Latest / Becker’s Healthcare - Clinical Leadership Podcast / Robert Calway, President and Chief Executive Officer at New England Life Care

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Robert Calway, President and Chief Executive Officer at New England Life Care · Becker’s Healthcare - Clinical Leadership Podcast

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  - This is the Becker's Healthcare Podcast, created
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  by the team of Becker's Healthcare,
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  Thanks for listening. Now here's the episode.
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  - This is Laura Dedo with the Becker's Healthcare Podcast.
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  I'm thrilled today to be joined by Bob Callway,
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  the president and Chief Executive Officer
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  of New England Life Care.
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  Bob, it's a pleasure to have you on the podcast today.
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  - Thank you, 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 right now in healthcare
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  and certainly just some really fascinating, um,
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  things you're doing there at New England Life Care.
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  But before we dive into my questions,
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  can you tell us a little bit more
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  about yourself and your background?
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  - Yeah, sure. Let me tell you both about me
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  and a little bit about my company,
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  because we're a little bit different than the, uh,
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  than the typical healthcare organization.
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  So, um, as you mentioned, I serve as the president
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  and CEO of New England Life Care.
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  Uh, my background, I was originally trained
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  as a medical laboratory technologist
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  and worked in acute care laboratories for a number
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  of years early in my career.
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  Uh, but most of my background,
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  I hold advanced degrees in healthcare
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  administration and in public health.
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  Uh, and most of my background has been in, uh,
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  large academic medical centers
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  and physician group practices.
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  And most recently
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  before joining New England Life Care, uh, I worked
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  with Atrias Healthcare,
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  which is a very large physician practice here in, uh,
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  eastern Massachusetts.
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  Um, and one of the first participates in the, uh,
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  pioneer Accountable Care organization, uh, which is, uh,
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  where I spent most of my time, uh, working with
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  and developing programs
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  to perform favorably in an accountable care organization.
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  And that's in part what drew me here
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  to New England Life Care and for New England Life Care.
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  Um, as I say, we're a unique organization.
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  Uh, we are organized as a, not-for-Profit
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  Hospital Services Cooperative, um, under Section 5 0 1 E
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  of the IRS tax code.
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  Um, and what that means in practical terms is that, uh,
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  we provide a designated service, in this case it's, uh,
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  home infusion services, uh, to, uh, not-for-profit hospitals
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  that are members of the cooperative.
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  And today there are 70 hospital members, uh,
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  in the cooperative located in Massachusetts, Maine,
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  New Hampshire, and Vermont.
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  Um, and, uh, an interesting feature of the cooperative is
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  that the member hospitals actually
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  own New England Life Care.
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  So we serve, if you will, as the infusion department, uh,
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  for the 70 hospitals that, uh, that we represent.
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  And internally, I maintain 70 profit
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  and loss statements for all of the hospitals
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  that are a member, member of the cooperative.
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  So, uh, very interesting structure, uh,
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  but in providing a really important services
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  to the not-for-profit hospitals located
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  in the region that we serve.
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  - That's amazing to hear,
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  and definitely, you know, a very big responsibility
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  to be serving that community in such a, a large area
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  of diverse population as well.
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  From your perspective, what are some
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  of your top priorities right now?
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  What are you really spending most of your time on?
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  - Yeah, it great question.
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  Um, you know, we, we conducted, um, in the last few weeks,
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  um, our town hall meetings where we bring together all
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  of our staff who are spread all over New England, uh,
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  to update them on what's going on with the business
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  and what are our priorities at the moment.
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  Um, and in that we shared with folks that, um,
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  we had hoped coming out of the pandemic
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  that things would settle down a little bit.
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  Um, but in fact, the opposite is true
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  that the market is changing so quickly both
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  after effects of the pandemic,
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  but just changes in the marketplace
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  that it's really caused us to take a step back
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  and reevaluate our strategic plans, um, over the course
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  of the next couple of years,
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  and in fact, shorten our strategic horizon
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  because the market is changing quickly enough
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  and new threats are emerging fast enough
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  that it's really shortened our, our, um, our visibility.
