Episode 68:
Transforming a Health System to a Health Platform
with Dr. Hal Paz, EVP and Chancellor for Health Affairs, The Ohio State University and CEO, The Ohio State University Wexner Medical Center
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In this episode of Fireside Chat, we sit down with Dr. Harold (Hal) Paz, EVP and Chancellor for Health Affairs, The Ohio State University, and CEO, The Ohio State University Wexner Medical Center to discuss social determinants of health and transforming a health system to a health platform. We also talk about key characteristics of a leader in a crisis and new health strategies in the COVID era.

Dr. Harold L. Paz is the first to serve in the position of Executive Vice President (EVP) and chancellor for health affairs at The Ohio State University and Chief Executive Officer (CEO) of the Ohio State Wexner Medical Center. At Ohio State, Dr. Paz leads all seven health science colleges and serves as CEO of the $4 billion Wexner Medical Center enterprise, which includes seven hospitals, a nationally ranked college of medicine, more than 20 research institutes, multiple ambulatory sites, an accountable care organization and a health plan. Read more

Transcription

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Hal Paz 0:03
I have to say whatever my perceptions were before arriving in Aetna, it was astounding to me how different that world was than I thought it might be. We always look at insurance companies, health insurance companies, as these monoliths but in fact, health insurance is not one business it’s almost hundreds of businesses between commercial plants, fully insured, self-insured, governmental, behavioral health, pharmacy, and the list goes on and on, and, in fact, in many cases, the real payers, the employer that hires the insurance company to manage risk for it.

Gary Bisbee 0:35
That was Dr. Hal Paz EVP and Chancellor for Health Affairs, The Ohio State University, and CEO Wexner Medical Center, reflecting on the eye-opening experience during his five years at Aetna. I’m Gary Bisbee and this is Fireside Chat. Hal led the initiative at Aetna to transform it from a health insurance company to a healthcare company. He’s using a similar strategy to transform the Wexner Medical Center from a health system to a health platform. The digital and virtual underpinnings of the new platform were significantly accelerated when COVID exploded in the spring. Hal discusses five determinants of health, social, behavioral, environmental, healthcare, and genetics. This lens is core to the new health platform strategy being pursued by Wexner, which considers all determinants of health and incorporates them into a personalized approach. Let’s listen.

Hal Paz 1:30
We know that healthcare and genetics are just two of five major determinants of health. There are behavioral determinants of health, social determinants of health, environmental determinants of health that all have an impact on an individual’s health status, number one, and likelihood of them dying of premature death.

Gary Bisbee 1:49
To outline the rationale for the new health platform, Hal referred to two neighborhoods in Columbus with dramatically different socioeconomic status and health outcomes as follows.

Hal Paz 2:01
There are two neighborhoods a mile apart here in Columbus. One is wealthy; one is financially insecure. The difference in longevity is 18.3 years premature death 18.3 years – one mile apart.

Gary Bisbee 2:18
I’m delighted to welcome Dr. Hal Paz to the microphone. Good morning, Hal, and welcome.

Hal Paz 2:27
Good morning, Gary. It’s great to be with you today.

Gary Bisbee 2:30
Well, we’re pleased to have you at this microphone. Let’s begin by learning more about you, Hal, and then your roles at The Ohio State University, dig into what’s changed due to COVID and wrap up with your views on leadership. Of course, you grew up in New York City area with your medical degree from the University of Rochester, appointments as Senior Health Officer at Rutgers Robert Wood Johnson, Penn State, and now The Ohio State with a stop at Aetna for good measure. So you’ve been connected now to four Big Ten universities if you include Northwestern for your residency. I think the Big Ten should give you a plaque, Hal, for being with four of their members. Was that by design by any chance that you ended up with all these Big Ten universities or just chance?

Hal Paz 3:15
Absolutely chance! I would have never guessed if you’d have asked me back when I was in Chicago, but entirely chance, looking at various roles where I felt I could have an opportunity to provide leadership and to have an impact on the health and well being of communities that we served and certainly to support our academic mission, educating students and residents and thinking about how we can advance research.

Gary Bisbee 3:42
Let’s drop back a bit in your career. When did you first become interested in medicine, Hal?

