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 Thanks for joining us on this week in Health IT Influence. My name is Bill Russell, former Healthcare CIO for 16 hospital system and creator of this week in Health. IT a channel dedicated to keeping health IT staff current and engaged. Today we have a treat for you. We are joined by Scott Becker of Becker's Healthcare founder of not only the conferences, the media assets, but also the Becker's Healthcare Podcast, and he's just a wonderful individual, easy to talk to, which is why his podcast is one of the most successful podcasts I.

In the industry. He talks to all sorts of people and we talk to him about a wide range of topics. We talk about the presidents that have come to the Becker's Healthcare Conference. We talk about the leaders that he's talked to, what makes a successful leader, and, uh, what's going on in healthcare. So we have a great visit.

I think you'll really enjoy it. Special thanks to our influence show sponsors series, healthcare and health lyrics for choosing to invest in our mission to develop the next generation of health IT leaders. If you wanna be a part of our mission, you can become a show sponsor as well. The first step. It's to send an email to partner at this week in health it.com.

Just a quick note before we get to our show. We launched a new podcast today in Health it. We look at one story every weekday morning and we break it down from an health IT perspective. You can subscribe wherever you listen to podcasts at Apple, Google, Spotify, Stitcher, overcast, you name it, we're out there.

You could also go to today in health it.com. And now onto today's show this afternoon, we have Scott Becker, partner at McGuire Woods, and publisher and founder of Becker's Healthcare and a lot of other things with us. Good afternoon, Scott. Welcome to the show. Bill. Thank you so much for having me. What a great pleasure to get to visit with you.

Thank you so much. Well, I'm, I'm really looking forward to it. It's, I, I feel like I'm on the show with a celebrity. I was out to dinner last night with somebody. And, uh, he goes, well, tell me what you do. I said, well, this is what I do and whatnot. It turns out he worked for one of the healthcare companies in, in Chicago before he retired.

He goes like, who do you interview? I said, tomorrow, I'm, I'm with Scott Becker. He goes, Scott Becker. Oh my gosh. It's like, I feel like everyone knows who you are and you do have. I think one of the most distinctive voices in all of podcasting. Thank you, bill. It's, when you say celebrity, we think of a, B or C list celebrity.

But thank you for having me and I appreciate it and it's great fun. It really is. It's, you know, as it's great fun to get to visit with lots of different people, to see what they're thinking, see what's going on and, and just a pleasure. Yeah, I, I've joked and, and maybe you feel this way too, I've, I've joked that the podcast for me is really the education of Bill Russell.

I get to talk to so many phenomenal people, and they just share their insights and their, their wisdom. And just after a while of being around it, you just, you pick up so much stuff. What a great industry to be a part of. People are just so willing to share and help each other out, and so it, it is really fun.

So you're doing a lot of podcasting. You not only have the Becker's Healthcare podcast, you have the private, uh, is it, is it called the private equity or business podcast? What, yeah. Really a private equity podcast that we sort of, it's more of an advanced hobby than a business, but private equity and, and some business generally.

But those are, those just gimme an opportunity to visit with some other people and see what's going on and learn. And connect. So, but yes, the, the principle thing I do is Becker's Healthcare. I'm also a lawyer by background, but, but my life really rounds first and foremost from Becker's healthcare and secondary around being a lawyer, at least by background.

Yeah, a lawyer and a degree from University of Illinois in finance. And you are almost like, like me in that you've had multiple careers. Yes, we've had concurrent careers. So yes, university of Illinois finance, cpa, undergrad, Harvard Law School, excuse me. And then for better for worse, and then have really practiced law for the last 30 years.

A long, long time ago when I was starting to practice law, I started the Becker's healthcare media business and ended up sort of doing those things concurrently. And they, they were, they were very guy, they were synergistic for a very long time. And so we had had the fortune of . Building great law practice, but then also having building Becker's.

Healthcare started off as sort of a legal marketing type thing, a hundred years ago, 30 years gonna be exact, and turned much, much more into the centerpiece of my professional life. And what really happens is at some point I ended up hiring magnificent people there. I. They really built Becker's Healthcare into a serious franchise and, and Jessica Cole, our editorial team and some others.

Yeah, Katie Atwood, Bob Gamble. They really built it into a real media enterprise and it's been great fun, but we sort of did 'em all concurrently and it, well, they sort of fed off each other and just kept on doing it. No, great brilliance, but being in specific niches, in hiring great people and, and great fun.

Yeah. Well, last do LA Last year was an interesting year and you guys pivoted pretty quickly. The The Becker's Podcast felt to me, the healthcare podcast felt like it came outta nowhere, and then it was a podcast. Started producing. I, I don't, it felt like 10 shows a week almost. Well, even more than that, actually, a crazy number of episodes.

But what, what really, at Becker's Healthcare had always been about 50% digital, about 50% events, and, and some portion of that being a print magazine. But the print magazine was never more than five to 10% of the enterprise. We were fortunate to already be a 50% digital type of business, and podcasting ended up fitting sort of within that.

and what happens is we, we had started doing it two and a half years ago, but during the pandemic, all of a sudden the numbers of listens to podcasts and downloads just jumped as you saw. And so. We ended up doubling and tripling down on the amount of them and, and of course originally a lot of our business in Beckers Healthcare was these in-person meetings where you and I have met before, but those were of course off and canceled last year.

So we ended up having a tremendous amount of time to do more of this and, and a tremendously interesting year in terms of the healthcare information world. Just in terms of like, obviously Covid 19, the digital transformation and health equity issues. So many interesting issues that people wanted to talk about.

