Dennis Pullin 0:03
With COVID, it forced us to accelerate a number of things and so our strategy is still our strategy. I don’t think we’re going to completely jettison our strategy because of the pandemic, but certain elements of that strategy has been accelerated as a result.
Gary Bisbee 0:22
That was Dennis Pullin, President, and CEO of Virtua Health, discussing the acceleration of certain strategies as a response to COVID. I’m Gary Bisbee and this is Fireside Chat. After growing up in San Antonio, Texas, and receiving his education there, Dennis spent 26 years in Texas and 11 in the Washington DC area. before traveling to South Jersey to lead Virtua. He described Virtua in the South Jersey market while discussing the effects of COVID. He believes that innovations and technology will continue to add efficiencies and improve the practice and delivery of medical care using telehealth as a prime example. Dennis spoke about the effect of remote working on Virtua’s workforce, physical locations, and asset strategies. He believes it will fundamentally change Virtua’s approach to doing business. Let’s listen.
Dennis Pullin 1:13
I don’t anticipate ever going back to 100%. I think when we look at the beginning of 2021, if we get to 50%, maybe at its peak, maybe 75%. But it will change the way we do business going forward. It will change the way we look at our assets in terms of our physical locations and what we need and don’t need. So I think it’s a new day.
Gary Bisbee 1:40
Dennis has concluded that the country’s health infrastructure will be enhanced with more focus on social determinants and he sees a major opportunity to pay more attention to health literacy as follows.
Dennis Pullin 1:52
Something that I think a lot of us fail to talk about is health literacy. How can we create better consumers of our services by educating people better? And then the other one is really, as I mentioned, dealing with the social determinants of health.
Gary Bisbee 2:10
I’m delighted to welcome Dennis Pullin to the microphone. Well good afternoon, Dennis, and welcome.
Dennis Pullin 2:20
Gary thanks for having me on.
Gary Bisbee 2:22
We’re pleased to have you at this microphone. Let’s start by learning about you and Virtua Health, then we’ll dig into what’s changed at Virtua since the COVID crisis, and wrap up with your views on leadership. You grew up in San Antonio, Texas received your undergraduate degree at Texas Lutheran, your master’s at Texas A&M. After 26 years working in Texas, 11 in the DC area, how are you finding South Jersey, Dennis?
Dennis Pullin 2:47
For the life of me, I still don’t understand why the state is so opposed to left turns. It’s one of those states that you can’t make a left turn and you have to, they have these crazy things called bucket handles. But for the most part, I have had a really warm welcome from colleagues and the community and from other health systems. When I first arrived, people reached out to me and, so far, my time here has been incredibly rewarding.
Gary Bisbee 3:16
When did you actually become interested in healthcare, Dennis?
Dennis Pullin 3:19
I’ve been interested in healthcare for a long time. Both my parents taught me that helping others was always a noble and worthy thing. So I guess I just grew up wanting to be part of an industry that made a difference in people’s lives. And so it was just a natural fit for me. I started out as an exercise physiologist for 10 years and then after that had a number of different roles in healthcare, been going down this path ever since.
Gary Bisbee 3:49
In terms of exercise physiology, I did a little bit of homework and it looks like you were a terrific athlete in your day.
Dennis Pullin 3:55
Only if you listen to me and my family. But if you look at the box scores, it was okay. But I think my passion outpaced my skill.
Gary Bisbee 4:07
Well, at least one out of two is not a bad average, right? How about leadership, then? At what point did you recognize that leadership was rewarding and you were good at it?
Dennis Pullin 4:18
Once again, being good at it is still up for discussion. But I just felt that being a leader is I think what enables us to have the biggest impact. At Virtua, Gary, we talk about being here for good. And I think as President and CEO, I have an opportunity to have that big picture view and it allows me to see how I and we can be most effective and improve the overall health and well-being of the communities that we serve. And so it’s a pretty massive responsibility and it’s one that I truly take to heart.
