Latest / Becker’s Healthcare Podcast / James Dover, President and CEO, Avera Health

Transcript

James Dover, President and CEO, Avera Health · Becker’s Healthcare Podcast

• 0:02
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• 0:30
  Hello, and welcome to the Becker's Hospital Review
• 0:33
  podcast. My name is Will Riley from r
• 0:36
  one.
• 0:37
  Today, I am joined by Jim Dover.
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  Jim is president and CEO
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  of Avera Health in South Dakota. Welcome to
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  the podcast, Jim. Thank you. Glad to be
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  here.
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  Let's start by telling us, please, a bit
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  about yourself. Tell us a bit about Avera,
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  the community you serve.
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  Set the scene for us. Sure. Sure. Well,
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  I'm president CEO. I'm about forty years into
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  health care leadership, bacteriologist
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  by training,
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  and, found that I didn't wanna stay in
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  the lab all my life. So went on
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  to get my master's in hospital administration and
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  never looked back. So it's great.
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  Vara Health,
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  four states,
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  that we cover about 72,000
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  square miles. We're about a $3,500,000,000
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  integrated health delivery system
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  across South Dakota,
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  Minnesota, Iowa, Nebraska.
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  And,
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  we also have a very large ambulatory platform.
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  We have over 300 clinics, probably do over
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  2,000,000,
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  clinic visits a year.
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  And we also have a provider owned health
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  insurance company along with long term care and
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  post acute care. Excellent. Okay.
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  What's what's on your mind as an organization
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  as you go into 2026?
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  What are some of the key the key,
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  priorities that you're you're looking at? Yeah. So
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  probably about three. First, we just, launched,
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  our three year strategic plan,
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  called Luminate. And so we wanna make sure
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  that we effectively,
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  operationalize
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  the strategic plan. We had over 200 stakeholders
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  write the plan, so we feel pretty good
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  about it. Number two is,
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  we're converting our electronic health record
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  to a new system.
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  And,
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  it's really no longer an EMR. It's an
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  electronic health information system, not a medical record.
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  And so the operational changes necessary for something
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  like that across our, you know, 300 plus
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  sites of care
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  and, is pretty,
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  phenomenal. So that's gonna happen in the late
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  spring.
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  And then the third one is we're a
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  Catholic health organization,
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  and,
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  some of our legacy facilities have been in
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  the Upper Midwest for well over a hundred
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  years.
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  And so adapting and changing to the current
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  environment and the future environment in a world
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  that is becoming more and more secular,
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  I think sometimes is a challenge for faith
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  based,
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  health care organizations.
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  Got it. Okay. Thank you for setting the
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  scene. I'm sure we'll come back to some
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  of those things as we talk. I want
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  to start by talking a bit about technology
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  and new technology. Yeah. Healthcare's
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  sort of historically moved relatively cautiously
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  when it comes to new technology.
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  Is that still true, and is that the
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  same with AI, or
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  or or do you see a difference in
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  how health care is using and adopting new
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  technology? Well, I think the jury is still
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  out. I think that some some health care
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  organizations have been, you know, pretty good to
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  adapt to new technology from partners they trust.
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  And,
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  there but some have been too faddish, and
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  so we all know about those
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  scary stories of jumping on a fad too
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  quickly
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  and then finding out that it fizzles out.
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  So,
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  so I think some of us are more
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  cautious than others. That being said, I think
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  when it comes to AI, what is truly
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  different about AI, for me personally, I believe
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  AI will do
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  to data and information and health information
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  what the Internet did to how we communicate
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  with each other. I think it's that big
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  of a sea change.
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  So for me, I think it goes one
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  or two directions. There are those who say,
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  we are an AI company. We're developing
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  AI.
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  And here, you know, we want to be
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  your AI partner.
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  Now use our tool across your entire platform.
