Latest / Becker’s Healthcare Podcast / Abha Agrawal, President and CEO, NorthStar Hospitals

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Abha Agrawal, President and CEO, NorthStar Hospitals · Becker’s Healthcare Podcast

• 0:02
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• 0:31
  Hello, and welcome to the Becker's Healthcare podcast.
• 0:34
  My name is Will Riley from r one.
• 0:37
  With me today is Abba Agrawal. Abba is
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  president and CEO of NorthStar Hospitals. Welcome to
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  the podcast. It's a pleasure to be here.
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  Good. Thank you. Thank you. Tell us a
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  bit about yourself and tell us about NorthStar.
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  Yeah. Thank you, Will, for having me. I'm
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  a huge fan of Becker's podcast.
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  I'm a physician. I'm board certified and trained
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  in internal medicine and medical informatics.
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  I've been involved in hospital and health system
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  turnaround and transformation
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  for over two decades.
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  And now drawing and based on that on
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  that experience,
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  I have founded this company, Northstar Hospitals.
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  It's a mission driven organization,
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  and our mission is to revitalize,
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  rural hospitals,
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  small community hospitals
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  through strategic investments, acquisitions,
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  and management.
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  Why is that?
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  It's
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  there are about 1,800 hospitals hospitals
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  in The United States that are rural. Over
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  a third of them are at the risk
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  of closing.
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  Almost 300
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  of them are at the risk of imminent
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  closing.
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  When a rural hospital closes,
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  there is a major
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  detriment to the community.
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  Not only
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  an ER goes dark,
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  which causes
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  problems for patients with medical emergencies, heart attack,
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  stroke, deliveries.
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  They have to go thirty, forty miles to
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  get those essential emergency services done.
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  But, also, people have to take a day
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  off just to get grandmother for a medical
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  appointment.
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  On top of that, a closure of a
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  hospital
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  disrupts
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  the entire socioeconomic
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  fabric of their community,
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  loss of jobs,
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  loss of
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  development,
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  because many of these hospitals are economic anchors,
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  maybe the largest employers in these small communities.
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  On the other hand, a dollar invested in
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  rural hospitals
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  provides $2.30
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  in overall community benefit.
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  So I feel it's imperative for us as
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  a country
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  to
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  reimagine,
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  redesign,
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  and rebuild
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  rural health care.
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  And I see this as
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  a not just a health care project,
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  but a community building and nation building project.
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  So I'm very excited about it. Yeah.
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  Okay.
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  And and I I suppose
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  with all there's a lot of conversation at
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  the moment about the big beautiful bill,
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  and changes to reimbursement.
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  Feels like some of these hospitals are particularly
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  vulnerable to some of those changes.
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  I think these hospitals have some unique challenges,
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  including the policy headwinds that you mentioned.
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  Let's start even with the basics.
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  So if you look at about
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  20%
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  of the,
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  population in The US is considered rural.
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  And if you look at the land mass,
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  80% of the urban population
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  lives in 3% of the land mass. So
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  20% of the rural population lives in 97%
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  of the land mass. So you can imagine
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  just the geography
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  of it is poses a challenge itself.
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  Alright. I feel our health systems and health
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  care ecosystem in the country was designed
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  for places like we are in Chicago where
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  you have
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  five major academic medical centers within five miles
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  of distance.
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  And here, we have communities, you know, 5,000,
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  20,000 people
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  in a mileage of, hundred, two hundred miles.
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  So how do you rethink and redesign a
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  system for that? So that poses a challenge.
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  When it comes to the the policy, there
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  are headwinds, but there are also some tailwinds,
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  some positive things that are happening. I mean,
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  obviously, the biggest concern people have
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  is the Medicaid reductions.
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  And many of these communities have aging populations.
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  They do have, patients who are on Medicaid.
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  And if those benefits go away,
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  one, there is hardship on the patients in
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  the community.
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  And if they show up in the emergency
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  room and there is much more uncompensated
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  care, a hospital in financial distress may not
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  be able to tolerate
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  that, right, and puts additional distress on that.
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  There's some good things, though, that are happening
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  from a policy perspective.
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  There is rural health transformation bill,
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  which allocates $50,000,000,000
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  over five years, all for rural health.
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  So I'm very optimistic about
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  what those dollars can do to revitalize and
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  rekindle
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  our rural health.
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  There is rural emergency hospital conversion,
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  which provides federal subsidies for hospitals
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  that provide emergency care, but not necessarily in
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  patient care. So I think we have to
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  look at it in totality and see how
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  we can risk mitigate
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  this stuff that could be potentially detrimental,
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  but also take advantage of,
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  what we can do in terms of the
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  additional dollars that are being allocated,
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  to our rural health. And it it feels
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  like,
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  well, let me ask you. What what what's
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  the role of technology and innovation
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  in that? Right? Because there's a there's a
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  window of time,
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  where perhaps some of these funds can be
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  used
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  to advance the technology agenda. But, again,
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  with rural health care, there are some challenges
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  in using and adopting innovative technologies. Right? So
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  so how how's that gonna work? Jump. So
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  I think
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  it is I mean, obviously,
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  we are trying to redesign rural health,
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  Continuing to do as it was designed, which
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  is not showing us the results, would not
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  be a good idea.
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  I think technology
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  could be truly a lifeline
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  for redesigning health care in rural areas.
