to say is one of the most generous charity care policies for patients who come to us for care and are uninsured. If patients have an income that's 300% of the federal poverty level or lower, they get free care, regardless if they are seeing a primary care physician or specialist. This policy is a cornerstone of our culture and is an essential element in allowing us to provide remarkable healthcare to all members of our communities, regardless of their ability to pay. This program covers about 90 percent of all uninsured patients. For the other 10 percent who do not qualify because their incomes are above the guidelines, we offer a discount on their bill that is similar to a managed care contract discount, which means that patients in this category will not pay more than what an average insurance company may pay. We also offer no-interest payment plans for those who do not qualify for financial assistance and need the option of paying their outstanding balance over a period of time.  While healthcare is a complicated industry and billing is confusing, we at Novant Health work every day to offer solutions to our patients and to help them fully understand every aspect of their care so they can make the most informed healthcare choices possible. Gina DiPietro:Gina DiPietro again. Healthcare is a complicated industry and Novant Health is committed to helping patient's understand every aspect of their care - down to what they can expect to pay. Thank you for listening to this episode of Industry Insights. If you enjoyed this podcast, please take a moment to rate and review it, and subscribe to this and all the Novant Health podcasts. We post new episodes all the time and most are just 15 minutes. 

Gina DiPietro  0:04  Welcome to Industry insights, a healthcare podcast presented by Novant Health. I'm Gina DiPietro, and I'll be guiding the conversations in each episode. In this podcast I talk with Dr. David Priest - chief safety, quality and epidemiology officer at Novant Health - has been integral in leading the charge against COVID-19. We dive into how the Coronavirus has changed the landscape for infectious disease positions. And Dr. Priest also discusses why public health should stay outside of politics, what the future of viruses like COVID-19 may look like, and key lessons learned while combating this pandemic. Thank you for listening.Gina DiPietro  0:45  Dr. Priest, tell us what an infectious disease physician does. And before COVID-19 what things did you work on? Dr. David Priest  0:54  An infectious diseases physician is a sub specialized internist. So after you go to medical school, you do internal medicine residency, and then you choose to sub specialize within internal medicine. So for instance, a cardiologist specializes in heart care and oncologist specializes in cancer care and infectious disease. Physician sub specializes in infection. So every patient we see has an infection of some kind. And what's great about being an infectious diseases medicine is it's incredibly broad. So any part of the body can be infected. And so you get to interact with all the other medical disciplines. The terrible thing about being infectious diseases physician is that it's so broad, you're expected to know things about things you've never seen, and tropical diseases. And so that can be intimidating and a little scary when you're not focused on a say a single organ system. But that's what to me is made it fun how broad it is. So we work on a variety of things. We do Tropical Medicine, we do hospital cases, like sepsis. patients with cancer who've developed infections we do emerging infections like Ebola, we help deal with influenza, we do orthopedic infections. So really anything you can imagine that's an infection, fixing the heart valve infections, the central nervous system, sexually transmitted infections, we also care for those with chronic viral infections like HIV or Hepatitis B, or C. So it's a really broad, exciting field. Gina DiPietro  2:30  Do you think that there was more early community concern to something like Ebola than COVID-19? And if, so why would that be the case? Dr. David Priest  2:39  I think there was. One is just the fact is the mortality rate for Ebola is much higher than it is for COVID. And so I think that that's a scarier proposition for the general public. I think there was actually really more known about Ebola this last time. I mean, we'd known about Ebola for several decades, and people knew how deadly that was. And, and they knew that if they acquired it, the risk of death was quite high. I think COVID was a little different. I think they saw people saw it, even if this was inaccurate, they thought, well, maybe it's some kind of flu. I've had the flu before, it's probably not that bad. And so I think the response to the public was a little different. Also, we got control over Ebola, at least outside of Africa more quickly, was a devastating problem on the continent of Africa. COVID has gone on for many, many months. And so it almost has the sense of complacency that comes along with it. Because of how long we've been dealing with it. Gina DiPietro  3:44  The world anxiously awaited a vaccine for COVID-19, which could put an end to this pandemic. But at the same time, concerns are raised that a vaccine created quickly might not have had enough time to vet long term issues. So from a historic perspective, how has the vaccine development and the testing process for COVID-19 been in comparison to vaccines for things such as polio, or smallpox and others?Dr. David Priest  4:12  The current vaccines that are coming out for COVID are mRNA vaccines. And I'm incredibly excited about this technology. The idea around mRNA vaccines is actually not as new as people think, for a number of years, researchers have been using this type of technology or we're testing it for a variety of medical problems, including infections and cancers, actually, traditionally, the way a vaccine is made is you have to take a virus or a bacteria or whatever micro organism you're trying to protect people from, and you have to alter it in such a way that it's weakened. And then give it to the person to hopefully get them to make an immune response. So they're protected against whatever that virus or bacteria or micro organism is. When you do that, that process is potentially painstaking, expensive, can take months and years, people remember flu shots have traditionally been grown in eggs. So you have to have warehouses