We had started this two years ago. In the first year of doing podcast, we had 143 downloads to give you a sense of scale, and one of our months, last couple months, last month, we had 250,000 downloads, just as an example of the difference in the amount of listenership from when I started. And it's discouraging when you start.

140 people listen to it the entire month. You probably had several episodes. It's all discouraging, but it's, it's grown a great deal and it's been fascinating to just hear what's going on. It really gives you a chance as you in, in a very quick way to understand what's going on. Yeah. We, we trying to, we, we could relate on so many different levels.

So my, my first podcast was downloaded 28 times and it was, it was after that was downloaded. But I'm just gonna commit to doing this for a year and see where it goes because you just, you can't look at the numbers when you're first starting out. And then this wave, I. The last, uh, you know, over three or four years, it's been amazing.

Yeah. Well, and you've hit it right down the middle and this week in health It, which is just a, a fascinating area and you've got this great sort of, uh, perspective on it from your years of serving as ACIO too. So, sort of a fascinating, I mean, you've hit it just beautifully down the middle. Yeah, so, uh, I, I went out and went to the community this week in health IT community.

I said, Hey, I'm, I'm interviewing Scott Becker, do you have any questions? And the questions started flooding in. So, a, a bunch of these questions are really from, from people out there in the community. So this, this should be interesting. I, we'll start with the easy ones. Best moments from the interviews, uh, so far from the Becker's Healthcare Podcast?

Sure. So that's, that's a great question and it's hard to, it's, I'll give you specific themes as opposed to exact moments, but I, and I'll talk about some different speakers and there's obviously some really critical leaders in the healthcare community. Whether Janice Biso at UCLA, gene Woods at Atrium Health, Mike Dowling at Northwell Lloyd Dean in Common Spirit that have provided fascinating listening to hear their perspective on what's going on and with Covid and with health equity and so forth.

So those are those kinds of interviews with some of the people that are right in the middle of the game. I'll talk again to Mark Harrison, the CEO of Intermountain tomorrow or, or Monday and, and those are fasting perspectives on just what they're seeing. But in addition to those, I get a chance to talk to people at every sort of like size and position in healthcare, not just CEOs of the Matrix.

And some of the things that I find the most fascinating are I talked to the CEO EO of a smaller health system last year, and we often ask the CEOs. What are you thinking in terms of strategy? How has strategy evolved in the last couple of years and, and the standard industry you'll get from people is, well, strategy hasn't changed that much, but we've made some pivots and I think I-A-C-E-O last week say, what have you seen in terms of strategy evolving?

And she had the, the wherewithal to say, well, it changed completely. We had, we had to sort of completely throw it out the window the last year and re-figure it out and re-look at what we're doing and so forth. And, and I find those kinds of discussions so refreshing. Just so refreshing. Like, I mean, of course this is hit us outta nowhere.

Yes. We're still serving patients. Our number one priority is, is. Great quality and, and connectedness with patients and so forth, but strategy, we had to reeve it and so forth. So that's, that's always fascinating when somebody talks typically than the rest of the tribe. The other people that I find so fascinating to talk to, I find as interesting as anybody to talk to, and, and so many people in healthcare fit this category, they're first generation immigrants or second generation immigrants.

They're from India, from Africa, from wherever they might be. And, and I find the perspective so fascinating because they have such a different worldview than we do. And I enjoy those so much. And we talk so much about, well, was healthcare like in I Jerry, what was healthcare like in India? How does it look compared to here?

What do you think? How was training? Talk to somebody last week, a woman doctor from Nigeria, her mother's a doctor, and now her daughter is finishing. Medical school at Mayo Clinic, so three generations of of African American doctors from Nigeria. Those to me, are very special moments. I mean, they give you a fascinating human perspective on everything versus the Here's what's going on.

I mean, there's other guests, Steve Klasko, we've had on a number of times the CEO Jefferson. I could talk to Steve Klasko all day. He's just way out in front of digital transformation. Very, very smart. Amelda Decon who's with Kaiser Permanente always man, gives us a doc. Deep perspectives on leadership as well as on health equity, as well as gender issues in healthcare and how women have been treated and not treated and stuff like that.

Fascinating. But there's just a whole host of people I find, just fascinating. But I do love as much as anything, talking to doctors, you know, or early leaders who've immigrated here. First, second generation, have just a whole different world perspective. I I as much as anything I. People ask me, it's like, or do you think you'll go back to being ACIO or that kinda stuff?

Do you, you know, do you really like what you're doing? I'm like, I love what I'm doing. This is I to get to talk to these people and to hear their stories and to ask them the questions that get, get that knowledge out into the industry. It is so much fun and it is so great to, to meet those people. And it sounds like, I mean, when I hear you talk about it, you, you light up as you talk about all the people you've gotten to talk to.

One interview that does.

Michael Dowling really during almost the, the height of the pandemic last year, and he was just sharing the burden on the, the frontline care workers and those kinds of things. That was, I mean, that was a, a pretty powerful moment and I. I, I, I really appreciate you, you know, you have access to so many people within healthcare.

I'm just so glad that you're not focusing just on the celebrity CEOs, but that you are going pretty broad across the, the entire industry and pulling those stories out. Oh, we, we love it. I'll make one comment. Mike. Mike is a fascinating individual. He's also an immigrant from Ireland. I'm not, he's an immigrant from Ireland, but he's a fascinating leader, and yet he's got this, this huge brain.

