Latest / Becker’s Healthcare Podcast / Andy Mueller, MD on Redesigning Primary Care and Advancing Affordable Healthcare at MaineHealth

Transcript

Andy Mueller, MD on Redesigning Primary Care and Advancing Affordable Healthcare at MaineHealth · Becker’s Healthcare Podcast

• 0:02
  The most important health care decisions don't happen
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  in isolation.
• 0:06
  They happen when leaders come together.
• 0:08
  Becker's sixteenth annual meeting brings together more than
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  3,500
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  hospital and health system executives this April in
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  Chicago.
• 0:16
  With 800 speakers from Ascension,
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  Cleveland Clinic, CommonSpirit and more, the conversations get
• 0:22
  real. Leaders will share how their scenario planning
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  for policy shifts, breaking through value based care
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  barriers, and building clinical teams that translate
• 0:46
  This is Laura Dirda with the Becker's Healthcare
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  podcast. I'm thrilled today to be joined by
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  doctor Andy Mueller, president and chief executive officer
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  at MaineHealth.
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  Doctor Mueller, it's a pleasure to have you
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  on the podcast today. Hey. Thanks for having
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  me.
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  Absolutely. Now I'm excited for our conversation because
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  I know it it's always such a pleasure
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  to speak with you. You've got so many
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  great things going on there at MaineHealth. And,
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  you know, health care is such a dynamic
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  field that'll be great to get your perspective
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  on your future as well as some of
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  the cool things that you're doing. But before
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  we dive in, can you introduce yourself for
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  our broader audience and,
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  talk a little bit about MaineHealth?
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  Yeah. Hey. I'm Andy. I'm a family physician,
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  and I have the privilege of serving CEO
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  of MaineHealth.
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  MaineHealth is 24,000
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  care team members who are really committed to
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  our communities and patients in Maine, both our
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  urban setting in Portland, our rural communities, and
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  then, of course,
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  Carroll County, New Hampshire,
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  where we have both the hospital and physician
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  and APP practices as well.
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  That's great to hear. And, you know, what
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  a,
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  huge, area that you're serving in definitely seems
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  like a very dynamic market. So what was
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  the most important initiative that you led last
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  year? What did you do, and what were
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  the results?
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  We did a lot last year, and I
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  think,
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  they're really it's hard for me to it's
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  like having children. I don't know that I
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  have a favorite among them, but there are
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  five things that we always focus on that
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  are really important. I think these are really
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  important whether you're talking about health care today,
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  whether you're talking about health care tomorrow.
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  And that starts with the engagement of our
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  care team. It includes quality and safety, the
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  care we deliver,
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  the experience that our patients have in visiting
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  our facilities,
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  the ability to access that care, and then
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  the financial health of the system. And,
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  fortunately, over the last four years, we've actually
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  made great progress on each of those five
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  things. We kind of refer to them here
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  as the five pack.
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  And,
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  you know, I think if we can always
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  make sure that we're doing well in those
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  five areas, then I I give them great
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  optimism and hope for the future.
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  That's sort of the nonnegotiables
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  for us. Those are the things that we
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  do, not necessarily strategic pillars, but just sort
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  of the things that we feel are just
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  the table stakes and delivering care, for our
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  patients and communities.
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  But in addition to that, I think one
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  of the big things we've done over the
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  last,
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  year is we've really made,
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  sort of an educational foray into
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  sort of what capitated primary care looks like
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  and we've done that with a little spin
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  off that we've done called Trellis Health that
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  was ignorantly successful last year.
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  But we've also taken one of our existing
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  primary care clinics and flipped it to a
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  synthetic capitated model,
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  and also saw some really interesting and improved
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  results as well. And so that really gives
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  us,
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  a great deal to kind of,
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  a lot of optimism and confidence in thinking
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  about expanding that, to the rest of our
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  health system.
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  That's great to hear. And, you know, how
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  interesting,
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  having, as you mentioned, those primary care spaces
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  where you're doing some different things, like cap
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  capitated primary care as well as,
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  you know, how you're looking at that. Can
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  you talk a little bit deeper on,
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  what that looks like for you, how you're
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  able to work with your teams in order
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  to create these programs, and, what are some
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  of the tangible results you're seeing?