full of eggs. It's a, it's just a time consuming hard process. What's exciting about mRNA vaccines is that's not necessary. So rather than trying to get people a weakened version of a micro organism, instead, we're saying we're going to teach your body to make a protein that's on the side of the micro organism. And that's what's going to give the immune response. So mRNA, vaccines can be developed very quickly, and be made much more quickly. The reason it took a few years for these to come to the point they can be used is that mRNA is very, very fragile. it degrades very quickly. And so there were important technological advances that actually help protect the mRNA by putting a little lipid around it, and also storing those vaccines that very cold temperatures. And so once those things were worked out from a technology standpoint, then the vaccine could move forward. So while it seems like oh, this happened very quickly, actually the background on it's been around for some time, is it unusual to have multiple versions of a vaccine with different formulas like we do with Pfizer, and Moderna and several other global companies, it's really not that unusual. Manufacturers can ake the same type of vaccine. And we want that, right? We want different companies coming at a problem as important as this from several angles. And you want them to, to, we want the best one to rise above the others. And if they work equally, we want to use them all. I mean, we're in such a situation, now that we need all the vaccine help we can get. And we want to be safe and effective. And I think both of Pfizer maternal products are both safe and effective. Gina DiPietro  6:57  And since there are multiple versions of the COVID-19 vaccine, how can people know that they're all safe?Dr. David Priest  7:03  So both the Pfizer materna products are using mRNA technology and because that mRNA is so fragile when it's given to you and only lasts in your cells about 24 to 48 hours, and then it degrades. So there's really no mechanism that would lead to the long term problem or a situation where you have a long term side effect. Now in the short term, you may have what we call expected effects, where you get the vaccine, and then you have the symptoms that are consistent with an immune response to your arm can hurt, you get a little little low grade fever, maybe some redness you have kind of the blahs for a day or two. And that quickly goes away in both the trials. With Moderna and Pfizer, there were no long term serious safety events that were noted. And so we feel very good about the safety profile not only from what was observed in the trials, but also the mechanism and how the vaccines work. Now other vaccines could come to market and we would have the same demands of those vaccines show us that this vaccine is both safe and effective. Moderna and Pfizer both reported around a 95% effectiveness rate for their vaccines, which is frankly incredible. We think about the flu vaccine that we give every year, which often is effective less than 50% of the time doesn't mean you shouldn't get it actually the more of us that get it no matter how effective it is, the better. But compared to our yearly flu vaccine, these are incredibly effective vaccines. Gina DiPietro  8:31  Another question for our listeners... Ethically, many leaders want to wait for the vaccine. Most people don't want to be the leader, the celebrity or the athlete who's accused of taking a dose of the vaccine from someone more in need. I know even Pfizer CEO said he would wait his turn to get the vaccine because he doesn't want executives to cut the line. But at the same token leaders and celebrities have incredible influence and can encourage others to get the vaccine. What would you recommend leaders do? Should they be leading by example to show people that they wouldn't encourage people to do anything they wouldn't do? Or wait until most people have gotten the vaccine to ensure that, you know, the people who are most in need have the opportunity to get vaccinated? Dr. David Priest  9:18  Yeah, so that's a great question. This is a really fine line to walk for leaders. Because to your point, we want to show that we have confidence in the vaccine, we want to publicly say we've gotten it. At the same time leaders and executives are often not the individuals who are on the front line, particularly in health care. We've seen controversy around the country related to this topic. So the what we've tried to do it in our organization is to say we're gonna we're gonna try to balance this we're certainly not going to give vaccine to executive leaders who are working from home ahead of our phase 1a team members -nurses and doctors and Environmental Services staff and respiratory therapists and those individuals who are caring for COVID patients every single day. They deserve, they're risking their lives. They deserve to get vaccine first. And that's what our approach has been. But we do have key leaders, particularly key leaders, who do you see patients who have publicly gotten the vaccine and say, Look, we believe in this. So there is a little bit of tension there. And you have to work that out, I think, maybe in your organization. But I would lead with those most at risk. And then some key just a few key leaders to ensure that that people are understand the vaccine is safe and effective. And look, we understand there's vaccine hesitancy. And so we need to do those things to get people to understand this is safe, and they should do it. But you have to be careful about how you approach it. Gina DiPietro  10:50  I want to go back to a point that you made, you mentioned herd immunity, it's really important that people buy into getting the COVID-19 vaccine to get this pandemic under control, right?Dr. David Priest  11:03  Absolutely. And we think 70 to 75% of our communities need to have some degree of immunity, either from having COVID or having the vaccine or both. In order for this to really slow down and let us move back to, you know, the way we lived before all of this happened. And so that's that's why we're emphasizing that we have that the vaccine is safe. And we're really encouraging individuals to get it. We understand vaccine hesitancy, particularly in certain parts of our community that have had historic healthcare disparities, the African American community and the the history that that community has had with the healthcare system has not always been good. And unfortunately, things