Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. Gian Varbaro, Chief Medical Officer and VP of Ambulatory Services at Bergen New Bridge Medical Center

Transcript

Dr. Gian Varbaro, Chief Medical Officer and VP of Ambulatory Services at Bergen New Bridge Medical Center · Becker’s Healthcare - Clinical Leadership Podcast

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  This is the Becker's Healthcare Podcast,
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  Thanks for listening. Now here's the episode.
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  This is Laura Dearer with the Becker's Healthcare Podcast.
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  I'm thrilled today to be joined by Dr. John Bar,
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  who's the Chief Medical Officer in Vice President of Ambulatory Services at
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  Bergen New Bridge Medical Center. Dr. Barbara,
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  it's a pleasure to have you on the podcast today.
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  It's a pleasure to be here, Laura. Thanks for having me.
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  Now, I know we've got a lot to talk about.
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  There's so much happening in healthcare and really some exciting things that
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  you're doing in, um, new Bridge. But before we dive into my questions,
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  can you tell us a little bit more about yourself and your background?
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  Sure. So, uh, you mentioned I'm a doctor. I'm an internal medicine physician.
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  I've been practicing, uh, for over 20 years now. Um,
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  I spent most of my career as a hospitalist, but I al but in recent years,
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  I've also, uh, started doing more primary care. Um,
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  I've been a chief medical officer for over eight years now.
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  The last almost six years of them I've been at Bergen New Bridge Medical Center
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  in Paramus, New Jersey. And about a year ago I took on also the, uh,
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  the duties of the vice president of ambulatory services.
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  Absolutely. And, you know,
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  I know that it's becoming an increasingly important aspect of the healthcare
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  strategy, is that ambulatory side of things. Mm-Hmm.
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  and what's going outpatient.
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  And so to become the vice president of ambulatory services, what does that mean?
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  How are you thinking about that and, um,
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  developing the strategy on where ambulatory is headed?
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  So, I mean, I think that ambulatory services is where healthcare is going.
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  I think it's the future of it. So, uh, when, when the opportunity presented, I,
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  I, I actually really wanted it. Um, but, um, I, that's,
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  I think that ambulatory, if,
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  if you really look at what's happening in healthcare in general,
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  and I listen to the podcast, so I hear all the news briefs all the time too. Uh,
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  you know, you,
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  you see all these things where people are going into ambulatory services. Right.
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  And it's been a trend over the last, even before I started, I,
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  I give a lecture to medical students sometimes where I show a picture of my
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  grandmother, my mother, and me. And I talk about how in 1980,
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  my grandmother had a gallbladder surgery and she stayed in the hospital for two
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  weeks in 89. My mom had one, and she stayed in the hospital for three days.
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  And in 91, I had my gallbladder taken United State for six hours.
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  And that's because as healthcare has evolved,
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  we've learned more what has to be in the hospital and what has to be outside of
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  it. And sicker patients are in the hospital.
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  But it means we do more and more stuff ambulatory wise.
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  And if you look at what's happening, you see Amazon and, and, uh, you know,
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  and CVS and all these companies are buying things like one Medical on Oak
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  Street. And there was news the other day that Walmart's trying to buy Chen Med.
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  They're all going into the ambulatory space because that's where the future is.
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  That's what's going to be driving healthcare in the future. Um,
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  it's not just good, uh, ambulatory care,
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  but it's good comprehensive integrated care. And that's really what,
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  where we need to go. I think that's the future of healthcare.
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  And in a hospital like Bergen Newbridge, which is a, uh, public hospital,
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  it's really imperative for us to kind of be ahead of the curve because we're
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  always kind of, you know, fighting to stay ahead or, or, or to keep open.
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  'cause we're a safety net. We take on, you know, the, the patients who,
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  who are the, the most vulnerable.
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  So that means we also have to protect ourselves from being vulnerable.
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  So we kind of have to be ahead of stuff. So it,
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  it's actually very exciting to be able to think of what healthcare's going to
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  look like in the future and how we can move it forward.
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  I love that. I think it's so important, as you said,
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  to just really have that mindset and idea and be forward thinking about how
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  healthcare is, um, being delivered, where it's headed and, and what really, um,
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  is going to be impactful for the community. And, you know, given that,
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  given that you're a public hospital safety net and just such an important
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  resource, what are some of your top priorities right now?
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  What do you really see yourself spending most of your time on and,
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  and energy in?
