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

Transcript

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

• 0:00
  - Prepare to dive into the forefront
• 0:02
  of healthcare innovation at our 14th annual meeting coming
• 0:05
  up on April 8th
• 0:06
  through 11th at the Hyatt Regency in Chicago, with thousands
• 0:10
  of industry leaders converging over four dynamic days
• 0:13
  of discussions on crucial topics from health IT
• 0:17
  to executive leadership.
• 0:18
  It's where the future of healthcare takes shape.
• 0:21
  We can't wait to connect with you in person
• 0:24
  and engage in these important conversations.
• 0:27
  - This is Laura Dedo with the Becker's Healthcare Podcast.
• 0:30
  I'm thrilled today to be joined by Dr.
• 0:32
  John Barro, chief Medical Officer
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  and vice President of Ambulatory Services at
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  Bergen New Bridge Medical Center.
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  Dr, it's a pleasure to have you on the podcast today.
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  - It's a pleasure to be here, Laura.
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  - Now I know we have a lot to talk about,
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  and I'm looking forward to catching up on just some
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  of the great things that you're doing at Bergen New Bridge.
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  It's certainly, you know,
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  a fascinating time in healthcare right now
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  and a lot of, uh, um, interesting in,
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  in exciting changes happening.
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  But before we dive into that discussion,
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  can you tell me a little bit more
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  about yourself and your background?
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  - Sure. So I'm an internal medicine doctor by training.
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  I'm, but most of my career as a hospitalist.
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  I was one of the early hospitalists
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  and eventually transitioned into, uh, leadership.
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  Uh, I've been a Chief Medical officer, uh, now
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  for almost nine years.
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  The last six plus have been here at Bergen New Bridge
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  Medical Center and for the last year
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  and a half have been the vice president
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  of ambulatory services here as well.
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  - Well, that's great to hear and,
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  and definitely, you know, such a, an important role, um,
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  especially as more services and,
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  and, um, procedures are going on at the hospital
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  into the inventory setting.
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  When you look at, you know,
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  what you've done there at Bergen New Bridge,
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  what is one change that you've made in the last year
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  or so that's had some great results?
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  - I mean, there's been a whole bunch of them.
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  You know, the, the big thing I think we try to do, we we're,
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  so, Bergen New Bridge is a safety net
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  hospital here in North Jersey.
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  And, and more importantly, even in the story of it is, uh,
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  it had been grossly mismanaged for decades
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  until 2017 when there was a, the,
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  the county basically initiated a massive leadership change.
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  Uh, I came here three months, uh, after that change.
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  And so we had a bunch of different challenges here,
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  you know, and then of course we had a
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  pandemic two years into it.
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  Um, but, uh, we had a number
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  of different challenges when we were starting out,
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  which was we had to rebuild everything.
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  We had to build a quality infrastructure and infrastructure
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  and relationships with our medical staff and, and so forth.
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  And we also are surrounded by four other major hospitals,
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  and we're very close to New York City,
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  so there's a lot of competition.
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  So we were in a hospital where we were behind everybody.
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  We had a bad reputation, uh,
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  and we didn't have a ton of resources.
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  So, you know, that's obviously very challenging,
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  but it also can be very freeing.
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  And in the last year we've really seen a lot of, uh, changes
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  and, and things coming to fruition.
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  The big thing we've done,
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  and we've built a few services on this model now, is,
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  you know, I, I spent at least 15 years going to conferences
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  where people talked about population health
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  and integrated medical care,
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  and everybody kind of does the same things
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  and they check a box,
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  but they don't really put their money where their mouth is
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  for, for lack of a better term.
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  And we did, what we did was we, uh, kind of democratized,
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  uh, concierge medicine.
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  We created a, a series of navigators
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  that's basically like a concierge service
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  and concierge medicines usually
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  for, for people with a lot of money.
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  And this was basically for everybody.
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  And we were able to,
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  and we also did it by getting primary care physicians
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  who were multi-talented.
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  When I trained, I, I sound old when I say this, I'm,
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  I'm middle aged, but not old.
