Latest / Becker’s Healthcare Podcast / Healthcare Upside / Down: Leading Academic Health Systems Through Growth, Integration, and Complexity

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Healthcare Upside / Down: Leading Academic Health Systems Through Growth, Integration, and Complexity · Becker’s Healthcare Podcast

0:00
This is Scott Becker with the Beckers Healthcare
0:03
Podcast.
0:03
We're thrilled today to be joined by two
0:05
fantastic
0:06
guests. We're with Kevin Mahoney, the CEO of
0:09
Penn Medicine at the University of Pennsylvania,
0:11
and Chris Collins, the CEO of ECG Management
0:14
Consultants.
0:15
This is the Healthcare Upside Down podcast,
0:18
a podcast by Becker's Healthcare plus ECG Management
0:22
Consultants
0:23
in which we explore the upsides and downsides
0:26
of health care in the industry's most current
0:28
trends. Thank you so much for joining us.
0:31
Kevin and Chris, thank you so much for
0:33
being here. Let me ask you to start
0:35
off by each of you taking a moment
0:37
to introduce yourself and talk for a moment
0:39
about the work that you share in health
0:41
care. Kevin, let me start with you, and
0:43
then I'll go to Chris.
0:45
Scott, thanks so much for having me on.
0:47
It's a a privilege, and we have a
0:48
long relationship. And I enjoy
0:51
communicating with Becker's because we're able to spread
0:54
knowledge throughout the country, and it's really terrific.
0:55
But I'm Kevin Mahoney, and I'm the CEO
0:57
of Penn Medicine, as you mentioned. I've been
0:59
there for thirty years
1:01
and have touched almost every part of our
1:03
mission from research to clinical,
1:05
finance, and everywhere in between.
1:07
And it's just it it's an honor to
1:09
be part of Penn Medicine. We're the nation's
1:11
first hospital two hundred and seventy five years
1:14
ago.
1:15
I continue on forward, so we may have
1:16
a bad day at Penn Medicine. We know
1:18
in bad centuries.
1:19
It's really remarkable. And in watching Penn Medicine
1:23
and quite frankly watching yourself lead has been
1:26
one of the great pleasures I've had over
1:28
the last decade or so. Just phenomenal to
1:30
watch the leadership, the manner in which you
1:32
deal with people, and and and the the
1:34
thoughtfulness that goes into pet medicine.
1:37
Similarly, Chris Collins in ECG Management, just a
1:40
remarkable, remarkable firm. Chris, can you take a
1:43
moment and introduce yourself
1:45
and and talk a little bit about ECG
1:47
too? Sure. And thank you for having for
1:49
having me, and it's a it's a pleasure
1:50
to be here with Kevin. It's a great
1:52
topic. Really excited about talking about it. I've
1:54
been in health care for thirty years.
1:56
I've been at ECG for twenty one of
1:58
those. Didn't know if I was gonna be
1:59
there for five years or twenty years,
2:02
and,
2:02
fell in love with academic health care
2:05
as a young associate at, PricewaterhouseCoopers
2:08
shortly after they formed and they merged with
2:10
Cooper's Labyrinth.
2:11
And I lived in the basement of NYU
2:13
Medical Center when Bob Grossman was, was coming
2:16
in as as chair of radiology,
2:18
and fell in love with that space. So
2:20
I ECG was always been known in that
2:22
space, and so I stayed there and,
2:24
and led the academic health care division for
2:26
many years, and and now I'm a bit
2:28
more overhead than I was before. So But
2:30
but you also
2:32
when did you take over as CEO? Remember
2:34
when you took over as CEO? But give
2:36
me the time. About four years ago, I
2:38
became president as part of a succession plan,
2:40
and then, I'm I'm president, CEO, and chairman
2:42
of the board.
2:43
Fantastic. And and and, Chris, you also enjoy
2:46
just an absolutely fantastic reputation
2:48
from both your colleagues and your peers at
2:51
at ECG
2:52
and also outside of ECG. So it's a
2:54
pleasure to get to visit with you as
2:56
well. Really a tremendously positive reputation.
2:59
We'll start with academic health systems. So academic
3:02
health systems over the last 20 half centuries,
3:05
as as you mentioned, Kevin, have grown
3:08
tremendously in particularly over the past decade to
3:10
two through acquisitions,
3:11
affiliations, regional expansion.
3:14
With that growth comes a lot of complexity.
3:17
At what point does scale start to strain
3:19
the operating model, And how should leaders think
3:22
about how they evolve when they have greater
3:24
and greater greater scale and how to think
3:26
about governance and organizational
3:28
structure so the system could keep on executing
3:31
even as the systems act out at mental
3:33
centers get so large and complex? How do
3:35
you think about?
3:36
So one thing we spend a lot of
3:38
time on at Penn is not aggregation
3:41
of assets, but integration of assets.
3:43
And just compiling more hospitals
3:46
might make a a great headline, but
3:48
our our mission of
3:50
creating and disseminating knowledge
3:53
requires us to be tightly, tightly integrated.