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  Yeah. For sure. So, I can't say enough
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  good things about our MaineHealth Premier Care team
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  broadly in general. We've got some amazing clinicians
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  and care team members
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  delivering really, really good care. And at the
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  same time, it was really a couple years
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  ago after hearing about just some of their,
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  you know, justifiable challenges. I'm a family physician
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  myself
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  and appreciate some of the real challenges they're
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  facing.
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  Sort of in a moment of frustration, I
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  thought, my gosh. It would almost be easier
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  to sort of blow up primary care and
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  start with from scratch. And we kind of
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  thought, why don't we try it? And so
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  we went to market, hired an incredibly successful,
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  serial entrepreneur from Silicon Valley who joined us
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  to open
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  sort of a de novo new way of
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  thinking about primary care. In fact, sometimes we
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  even hesitate to call it primary care
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  because we don't wanna conform to anything that
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  exists today. And there were really two rules,
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  one of which was,
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  you can never accept a single penny of
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  fee for service payment. The second was,
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  it's gotta have standalone p and l,
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  that's positive within two years. And
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  I think we've demonstrated we can do both
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  and in fact went from nothing to seeing
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  the first patient in that new payment model
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  at eleven months.
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  And since that time,
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  we've been able to see some pretty incredible
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  results for our team
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  that uses it. We've offered it as a
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  benefit option to some of our care team
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  members. We've had about a thousand use it
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  during the first year.
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  So we can look at that data for
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  our own care team members and benefit members
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  who use the use Trellis versus those who
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  don't. And in an age and acuity adjusted
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  fashion we're seeing about a 16
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  reduction in admissions per thousand in the Trellis
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  population about a 35% reduction in ER visits,
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  37%
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  reduction in specialty referrals.
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  And for about a thousand of our care
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  team members on the benefit plan it's resulted
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  in a savings of about $600,000
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  relative to those who don't use it with
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  a 90 net promoter score and quality and
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  safety outcomes that are outstanding.
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  And so we just really see that this
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  is part of the future.
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  As we were building this it started giving
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  us confidence that we wanted to experiment with
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  one of our existing practices.
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  We've done that and while the results aren't
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  quite as dramatic as with Trellis and Trellis
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  only sees the commercial population
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  of course, a regular practice see everything.
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  The results are still pretty impressive.
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  And I think what's been most impressive are
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  the results around patient experience and care team
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  engagement,
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  in their clinic as well.
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  That's fascinating
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  Nidding to hear. You know, really cool to,
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  have an understanding of how you're seeing
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  these actual,
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  remodels play out and how it's making for
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  better care for patients as well as,
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  savings,
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  for the health system. So,
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  really truly impressive. And, you know, when you
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  started working on, the pay models as well
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  as, you know, bringing some of these changes
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  into how,
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  the clinicians are thinking about things, did they
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  embrace it, or or were there was there
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  a,
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  change management period where they had to, you
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  know, do things a little bit differently, but
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  ultimately found it was, better overall for the
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  system?
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  Well, it's interesting. I think Trellis in particular
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  was a little bit different because it's a
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  it's truly a it's a subsidiary of MaineHealth.
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  It's it's its own startup. And so I
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  think people who join that team recognize they're
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  going to be doing something very different and
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  embrace that. But for our regular practices,
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  I think there are a couple of things.
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  I think there's general enthusiasm for trying something
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  different although you know change is hard in
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  the moment particularly when you still have the
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  demands of seeing
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  patients in the environment. And so I think
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  they did an amazing job of figuring that
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  out. And then I think among the rest
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  we've been very transparent with our
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  medical group around what it is we're trying
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  to accomplish. I think there's been there's been
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  mixed receptivity. I think there are some who
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  are really interested, really excited, wanna go do
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  that type of work to those who really
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  are still struggling to understand why we're doing
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  something different like this and everything in between.
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  Absolutely. That makes sense. And I'm sure it's,
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  you know, similar for pretty much any new
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  initiative that you're working on or or change
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  that occurs.
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  Looking ahead to 2026, what are some of
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  the big priorities or headwinds that you're focused
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  on?
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  You know, I think one of them that
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  we all have to be focused on is
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  affordability
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  and how do we think about that and
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  how can we really work to change how
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  we deliver care
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  to make it more affordable and accessible for
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  our communities.
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  Maine is not a particularly
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  affluent state.
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  New Hampshire is a more affluent state but
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  nonetheless
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  it's a challenge for the individuals to figure
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  out how they're going to pay for care
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  particularly in the current environment.