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  Yeah, hopefully. Um,
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  but, um, when I trained, the way that I was trained
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  as an internist was that as a, as a physician,
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  you would handle everything until it got very severe,
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  you know, some people practice by consulting everybody.
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  What we did was we got primary care physicians
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  who could do a lot of different things
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  and use them as the center of it.
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  And that has born grapefruit in a couple of services.
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  We have our addiction medicine service.
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  We do stuff that nobody else in the country does,
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  where it really is a comprehensive service
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  where the patients get, um, full care.
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  And, you know, I think people now realize how important
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  that service is, and it's really an underserved population.
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  Uh, we also created an lgbtq plus healthcare program
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  that's exploded in the last year.
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  Um, in the last year, the, um, number
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  of patients in the program has increased by over 10 times.
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  And unlike our normal payer mix, as I mentioned,
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  we're Charity Care Hospital, where we have a large amount
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  of charity care and, and Medicaid.
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  This service is 65% commercially insured, and,
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  and the rest of the patients have some other
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  government payer source.
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  So, uh, it's very different for us,
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  and it's brought other patients in contact with us
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  and starting to see what we can do
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  and how we can provide service
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  for them at a really high quality.
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  And so the last year has really been refining those things
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  and getting the word out, and now trying to take that model
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  and expand it into other services as well.
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  - Well, that's fascinating to hear
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  and just really cool to see, you know, those types
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  of programs that are not only great for the community in,
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  in something that, you know, um, is great for your, um,
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  hospital to provide, but then too to, to see, uh,
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  those additional, as you mentioned, the commercial, um,
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  patient with commercial insurance
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  and a different patient population coming in, um,
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  and really experiencing the great
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  care that you can provide there.
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  Um, I can imagine that's really rewarding
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  for yourself and your teams.
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  - Oh, absolutely. And,
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  and you know, the other nice thing is in the last year
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  we've brought in and expanded our team greatly.
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  We've brought in a lot, and
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  that's obviously such an important thing in healthcare right
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  now, is recruiting and maintaining
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  and developing good talent, right?
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  And so we've been able, we've been very fortunate
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  that we've been able to do that, and,
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  and it's just very rewarding.
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  I think that the other thing is that that
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  best in these types of things begets more success, right?
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  So we do something, we pull it off,
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  then other good people wanna come be a part of it, right?
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  So as we've built up some of these programs
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  that they've gotten some attention,
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  we've actually had really talented people reach out to us
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  and ask if they could be part of it,
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  which is really something you don't normally see.
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  And again, I think it's just by engaging people
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  and having them be excited to do something different
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  has been where we've been able to find success.
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  We, we kind of didn't have a choice , um, you know,
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  but to be different because if we tried to do
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  what everybody else did, uh, we would've gotten slaughtered.
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  But, uh, but by doing it and,
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  and figuring out a way to make it work, uh,
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  it's really drawn in people
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  and it's been very exciting for the talent
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  and that it's people more engaged
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  and they wanna do more things and they become more involved.
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  And, and it's really great to also see, you know, the,
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  the younger people or sometimes people who aren't younger,
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  but who are newer to being in a leadership capacity
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  really blossom into the roles.
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  - That's amazing to hear. And just
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  what a great opportunity all the way around now, you know,
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  broadening out one bit.
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  What are some of the top trends
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  that you're following in healthcare?
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  What's really something you have your eye on in,
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  um, top of mind for you?
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  - I think there's a bunch of them that are, I think,
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  very important that we're, that I'm kind of watching.
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  One has been, again, this movement of services more
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  to the ambulatory setting that we've kind of tried
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  to hone in on with some of those programs.
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  Uh, in particular, you know, I kind
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  of mentioned population health.
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  We've been hearing about it for years,
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  and I know that there's a, a push towards, um,
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  value-based payments.
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  Um, you know, I don't know if that's the going
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  to solve everything,
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  but I do think that it's going to be necessary
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  because, you know, the, the one thing I had in doing that,
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  that a lot of other places don't have is that
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  because I didn't have the reputation, I couldn't poach
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  for my inpatient services.
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  You know, a lot of people, if they built a program like I
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  did, they would decrease the services
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  that actually create a lot of their revenue, right?