like Tuskegee and other experiments like it really builds a sense of distrust within the African American community, which is entirely understandable. And so we need to work through that. And we have leaders, African American leaders in our organization who have gotten the vaccine and are helping with that messaging. We are not going to get to herd immunity if we don't get all parts of our community equitably immunized. Gina DiPietro  12:13  What do you think the future of viruses like COVID-19 looks like? Meaning, do you think that we'll continue to have outbreaks of new viruses, maybe not to the scale, but in the future? Dr. David Priest  12:24  I think invariably there will be other pandemics. The key is when and I think we're certainly not done with this one. There also are concerns that in any pandemic, could the virus mutate in such a way that it becomes more transmissible, more infectious, would require adjustments to the vaccine? I think all of those things are possible. From kind of early in the pandemic to more recently, we've seen reports of mutations in SARS -COV2, to the virus that causes covid. Those mutations have made the virus more transmissible, but to date, we have not seen that it caused it to cause any more serious infections. But that can change over time. And so that may change how our vaccine approach works. So for instance, if enough mutations occur to the virus, that the current vaccines are not as effective, we would have to adjust those, and perhaps you're getting a new vaccine every year against COVID to protect you. We don't know that yet. Right now, the mutations that have been seen are, we believe are still covered by the current vaccine. But it just speaks to our need, as a nation and globally to put more resources into public health, more resources into pandemic response, more resources into monitoring situations and having the appropriate testing we need for individuals and certainly monitoring at our borders and the borders of other nations to ensure if these things are detected, we get on those we get on these things quickly. If you remember the original SARS epidemic pandemic was obviously much smaller. And the reason it was was individuals didn't transmit the virus if they didn't have symptoms. So you knew who was contagious because they had symptoms. In COVID, SARS-COV2, you could transmit the virus and have no symptoms. That is why it's been so much hard to get our arms around it compared to what was happening with original SARS. So the characteristics of whatever that virus is are really important. And I think invariably, there'll be other pandemics, we just need to be better prepared. Gina DiPietro  14:33  Many of our listeners are business and government leaders who want to do anything they can to prevent this type of mass pandemic from happening again, from your personal perspective, what have we learned as leaders that we can do differently in the future? Dr. David Priest  14:47  I think there's been a lot of hard lessons. I think when times are good and there are no outbreaks or pandemics. We tend to cut back on public health funding. I think when there is a budget crunch of some kind, sometimes that's the first thing to get removed. And I think this teaches us that's not a good idea. We need to make sure we do have those, the capability to monitor for outbreaks around the world. We have some systems that do that. But we need to have more systems that do that we need better cooperation across national lines, in order to have early warning systems when these kind of things develop and have the ability to develop diagnostics, and vaccines and therapeutics more quickly than we did with COVID. And I think the other thing is, we have to make sure that public health stays outside of politics as much as possible. I understand that often leaders of these public health organizations are appointed or occasionally elected leaders have some jurisdiction over public health. And so it's hard to totally avoid politics. But when public health becomes a political football and gets thrown around, we found through the this particular pandemic, that that's not as used, it's not a useful thing it doesn't allow that are the public health officials and our scientists and our physicians to do the things they need to do to protect the public. And I think the other thing I would say is more unified national message, I think will be helpful for the next pandemic. Because it's kind of there's kind of confusion, there's been some confusion and look, the guidance can change over time. That's okay. As we learn more, we have we need to be able to give new advice and make new guidelines as we learn more. But the message wasn't very unified. And I think that fostered distrust, and also allowed rumors and false statements about COVID to be spread online. And I think online is the other piece, right? We live in an age of this of social media and online influence, which has some benefits, but also has some downside when small, contrarian voices can get amplified with things that are true. And so we are the constant battle to explain to people that the things you're hearing about about COVID or the vaccine are not are not true. So I would say making sure public health is in a position needs to be improving communication. Improving diagnostics and monitoring are all important pieces of what we need to be doing when the next pandemic comes.Gina DiPietro  17:33  On behalf of Novant Health team members and our listeners here, thank you so much for your leadership and helping Novant Health and our communities navigate this pandemic. Dr. David Priest  17:42  Thank you.Gina DiPietro  17:47  Gina DiPietro again. Some great information there from Dr. Priest and a well deserved thank you for his leadership throughout this pandemic. We hope you'll join us for a future episode where other healthcare leaders and influencers provide insight on everything from Digital healthcare, and consumerism to Care Transformation. Keep your finger on the pulse of healthcare with Industry Insights, a healthcare podcast presented by Novant Health. Thank you for listening

How are healthcare leaders solving for the next big challenge? Novant Health presents insights from healthcare leaders and influencers on everything from digital healthcare, consumerism and care transformation – the biggest questions and latest trends in healthcare. Keep your finger on the pulse of healthcare with Industry Insights presented by Novant Health.