Latest / CareTalk: Healthcare. Unfiltered. / The Blueprint for Rural Health Success w/ Albert L. Wright Jr., President & CEO, WVU Medicine

Transcript

The Blueprint for Rural Health Success w/ Albert L. Wright Jr., President & CEO, WVU Medicine · CareTalk: Healthcare. Unfiltered.

• 0:00
  David: Delivering high quality healthcare across a sprawling rural region is one of the toughest challenges in medicine.
• 0:06
  David: But WVU Medicine has done it building a 25 hospital network that delivers advanced care in communities across West Virginia and beyond.
• 0:15
  David: In an era of workforce shortages, reimbursement pressures, and rising patient expectations, WVU Medicine stands out as a model of how to grow, sustain, and innovate in rural healthcare.
• 0:33
  David: Welcome to Care Talk Executive features where we spotlight leaders transforming healthcare from the inside out.
• 0:38
  David: I'm David Williams, president of Health Business Group, and my guest today is Albert L. Wright Jr.
• 0:41
  David: He's president and CEO of the West Virginia University Health System.
• 0:47
  David: Albert, welcome to Care Talk.
• 0:49
  Albert: Hello David.
• 0:50
  Albert: Thank you for having me today.
• 0:51
  Albert: I'm excited to, uh, be here.
• 0:53
  Albert: Outstanding.
• 0:54
  David: Well, you know, you spent your career in healthcare leadership and I'm wondering, you know, what drew you to that field in the first place?
• 1:01
  David: How did the path that you took lead you to WVU Medicine?
• 1:05
  Albert: You know, I'm a, I'm a pharmacist by background and I, you know, when you're young and you're looking at different opportunities, you know, nobody ever, um, nobody at a young age says, Hey, I wanna be the CEO of a large academic health system.
• 1:18
  Albert: That just kind of happens over time.
• 1:20
  Albert: So I, I'm a pharmacist by background.
• 1:22
  Albert: I work in small hospitals to start, and, you know, and I, over time, I, um.
• 1:28
  Albert: I became very interested in some of the hospital operations, uh, some of the quality aspects that I was involved with, and, you know, wanted to become a, a hospital pharmacy director, which I, which I did.
• 1:39
  Albert: And then, you know, when you work in small hospitals, um, you wear lots of hats.
• 1:44
  Albert: And I started to run some different departments over time.
• 1:47
  Albert: You know, whether that.
• 1:48
  Albert: Be, uh, you know, imaging or the lab or whatever the case may be.
• 1:52
  Albert: And, you know, the, the widgets are different, but the working with people, managing budgets, working with medical staff is the same.
• 2:00
  Albert: And my, my career, um, kind of, kind of grew into more general administrative, uh, functions over time.
• 2:08
  Albert: And, uh, you know, and now I have the privilege of, uh, being the CEO at a large rural based healthcare system.
• 2:15
  Albert: You know, that, that, uh.
• 2:17
  Albert: That is.
• 2:17
  Albert: Um, and I've been here a little over 11 years and it's a spectacular place to be.
• 2:21
  David: Yeah, that's good.
• 2:22
  David: You know, uh, my cohost sometimes talks about his.
• 2:25
  David: Uh, his career path and going up the, the ladder kind of as you had, and he described it like a pie eating contest.
• 2:31
  David: He said that, you know, you do this thing and you, you do well, and what's the prize?
• 2:35
  David: A bigger, a bigger pie and less time to eat it.
• 2:38
  David: Is that a fair characterization?
• 2:39
  Albert: I, I, I think that's fair.
• 2:41
  Albert: I think, you know, and, and those of us that are successful.
• 2:46
  Albert: Learn that as that pie gets bigger, you need to surround yourself with really brilliant people and complimentary partners to help you, uh, make, make a bigger impact in time.
• 2:56
  Albert: And that's what I've, I've certainly been able to do.
• 2:59
  David: That's great.
• 2:59
  David: You know, the organization has actually grown a lot under your leadership.
• 3:03
  David: So it's not just that, you know, they needed someone to do it and, and, and you, uh, you managed to, to fill those shoes.
• 3:09
  David: But, so what's been your guiding vision for the role of the system in, in serving the region where you operate?
• 3:15
  David: You know, um,
• 3:17
  Albert: it's, it's our, our, our health system has an interest in history because, um, we were formed by an act of the state legislature.
• 3:26
  Albert: In 1996 and, uh, there was a concern by the legislature at that time that a lot of, uh, West Virginia hospitals were being purchased or acquired by for-profit out-of-state entities.
• 3:39
  Albert: And there was a concern that if we did not have a West Virginia based headquartered health system that, you know, you know, we.
• 3:49
  Albert: Those out-of-state entities might not make decisions that are in the best interest of West Virginians.
• 3:54
  Albert: And so our, the, the goal of our health system, and we have a, a twofold mission.