3:56
So
3:57
as we've grown to now, you know, 53,000
4:00
or so, employees,
4:02
$12,500,000,000,
4:04
it's a real challenge from a stand alone
4:06
hospital.
4:07
How do we do that integration? We we
4:09
focus.
4:10
We have a common ethos
4:12
that we communicate constantly to all the employees
4:16
all the time, walk in the hallways, be
4:19
invisible,
4:20
but reminding them you're taking care of a
4:23
patient today,
4:24
but you're curing a patient in the future.
4:26
And and make sure they know they're working
4:27
at a truly special place.
4:30
And talk about that merger for a second
4:32
of of bedside and
4:34
and and sort of bench or bedside and
4:36
research in both because you mentioned that to
4:38
your patients today, and also we're trying to
4:40
fix things for the future, cure things for
4:42
the future. Talk about mixing those missions and
4:44
also the challenge of academic health systems. Traditionally,
4:47
the health center
4:49
or hospital
4:51
versus or together with the faculty and how
4:53
you work on that integration.
4:55
So we have a
4:57
advantage at Penn. We're 100% owned by the
4:59
university.
5:00
Most academic medical centers, the health system is
5:03
separate from the school and it's a contractual
5:06
relationship.
5:07
So my boss is the president of the
5:09
university.
5:11
It is pushing a common agenda forward. And
5:14
is there friction? Of course, there is. But
5:17
we get through it much easier because of
5:19
that that commonality.
5:21
Examples, though, are we build integrated.
5:24
So if you go onto the Penn campus,
5:26
in one building, you have the school of
5:28
medicine.
5:29
You have the clinical.
5:30
You have the world's largest proton therapy,
5:33
but you also have wet labs and vivariums.
5:36
So in our proton therapy, we'll be treating
5:38
four patients
5:40
and two animals doing research at the same
5:42
time.
5:44
And that tight integration allows for what I
5:46
I call collision of ideas.
5:48
One of our more famous is messenger RNA.
5:51
Doctor Weisman and Kriko went on to win
5:53
the Nobel Prize. So they met at the
5:55
copy machine.
5:57
Amazing.
5:58
Amazing. By actually just interacting, you sort of
6:00
the the day to day interacting and becoming
6:02
just sort of, like, clicking together,
6:05
and then started to work deeply on something.
6:06
So you you have to build, but you
6:08
also have to celebrate that that culture of
6:10
we're in this together. There's not a researcher
6:12
and a clinician and a finance person. I
6:15
I tell everybody,
6:17
if you're working at Penn, you're a cancer
6:18
researcher. Your job title might be AR rep.
6:22
If you do the job the very best
6:23
you can, you're gonna create enough free cash
6:25
flow that we can fund
6:27
novel clinical ideas
6:29
that maybe the FDA is not ready for
6:31
yet, maybe the NIH isn't ready for yet,
6:34
but science needs to move forward. And so
6:36
I I try to inspire
6:38
our our employees that
6:40
we're we have a mission bigger than
6:43
just taking care of patients.
6:46
Literally remarkable. And and and, Chris, let me
6:48
ask you this, because
6:50
your firm developed a preeminent
6:52
expertise in dealing and working with academic medical
6:55
centers. You also, to the point that we
6:57
just asked Kevin about,
6:59
did a lot of design a long time
7:00
ago about what the practice looks like and
7:02
the practice plan looks like. How have you
7:04
seen the evolution of academic medical centers? You've
7:07
been working on personally for twenty plus years,
7:10
but ECG also has about the preeminent reputation
7:12
working with academic medical centers. How are you
7:14
seeing the evolution? What are some of the
7:16
things you're watching? Well, we're at the most
7:17
interesting point in the in the market right
7:19
now because for many years, it was the
7:21
integration,
7:22
to Kevin's point,
7:24
of the three part mission
7:26
and the assets of an academic medical center.
7:28
So
7:29
and then I don't just mean organizationally. I
7:31
mean, culturally,
7:32
fusing together. It's not three missions. It's one
7:34
mission with three parts. Right? And so a
7:37
lot of that work and the economics behind
7:39
that, the governance and leadership,
7:41
that I think is has has,
7:43
has been successful in the market. But
7:47
just as we catch our breath,
7:49
systems like Penn, and I think they're doing
7:51
it responsible way,
7:53
are aggregating. They're adding
7:55
systems that are less academic or academic light
7:59
to the flagship.
8:02
And they're not really they're integrating the logos
8:04
in some cases.
8:06
They're not behind the curtain, they're not integrating
8:09
the systems.
8:10
And,
8:11
and we see that. And it's not easy.
8:13
Right? Because from a community regional system,
8:16
they look at an AMC and
8:18
see, they're sluggish.
8:20
They're a bunch of you know, they're they're
8:21
slow. They don't like to see patients quickly.
8:23
They like to have this academic time. I
8:25
don't know what they're doing. And that's the
8:27
perception.