Gary Bisbee 4:55
Speaking of CEO, at what point did it dawn on you that you wanted to be a CEO of a health system?
Dennis Pullin 5:02
I’ve been really fortunate to work for and alongside many, what I consider to be extraordinary leaders throughout my career, and I think they’ve demonstrated how to use your time and talents to move an organization forward. And it really inspired me and it gave me something to really work towards. So I don’t know if there was ever a point where this lightbulb or the switch just went off and said, “Okay, I want to be a CEO.” I’ve always wanted to make a difference and I think having the front row seat with what I thought were some extraordinary leaders allowed me to see that perhaps that was the way that I could be most impactful and make the most out of my time in this particular industry.
Gary Bisbee 5:48
Speaking of leaders, how would you characterize your leadership style, Dennis?
Dennis Pullin 5:53
One that’s still learning and evolving. I think for me, it’s maybe not so much how I characterize it, but how others see it. And I think people would say that I try and present myself in a very purposeful way. I try and be authentic. I try and really be engaged. I just don’t think at this point that there’s no way to just phone it in and be successful. And that has never been my style. And so I think a true leader is someone that is fully committed and can demonstrate that they care about the work and the people involved. And people don’t always agree with all of my decisions all the time but I think what they can tell is that I have a purpose and conviction in supporting some of my decisions. And so that’s how I try and present myself. It’s just someone who is committed, authentic, and I think trustworthy.
Gary Bisbee 6:54
Diversity in leadership ranks at our health systems has been, frankly, a challenge. As an industry are we making gains, Dennis?
Dennis Pullin 7:03
I believe we are. I think the progress tends to be a little slow, but steady. I look at my own organization, Virtua Health. We’re committed to inclusion and diversity and not just in words, but in our actions and the things that we do to improve the way not only we work together, but the way we care for our communities. I’ve been really fortunate to appear on many lists that highlight minority CEOs and leaders of color. And I really do see it as an honor. I often remark that I hope to see these lists go away someday. That they will no longer be necessary because all of us, regardless of our color, or background or gender, would be afforded the same opportunities to be successful. And unfortunately, that’s not the reality of today. And so there’s still work to be done. But I will say that there has been progress that have been made.
Gary Bisbee 8:07
We all need to continue our commitment there for sure. I noticed that you’re hosting a podcast called Here for Good. Are you enjoying your life as hosting a podcast?
Dennis Pullin 8:19
I want to be like you when I grow up! I am still working on it. Am I enjoying it? I am! It’s a heck of a lot more fun than I ever imagined. I think what I like about it is that even though it’s my podcast, the focus really isn’t on me. Instead, it’s about these incredible, accomplished people who come on as a guest. Some of them I’ve known for years and others that I’ve simply admired from afar. And just to hear their stories and how they have been very successful on the one hand in their careers, but how they have taken that and tried to inspire and motivate others to help improve the overall health and well being of our communities. And so it’s not necessarily about healthcare. I mean, it could be someone in the political arena or in the clergy or in celebrities and sports and just anybody that’s reaching back to try and improve the health and well being of the community, and how they’re inspiring others to do so. So it’s been fun.
Gary Bisbee 9:30
So am I sensing a possible second career blooming here, Dennis?
Dennis Pullin 9:34
I don’t think so. Not unless I get as good as you are. But I am enjoying it.
Gary Bisbee 9:41
Well, why don’t we turn to Virtua? What drew you to Virtua Health? You’ve been CEO now for about three years. What drew you to Virtua Health to begin with, Dennis?
Dennis Pullin 9:50
It goes back to what I was saying, Gary. I saw that it would afford me the opportunity to have a greater impact, being able to extend my reach across a larger community. When you talk about a calling, I just felt the time was right. I felt like the organization was uniquely positioned in the community. I thought I brought a unique talent to the organization that would allow us to really do good in the community.
