Latest / Becker’s Healthcare Podcast / R. Kyle Kramer on Rural Healthcare Transformation and Expanding Access Through Partnership

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R. Kyle Kramer on Rural Healthcare Transformation and Expanding Access Through Partnership · Becker’s Healthcare Podcast

• 0:02
  - There's a small circle of people who truly
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  - Becker's fourteenth annual CEO and CFO roundtable
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  - workforce strategy, and the leadership questions that don't
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  - Join us November second through the fifth in
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  - Chicago.
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  - For the agenda and event details,
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  - visit beckershospitalreview.com
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  - and click on the events tab in the
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  - upper right.
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  - This is Laura Deirdle with the Becker's Healthcare
• 0:53
  - podcast.
• 0:53
  - I'm thrilled today to be joined by Kyle
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  - Kramer, chief executive officer of Day Kimball Health.
• 0:58
  - Kyle, it's a pleasure to have you on
• 0:59
  - the podcast today.
• 1:00
  - Laura, it's such a pleasure to be here
• 1:01
  - with you, and I'm excited for our discussion.
• 1:04
  - Absolutely. Now I'm looking forward to catching up
• 1:07
  - and and learning a bit more about some
• 1:09
  - of the cool things you're doing at Day
• 1:10
  - Kimbell as well as how you're thinking about
• 1:12
  - the future. But before we dive in, can
• 1:14
  - you tell our audience just a little bit
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  - about yourself and your background?
• 1:17
  - Certainly.
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  - As things go, I have,
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  - been in health care going on thirty six
• 1:23
  - years now, always in a, a leadership capacity.
• 1:26
  - Have been
• 1:27
  - the chief executive officer here at Day Kimball
• 1:30
  - Health for the last
• 1:32
  - six years. And prior to that, spent
• 1:35
  - significant time working
• 1:37
  - in places like mainline health on the West
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  - Side Of Philadelphia, Yale New Haven Health in
• 1:42
  - Southern Connecticut, Penn State University Health
• 1:45
  - in Central Pennsylvania.
• 1:47
  - And I started my career at the University
• 1:49
  - of Texas and Hermann Hospital
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  - in the Texas Medical Center, all of those
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  - locations being much larger
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  - than the the place where I'm at now.
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  - And Day Kimbell is
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  - a formally designated
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  - rural health care hospital
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  - in Northeast Connecticut, and we serve a population
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  - that is approximately
• 2:10
  - a 125,000
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  - people with most of those individuals residing in
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  - Northeast Connecticut, and we draw from Southern Massachusetts
• 2:18
  - and Western Rhode Island as well. It's an
• 2:21
  - exciting place to be, a very
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  - beautiful place to live, but,
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  - an area that is
• 2:27
  - very much
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  - rural and totally nonurban,
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  - albeit
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  - within,
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  - an hour
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  - north, south,
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  - east, or west, you can be in more
• 2:38
  - urban environments. But, you know, populations in rural
• 2:40
  - areas tend to behave very locally. So as
• 2:43
  - a consequence, we focus on
• 2:45
  - being a strong provider
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  - of local health care
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  - to serve our population
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  - and make a difference for their overall well-being.
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  - That's great to hear. And, you know, really
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  - exciting to have that opportunity,
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  - to
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  - keep serving a a population, as you mentioned,
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  - that's very local and really cares about their
• 3:04
  - health care and the institutions within the community.
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  - So,
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  - that that's a great focus and and definitely
• 3:10
  - being a rural state.
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  - You know, I know there's a lot of
• 3:13
  - challenges, but also a lot of opportunities. So
• 3:15
  - let's first talk of some about some of
• 3:17
  - the headwinds. What do you have your eye
• 3:18
  - on right now, and what are you preparing
• 3:19
  - for?
• 3:21
  - Well, I think everybody
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  - across the country, regardless
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  - of whether you are a large urban academic
• 3:28
  - center or a small
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  - rural critical access hospital,
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  - we're all concerned about the changes that are
• 3:35
  - are in play with Medicaid reimbursement. And, you
• 3:38
  - know, given in rural geographies, there's perhaps even
• 3:42
  - a more profound
• 3:44
  - tendency for patients to be on, on Medicaid.