Hal Paz 3:47
In college, I had a number of different interests. And I went to graduate school in life science engineering/biomedical engineering and got a graduate degree. And I think it was at that point that it was abundantly clear to me that I wanted to be a physician. And my thought was, I’d probably wind up continuing to do research and be at an academic institution. And from Northwestern I was at Johns Hopkins where I did my training in pulmonary and critical care medicine and sleep and environmental health sciences over the School of Hygiene Public Health. And it was there that I really could appreciate the impact that academic medicine has on the missions of education and research, really translation and then thinking about how we could have an impact in care delivery. And one thing led to another. My first role was in running a medical intensive care unit and in critical care medicine and along the way was offered opportunities in leadership positions that started from that first administrative role. And then one thing led to another, became dean at Robert Wood Johnson and CEO of the Medical Group and then Penn State, then Aetna, which then became CVS Health, and then here at The Ohio State University.

Gary Bisbee 5:02
So as you’ve moved through your career, what have you found the most rewarding about leadership?

Hal Paz 5:07
I’ve really tried to focus on, particularly at the level of being a CEO, what are the most important parts of that role of that job. And for me, it’s really three things. One, to focus on the vision and the strategy. So what’s the vision for the organization that everyone can agree on, in as much as that’s possible, and certainly with the board of directors. And then to develop a strategy that is very measurable, that holds people accountable, identifies resources and investments, and has defined benchmarks against timelines for achievement, and to use that plan as a way to move the organization forward. Second, to go out and recruit the best and brightest talent, to develop and retain outstanding talent, to make sure that they have that game plan, that strategic architecture to work within. And then third, to go out and get the big resources to support that work through a combination of funding, philanthropy, grants, and certainly even reimbursement because without those resources it’s absolutely impossible to achieve the vision of the strategic plan and to move the organization forward. It’s amazing to me that focusing on those things in a leadership role, I’ve seen a number of institutions over and over have the greatest impact on being able to advance healthcare for populations and communities served, to educate the next generation of clinician or educator, and to focus on the translation of fundamental research into discovery to develop cures and treatments that historically didn’t exist. And that, in my mind, is what is so unique about academic health centers across the nation.

Gary Bisbee 6:59
The three aspects of leadership, vision, and strategy, talent and resources as you come to a new posting like you did 18 months ago at The Ohio State University, how do you think about the timeframe for developing and implementing your leadership? I mean, is this a three to five-year plan or a one to three-year plan? Or how do you think about that, Hal?

Hal Paz 7:23
I’ve had a chance to try this and observe it at several different institutions. And certainly, what we’ve been doing here at Ohio State is quite similar to the approach I used at Penn State. But I have to say it’s been significantly influenced by my time at Aetna and CVS Health. I mean, by the time I left, the company was over $200 billion over 200,000 employees global company and it really gave me tremendous insight around how to optimize strategy, how to really affect the talent and where you recruit the best and brightest, you retain and develop the best and brightest, and then you focus obsessively on ensuring that you have adequate resources to give those people to achieve the plan. And first and foremost, and this has been very similar, certainly at Penn State, Aetna, and Ohio State, the first six months when I arrived at Ohio State if I spent a couple hours in the office, it was a lot to be quite frank, and this was pre-COVID. But my attitude was, look, the place has been around for a really long time. It’s running reasonably well. What I need to do first and foremost is get out of that office and meet with as many of our faculty and staff across the Medical Center, and the Medical Center at Ohio State is a little different than one might think of as a Med Center. It’s actually a health system of seven hospitals, including one of the largest cancer hospitals in the nation, third-largest; hundreds of ambulatory care sites; a health plan; and an 1800 physician, multi-specialty group practice. So it is a large enterprise. And first and foremost, I felt it was imperative to get out and meet with as many of our faculty and staff as I possibly could, house staff and students, to spend as much time with the board as I could possibly spend, and then get out in the community and meet with community leaders and develop a deep understanding of the history, the culture, the values, the priorities of the organization, but also the environment in which it sits. I think that if a leader doesn’t do that, and doesn’t invest heavily in that for the first six months, they miss the opportunity to develop these exceptionally valuable relationships, to build trust, and to have the currency they need to move the organization forward. The work will always be there. One can always sit behind a desk or sit in their office having meetings. There’s always opportunities to do that. But the real and the most important opportunities are in many ways across the organization and externally facing for that leader. And that’s what I did, by the way, and good fortune that we were able to get that all done before March of this year. I arrived in July of 2019. And it’s paid huge dividends. And I would recommend to anyone who is taking on a new role, particularly at the CEO level or the equivalent, to spend that time. Because if you don’t do it early on and you try to do it later, it’s often too late. The cement has dried. The perceptions have been formed. The opportunity to create trust and shared values has past and you can’t make it up. You can, but it’s very hard.