Crazy personal skills and he deeply cares about everything. I mean, and it's this huge mix of talent, which is very smart, very motivated, and deeply caring and, and incredible personally gifted personal skills, but incredible caring. When you talk to, when I, when I find fast about Mike, Mike himself, magnificent, but when you really get the measure of a person is.

Whenever I get a chance to visit with any of the senior leaders, men or women at Northwell Health, it all comes back to the leadership culture that he's built there. Lots of highly talented people that have the same vision of compassion and energy and, and wanting to do caring great things, and that's more the measurable leader to me than that leader speaking themself.

It's what all their other team speaks of and how they talk and, and the, and the quality of leader that he's been able to attract and keep and retain and, and groom. So as I find that to be the biggest compliment to some of these leaders is the leaders around them and that they've grown with and how they speak of them and speak of the system.

You getting onto some of these other questions the, because it feels to me like you and I could probably talk for the next five. You've had a bunch of US presidents at the S Conference and a bunch celebrities, high profile people. Which, which president's current past with their grasp of healthcare, really understanding the healthcare issues.

Sure. So it's a, it's a, it's a great question. So I've got three perspectives on it. I've had, in terms of actual presidents. President Bush and Clinton, um, and Hillary Clinton as well, and, and, well, Hillary was not president, but so she's got the greatest grasp of the three of them of healthcare issues by far.

I mean, just, she's got the most depth of any of them on actual healthcare issues by far. And that's part of how her mind works, how she approaches things and so forth. She is really, does the beauty of healthcare. One of the great things about healthcare is every single one of us, aside from whether we're involved in the healthcare industry.

A consumer, so, so in some ways you can't really fool anybody about the healthcare system, at least anybody that's listening or trying to pay attention, because we're all consumers as well. So we see it from both sides. But I don't, I don't, I do find often that the grasp of the senior most. Presidents, et cetera, et cetera, is is fine.

But plenty of people have a better grasp of some of the healthcare issues specifically than they do. It doesn't mean that other people are better leaders than they are. I mean, George Bush, magnificent personal leader, bill Clinton, the absolute pleasure and fasting to listen to Hillary's got the greatest depth on the healthcare issues itself.

Whether you agree with her, where she's at, in them or not. And then there's on the right and left. There's so much sloganeering on the right. It might be free market for everything. And we know it's not free market because 50% plus is paid for by Medicare or Medicaid. It's already 50% of government market no matter what.

And on the left it might be Medicare for all, but we know that only 14% of the population is covered by Medicare. So if you move to Medicare for all. Be prepared for a huge amount of unexpected consequences. And it's not that I'm a pro Biden Antibi either way. I try to be as impartial constantly as I can be.

But the concept of incrementally changing Medicare from 65 to six or something like that is to me far more appealing. Then completely disrupting and changing the system. And so because there's only 14% of us are covered by Medicare, I'm not covered by Medicare yet, but I will be not too long, but it's a small percentage in total, in total of the population.

So I find that of the three is, oh, Hillary's not a president, but, but it just comes to mind and excuses my senioritis. But she is, she had the most grasps of Bill George and her. I had the pleasure of being in law school with President Obama. We didn't talk about healthcare, but he also was an absolutely fascinating leader.

I had a chance to have President Obama as a student in a class that I was the TA for, which is daunting 'cause President Obama was far, far smarter than I was. And so what Barack would do is he would say in the class when I was explaining something, he would say, I. This is, I think, what Scott means to say.

And, and, and, and, and the thing about President Obama, I mean, he's, he says, I don't agree with all his policy positions, anything like that, but he's a absolutely wonderfully bright and nice person. And so he was able to handle this with a glass of like 12 people and not embarrassed me while having a brain that was just far deeper than mine.

He's just a very, very bright, bright person, and so I've had that experience with, with all three of them. I mean, obviously. We would've loved to have President Trump as a speaker. The world's become so right now, just because he's so combative and interesting. I mean, it's interesting is entertaining. When we went to try and get him as a speaker before he was president.

Before he was such a lightning rod. The cost of President Trump was so crazy before he was president that we couldn't do it. It just didn't make sense. Now, at some point we'd love to have him as a speaker. We try and be balanced completely. So if we had him as a speaker, we'd also have President Quin as a speaker, or Stacy F as a speaker as, or NCE as a speaker.

But today. The world is so combustive that we couldn't do it without people going crazy. Oh my God. You can't have him as a speaker. You can't have version speaker. We get an equal amount of people upset when we have a right wing politician or a Lefting politician, and, and so the best that we try and do is balance it out.

But Scott, I mean, so this is one of my passions in this, in this role. We've gotta get the conversation going again. It's like we have to jumpstart it again where, how do we get people to sit across from each other and just start to dialogue? Just start to, I don't know, to listen to each other, to have the conversation.

What I hear you saying is, let's bring these people back into the, the room together regardless. At any time, whoever's speaking is gonna be speaking, you know, to audience.

You can be more off base, but at least let's get the conversation going. No, we, and we try and hit it as much as possible and it fires down the middle. And it's truth on almost all issues is, is somewhere in between on all these things. And so, so we, we try and do foster that. It's become harder today just because the world has become so binary.

As you said, the 50% issue. So we try and make sure if we're doing either, we do both. Yeah. But it, but it's constantly a fascinating thing, but I, I, I find talking, I mean, president Bush is about as nice a person as they come. Hillary Clinton is also, you couldn't find a more pleasant person to be around.

You just, you just couldn't. You just, it's just not possible. She's is like when you actually meet her in person with your right wing person or left wing person. No matter what you see on tv, what you hear, what you do, she's just an absolute pleasure and that surprised. I didn't expect that she just president.