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  So I do think it's, it's related to both the, uh, ambulatory site and,
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  and digital health in general. Um, you know,
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  we actually did pretty well last year in 2022 from a financial
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  standpoint. And, you know, but like everybody else, we got hit with, you know,
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  the increased labor costs and everything else this year. So we're, we're okay.
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  We're doing fine financially. Um, you know,
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  compared to other hospitals in the state, we're doing very well. Um, but for us,
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  I think what we're really focusing on, or, or what I,
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  what I see coming is the need to again,
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  just build out that ambulatory side and, and quite frankly,
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  to integrate the service and make 'em easier for patients to use,
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  I think is really the key point. So I'll give you an example. Um,
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  we already did, you know, we already did this on,
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  in a couple of service lines for, for years, decades,
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  I've been going to healthcare conferences and everybody talks about integrative
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  care and population health. Now,
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  the most recent buzzword is AI and that kind of stuff,
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  but I don't know that everybody really does it. You know, they say it,
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  but it's kind of a name only. People do things that are kind of, uh, you know,
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  they check the box, but I don't know that it has depth or meaning to it.
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  But on our, in our addiction medicine service,
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  we actually created a real integrated health system for our patients. So,
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  you know, we deliver every level of can. Obviously,
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  addiction medicine is a huge problem in the country right now,
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  and particularly for Safety Net Hospital. Um,
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  but we provide every level of care we, what we do.
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  I would put up against any hospital in the country,
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  even the big academic centers. You know,
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  a patient can come to us and we follow up with them through telemedicine
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  afterwards. We give them bridge clinics, we get 'em into the most cutting edge,
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  uh, medication assisted treatment. We provide social, uh, support for them.
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  We have every level of inpatient care, long-term care, psychiatric care.
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  We provide all the medical services fully because we're a full medical surgical,
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  uh, facility as well. So we can really take care of the entire patient.
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  And we use, uh,
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  primary care providers as the frontline to that who can provide most of
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  those services. So you don't have, you know,
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  medicines become more and more specialized,
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  which is good because we have more and more medical knowledge,
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  but it also is harder and harder for patients to navigate.
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  So we employ navigators and they help the patients out,
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  and patients can call in and we help them through the system,
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  and we get 'em on with a, a primary care provider, usually initially,
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  who can do a lot of the stuff because a good primary care doctor, and I,
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  you know, when I was trained in, in medicine, um,
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  it was kind of a point of pride that, you know,
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  you could handle most of the problems, you know,
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  and you only sent to a specialist when it was really complicated. And,
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  and we've gone away from that a little bit over the years,
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  but I think it's coming back.
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  So really focusing on getting that system set up so that it's easy for patients.
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  We can handle most of the stuff up front,
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  and then get 'em quickly into the specializations that they need or the other
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  services that they need. Um, you know,
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  the other place we've done this is already is in our lgbtq
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  plus health program. Again, I hear everybody talking about DEI,
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  and then I ask them what they're doing, and it's just like a, a statement,
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  you know, a non-discriminatory statement.
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  We have an actual LGBTQ plus program here that is comprehensive.
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  Um,
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  it's run by two phenomenal people who are both members of the community,
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  but it's, it's very patient facing. It's not just, you know,
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  the check boxes of hormone therapy or, or sexual health. We,
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  we do all of those things,
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  but it's pretty much any issue that a patient can have that might be specific to
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  them. And we can guide patients through the whole system,
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  and they have their own phone line they can call into,
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  they can reach a provider.
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  There's a primary care provider who provides their services every day.
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  And then we offer those services to other patients outside of L-G-B-T-Q
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  patients. But we've particularly made it an inclusive, uh, patient, uh, uh,
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  an inclusive system to provide access, because again, we're a safety net.
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  That means access is one of our pillars of, of, of who we are.
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  But access does not just mean access when there's a, a difficulty in paying,
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  it means access for patients who have difficulty getting access to health
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  appropriate healthcare for all kinds of reasons. So that includes,
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  I mentioned addictions and mentions any, uh, DEI related or,
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  or any discriminatory reasons. It includes psychiatric care. We do all of it.
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  And I think that's, that's where I'm focused,
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  is trying to see how we can take what we've done in those niche areas and expand
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  it to everything. I'm sorry that was a long answer, but.