8:28
And some of the AMC's look at the
8:29
community saying,
8:31
you know, we're more subspecialized.
8:33
We're we're where people come with for research
8:35
and discovery and and I'm being a little
8:38
acute there, but my point is that now
8:40
they're colliding. Right? And so yeah. And you
8:43
see that more and more. I mean, see
8:44
Oh, it's yeah. Here here in Chicago, you
8:47
got the University of Chicago, one of the
8:48
great academic medical centers, then also trying to
8:50
build a community base of community hospitals.
8:53
Russia's tried to do the same thing. Right.
8:55
And some of it's very challenging. Sometimes people
8:57
in the research,
8:58
the deep science, deep research think they're doing
9:01
commodity medicine, and at the same time, the
9:03
system thinks, well, this is really important to
9:05
the community that we do both. And and
9:07
you have great examples at Penn, great examples
9:09
at here with, doctor Latif at Roche trying
9:12
to combine both and at Erie Chicago. So
9:14
how do people mesh that doing both? Well,
9:16
I think what's what we're missing in the
9:18
the average system with this issue is that
9:21
we're
9:22
there's a bunch of suits in a conference
9:24
room trying to figure this out, and I
9:26
don't think that's the solution.
9:29
The solution is you need to put out
9:30
the welcome mat to the clinician
9:33
who's never been around a resident,
9:35
and you need to bring in a full
9:36
time faculty member who's has more orientation towards
9:39
research than patient care,
9:41
and let the physicians have a voice.
9:44
And I I think too often, and I
9:46
and I'm not being critical,
9:48
we it's a lot of lip service, but
9:49
we're not really drawing them in. I mean,
9:52
this is hard. Right? These are these are
9:53
one group has
9:55
really a three part job, and the other
9:57
group has one. But they come from different
9:59
medical communities, which should be respected.
10:02
But, ultimately,
10:03
we need to integrate, and we need the
10:05
best minds to do that.
10:07
That means operationally, that means
10:09
in terms of protocols and policies and and
10:12
right down to scheduling templates that you use,
10:15
I'm gonna use, right, to to really be
10:17
behave as one system.
10:19
And I and I know there's a lot
10:20
of literature on it, but I think the
10:22
execution in some cases is is quite light.
10:25
A 100%. And and and, Kevin, let me
10:27
ask you a question as a fall to
10:29
that.
10:30
Some systems do this tremendous job of integrating
10:33
to to the point
10:35
what gets done with the patient with what's
10:37
getting done at research and doing a really
10:40
good job of integrating those two things as
10:42
much as possible so that there is a
10:44
constant connectivity, a constant fluidity between the research
10:48
institution and the patient
10:50
care institution.
10:51
How do you sort of work on that
10:52
to make sure that that thrives, that that
10:54
goes as well as it can
10:56
between research and taking care of patients? So
10:59
let me go back and repeat my integration.
11:01
So at Penn Medicine,
11:03
every patient's on the same electronic medical record.
11:07
So
11:08
protocol changes
11:09
changes on every patient throughout the system, and
11:11
and that has knitted together. But it's also
11:15
a great research tool because you can mine
11:17
through the EMR
11:19
to find the patients that you need for
11:20
that Crystal Myers
11:23
clinical trial. So we're able to present the
11:26
BMS
11:27
United. We have this pool of, of patients
11:30
that, we can help fill your clinical trial
11:33
on. So it it is intentional,
11:36
and it's not
11:38
AMC. You know, HOP is better than
11:41
Lancaster. It's better.
11:43
To Chris' point, it's not we change the
11:45
logo, but everything else has stayed the same.
11:47
We've been working hard
11:49
for decades on
11:51
it's one Penn Medicine. And and and, Chris,
11:54
let me ask you a follow-up to that.
11:56
You see, of course, academic medical centers and
11:58
your firm works with a lot of them
12:00
across the country that are all different parts
12:02
of this continuum.
12:03
What are some things that you can do
12:05
when you see sort of this fissure between
12:08
the academics and the bedside
12:10
to see systems improve upon that or better
12:12
integrate it. Well, I'll go back to I'll
12:14
just I'll just expand upon a point I
12:16
made earlier.
12:17
Instead of
12:18
of forcing something on them,
12:21
bring people together,
12:23
learn where they're coming from, and create a
12:25
hybrid model,
12:27
truthfully. And that that means,
12:29
meaningful,
12:30
not a galaxy of committees, but meaningful advisory
12:33
bodies that are informed
12:35
where you're transparent
12:37
about the financials, which is another complicated. We
12:38
could spend a whole another podcast on that,
12:40
and bring them together and have them be
12:42
a part of it. Have them have their
12:44
fingerprints on that process
12:45
and make a decision. And I think that
12:47
that has worked when you have the right
12:48
leadership
12:49
that is willing to put their neck out
12:52
there and spend the political capital to make
12:53
it happen. And I think too often,
12:55
if you shut the door, they know what
12:57
the right thing to do is. And I
12:58
give Penn a lot of credit. It's okay.