Gary Bisbee 10:23
Being relatively conversant with a number of the board members at Virtua through our trustee summit, they’re all delighted with the decision they made three years ago for sure.
Dennis Pullin 10:35
That’s good to know.
Gary Bisbee 10:38
Always good there. But at any rate, could you describe Virtua Health for us, Dennis?
Dennis Pullin 10:42
Virtua is a community health system, so an integrated community health system that is in the most southern part of New Jersey, just across the river from Philadelphia. And we really focus primarily in a 3 county area in the state, anchored with 5 hospitals, 23 ambulatory surgery centers, 8 urgent care centers, about 280 care locations, and about 15,000 employees. And so we truly have a great opportunity to be impactful in the community in which we support because we also are one of the largest private employers in the South Jersey region. So it takes on a whole different meaning for us in terms of really supporting the community.
Gary Bisbee 11:34
How’s your merger with Lourdes Health System, the relatively recent one, how’s that proceeding?
Dennis Pullin 11:40
It’s well. We’re about 15 months out, 8 months into the acquisition, of course, we were hit with something called COVID which absolutely, as you can imagine, bringing on a new organization with 4,000 employees and trying not only to transition but to integrate and then have that really interrupted and impacted by COVID, was a challenge. But all in all, things are moving as I hoped and I think we are better as an organization having brought Lourdes on board than we were before.
Gary Bisbee 12:20
Where does scale matter in this case, Dennis?
Dennis Pullin 12:22
Obviously, it allows us to address the community much better. One of the things that I’ve always wanted to focus on was integration and being able to provide care from home to home and everything that patients need in between. And so by bringing them on, it added something to our portfolio that we didn’t have in the past, in terms of some of the real critical care things such as transplants, such as cardiac surgery, the things that we previously didn’t have, now we’re able to provide and care for our patients closer to home and work and they don’t have to leave this community to go to seek out the advance, tertiary, or quaternary care elsewhere. So it really has been a great benefit for us.
Gary Bisbee 13:13
Will there be more consolidation in Virtua going forward, do you think?
Dennis Pullin 13:17
Don’t know yet. I mean, I think we’re gonna see really what the market shakes out as we approach our new norm than a post or even a during COVID environment. I think I will continue to look for the opportunities where it supports our strategy and if it makes sense. But we don’t have as a strategy, acquisition and consolidation. I mean, we will consolidate as we do what I call care optimization and look at where are the best places to provide certain services. And that’s how I look at it.
Gary Bisbee 13:59
How competitive is the Virtua marketplace?
Dennis Pullin 14:03
Extremely. When I mentioned we are in South Jersey, when you look at New Jersey as state, the population density runs along the border on the southern end of Philadelphia and on the northern end, New York City. And so we compete, not only with some of the large academic medical centers in Philadelphia, as well as some of the larger health systems on the northern part of the state, as well as our immediate neighbors. So it is a very competitive marketplace.
Gary Bisbee 14:40
On to health insurance plans. What kind of relationship does Virtua have with the health insurers in your markets?
Dennis Pullin 14:48
About as good as any health system will have in the marketplace. We try and keep an open relationship, we try and make sure that it’s positive and we don’t get into these media battles with the payers. We try and really collaborate where we can. So I think from where I sit, we have fairly positive working relationships.
Gary Bisbee 15:14
Looking back 6 to 8 months ago, what have been the major impacts from COVID on Virtua?
Dennis Pullin 15:20
I think the same as any of my counterparts around the country at the financial impact that it had. You hear people refer to the term in terms of our surgical procedures or elective procedures, I really say scheduled procedures. Not being able to do that for an extended period of time was a financial burden on us as it is most and so that was a huge impact. I think now, what we’re dealing with is try and restore confidence in the public around re-entering the medical field in terms of not medically distancing, as we saw most recently. And so trying to restore confidence that it’s safe. I feel safer walking the halls, I’ve heard somebody say this before, I feel safer walking the halls of my hospital than I do the grocery store. And so getting people to understand that it is safe and we are doing everything we need to do to be able to provide the quality care that they deserve.