• 4:00
  Albert: One is to improve the health trajectory of the state of West Virginia and the surrounding areas we serve.
• 4:04
  Albert: And two, is to really care out the teaching objectives of West Virginia University.
• 4:08
  Albert: So our growth.
• 4:10
  Albert: Been, you know, really about making sure that we're of a size, scope, and capability to care for West Virginians and our surrounding areas, and that we're always going to remain a West Virginia based, headquartered, you know, organization.
• 4:25
  Albert: So we've really focused on having a robust continuum of care, you know, primarily based out of our 890 bed academic medical center here in Morgantown, but simultaneously a. A population health footprint that covers the state and spills over into to border states.
• 4:42
  Albert: So, you know, when you, I always share, you know, when you're fo when you're, you know, any organization you, you run or operate, you really want to be focused on growth and or excellence and preferably both.
• 4:56
  Albert: And that's been kind of the, uh, the approach we've taken.
• 4:59
  David: You know, those of us who are active in health policy here, a fair amount about West Virginia.
• 5:03
  David: There's been, uh, you know, a place where there's been a lot of attention, special attention to some of the, the populations that are there.
• 5:10
  David: I'd love to hear from your standpoint a little bit about some of the communities that you serve.
• 5:15
  David: What makes those populations maybe in any way different from just sort of like, you know, the average.
• 5:20
  David: Uh, in America and what you do in terms of building trust and building those relationships in those communities.
• 5:26
  Albert: Yeah, that's a, that's a great question.
• 5:27
  Albert: So, you know, I, I, I like to to level set by reminding everyone that West Virginia is the only entirely Appalachian state in the country.
• 5:36
  Albert: So every county is Appalachian and our largest city, Charleston has I think 49,000 people.
• 5:42
  Albert: So we really don't have population centers.
• 5:45
  Albert: So when you look at West Virginia, you know, I could make the argument that we're the definition of rural healthcare.
• 5:50
  Albert: And so, you know, one of the things I, I think we've done.
• 5:56
  Albert: You know, differently as a healthcare system that I'm proud of is we've really focused on having access around the state.
• 6:03
  Albert: Because, you know, you can't just have one major health center and have everyone, you know, come to Morgantown.
• 6:09
  Albert: This is a, geographically, it's a very large and spread out state and it has really rough terrain.
• 6:15
  Albert: When you hear that song, country roads, these are literally country roads and they go up and down and all over the place, you know, so in, in our operating model.
• 6:25
  Albert: Our hospitals survive on their own bottom line, and we've become really good at having stable and financially viable, uh, hospitals around the state and clinics associated with those hospitals.
• 6:38
  Albert: Nine of our 25 hospital sites are critical access hospitals, and we're very proud that we've been able to make them work and in our operating model where we really.
• 6:48
  Albert: Push services out into those communities.
• 6:52
  Albert: I'm very proud of the fact that all of our hospitals and acquisitions are financially viable.
• 6:57
  Albert: We've grown clinical services in all of them, and we've significantly always, but sometimes very significantly increased the employment in those local communities as well.
• 7:08
  Albert: And those hospitals are economic, um, drivers in their communities.
• 7:13
  Albert: They're usually the largest hospital in the community.
• 7:16
  Albert: And we have community boards at every.
• 7:18
  Albert: You know, uh, you know, fiduciary boards at each of our hospitals, which I think is, has ingrained them in those communities.
• 7:27
  David: Are there any characteristics of the, of the population, let's say, if we look relative to, uh, you know, the US average people different, does that have any impact or, uh, you know, on, on, on your strategy?
• 7:39
  David: Uh.
• 7:41
  Albert: Yeah.
• 7:41
  Albert: You know, our, our population has, you know, some significant challenges in, in, you know, a lot of social determinants of health challenges, a lot of behavioral health challenges.
• 7:54
  Albert: You know, there's a lot of people that live, you know, financially challenged around the state.
• 7:58
  Albert: So, you know, we've really tried to focus over time, you know, how do we start to put some resources?
• 8:05
  Albert: How do we increase our number of.
• 8:08
  Albert: Of, you know, value-based care contracts and, or we can talk a little bit about our provider sponsored Health Plan Peak Health later on if you want.
• 8:16
  Albert: But how do we start to incentivize ourself to start to correct some of these challenges people have around social determinants of health or in-home monitoring so that we can really meet people where they're at?
• 8:29
  David: It's really intriguing to hear and it's, it's encouraging that.
• 8:32
  David: Uh, each of these individual hospitals is actually viable, uh, in its own right.
• 8:37
  David: It's not what I would've necessarily guessed from the outside.
• 8:40
  David: And I'm wondering what sort of strategies you've been using to make sure that patients can have access to world class care, you know, close to home.
• 8:47
  David: You mentioned you don't just have to come to this big like magnet.
• 8:50
  David: You not, you did.
• 8:50
  David: It's not just designed to draw everybody into the main facility.
