Episode 71:
Bravery, Resilience, Compassion and Dedication
Dr. Craig Samitt, Dennis Murphy, Ken Paulus, Dr. Janice Nevin
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In this episode of Fireside Chat, we welcome four CEO’s who have been previous guests on the show to talk about what they have learned during the COVID crisis and look ahead to priorities in 2021.

We’re pleased to welcome Dr. Craig Samitt, President and CEO, Blue Cross Blue Shield of Minnesota; Dennis Murphy, President and CEO, Indiana University Health; Ken Paulus, President and CEO, Prime Therapeutics; and Dr. Janice Nevin, President and CEO, Christiana Care Health System

Transcription

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Gary Bisbee 0:03
At the end of a year that would have been impossible to imagine only twelve months ago, we’ve worked our way through a spring COVID surge, a mid-year increase in COVID cases, and a second surge to end the year. In the midst of ensuring proper PPE and communicating with employees, caregivers, the community, board of directors, and let’s not forget families, our CEO guests work to assimilate the lessons learned from COVID in 2020 and plan for 2021. In this episode, we invited four CEOs, all of whom have appeared on Fireside Chat previously to share their plans for 2021. I’m Gary Bisbee and this is Fireside Chat. Dr. Craig Samitt will share a commitment to focus on the day after tomorrow and not return to yesterday, while Dennis Murphy will take a newly developed health system-wide agility out for a spin by focusing on care models for infant mortality and community health. Ken Paulus will implement a new strategy to coordinate a clearly fragmented health system while Dr. Janice Nevin will continue the increase to digital and homecare and use the headline of, “Be bold” in working with insurers to find a new middle of financing and delivery. Now on to our guests. We’ll hear first from Dr. Craig Samitt, president and CEO Blue Cross Blue Shield of Minnesota.

Craig Samitt 1:25
I think the biggest opportunity for all of us in healthcare is to see silver linings in this crisis and not miss the red flags. My biggest fear is that we will go back to the way things were, that we’ll ignore the red flags and that we’ll go back to what I’ve been calling “yesterday.” My hope is that we focus more on moving into the day after tomorrow, a fundamental reinvention of our industry. At Blue Cross Minnesota we actually had talked about reinventing the industry from the inside out long before the crisis hits. And I think that’s more important now than ever before. How is it possible that we can cost so much as an industry and yet not see the gaps we’ve seen through this crisis – coverage gaps, care, delivery gaps, equity gaps. If we come out of this crisis, and we see premiums rise, or ongoing inequity, or worsening insurance, or return to a fee-for-service chassis, I would view that as yet another tragedy on top of the tragedies we’ve already experienced. So my hope, and what I think our opportunities are, are to really see this burning platform for what it is. And frankly, I would say, let the platform burn down so that we can build a new one.

Gary Bisbee 2:55
Dennis Murphy, President and CEO, Indiana University Health.

Dennis Murphy 2:59
I think there are probably two broad categories, and I’ll start but the first one is really, there’s an immense set of internal opportunities with our teams. So if I reflect back on COVID, I think we’ve instilled in our teams this notion that they can accomplish anything that we set our minds to. That we’ve been able to stand up virtual health program over a weekend, we’ve done now hospital in a home took us about two weeks to stand up. Even at the very beginning, standing up COVID testing, we were the largest testing provider in the state, probably for the first three months of the pandemic. I think all of our organization has become more agile. We’ve got a stronger bias to action. Our COO coined a phrase early on in the pandemic that said, “Get your hustle on.” And that’s become code for our team to really just go do it. Go try something. It’s not going to be perfect and we’ll fix it after we get it up and running. But that whole notion that all of these things are required to get the organization moving. We’re really excited about the idea of what do you point that at next once we get through the tail end of COVID. And that really leads me to that second opportunity. I think there’s a whole set of many patient-facing opportunities that we can point this energized leadership and clinical team to and so we’re really excited. And I think we’ve seen massive changes in the way we think about delivering care and the care models. So what does that look like in a steady state when we can really take populations other than COVID patients and be thoughtful about it? I think we’re really interested in understanding how we can deal with community health issues differently, particularly with this idea of being agile and having a bias to action which is just, “Let’s go try some things.” Let’s do something different about infant mortality that isn’t based in our four walls of the hospital and how we think about healthcare disparities. So I think our team has woken up to the understanding that we can change the health of our state. And we’ve seen that and we have played a leadership role. So now they want to know what we’re going to ask them to do and how we’re going to support them making major changes. So I’m actually very excited. I think we have a highly engaged workforce coming out of COVID and that’s the core ingredient to long-term success for us.

Gary Bisbee 5:54
Ken Paulus, President and CEO, Prime Therapeutics.

Ken Paulus 5:58
I will tell you this COVID circumstance has just been an eye-opener I think for our entire nation, particularly for healthcare. I think we’ve all realized that we’ve got this incredibly fragmented, patchwork healthcare system that does so many great things when you look at all the disruptors that have come about over the last 10 years, just stunningly cool, interesting things. But none of it is tied together, literally none of it. And if we’ve learned one thing from COVID, we’ve learned that we have a patchwork system, a fragmented system without this vision of optimizing health. And the only way in my mind you can optimize health in a pandemic or any other time is to tie the pieces together, integrate these disparate pieces into a hole that would transcend the outcomes that we’re getting today. So I think COVID’s really opened all of our eyes to the fact that we’ve got a system that isn’t really working in its optimal place. I wouldn’t say it’s broken, because we do a lot of great things. But we do a lot of great things in different silos and none of those things are tied together. So that really stands out for me. And I think what we’re going to do at Prime is we’re going to take that knowledge that learning, if you will, and serve the role of air traffic controller for our patients who are new to medications, who are new to specialty treatments that are very complicated, bringing in their physicians into the process, their families, the insurer, pharma, and tie those pieces together for a far better experience and far better outcomes. So that’s one of our big aha’s. And it’s pretty stunning that we are the richest nation in the world in the history of mankind, and probably the least integrated and effective in terms of how we get our work done within healthcare. So it’s been really something and I think we’ve all learned a lot. Unfortunately and fortunately.