13:00
We're gonna do it the right way. We're
13:01
not bigger isn't better.
13:03
Better is better. No. I I I think
13:05
an important point Chris is making is also
13:08
we're all humans. We don't wanna be told
13:11
what to do. We wanna be part of
13:12
it. So we have four family medicine residency
13:16
programs.
13:17
It'd be easy for us to say we're
13:18
gonna have one DIO overall four effective
13:22
June 3. You have to go out to
13:23
each of those residency, but this is why
13:25
your life is gonna be better. Exactly. We're
13:27
gonna have common curriculum. We got common onboarding.
13:30
You're gonna have to you know, you can
13:32
focus on teaching, not on the administrative part.
13:34
But if you're not if you're just gonna
13:37
say from corporate effective tomorrow, it'll never work.
13:39
Right? You gotta burn the shoe leather. Yeah.
13:42
And and you do That burning the shoe
13:44
leather and actually talking to people and aligning
13:46
people, getting people on the same page, it's
13:48
so so important because you start with if
13:50
you got four different residency programs in primary
13:52
care or internal medicine, you start with, in
13:55
some way, shape, or form,
13:57
Each one having a different leader, each one
13:59
having their own sort of, like,
14:01
fiefdom in their own way. Not not that
14:03
they they are particularly fiefdom. They always got
14:05
their own leaders. I mean, people that wanna
14:07
be leaders wanna be leaders. And and so
14:09
if you're gonna change that some, you really
14:11
have to work through aligning and talking and
14:13
and and dealing with people. Chris, let me
14:15
ask you this question. You know, there's a
14:17
three part mission, clinical care, research, and education
14:21
across often multiple different entities, lots of different
14:24
leadership.
14:26
Are there particular governance or leadership approaches? You
14:29
touched on this a little bit Yeah. That
14:30
that help to reduce those tensions among the
14:32
different missions. And and what have you seen
14:35
work well
14:36
in practice for reducing some of those tensions?
14:39
I think we we when you speak of
14:41
governance,
14:42
let me start with,
14:45
I think competency based governance is far better
14:48
than representative.
14:49
So the first mistake is
14:51
you bring people to the table based on
14:53
their position,
14:54
and they feel like they're part of a
14:56
board,
14:57
but they're not that informed. You you want
14:59
a diversity of perspectives in the room. You
15:02
really do. And you don't wanna just give
15:04
somebody a board seat for that. So that's
15:06
important. Then there's a line between governance and
15:08
leadership and management.
15:10
Right? That has to be honored.
15:11
So governance should really guide, and I'm not
15:13
preaching. I'm just saying I think this is
15:14
where I see some of the gray area
15:16
and some of these institutions.
15:17
The three part mission is something that,
15:20
you know, it's often misunderstood. So when I
15:23
talk to board members
15:24
or CEOs, there's either there's either an appetite
15:27
to learn
15:28
what those missions really are
15:30
or not, and think of them as,
15:33
you know, maybe the well, it's a cost
15:35
of doing business. Well, not no. It's not.
15:37
Right? I mean, come on. Medical education,
15:40
we we don't have a health system unless
15:41
we have a farm system.
15:43
Research,
15:45
we're we look at the discovery and the
15:46
research we've done that goes right into patient
15:48
care.
15:49
Are they all underfunded? Yes.
15:51
But that's not the issue of the health
15:53
system.
15:54
So I think it's a lot of that
15:55
is you need good governance to guide and
15:58
but then needs to be informed
16:00
and needs to be competency based.
16:02
And in some systems, there's obviously boundaries to
16:04
that because they might be their state based.
16:07
Take a moment and and define for me
16:10
in in your thought process, your words,
16:13
governance versus leadership versus management. And and where
16:16
you see those play together and how they
16:18
play together. Well, any well, you could take
16:20
any sector. Right? High performing companies'
16:23
governance is is there to,
16:25
guide the institutions,
16:27
shape its strategy, and guide it. And And
16:30
they have a fiduciary responsibility as well. In
16:32
health care, I serve on boards of health
16:34
hospitals.
16:35
You also need to be, you're accountable for
16:38
quality and safety.
16:40
But that's where it stops.
16:42
And and the leaders,
16:44
need to execute on that. So once they
16:45
there's alignment on the strategy,
16:48
on the finances,
16:49
they need to execute on that. And you're
16:51
also a voice of the community. So if
16:53
you have a diverse board, you have the
16:55
perspective of the community.
16:57
I mean, the number of of people that
16:59
approach board members
17:00
fellow board members with me, it's about the
17:03
ER, patient access, and you bring those forward.