• 8:53
  Albert: Yep, yep.
• 8:54
  Albert: Yeah.
• 8:54
  Albert: The main facility, uh, believe it or not, is overly full all the time.
• 8:57
  Albert: So we're in, we're in, we're incentivized to keep people out in the communities and we call that our breadth and depth strategy over time.
• 9:05
  Albert: So there's a couple things we've done, I think, that are neat to.
• 9:09
  Albert: Um, to help spread that access around the state.
• 9:13
  Albert: And one is we are heavy investors in our electronic medical records, so we use Epic in every clinical setting we have so small clinic to, to urgent care, to small hospital, to big hospital and back to home health so that everywhere a patient goes, their images, their labs, their prescriptions, their physician progress notes follow them, which allows for us to really have, um.
• 9:36
  Albert: Robust population health management strategies and coordination, you know, around the state.
• 9:42
  Albert: The other thing that I think, you know, we've done well that we probably don't talk a lot about is, you know, over the last decade we really transformed from an academic medical center to an academic health system.
• 9:56
  Albert: And what I mean by that is in many, many cases.
• 10:01
  Albert: Our physician chair, leaders of our academic departments, you know, neurology, cardiology, uh, hematology oncology, you know, they have their faculty here at the academic medical center in Morgantown.
• 10:13
  Albert: But we have faculty now spread throughout the state and, you know, that, um, has really allowed us to increase our access around the state in good coordination when folks have to come to the academic medical center for higher levels of intervention.
• 10:30
  David: When I think about rural healthcare and rural hospitals in particular, uh, they face a lot of the same barriers, but also some additional ones compared with Yeah, a hospital in suburban or, or an urban setting.
• 10:41
  David: And I'm thinking about, you know, workforce transportation.
• 10:45
  David: You already alluded to chronic illness, um, other social determinants, uh, that, uh, that you, that you alluded to and you know, just the overall economic constraints.
• 10:56
  David: You're not gonna be able to change the entire, uh, state.
• 10:59
  David: Certainly not.
• 10:59
  David: Maybe they could change the economy easier than the geography, but you know, how do you adapt your strategy to overcome those challenges and are and from what you do?
• 11:08
  David: Are there lessons that others in other rural areas or regional systems could learn from, do you think?
• 11:13
  Albert: Be more specific.
• 11:14
  Albert: David, what exactly are you asking for?
• 11:17
  David: Yeah, so what I wanna know, uh, about is let, let's take this issue about like, you know, chronic disease.
• 11:23
  David: Yeah.
• 11:23
  David: Yeah.
• 11:23
  David: And so you've got, on the one hand, I get chronic disease, maybe I wanna be seen by a specialist.
• 11:28
  David: Mm-hmm.
• 11:28
  David: They're not gonna come to Morgantown.
• 11:29
  David: Even if they did, it's gonna be busy.
• 11:31
  David: There's a limited number of physicians that are there.
• 11:33
  David: How, how do you help somebody with a serious chronic illness?
• 11:36
  David: In a rural area to have good quality of life, good outcomes, and reasonable cost.
• 11:40
  Albert: Gotcha.
• 11:40
  Albert: First thing is you have to make sure that you have access points for them to get into the system.
• 11:47
  Albert: Right.
• 11:48
  Albert: And so whether that's through small hospitals, whether that's through our clinics, you know, we've taken a, an approach where we have to really blanket the state and make sure we have access for folks all around the state.
• 12:00
  Albert: Um, I do think, you know, one of the advantages we've had by tethering people to the academic departments, we've had much more success in recruiting great physicians and caregivers, advanced practice providers around the state.
• 12:14
  Albert: People are more comfortable to go to rural parts of the state to provide care and live there and work there if they know that they're going to have or be being part of something.
• 12:26
  Albert: Being part of something larger.
• 12:27
  Albert: And in West Virginia University in West Virginia, West Virginia University is, is, um, a significant player and a, and a and, um, a brand that people trust and feel good about.
• 12:40
  Albert: Uh, the other thing that's been helpful in our population health strategy and and allowing people access to um, subspecialists is there, there aren't a lot of silver linings that came out of the pandemic.
• 12:53
  Albert: But one of them is the, um, comfort people have with telemedicine, not only from a patient standpoint to say, Hey, I'm able to look and interact with my physician, but from the physician standpoint that it is, you know, it is very.
• 13:09
  Albert: Feasible and viable now for a physician in Morgantown to be in a traditional clinic, seeing three or four patients in person.
• 13:18
  Albert: Then to go in an exam room and see a patient from Princeton, West Virginia, which is in the southern most part of the state, and then see a patient from.
• 13:27
  Albert: Outside of, of Wetzel County, West Virginia, which is on the far west side of the state.
• 13:32
  Albert: And, you know, and have robust conversations.
• 13:35
  Albert: And with that interoperability of the electronic medical records, still be able to see all that information.