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  And then there's the other route, which is
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  our trusted electronic health record system or HIS
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  system. They've adopted h AI tools. And the
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  one we're going to has, you know, 70,
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  and they're gonna be at a 100 by
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  the time we join them.
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  And so
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  do we say, nope. We're picking AI. Now
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  everyone is gonna use it, or do we
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  say, how have you
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  as our trusted partner,
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  whether
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  it's radiology,
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  laboratory, the list goes on, how are you
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  using AI to better the patient clinical outcomes?
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  So I see that kind of be the
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  two tracks. Mhmm. I think for us, we'll
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  probably be the latter, not the former, with
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  a few exceptions.
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  We actually,
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  use ambient listening in all of our clinics,
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  and the data after a year of using
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  and implementing it is in.
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  And, basically, the the providers, the physicians have
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  said 63%
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  increase in satisfaction for them from a work
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  perspective. And, you know, physicians historically have really
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  struggled with the amount of time it takes
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  for,
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  the the,
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  computer piece of their job. Mhmm. And and
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  plus, they have it's reduced their cognitive burden
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  by 51%.
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  Mhmm. That's a pretty outstanding result. Now there's
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  a company we use for that. This is
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  their product. This is what they do, and
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  it integrates into our electronic health information system.
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  So I think it's gonna be a hybrid,
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  but it's mostly trusted partners. How have you
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  adopted it, and how does it apply to
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  the needs that we have? That's and and
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  yeah. So that trusted partnership way is the
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  how you're thinking about it because Yeah. I
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  wanted to ask you about there's a there's
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  a couple of archetypes in health care innovation.
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  Right? There's there's incumbents and in insurgent. Yeah.
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  And you've got the incumbents maybe who are
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  your established,
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  maybe players in general. Yeah. Be they providers,
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  payers, or big technology providers. Yeah. And then
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  you've got your insurgents who are, you know,
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  knocking at the door. Right. And so the
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  way you look at it is,
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  leaning more towards your
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  incumbents and and adapting this new technology
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  in line with those relationships.
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  Yeah. Yeah. I would add another nuance to
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  it. If and this is an important nuance
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  to me. Yeah. So
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  there are groups that we work with, and
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  you have to go back to organizational
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  intent.
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  So, you know, there's some really large payers
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  out there that have demonstrated through the use
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  and adaptive, AI technology. They don't have good
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  organizational intent for us as a provider. Uh-huh.
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  K? Mhmm. And so as a result,
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  just in this last year, we've terminated two
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  of our provider contracts with MA plans Mhmm.
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  Because their intent
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  using that technology is not to further patient
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  care. Yeah. And the intent was exact opposite.
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  It was in order to enhance their stockholder
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  premiums
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  or payouts
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  versus other organizations
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  who might be a start up, and they
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  and the Ambient Listening is a great example.
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  We used a start up company Mhmm. That
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  got a great product, solved our problem, but
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  their intent was they go, how can we
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  actually make the physician's life better? Mhmm. And
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  so, again, understand what's the intent behind why
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  they're using the technology. That's who we're gonna
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  partner with. Yeah. And that's who we will
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  use. Uh-huh. And so we always go to
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  what's your intent in using the technology? Yeah.
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  And then we let the conversation go from
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  there. Yeah. Okay. Makes makes total sense.
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  You you brought up payer relationship there and
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  payer dynamic. I'm curious what you think about
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  whether some of these new technologies
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  are going to help improve
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  what's been a troublesome relationship for many. Yeah.
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  What do you think about that? Oh, I
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  think it can. Yeah. Yeah. I think it
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  can. And we have to we on the
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  provider side now remember, our organization, we have
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  both a health insurance company, and we're on
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  providers. So we have both sides of the
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  house on that one. So we see the
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  AI technology on provider side of you know,
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  this can get a whole lot smarter for
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  us when it comes to, you know, if
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  there is, fraud, waste, and abuse,
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  it actually makes it a whole lot better
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  to get narrowed down and actually find the
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  real stuff versus casting this net that's so
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  broad and everybody gets caught up in it.