Gary Bisbee 16:20
When you had to not pursue elective or scheduled surgeries, how did that affect the strategic opportunities for Virtua going forward, let’s say on a three-year basis? Is it going to be a major effect on your strategy, Dennis?
Dennis Pullin 16:36
It’s making us more acutely aware of some things that we have since accelerated. We took a look at our digital platform and how we provide care, either through e-visits or telemedicine. We had what I would consider a near strategy to really advance that. With COVID, it forced us to accelerate a number of things. And so our strategy is still our strategy. I don’t think we’re gonna completely jettison our strategy because of the pandemic, but certain elements of that strategy has been accelerated as a result.
Gary Bisbee 17:19
What about CapX, Dennis? How’s your balance sheet holding up?
Dennis Pullin 17:22
For us, fortunately, we had a strong balance sheet going into this. And so we were able to maintain that. We’re AA- rated organization so we truly believe in being good stewards of our financial resources. And so we didn’t take that big of a hit on our balance sheet. But, you know, when you look at operations, we still have a little ways to go before we’re back to where we were pre COVID.
Gary Bisbee 17:48
Why don’t we move from specific reference to Virtua to more how will COVID affect health delivery in general? Certainly, you can bring Virtua into this if you want. But in terms of supply chain, how will we in the US develop a more reliable supply chain, Dennis?
Dennis Pullin 18:06
That’s a million-dollar question. I think as we talked about COVID and the impact that COVID had on us, a lot of it had to do with us dealing with PPEs. And us not being able to get, and when we were able to get it, how we were oftentimes gouged in our pricing and how sometimes you found a private sector competing with the government for the same products. And so I do think that there’s a tremendous amount of focus will need to be played on how we, to your point, have a more reliable supply chain going forward. How the government intervenes in that, and some of your larger GPOs, and so forth. For me, my concern is, are we going to be able to get the products that we need, be it domestically or globally? And then secondly, in times of a crisis or a situation like the pandemic, can the government enforce certain guardrails around pricing? It was baffling that we, for a mask that we paid pre-COVID 50 cents, sometimes less, for a particular mask, during the height of COVID we paid upwards of $6 for that very same mask. And so there has got to be some support, I think, from the government to help regulate how certain suppliers can impact us in that way.
Gary Bisbee 19:43
It’s important because it is a challenge. We can’t let this happen again. I mean, there’s been a lot of discussion around, we need to produce more PPE domestically and some of the GPOs are moving to make that happen. Some of the health systems are moving to make that happen. But how do you think about that, Dennis?
Dennis Pullin 20:03
I would support it wholeheartedly. I mean, the thing that we have to be concerned about is, can we do that and still keep it at a price point that we have all grown accustomed to pre COVID and to be competitive. But I would like nothing more than to have as much of our products that we need produced domestically. And I think you will hear and see that from many of my colleagues around the country as well.
Gary Bisbee 20:31
I bet we can do it for less than $6 a mask.
Dennis Pullin 20:34
But without question, without question.
Gary Bisbee 20:37
Moving to what I’ve been thinking about is the pace of change and that is that as I talk to you and your colleague, CEOs, everybody is referring to the fact that the pace of decision making has picked up during this crisis. It begs the question of will that pace of decision-making continue at this current rate or will it begin to slip back to pre-COVID levels?
Dennis Pullin 21:04
I think it’s going be a combination. I think there are certain things that we can continue this accelerated process on. But as you look at strategy and the overall health of your organization, I think you have to be somewhat more purposeful. During COVID we were managing, not on a week-to-week, not a day-to-day, but sometimes on an hour-to-hour basis. As things change, as we learned more about the mechanism involved with COVID and how we changed policy and procedures, sometimes on an hour-to-hour basis. So it’s forced us to make decisions at that rapid of a pace. And as you know, that’s not always good. When you accelerate things and make decisions too quickly, you have to be somewhat thoughtful and purposeful in certain things. So I do think it has taught us that we can when we need to, but I think you will find most of us want to find a new norm that incorporates a little bit of the old and a little bit of the new to find that sweet spot.