• 13:41
  Albert: So in, in many of our chronic diseases, in, in, you know, our, our endocrinology department is one of the best at this.
• 13:49
  Albert: They're seeing patients all the time and, you know, and, and.
• 13:53
  Albert: A high percentage of those visits are telemedicine wise.
• 13:56
  Albert: We've done that a lot in our pediatric subspecialties as well, where, you know, pediatrics is a numbers game and kids with, with, you know, um, different types of disorders where they might need to see a neurologist or a cardiologist or an endocrinologist.
• 14:12
  Albert: It's not realistic to put those providers in every part of the state.
• 14:16
  Albert: But having virtual visits, like, you know, like the conversation you and I are having right now have been a very effective tool in our toolbox.
• 14:24
  David: Talk a little bit about what you do on these, you know, social determinants of health.
• 14:28
  David: Like what would be an example of something people talk about obesity, you know, smoking, there may be some other factors, poverty, whatever it, whatever it may be.
• 14:37
  David: What are some of the main factors that you look at and how do you deal with 'em beyond?
• 14:40
  David: We talked on the one hand subspecialists.
• 14:41
  David: Now this is kind of all the way on the other side.
• 14:43
  Albert: Yeah.
• 14:44
  Albert: Yeah.
• 14:44
  Albert: So how do you, you know, your, your clinical health is only, you know, one component of your total health and a, a lot of the environment that you live in, you know, affects your care.
• 14:55
  Albert: So I'll, I'll take it from two angles.
• 14:57
  Albert: One is kind of directly what we're doing with patients today, and one is what we're indirectly doing to help give, uh, younger people here in West Virginia a brighter future in my humble opinion.
• 15:09
  Albert: You know, so when you look at existing families with social determinants of health, and we've got a, a pretty robust population health management group, about 200 people working in that department now, and I don't even know how many patients they're following these days, but you know, that can be anything from making investments in transportation, which is a real big deal of how do we get people where they need to go.
• 15:32
  Albert: Um, you know, for.
• 15:34
  Albert: Medical care or wellness or whatever the case may be.
• 15:37
  Albert: We made investments in, in, um, in food insecurity in some cases.
• 15:43
  Albert: Uh, we make lots of investments in, in home care.
• 15:46
  Albert: How do you modify people's homes that allow, you know, whether it's used or access or ramp access, whatever the case may be.
• 15:53
  Albert: Um.
• 15:54
  Albert: We're also making some significant investments in home monitoring.
• 16:00
  Albert: David, there's a lot of things we can do now from the home where we can monitor your, your cardiac situation, blood pressure, atrial fibrillation, your blood sugar, your weight, whatever the case may be.
• 16:14
  Albert: And how do we, um, how do we monitor you from afar before you end up coming back to the emergency department?
• 16:21
  Albert: The other thing we've really incorporated is a lot more in-home visits.
• 16:25
  Albert: So we also have a, a really robust home care division now that covers probably probably 35 of the 55 counties around the state where we can easily have someone drop in to see you.
• 16:39
  Albert: And you can learn a lot about, and I don't mean this in a judgmental way, but you can learn a lot about a patient when you visit them in their home and see the challenges they're facing to help learn of how can we, how can we make an.
• 16:51
  Albert: Interventions that will will keep this patient at their optimal state.
• 16:56
  Albert: Now, let me flip a little bit.
• 16:58
  Albert: The other thing we're starting to do more and more is what we call our med ed program, where we actually have high schoolers working in our hospitals as part of their high school rotation.
• 17:07
  Albert: We do that as a partnership with a group called the Education Alliance, and we're really trying, you know, whatever environment David you grow up in is normal to you.
• 17:16
  Albert: And if you grow up, and we, we have a lot of homes that have challenges.
• 17:21
  Albert: We were, we were hit hard with the, uh, the opioid epidemic here.
• 17:25
  Albert: We had a lot of kids that lost their parents and we had a lot of kids that grow up in houses where, where we don't that, where there aren't people that are working or there aren't people that are eating well or smoke and how do we.
• 17:38
  Albert: Get those kids into our envi, into our hospitals, help them to learn, you know, what it's like to have caring adults in their life.
• 17:45
  Albert: Make sure they have caring adults in their lives.
• 17:47
  Albert: You know, help them make better choices on what they eat, what it's like to have a job and help to realize that, hey, if I have a job when I come out of school.
• 17:57
  Albert: My life's gonna be a lot better than if I don't have a source of income.
• 18:00
  Albert: And, you know, we, we have one of the most challenged workforce enrollment numbers, workforce participation numbers in the state.
• 18:07
  Albert: I think we're at 51% of people that can work, do work.
• 18:11
  Albert: And, and you know, West Virginia gets a lot better if we get that number up.
• 18:15
  Albert: And more people employed and, and, you know, improving their lives.
• 18:19
  Albert: That
• 18:20
  David: makes
• 18:20
  Albert: sense.