Bush. President Clinton is also a pleasure, but in a different way. I mean, he's different than the two of them, but incredibly gifted and a politician that fits a mold that you almost can't have today. He was a social liberal and a financial conservative, and that world is almost lost today, even though so many people in America really fit down that profile.

Yeah. We, we could talk about presidents for, for a long time. I mean, the, the one thing I've heard about presidents, one of my friends, his father had to interact with each president over, uh, multiple years. And it was, it was George Bush, Sr. Bill Clinton and then and w. So he had interactions with all of them, and I said, what's the thing that stood out with you?

He goes, first of all, when you meet 'em, there's a presence of the office that just is there. He said, the second thing is it didn't matter what their politics were. They were just the most. Engaging people you ever come across. They, they got be president because they are engaging people, they're warm, they're charismatic, they know how to, to have conversations with people from both sides of the aisle.

And he said, that's the thing that really strikes you. I mean, you. They get painted as something in the media, but when you get to meet them on a personal level, that's really not how it's painted in the media is usually not who they're, but I think Bill, you fit that exactly what you're struck by when you meet them and get to visit with them.

They all have crazy personal skills. I mean, incredible personal skills. They're just incredible at it. And you wouldn't know it from seeing them on tv. But you meet Hillary in person and she sits with my parents. My parents are in love. They, they wonderful and and they tend to be, my parents tend to be Democrats themselves.

I tend to be more centrist, but I just absolutely love being with her. And President Bush, you talk for three minutes with 'em, you have mutual friends and he talk to three years later and he either he is great at notes or he's just personally great at it, whatever it is. You feel very, very good about visiting with them.

They're very, very good at it, president. Good. And we've had a couple times, and it's just a little bit different because he's, he, he holds himself in a higher, he doesn't get as down to earth as you in the same way, but it's got this incredible, incredible following and, and incredibly talented personally as well.

All right, so let's, let's get into healthcare. How would you assess the state of US healthcare today? How are we doing? Let's quantify it a little bit. How are we doing with regard to the triple or quadruple aim? Sure. So how do you look at the US health system? The US health system is magnificent and has huge challenges.

I mean, you have to take this in the context of we're serving 330 million people. So after India and China, we're the largest country in the world serving a lot of people. And there are lots of challenges with it there. There are so many sort of dichotomies. It's magnificent and we have problems. It's magnificent and we have access issues, but you, we talk about coverage for all and, and most of us come to the conclusion right after center that at some point we gotta get coverage for all and probably sooner rather than later.

Gotta figure it out. We all know it's a lot better to do it through increasing Medicare or Medicare than through these exchanges. It just has been shown time and time again. Congressional budget office shows it's much cheaper to get more people. Board and covered through Medicare and Medicaid than it is through the exchanges.

And that's not a knock in the exchanges. It was a road that President Obama wanted to go down because he felt another alternative to get there. But 80% of the bill that have been covered through expanded Medicaid, not through the exchanges outta 24 million, have come through expanded Medicaid. And it's more efficient way to do it.

Not not perfect, lots of challenges, but we all think . Most of us get to the spot. We think we should have coverage for all. Most of us believe that an insurance company should be able to deny us coverage 'cause we have a pre-existing condition. Most people have gotten to that spot, right, left center, et cetera.

Most people would like a public option of some sort just as an alternative. So the health plans and, and many of us look at it and say, well, we were the post office, which is alternative to UPS and Federal Express, and probably a good thing versus a bad thing that we, that we have the great challenge that nobody talks about in DC but we do hear about it from healthcare executives all the time, and it's not a, it's not a popular issue, it's not a right left issue, and it's why it's not talked about the, the.

Big looming problem we have. It's not coverage. 'cause coverage is solvable. We're 9% away, we're 30 million people away. Something like that. It's solvable. The great problem we have is access. Access is becoming a bigger bringing challenge with 330 million people in an aging population. So a huge aging population, and lots of healthcare needs and increased shortages of doctors and nurses and in DC.

They talk about all kinds of things that are lightning rods for their own side of the political table, right or left. They don't talk about solving problems and, and the bigger problem we gotta solve. Yes, technology helps a lot, of course, but beyond technology, we need to figure out how to mint more doctors in an easier way.

We need to figure out how more nurses, clinicians, and so forth, how to grow more. Over the years, we've imported a lot of doctors. We still need to do that, but we all know that that's a net. Zero sum game because it's not helping the rest of the world. We gotta figure out a way to increase the pool of doctors versus zero.

We have to make medical school a little bit easier to get into and get through. We've gotta make it easier for a doctor to become a doctor, a nurse, to become a nurse, clinicians to become clinicians with maintaining rigorous standards. But we've gotta fight through sort of the turf battles and the strengths of the medical boards and the AMA and everybody else to, to sort of make it a little bit easier to become a doctor, a physician, a nurse, a clinician.

So we're just facing looming shortages and we've gotta make it more attractive. If you make it till somebody's 32 to become a specialist, that just makes it very hard because people know they've got shortage, sort of professional lives and so you're, you're, you basically don't wanna be a professional until 32 or so.

Giving 'em x years of, of practice. We, we've gotta figure out the shortages issue, the labor shortages issue as, as much as all these political issues, which are the political issues are fun 'cause they get votes, but solving problems is hard and there's big problems to solve, but, so it's.

Coverage is one thing. Access is another problem. Quality. Compared to any other large country, I think it's ultimately very, very good. Cost is a challenge and, and I don't know how you're gonna change that cost structure without improving the labor pool as well in this situation, but, but we also are very used to, in our country, getting what we want.