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  Um, so the things that we're working directly on now are the
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  things that frankly, many
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  of our member hospitals are dealing with today.
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  So first and probably foremost is the shortage
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  of qualified labor, um,
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  to support the healthcare organizations.
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  You know, lots
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  and lots of people left healthcare during the pandemic.
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  The pipeline of replacement staff isn't adequate
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  to support the needs of the marketplace.
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  Uh, and we've got a large, uh, population
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  of healthcare workers who are approaching retirement.
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  So we're innovating strategies around how do we continue
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  to grow the organization in an environment that where,
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  where there will simply not be enough staff
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  to facilitate that growth.
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  And that's taken on a number of different strategies.
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  So that's sort of number one.
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  The second is really a focus on driving
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  interoperability and starting to deploy newer technologies
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  that have come out in the marketplace,
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  and particularly in the last six months or so.
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  Uh, and particularly starting to deploy
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  artificial intelligence and robotic process automation
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  into our workflows, frankly, as a strategy
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  to support the fact that there aren't enough staff available
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  to do the work and grow the organization.
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  So part of our strategy around dealing
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  with staff shortages is working to make sure
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  that we provide the tools that allow our staff to be as
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  efficient as they possibly can
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  and allow taking kind of the mundane work out of the work
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  that they do and allowing them to work at the higher end
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  of their licenses or their capabilities.
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  So that's been a big change as well.
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  Um, but I would also reflect it as both a curse
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  and a blessing because while the drive
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  for interoperability is really critical, both to kind
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  of support the organization
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  and to develop a patient-centric approach in managing care,
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  um, the flip side to that is the rapidly increasing
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  incidents of cyber attacks.
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  Uh, we were a victim of a cyber attack earlier this year,
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  and thankfully we're able to respond to it quickly.
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  Uh, but a lot of time
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  and effort has to go into protecting our information systems
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  and keeping ahead of what is a burgeoning crisis in terms
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  of, uh, the, the ability for, uh, threat actors to be able
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  to invade systems that we use to care for our patients.
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  Um, and then lastly, a big focus for us, particularly
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  as a not-for-profit, um, is operating profitably.
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  So, you know, we've seen both in an inflationary economy,
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  but also as a result of sort
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  of ongoing supply chain disruptions, both in terms of
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  supplies, but also in pharmaceuticals,
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  relatively rapid increases in the prices for, um,
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  for the products that we purchase
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  and that we use in patient care.
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  Uh, and, and candidly, uh,
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  third party payer reimbursement is
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  not keeping pace with that.
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  So this, we find this eroding our margins together
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  with higher labor costs
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  and needing to look at ways to make sure we can continue
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  to generate sufficient margins to support the operations
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  of the business and continue to grow.
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  - Absolutely. I think that's fascinating and,
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  and certainly a lot of the issues that you touched on, um,
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  are top of mind for healthcare executives across the board.
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  Certainly when you're looking at the
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  labor shortages and challenges.
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  Um, love to hear, you know, working on some of the AI RPA
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  and, and other digital transformation aspects
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  that can boost the workforce.
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  And then, um, the supply chain disruptions too,
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  it just seems like, you know,
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  or continue a one-two punch of yeah, really just trying,
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  trying to hospital financials and trying to figure that out.
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  Um, you know, when you look at all those things,
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  obviously bringing technology and can make a big difference,
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  but how do you incorporate that into the broader culture
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  of the organization and making sure people, um, you know,
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  are, are working to the top of their abilities,
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  but then also comfortable with the, um,
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  digital transformation strategy?
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  - Yeah, well, I think it's a great question.
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  Uh, I sort of express that in terms of, um,
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  our strategies
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  or our tactics for dealing with, um, staffing shortages.
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  Um, and we've really got kind of five approaches, one
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  of which speaks directly to the question you're asking.
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  So number one is that we, we recognize that we have
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  to be much more innovative in recruiting
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  for the limited staff that are available in the marketplace.
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  And part of that requires us
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  to make the organization an attractive one
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  for healthcare professionals to want to join, right?