• 18:21
  David: Now, based on the work that you've done there, do you get other rural or regional systems coming in and asking you for, you know, for, for advice or, or sharing thoughts with them and what, what are the kinda the topics that people like to discuss?
• 18:34
  Albert: You know, I, I think, um, you know, rural, rural healthcare is a sexy topic these days.
• 18:39
  Albert: So a lot of people are talking about rural healthcare.
• 18:42
  Albert: And, you know, and you know, and I, I remind everyone that, that, you know, past success does not guarantee future success.
• 18:50
  Albert: So I never, we never want to get, you know, too big for our britches.
• 18:54
  Albert: But I, I, I am trying to be a constant voice to remind folks.
• 19:01
  Albert: Rural healthcare can be tough, but you can make it work and you have to be committed to making it work.
• 19:06
  Albert: And you have to make investments.
• 19:09
  Albert: You know, we're, we're a nonprofit organization.
• 19:12
  Albert: I shared our mission earlier, and so, you know, I'm still waiting for the affluent West Virginia Hospital to come join our system.
• 19:18
  Albert: You know, they're all struggling and that's why they join, and our job is to help them get a.
• 19:21
  Albert: Get on their feet and do well.
• 19:25
  Albert: And so I think people are, are paying more attention to that.
• 19:29
  Albert: And I, and I, and I, we've had a number of calls of folks, or I'm get to speak on some panels once in a while.
• 19:34
  Albert: And I think, I think the message is, rural healthcare is tough, but we have to be committed to these populations and we have to find ways to, to make it successful.
• 19:44
  David: We discussed this topic a little bit before, but I wanna come back to it, which is about, uh, recruitment and retention of top clinicians.
• 19:51
  David: So, mm-hmm.
• 19:52
  David: You mentioned, first of all, tying people into their academic departments so they could feel comfortable.
• 19:56
  David: Yeah.
• 19:56
  David: Living there.
• 19:57
  David: You've got, um, you know, telehealth and so on.
• 20:00
  David: Do you have an overall kind of playbook for attracting and keeping great physicians and nurses and, and specialists and think about Yeah, there's, there's a lot of demand for such people all over the place.
• 20:11
  David: How, how do you compete?
• 20:12
  Albert: Yeah.
• 20:13
  Albert: You know?
• 20:13
  Albert: Yeah.
• 20:14
  Albert: It, it, it is, it is.
• 20:16
  Albert: Um, historically, you know, unless you have a tie to the university or the state, most people aren't waking up on both coasts and saying, how do I get to, to West Virginia?
• 20:26
  Albert: So, you know, when we get them here though, I think they realize.
• 20:30
  Albert: There are a lot of spectacular things here.
• 20:32
  Albert: There's great places to, you know, it's a, it's a great, Morgantown itself is a great college town.
• 20:37
  Albert: Great places to eat, great culture.
• 20:39
  Albert: Um, you know, we've really, if you look at our academic medical center a decade ago, really looked like big general hospital.
• 20:47
  Albert: It now looks like a collection of six or seven sub-specialized institutes where we've really done a good job of people.
• 20:55
  Albert: Putting people, programs and physical plants in one place, whether it's heart and vascular, neurosciences, cancer.
• 21:02
  Albert: And I think it's shown David a commitment to doctors that, hey, this place is really, um, committed to what I do for a living.
• 21:10
  Albert: You know, we just built a beautiful new children's hospital, and if you're a pediatric subspecialist, you wanna be at a place that says, I'm very serious about, you know, pediatric subspecialties.
• 21:19
  Albert: So that has helped us.
• 21:21
  Albert: Uh, you know, I'm, I'm bias.
• 21:23
  Albert: I also think we have a spectacular culture.
• 21:25
  Albert: You know, um, every CEO is probably gonna tell you they have a spectacular culture.
• 21:29
  Albert: But, you know, that's been, that's helped us, you know, recruit, you know, greater than a net new thousand physicians to Morgantown over the last decade.
• 21:39
  Albert: And we'll continue to do that.
• 21:40
  Albert: And, and we already talked about that.
• 21:42
  Albert: You know, how do you get them out into the communities where a lot of these subspecialists now live in our, what I call our regional 200 bed hospitals.
• 21:52
  Albert: But having them tethered to the academic medical center really, you know, I, I think makes, it, makes it psychologically safe for them to come and, and work in those communities.
• 22:03
  Albert: And some of those communities are beautiful.
• 22:04
  Albert: I mean, they're, you know, one, one thing we do have in West Virginia is beautiful outdoor recreation and a beautiful state.
• 22:11
  Albert: So a lot of folks fall in love with that.
• 22:13
  David: You've described this maybe, but I don't know if there's anything you would explicitly say about the culture, any particular attributes of it that you would describe When people say, what's the culture like?
• 22:21
  David: Is there.
• 22:22
  David: A way that you would describe it or someone would describe it?
• 22:24
  Albert: You know, I don't know that, um.