Gary Bisbee 10:41
That’s great advice. Why don’t we drop back to your Aetna experience for a moment and then we’ll come back to Ohio State. But you spent five years at Aetna as Executive Vice President and Chief Medical Officer. What were the circumstances of your joining Aetna Health?

Hal Paz 10:56
It was a fascinating opportunity. I had been at Penn State for about nine years and Robert Wood Johnson for eleven. So I had had roughly twenty years in those two roles. On the academic side, I was presiding over my 20th Medical School Graduation, two dean shifts at two institutions. I had been CEO in one form or another at an academic health center for that period of time. And I felt like it was a great opportunity for me to do something totally different. And through a set of circumstances, that role was brought to my attention. And at first, I thought, well, that makes no sense. Why would I want to leave academic medicine? And some of my colleagues probably wondered why I would give up my tenure and all the things that go with being in an academic medical center and university to do that. But to me, it seemed like an intriguing opportunity. The CEO Mark Bertolini of Aetna had this vision. And his vision was how to transform Aetna from being a health insurance company, largely in a fee-for-service world to becoming a healthcare company. He recognized that the world was changing rapidly and that for Aetna to be successful on its trajectory for a company over 100 years old, it needed to continue to transform itself. So that was the vision that he and the board had. But he also recognized that there wasn’t anyone on the executive committee of the company that knew anything about running a health system or had direct involvement in healthcare. And the role before I arrived was the very traditional chief medical officer role at an insurance company and what Mark was looking for and what the board was looking for was something very different. And so one of the large parts of my job was to develop a clinical strategy for the company that would create a glide path to that overall corporate transformation, to think about what are the proof points that would be involved in Aetna pivoting from being primarily a health insurance company to becoming this healthcare company. And that’s what I worked on. And when I arrived, Mark said, “Well, why don’t you take six months, let’s call it your sabbatical, learn the insurance industry, this business inside and out, and then also spend the time to think about what this clinical strategy would look like.” So despite all the years at universities and academic medicine this was actually the first, quote/unquote, “sabbatical” I ever had. And I did do that. I spent time with the retired CFO of the company, spent as much time as I could learning the intricacies of the health insurance business. And I have to say, whatever my perceptions were before arriving in Aetna, it was astounding to me how different that world was than I thought it might be. We always look at insurance companies, health insurance companies as these monoliths but in fact, health insurance is not one business, it’s almost hundreds of businesses between commercial plans, fully insured, self-insured, governmental, behavioral health, pharmacy, and the list goes on and on, and in fact, in many cases, the real payers, the employer that hires the insurance company to manage risk for it. And he gave me huge insights in terms of particularly coming from the provider side, how all of the mechanics work around payments and risk and decisions. And I had physicians and nurses reporting to me who had responsibilities around medical policy and appeals and all that. And it really was extraordinary to get that deep understanding. And it’s something that has been enormously useful in my current role. So that was one part. The second part was how do you run, at the time it was a over $70 billion company, a Fortune 50 company, how do you run this large public corporation efficiently and effectively? And sitting on the executive committee I developed, I think, some enormous insights and it was a great learning experience for me. Because it’s one thing to be at a $4 or 5 billion operation, but then to look at the scale and operations of something of that size and eventually, as I said earlier, we merged with CVS Health, it became a Fortune 5 company, very different set of scale. And to understand that complexity gave me huge insights in HR, finance, communications, and marketing, the list goes on. And those are skill sets that I absorbed and picked up while I was at Aetna and in CVS Health that I’ve brought with me now to this role. And I think it’s been a phenomenal opportunity to transfer that here.