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  So, um, you'll hear threaded through these strategies,
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  the goal of what we refer to as creating allies
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  with our employees, right?
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  Embedding them and engaging them actively, um, in
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  how the business is run.
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  Um, creating an environment where people feel connected
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  to the purpose, where their voices matter
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  and where they feel connected with, uh,
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  where the business is going and how we're gonna get there.
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  Um, that will in fact,
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  I think ultimately also make it an attractive place
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  for people to wanna come to work.
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  Um, that gets to the second piece,
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  which is really focusing on staff retention,
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  keeping the good staff that we have.
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  Um, and that gets back to what I was just talking about
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  around ke keeping people connected, having them feel a sense
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  of purpose and commitment
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  and engagement with the organization, uh,
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  that their voice matters
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  and that, that their folks listening to their points
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  of view on how the business should re run.
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  But there's also a big focus on our part around
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  preserving staff wellness
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  and identifying, reducing the signs of burnout,
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  which we're really endemic during the the covid period.
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  Um, you know, third for us is improving the efficiency
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  and the productivity of the staff we have,
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  and that's where I mentioned starting to apply things like,
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  uh, artificial intelligence and robotic process automation
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  and, and frankly, modern information system.
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  So we'll be going through, uh, an upgrade
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  of our electronic medical record in the next 18 months
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  to provide a more ma modern platform that allows us
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  to better, better digitize our, our systems.
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  Um, and in AI
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  and RPA, we've applied it in a couple of places already.
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  So, um, we were able to, uh,
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  to use robotic process automation
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  to basically digitize order entry coming into our
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  organization, uh, which had an enormous benefit.
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  So historically, our orders came to us generally by fax, um,
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  but were sometimes available through hospital's use
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  of post-acute, uh, discharge software.
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  Um, but all of that was ultimately converted to paper
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  that our staff then end up having
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  to reenter into our electronic medical record.
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  And you can just imagine both the, the labor requirements
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  to do that and the degree of error that comes
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  with anyone trying to transpose information from, you know,
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  a written document into an electronic record.
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  So we actually use robotic process automation
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  to receive those incoming faxes, digitize the results,
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  and load it automatically into our
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  electronic medical record.
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  So we eliminate all of that manual data entry.
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  Uh, we're applying that in some, in a number
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  of areas also within our billing operations.
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  And again, the goal here is trying
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  to identify the mundane parts of the work that all
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  of our staff do, whether professional staff
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  or administrative staff,
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  and remove that use technology to support that.
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  So to your question about staff acceptance of that, um,
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  there, you know, kind of two pieces to this.
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  One is staff view it as incredibly valuable, right?
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  We're looking for small wins here to show
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  how the application
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  of this technology can make their work lives better,
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  because no one wants to have to do all of that mundane work.
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  Uh, staff wanna be using kind of a higher level of judgment
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  and capability in the work that they, uh, that they do.
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  So we're seeing acceptance there from that point of view,
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  um, and two,
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  by actively engaging our staff in utilization of the software.
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  So we were really clear as we went into this,
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  we're not developing this, this software to replace anybody.
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  This, this is not gonna eliminate jobs.
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  Um, what it will do though is turn the trajectory
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  that will require us to have less labor as we continue
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  to grow, um,
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  and it's labor working at, at a higher level
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  of competency and capability.
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  Um, so that's where our AI models come in.
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  And then, you know, we're also looking at
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  alternative staffing models.
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  Uh, you know, given
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  that there aren't enough infusion nurses, for example,
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  to be able to support the healthcare marketplace, starting
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  to look at places where, um, other kinds
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  of staff can do the work that
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  infusion nurses are, are not available to.
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  So for example, here in Massachusetts, we're now using, um,
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  LPNs to do IV line management.
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  It's within their scope of practice.
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  Um, and instead of having to deploy expensive, uh,
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  infusion nurses to do that, so again,
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  it's using the right folks at the right end of their scope
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  of practice and their capabilities.
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  Um, and then lastly, we're really starting to look at
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  how we develop staff, right?
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  And this will include training programs designed
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  to create a clin, a pathway within the organization
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  that allows staff to stay here, develop new skills,
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  and move into increasing levels of, of, um,
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  of capability within the organization.