• 22:29
  Albert: That I have a specific way to describe our culture.
• 22:32
  Albert: I have found, though, that tying everything back through our mission to improve the health trajectory of the state, we always think about our decisions through those lenses, which I think we all do.
• 22:45
  Albert: You know, from myself and our leadership team and our board of directors, I think people, you know, I, I, I think.
• 22:52
  Albert: We have a healthy mix of folks that are from West Virginia, obviously, especially in the medical staff that love the state and I, I'm not from West Virginia.
• 23:00
  Albert: I will tell you though, people in West Virginia, from West Virginia, love West Virginia more than other people from other states do.
• 23:06
  Albert: So there's a great pride there and we've done a good job of making sure we recruit physicians that come in.
• 23:15
  Albert: That maybe aren't from here, but fit that culture.
• 23:18
  Albert: And it's, and it's fun to see good things happen to a population that in a lot of ways has been forgotten about over time.
• 23:26
  Albert: And so to, to do good things and to start to.
• 23:30
  Albert: Put infrastructure in place that someday, hopefully takes West Virginia from a, a population that, you know, depending on what metric you look at, heart disease, obesity, diabetes, drug addiction, sense of purpose is historically 45th to 50th.
• 23:46
  Albert: As we put in generational change to make this a, you know, a top quartile population with top quartile health outcomes someday, that's, um, that's easy to get people excited about.
• 23:57
  David: No,
• 23:57
  Albert: that's
• 23:58
  David: great.
• 23:59
  David: So we've been talking about a lot of the successes and at the other, you know, the, the, on the other side of things, it's, we're sitting here in late 2025.
• 24:06
  David: Um, all hospital systems that I know about.
• 24:08
  David: Health systems more broadly are, are feeling a squeeze.
• 24:11
  David: Mm-hmm.
• 24:12
  David: Um, if you're immune, let, let me know, but I wonder what some of the big challenges are that you're facing and how you're looking at steering the organization through a time like this.
• 24:22
  Albert: Yeah, great question.
• 24:23
  Albert: So, you know, we're, we're doing well, uh, you know, uh, you know, in, in sustainably, well, not, not.
• 24:31
  Albert: You know, spectacular to the point where we can put it on autopilot or anything.
• 24:35
  Albert: And, you know, and, and, and the, the healthcare system financing is, any way you look at it is kind of held together with toothpicks and bubble gum, you know, and it's, it's put together with a patch for patchwork of, you know, federal programs around three 40 B or, you know, DPP payments and different things.
• 24:54
  Albert: But we've been able to, to make it work, and we've been, we've been able to thread a needle.
• 25:01
  Albert: Which allows us to continue to grow not only growth in in acquisitions and the number of entities in the health system, but we've truly grown access around the states significantly.
• 25:13
  Albert: The number of patient business we have, our board has approved about a billion dollars in new.
• 25:20
  Albert: Strategic capital investments in the last two years.
• 25:23
  Albert: So we've got building projects going on all around the state to keep up with that growth.
• 25:28
  Albert: And we've kind of had to thread the needle with, you know, growth and meeting our mission and staying in good financial order to keep our bond holders and investors, you know, sat in our rating agency, sat aside and we've been able to maintain our, our.
• 25:45
  Albert: Rating agencies, um, uh, you know, our ratings for the last decade while we've done that.
• 25:51
  Albert: So we've been pleased, you know, we could, we could hoard capital and, or, I'm sorry, hoard days cash on hand and try to get a better rating.
• 25:58
  Albert: But that would be inconsistent with, you know, the investments we're making to improve our population.
• 26:03
  Albert: So, like I said.
• 26:04
  Albert: Past success does not guarantee future success, but right now we're managing it.
• 26:09
  Albert: We're obviously watching the, the, um, changes through the, the, you know, the one big beautiful bill and, you know, um, obviously that will hurt.
• 26:20
  Albert: I think a lot of folks, especially with, um, high Medicaid populations like the one we have.
• 26:25
  Albert: So I'm, I'm hopeful that there's time for advocacy and, you know, and, um, and, and maybe some changes to make sure we don't.
• 26:34
  Albert: Lose, have people lose their health insurance in the future.
• 26:37
  Albert: So we worry about that like everyone else does, but we, um, we, you know, we, we try to, um, keep checks and balances to make sure we're moving forward.
• 26:47
  David: I guess the, uh, you know, the, the, there was some awareness in the, uh, one big beautiful bill that, uh, rural systems would be hit hard and they, this rural transformation fund with$50 billion, which sounds like a lot of money and still you start divvying it up and, uh, seeing what your share is and what it's supposed to make up for.
• 27:01
  Albert: You just hit the nail on the head.
• 27:03
  Albert: David, I think it's important for people to realize that the, the 50 billion well appreciated, we never turn anything away.
• 27:08
  Albert: Yeah.