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  No, that was fantastic. And you know,
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  it's so impressive to hear some of the different things that you're doing there
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  both in addiction medicine as well as the LGBTQ plus, um,
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  programming that you have. Because, you know, as you were saying,
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  you can really, um, stand up the bare minimum in,
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  in service patients in the community, but to be able to go above and beyond and,
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  and really, um, have the different services, the navigators,
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  the those who are gonna make it easy for patients to access care, um, and, and,
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  um, improve their health and, and really get the services that they need,
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  like that's next level, um, type of situation and,
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  and really something that I think a lot of organizations strive for, um, today.
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  So it's great to hear that you're doing that,
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  and thank you so much for describing the processes that you've gone through in
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  order to get there, because I know it's not easy.
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  No, it wasn't. And you know, I, I have to say I'm lucky.
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  I had ACEO who let me do whatever crazy thing I had to came to mind. You know,
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  um, I've worked in the big academic centers over the years and, and uh,
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  one of the things is that, you know, I think in the big centers,
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  you know, we got very comfortable in healthcare because things were easy.
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  We could kind of continue doing the same stuff, um, over and over again.
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  It was successful and there was no reason not to, not to change it.
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  But I think that, you know, and there's,
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  I think one of the other times I was on,
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  we talked about that change has been constant my whole career.
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  I've constantly been hearing about health, healthcare is changing, but I,
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  I think that now it's particularly accelerated and I think that everybody's
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  feeling the stress. And oddly us, you know,
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  us at the safety nets in the smaller places,
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  we've had to kind of move and change more quickly because we had to,
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  to keep our heads above water. So oddly, we're in some ways better positioned,
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  uh, than some of the big places who have a lot to lose by changing what they're
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  doing. Whereas I don't, you know,
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  I can kind of experiment and it's been a real, uh,
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  pleasure to be able to build these programs.
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  But I think actually it's kind of interesting, you know,
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  typically everybody's a copycat in healthcare. You know,
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  somebody does something successful and everybody copies,
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  and that usually comes from the big places. But I think, you know,
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  the big places that could probably look to us or,
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  or to other places like us who found success, um,
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  doing things because we've had to, to stay alive and the,
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  the environment we were already in this environment for a long time.
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  Yeah, absolutely.
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  I know it comes out of necessity a lot of times that innovation and,
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  and really nimbleness to be able to change and evolve. And, you know,
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  speaking of that, when you're looking into the next two to three years or so,
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  mm-hmm, , what do you see as, um,
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  the organizational changes coming up? You know, I,
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  I know there's a lot of different factors out there driving change within the
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  healthcare space, and especially given, you know, your unique role,
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  I guess within the community.
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  What do you see as being most impactful in the way that, um,
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  the hospital is evolving.
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  Uh,
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  in addition to this kind of integrative care and the ambulatory side I've been
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  talking about? I think it really, um, I think it really,
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  I think that digital health is a huge part of it. 'cause again,
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  that comes back to access for patients. And again,
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  making it easier for patients to use us. Um, you know,
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  we can provide the best services and, and the big systems,
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  but we have to make it easy for patients to do it. You know,
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  we do everything to make it difficult. So, you know,
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  one of the things the pandemic taught us was that telemedicine worked very well
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  for certain things, not for everything, but for certain things.
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  And that there's opportunities to do things even more innovative there to make
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  things easier for patients or make it easy for them to get information or get in
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  touch with their providers. Um,
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  and so really building out that infrastructure,
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  I think is probably our number one priority, at least from my standpoint. Um,
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  because I, I think that that's going to be the next driver. And again,
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  if you look at the people who've been successful on that ambulatory side,
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  the Chen meds and the Oak Streets and those places that everybody's buying up
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  now, what they've done is this really hands-on approach with patients. You know,
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  they've made it easy for the patients to come to them.
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  They give them very frequent visits. They see them. They,
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  they provide a strong primary care base. They've done all that,
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  and that's how they've been successful. Um, and in a big system,
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  I have even more resources than they do, even as a safety net, but I can,
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  but I need to make it so that the patients can get to them.
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  And I think digital health is a huge part of that because, you know,
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  especially me as it is safety net,
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  I have a patient who needs to come in and see, you know,
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  six different specialists. They have to take off from work,
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  and those patients can't take off from work.
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  And that's not just true of my safety net.
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  And that's true of patients in general. It's very difficult.
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  But if I can make it that they can go on a break and go on 15 minutes on their,
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  their smartphone and everybody has a smartphone and see the provider and get 90%
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  of what they need done,
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  then I'm gonna provide better healthcare for the patients.
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  And I can see them more frequently in shorter visits,
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  which has a much better impact on the patient, right?