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  So we are looking at training, for example,
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  our own pharmacy technicians so
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  that they can work in the clean room taking folks without
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  having that experience
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  and actually building the training programs here.
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  So multifaceted in terms of how we're gonna accomplish that,
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  uh, and all rely on one another.
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  But the essence to this, in, in the answer again
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  to your question is you can't be successful in doing this
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  unless you're engaging staff at every level to know
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  what you're trying to accomplish as an organization
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  and them feeling a part
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  and engagement in achieving those goals.
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  - Absolutely. That makes a ton of, of sense,
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  and I, I really love it.
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  Um, love that strategy there.
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  Now, looking into the future,
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  how do you see New England life care
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  evolving over the next few years?
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  What do you see as accelerating and changing over time?
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  - Yeah, that's a great question too.
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  Um, and you know,
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  my answer would've been different if you had asked me that
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  during the, uh, during the pandemic,
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  but one of the things that we saw, um, really prior
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  to the pandemic and,
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  and sort of on steroids, if you will, during the pandemic,
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  was, um, more migration of care out
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  of acute care settings and into the home.
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  And where that really got wheels, if you will,
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  during the pandemic is, you know, one was CMSs, um,
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  expansion of the hospital without laws
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  or the hospital at home programs
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  and providing reimbursement for those programs that, um,
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  you know, that created just a waterfall of organizations now
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  that are implementing their own hospital at home programs,
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  bringing care into the home.
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  Uh, that was sort of one, uh, one op uh, one, uh, feature,
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  uh, of the pandemic.
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  Um, you know, organizations were realizing that a lot
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  of the care that is provided in acute care settings can be
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  provided in the home, and we're simply lacking a
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  reimbursement mechanism for that.
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  Um, and we're also now seeing in large part,
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  to compete favorably in accountable care programs.
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  Uh, more and more programs aimed at trying
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  to avoid patients going into acute care settings
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  or being unnecessarily hospitalized for services
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  that could be provided in the home.
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  And home infusion is a big part of that,
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  because it's not uncommon that patients go
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  to the emergency room to get a line installed
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  to start their antibiotic treatment, for example,
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  and then get admitted for
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  that when in fact those services could be
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  provided equally well and equally safely in the home.
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  So we expect that expansion's gonna continue.
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  Uh, you see it in, in a number of the disruptors that are,
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  that are moving into the marketplace.
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  You look at places like Amazon and Optum
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  and uh, so forth
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  that are really focused on both the pre acute
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  and the post-acute settings, recognizing
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  that more care is gonna be happening in the home.
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  So for us, that means both a, a a, you know,
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  significant growth in the services that we provide, uh,
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  but it also means that, uh, we've gotta think about
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  how we do di things differently, right?
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  Because, for example, providing home infusion
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  for a hospital home patient, uh, is the same as we've done
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  for many years for a, you know, a patient
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  that has been discharged from an acute care setting.
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  The difference here is the turnaround time.
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  These are hospitalized patients,
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  so you've gotta build your operation that allows you
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  to prepare compounded medication
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  and infusion supplies in a requi
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  relatively quick turnaround.
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  So that's a big change for our organization is trying
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  to keep up with that, uh, with that pace of change.
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  Um, I think the other thing we expect to see is that, again,
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  the, the, um, pandemic taught us that many more therapies
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  that we always assumed could only be
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  provided in acute care settings, um,
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  can in fact now be done in home, in the home.
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  So, you know, you're seeing in the marketplace, for example,
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  more movement of, um, cancer treatment
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  for patients in the home, including some types
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  of chemotherapy now
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  provided in the home, um, that's supplemented by another,
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  um, uh, service that emerged during the pandemic,
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  which is the application of telemedicine
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  and patient telemonitoring.
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  Uh, right. And that emerged very quickly out of necessity
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  during the pandemic, but that's gonna survive now,
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  that will sort of be the platform that allows us
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  to provide more services
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  to the patient in the home environment.