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  - It, it certainly
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  - causes us to scratch our heads. I think
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  - the other thing that we are
• 3:53
  - very much
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  - in touch with and attuned to is the
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  - whole concept of value based care and creating
• 4:00
  - a value based enterprise as we move forward
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  - because
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  - we know that, you know, while what we
• 4:05
  - do is important, the value we create and
• 4:08
  - the outcomes we produce are becoming even more
• 4:10
  - important. So
• 4:12
  - having systems in place to be able to
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  - measure that performance and to be able to
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  - then use data to
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  - drive transformation
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  - of care processes,
• 4:22
  - structure
• 4:23
  - our clinical efforts around how do we produce
• 4:26
  - the best outcomes, who are the best team
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  - members to participate
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  - in that care provision, and, ultimately, how do
• 4:32
  - we generate results that are
• 4:34
  - consistent with the demands of our patient population,
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  - but also elevate our performance to that next
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  - level. Those are the things that we're really
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  - paying attention to, and I think, you know,
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  - transformation
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  - is the name of the game.
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  - As a rural organization,
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  - obviously, rural health care transformation
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  - has been a significant discussion point over the
• 4:54
  - last year or so based upon
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  - some of the tenets of HR one.
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  - We're very engaged with that and are very
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  - excited about the opportunities that we have going
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  - forward.
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  - You know, obviously,
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  - there's a lot at stake for organizations
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  - like ours. The feds have
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  - given us the opportunity to create
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  - a focus on innovation and advancement,
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  - hopefully to elevate health care status and overall
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  - outcomes for populations
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  - in rural areas. And we're embracing that challenge
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  - and look forward to
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  - leveraging
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  - opportunities
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  - to make a real difference for the population
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  - we serve by capitalizing upon
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  - funding opportunities, especially for rural hospitals, are not
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  - necessarily
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  - as readily available.
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  - That makes a ton of sense. And, you
• 5:44
  - know, I I love that,
• 5:47
  - mindset of looking at it and seeing some
• 5:48
  - of the opportunities
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  - and being optimistic about how you're going to,
• 5:53
  - see those funds and continue to grow. And
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  - to that point, you know, how are you
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  - thinking about using some of the additional funds
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  - for rural health care, and where are the
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  - opportunities that you're seeing for growth and development
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  - in the next two to three years or
• 6:04
  - so?
• 6:05
  - That's a great question. And, you know, one
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  - of the things that we have been very
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  - steadfastly committed to is driving health care from
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  - a population specific
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  - perspective. And when we look at the population
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  - that we serve here in Northeast East Connecticut,
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  - first and foremost, we know that we have
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  - a population
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  - that is very much localized. The population does
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  - not commute in and out of major cities
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  - and pretty well chooses to stay local for
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  - all things. And that obviously
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  - creates an opportunity for us to think about
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  - health care delivery in a little bit more
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  - of a focused manner.
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  - Part of our our growth strategy
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  - is built around elevating and expanding our primary
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  - care access,
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  - both from the standpoint of your traditional office
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  - visits as well
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  - as building convenient care type opportunities
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  - whereby
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  - patients can receive walk in care and and
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  - quick support for smaller problems. What we wanna
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  - try to do to the extent that we
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  - can is mitigate
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  - the the need or the tendency
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  - for individuals to use the emergency department as
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  - a
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  - a basis of primary care. That's an expensive
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  - proposition first and foremost. And more than that,
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  - for simple things, oftentimes, patients tend to wait
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  - because we have more acute patients in front
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  - of them. So we're focused intensively on expanding
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  - primary care, but also looking at the diseases
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  - and the conditions that naturally present
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  - with a population such as ours. So, you
• 7:34
  - know, again, in an aging population, you're looking
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  - at
• 7:38
  - programs that identify
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  - cardiovascular
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  - risk or digestive health risk or
• 7:43
  - pulmonary and respiratory care risk. And, you know,
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  - given that we are a rural community but
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  - consistent with the rest of New England over
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  - the past,
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  - we've been a mill area. We've got a
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  - lot of presence of cancers. There's a higher
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  - presence of
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  - lung cancers in our region, not just because
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  - of, higher levels of smoking, but because
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  - individuals have worked in environments where they're breathing
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  - in a lot of fine particulate, which can
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  - contribute to some of those concerns. And then,
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  - again, we have a community
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  - that works farms and does a lot of,
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  - processing type work. So orthopedic,
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  - concerns become a, a significant area of focus
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  - as well. And just like
• 8:28
  - with, with our our cars, you know, when
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  - we have to, rotate the tires or or
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  - maybe, replace those tires, our,
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  - our our folks out here are, you know,
• 8:38
  - prone to needing knee replacement, hip replacement, or
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  - perhaps
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  - they're developing carpal tunnel,
• 8:45
  - conditions
• 8:46
  - or or shoulder or elbow injuries just due
• 8:48
  - to repetitive motions. So we've really focused on
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  - those things. But I think what is
• 8:54
  - probably our greatest area of opportunity
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  - and our,
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  - our our strategy moving forward is as a
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  - small organization, we know that, being an independent
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  - rural hospital
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  - is only going to get harder, which is
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  - why we have focused on
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  - identifying a partner. We are in final stages
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  - of a potential partnership opportunity and an ultimate
• 9:17
  - affiliation
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  - with the University of Connecticut Health System.