You want your knee replaced, you get it done pretty quickly. You wanna go to the urgent care, you go in 20 minutes. And that's not the same in other countries. And we like those conveniences as citizens. We like those things, and I don't think we'd be happy without having those things. Is there gonna be a way to change from sick care to WellCare to more of a health focus?

I, I mean, I know we talk about it all the time, but are, are we making progress in that area? Are we making progress in that area? I mean, um, I think we know that the answer's not really. I mean, we talk about it all the time. We talk about apps that will give people better information for their own personal fitness.

Well, obviously we've had good success in this country and smoking cessation and reducing the amount of people smoking cigarettes in terms of health and wellness and really improving health and wellness and making it so, I mean, you could be in some cities in America. Where every running trail, every biking trail is full.

I mean, Denver is known as one of those cities. San Diego is one of those cities. Can we change human nature so that there's, so in terms of a bell curve, there's more of us acting like that. I don't know. Can you make it easier to go get the checkups you need to get to do the things you need to do to pay attention to it?

Can we move more towards this model of wellness? We all talk about it. We all know. That a huge percentage of our healthcare problems and costs are due to one way or another, us as individuals not doing the things we need to do. And so can we really change that? I don't know. I, I don't know. It's, it's a great question.

Everybody talks about so many things, and I'm not clear where they're going. You know what? When you see. Governments in, uh, high school, junior high elementary education, get rid of gym classes. I, I think that just, it, that's, that, that boggles my mind. If you wanna talk about wellness, well, you gotta start with, as an adult, having a gym class today, as a kid, having a gym class today, and as adult, you define your own.

As a kid, you gotta have that. You have to have that. Just in terms of, it doesn't have to be like running, it doesn't have to be playing a competitive sport, but something that keeps the mind and body active is socially important. Are we making progress? I don't know if we're making progress as a society or whether, we'll, yeah.

I interviewed a doctor earlier today and we were talking offline. I'm like, he's lost weight through Covid. I put on weight through Covid. I said, you're a doctor. I'm gonna ask you about, you know what I can do to lose some weight. I said, but.

50 years, which is essentially get active and watch what you're putting into your body in terms of eating and and your diet. He goes, yep, that's pretty much what I'm gonna tell you in different ways, but that's pretty much what I'm gonna tell you. We have to get people to stop ordering Big Max five days a week before we're gonna see any movement on diabetes and.

That's, it's hard to say whose role that is. Is that healthcare's role or is that really public health's role? Right. I mean, less sugar, less everything, but, but where does that come down in terms of individual responsibility versus, versus the culture of the country? I. Versus how we push those things and, and encourage those things.

I mean, the one thing I do know is that through the school systems and so forth, we ought to be having physical education and gym class. We ought to be doing some other things as well. It just isn't, it's too early to give up on people and it's a horrible model. 'cause we know in the long run this has been written so many times, but you know, as we get older, we believe it so much more.

Health is the number one asset you could have. Yeah. You know, we take that for granted in our twenties, thirties, when we're a kid. You know, you get to be in your mid fifties. You just start to like realize that when people have said that health is your number one asset. Health is the most important thing you could have.

Health is this, is that You sort of give that all as lip service for a long time and you get to your mid fifties and you're like. Absolutely. Health is important as you can have. It's, it's actually true . So how do we sort of make that part of the country and what we're trying to do? But you see, our, our politicians don't talk about that.

They don't, they don't use their bully put, but to talk about that, not in a long time, at least. I mean, I mean, to the credit of George Bush, bill Clinton, they were fairly active. They tried to show themselves being fairly active. They sort of like, and, and Bill would have his, his challenges with the periodic Big Max like that.

But now it's famously a very, very . Careful about his diet, but, but they were at least actively engaged and set that kind of role model. You wanna talk about health, but we all know when people talk about this constantly, 80% of health is outside of the hospital health system. But how to change that when, when I hear systems all trying to change that, it's a laudable goal, but trying to figure out how they actually do it are different things and, and have a real impact and very challenging.

Scott, we'll, we'll, we'll move through some of these questions a little quicker. Let's start with where's the industry move fast and where's the industry move slower than you expect? Well, I, I think the industry has moved very, very fast in the acceleration of use of digital tools, digital technology, digital, everything.

In the last year or so, I mean, you, you, you see, like if you went just a couple years ago to your portal for a health system. It was very clunky, very hard to use. You almost had to be on a mainframe to do it or, or a laptop, not your iPad, not your phone. And I think in the last year there's been tremendous progress.

Obviously the systems that did the best at it had already invested a lot in it before. I mean, Kaiser Permanente. Everybody else was already doing 56% of their visits virtually before the pandemic. Jefferson Health had put a ton of effort into this early on. The systems providence to an extent similar.

The more systems had really put time and effort into digital upfront. The more they were able to accelerate through the pandemic, but a lot of other systems are catching up and catching up quite well. I mean, they're not perfect, but they're, but they're making a ton of progress. The the, the flip side is

Systems differ broadly in care. Navigation, patient navigation, ease of access. I mean, you and I, I think, know if you wanna see a specialist in our country, you could be as connected as you are and it's still is an effort to figure out how to get to the right specialist, who's the right specialist, how to get that person, how to get an appointment with that person, how to make it work.

Even if you have influence and know people, it's very hard. So you could imagine people that don't know people and so forth. This is still incredibly difficult and care navigation from the very most elite systems. Sometimes in the community systems, it's far better than at the most elite systems. And so it's uh, digital acceleration, digital stuff, the system, the systems are making great, great progress care, navigation, access in how to access care in the right way, the right spot.