Gary Bisbee 22:12
That makes good sense. Onto remote working, will remote working become a workforce and facility planning asset for health systems in general or Virtua in particular?
Dennis Pullin 22:23
Without question. You know, in those areas where we can, particularly in our corporate office and back office functions, I will tell you here at Virtua, we went to 100% remote working. To date, we’ve brought back about 25% of the workforce. I don’t anticipate ever going back to 100%. I think when we look at the beginning of 2021, if we get to 50%, maybe at its peak, maybe 75%? But it will change the way we do business going forward. It will change the way we look at our assets in terms of our physical locations and what we need and don’t need. So I think it’s a new day.
Gary Bisbee 23:10
What’s the status of telehealth usage at Virtua?
Dennis Pullin 23:13
It’s sort of goes back to what you said a moment ago about some other things. At its peak, we saw an all-time high usage. I think we’ve seen that has slowly come down. But I think it’s going to normalize, but it will still be around. For instance, in 2019, at Virtua, we had I think 5 billable ambulatory telemedicine visit. I mean, it was part of our future strategy. To date in 2020, we’ve done over 125,000. So you can see the acceleration, but I will see that come down as we start to find a new norm. I do think it’s going to be here though, for good.
Gary Bisbee 23:59
Right, what about health plans willingness to pay for telehealth usage? Sounds like that’s going to become something of an issue going forward.
Dennis Pullin 24:07
Currently in New Jersey, yes they are paying and I think the commercial carriers have agreed to extend payment parity for 90 days beyond the state of emergency and that’s evaluated by the governor each month. But I think that’s the big question is, “How will the payers once we ease up or move away from the state of emergency, will they extend this, and will they continue to reimburse us the way we need to be reimbursed for telehealth services.”
Gary Bisbee 24:40
So now that patients and physicians are becoming more comfortable with it, do you think there will be innovative uses developed over time?
Dennis Pullin 24:49
I believe so. I’m not the technical expert here. But I think there are certain areas where no one’s really cracked, for instance, the peripheral devices. Will there be a device that will allow clinicians who work remotely say, to see into the eardrum or listen real time to heart sounds, and there are a few things out there that you can buy, but I think for the most part are still not affordable. And so, as we look at these types of things and the price point comes down, I see things really moving into overdrive because it gives the clinician a much better tool.
Gary Bisbee 25:31
You speak about price point and, of course, affordability is one of our major problems we’re gonna have to try to solve this decade. But do you think that telehealth will contribute to increasing affordability?
Dennis Pullin 25:43
Absolutely. And I think that’s where an organization like Virtua and many other health systems that have these integrated delivery networks, as opposed to just some of the on-demand services by some of the national players, I think when you have this integrated delivery network, with a centralized EMR platform, where you can see across the continuum and see the medical records, I think it’ll be a huge advantage to being able to get care and maintain quality and have a view of a person’s complete medical history in front of you. I think this is where you will start seeing the real value come in. It puts those of us that have these integrated systems, I think, in a much, much better place.
Gary Bisbee 26:38
We spoke about this a bit earlier, but what are the most important factors, do you think, for successful relationships or even partnerships between health insurance plans and our health systems?
Dennis Pullin 26:49
I think it’s really about how you communicate. I think your willingness to work together to do pilot studies and to really work to find how you best take care of communities. Where are some of the areas in the communities in which you as a provider and the payer can come together, I think to make things more accessible and more affordable.
Gary Bisbee 27:16
One basic question is, does the federal government need to change the incentive structure to allow the providers and the insurance companies to work more closely together?