Gary Bisbee 15:22
That’d be great if every CEO of a health system in the country had the opportunity you did and vice versa, don’t you think?

Hal Paz 15:29
It would be very interesting.

Gary Bisbee 15:31
A lot of us have been talking about what some people referred to as the new middle, which is closer alignment between health systems and health plans. Do you think there’s a point in the future where that might be the case?

Hal Paz 15:46
Yeah, I think that we are seeing that happen in a number of different ways. There’s not one path, there are multiple different paths. Some of it occurs because health systems then have health plans that they operate. I mean, there’s some well-known examples of UPMC and Geisinger and others, obviously Kaiser on the oldest of that model. There are examples like here at Ohio State where we have our own health plan for The Ohio State University which is the third-largest university campus in the nation. So we have a lot of employees and dependents here that we care for through that health plan. So there are a number of examples of that. But I think in the mainstream, where we’re going to see more and more of this is through the move to value-based reimbursement. And that’s something that was certainly a big part of the clinical strategy that I was working on at Aetna. And my work there was focused on, “How do we change the model to create personalized health for individuals?” If you look at what is the greatest opportunity we have, it’s really to take the concepts of precision medicine, which focuses on genetics, and now apply that holistically to individual personalized health. We know that health care and genetics are just two of five major determinants of health. There are behavioral determinants of health, social determinants of health, environmental determinants of health that all have an impact on an individual’s health status, number one, and the likelihood of them dying of premature death. And in fact, those three – social determinants of health, behavioral determinants of health, and environmental determinants of health – clearly outweigh the impact of healthcare or genetics. So how do we take a deep understanding using analytics for applying solutions to those determinants beginning in the home and the local community to improve an individual’s health status and to decrease the likelihood of him dying of premature death. So in the prototype model that I launched at Aetna called Aetna Care, we used analytics to identify patients with the greatest need, we sent nurses into the home to then look at what were the interventions that they needed to use working in partnership with physicians in the community who are connected over telehealth, and this goes back now about five years ago, and then working with an array of partners, including companies like Merck, for example, Medtronic, to have partners that we could create an opportunity for an interoperable group of solutions that we could link together to address those behavioral, social, environmental determinants and, in addition to healthcare, then look for opportunities to improve outcomes and put that in a value-based reimbursement model. So the physicians were in a value-based reimbursement model, we put those pharmaceutical drugs, some of them, into a value-based reimbursement model to say that look, if we could have an end-to-end approach to improve how care is delivered to really focus on where the greatest need is, and then get various entities working collaboratively and then reward everyone based on outcomes that’s a very different way than healthcare is delivered today. And included in that vision of that model was using CVS mini-clinics, for example, as a way to offer care when a patient was not sick enough to go to the ED but realistically we couldn’t get them into a doctor’s office or if they had a need that could be better addressed in a site like that as opposed to having to bring them into a doctor’s office. So that was what was in that strategy in that clinical strategy. And coming here to Ohio State, I see the opportunities in exactly the same way. What we’re working on at Ohio State is how do we take this health system and transform it into a health platform? So we have these seven hospitals, enormous infrastructure and bricks and mortar in inpatient facilities we have over 1200 beds here on the main campus here in Columbus. We have these clinics, we’re building three major ambulatory care sites in addition to what we already have. Each of these buildings is somewhere between 250 and 300,000 square feet of ambulatory care facilities with ORs and imaging. We’re doing all that. But at the same time, we’re moving from the traditional bricks and mortar, this system, to becoming a platform and the platform is digital and virtual, using telehealth solutions, using mobile, and, for example, to drive care into the home and into the local community. That was the strategy that when I arrived here in July we spent the first six months working on and no one in their wildest dreams would have imagined when COVID hit here in March of this year, that that would actually accelerate the move to that strategy even faster than we imagined. But that’s exactly what’s happened. We went from 50 telehealth visits a month in February to in a matter of weeks now, 2800 a day.

Gary Bisbee 21:00
I love the strategy, of course, and we need to get you positioned to implement that strategy for the United States, not just Ohio. But one quick question on the five determinants of health, the behavioral, social, environmental, can the private sector do that by itself or does this need leadership from the federal government? I don’t mean that as a political question, by the way, I just mean it in terms of looking forward over the next decade?