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  And then on the provider side, when it
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  comes to population health, you know, our ACO,
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  accountable care organization that we have, we have
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  saved the federal government money the last three
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  years running. Now we have to share it
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  with them, and then we get to keep
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  some of it. But, you know, at the
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  end of the day,
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  we are using those tools to actually
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  reduce admins per thousand ER visits and make
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  best care appropriate and those sorts of things.
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  So I think,
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  I think it it can actually improve our
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  relationship
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  versus the fractured nature that we find ourselves
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  in today. Yeah. And and that's through improved
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  visibility
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  and maybe technology that is providing a new
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  platform for collaboration Right. Claim adjudication and so
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  on. Right. And there are some there are
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  some payers out there quite honestly who say,
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  here's your data. Here's everyone's data. And so
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  that's wonderful. And there are some who go,
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  no. We hold the data. Mhmm. We're only
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  gonna give you what we want you to
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  see. Mhmm. That goes back to organizational intent.
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  Look. If we wanna improve it for everybody,
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  we want to, again, only the correct utilization,
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  better better clinical outcomes,
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  reduce morbidity and mortality, give us all the
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  data. Mhmm. If you don't wanna share all
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  the data, then why not? Yeah. Fair enough.
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  Staying in the administrative realm,
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  we see a shift in health care administration,
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  financial administration in particular,
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  from what's been a very labor centric paradigm
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  to much more of a technology centric paradigm
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  linked to all of the things that we've
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  been talking about.
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  How how is that, playing out for you?
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  Well,
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  it's interesting. Now we're we have a big
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  rural footprint. Right? Mhmm. So you have to
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  think about, okay, how does that work in
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  that big rural footprint? Right. And so, you
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  know, we've tried where, you know, you have
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  this small clinic in the rural area that
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  you only get so many dollars, and so
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  people have to wear a lot of hats.
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  Right. And so, you know, we experimented with
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  kiosks, you know, too cost prohibitive
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  and work, you know, etcetera. So we don't
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  do that from a technology. So so but
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  the technology of kiosks might be very appropriate
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  in a very large urban environment.
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  So instead, what we do is we use
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  you understand telehealth, we use teleregistration.
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  So the clinic visit, the patient's there, but
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  they can actually go and see a live
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  person on a screen, and they do their
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  registration
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  through our centralized
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  registration group. Right? So we're using technology to
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  help,
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  utilize our our labor resources to the best
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  way Got it. Possible. Yeah. And in another
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  location, we actually have patients who self room
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  themselves to the clinic room. Once they register,
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  they're given a they're given a a number.
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  And then when it shows up on the
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  screen, tells them what room to go to,
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  and they self room themselves to the room.
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  So, yeah, technology can actually help you turn
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  that curve. Yeah. But, again, it sounds like
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  it's all about trying to making sure it
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  fits in with the Exactly. The one size
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  doesn't fit. Setting Yeah. The objective that you're
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  trying to deal with. Right. Yeah. Yeah. Yeah.
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  Makes sense.
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  You've talked about using new technology. You've talked
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  about using AI technology. Has that brought any
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  new challenges to you as a c suite
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  leader in terms of governance and oversight and
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  Absolutely. Yeah. Okay. Oh my gosh. Okay. So
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  and we now and guess what? We now
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  have a governance committee, and it's got the
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  right people on it and those sorts of
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  things. But I think the most glaring example
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  is, you know, our CIO walks into my
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  office and says, just wanna let you know
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  we shut it down. I mean, that's how
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  you opened up the conversation. It's like, well,
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  shut what down? Said, well, we had a
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  couple of clinics that they went and got
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  their own,
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  ambient listening and said, hey. This works great.
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  Linked it into the system.
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  Of course, there's all kinds of problems. Like,
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  how did they do that in the first
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  place? But they kinda, like, did the SubRosa,
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  you know, acquisition of software and implemented it.