Dennis Pullin 27:28
I think so. And I think one of the things that we saw happen as the government eased up on some of the regulations around telephonic visits, e-visits, telehealth made it much easier for us to respond. And it made it such that we could be reimbursed for those services. So it has been extremely helpful.
Gary Bisbee 27:50
Moving to healthcare infrastructure, it’s now evident that public health is part of the national security. I’m just thinking that if you look at our economy, you look at the number of people that COVID has basically caused to be laid off, not working, it’s been a substantial effect on the nation’s health and nation’s economic status. It kind of makes you think public health is part of the national security and needs to be treated by the government more that way.
Dennis Pullin 28:24
I do. And one way that you do that is, you look at the science of it. And I think we have to rely on the science that tells us how we can best address some of our public health crises. Some of the things that we need to do in creating confidence in the public with those of us that are in positions to help to support this, but I absolutely agree. I think we’ve all seen how vulnerable we’ve become as a nation when we’re dealing with a health crisis and the impact that it has on every aspect of our lives.
Gary Bisbee 29:06
Digging deeper into that, of course, is what we call health equity, which has come to the fore during the COVID crisis. And the question there is what steps can health systems take to try to address this disparity in health equity?
Dennis Pullin 29:21
When you look at it, I think all of us, at least once a year, once every three years we do what is called a community needs assessment. And the community tells us what we need to do in terms of mitigating some of these issues. It jumps up at us all the time – issues with transportation, issues with housing, behavioral health attention, food insecurities, and so I think as a health system that we can help to mitigate some of these things through one, prevention in educating and then finding programs and services that we can implement to address those things. And something that I think a lot of us fail to talk about is health literacy. How can we create better consumers of our services by educating people better? And then the other one is really, as I mentioned, dealing with the social determinants of health.
Gary Bisbee 30:22
This has been a terrific interview, Dennis. We appreciate your perspective and your time. I’d like to ask a question or two about leadership. First, what are the most important characteristics of a leader during a crisis?
Dennis Pullin 30:35
First and foremost, the ability to listen. I’m a firm believer, if you listen well enough people will tell you what you need to know. And I think, oftentimes, we may not have the answers. But it’s okay also to admit and acknowledge that after you’ve heard what the community is saying, after you’ve heard what your employees and your colleagues are saying. Be a good listener, be present. Demonstrate that you understand that you are there. Any good leader needs to be someone who is, as I mentioned, authentic and an effective communicator. Have a solid message that you want to communicate to folks and make sure that message is digestible, you’re communicating it in a way that people feel that they have confidence in what you’re saying, even if they don’t like what you’re saying. So I think your presence is extremely important.
Gary Bisbee 31:35
Well to wrap up, has the COVID crisis changed you as a leader and a family member?
Dennis Pullin 31:40
I won’t say it’s changed me, Gary, but it has made me more keenly aware of my environment. And when I say that, I mean, being able to make sure that we can maintain the confidence of the communities that we serve. Being able to make sure that I pay attention to those things that are important, not just to me, but to our employees, to our patients, to our communities, to our families. You just never know what we’re promised with. And so just take advantage of every day to make a difference, to be present. I think for me, you can’t talk about COVID without also referencing some of the social unrest that we dealt with all at the same time. We were dealing with two pandemics. And so just making sure that we do as good a job as we possibly can to create an environment that is inclusive of everyone, that is diverse, and each and every one of our talents and skills can be appreciated and valued, regardless of what we look like or what gender we are, and just keep doing the things that we are all here to do.
Gary Bisbee 33:07
That is such a great way to wrap up the interview. Excellent job. We appreciate very much your being with us today.
Dennis Pullin 33:13
Gary, again, thanks. It’s always a pleasure speaking with you and thanks for having me on.
Gary Bisbee 33:19
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 firstname.lastname@example.org. Thanks for listening.