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  We've traditionally in healthcare, done this thing where we see patients every,
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  you know, three months, six months every year,
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  and they come in with a laundry list and we give 'em 12 things to do. Uh,
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  and who's going to do that? Like, we make it so hard for the patients to,
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  to actually take care of themselves. You know, we're,
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  and sometimes then we blame the patients and it's not their fault.
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  We make it hard for them, and we really, I think, need to make it easier.
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  And so by splitting things up and doing the smaller visits,
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  but allowing them to do it where they are so they don't have to rearrange their
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  schedule, I think is really important.
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  And I think that's what we're going to be focusing on. You know, maybe,
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  maybe other people will focus on other things, but that's kind of where,
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  where our headspace is here.
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  That makes a lot of sense. And, you know,
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  definitely is awesome to see how you're piloting some of these things with
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  digital health and, and definitely, um, you know,
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  jumping in and figuring out what works for your patients in your community.
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  And I love the idea of having the more frequent visits, but shorter visits too,
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  um, from just kind of purely the perspective of operationally. And then, um,
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  you know, I know sometimes it can become a challenge, um,
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  when dealing with payers and all those kinds of things to try to figure out
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  mm-hmm, how to make these transitions. Um,
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  how have you been able to do it effectively?
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  Is it just having that patient first in mind and we'll figure everything else
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  out later? Or, you know, what do you do to, um, kind of get the, the, um,
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  make sure that that business and operations side of this makes sense? Um,
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  as you're making these transitions?
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  It's such a phenomenal question, right? I'm, I'm a physician, so, you know, my,
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  my initial instinct is what you said,
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  I'll do the good care first and everything else will come later,
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  but that's naive. Uh,
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  I also have an MBA and I did that intentionally when I was moving up through the
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  ladder because I, you know, I, I was talking doctor to everybody and,
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  and you kind of had to see the other sides to it.
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  So we do make sure that we have the, the business, um,
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  site set up in the building systems before we launch any of these things.
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  You know, obviously there's things you need pre-authorizations for.
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  There's thing, you know, with telemedicine, you do have to follow the rules,
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  otherwise you won't get paid for them. Um, so, you know, we,
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  we make sure that we have everything structured first. So, you know,
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  that's why we didn't just blow out and,
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  and introduce every system all at once because we're very carefully building
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  each part as we add it on. So in the addiction medicine program,
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  we built all of the building codes,
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  we built all the documentation correctly so that we know that when we're doing
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  something that's appropriate, we'll get paid appropriately for it.
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  And we've already checked with the payers so that we're, we're set up for it.
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  And for the payers, it's a boon, right? I mean, the payers, you know,
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  longer term would rather pay. You know, I,
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  I always say this is like, again, I think what some of, uh,
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  some of the bigger systems have a are gonna have a problem with is, you know,
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  as a payer, I'd rather spend, you know,
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  $10,000 in ambulatory visits than $80,000 on an inpatient visit.
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  I'm obviously exaggerating numbers, but you get my, my drift. Um, you know,
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  obviously there's less inpatient visits when, you know, per patient,
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  but it's still, it adds up your preventing a lot of stuff.
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  So for them it's a boon. So if we make it again, easy for them,
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  and we make sure we're following everything regulatory wise, you know, it,
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  it behooves them to, to, to pay for that. Um,
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  and they understand that they're not stupid. Um, so it, it really though,
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  we, we always first make sure we have everything built because we,
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  we learn the hard way. And we've had, uh, you know, we've,
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  some of my colleagues have kind of rushed head into some of these things and
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  not, then we haven't gotten paid for things. Um, and I think, you know, we,
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  we have a, a mantra of like, we wanna provide the highest level of care,
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  but we also wanna be financially stable because if we are bleeding
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  money, we do, and we're not able to keep our doors open, we do nobody any good.
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  So we have to really make sure that that's all in place before we start.
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  That's such a great point. And definitely, you know, to have that business case,
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  um, in mind and, and said, and, and all, uh, everything, um, in the background,
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  you know, I guess all worked out before you jump into some of these things,
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  I can imagine is really helpful. And having that business background, you know,
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  definitely seems like it's been helpful in your end.
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  Uh, hopefully , hopefully. So I, I, you know,
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  I think that the people I train with at think so.
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  Yeah. Yeah, for sure. Um, well, before we wrap up our conversation,
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  I was wondering if you could talk through what is one change you or your team
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  has made in the last year that yielded great results?
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  I know we've touched on many different things already, but, um,
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  we just love your thoughts.
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  If there's any other examples you'd like to share with us.