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  So, big impact for us, as we're, I mentioned at the outset,
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  that the market is changing really quickly for us,
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  and it's those areas where we're really starting
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  to see the pace of change, um, just moving very,
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  very quickly and many competitors,
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  mo including not-for-profit competitors, um,
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  and big tech moving into this area to try
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  to capture a piece of the pie.
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  - Absolutely. That's such a great point.
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  And, you know, so interesting to think about how that pace
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  of change has really made a difference, um, you know,
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  over the past couple years.
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  And certainly one of the things you mentioned at the top
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  of our conversation too, is there being new threats as,
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  as part of the reason why you're needing to, um, shorten
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  that strategic horizon
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  and looking at, you know, um, what's happening there.
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  And so I was wondering, you know, is
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  that typically looking at some
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  of these non-traditional healthcare entrants or,
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  or what other threats do you really see as arising now that,
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  you know, may not have been there
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  or part of that strategic process before the pandemic?
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  - Yeah, it's a great question,
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  and you're right that, you know, all of this environment,
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  um, has really shortened our strategic horizon
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  where we typically would've looked out two
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  to three years in our strategic planning.
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  You know, it's, right now it's impossible
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  to look at the market and determine where it's gonna be
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  and what the threats will be three years from now, uh,
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  which has kind of shortened that up.
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  Um, but the, you know, we, we see as the principle threats,
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  the, so I mentioned, um, really a rapid invasion, um,
• 20:12
  into the, particularly the post-acute in the home
• 20:15
  marketplace, um, uh, again, by very large organizations.
• 20:20
  So, you know, you're seeing entrants around things like,
• 20:23
  you know, Amazon, Google, uh, Optum, um, most recently,
• 20:28
  um, you may have seen that Costco has announced
• 20:30
  that they're entering the primary care market
• 20:32
  and they're gonna be offering telemedicine and,
• 20:35
  and pri uh, uh, primary care services through their,
• 20:39
  uh, big box stores.
• 20:41
  Um, that's a momentum that's underway.
• 20:44
  And, um, the, the, the reality is that part of this is
• 20:49
  recognizing the patient centricity to care
• 20:53
  that these are organizations that are very much focused on
• 20:57
  what do patients want.
• 20:59
  And, you know, the marketplace is changing quickly, right?
• 21:01
  We're now seeing, um, the majority
• 21:04
  of the population in the United States at least,
• 21:07
  or Gen Xers, gen Ys, and they have very different, uh, needs
• 21:10
  and wants, uh, in the healthcare marketplace.
• 21:14
  They want immediate access, they want immediate contact,
• 21:16
  they don't wanna wait in line,
• 21:17
  and they don't wanna wait six months to get services.
• 21:20
  Um, and if you can't provide them as an organization,
• 21:23
  they're gonna go somewhere else.
• 21:25
  Um, so a lot of folks entering the market to try to be able
• 21:28
  to build on that desire
• 21:30
  that you're seeing coming from the, uh, population.
• 21:33
  Um, so we're looking at that both in terms of
• 21:36
  how do we deploy, how do we deploy technology to, to try
• 21:39
  to mimic that and meet that demand in our, in our members,
• 21:43
  but it's also gonna require some association
• 21:46
  with these organizations to really start
• 21:49
  to build partnerships to figure out how to do that,
• 21:52
  uh, collectively.
• 21:54
  Because, you know, if you're not doing it as part
• 21:55
  of a partnership, you're going to lose that part of your,
• 21:59
  uh, your care healthcare spectrum.
• 22:04
  - Absolutely. I, I love that.
• 22:05
  And, you know, really sets a, a really strong kind of, uh,
• 22:08
  vision in motion for how you're able to tackle some
• 22:11
  of these big challenges and leverage partnerships
• 22:13
  and connections creatively, um, within the industry to,
• 22:16
  to really deliver care and make sure people
• 22:18
  have access to care too.
• 22:20
  Um, I love that.
• 22:21
  Before we wrap up our conversation,
• 22:23
  I'm wondering if you could talk through what is something
• 22:25
  that you or your teams have done differently
• 22:27
  that has really made some great results?
