Tommy Inzina 0:03
It’s an exciting thing for our team members and physicians. The NFL is allowed to have about 14,500 paid fans at the game is what I’m told. And they did some work with the CDC and others wanting to recognize healthcare workers, and they came up with a pretty unique model. They got to go-ahead to include an additional 7,500 people with the stipulation that all of them had both doses of their vaccine two weeks before the Super Bowl. So the NFL has donated those tickets to many of the healthcare organizations in our community.
Gary Bisbee 0:40
That was Tommy Inzina, president and CEO BayCare Health System, speaking about the excitement of Tampa hosting the Super Bowl, and the NFL offering 7,500 tickets to frontline health workers as a token of its appreciation. I’m Gary Bisbee and this is Fireside Chat. Tommy spoke in depth during our conversation about why he became a CEO, what he enjoys most about it, and why he made the move from previous positions as CFO and COO. He also had a very interesting perspective on characteristics of the post-pandemic, next generation health system CEO. He dug into the issue of scale, what is the value of Regional Health networks, and why he thinks that they will grow this decade. In response to the question about lessons learned from the COVID crisis, Tommy referred to a lesson that we have not heard in previous conversations. Let’s listen.
Tommy Inzina 1:34
The one that comes to mind is almost like a hard one to admit. And that is having to be okay changing your mind almost daily. Because one of the things that leaders do, particularly CEOs, we get a little entrenched. When you make up your mind what you want to do and you lay out your position, there’s this sense, typically, that if you back off of that, perhaps that’s a sign of weakness.
Gary Bisbee 1:57
He outlined BayCare’s Medicare Advantage program, why it was a priority, and how it is growing. During our discussion about planned excess capacity as a contingency for crises. Tommy made the point that staffing at Baycare was more of a constraint during the surge than facilities, as follows.
Tommy Inzina 2:16
There is some excess capacity in general. I can’t speak to the whole country, but my concern, Gary, is what we experienced in COVID was we ran out of staff before we ran out of beds. And as we looked at contingency and planning, I think it’s more of a workforce issue. Now that might have not been true in some specific communities, but while ideally, I’d like to think there would be excess capacity in the system, I don’t see that happening, because there’s not anyone that’s going to want to pay for that.
Gary Bisbee 2:50
I’m delighted to welcome Tommy Inzina to the microphone. Well, good afternoon, Tommy, and welcome.
Tommy Inzina 3:00
Thank you, Gary, happy to be here.
Gary Bisbee 3:02
We’re pleased to have you at the microphone. We are very interested in the Super Bowl, as we’ve talked about, and you’re active in that, we will get back to the questions about that later. But opportunity to get to know our guest a bit better, you’re, of course, the founding CFO and that was, what, 24/25 years ago. Going all the way back, you were an accounting major at Auburn. What drew you into accounting, Tommy?
Tommy Inzina 3:31
Actually, it wasn’t my first love. Some people kind of follow on things right away, but when I was in high school, I was what people typically thought of as a smart kid. And back then, smart kids were expected to be doctors. So I finished high school, started college in pre-med, realized before too long it wasn’t really what I wanted to do as much as what I thought I was supposed to do. So after struggling a couple years trying to find my way, I actually quit college. I worked for three years, I had a real job working hourly work in a chemical plant doing shift work. And during that time there, with the help of a couple of coworkers, I stumbled across what am I good at, what did I like? And I decided I was going to try accounting out. So I took the first couple of accounting classes while I was still working at the chemical company, and confirmed that was a good fit for me. So I left my job, went back to school full time, and finished it up.
Gary Bisbee 4:23
Did you go to E&Y directly out of college?
Tommy Inzina 4:27
I did. I did. I went to Auburn undergraduate and lived in Mobile, Alabama after that. And so I started with, it was Ernst & Whinney and quickly merged, became Ernst & Young after that. But yeah, started there right out of college in 1983.
Gary Bisbee 4:39
So is that where you plugged into healthcare when you were at E&Y?
Tommy Inzina 4:44
Exactly. But it’s amazing. I’d like to tell you it was a lot more profound than that, but I fell into healthcare a lot like I fell into accounting. Mobile office at E&Y was a small office, about 25 people. Had a good healthcare practice, though. And I started in August, and it’s just luck has it, my first two clients that I worked on happened to be hospitals. And that took me in several months. And after doing that for about six months, a couple of people the next level up who were doing healthcare quit, left the firm. So then they had a shortage of people, so the next four or five jobs I worked on were healthcare. And I noticed after about a year, people kept talking about me as the new healthcare guy. So I sat down with the managing partner one day and asked him, “Was I the new healthcare guy?” And he looked at me for a minute and said he hadn’t really thought about it quite like that, but would I be okay with that? I said, “Sure, I like it, it’s a lot of fun.” And so I spent my entire career at Ernst doing nothing but healthcare auditing and consulting.