Hal Paz 21:31
Without a doubt, there are aspects of it that have to come from the federal government. So for example, the move to value-based reimbursement, if we’re dealing with a population over the age of 65, having the support to move to value base, which, as you know, already, there’s evidence for that is it does exist, but to continue to focus on how do we reward value and not volume. So clearly, that has to be supported because health systems to try to go down this path, and they only have one commercial payer that’s interested in value-based reimbursement, but the others aren’t, or the majority of the payments they received are Medicare/Medicaid payments, it’s very hard to transform an organization when only a small part of it is being financially rewarded for doing what arguably would be better for everybody. So yes, so there are examples of where at the federal level, this is really important. But I think a lot of it gets back to what I said before. It starts in the home and it starts in the local community. And that’s where I see places like Ohio State Wexner can have a huge impact. Because we have all these resources, we have all these assets and we can go into the local community and we can partner in local communities. At Aetna we were partnering with Meals on Wheels, for example, visiting nurses. Well here at Ohio State we have partnerships, for example, there’s a community predominantly African American, in the near east side, we have a hospital building there, we have ambulatory care clinics, but we’re spending more and more time building a community health center focusing on food insecurity, diet, focusing on exercise, we have mobile van’s going there addressing issues such as handing out masks and hand sanitizer and educational pamphlets and doing COVID testing and working in the local community in partnership. Because that’s where the greatest opportunity is. There are two neighborhoods a mile apart here in Columbus. One is wealthy; one is financially insecure. The difference in longevity is 18.3 years premature death, 18.3 years – one mile apart. So we have huge opportunities to go into those communities, those underserved communities, often largely minority communities, financially insecure communities where there are challenges with education, financial status, housing, transportation, food insecurity, racism, and have an impact on improving health and well being in those communities and therefore having a meaningful impact on outcomes. We’ve seen that with one of our programs called Moms to Be which addresses early infant mortality. It’s been around for ten years now and it goes into eight different communities here in Columbus that have high numbers of early infant mortality compared to the overall number and working on addressing interventions to address that to improve outcomes. And we’ve seen success in those efforts and that we need to do more and more and more of that. If you look at some of the data on patients with chronic illness for example, take patients with diabetes. There’s great evidence that says that within three months of a patient with a chronic illness like diabetes receiving their prescription, only 50% of those patients are adherent to their meds. So in the typical scenario, the patient gets their prescriptions, stops taking their meds. Why? Either because they can’t get to the pharmacy to pick it up or they can’t afford the copay or it has side effects that it’s serving to the patient, they’re too embarrassed to tell their doctors. So when they go back for a visit 3 months later, the doctor doesn’t even know they’re not taking their meds, their sugars are out of control. So what does the physician do? Increases the dose or orders the next more expensive medication expecting to have a better outcome. That’s not the solution. The solution is getting in the home, understanding the patient’s not taking their meds or able to get their meds, and then figuring out how to make that happen. Think about how much the outcomes have improved for that patient in terms of controlling their diabetes and then avoiding another visit to the physician, a hospitalization, and all the costs associated with it. The costs in my mind here are secondary. It’s what can we do to improve the health status for that patient and what can we do to optimize the interventions that the physician or the nurse practitioner, the physician assistant hope to achieve in the first place. But if we don’t have that deep understanding of what’s going on in the home, if we don’t have a deep understanding of what’s going on in the local community around things like food insecurity, transportation, housing, education, it’s going to be virtually impossible to make the kind of progress we would all hope to see in the coming years. And I would say at a place like Ohio State, we have an additional responsibility. We have seven colleges of the health sciences here on our campus. It virtually is the largest health science campus in the nation with 10,000 students, everything from medicine to dentistry to pharmacy and nursing, optometry, public health. I would argue we have this enormous responsibility to educate these students in interprofessional teams in ways that healthcare will be delivered in the future, not in the ways it’s been delivered in the past. Because their diploma needs to last forty years or more.

Gary Bisbee 26:50
That’s just a terrific review of where we’re at in this country and how we should be proceeding to move forward. Thinking about the health disparities, do you think that Medicaid will become thought of as the healthcare floor?