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  And I it's like, love the creativity, love
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  the initiative, but there are a few steps
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  to go through, like a BAA agreement and,
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  you know, have they passed an IT security
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  test and and that sort of thing. So
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  so what happens is when it starts to
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  spread so fast and people have it in
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  their home Right. And if you haven't been
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  keeping up as a system or an organization,
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  they're bringing it whether you want them to
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  or not. They being our our people. So
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  cute. And they're our most valuable assets. So
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  you better keep up with them. And I
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  think that's been our biggest challenge. So we
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  do have a governance committee.
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  It's not that big, but we have all
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  the right representation. We have three subcommittees. So
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  we think we have a better handle on
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  it today, but there is a point where
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  it's like, it was coming faster than we
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  could keep up with. Yeah. Okay. And have
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  you had
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  new roles in the c suite or near
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  the c c suite because of that? Or
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  is it a bit more about just like
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  No. It it it's we all have to
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  be ex non experts. We all have to
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  be content
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  savvy about AI. And then how does that
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  how is that going to improve our future,
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  really improve our clinical outcomes?
• 12:48
  Yeah.
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  Now I would tell you that cybersecurity
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  ends up being the role that we have
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  really had to beef up that department. Yeah.
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  Because,
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  with AI comes bad actors. Right? So we're
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  not sure anyone's using AI. So the people
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  who wanna hack, the people who wanna get
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  ransomware, they're using AI too. Right. And so
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  now the phishing attempts have gotten incredibly,
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  incredibly
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  sophisticated
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  where my staff are getting they'll get a
• 13:14
  cell phone text saying it's me,
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  and they'll say, can you get a, you
• 13:19
  know, go ahead and, you know, do a
• 13:21
  whatever or do a password reset and those
• 13:23
  sorts of things. So so we have to
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  be we're finding that, we've had to beef
• 13:28
  up cybersecurity.
• 13:29
  Yeah. Yeah. Okay. Yep. Make makes sense.
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  Let's let's round it out then with with
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  with your maybe your your hopes.
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  You've talked about using new technologies from different
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  different vantage points. But if you think about,
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  like, what you what you hope some of
• 13:44
  these new technologies are gonna be able to
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  to do. What what does it look like
• 13:48
  if you're a patient or Yeah. A provider
• 13:51
  or an administrator?
• 13:52
  Like, how Yeah. Yeah. Well, you know, and
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  I've been a patient in, you know,
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  in one of my hospitals before where I
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  was very sick.
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  And I looked at all the staff who
• 14:02
  were working so hard to make sure that
• 14:04
  I made it out after nine days in
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  the ICU.
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  And,
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  and I couldn't help but think that
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  if AI was looking at all my clinical
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  data
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  saying,
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  I think this is what's going on because
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  they're trying to figure out what's going on.
• 14:22
  Mhmm. And they did, but I can't help
• 14:24
  but think that AI couldn't have turned the
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  flywheel
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  faster. Mhmm. And,
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  so I what I hope for it is
• 14:32
  that for our clinicians
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  who,
• 14:36
  are taking care of our patients
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  is that the AI is becomes this assistive
• 14:41
  tool that says,
• 14:43
  you know, doctor James,
• 14:45
  you know, your patient 02:30
• 14:47
  a, you know, there overnight. Their vitals went
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  to
• 14:51
  and therefore,
• 14:53
  they're kinda like first on your priority list
• 14:54
  to see this morning. Because what we rely
• 14:56
  on right now is our nursing team
• 14:59
  to do clinical reviews and to shift reviews,
• 15:01
  and they review it. And then they go,
• 15:03
  I think I'll call doctor James because I
• 15:04
  think this patient something's not right. Mhmm. AI
• 15:07
  should be able to say what's not right
• 15:09
  and be able to put it on a
• 15:10
  priority list and notify both the nurse and
• 15:12
  doctor James at the same time to and
• 15:14
  then we can use nursing
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  for let them be even function at a
• 15:19
  higher level Mhmm. And not overburdening them. So
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  I think if AI can help them with
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  that, that'll be great. If it's just one
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  more key to hit on the keyboard, I
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  think it'll it won't work. So that's one
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  hope. The second hope that I have so
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  I have two hopes.