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  So that's going to be an area that
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  we're going to continue to have to focus
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  more and more on and in some ways
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  that means rethinking how we engage with payers
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  around some of our services, our own pricing,
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  what that looks like. In some cases it's
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  really around how do we appropriately manage utilization
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  much like Trellis or Project Horizon are doing
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  that we referenced earlier.
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  And then in some cases it's around killing
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  a lot of the good work that's been
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  ongoing here around appropriate reduction of clinical variation
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  which has the benefit of both really improving
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  quality and safety outcomes as well as reducing
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  the cost of living that care.
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  That makes a lot of sense. And, you
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  know, it really is helpful to understand,
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  that kind of focus. I think looking at
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  the affordability of care, there are so many
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  factors that go into it and how you
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  can really expand access,
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  and access points to the community. So,
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  from your perspective, when you think about health
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  care, when you think about being able to
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  continue to,
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  you know, close some of those gaps or
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  or make sure it's accessible,
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  how are you how does that look, I
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  guess, in in the next couple of years?
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  What are some of the things that you're
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  planning to do, in order to make sure
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  that, you know, health care is still, something
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  that's affordable and accessible for the community?
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  So there are a couple of things. I
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  think one of the one of the most
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  important quality metrics that we probably don't talk
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  enough about in our industry is the total
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  cost of care on a capital basis. I
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  think that's something that we're going to be
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  focusing on increasingly
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  as a metric to hold ourselves accountable
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  to making improvements there. The other thing we've
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  really been doing is having a lot of
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  conversations but also doing a lot of listening
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  with those purchasing care whether that's at the
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  federal level whether that's at the state level
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  and certainly with the employers, brokers
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  and in our community and trying to understand
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  their frustrations, their needs, their concerns, their worries
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  and really trying to
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  take that feedback and put that back into
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  the healthcare system for improvement.
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  And those are things that we'll have to
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  continue to focus on. Clearly drug costs are
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  going to be a big area of focus
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  and so I think we're going to continue
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  to work with our own pharmacy team, specialty
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  pharmacy team, to think about how we can
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  manage that.
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  Certainly not just for
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  all of the employers in the community but
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  also for our own care team. You know
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  we're a large employer and we have you
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  know we're seeing the increase in drug costs
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  and impact us as well and so that's
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  something that we're going to have to figure
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  out. And then of course we're going to
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  have to think about some of the other
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  externalities
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  that are going to impact us and frankly
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  put additional cost pressure on us. Some of
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  that's going to include
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  both the cost risks and opportunities that exist
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  with artificial intelligence as well as continued development
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  of precision medicine genomics and biomarkers
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  that are gonna really impact how we think
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  about delinquent care.
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  That's helpful for understanding
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  to understand, and I I really appreciate you
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  digging deeper into some of those things that,
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  will have more of a focus in this
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  year, especially when you're looking at some of
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  the different challenges, whether it's,
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  access to care, financials, and more. So,
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  that's really interesting to to hear.
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  What do you think the hardest thing you'll
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  have to do next year will be?
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  I think just helping our care team with
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  change. I think we recognize that we can't
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  keep doing things the way we've done them
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  and expect that we're gonna we're gonna solve
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  these challenges. And you know we've got an
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  amazing care team cares deeply
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  about their patients, their communities, and each other.
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  And they've already been through a lot of
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  change. We've been through a lot of changes.
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  We've continued to think differently about the health
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  care system moving forward. You know one of
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  the another example of how we're going to
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  have to think about things differently side of
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  service
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  and making sure that we're delivering things in
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  the lowest acuity
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  setting that's appropriate.
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  And that changes the way we've done things
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  historically as a system And so that's a
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  lot for our care team to continue to
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  try to navigate
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  but the reality is we don't have the
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  luxury of time we have to move quickly
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  and so I think one of the things
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  that keeps me up at night is just
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  really trying to help everyone
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  through the amount of change that we've necessarily
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  had to inflict on our organization.
• 12:36
  Absolutely. I think that it is such a
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  critical point and, you know, it can mean
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  the difference between,
• 12:41
  doing it right and being able to weather
• 12:43
  some of these storms or or having, you
• 12:44
  know, additional storms, internally as well. So,
• 12:48
  that makes a lot of sense. And,
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  I think when you look at that culture
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  being able to build teams that are adaptable
• 12:55
  to change, is there any overarching messaging that
• 12:57
  you share with them or prepare your leadership
• 13:00
  team for so that they can,
• 13:02
  you know, have that kind of team and
• 13:04
  mindset in place?