Hal Paz 27:05
Well, again, one of the things I learned when I was in the health insurance industry is it varies so much by plan and varies in the case of Medicaid by state and the way that those plans are organized. So it’s hard to generalize. And I think, like everyone, I would be very interested to see what direction these issues go with the new administration following January 20. What will be the direction that healthcare reform takes at that point? How will states participate in that? And what are going to be the approaches to really address a number of issues around coverage, access, and the ability to make sure that patients with the greatest need are able to have their healthcare needs met?

Gary Bisbee 27:50
Hal, could you outline the newly minted relationship with Humana for MA subscribers?

Hal Paz 27:57
We’ve had several initiatives that we’ve been working on with insurers and, first and foremost, looking for opportunities through our accountable care organization to move towards value-based reimbursement where we can do that. So we’re very pleased with the direction we’ve been going overall. And certainly with Humana in the Medicaid space we see that there’s tremendous opportunity there. I know the folks at Humana well. As you may know, at one point, Aetna and Humana were talking about merging so I was very involved in working with the leadership at Humana, Bruce, and his leadership team. It’s a great organization and a great company. And Bruce, I have to say, has tremendous vision for what they’re trying to achieve at Humana. So we recently signed an agreement to expand access in-network Humana Medicaid Advantage members for Central Ohio. It allows us to expand our ability to serve the community, particularly during this critical time with the pandemic. And it gives those members in-network access to numerous outpatient facilities with nearly 3000 physicians employed through the Ohio State University physicians network. And we’re very excited about this. And we’re looking forward to continuing to develop that relationship, particularly in the Medicaid space.

Gary Bisbee 29:14
One other relationship that is relatively recent is the one with One Medical. Could you give us background on that relationship?

Hal Paz 29:22
Sure. Again, when I was at Aetna, one of my responsibilities was looking at some of the new innovative approaches to care delivery. Sometimes they’re called disruptors, but to really have a deep understanding of that. And looking for opportunities to partner, we at Aetna, we partnered with companies. One of the companies that I had an eye on back then that was started by Tom Lee who was the founder of One Medical out in San Francisco. And after I arrived here, we engaged them in a conversation about their interest in coming to Central Ohio. Amir Dan Rubin who’s succeeded Tom as their CEO, I thought had tremendous vision as the former CEO of Stanford Health in the Bay Area had a deep understanding of academic health and academic medicine with his leadership at the Stanford University of their health system. So I just thought it was real natural in terms of engaging in a conversation and we were delighted that they were interested. For us, we see this as a way to amplify our primary care services across the region. We have terrific departments of family medicine, general internal medicine, general OB/GYN, I mean, these are phenomenal programs. But we want to continue to grow them. We could have continued to do that organically or through a partnership like this, join up together, use their skill sets and their approaches to very innovative primary care delivery. And I visited one of their early facilities in Manhattan when I was there as part of Aetna and I was just very impressed by the way they organized their care delivery model, their facilities, and I thought this was particularly a great opportunity for us. And then also the way that they work with payers and the way they work with employers. So it just made a lot of sense. And we were able to come to an agreement that I think is really beneficial to both of our organizations and allows us to partner with them and I think gives them, without a doubt, access to a premier academic health center with tremendous resources across the community. So I’m very excited about this. I’m looking forward to them in the very near future, opening their first clinic with us here in the greater Columbus region.

Gary Bisbee 31:33
Well knowing Amir well, I’m sure he’s absolutely delighted to be with you and your leadership as well. This has been a terrific interview, Hal. I wonder if I could ask two leadership questions to wrap up. The first is, what do you think the most important characteristics of a leader during a crisis are?