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  I mean, I mentioned the two biggest ones, which are the,
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  the Addiction Medicine and the L-G-B-T-Q program and the,
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  and we're working on the expansion of our navigation and our digital health.
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  The other one is, um,
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  I mentioned earlier I took over as the vice president of ambulatory services
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  about a year ago.
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  And there was just a lot of operational opportunity on that side where we were
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  really inefficient in a lot of ways in how we were deploying our providers
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  and how we were registering and getting patients in and out of rooms.
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  And this is really basic stuff,
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  but it has such a high impact on what you're able to do. Uh, you know,
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  you know, because we were always short staffed on stuff,
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  we were having our providers do a lot of things that, that somebody, you know,
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  at a lower level of training could do. And that, you know,
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  sometimes you're pennywise and pound foolish, like, you know,
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  you're short staffed, you know, somebody thinks, oh, we're short staffed,
• 18:23
  so we're keeping our cost down,
• 18:24
  but you're also cutting your productivity way more.
• 18:27
  So by actually investing intelligently, you know,
• 18:30
  you don't just throw money at things, but investing intelligently,
• 18:33
  we've been able to really ramp up our volume, um,
• 18:36
  on the ambulatory side and our, actually on our surgical side too,
• 18:39
  because things flow down from that and procedures. So, you know,
• 18:42
  we've been able to make money in the traditional ways too, and again,
• 18:46
  provide better care for the patient. That's ultimately the,
• 18:48
  the big goal for all of this. You know, the,
• 18:50
  the finances allow us to provide better care for the patients,
• 18:54
  and that's ultimately the goal. Uh, that's why I,
• 18:57
  I think most people in healthcare are in it. So by improving our,
• 19:02
  our efficiencies and our operations on that side,
• 19:05
  I think we've seen a real huge impact.
• 19:07
  We've also done a lot on our behavioral health side.
• 19:11
  We've launched a whole bunch of innovative programs there as well. Um, you know,
• 19:15
  there was a huge need post pandemic for mental health services for children,
• 19:20
  and we had some, but we, we expand and created this, uh,
• 19:23
  intensive outpatient program for children, which has been a huge success.
• 19:26
  And again, we have a phenomenal physician running it. Um,
• 19:29
  and that's a big part of the success, you know,
• 19:31
  is when you recruit the right people, it, it, it has a big impact. Um, but it's,
• 19:36
  we've made a big impact in the community and we've provided something that
• 19:39
  everybody really needed, and at the same time, uh,
• 19:43
  done ourselves well on the bottom line by doing it.
• 19:46
  So that's another one that I, I'm really proud of.
• 19:50
  I love that. I, I think it's just so helpful to see and understand, you know,
• 19:54
  you can make these ambulatory strategies work and really, um, you know,
• 19:57
  have on the business side of things, like be more efficient, effective and,
• 20:02
  and still have your operations go. Well. And then, as you said,
• 20:05
  making an impact with more of the behavioral health programming, um,
• 20:08
  more specific programming, especially for children, as you said. I know it's,
• 20:11
  uh, constantly coming out with the numbers and the,
• 20:13
  just the challenges a lot of kids are going through these days.
• 20:15
  And so it's awesome to hear that that's been a priority for you as well, um,
• 20:19
  in really taking care of those who are most needing it.
• 20:22
  Oh, no, absolutely. And, you know, I'm a father of three myself, so, you know,
• 20:26
  I, it's very easy to put yourself in the place of the, of the parents, you know,
• 20:31
  who are struggling or having other issues with their children.
• 20:33
  You just wanna help them. So I, it's really, it's impactful that, uh, I,
• 20:38
  I gotta hold myself together.
• 20:39
  I'm gonna get emotional talking about it because it, it really is, it's,
• 20:42
  it's among the most rewarding things I've,
• 20:44
  I've had an opportunity to do in my career is, you know,
• 20:47
  these programs like this where you really get to change people's lives is,
• 20:50
  is why you do it. And, um, and, and it just really, it's, uh, it's impactful,
• 20:56
  but it's also very satisfying.
• 20:59
  Dr. Berro, thank you so much for joining us on the podcast today.
• 21:02
  We'll definitely have to jump on again and talk more about some of the work
• 21:04
  you're doing with the behavioral health side as well. But, um,
• 21:08
  thank you again for your time today,
• 21:09
  and I look forward to connecting with you again soon.
• 21:12
  Absolutely. Thank you so much for having me.
• 21:17
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• 21:20
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• 21:22
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• 21:36
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