Still a really evolving challenge. So the next question's always a fun one for me. Do new entrant pose a. Health systems, this is the Amazon CVS, Walmart, Teladoc, et cetera. Are they a real threat to existing healthcare providers? Sure, sure they are. Sure. I mean, what happens is the existing health systems have some real advantages.

Deaths of care, deaths of talent. Theft of people and so forth. The CVS Aetnas, the Optum United, you have some of those two companies are two of the sixth largest in the country right now by revenues. So CVS Aetna and United Optum are 300 billion a year companies. They're, they're literally huge and they huge amount of resources and magnificent technology.

When you have a choice to take your child to CVS Aetna, ACVS store, or do you take 'em to, in our neighborhood, north Shore University Health System or Northwestern, generally, if it's anything more than a cold or a quick physical, you get to do four year kids. You're aiming still towards Northwestern slash North Shore University Health System.

Just 'cause the depth of staff that the urgent care gives you more confidence. Whatever it is that's gonna be looked at seriously taken care of seriously. You, you take your 18 year old in and very quickly you got a mono covid strep test. You sort of know what's going on quickly with your kid and, and you've got a doctor that's there, or a pa or a nurse that's there, and you feel like they've been well trained.

They know what's going on. And so, so there's still, there's still built in advantages for the health systems, but you can't underrate the scale, the assets, the money, the technology that the Amazons, the CVSs, the Optums. You have Optums obviously. Full and friend of a ton of health systems. I mean, they're one of the largest employers of doctors in the country, but they're very powerful.

They're very good at what they do. CVS Aetna is very good at what they do, but there's still this difference in depth and quality that people perceive in their health system versus CVS. But in the long run, the, the great strength that these new have is. They're not encumbered by somebody. The real estate and operating cost that the health systems have, and this is this in the long run, will either be a fatal flaw for health systems or it'll be their great advantage because I mean, we saw during covid, at the end of the day, we needed these health systems.

I mean, we needed them. If you were gonna really take care of patients during a pandemic. I mean the biggest systems, the biggest, um, contributors to taking care of patients during covid 19 were these major, major health systems in terms of actually taking care of the people, actually taking care of people that had Covid 19 and so forth.

And you needed enough mass and enough critical scale to take care of them. And yet the whole race, the last 10 years has been to getting rid of beds. All of a sudden we needed beds. We found, oh my God, we need beds. We can't get rid of beds. So, so there, there's built-in advantages that the big systems have.

They've gotta have great depth of talent, they've gotta have great, you know, physician talent and nurse talent and clinician talent. But there's also huge advantages that the CVSs, the Optums, the Amazons, the Walmarts, the great issue will be whether these companies put the resources in. Providers. So for example, is making a.

That will either be great or not great based on how deep they staff and how much you filtering care of when you go to get taken care of through Walmart Health. And that remains to be seen. But they, they have the huge advantage of, they don't have all the bricks and mortar costs. A lot of these health systems have, so we'll, we'll see how it plays out, but there's, there's certainly real interest, real concerns.

More and more when I talk to health system leaders, they're not talking about the system down the street. They're not talking about the physician moving out with their cases to an ASC, to the outpatient surgery center. Those are threats. They know those are the known threats. It's almost like an old Donald Rums thing.

Then there's the known unknowns, which is they don't know how big a threat. The, the, the CVS, the Optums, the Amazons and Walmarts are gonna be. So it remains to be seen. But no, you can't not take 'em seriously. They got such huge resources. Three of the six biggest, uh, four of the six biggest companies in America by revenues are Walmart, Amazon, CVS, and Optum.

I mean, the people don't. Understand apple's right up there too. But for the six biggest are those companies, and so you can't not take 'em seriously. Yeah. And I did an interview with, uh, Rob Mache former CFO for UPMC, and he said it's it, he goes, they're not going after the, you know, specialty care or the, the, the highly acute care, that kinda stuff.

That's not what they're going after. They are. It, it's going to be death by a thousand cuts to a lot of health systems because just like we stood up ambulatory surgery centers and other things, they just started taking revenue profitable and, and imaging centers that just profitable revenue started getting filtered out of the hospitals.

And that's what weakens the hospitals. Uh, just over time, that is one of the, I think one of the greatest threats out there, disciplined.

I, here's a great question from, from, again, one of our listeners. Uh, how much of healthcare will.

Yeah, so I, I, I don't know, when people talk about hospital at home, the skeptic, skeptic in me thinks of it as just a different new wave of home health and thinks of it as hospitals are very aggressively trying to reduce their length of stay, and this is another way to really move towards that. That's the skeptic in me.

The, the optimist to me says. A, a patient would much rather be at home for those extra couple days of length of stay, and if there's the right technology, the right care, they feel taken care of and they've got some help, the better off they are. So there's this, there's this great mix. We certainly talked to tons of health systems, whether it's Jefferson at Ven Health in the West Coast or others.

View the growth of hospital to home is a huge, huge growth opportunity. Adventist talks about they've got 25 hospitals or 24 hospitals. They believe their biggest hospital will be their 26 hospital, which they call their hospital at home. And the beauty of it is 'cause you live in the technology world.

So much of the value in the world, at least in terms of economic value, has moved towards asset light models. So, so the asset heavy models in terms of industry, the stock market getting killed, the asset light models like the Ubers, the Airbnbs, well, they don't own all the assets, they just own the technology.

Is where the economic value has been because you're not holding all these costs, you're just simply the technology inter weaver of all of it. So if, if hospitals can move themselves to being this technology asset light business where they don't have these $5 billion campuses, it's not so much the $5 billion cost to build a campus.