Hal Paz 31:54
Great question. First and foremost, being visible and communicating. You can’t over-communicate. Early in the pandemic, recognizing that our ability to have the usual walk the halls, which is something I love to do was going to be challenged for a whole host of different reasons, we very quickly put together a communication vehicle channel that we launched every single day, seven days a week. And I still get the feedback from, we have almost 30,000 employees at the Wexner Medical Center, that they came to count on that every morning as the single source of truth as to what was going on across the Med Center in the region, the information they needed. They could go to one place and find out what they needed to know and they could communicate back to me or to anybody in our leadership around issues or concerns that they had. And they found that to be invaluable. And I was so pleased that we launched that very, very early on in the pandemic because it was something that I think helped our entire workforce understand what was going on and where we were going and help explain if we were going in a certain direction, why we were going in that direction. So that was number one. Number two, being honest and truthful. We all are, but really ensuring that we’re absolutely clear about the situation, being realistic about it, but also having a sense of optimism. Because I think that it’s important, no matter how challenging or how difficult it is, we have to start with the view that we will overcome this, we will get to the other side, and here’s how we plan to do it. If we can’t start the conversation that way, I don’t think there’s much of a conversation and there isn’t the inspiration that exceptionally hard working people need to get in first thing in the morning and do their work. So I would say that’s exceptionally important. It’s a trust, it’s the truth, and it’s the transparent communication that is something that has to be emphasized. And you just can’t do it enough, you can’t do enough. Over-communicate.

Gary Bisbee 34:02
Final question. How has COVID changed you as a leader and as a family member?

Hal Paz 34:09
Well, I would say that might be a better question when I’m looking at COVID in the rearview mirror. But I’ll say this, I guess I’m fortunate in the sense that I spent the first seven, eight years or so of my career running the medical intensive care unit director because it just gave me tremendous insight around what these challenges are and gave me a very real sense of how you navigate through critical issues like this. The first thing is, you’re never going to have all the information you need. It’s impossible and you’re going to have to collect as much information as you can and be prepared to make decisions immediately. This is not a situation or environment where someone can expect, not in these roles at least, there are other roles certainly where a person is afforded the opportunity to study things and collect large amounts of data and delay making a decision. But here, you can’t do that. Here you collect as much information as you can and then have to be prepared to make decisions based on the ground, whatever you have, and to continue to do that day in and day out. So it’s really critical to do that, as I said before, really critical to be visible, and to over-communicate, to be optimistic. And I continue to, I find it’s immensely rewarding that I could be in this role at this time. I think about why I came to Ohio State, I saw this as an enormous opportunity at this point in my career, to have an impact on the direction that a large academic health center could take. Early in my training, when I was in Baltimore, people were still talking about Abraham Flexner and the medical school hospital model and we are so past that. I mean, the work that Flexner and many fine institutions did back in the early part of the 1900s was exceptional, particularly the scientific model of research that we brought over from Germany was exceptional, that’s all still very valid. But it’s no longer about a hospital and a medical school. It’s about a large health platform and about interprofessional education bringing all healthcare workers in teams, physician, nurse, pharmacist, and so on. That’s the new model. And here at Ohio State, we have the opportunity to create that model. COVID, as I said before, accelerates some of that. In other cases will cause us to focus elsewhere right now to get through this pandemic. But I’m just so enormously impressed by what we’ve done here. We created a testing facility in a matter of weeks that allowed us to go from 40 tests a day, which was what was available to us doing our own testing, where we could do over 4000 tests today. We created our own viral transport media, even our own swabs using 3d printers and were able to scale PCR testing early on in the pandemic to serve not only our own patients, but the state of Ohio. And we exported that viral transport media to other states and cities and the technology, so exceptionally rewarding. I personally feel that being involved and being in a leadership role at this time is such a tremendous honor. It’s been as you can imagine a challenge in terms of work-life balance. My wife is also a clinician so she’s certainly deep into her work in her practice at the same time. But it’s recognizing that we will get to the other side and through the recent development in the last few weeks I’m more encouraged than I ever was before that we will see this light at the end of the tunnel sooner rather than later. And that’s what keeps us coming into work every single day despite the fact that we’re in the midst of this huge surge right now at around Thanksgiving.

Gary Bisbee 37:47
That’s a great place to land, Hal. This has been an outstanding interview and we spoke about the Biden administration and direction they’re going to take. For my money, I’d love to see you as the HHS Secretary. I think it would be terrific.

Hal Paz 38:00
Well, you’re very kind, Gary. Thank you.

Gary Bisbee 38:03
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 capitol 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 gary@thinkmedium.com Thanks for listening.