Gary Bisbee 5:41
Well, what caused the switch from being at E&Y to the hospital business?
Tommy Inzina 5:47
A couple of things. One is, I went to work for a client, when I left E&Y I went to work for St. Joseph’s Hospital in Tampa. And it was pretty commonplace, at least back then, because you get to know your clients and they get to know you and there’s a little bit of less risk of the transition. But the greater issue for me was, when I joined public accounting, the idea of being a partner in a national accounting firm was a really big deal. It almost felt like a small partnership inside a big firm. And as those firms began to merge, get bigger, I got a little disappointed with what I thought that life for me would be. And I didn’t really think I was going to accomplish as much or contribute as much to healthcare as I could on the industry side. So after giving it a lot of thought, I was in the public accounting space for about 10 years, an opportunity presented itself to join St. Joseph’s Hospital, which later became part of BayCare. And a goal is, all along was to be, one of a small group of people that really made a difference in a business or organization. I just concluded I could do that better inside a healthcare provider than I could to continue to do it in public accounting. But I wouldn’t give back that time I had at Ernst & Young for anything. What you learn there has really helped me tremendously in my career.
Gary Bisbee 7:03
During your time at BayCare, you went from CFO to Chief Operating Officer to CEO. What was the thought, Tommy, about becoming a CEO? Is that an aspiration that you had or what was the progression of your thinking there?
Tommy Inzina 7:18
Every once in a while my wife will look at me and say, “Did you ever imagine in your wildest dreams you’d be a CEO of a company the size of BayCare?” And the truth of that is, no, not really. I loved being the CFO. It was a good job, a good role. I always prided myself on not being defined by the role. The role I played, it just, it wasn’t who I was. I was blessed to have a CEO, the second CEO of BayCare, a guy named Steve Mason, who believed in me a lot. He knew I wanted to grow and I wanted to stay in BayCare a really long time. I’m the kind of person, like a lot of us, who get a little bored and want to do something different. And starting in around 2005, he gave me the opportunity to become broader. I kept the CFO title, but I became chief administrative officer in addition. I had most of the system functions report to me. And it wasn’t really until we started to talk about succession planning and Steve retiring, that the idea of being the CEO really hit me. And it was more about wanting to help BayCare, if I could, than having get the CEO job in and of itself. BayCare is a wonderful organization, a wonderful culture. Having been part of it since before it was created, it probably means more to me than some systems mean to other leaders. And when the decision was made that he was going to move on at some point, and the organization needed a new CEO, I felt like I could do it and I felt that I was uniquely positioned to continue the culture and the successes that we’ve had. So it was less about me deciding I want to be a CEO and me deciding that if I could be helpful in the next phase of BayCare’s existence, I wanted to do that.
Gary Bisbee 9:07
Well, you’ve done a terrific job at it, Tommy. So good choice by the board. What do you enjoy most about being CEO?
Tommy Inzina 9:14
Probably my interaction with team members. We’re blessed to have 30,000 team members as we call them here inside BayCare. And I spend a lot of time, more pre COVID, but even now. Twice a month, I get out and have breakfast or lunch with a group of about 10 or 12 non-management team members. I also do a couple of town hall meetings each and every month year-round. And the purpose of that comes all the way back from our existence. The first CEO of BayCare cautioned me that as you move higher and higher in a big organization, you get farther away both from the customer and from the frontline team members. And if you don’t find a way to stay connected to them, you run the risk that you’re asked to make decisions that impact people when you don’t really know what’s important to them. And that really resonated with me. So the time I spend with them each and every month asking questions, asking what’s important to them, asking what they like, is really rewarding for me. Because I do a lot of that, I also get a lot of emails from team members with questions, concerns, career advice, and some of them are just tickled to death to be able to interact one on one with the CEO. Just recently, I was responding with someone. And I actually didn’t tell her what she wanted to hear. I told her the truth, it just happened that it wasn’t what she wanted to hear. And she was very gracious and said, “You know, I understand that. I appreciate your follow up. I work with a lot of companies, but I’ve never actually had the chance to talk to the CEO.” So seeing people get energized from that and being able to stay connected to what’s happening is actually the most rewarding part for me.
Gary Bisbee 10:52
Tommy, why do you think more CEOs didn’t start out as CFOs?