• 27:09
  Albert: Is, is not, um, is not gonna be sufficient to cover the, the losses If these, if these Medicaid cuts went through.
• 27:15
  David: Yeah.
• 27:16
  Albert: Yeah, that's right.
• 27:17
  David: So you, we've talked about some of the successes that you've had in bringing, you know, advanced medicine to underserved population.
• 27:24
  David: Are there specific initiatives or programs that would stand out to you if someone's listening here and saying, Hey, I've got either a rural system or another system, we've got challenges, uh, in terms of population health, anything you might encourage people to look into and possibly replicate?
• 27:41
  Albert: Um, you know, a, a couple things, and I think this just kind of goes hand in hand of, of really, you know, building the system out the way we have.
• 27:50
  Albert: And it's, and it's interesting because most systems of our size and scope we're a little bit over a $7 billion in net revenue system.
• 27:57
  Albert: So we're, we're not the biggest, but we're, we're a good size.
• 27:59
  Albert: Most systems like ours are built around urban settings of, you know, with two or 3 million people, so everybody can kind of drive.
• 28:08
  Albert: To this, to the, you know, the big hospital or the hospitals in those urban settings.
• 28:13
  Albert: One of the things I think we've done that I think is neat and, and, and you know, that, that others should consider, is there a lot of things you can do.
• 28:27
  Albert: In these more remote hospitals.
• 28:29
  Albert: So, you know, I was reading the other day, you know, I won't name the, the, the, the system or the city, but I was reading a newspaper in another city and they were bragging that their academic medical center had just started to do these, um, these, um, Alzheimer's antibody infusions, you know, and I, and I.
• 28:50
  Albert: I called our, our, our physician that leads the Rockefeller Neuroscience Institute.
• 28:54
  Albert: And I said, aren't we doing that in Wheeling in Princeton?
• 28:57
  Albert: And you know, like, and he is like, yeah, we started doing that like a year ago down there.
• 29:00
  Albert: So, you know, and the same thing with clinical trials.
• 29:03
  Albert: Like we have, you know, our cancer clinical trials from our WVU Cancer Institute.
• 29:09
  Albert: We've got almost as many clinical trials going in these remote sites that we do in, in Morgantown proper.
• 29:15
  Albert: And so, you know why if a patient gets cancer in Parkersburg, West Virginia or Kaiser West Virginia, why shouldn't that patient have access to the exact same clinical trials that you get if you live in the, in the academic medical center county?
• 29:30
  Albert: You know, so I think just being committed to now, you can't do everything everywhere.
• 29:36
  Albert: We can't do heart transplants in all of our sites.
• 29:38
  Albert: We do that in one site.
• 29:39
  Albert: But for the things that you can do in multiple sites, you know, especially for a rural population, I think health systems should really be open-minded about trying to do these things in a safe fashion as we can.
• 29:51
  Albert: And we, we make sure the protocols and the physicians working at the sites are all the same.
• 29:55
  Albert: But you know, you can do a lot more in rural sites than people realize.
• 30:00
  David: Albert up near the top of this episode.
• 30:02
  David: You alluded to, uh, the fact that you started a health plan mm-hmm.
• 30:05
  David: A few years ago.
• 30:06
  David: I would love to hear a little bit, a bit about what was the motivation for that, how well it's panned out and how we think about, you know, it's like you pay yourself sounds good, but I'm sure it's not quite as simple as uh, uh, you know, as that.
• 30:18
  David: Yeah,
• 30:19
  Albert: yeah.
• 30:19
  Albert: Starting a provider sponsored health plan is not for the faint of heart.
• 30:22
  Albert: It's something you have to be committed to.
• 30:24
  Albert: And, you know, here's, here's why is we, we.
• 30:28
  Albert: We spent a few years trying to figure out our operating model and, and, and I believe our board of directors believes, and our leadership team believes that you can never.
• 30:38
  Albert: Truly improve outcomes and lower costs until the people that pay for healthcare and the people that provide healthcare are financially aligned.
• 30:47
  Albert: Right.
• 30:47
  Albert: And, and you're trying to do the same thing because if you're, if you're fighting over what you wanna do to someone and somebody's fighting over, are they gonna pay you for it?
• 30:55
  Albert: You just don't get anywhere.
• 30:56
  Albert: And so we started our own provider sponsored health plan with two other health systems.
• 31:01
  Albert: We're the.
• 31:01
  Albert: We, we operate Peak Health.
• 31:03
  Albert: Um, our partners are Marshall Health down in Huntington, West Virginia, um, and Valley Health in Winchester, Virginia.
• 31:12
  Albert: Um, and those are, those are two kind of like-minded organizations and they're, they're owners in peak health as well.
• 31:18
  Albert: And so what we've really tried to do.
• 31:21
  Albert: Peak health.
• 31:22
  Albert: And, and David, this really leans back into those conversations we had earlier about making investments in the social determinants of health, behavioral health, uh, home monitoring, uh, you know, screening is, we've set peak up, um, a little bit differently than, than, than I think.