• 9:22
  - Becoming a part of the Yukon Community Health
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  - Network, number one, gives us
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  - peer network organizations
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  - to,
• 9:29
  - collaborate with, identify,
• 9:32
  - best practices
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  - as a part of discussion, and then ultimately
• 9:36
  - capitalize upon workforce development through
• 9:39
  - having residents and fellows that could potentially rotate
• 9:42
  - into our region. And
• 9:44
  - if we think about that from an overarching
• 9:47
  - construct
• 9:48
  - perspective,
• 9:49
  - most of our medical schools around this country
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  - are in urban areas. And
• 9:55
  - if we if we follow the natural progression,
• 9:58
  - four years of medical school, three or four
• 10:00
  - years of a residency program, maybe additional time
• 10:04
  - as
• 10:05
  - a subspecialty residency or fellowship training program.
• 10:09
  - Oftentimes, individuals who are going through that have
• 10:12
  - established relationships, perhaps have started a family, and
• 10:16
  - have
• 10:17
  - started to grow roots in those areas. And
• 10:20
  - none of that time is ever spent in
• 10:22
  - a geography like ours.
• 10:24
  - So what we're working with our colleagues at
• 10:26
  - UConn Health on already is establishing
• 10:29
  - residency rotations that will bring
• 10:32
  - trainees into our environment to demonstrate, number one,
• 10:35
  - areas like ours are rich and robust in
• 10:38
  - terms of lifestyle,
• 10:40
  - great opportunities
• 10:42
  - for
• 10:42
  - raising a family, etcetera, but also it begins
• 10:45
  - to bring additional
• 10:46
  - specialists into our region
• 10:48
  - in a manner that ensures that patients have
• 10:52
  - the ability to access care locally
• 10:54
  - without having to travel great distances. Because in
• 10:57
  - geographies like ours, we often have
• 11:00
  - situations where people are traveling on two lane
• 11:03
  - roads, not eight lane highways,
• 11:05
  - and that makes the getting from here to
• 11:07
  - there a little bit harder. So those are
• 11:09
  - some of the things that we're excited about.
• 11:11
  - Obviously, we think the affiliation
• 11:14
  - will certainly bring us natural level of scale.
• 11:17
  - But I think more importantly, it gives us
• 11:19
  - the opportunity for clinical collaboration
• 11:21
  - with our partners,
• 11:23
  - across the state and gives us the ability
• 11:26
  - to enrich the care services
• 11:31
  - access.
• 11:32
  - Wow. That is a huge undertaking to do
• 11:34
  - an affiliation like that. And as you mentioned,
• 11:37
  - a ton of benefits for Day Kimbell as
• 11:39
  - well,
• 11:40
  - you know, as it it progresses in when
• 11:42
  - it goes through. And so,
• 11:44
  - that that's really exciting to hear. What does
• 11:46
  - it take to go through a process like
• 11:48
  - that from a leadership perspective, you know, to
• 11:50
  - really find the right partner and then make
• 11:52
  - sure that you're doing your due diligence, I
• 11:55
  - guess, to understand, you know, how you can
• 11:58
  - make it as beneficial as possible for the
• 12:00
  - organization.
• 12:01
  - So that's a really good question. I think,
• 12:04
  - like any relationship,
• 12:07
  - the first and foremost thing
• 12:09
  - that you're looking for is fit. And in
• 12:11
  - in this setting, it's really about culture and
• 12:14
  - clinical beliefs.
• 12:16
  - We think that the Yukon health system
• 12:19
  - is, number one,
• 12:21
  - a leading system in the country academically,
• 12:24
  - certainly has a tremendous amount of positivity with
• 12:28
  - regards to
• 12:29
  - its clinical training programs as well as its
• 12:32
  - clinical research programs.
• 12:34
  - All of that is enriching
• 12:36
  - potentially
• 12:37
  - for a geography like ours, not to say
• 12:40
  - that we're going to be participating
• 12:42
  - in those types of things directly, but what
• 12:45
  - it promotes is a level of scholarly activity.