Tommy Inzina 10:57
It’s interesting. Whether your personality type causes you to choose a career path or a career path causes you to behave in a certain way, but CFOs stereotypically have this sense around, they’re typically introverted, they’re not really good with people, and they’re not very visible. And I think sometimes people in general and CFOs in particular, can sort of fall in love with the role. And if you fall in love with the role, and there’s that stereotype, you’re not going to be able to break from that. And so I was always real careful, and Steve Mason, as I mentioned, he was always really good to recognize that I was being skeptical, glass half full kind of guy, not because necessarily that’s who I am, it’s the role I play. And so that to me is what helped me is not letting the role define who I am and I think some people do that. And when you do that, you get pigeonholed. And people don’t think you can be different. You don’t think you can be something other than who you have been.
Gary Bisbee 12:05
I wonder if it’s a coincidence that the only two of you who started out as CFOs became CEOs are in Florida? The only two out of the largest 100 health systems, its you and Terry Shaw at AdventHealth. So maybe there’s something about the water in Florida, Tommy, I don’t know.
Tommy Inzina 12:22
Could be. Terry’s a good guy. We knew each other back when we were both CFOs. He’s done really well for himself as well.
Gary Bisbee 12:28
Well, let’s turn to COVID. How’s the surge in the Tampa area, in West Florida, Tommy?
Tommy Inzina 12:34
Fortunately, as we sit here, early February, it’s actually a little better. To give you context relative to our system, July was the worst peak of COVID we had. At its highest, we had about 700 COVID-positive people in our hospitals. In early to mid-January, that number got back up as high as in the high 500s. So we didn’t get back to 700, we got almost 600. For the last 10 days or so, we’re back down in the 450 range. So 450 people is still a lot of COVID positive patients in our system, but we think the wave and surge that we saw that people were expecting around Christmas, New Year’s, and the holidays, we think the peak of that may have already passed here and we’re beginning to come down just a little bit. So we’re happy to see that, while it still applies a lot of pressure on our system.
Gary Bisbee 13:25
Speaking of pressure, the caregivers certainly are tackling an ongoing stream of these COVID patients. How are you looking at the caregivers in terms of the stress that they’ve been under, Tommy?
Tommy Inzina 13:37
I couldn’t agree with you more, Gary. It’s amazing. Not just our team members, but the healthcare workers all across America that dealt with this for the last year. We compare early on. COVID, we created an incident command center like you would with a hurricane or a disaster and the difference is a hurricane, and for us living in Florida, that’s a four or five-day event. This has turned into a year. The major focus area in our organization has been a couple of things. One is, I’m really thrilled that our board has made team members and physicians first, and financially, they put their money where their mouth is. So throughout this entire pandemic, we pay what we call a team award, which is a team member bonus that goes to every team member in the organization. We continued to pay team awards throughout COVID, we continued to implement merit increases throughout COVID. So we made sure that our team members didn’t have any greater difficulty with hardship. And then from a resiliency perspective, we run a large behavioral health program. So our vice president of behavioral health, as well as our VP of mission and integration have worked together to try to work on team member resiliency and they held focus groups, they held webinars, we’ve got an employee assistance program that we’ve ramped up. And so there’s a lot of work being done with team members to try to help them. Sometimes you just want people to listen. And then the other thing we do, like most people, is that we do give people that work directly on COVID units the opportunity to rotate off of those COVID units. So we don’t ask a nurse to work in a COVID unit full time. Once they’ve been at that a while, if they want an opportunity to rotate off and get a little bit of a breather, we do that as well.
Gary Bisbee 15:25
Yeah. That makes great sense. Tommy, if I ask the question directly, what are the top lessons you’ve learned from this, virtually a year worth of COVID experience?
Tommy Inzina 15:35
The one that comes to mind is almost like a hard one to admit. And that is having to be okay changing your mind almost daily. Because one of the things that leaders do, particularly CEOs, we get a little entrenched. When you make up your mind what you want to do and you layout your position, there’s this sense typically, that if you back off of that, perhaps that’s a sign of weakness. So sometimes you get rigid to a fault. But with COVID, particularly thinking about early on. We had mask protocols, and then something would change, and it seemed like we were having to change our mask protocols every two or three days. And that’s been throughout the entire pandemic. And it’s frustrating for our leaders, but when we had to realize that COVID was in control, not us. Probably my most difficult one, call it almost embarrassing, we had our corporate office workers that we had sent remotely back in April. When we got through the wave in July and August and things leveled out, we decided to start bringing our people back. And by the end of October at the corporate office, we had about half the workforce back in the building. And I’m doing one of these town hall meetings and I get a question that says, “Tommy, do you anticipate if COVID cases go up a little bit, do you anticipate we’d send people back home again?” I said “No, no, no, I don’t think so. We’ve got this under control. We think we’re doing safe things.” And in less than two weeks, we sent everybody back home again. The environment changed so dramatically. So to me, just having to be more comfortable with making decisions at a point in time based on the facts that you have and being okay when the facts change, recognize that you may have to change your view. That’s hard for some people.