17:05
It doesn't matter what sector you're from, if
17:07
you're a lawyer, if you're investment banker. But
17:09
you have to put the time in to
17:11
learn,
17:12
enough to be
17:14
a good effective board member. And I think
17:16
in some cases, we don't have that. We
17:18
have, a little bit of, you know, kinda
17:21
winging it, a little bit of, you know,
17:22
you're there having coffee in Danish, but you're
17:24
not really dialed in and trying to learn
17:27
that. In in in AMC's,
17:29
it's particularly hard because to learn the basics
17:32
of a research enterprise and understand that, you
17:34
know, it doesn't even it doesn't even cover
17:37
the cost of research. That's hard for a
17:39
business person from
17:40
another sector to understand.
17:42
A 100%. And and and I wanna talk
17:45
for a moment about the people aspect of
17:47
it. And, Kevin, I'll come back to you
17:49
on this. Both of you have tremendous reputations
17:52
as CEOs,
17:53
and part of that is
17:56
being gracious people and good people with people.
17:59
How do you mix that sort of being,
18:02
Kevin,
18:03
sort of balanced and thoughtful
18:05
and at the same time deeply getting things
18:07
done? And how do you think of that
18:08
in the context of leadership and management and
18:11
governance? Because I I see it in you.
18:13
I see it in you.
18:15
This this incredible ability to be incredibly knowledgeable
18:18
about the enterprise that you're leading,
18:21
very gracious with people. I mean, you do
18:23
this incredible job of constantly supporting the people
18:25
around you, as do you, Chris. You've got
18:27
a great reputation for this. How do you
18:29
do that and make sure things get done
18:31
at this balance of being gracious, thoughtful,
18:33
and execution oriented or or leadership and management?
18:37
Chris used the word competency. I think the
18:39
competency of a CEO is humility,
18:42
authenticity,
18:44
and empathy, a willingness
18:46
to understand.
18:47
I I learned it during,
18:49
COVID.
18:50
I was very proud of myself. I got
18:51
on a video. I told everybody we're gonna
18:53
bend the curve, flatten the curve, wear your
18:56
mask, and stay six feet apart. We'll get
18:58
through this together.
18:59
I was walking across to the hospital, and
19:00
one of the nursing assistants stopped me and
19:02
said, you you sound stupid.
19:05
I said, what what are you talking about?
19:07
And he said, maybe where you live,
19:10
you can stay six feet apart. I got
19:11
five kids in one room.
19:13
So what I heard you tell me is
19:15
my kids are gonna die.
19:16
And if if you're not willing to say,
19:18
I'm sorry.
19:20
Thank you for telling me. But
19:22
if if I wasn't approachable, he wouldn't have
19:24
told me that. And I would have just
19:25
kept repeating it, and most of the employees
19:27
have been shaking their heads. Right. They live
19:30
in a different world. The fact that he
19:31
was willing to tell me and then I
19:33
I and I adjusted,
19:35
that's, I think, the role of the CEO.
19:36
We can figure out debt service. You can
19:39
figure out accounting.
19:40
You can all that stuff you can figure
19:42
out. What you can figure out is how
19:45
your employees are feeling,
19:46
what motivates them. And the only way you're
19:48
gonna do that is to get out there
19:49
and and and talk to them, be approachable,
19:52
and and to admit when you do things
19:54
wrong.
19:54
Truly remarkable. It's it's fascinating.
19:57
Chris, I comment on that too, this this
19:59
mix of being a leader
20:01
and accountability
20:02
or competence to getting things done. How do
20:04
you mix both those things? Well, Kevin said
20:07
it well. I I think,
20:08
you need to be authentic. You you can't
20:10
be somebody that you're not, and
20:12
and people see through that. Right? So
20:15
you wanna be a supportive leader
20:17
and, put them in a position that where
20:19
where they feel like
20:21
it's their organization as well.
20:24
Truthfully,
20:25
I grew up my father owned small businesses,
20:27
and we took people out of unemployment lines
20:29
and never paid a minimum wage.
20:31
And they would drive through snowstorms to open
20:33
up the gas station because they felt like
20:35
it was theirs
20:36
as much as it is ours.
20:38
And I think that's what I what I
20:40
try to do. But, ultimately, you have to
20:41
be decisive,
20:42
and you're gonna get it wrong. And you
20:44
know what? Not too many leader leaders do
20:46
need to do it more as to say,
20:48
you know what? I screwed that one up.
20:50
And it's my bad, and I own it.
20:52
It's not somebody on my team. It's it's
20:54
me. It's my decision.
20:56
So when you strike that balance, you empower
20:58
people, and
20:59
and they they you hope that they follow
21:01
you. But, you do it as a team.
21:03
You try to be a we organization and
21:05
not I.
21:06
When we when we interview people, as soon
21:08
as we hear I a lot,
21:10
even if their CV looks great, we say,
21:12
thanks very much. So Yeah. But but especially
21:14
what you say about decisions. Jeff Bezos often
21:17
said, you're gonna make a lot of decisions.
21:19
Some are gonna be wrong. Some are gonna
21:21
be right, but you gotta be able to
21:22
pivot and change. It's much like when you're
21:24
talking about you gotta be six feet apart
21:26
and and somebody tells you that's not possible
21:27
for us, you gotta be able to pivot
21:28
and make that adjustment.