• 12:48
  - And for our medical staff, as well as
• 12:51
  - for the rest of our clinical staff, it
• 12:53
  - creates exposure
• 12:54
  - and the opportunity
• 12:55
  - for continuing education. And that growth mindset and
• 12:59
  - that continuous learning mindset
• 13:01
  - is what drives the ability for us to
• 13:03
  - continue to elevate our services, grow our our
• 13:07
  - teams, and expand our performance capabilities
• 13:10
  - in just about every way. I think the
• 13:12
  - other piece of it is is really having
• 13:15
  - the support of,
• 13:17
  - number one, your community, number two,
• 13:20
  - your legislature,
• 13:21
  - and number three,
• 13:22
  - the rest of the state in order to
• 13:24
  - ensure that, that the whole process moves forward.
• 13:28
  - Mergers are are occurring and have occurred for
• 13:32
  - many years all across the country. Each one
• 13:34
  - has its own nuances and novelties. This one
• 13:37
  - has been
• 13:38
  - perhaps a little bit more
• 13:40
  - unique than others that I've had the opportunity
• 13:43
  - to either be a part of or observe
• 13:46
  - largely because
• 13:48
  - we're integrating with a state organization.
• 13:51
  - And, of course, every single move
• 13:54
  - is is seen, is
• 13:56
  - visible, and is scrutinized. So as a consequence,
• 13:59
  - it was very important for us, very important
• 14:02
  - for the University of Connecticut leadership team,
• 14:05
  - as well as for state leaders to ensure
• 14:08
  - that number one, this was the right direction
• 14:10
  - to move.
• 14:11
  - Number two, this would create stabilizing capability
• 14:14
  - for
• 14:15
  - our organization, but also would be a
• 14:19
  - an appropriate fit with the University of Connecticut
• 14:21
  - Health System.
• 14:23
  - And I think we've checked those boxes very
• 14:25
  - nicely. I think the other piece for us
• 14:28
  - that
• 14:29
  - makes a huge
• 14:30
  - opportunity
• 14:31
  - come to bear is that we are very
• 14:34
  - close to the University of Connecticut's
• 14:36
  - university campus in Storrs, Connecticut.
• 14:39
  - And as a byproduct of that, there are
• 14:42
  - student training programs in that space, both from
• 14:45
  - the nursing,
• 14:46
  - from a pharmacy,
• 14:48
  - and from other clinical,
• 14:51
  - sub disciplines that will will be very
• 14:54
  - excited about that will be excited about having
• 14:57
  - come to our campus for some of their
• 14:59
  - clinical rotations, and that also becomes an important
• 15:02
  - piece of workforce development.
• 15:04
  - But I think the the sum total of
• 15:06
  - this is that
• 15:07
  - you're always looking for a situation where the
• 15:11
  - sum of the parts is going to total
• 15:13
  - something greater than
• 15:15
  - the the individual components. And I think in
• 15:18
  - this instance, we have
• 15:20
  - leadership colleagues with the University of Connecticut Health
• 15:23
  - System that have very similar
• 15:26
  - and consistent belief from what we have. I
• 15:29
  - think they see just as much opportunity for
• 15:32
  - growth in our region as we do. And
• 15:35
  - I think the combination
• 15:37
  - of our teams will lead to even better
• 15:39
  - service availability
• 15:41
  - and elevated clinical outcomes
• 15:43
  - for the population that we've been so privileged
• 15:46
  - to serve for so many years.
• 15:48
  - It makes a ton of sense. And and
• 15:50
  - thank you so much for going a bit
• 15:51
  - deeper there. Really, really exciting news. So we'll
• 15:54
  - keep an eye on,
• 15:55
  - how things go as you're finalized,
• 15:58
  - the the alignment.
• 15:59
  - Now before we wrap up, I want to
• 16:01
  - ask you about leadership as well. Can you
• 16:03
  - share with me a leader that you admire
• 16:05
  - really from any industry and why?
• 16:07
  - I certainly can. And, you know, I've had
• 16:10
  - the very good fortune
• 16:12
  - in my career of working with some really
• 16:16
  - amazing people, and I will
• 16:18
  - I will start by
• 16:20
  - recognizing
• 16:21
  - someone that I truly admire, have learned so
• 16:25
  - much from, and
• 16:27
  - really aspire to, to emulate her
• 16:30
  - leadership style and behaviors, and that's Marna Borgstrom,
• 16:33
  - who is the,
• 16:36
  - the former CEO and president of the Yale
• 16:38
  - New Haven Health System.