Gary Bisbee 17:21
Vaccinations, Tommy? What role is BayCare playing in vaccinations?
Tommy Inzina 17:26
We’re playing, I think, a very good role. What occurred here in Florida, our governor did things a little differently. He issued an executive order. He started with the senior population at 65 and older rather than 75. So he started and said we’re going to have long term care facilities, healthcare workers, and seniors. They did a partnership with CVS and Walgreens and used the National Guard to tackle the nursing home facilities. They relied predominantly on hospitals and healthcare systems to vaccinate healthcare workers and to start with seniors. So we vaccinated all of our team members and physicians who wanted vaccines. But in addition to that, they asked us to help vaccinate community healthcare workers. Think about dentists, think about physician practices that don’t work in the hospital. So that was a tremendous outreach to vaccinate that population. And then we helped with the senior population until the county health departments could get ramped up for that. So where we are right now, is that we’ve issued all of the phase one doses that we had for healthcare workers, to seniors, and we’re in the midst of phase two vaccinations. The next phase for us, the state just recently began talking about the extremely vulnerable, medically vulnerable population of people that are below age 65. And there’s a belief, and I believe, that that’s a unique role hospitals and health systems could play because the public health departments they know if you’re 65 or older, they just get a driver’s license. But when you talk about some of these chronic conditions, that would be very difficult for a county health department to do. I just had a phone call earlier today with the CEOs of the other health systems in our market, comparing notes around how would we identify, how do we prioritize those most medically vulnerable patients?
Gary Bisbee 19:21
That’s going to be interesting. What is the declination rate among the BayCare employees and staff?
Tommy Inzina 19:29
It’s higher than I would want it to be. The team members that were offered a vaccine, I don’t have the exact percentage, but about 60% are taking the vaccine, 40% hadn’t. But of the 40% who haven’t, they didn’t say, “I don’t want to take it.” They basically said, “I want to wait. Let me let a bunch of other people get through first dose and second dose, because there were some people worried about side effects.” And they said they didn’t say no, they just said, “Not now, we want to watch.” So I fully expect once we get another few weeks in, we’re gonna have another round of people wanting to come forward. The physician community has a much higher percentage of them wanting to take the vaccine than some of our team members. And then amongst the senior population, they all want it.
Gary Bisbee 20:17
Yeah, I would think so. Well, some of us may be more familiar with BayCare than others, Tommy. Could you describe BayCare for us, please?
Tommy Inzina 20:25
I can. BayCare is a wonderful organization created back in 1997. We are today an integrated health system. We’re about four and a half billion dollars of revenue and about 30,000 team members. We’re in West Central Florida, so think Tampa Bay, and our primary market is four counties and those four counties have about 3.8 million people in them. We operate a number of hospitals, about 15 hospitals. We have a full array of ambulatory capabilities. We operate imaging centers, surgery centers, an outpatient lab business as well as urgent care. We have about 600 person employed physician group. And then we have a really large home care company. We’ve got a home care agency that does about a million home visits a year. We were formed in 1997 when a lot of systems came together when Bill Clinton was in office and there was talk about healthcare reform then. One of the things that makes us a little bit unique, because we’re a joint operating agreement. There were a number of those that were created but didn’t survive. But we brought together two secular, not-for-profit organizations in the community and one Catholic partner. And we’ve been around now for, July this year will be 24 years.
Gary Bisbee 21:41
How is that operating agreement working out? I’ve heard that some work pretty well and some don’t work so well.
Tommy Inzina 21:48
I can’t evaluate every single one of them, but I think we have been about as successful as any. The major reasons, I think that is, many people when they create a joint operating agreement, the intent was to date, not get married. So most of them were relatively short and typically either party could get out. We were created in the form of JOA for a lot of technical reasons. The parties would have merged, but there were reasons why they couldn’t. And they wanted to make it as much like a merger as they could. So our partnership has a term of 50 years and no single party can withdraw unilaterally. So to get into this, they said “We’re in it for good.” And as a result, while there are some unique characteristics that we have to think about relative to our owners, we operate way more like a merged entity than most JOAs would.
Gary Bisbee 22:41
Thinking about 15 hospitals, a number of ambulatory care centers, physician’s offices, and so on, how has scale mattered during this COVID crisis?
Tommy Inzina 22:54
I think scale always matters. I think we are in the sweet spot where I think we are large enough that we can get to economies of scale, but I also think we’re not so large that it becomes wasteful. Clearly, access to capital and the ability to keep capital funding going has been really helpful. I think the ability for us to move people around. We have our own internal nursing float pool. So if we have shortages in one place, we can move them around. Back during the peak, there was concern some people had around ventilators. We have that capability to move things around. And then probably the one that we’ve worked on most is we have our own supply chain operation. We own our own group purchasing organization. We actually do our own distribution to our hospitals. That operation is housed out of a warehouse, it’s more than 200,000 square foot warehouse. So as the crisis that was COVID, early on, started to subside, we continued to buy PPE for the future. And that scale and ability to bring resources together, I think, has made us better prepared for the future.