It's all the constant operating costs of having that kind of, of, of bricks and mortar and, and weight. That will move hospitals more into this world of being able to spend money on technology and people versus bricks and mortar. So there's a lot of incentive to do it, to move in that direction. And it, it just depends, again, it's like a lot of things, it, it depends on the health of the patient itself.

Certainly the more healthy patients would much prefer to be at home than in the hospital. So if you're a pneumonia patient, you're not that sick. You're gonna be at home if, if you're recovering from surgery and you don't require that much care, you're gonna be at home. My, my father just had a procedure.

He could have been in the hospital for two days or five days. He ended up home after two days, but he has support. He's got my mother watching him and he's got hospital support as well. But, but, so it depends a lot on the health and support systems and so forth as to how far this goes. But it's something that everybody, everybody's very incentive to because hospitals are trying to figure out how do they compete against the rest of the world That's moved towards an asset light model where they're an asset heavy model.

Yeah. You, you talked about Adventist. Intermountain also has that. That digital, uh, hospital concept in place, mercy in St. Louis as the digital hospital concept in place are, are they positioned ahead of everybody else to be, to provide a higher level of acuity care out of the home, do you think? I think everybody in many places are trying to figure it out.

I, I don't know if they're positioned ahead of it. What, what they do know is there's technology tools and there's staffing issues too. The beauty of the hospital model is you have all your patients at one place and your staffing in one place. So there's, there's actually a, a beauty of it from a staffing perspective where you're centralizing care now you're putting out all these different points of care.

It depends on how much it could be done technologically versus people going from place to place. I mean, what I've heard from some systems is what's causing them to slow down on doing this is they still can't staff it. How they need to staff it. Yeah. Aside from getting patients comfortable with it, which more and more patients are comfortable with it.

'cause patients would like to, all thinks be being considered depending on their own health. Be cared for at home. Than in the hospital. But staffing issues are a real, real challenge. You've interviewed a lot of people over the years. You've been with successful CIOs, CEOs and whatnot. What do highly successful CIOs, CEOs do that that others may not do, obviously without naming names?

So what do they do? What aspects of the things they either choose to do or don't choose to do make them successful? Well, I think, I think you hit one thing right there. They're very good at prioritizing. They're very, very good at team building, at building teams and relationships, and they have to be technically good enough.

They have to have proved themselves somehow or another in a system, but ultimately they've gotta be very, very good at like at, at the sort of like getting the most outta their people, like wellbeing Welllike. So I always look at this mix of skills of. Bright, disciplined, driven, and personal skills, and great personal skills and great team building skills.

There's also a complexity to the world that that many of us are not capable of. I'm not capable of it. For example, there's a big difference between running a team with 70 people. Then running a team with 3,500 people or 50,000 people there, there's an ability to manage that kind of complexity that some people are capable of and some people are not.

I, I don't view myself as personally capable of that. Others are very good at it. They, they see it, well, they build teams as well. They're able to manage all these different thoughts at one time and able to manage priorities. And I think the other part of all this is there's an emotional maturity and emotional intelligence.

That comes with leadership that is absolutely critical to be able to be very good at this, to be very good as a leader. ACIO, ACEO, whatever it might be there, there's an an emotional centeredness there. There's times where some of us could be too impulsive, could be too excitable, could be too different things, and those could be very good qualities, but, but there has to be a centeredness to leadership as well.

So there's a number of different skill sets that seem to go with it, and I think probably tying a lot of that together. There's a consistency of leadership. People have to know what they're getting every day and, and sort of what you've seen this, we've seen this with fasting role models. We've seen fasting leaders or magnificent leaders that can't help themselves but be change agents and change jobs every five to seven years.

Then you've seen other magnificent CEOs that have been in the same place for a long time and just magnificent leaders in a steady hand. Nancy Aging at Corrillion Clinic has now been there for some time, sort of a magnificent, steady leader and very supportive, very nurturing, very much a leader of people, not just, not just excitement in the flavor of the day, but a serious leader for a serious period of time.

And, and there's a consistency and a caring and a straightforwardness that that come with being a great leader. Yeah, Iman. And I, I sort of joke with him. I'm like, man, you, you kicked into talking points there. And he said, bill, he said, I'm gonna have to deliver that message about 200 times in the next three months.

He goes, if I vary in the way I say it or miss something, or whatever, that may be the only time that that person hears that message from me, the.

And, and a message, and they're, they understand that words are such a powerful thing, uh, as a leader in terms of rallying people, get them excited about the mission. It's, I, I think you're right. I mean, there's so many, so many things about, about being that leader of 30,000 people that is so different than leading a department.

That's right. And Ron Ackman's a fascinating example. I mean, here's the case. He's been a consistently magnificent leader. An innovative leader, but with the message of Providence St. Joe's throughout the system is one of compassion, compassion and excellence. And, and they've done a great job of both delivering on that and building that reputation that they care.

And, and Rod is a magnificent fire starter for both being an innovator and someone who cares and, and that's kind of come across. It's gotta be true. It's gotta be genuine, which I believe it is. And then it's gotta be consistent and constantly the message that's sent and the way that they approach it.

You see some of the great faith-based systems, common Spirit is right up at the top of this in terms of being viewed as sort of, we wanna do great care and we care and we actually care. We're, we're compassionate about what we do. We, we care about our people. We care about the people that we serve. We wanna be great at it too.