• 31:40
  Albert: Other traditional provider sponsored health plans.
• 31:43
  Albert: 'cause we're not the first organization to ever create our own insurance product.
• 31:46
  Albert: But a couple things we're doing differently.
• 31:48
  Albert: First off, we're processing claims in Epic as well.
• 31:51
  Albert: So we've got complete real time visibility and interoperability between payment and provision of care.
• 31:57
  Albert: So you know exactly what's going on everywhere all the time, which, which allows us to.
• 32:04
  Albert: Intentionally decrease administrative burden, you know, the back and forth between healthcare providers and healthcare payers.
• 32:12
  Albert: So we've decreased, we're decreasing administrative burden there.
• 32:14
  Albert: One, two is we're treating peak health as a cost center rather than a profit center.
• 32:21
  Albert: And hopefully that breaks that historical fighting between the payer and the provider of who's gonna get the dollar.
• 32:28
  Albert: Right.
• 32:29
  Albert: And in our case, peak exists as a cost center to support.
• 32:34
  Albert: The health systems that own it and any profits go back to the health systems.
• 32:39
  Albert: So what that allows us to do, David, is really create neat alternative payment models.
• 32:44
  Albert: So when peak, like for, let's say for our Medicare Advantage population, peak gets all those dollars on January 1st of the year, I'm being blunt for impact, but gets all of those dollars on January 1st of the year and it hands the entire dollar amount.
• 32:59
  Albert: Over to the health system as payment in full for that Medicare Advantage population.
• 33:05
  Albert: And what that does for the health system now is we are completely incentivized to keep people as healthy as possible and in the lowest cost setting to maintain our financial viability.
• 33:19
  Albert: And when you're, when you're incentivized to keep people as healthy as possible and in the lowest cost setting, you start to make investments that keep them.
• 33:27
  Albert: Out of the ED and out of the hospital whenever you can.
• 33:31
  Albert: And very consistent with those investments we talked about earlier around the social determinants of health and, and those types of things.
• 33:38
  Albert: So we're, we're only a couple years into the journey.
• 33:41
  Albert: We're making some progress, but I think we're laying the financial alignment and infrastructure to hopefully do really cool things in the future.
• 33:51
  David: Well, it sounds compelling and I, I know it's not for the faint of heart, so we won't, we won't frighten anybody with some of the, uh, the scary details.
• 33:57
  David: But, uh, congratulations on getting that going.
• 34:00
  David: Thank you.
• 34:01
  David: Now, of course, thank you.
• 34:01
  David: I don't expect that these payment models and and delivery systems are gonna just stay the same.
• 34:06
  David: So when you're looking ahead, um, you know, what do you see as, as coming next?
• 34:11
  David: What's on the, what's on the horizon and will it be something, uh, where the patients see the impact?
• 34:17
  Albert: You know, I think we, you know, we don't know exactly what tomorrow looks like, but we as a health system, we want to be as flexible as possible and, and have the infrastructure, whatever our future payment models and mechanisms look like.
• 34:34
  Albert: I do think over time, if we're successful on our journey with peak in the things we're trying to do, you know, I, I always equate it to the.
• 34:44
  Albert: You know, to the iPhone.
• 34:45
  Albert: And there was a time when I had a computer and I had a camera, and I had a phone on the wall and, you know, those types of things.
• 34:53
  Albert: And, and now you have this little device that you carry, you know, in your pocket that has all of that.
• 34:58
  Albert: If we're successful in peak, you know, from a physician standpoint, um, they, they shouldn.
• 35:04
  Albert: It should feel a lot easier to take care of peak patients in a decreased administrative burden than if they're working with outside payers.
• 35:12
  Albert: And same from a patient standpoint.
• 35:14
  Albert: If we're successful, people aren't thinking that I have health insurance and I have a healthcare provider, they think they have an entity that is lightning or you know, laser focused on keeping me as healthy as possible.
• 35:25
  Albert: That's, you know, that's where we're trying to steer this ship to.
• 35:29
  David: Yeah, that's a great vision.
• 35:30
  David: I know.
• 35:30
  David: I would like that as a patient, so hopefully it could be achieved.
• 35:34
  David: Well, that's, we're working on it.
• 35:36
  David: Yes.
• 35:36
  David: Good.
• 35:37
  David: Well, that's it for another episode of Care Talk Executive Features.
• 35:40
  David: My guest today has been Albert L.
• 35:42
  David: Wright Junior, he's president and CEO of WVU Medicine.
• 35:47
  David: I'm David Williams, president of Health Business Group.
• 35:49
  David: If you like what you heard, I hope that you'll going to subscribe on your favorite podcast platform.
• 35:54
  David: And Albert, thank you for joining me today and for all that you're doing.
• 35:58
  Albert: Thank you, David.
• 35:59
  Albert: I appreciate the opportunity.