Gary Bisbee 24:02
So do you have your own warehouse or how do you store this PPE?
Tommy Inzina 24:05
We do. We have this big warehouse. We had not built it out. It’s a really tall interior building. And there was the ability to build out a mezzanine to create a second level. And so we have just thousands of square feet of product there to be used. We gave our supply chain leader the okay to get us at least 120 days supply of everything and he could go up to six months if we needed it.
Gary Bisbee 24:31
Thinking about scale in the situation of a health system, what do you think is going to happen nationally? Will we see more consolidation among health systems?
Tommy Inzina 24:42
It appears so, Gary. You study this a lot and you follow it and talk to all of my colleagues more than I do so you probably have a better sense. But what I see, I will admit, I have a bias. Most people would think of us as sort of a regional system, I actually think regional, large regional health systems is a sweet spot. I don’t think it’s going to be very feasible for independent, single standing hospitals to be effective going forward. I think even a two-hospital system will stretch itself. But sometimes the multistate systems, not to be critical of any of them, there are a lot of wonderful organizations, they face challenges of almost diminishing economies of scale because they have to duplicate things at a local level and a system level. But I do think there’s going to have to be more consolidation. I predict you’ll see some virtual consolidation. Because when we talk about growth, we talk about why. What are you trying to accomplish? Are you trying to get unit cost down? Are you trying to diversify risk? Are you trying to get in a position to take on more population health-based risk? So any individual organization has to first address why it’s doing what it’s doing in order to decide the strategy. And when you think about this population-based risk, I think organizations could come together and agree on a health plan strategy or a network strategy without merging and be able to get there. So I think it will be some, but the belief that we’re going to end up with five or six large health systems across the country, I don’t see that going that far that fast.
Gary Bisbee 26:21
No, I agree with you about the regional nature. That’s certainly the next step. What about BayCare? Do you see BayCare participating in M&A at any point in the future?
Tommy Inzina 26:32
I look at that in two levels, Gary. In our market, we’re always open to opportunities. We have built a couple of new hospitals, have another one planned. The last acquisition we did was 2016. We did one in 2013, one in 2016. So we’re always open to those opportunities as they present themselves. But we’re already about a third of our market. And we’re somewhat constrained with the number of opportunities that are available. Then the question becomes, does BayCare get to a point where it feels like it needs to be part of a $10 billion system or a $20 billion system? And I don’t necessarily think it’s impossible that we’re going to get there, but it hasn’t been my priority. I’ve been the CEO since 2016. And my priorities have been to make BayCare the highest performing health system in this part of the country across all three elements of service, outcome, and cost, and make us the best we can possibly be. If we had to be part of something that was a lot bigger, it’s hard to get there from our geography. We have water to the west, so we can’t grow west. And so it’s going to be difficult, We possibly would have to leap a market and merge with somebody in a completely different area. And my thought is, if we can become the highest performing organization in a lot of metrics, then if that time comes, we’d be in a better position to take a part.
Gary Bisbee 28:00
Can we turn to Medicare Advantage and share how BayCare thinks about Medicare Advantage and what your strategy is there, Tommy?
Tommy Inzina 28:09
I will, Gary. It’s a timely one because you know, we just finished the annual enrollment period. So we think that health systems, particularly if you have the scale and the ambulatory network, health systems need to be more responsible for the total cost of care. We have an account care organization with about 45,000 Medicare beneficiaries in it. And we’ve been at that for a number of years. In Florida, there’s obviously a large senior population and a pretty high Medicare Advantage penetration rate. And so we felt that was an area we need to be in and we need to learn. We explored joint ventures with other payers as a lot of health systems have done, and for a lot of reasons, that didn’t play out. Probably as much due to our issues as it was theirs. So a few years ago, we decided to launch our own MA plan called BayCare Plus. We launched it January of 2019, so we’ve finished two years of operations. We have 10,000 members, and while 10,000 is certainly not what you need to operate at scale, for a brand new startup plan in a highly competitive market, I’m told getting 10,000 members in a couple years is not real bad.
Gary Bisbee 29:20
What’s the goal? Let’s say at the end of five years, you’re already two years in, so over the next three years, will it grow pretty much proportionally do you think or will it accelerate?