21:30
I mean, it I think it's a fascinating
21:31
point on decision making. You have to be
21:33
decisive
21:34
but thoughtful. Right. Decisive but humble. Right. And
21:37
and and I love that. Talk about But,
21:39
Scott, I I also think the most important
21:42
thing I do is I keep 52,000
21:44
people and their dependents
21:46
employed. They're not coming in worrying,
21:48
oh my god. Penn's losing money. We're gonna
21:50
lose our jobs. We're gonna lose our benefits.
21:52
So
21:53
you you still have to drive.
21:55
You you drive with empathy, but, man, we
21:58
have an obligation to lead.
22:00
And and it's not, I'm gonna go take
22:01
a poll Right. And see what's on everybody's
22:04
mind. But but this is very important because
22:06
you gotta be running a thriving enterprise to
22:08
be able to keep people 50,000 people employed
22:10
and moving forward on clinical research, clinical taking
22:13
care of people, and and education.
22:15
And so remarkable
22:16
mix of of doing everything and and driving
22:19
forward. I mean, same thing with you. You
22:20
run a company. You gotta make sure, or
22:22
you run a partnership, but still a company.
22:23
You gotta make sure that it's that it's
22:25
that it's working, that that things are going
22:27
well and and the same thing. So it's
22:29
humility with some decisiveness, with leading, and at
22:31
the end of the day, it's not a
22:32
poll. It's not a survey. It's ultimately you
22:34
you're gonna talk to a lot of people
22:35
and then align goals for the organizations
22:37
and the organizations that you work with and
22:39
the organization that that you lead.
22:41
Take a second. You talked about this earlier,
22:43
Kevin,
22:44
about systemness
22:47
versus operating as a bunch of
22:49
different parts,
22:50
And talk about what that what that means
22:52
to be more unified, to be more integrated,
22:55
and how important that is as an academic
22:56
health system today. So we we started the
22:59
system when we started adding hospitals,
23:01
and it was a holding company.
23:04
Right? You float on your own bottom, and
23:07
we'll add it up, and everything will be
23:08
fine.
23:09
And that doesn't work. What I've tried to
23:11
go is from
23:13
holding to operating company. I've tried to go
23:15
from being entity driven to being patient driven.
23:18
So
23:19
a patient that needs a VAD,
23:22
I want them to go to the best
23:23
place. That is not I want this CEO
23:25
playing with that CEO. That was my patient.
23:27
They shouldn't go. So we we have been
23:30
forcing hard patient centric
23:33
operating company.
23:35
Some of our entities might lose money. It's
23:37
okay if the other if they're balancing out
23:39
the because we add up the money. It's
23:41
one balance sheet.
23:43
But talk about this. Because if you went
23:44
back ten to twenty to thirty years in
23:47
mergers and acquisitions,
23:49
when some of the systems were first doing
23:50
acquisitions,
23:52
one of the selling points to people join
23:54
them was there'd be a it'd be more
23:56
of a confederation,
23:57
and there'd be lots of independence. And that
23:59
was a good selling point. And then you
24:01
saw
24:01
systems that got more mature at this
24:04
being much clearer about there's gonna be some
24:07
independence, but there's gonna be this mix of
24:08
governance because we will have to run as
24:10
a system to make this work.
24:12
Talk about watching that sort of evolution in
24:15
sort of affiliation over the years from
24:18
everybody's gonna have a ton of independence to
24:20
we're gonna mix independence with being a system.
24:23
Take a moment, and and I'd like you,
24:24
Chris, to weigh in on that too. The
24:26
the mistake we were making, and I was
24:27
at a system that we did that,
24:30
we said corporate office is gonna be a
24:31
a card table and two folding chairs when
24:33
you buy paper clips. And that sounded pretty
24:35
good to everybody.
24:37
The truth was we owned them,
24:38
and and, you know, we were making the
24:40
decisions.
24:42
Lying
24:43
or misaligning,
24:46
where we told them it was gonna be
24:47
this and it was that, just led to
24:49
a decade of Tension.
24:52
Tension and not moving forward, slowness and and
24:55
bad feelings, and nobody wanted to come to
24:57
work. So now when we acquire a house,
24:59
we tell them upfront, this is our model.
25:01
Right. If you don't wanna do it, if
25:02
you don't wanna join us, don't join us.
25:03
But this is how we have to. We
25:04
can't have independent boards every place. You could
25:07
have some independent I mean, you might have
25:09
some independent boards, but you have to have
25:11
a system. Yeah. No. You need independent boards
25:13
for joint commission for department of health regulations.
25:16
What what you need, though, and and Chris
25:17
mentioned it earlier, is competency based
25:20
board leadership. I don't need representatives.
25:23
So when we bring them together, a new
25:25
hospital might have two seats on the board.
25:28
I don't want them showing up voting
25:31
for my entity.