• 22:30
  - Yeah. Um, well, I mentioned one already, um, which was,
• 22:35
  um, our first effort in applying, um,
• 22:38
  robotic process automation to improve the efficiency
• 22:42
  and the timeliness of order entry and processing.
• 22:46
  Uh, that was a huge success for us.
• 22:49
  So, um, we allocate, you know, roughly four to five
• 22:54
  FTEs a day within our organization, uh, simply, uh,
• 22:58
  taking orders and entering them into our electronic medical
• 23:01
  record and an untold number of errors that come
• 23:05
  with just anybody entering information
• 23:07
  or transposing information.
• 23:09
  Uh, so the application of RPA,
• 23:12
  there was an enormous success for us, right?
• 23:14
  It really took a huge demand off of the staff that manage
• 23:18
  that and dramatically reduce the, the number of errors
• 23:22
  that we see with the input of
• 23:24
  what is frankly, critical data, right?
• 23:25
  No one wants to put a, a, um, an order in incorrectly
• 23:30
  'cause that can result in direct patient harm.
• 23:32
  So that was a big success both in terms
• 23:34
  of improving the efficiency and productivity of our staff.
• 23:38
  Uh, this was by the way, a staff driven initiative.
• 23:41
  So the suggestion came from one of our staff to look at this
• 23:45
  as a, as a model.
• 23:46
  So, um, it accomplished our goals
• 23:49
  around engaging our staff in, in moving this forward,
• 23:52
  but it also accomplished the goal of ensuring
• 23:55
  that we keep our patients safe
• 23:57
  and provide good, effective safe care for them.
• 24:00
  So that was certainly one area.
• 24:02
  Uh, the other, uh, um, option I would,
• 24:05
  or the other, uh, project that we're working on that not
• 24:09
  yet complete, but I have very high hopes for, um, is
• 24:13
  where in the latter stages of a trial using
• 24:17
  artificial intelligence and natural language processing
• 24:21
  as the front end for patients calling into our organization.
• 24:25
  Um, specifically one type of patient where,
• 24:28
  which is on a therapy called TPN,
• 24:30
  it's a nutritional, uh, therapy.
• 24:33
  Uh, and often this requires a lot of management
• 24:36
  with these patients, uh, to make sure
• 24:38
  that they are not getting readmitted back to the hospital.
• 24:42
  So we're using a front end ai, um, uh,
• 24:46
  avatar if you will, to receive incoming patient calls,
• 24:50
  answer the standard questions that are roughly 80% of the,
• 24:54
  of the, um, calls that come in,
• 24:56
  and then triage those calls that can't be answered over
• 25:00
  to a registered nurse who
• 25:03
  before was answering all of these calls.
• 25:05
  Uh, so, uh, we've had some really interesting
• 25:09
  and really good acceptance by patients in the trials, um,
• 25:12
  to using this model.
• 25:14
  And, um, if it's successful here, we expect to deploy
• 25:18
  that in a number of different areas
• 25:20
  where our organization comes into contact with patients
• 25:23
  around the patient service interface.
• 25:27
  Uh, and that has promise for, uh, enormous cost savings,
• 25:31
  uh, and value.
• 25:32
  Because, you know, one of the values
• 25:34
  of AI here is it's learning, right?
• 25:37
  The more data I'm giving it, the more it's learning how
• 25:40
  to respond to even the unique questions that,
• 25:43
  uh, patients have.
• 25:44
  So it's a really exciting time, um,
• 25:47
  to be rolling things out like that.
• 25:49
  And we have very high hopes
• 25:50
  that this is gonna be a big win for us.
• 25:55
  - Absolutely. That sounds amazing.
• 25:56
  And, and those results really speak for themselves.
• 25:59
  Bob, thank you so much for joining us on the podcast today.
• 26:01
  This has been such a fun and interesting conversation,
• 26:03
  and I look forward to connecting with you again soon.
• 26:05
  - It's my pleasure. Again, thank you for having me.
• 26:09
  - It's so important for leaders at the top of organizations
• 26:12
  to keep learning, stay sharp, grow their networks,
• 26:15
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• 26:20
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• 26:34
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