Tommy Inzina 29:31
We think we have to get at least to 25,000. One of your bigger challenges with a startup plan is the administrative costs. In the industry a lot of people talk about how you’ve got to get your administrative expenses to 15% or less of the premium. If the medical loss ratio is 85%, you’ve got to get administrative expenses. And our administrative expenses as a percent of premium, as you might imagine, is well north of 15%. So we’ll see how much we can grow. What our projections tell us that we have to get 25,000 to spread the administrative costs across that base. We’ll see where it goes from there, but the near term goal is to get to 25,000 as quickly as we can.
Gary Bisbee 30:12
Well on to the Super Bowl. Everybody’s waiting for me to ask this question. So how is BayCare involved in the Super Bowl activities, Tommy?
Tommy Inzina 31:21
Yeah, it’s an exciting thing for our team members and physicians. The NFL is allowed to have about 14,500 paid fans at the game is what I’m told. And they did some work with the CDC and others wanting to recognize healthcare workers and they came up with a pretty unique model. They got to go-ahead to include an additional 7,500 people with the stipulation that all of them had both doses of their vaccine two weeks before the Super Bowl. They picked two weeks because they wanted to make sure they were highly affected. So the NFL has donated those tickets to many of the healthcare organizations in our community. BayCare is involved, Tampa General, there in Tampa is a lead partner with the NFL on this, ACA, AdventHealth, and a number of other organizations. So we went through a process where everyone had been vaccinated, both vaccines by a certain date, expressed interest in that. The NFL ultimately allocated a certain number of tickets to each organization, then they allowed us to hold somewhat of a lottery drawing in order to identify people to get back to the Super Bowl. So at the Super Bowl, they’ll be 7,500 healthcare workers there as the guest of the NFL.
Gary Bisbee 31:38
Tommy, I’m wondering how many emails did you get by people requesting that they be allowed into the game?
Tommy Inzina 31:44
Hundreds, hundreds! Every day I would tell my wife a couple of stories about it, because what happened was, as I said, the first email was, you have to tell us if you’re interested. Well, this moved very quickly. So we had to turn that around in a couple of days. And then you would get all the reasons in the world for why I couldn’t respond to the email. It was a lot, what comes to mind is the dog ate my homework. And so we’ve had a lot of that, and even once the tickets have been awarded, which was last week, I still get probably six or eight emails a day. People with some good, they’re wonderful stories, them wanting to help their colleagues, but you’ve got to get me a ticket. It’s almost like they think I have a bunch of tickets in my desk drawer somewhere. But it is exciting thing, but having the database box in it adds to the excitement around it. So it’s wonderful for the healthcare workers in our community. It’s sad that they all can’t go.
Gary Bisbee 32:41
That’s true. Well, thanks for the update on BayCare and the Super Bowl. Why don’t we turn now to what changes COVID is going to cause going forward. One obvious one is telemedicine. You all have seen an exponential change increase in telemedicine visits. What do you think looking out maybe three years or so, what do you think the changes will be in telemedicine due to COVID?
Tommy Inzina 33:09
A lot. I would take telemedicine and make it broader in that I think this idea of remote functioning is going to continue. So obviously, you’ll have telemedicine. We have started a program, it’s just in its infancy we’re calling BayCare at Home. I mentioned we operate a really large home care company. There are a lot of people who would like to get more care at home. So we are going to supplement our homecare nurses with advanced nurse practitioners who are being overseen by physicians. And we’re going to begin to try to provide more acute services in the home. We don’t go so far as to call it hospital at home, we call it BayCare at Home. We also have a very robust home monitoring. I think we’re gonna do a lot of home monitoring capabilities. If you shift then to the workforce, there’s a lot of debate amongst my colleagues. I participated in a group of CEOs that talk about this across the whole healthcare industry, not just health systems. Some believe remote working will stay forever. I know some companies who have said their key people are never coming back. There are others who culturally don’t believe you can function remotely. At BayCare, I will tell you that during COVID, we’ve approved half of the people that work in the administrative areas in our corporate office, we’ve approved half of them to continue to work remotely. And so I think the remote nature of it. Pre COVID, while our markets not that big, it can be an hour and a half to two hours to drive from some part of our system to the corporate office. And we made leaders drive for those meetings. And now that we’re doing them through Zoom and Skype and Teams, people are more comfortable. So I think there’s going to be more remote nature of it. And that’s actually one of the things I’m concerned about. I think it’s inevitable, but one of the goals I gave our HR executive this year was I wanted her to go out and look at other industries that have done remote working for years to figure out what are they doing? What are the best practices? How do you maintain culture in an environment where people are working remotely, so we’re gonna work on that this year. The other one that I think is gonna change, I hope for the good, is this idea around cleanliness, hand hygiene, and that type of thing. It’s not going unnoticed that the flu season this year has been very, very mild. Not only are people at home more, the wearing of masks and the constant washing of hands till they’re so dry you need lotion on them, is reducing just the regular flu. And we’ve talked inside our organization around how can we take advantage of that and keep that going. Because as I see our team members and society at large paying way more attention to cleanliness and hygiene, I think if we could continue that, we could eliminate some of the spread and other illnesses that go around.