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  And that is when it comes to management
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  decision making,
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  when we make really big decisions, has anyone
• 15:39
  yet given all the input into whatever the
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  AI
• 15:43
  technology is and say, what do you think
• 15:45
  we ought to do? Because we stand in
• 15:47
  front of boards and say based on our
• 15:48
  judgment and based on this information, that information,
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  you know, we made a $300,000,000
• 15:54
  capital decision to build something. And we never
• 15:57
  went to AI and say, what do you
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  think our probability of success on this is?
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  I I think there could be a way,
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  and I don't I'm I'm not worried about
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  it taking away leaders. I just and again,
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  assistive tool if it's a good enough assistive
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  tool for clinicians, it should be a good
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  enough assistive tool for leaders in terms of
• 16:15
  their decision making. So we can't say, hey,
• 16:17
  docs. It's good for you. Use it. But,
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  oh, no. Don't bring it to c suite.
• 16:21
  Doesn't work that way. Right. Right. Right. Any
• 16:23
  other hopes or thoughts for 2026? At the
• 16:26
  start, you mentioned
• 16:27
  Luminate.
• 16:28
  Do you wanna end by telling us a
• 16:30
  little bit more about that? Sure. Yeah. No.
• 16:32
  Our strategic plan, we have five pillars, and,
• 16:34
  you know, we're very excited about it. And
• 16:36
  one of our key,
• 16:38
  pillars is,
• 16:39
  it's interesting.
• 16:41
  Our first pillar is all about the exceptional
• 16:43
  patient and employee and community experience. It's our
• 16:46
  culture. Mhmm. And we feel that our culture
• 16:48
  is so strong that actually people are coming
• 16:50
  to look to work for us because of
• 16:51
  our culture. May not make as much money,
• 16:53
  but it we brought back the enjoyment in
• 16:55
  terms of health care and why they got
• 16:57
  into it in the first place. So,
• 17:00
  that's really important for us as an organization
• 17:02
  and our faith based organization.
• 17:04
  And then, and we have a number of
• 17:06
  and we have to continue to innovate, I
• 17:08
  mean, across a big rural platform. If we're
• 17:10
  not innovative, then, you know, we have a
• 17:12
  real tough time.
• 17:14
  Number three is our dynamic physician and provider
• 17:16
  enterprise. You know, we employ over 1,300 clinicians.
• 17:19
  Forty two years, I've never admitted a patient.
• 17:22
  So if that if that has got to
• 17:24
  work really well because because that's where our
• 17:27
  patients interface with us is with our clinicians.
• 17:30
  And then,
• 17:31
  the fourth one though is growth. So I
• 17:33
  see us growing. We have to continue to
• 17:35
  grow organically and otherwise
• 17:37
  Because in today's environment,
• 17:39
  size and scale matters. And, you know, when
• 17:41
  I say 3,500,000,000,
• 17:42
  I go, wow, that's kind of a big
• 17:43
  number. But, you know, five years from now,
• 17:46
  it's gotta be a bigger number just in
• 17:47
  order to stay,
• 17:49
  a strong, thriving, independent organization. And then the
• 17:53
  last one's leadership and essentiality.
• 17:55
  You know, we have to be essential to
• 17:56
  our communities.
• 17:57
  And if we're essential to our communities, then
• 17:59
  we know we're doing a good job. So
• 18:01
  those are the big five. Wonderful. Yeah. Jim,
• 18:03
  thank you so much for talking to us
• 18:05
  today. For having me today. Great.