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  I think it's a couple things. So I
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  think first and foremost, really continuing to try
• 13:09
  to get the why behind the change. I
• 13:10
  don't think any of us want to be
• 13:12
  change for change's sake, it's too hard,
• 13:14
  and not really beneficial.
• 13:16
  So if we're if we are changing somebody
• 13:17
  has to be a good reason why. And
• 13:19
  so really making sure that we understand that
• 13:21
  why. I think really
• 13:23
  we've got opportunities to do a better job
• 13:24
  of equipping our leaders with that and that's
• 13:26
  something that we're going to continue to be
• 13:28
  focused on here in the short term. And
• 13:30
  then I think sometimes
• 13:32
  even in the midst of all the change
• 13:33
  redirecting people back to the things that really
• 13:36
  don't change and I go back to the
• 13:38
  five pack to focus on engagement, body safety,
• 13:41
  patient experience,
• 13:42
  access, and financial health.
• 13:45
  Those things never change. And so how do
• 13:47
  we continue to find those opportunities, focus on
• 13:49
  those things that will benefit us without having
• 13:52
  to do something
• 13:53
  dramatically different
• 13:55
  is also helpful.
• 13:58
  That makes sense. Thank you so much for
• 13:59
  digging a bit deeper there. Now before we
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  wrap up, I wanted to make sure we
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  talked about growth as well. Where do you
• 14:04
  see some of the best opportunities for organizational
• 14:06
  growth in the next year?
• 14:08
  Yeah. It's kinda interesting. So, we don't want
• 14:11
  to ignore growth by any stretch of the
• 14:14
  imagination. At the same time,
• 14:16
  we really kind of want to start focusing
• 14:18
  on making sure we're being authentic to our
• 14:20
  mission
• 14:21
  and not necessarily chasing the top line for
• 14:23
  chasing the top line's sake. And I think
• 14:26
  that if you do that in a way
• 14:28
  that's not necessarily careful it puts a lot
• 14:29
  of stress on the health system and the
• 14:31
  care team.
• 14:32
  So we want to be really thoughtful about
• 14:34
  that. And at the same time we've got
• 14:36
  to get really thoughtful about how are we
• 14:38
  managing and thinking about the the capital cost
• 14:40
  of care for our community.
• 14:41
  Sometimes those two things are at odds. What
• 14:44
  we realize in our current environment
• 14:46
  is Maine is the oldest state in the
• 14:48
  nation on a relative basis and we've just
• 14:50
  got insatiable demand for our services at the
• 14:52
  moment. It really outstrips our capacity.
• 14:55
  Some of that is just an aging population.
• 14:57
  Some of it's a little bit of growth
• 14:58
  in the state of Maine and some of
• 14:59
  it is that our other health system partners
• 15:02
  in the state have struggled a bit and
• 15:04
  have had to reduce some services.
• 15:06
  And so we're feeling the breadth of that
• 15:08
  particularly
• 15:09
  in Portland although we're feeling it off throughout
• 15:11
  our system.
• 15:12
  And so we've seen really close to you
• 15:15
  know near double digit growth in terms of
• 15:18
  volume over the last couple years and that's
• 15:19
  going to continue again this year we believe.
• 15:22
  That's not going to continuously be sustainable and
• 15:24
  so that's why we think we're in a
• 15:26
  really unique position to really be able to
• 15:28
  focus on avoiding unnecessary utilization
• 15:32
  and reducing duplicative care and so that's going
• 15:34
  to continue to be a big area of
• 15:35
  focus for us as well.
• 15:38
  Fascinating. Andy, thank you so much for joining
• 15:40
  us on the podcast today. This has been
• 15:42
  such a fantastic discussion. I have learned so
• 15:45
  much and, you know, appreciate your time here
• 15:46
  today, and I'm looking forward to seeing you
• 15:48
  as well in person at our annual meeting
• 15:50
  coming up in April. I know you'll be
• 15:51
  speaking on a panel, and, you know, it'd
• 15:54
  be great to catch up a bit and
• 15:55
  and learn a little bit more as well
• 15:57
  about how things are going and where you
• 15:59
  see health care really changing and making the
• 16:00
  biggest impact in the future.
• 16:03
  You bet. Looking forward to it. We'll see
• 16:04
  you then.