Gary Bisbee 36:04
Historically, you kind of scratch your head a little bit that we didn’t learn as much from the 1918 flu as we should have in terms of things like you’re talking about, the cleanliness, washing the hands, and so on. Let’s hope we learn more after this one. That’s a segue into public health. I think we’ve all learned that the public health infrastructure in our country really isn’t up to this kind of challenge. How has BayCare participated with your local and state governments and has BayCare jumped in and helped with some of the infrastructure issues?
Tommy Inzina 36:40
Yes, we have. I’ve got to give credit to my colleagues. All the hospital systems in our area have done a really good job with that. I mentioned I have a weekly call we’ve been doing almost for a year with most of the CEOs of the other healthcare providers in the area. There is also a weekly call with each county where we’re all on the phone with them. So we’ve been collaborating with our local county health departments for the better part of a year – comparing information, seeing where we can be helpful. The vaccines is a really good example. We started vaccinating first. Now the governor is moving more of that to the county and the counties have begun to ramp up. But an example just in the last two days is one of our counties built scale to how much they could vaccinate. Well, they were focused on only doing first doses. Well, now that they’re hitting the point where they’re having to do second doses, they’re concerned next week, they can’t get everybody vaccinated. So in that particular county, they’ve reached out to us and asked the hospital systems, could we pick up some of the slack. So for example, they asked us could we take 2,000 doses and we divvied those up among BayCare and the other hospital systems as a way to help relieve some of that on the county. So it’s been very, pretty collaborative. We don’t always agree because you are dealing with county governments and elected officials, but there is weekly communication amongst all of those. Myself and the other CEOs have been asked to speak before most of the county commissions at some point during COVID. Because to their credit, they wanted to hear from the people who are dealing with this at the front line. So that’s another thing, Gary, I hope that will continue. In Florida, we’ve always worked together around hurricane readiness, but that’s so infrequent, it’s not really consistent. So I’m hoping what we’ve learned here, we will maintain that collaboration because it has been very refreshing.
Gary Bisbee 38:37
The odds that the body politic allocate substantially more dollars to public health aren’t great, unfortunately. So it feels to me like health systems like BayCare are in a position where you’ll probably continue to become more and more involved in the public health infrastructure through the years. Do you think that makes sense, Tommy?
Tommy Inzina 38:58
I do think so, particularly for situations like this. I don’t know, if you just think about public health in general, I don’t know that I see health systems. But when you’re talking about contingency planning, I do think we’ve learned so much in COVID and because there’s some concern that we’re going to be at it a while. I do think when the county health departments have to think about scale and ramping up, they’re going to have to rely on the health systems to do that because they just can’t grow fast enough to get that done.
Gary Bisbee 39:28
What about excess capacity, because the payment systems in the country are designed basically to whittle down number of hospital beds, whittle down capacity, and yet at times, like, well, hurricanes in your neck of the woods, which are more common, but this kind of public health crisis, should there be more excess capacity in our health systems? And if so, who would pay for that?
Tommy Inzina 38:55
Well, I think there is some excess capacity in general. I can’t speak to the whole country. But my concern, Gary, is what we experienced in COVID was we ran out of staff before we ran out of beds. And as we look at contingency and planning, I think it’s more of a workforce issue. Now, that might have not been true in some specific communities, but while ideally, I’d like to think there would be excess capacity in the system, I don’t see that happening, because there’s not anyone that’s going to want to pay for that. But what we experienced is more a staffing situation. In most hospitals have more licensed beds than they have staff and there’s some ability to expand there, but it’s hard to ramp up your staffing with something this intense.
Gary Bisbee 40:46
You mentioned this a bit, but let me ask the question directly. Regional health networks, do you think that over the next 5 or 10 years we’re going to see substantial increase in regional health networks of one kind or another?
Tommy Inzina 41:01
I hope so. And the reason why I say I hope so is when you think about some of those smaller organizations, even regional systems, they may not have all the capabilities they need or the scale they need to get into risk-based contracting if you don’t have an ambulatory network if you don’t have that. So regional networks designed to do risk-based contracting is something that would enable other organizations who perhaps don’t have the scale that BayCare has, or someone other has to do that. So I think that would be a good thing. The Medicaid program in Florida is all through Medicaid managed care companies. And there’s something in their provision called provider-sponsored networks that would allow providers to come together. And we’ve even had providers in Tampa Bay, otherwise, competitors, talk about, should we consider creating a Medicaid provider-sponsored network so that we could get into the risk-sharing business around Medicaid. So I hope that will happen. You do have to put competition and egos aside so it’s not always the easiest thing to do. But if we as an industry are going to take more responsibility for the total cost of care, that means we’re going to have to be more accountable for most of the premium dollar. And the really large systems in the geography can do that. But there are others who can’t and forming regional networks would get more people involved and I think that would be good.