25:32
Right. Right? Right. Yeah. Otherwise, you I could
25:35
just call and pull the the board. I
25:37
want them showing up. How does my entity
25:39
fit in? How can I go back,
25:41
explain to the community, alright? This is what
25:43
I heard. This is why they're doing it.
25:44
So
25:45
it it it it's critical
25:48
for day one integration,
25:50
not
25:51
come in and we'll get to it later.
25:52
A 100% to be clear upfront. And we
25:54
we saw better and better organizations at this
25:57
get clearer and clearer upfront as to how
25:59
we're doing it. And we saw that evolution.
26:01
Front mortgage is doing their first deal, their
26:02
first affiliation.
26:04
Deal is such a bad word, but their
26:05
first merger, their first affiliation, their first 20
26:07
together in trying to do what you said.
26:09
Like, where everybody can be still very independent,
26:12
and over time, they have to move towards
26:13
systemness. Chris, you've been watching us for twenty
26:15
plus years. Yeah. Talk a little bit about
26:17
sort of this this evolution of affiliation and
26:20
systemness
26:21
at at at academic medical. So it's it's
26:23
transactionally, it's been going on for some time,
26:25
but but it's just recently
26:27
that they're finally
26:29
sort of waking up maybe through economic pressures
26:31
and saying, uh-oh. We need to have systemus,
26:34
which is a which is a a new
26:35
favorite word. And I and I think Kevin
26:37
said it well, and I I I think
26:39
that they're depending on the proximity between
26:43
the the main,
26:44
academic medical center and the community hospital,
26:48
What's really important is to honor
26:50
the medical community
26:52
and the community itself of that hospital.
26:55
The mistake is coming in even if it's
26:57
the right model to come in too heavy
26:59
handed. And I think Kevin pointed out earlier,
27:02
being transparent
27:03
and explaining why this is the way we're
27:06
going to do it
27:07
and bringing them to the table,
27:09
it's highly effective.
27:11
I I think,
27:12
I I'm not speaking out of school at
27:16
back to the holding company.
27:18
Mass general Brigham was partners.
27:20
It formed in 1993.
27:23
Right?
27:24
They're just integrating today.
27:27
And and and they're owning it. And they're
27:29
saying, you know, it's it's time, and it's
27:32
gonna be it's gonna take a while. Right?
27:34
And so it's a good example where
27:36
it took a long time to realize we
27:38
should do it for the patients.
27:40
Right. It's not for the money. It's not
27:42
for the if you if through the lens
27:43
of a patient at any point of entry
27:45
into that system,
27:46
they know
27:48
if a system is integrated, whether or not
27:50
A 100%. In a conference room is saying
27:51
it's integrated. It's the patient.
27:54
And their experience is gonna be defined by
27:56
that interaction with the provider.
27:59
Yeah. No. I mean, we we've seen,
28:01
locally, Northwestern some tremendous job of that integration
28:04
between their research institution
28:06
and their teaching
28:08
and their different community hospitals. And they've put
28:10
lots of resources into the different community hospitals
28:12
to make sure they are integrated, and you
28:14
feel like you really are part of a
28:15
system. And it's it's very, very important, very
28:17
impressive.
28:18
I I do think I I'd love you
28:19
to comment on this. What we see is
28:21
systems that have done
28:24
once they've done three to four affiliations,
28:27
they're much more mature in how they approach
28:29
it.
28:31
Any sense? Not not not any not number
28:33
specific, but You you mean as a trial
28:36
period sort of affiliation before
28:38
No. No. No. More that more that if
28:40
you have a system that's acquired
28:41
one community hospital, they often don't have any
28:44
idea how they wanna integrate those. Yeah. But
28:46
once somebody's done it six or seven times,
28:48
they realize, well, we did it twice that
28:50
way under one one where we think, like,
28:52
you know, we're gonna give a lot of
28:54
portal independence and so forth. And then by
28:56
the time you've done it five or six
28:57
times, you end up with exactly what you
28:58
talked about at your early system where we
29:00
thought the central office would just be a
29:02
cart table and a couple computers,
29:04
and then you learn that doesn't really work.
29:06
We we've gotta be I I I think
29:08
that we're we're I know we're talking about
29:10
it in a macro sense.
29:11
I think there's integration of policies, procedures, shared
29:15
services, infrastructure,
29:17
electronic health record. I think
29:19
you're really test it. You skate around all
29:22
that, and you go right to the physicians
29:23
and the health care professionals.
29:26
That's the hard part. Right?
29:28
Because
29:29
you're those are could be wildly different. Yeah.
29:32
A 100%.
29:33
In some of these top tier AMCs like
29:35
a pen, you have full time faculty,
29:38
and then you have a community physician
29:40
who actually might want to do some teaching
29:43
with the residents. And then there's, oh, well,
29:45
can I have an adjunct appointment?
29:47
And then the full time faculty, well, I
29:49
don't know if I want you know? It
29:50
there it's hard. It's hard. It's not easy.