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  'cause it prevents patients from getting hospitalized.
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  Um, so having value-based
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  payments, I think will be important.
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  So I think it's been really interesting
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  to see what's been happening in
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  that space over the last year, both in terms of
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  some hospitals or health systems buying, um, buying payers
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  and reverse payers, buying, um, medical practices
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  and trying to get into the space themselves.
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  Um, and then the, the movement of a lot
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  of IT companies into the area,
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  but then watching them have trouble trying to, uh,
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  adjust has been very interesting.
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  The other mega trend is, you know,
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  it sounds like a cliche,
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  but it's ai, you know, I think everybody's kind
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  of excited about where it could be and also scared,
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  but right now it's very kind of superficial, for lack
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  of a better word, because it's a new technology
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  and people are figuring out what they could do with it.
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  But I, I can imagine dozens upon dozens
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  of different applications if you did them right.
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  But obviously they're going to take, um, a lot
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  of refinement, a lot of computing power,
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  and a lot of security, um, being built around it.
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  - Absolutely. I think both are such great points,
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  especially, you know, it is just fascinating to
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  to think about, you know,
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  when you were first talking about moving
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  to the ambulatory space
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  and, um, looking at population health as well
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  as value-based payments, um, those types of things,
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  how they really challenge the traditional models
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  of healthcare in, you know, in some ways a push
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  and pull between, um, the, the traditional way
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  of looking at, um, performance and,
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  and metrics within the hospital system,
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  and then to, um, you know, where healthcare is headed
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  and how to kind of transform those things.
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  It seems like, um, you know, a very much a challenge,
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  I think for many organizations, um, to figure out, you know,
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  how to make that transition smoothly.
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  I think when you look at, um, being able to kind
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  of thread the needle there with having the, these programs
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  that are clearly, um, you know, essential to the community,
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  um, how do you, I, I guess,
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  what do those discussions look like
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  for you when you're working with, you know, trying
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  to make sure you have the right resources
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  to build out these programs that, um, can be really valuable
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  and useful, especially considering
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  where healthcare is headed with technology, um, in, in,
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  in just the landscape in general,
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  pushing things more outpatient
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  and in the ambulatory setting?
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  - Yeah, I mean, fortunately I think our,
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  our senior team here is kind of on the same page
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  that we think that that's where things are going.
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  But, you know,
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  we're obviously very involved in the community.
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  Again, we're a safety net hospital, so we kind of have
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  to be, and you know, uh, healthcare equity and,
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  and social determinants of health are kind of part
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  of our, our mission statement.
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  A you know, we, we have, uh, what we call our pillars
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  and there, there's, there are, uh, five
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  or six of them, uh, that kind of guide what we do here.
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  And one of them is access to care.
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  And so that's a huge, uh, deal
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  for us in terms of planning it.
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  I mean, we have to be careful
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  because, you know, um, unfortunately for us, we,
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  while we've been doing well financially, uh, compared
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  to a lot of other places,
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  like we don't have the big endowment or,
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  or the big starting amount of, of funds that other people do
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  because we started as a, a safety net.
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  So, you know, we have to really pick
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  and choose where we grow things into, you know,
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  if I had a magic wand, I would do about
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  17 different things right now, but, you know, I can't
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  because I have to pick and say, okay,
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  I'm gonna do these three programs right now.
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  I'm gonna take this much cash up front to do
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  and we'll start them and, you know, suck that up.
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  And then when they start generating them,
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  we'll move on to the next ones.
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  And sometimes that's frustrating
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  'cause you have people who are really raring to go
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  and wanna do something new, but you kind of have to choose
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  and how do we choose?
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  Some of it is analysis,
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  and some of it's a little bit by by feel of kind
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  of getting involved with the community
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  and knowing what's really needed.
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  Um, you know, we're very active
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  and involved a lot
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  of community groups and we kind of get out there.
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  I live in the area too, so, you know,
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  I think a bunch of us do.
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  So it's, it makes it easier to kind of get a read and,
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  and just being, you know, empathetic towards
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  the people in the area and figuring out what they need.
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  Um, but like I said, we do use a bunch of analysis.
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  It's not just totally guessing blind, um, to try
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  to figure out if, if something has a market or not.