• 16:40
  - Marna has always been an inspirational
• 16:44
  - leader, not just in terms of what she
• 16:46
  - knows, but more so
• 16:49
  - because of how she engages with
• 16:52
  - staff, how she engages with physicians, how she
• 16:55
  - engages with the community. And
• 16:57
  - I've always been very
• 17:00
  - impressed with how she comports herself,
• 17:02
  - and I
• 17:04
  - always enjoy a conversation with Marna. And never
• 17:07
  - once have I ended a conversation not having
• 17:10
  - learned something. So without a question, I would,
• 17:14
  - I hold Marta Borgstrom in the the very
• 17:16
  - highest regard.
• 17:18
  - Another person that has been probably the best
• 17:22
  - mentor that I've had is my direct boss
• 17:25
  - when I was at Yale New Haven, and
• 17:26
  - that was Brian Condon.
• 17:28
  - Brian gave me opportunity to grow and expand
• 17:31
  - across multiple clinical service lines and also the
• 17:34
  - opportunity to work in system leadership growth and
• 17:36
  - development.
• 17:37
  - And
• 17:38
  - he is still a very close friend,
• 17:41
  - although long retired from you know, New Haven,
• 17:44
  - but I've been very blessed to to have
• 17:46
  - had him.
• 17:48
  - Another gentleman,
• 17:49
  - is Kevin Nowak, who was the very first
• 17:52
  - person that I met when I started in
• 17:54
  - 1991
• 17:55
  - at the University of Texas
• 17:57
  - in Houston. Kevin took me under his wing,
• 18:00
  - and I have consistently
• 18:03
  - called upon him for advice, guidance,
• 18:06
  - or just to, be a sounding board. And
• 18:09
  - he remains
• 18:10
  - one of my very best friends and is
• 18:13
  - always available to provide advice. But I think
• 18:16
  - the one person that
• 18:18
  - I most admire
• 18:19
  - and have
• 18:21
  - aspired to be
• 18:23
  - in my, in my own professional career
• 18:26
  - is, is my dad.
• 18:28
  - Ron Kramer was a high school football coach
• 18:31
  - in Texas,
• 18:33
  - and he would tell you that he coached
• 18:35
  - football, but he taught life.
• 18:37
  - And the life lessons that I learned,
• 18:40
  - with my dad who, when I was in
• 18:42
  - elementary school,
• 18:44
  - was dad. When I was in middle school,
• 18:46
  - was coach dad. And when I had the
• 18:48
  - opportunity to play football for him in high
• 18:50
  - school, he was coach Kramer.
• 18:52
  - But ultimately, he became my very best friend
• 18:55
  - and
• 18:56
  - my
• 18:57
  - my my hero. He he is,
• 19:00
  - has been, and will always be my hero
• 19:03
  - and has been somebody that
• 19:06
  - I've tried to model. And many people have
• 19:08
  - asked me, you know, why I didn't go
• 19:10
  - into coaching, and I respond to them that
• 19:13
  - in my own way I did. I just
• 19:15
  - coach a different team than what my dad
• 19:17
  - coached.
• 19:18
  - But the the things that he taught me
• 19:20
  - about focus, commitment, dedication,
• 19:24
  - resiliency,
• 19:25
  - flexibility,
• 19:27
  - and overall engagement have stood with me for
• 19:30
  - my entire career, and they are things that
• 19:33
  - I am
• 19:34
  - reminded of in subtle ways each and every
• 19:36
  - day. So I would, unquestionably
• 19:39
  - say that
• 19:40
  - my, my greatest inspiration
• 19:43
  - and my
• 19:44
  - greatest influence,
• 19:46
  - remains my father, Ron Kramer.
• 19:49
  - That's beautiful. Kyle, thank you so much for
• 19:52
  - joining us on the podcast today. This has
• 19:54
  - been such a amazing opportunity to hear from
• 19:56
  - you and be inspired by all the things
• 19:58
  - that you're doing. And I look forward to
• 20:00
  - seeing you as well at our CEO CFO
• 20:02
  - roundtable.
• 20:03
  - I know you'll be speaking on a panel
• 20:04
  - and really digging deeper into many of these
• 20:06
  - themes we talked about today. So I look
• 20:08
  - forward to seeing you there.
• 20:10
  - I look forward to seeing you as well,
• 20:11
  - and have a great rest of your week.