I mean, it's, it's a fascinating mix of things and you see it differently in faith, in certain faith-based systems than others. And, and you see the, the race to excellence plus compassion. And Rod Hagman's a great example of that. So, Scott, you're doing a bunch of speaking. I saw that you're gonna be speaking on digital health.

The money is just pouring into health tech, digital health at this point. I, I wants.

What areas do you expect technology to have the, the greatest impact within healthcare over the next couple of years? So it, it is very, very hard for me to tell. I, I get the chance through what I do to talk to both lots of, I. Healthcare IT entrepreneurs plus people that have funded them and others, and the reality is I'd be wanting to say I have a crystal ball.

I'd say that many times it is dizzying to me the pace and trying to figure out what's gonna work and what's not gonna work. And so I don't have great clarity on it. What I do see is this, I sort of look at companies and divide 'em into five phases. There's the idea, which in some ways is . Meaningless.

'cause everybody's got an idea and, and I don't mean that to be negative because in reality big ideas make a big difference. But there's an idea and then there's somebody actually taking the idea to product actually, where it's actually a product. It's actually a software as a service. It's actually a technology that could be used.

And that's sort of a big giant step. It's a big funnel from idea. To get into the spot of actually having a product. Then there's actually having revenues. Can you actually turn it into revenues? Somebody actually wanna buy it. Somebody actually wanna use your product. Is there really a need for it? Does somebody really wanna use it?

Then we look at next, is there profits in it? Could they actually turn into profits? And then, then the big, big challenge and the big differentiator between so many of these companies is, is it something that could be scaled or not? And how are they gonna scale it? That's a. Big unknown for a lot of these, so, so we, you could place betts on this alongside other very knowledgeable investors, but it's, it's very hard to tell.

And so will wanna keep on pouring into digital health and digital technology? Absolutely. It, it's. Asset light, it's viewed as the gold mine. Some of these things will pop, become used by every system, others won't, but it's absolutely, money's gonna keep pouring into it. When you talk to people in the digital health world and everybody's raising funds in digital health, everybody in their brother's raising funds in digital health.

And if you ask somebody, and, and I never know this as an investor, never know this. They'll say, I always think it's the ninth inning. Somebody will tell me, no, it's a second. And there's a huge amount of opportunity. And I never know if I knew I'd be far, far wealthier than I am, but I never know. And I'm very, very nervous by nature.

Just by nature as an investor and as a person. But they'll all tell you when you talk to 'em, no, we're in the second or third inning. This is just gonna explode. And so where to go? And that may be very well be the case. But in terms of deciding, is it gonna be in predictive analytics, is it gonna be in.

Different type of EMR that's cloud-based, that sort of, uh, takes away the, the sort of entrenched ness of Epic and CER and so forth. I, I don't know. Or is it all these apps or software as a service that's gonna be so deep and embedded in these things that that's gonna be used by so many that it's gonna be a winner?

I, I don't know. It was just an explosion of you. And I know like if you look at podcasting, at one point there were three podcasts. Now there's a thousand new podcasts Today. If you look at digital technology, the the people that have a much better sense of it, I talk to venture capital investors very often as part of our private equity podcast, and it's fascinating to me to sort of see the ecosystem events built, built around all these things.

And obviously seven wire ventures. They hugely successful. They were one of the funders of Livongo and Glen Tolman and Lee Shapiro out speaking a decent amount and brilliant, brilliant people. And they, they just raised another fund. They've, they've publicized that. They just raised another fund and everybody hopes it's an investment in that fund.

And I'm not that they'll have the next Livongo in that fund, but who knows? So I don't know. I mean, but for Covid, telehealth, Teladoc, all these things was taking off and doing great. But it, it was for the last year was steroids to the max of those things. It made, it made Sammy Sos and Mark McGuire's out of a lot of those things, just because also there's this huge need for t in a way that there wasn't before.

So I, I don't know what, what inning, Morgan hand's very hard for me to predict. I'm not good at predicting it, but there'll certainly be, certainly lots of, lots more winners. Yeah, absolutely. Are you a Cubs fan? I'm more of a Cubs fan than I'm a White Sox fan, but I like both. But I grew up more as a Cubs fan.

So it's, it's, it's different. I, I like the socks. I've always liked the socks, but I'm more of a Cubs fan. Well, I am a, uh, I'm a Cardinals fan, so let, let's try to remain friends. I think you just took the lead. I think you're a half game up. Maybe even, maybe even a full, full game up. Yeah. No, my brother-in-Law is a Cardinals fan and as good a per is as they come.

So we, we, we could be friends and love Cardinals fans as well. Well, you would laugh. I moved to Naples, Florida. I have a Cardinals flag, little flag out in the front of our house, and I have a neighbor right across the street who has a Cubs flag and a neighbor, two houses down that has a Cubs flag in front of their house.

So Naples seems to attract people from, from Chicago and and in the Midwest. So I've actually bought some extra Cardinals flags. I'm gonna steal their Cubs flags and put Cardinals flags after I get to know them a little better. Start doing that stuff. Hey. Hey Scott. Thanks. Thanks for so many thanks. Your contributions to the industry.

Really appreciate and thanks on, have this conversation. I look forward to catching up with you hopefully in person next time. That would be, that would be fantastic. We hope so. We don't think we're very far away from in-person meetings. Again, bill, you've built a dynamic reputation industry for a very long time.

Just magnificent. So what, what a great pleasure to get to visit with you today and thank you very much. Hopefully I didn't offend anybody or embarrass myself, but a pleasure to visit with you. Thank you so much. Thank you. What a great discussion. If you know of someone that might benefit from our channel, from these kinds of discussions.

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