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  - That makes a lot of sense, you know,
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  and, um, really great to hear
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  and kind of get a one bit more inside look at how you, um,
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  can, can really, like you mentioned, um, select the,
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  the things that you're gonna move on, um,
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  and then do that quickly and be able to,
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  to serve the community better.
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  Now, before we wrap up here, I'm wondering, uh,
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  I wanted to look into the future.
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  How are you thinking about growth in the next 12
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  to 24 months or so?
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  - Uh, I think for us it's going to be doing a lot
• 13:05
  of similar things to what we're doing currently.
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  Um, you know, I,
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  I think I've mentioned it the last time I was on,
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  but the other thing I'm trying to really move to is on
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  that ambulatory side, I mentioned already centering, uh,
• 13:19
  primary care, but giving people more frequent
• 13:22
  but shorter visits, um, I think is a really important, um,
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  for patients both for patient engagement, um, you know,
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  which will lead to better satisfaction, also,
• 13:33
  them coming back and staying with you.
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  Um, you know, and just having a little bit more of
• 13:38
  that high touch, uh, feel to how we're providing care.
• 13:41
  I think, you know, with my pet peeves in healthcare has
• 13:44
  always been that we call patients in, we have a visit
• 13:47
  with them, we give them a list of, you know, 11 things
• 13:49
  to do, and then we have 'em come back in, you know, four
• 13:53
  to six months and nobody can do that.
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  And then they have to take time off from work to come
• 13:57
  and, and all of that.
• 13:58
  Whereas, you know, with technology and,
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  and with the pandemic, you know, we saw
• 14:03
  where you can use telemedicine.
• 14:05
  I think some people overuse it,
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  but I think if you use it really intelligently,
• 14:09
  you can really use it to supplement things.
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  Just people can easily take a five to 10 minute break
• 14:13
  and jump on a call with their, with their provider
• 14:16
  or provider in the group, you know, a a mid-level or,
• 14:18
  or somebody, uh, of that nature.
• 14:21
  So that's one, uh, thing I think will be important
• 14:24
  for us for, for growth.
• 14:26
  Um, the others are, again, just getting,
• 14:31
  um, getting a little bit more of that, uh, engagement
• 14:35
  with the community and reading what,
• 14:37
  what services we really need to bring on.
• 14:39
  And then it's also recruiting talent.
• 14:42
  Um, that's really the biggest thing right now.
• 14:44
  The last several months I've spent a lot of time trying
• 14:45
  to bring in some new providers
• 14:47
  to fill in some of these new services.
• 14:49
  And then last but not least I also mentioned is the
• 14:52
  technology end to it.
• 14:54
  Um, you know, we start off behind people, so we really have
• 14:57
  to build up our technology to make things easier for people.
• 15:00
  So making it easy for them
• 15:02
  to schedule appointments and come in.
• 15:04
  A lot of people have done this already.
• 15:06
  Um, but just finding ways to make it a little more appealing
• 15:09
  to patients so that they, they feel very involved
• 15:11
  with their providers to become attached to 'em,
• 15:14
  I think is really important.
• 15:15
  Both for the patient's care, the quality of the care,
• 15:18
  and for the, the, the, the business strategy.
• 15:21
  And of
• 15:23
  - That makes a lot of sense.
• 15:24
  And you know, I really appreciate your time today, Dr.
• 15:26
  Barbara, and looking at so many different aspects
• 15:28
  of healthcare, in particular, what you've been able
• 15:31
  to do at Bergen New Bridge Medical Center.
• 15:33
  I appreciate your time today
• 15:35
  and look forward to having you, um,
• 15:36
  speak at our April annual meeting
• 15:38
  and then again at our C-E-O-C-F-O Roundtable in November.
• 15:41
  Um, it's just such a pleasure listening to you and,
• 15:43
  and hearing your perspective on healthcare
• 15:45
  and looking forward to seeing you in person at both
• 15:47
  of those spaces and continuing the conversation.
• 15:51
  - Thank you so much, Laura.
• 15:53
  It's a pleasure to be here
• 15:54
  and it's always a pleasure to speak with you as well.