Gary Bisbee 42:30
One more question and then let’s turn to leadership. And that is some have dubbed the term “the new middle” to refer to health systems and health plans working closer together, having partnerships perhaps in pursuit of a value-based care model. Do you think that’s more likely to happen over this decade?
Tommy Inzina 42:50
I’m not very optimistic about it. Payers and providers have got contracts to deal with and negotiations to deal with. And we’ve worked with the payer community pretty collaboratively, tried to work pretty collaboratively, but it’s difficult. What is important to a payer is sometimes different than what’s important to a provider. There’s an essential part of that, what we have seen today is the notion that you’re going to get a price increase just because is going away. So you’re not going to just go get more money just because you want it. We are going to enter in more agreements that are quote, “value-based,” where we’ve got to hit readmission targets, we’ve got to hit length of stay targets and certain things like that. So I do think it’s going to be more, call it value-based, but most of those arrangements are more of what I call, they call them value, but it’s more financial, right? So the metrics aren’t really around quality as much as they are around cost. So that’s going to be more and more part of it. But I don’t see that widely as being a solution to the problem.
Gary Bisbee 44:01
Tommy, this has been just a terrific interview. Let’s turn to leadership. What leadership characteristics come to mind as being top for a crisis, particularly?
Tommy Inzina 44:13
The one that comes to mind is you’ve got to stay calm and you’ve got to be pretty even-tempered and consistent, right? During situations like this, they both bring out the best of people and the worst of people. And a lot of people around you get wound up and they get wound up, they get to be very reactionary and that can create frustration and chaos. And so I think about it in terms of sort of the calm in the middle of the storm, and that if you’re asked to lead during a crisis, what people need is they need confidence and they need to feel like the world slowing down a little bit. Because if not, there’s a quest out there to go deal with the problem. So the top of mind is that sense of calm. I’ve heard it said by other leaders, so I’m not making it up. But at some point during COVID, I had to remind people that this is a marathon, not a sprint. And if you’re working at a pace that you can work at for a month, but not six months, you’ve got to adjust your lifestyle, because you’ve got to be able to function in this environment. So that’s probably the one in a crisis situation that is most important.
Gary Bisbee 45:26
Thinking about how CEOs may evolve over time and particularly in these crisis situations, do you think the next generation of CEO for our health systems will, in fact, be evaluated somewhat differently in terms of the characteristics that the health systems will be looking for?
Tommy Inzina 45:48
I think they could. I think about the crisis similar to change. And I think as we think about our industry evolving and changing, and crisis is a little bit of dealing with that. I think organizations will have to decide what’s most important to them. Our board is very focused on succession planning, not just at the CEO level, but at all levels. And when we have those discussions, it starts with, where are we as an organization? Where are we going to go in the next three to five years? And then what type of leader do you think you need for that? Because I feel strongly that different leaders fit best for different situations. It’s true with sports and coaches. I think I was the right person in 2016 to take the lead. In five years, if they were going to do a CEO search, I’m not sure I’d be the right person to lead then. It depends on what they need then. And so I think it’s, it’s more organization-specific relative to where they are to decide what they need. I feel pretty strongly that that changes from time to time. Because we’re all leaders, but we’re also all different. We don’t always have the same strengths and weaknesses, and to me, the skill is matching up a particular leader’s skill set with what’s the organization need at that point in time.
Gary Bisbee 47:10
Tommy, once again, this has been a terrific interview. I think this is a good place to land. Thank you very much for being with us today.
Tommy Inzina 47:17
Great. Thank you, Gary.
Gary Bisbee 47:19
Fireside Chat with Gary Bisbee is a Health Management Academy podcast produced by Think Medium. Please subscribe to Fireside Chat on Apple Podcasts or wherever you’re listening right now. Be sure to rate and review Fireside Chat so we can continue to explore key issues with innovative and dynamic healthcare leaders. In addition to subscribing and rating, we’ve found that podcasts are known through word of mouth and we appreciate your spreading the word to friends or those who might be interested. Fireside Chat is brought to you from our nation’s capital in Washington, DC, where we explore the strategies of leading health systems through conversations with CEOs and other interesting leaders. For questions and suggestions about Fireside Chat contact me through our website firesidechatpodcast.com or email@example.com. Thanks for listening.