29:53
And so that, I think, that's the integration
29:55
where the day that they wake up and
29:57
they feel like one unified
29:59
group of different,
30:01
skill sets and specialties
30:03
and orientation towards academics,
30:06
I think that'll be the tail wagging the
30:07
dog. That that is that's where you But
30:09
when you when you talk about like that,
30:11
that that can be a very challenging problem.
30:13
You have very different communities. You you might
30:15
have here University of Chicago,
30:18
magnificent academic medical center, and then they have
30:21
a local hospital where they're doing,
30:23
you know, the very needed work, taking care
30:26
of the community. And there would be very
30:28
different physicians out in the community that are
30:30
in the academic
30:32
center and trying to get them to communicate
30:34
and be on the same page or as
30:36
integrated as they can be. But in the
30:37
capacity
30:38
of of seeing patients
30:40
and patient care,
30:42
they're all cardiologists.
30:43
Yeah. Right? And so how do you find
30:45
that how do you find that that that
30:48
that that common ground with all of them?
30:50
They all bring something to the table. We
30:51
all have a job to do. They have
30:52
a job to do. And so, I, you
30:55
know, I think that's the part that is,
30:56
like, the hardest part. It's that Venn diagram.
30:58
Yeah. At the end of the day and
30:59
and, Kevin, you both said this really well.
31:02
You got this Venn diagram. This person might
31:04
be principally
31:05
involved in research, this one in patient direct
31:08
patient care, but the Venn diagram is they're
31:10
both deeply involved towards committed to make sure
31:12
the patient's lives get better. That's right.
31:15
Kevin, any thoughts there or anything that we
31:17
didn't touch on that you'd like to share
31:20
with listeners? And then, Chris, I'll ask you
31:21
the same question. I I think what
31:24
academic medical centers,
31:26
they reviewed as being the aircraft carrier and
31:28
all the patients flew into the aircraft carrier.
31:31
We need to blow up that paradigm,
31:33
and we need to take what we know
31:35
out to the community.
31:37
So
31:38
Lancaster General is a fantastic,
31:40
almost $2,000,000,000
31:41
enterprise,
31:43
always in the top 50,
31:44
solution. I mean, it's fantastic.
31:46
Head and neck surgery
31:48
should be done at the AMC.
31:50
Our doctors, though, they'll drive out and do
31:52
the pre and post op work in the
31:54
community.
31:55
So they're they only have to come down
31:57
one time.
31:59
The other thing that creates, though, is it's
32:01
hard to dislike
32:02
or not have trust
32:04
in someone you know. Right. Right. So they're
32:07
they're out there. They're not at the end
32:09
of 180789
32:10
Penn. You meet doctor Weinstein. You you you
32:13
see what makes them tick. You say, alright.
32:15
I can work together with him because he
32:16
values me, and I value him. He he
32:18
he's not looking at you the wrong way.
32:21
Like, you're not a trusted partner as well.
32:23
He's you're you're you're two people together or
32:26
or a team working together through things. No.
32:28
I think that I think that's fantastic. And
32:30
and and talk about that for a second.
32:32
How important is it, especially in some of
32:34
these large systems, for people to get to
32:36
know each other, you know, in in It's
32:40
a relationship. It's it's it's people fill in
32:43
the blanks and and and have a perception
32:45
until they get into the room and say
32:47
we're we're all part of the same system.
32:49
Right? We have a common mission in patient
32:51
care. And you need some leaders to step
32:54
up. You know, I was when we go
32:55
through this integration, I always over the years,
32:58
you know, you picture this line of of
33:00
senior physician leaders, and there there's some that
33:03
will take a step back
33:04
and and say, this doesn't make any sense.
33:06
There are some that stay right on the
33:08
line and say, I hope this storm passes.
33:10
And you always need a couple
33:12
and hopefully in some big departments to lean
33:14
in and say, you know what? This is
33:16
gonna be good. Let's let's shape this together.
33:19
And it makes a I mean, I know
33:20
it it sounds very basic. It's so true.
33:22
I mean, every one of those stories,
33:24
there are some leaders behind there
33:27
that that help make it happen, and it's
33:28
through relationships and trust, transparency.
33:31
And and your point, I think, is so
33:32
well taken that whether it's an affiliation,
33:35
whether it's integrating the
33:37
academic medical center mission with the community hospital
33:40
mission,
33:40
or whether it's embracing new technology,
33:43
you you need some people that are gonna
33:45
weed and wean in and and be willing
33:47
to do so if you're gonna move the
33:49
ball forward Right. If we're gonna make things
33:50
work. Yeah.
33:51
Kevin and Chris, again, we're visiting to you
33:53
with Kevin Mahoney,
33:56
CEO of Penn Medicine at the University of
33:58
Pennsylvania,
33:58
Chris Collins, the CEO of ECG Management Consultants.
34:02
What a great pleasure to visit with the
34:03
both of you. Thank you, folks. Thank you
34:04
for having us. Thank you, Scott.