Gary Bisbee 7:58
Dr. Janice Nevin, President and CEO, Christiana-Care Health System.

Janice Nevin 8:03
We’ve always been a place that valued our people and COVID, as much as any other experience we have had, has shown us the importance of putting our caregivers first. Throughout the pandemic, we really focused on them, their safety, provided them with additional resources for housing, childcare, so that they could come to work and do what they needed to do. We didn’t do furloughs, we didn’t do layoffs. In fact, in the middle of this, we implemented paid parental leave. In addition to that, we’ve learned how important it is to be transparent when it comes to communication, and really leveraged every channel that we have to be very clear, open, honest with our caregivers. And I think all of that work together really is paying off now, in particular, when we are at yet another even more challenging time with COVID. And when we have to not only do the work of caring for our patients and our community, also shift to vaccination for our caregivers and our community. And as I think about the future, what we have done is actually taken that commitment to caregivers and embodied it as a priority in our strategy in a way that we had not done as explicitly before. So a very important part of learning for us is really, invest in your people. They are your most valuable resource. They will amaze you and inspire you and they make all the difference in the world no matter what comes our way.

The other real opportunity that COVID has demonstrated has been the opportunity to address issues of health equity and issues of racism, which I believe/we believe is a public health issue. Lots of learning with COVID. We not only refined our ability to collect data, but we were able to use that data to deploy resources to communities of need. And we established some new sites in communities that, although they were there to help that community learn about COVID and do testing, what they have become have been platforms for trust-building. And I see us really building on that platform as we go into the phase of administering the vaccine and well into the future. And what we’ve learned is you can do a lot without a whole lot of resources. You don’t need a fancy building in order to make a meaningful impact. In fact, some of our most important and impactful sites have been reused rooms in a community center or a cafeteria. And what we learned is, it’s really the people who connect to the people, think community health workers, social workers, substance use disorder, counselors, medical assistance, that can create that trust because they know the community, they’re from the community. And a lot of the fancy stuff when it comes to care can be delivered with technology. We deployed a tremendous amount of technology to allow for virtual care and ongoing digital interactions to communities. And of course, you do need someone on the ground who can introduce a community member to that technology, make sure that they have the right equipment, and the right connection. We received an FCC grant to deploy some of that technology. And as I think about the next few years, I really do think it will be a new approach for us to continue to grow, to make sure that we’re reaching people, everyone in all the communities that we serve, and giving them an opportunity to access health. I think you’ve heard me say before that as we think about the future, we talk about how everything that can be digital will be. All care that can be delivered in the home will be. Certainly, our experience with COVID has shown us the importance of that approach. It has accelerated the work that we have done. And it’s really opened up our thinking about what else is possible as we think about the future. Hospital at home, skilled nursing facilities at home, you name it – there’s a great opportunity again, to marry the right people with the right skill sets with the technology that’s available to us. In the midst of COVID, we launched one of the first Alexa home skills in the country, HIPAA compliant Alexa home health coach. Again, an example of taking the learnings from COVID, using technology that was already in development, deeply understanding now how it can be used to make a difference, and pushing forward to make sure that we can deploy that so that the future is digital and it is care in the home.

One of the other elements of COVID has been, it’s shone a light on behavioral health needs in our community. Needs that existed previously have only worsened as we’ve gone through this crisis, care needs for our community and also care needs for our caregivers. As a result of that, we have now developed a very robust and comprehensive behavioral health strategy that is all-encompassing. We were already beginning to push it out, but again, COVID really highlighted the importance of behavioral health to overall healthcare and well being. And we are using a combination of physical sites, people, and technology, which is really important in caring for people with behavioral health needs and really accelerating our work in that area.

And finally, I would say one of the great opportunities has been to accelerate our work with payers. Because I think that what we were doing, we believed we were bold because we’re in a part of the country where fee-for-service is very much at the core of how most providers are paid. We had been out there in front being aggressive, looking for contracts where we would share risk with a payer. As I think about the last nine months, very proud of what we accomplished, but COVID has really underscored the need for us to be much bolder in that area to develop larger partnerships, more impactful partnerships. And I do believe as we go forward, certainly in the next three to five years, you’ll hear us talking about some new innovative partnerships that will really drive value, deeply personalized experience, improved quality reduced costs, and make care affordable. And I’m excited about all of this. I’m a family physician. I trained on the biopsychosocial model of care. What COVID has shown us is that integration of medical care, behavioral care, social care, absolutely critical. We now have a 21st-century question framework in which to launch that and it will require that we rethink payment. That’s what we’re all about at Christiana-Care. I couldn’t be more optimistic, more excited about how we will grow, and make a difference to those we serve.

Gary Bisbee 15:15
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 gary@thinkmedium.com. Thanks for listening.