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  And remember when we talked about early on
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  how, you know, 20% of the population lives
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  in 97%
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  of this.
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  Add to that a severe health care provider
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  shortage
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  from surgeons to nurses to primary care physicians.
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  So if you look at that, it's almost
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  technology is absolutely the right solution
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  waiting to be deployed.
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  You can use telehealth.
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  You can use telestroke,
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  telebehavioral
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  health services,
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  teleprimary
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  care.
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  You can do remote patient monitoring, so maybe
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  patients don't need to come into hospitals all
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  the time. You can do chronic disease management,
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  which not only will improve the health of
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  the community,
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  but also reduce their dependent on
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  scarce physical
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  health resources that exist. So I see a
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  tremendous,
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  I would say,
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  a critical role at a critical point of
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  time
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  where technology has evolved to the extent it
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  can be deployed anywhere with a level of
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  ease.
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  There are companies. There are solutions available to
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  be deployed.
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  The cost of solutions is coming down so
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  that even smaller organizations can take. So I
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  would say,
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  technology,
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  AI would be
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  instrumental.
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  Not the not panacea. It would not solve
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  all the challenges,
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  but
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  providing access to care Mhmm. At the point
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  of where patients and communities are,
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  it would be critical.
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  And,
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  maybe continuing on that theme, looking at the
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  back office and looking at administration, financial administration.
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  Because, again, rural
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  systems small independent rural systems face some pretty
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  unique well, not unique, but they face tough
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  challenges from a payer perspective. Right? Not just
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  heavy dependence on government payers, but they're not
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  always in a strong position when it comes
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  to commercial contract negotiation.
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  Yep. So, you know, there's a study that
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  came out recently, a few months ago, and
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  they looked at the causes of distress in
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  rural hospitals. Mhmm.
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  So, typically, we always blame government payers.
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  But that study said the the bigger reason
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  for the financial distress being faced by rural
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  hospitals
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  is under reimbursement
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  by commercial payers.
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  There are many times, these are isolated independent
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  community hospitals.
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  They do not have the the leverage,
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  to negotiate the best possible commercial contract.
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  They don't have the economies of scale.
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  There are some,
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  areas, for example, Alabama,
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  where there is only one commercial payer.
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  And they if you look at the difference
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  with large systems versus small systems, there is
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  a major gap
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  between this one commercial paying payer paying smaller
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  hospitals.
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  So no question, this payer landscape.
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  But even here, hopefully, besides the rates and
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  the contract negotiation and the leverage,
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  that's also our thesis that if we can
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  create a conglomerate,
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  sort of a confederation of rural hospitals,
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  even if they are independent
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  sort of through my project,
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  then collectively, they can have a better leverage
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  power as opposed to one individual. Mhmm. Secondly,
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  if you look at the financial health, you
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  can absolutely leverage technology,
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  to make sure that,
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  you are appealing every claim. Make sure you
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  are submitting all the claims that are or
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  most of the claims that are not denied.
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  You're doing all the right documentation.
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  And technology solutions don't cost as much because
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  you are not dependent on the human labor
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  to do all of that. So, again, even
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  in the back office administration
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  side, especially finance,
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  I hope technology innovation can provide a lifeline
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  to rural health. Yeah. Yeah. Exactly. Okay.
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  I'm curious about how how you've talked a
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  little bit about patients, improving the patient experience
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  through access,
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  right, through through technology. But, I guess, what
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  are some of the other ways that the
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  patient experience might be improved? Yeah. So if
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  if you look at technology, we have talked
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  about back end. We have talked about physicians.
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  I mean, access itself is you know, I
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  think the way to look at it is
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  the friction
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  between health care providers, whether it's physicians or
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  hospitals or any provider system and patients.
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  Technology can reduce
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  that friction.
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  Technology can produce literacy,
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  you know, fifth grade literacy level patient education
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  information
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  in any language that you want without incurring
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  any additional cost that we don't do right
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  now. If you look at AI used by
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  patients,
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  it's the apps
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  not
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  that provide the translation of jargon
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  that are far more acceptable to patients as
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  opposed to saying, I don't wanna go to
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  my doctor. Can you diagnose me? Right. So
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  patients and are already showing us
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  they wanna remain they wanna see the doctor
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  for the real diagnosis,
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  but they wanna use AI, like, chat GPD
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  type of things, most to help them translate
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  all that jargon. Right? So, again, reducing that
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  friction that we have in this health care,
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  that's another
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  extraordinary opportunity for technology and especially AI these
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  days.
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  Excellent. Abba, do you have any con concluding
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  thoughts? Anything else that you'd like to share?
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  I think we,
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  I like to share that,
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  I'm a huge believer in health care good
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  health care for everyone and whatever we have
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  called it by different names. So I go
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  back a couple of centuries. There is a
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  in Chicago,
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  Cook County Hospital, Hospital,
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  Louis Pasteur, the famous scientist, there's a plaque
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  with his saying,
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  one doesn't ask of the one who suffers,
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  what's your country and what's your religion.
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  One merely says you suffer, that's enough for
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  me. You belong to me, and I shall
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  help you.
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  And I hope we can keep that ethos
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  in health care, whether it is technology or
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  rural or urban health.
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  Awesome. Thank you. Thank you very much for
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  talking to us today. Of course. Thanks.