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      Opportunities in Community Health with Brook Ward

      Healthcare Rethink - Episode 4

      In this episode, we talk to Brook Ward, President & CEO of Washington Health System, about the importance a regional health system brings to local communities.

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      Jonathan Wiik: [00:00:22]
      Well. Hello, everyone. I'm Jonathan Wiik from FinThrive. I'm the vice president of Health Care Industry Insights. We're kicking off a podcast in the provider space called the Health Care Rethink. Our topic today is Regional Health systems are the heartbeat of community health. Really honored to have a gentleman here below me, Brooke Ward, the CEO of Washington Health System, talk about what he's been doing. He's been doing some really innovative things in the value-based care and accountable care space with some of us provider and physician groups out there. Welcome, Brooke. And we'll go ahead and kick it off here and just talk about. You'd like to introduce yourself, sir. Sure.

      Brook Ward: [00:01:02]
      Well, Jonathan, thank you for having me on. And thank you to Finn Thrive as well. It's my honor to be with you today on your podcast. As you said, my name is Brooke Ward. I'm the president CEO of the Washington Health System. That's a small to medium size health system, about 25 miles south of Pittsburgh in southwestern Pennsylvania. We're a nonprofit organization. We're actually celebrating our 125th anniversary this year. Awesome. So we've been around serving our community for a very long time.

      Jonathan Wiik: [00:01:28]
      That's great. Well, I always like to kind of break the ice with folks. Just on a personal level. Let's talk about where you were born and where you went to school, who you rooted for over the weekend. Football's back in session. I thought it'd be good to kind of see if we have any rivals on the call or not.

      Brook Ward: [00:01:43]
      Sure. I appreciate it. I was born on Mackinac Island, Michigan, of all places. My parents live there and that's pretty rare feat. There's not many people that live on that island year round. Most people know it as sort of a tourist destination. But I grew up and spent most of my life in the southern part of Michigan, in Sandusky, Michigan. That's where I went to school. And then I later did my undergrad at Ferris State University and my graduate work at Grand Valley University in Michigan. And I worked in the past. I was in the military as an Air Force firefighter. Nice. And then I went on to school and got into radiography health care administration and then eventually worked my way here to the Washington health system in southwestern Pennsylvania. As far as sports, I'm a fan of all teams Michigan Lions, Tigers, Red Wings, Pistons, and of course, Michigan and Michigan State. And I don't have a preference over who's winning as long as they're all beating up on Ohio State.

      Jonathan Wiik: [00:02:39]
      There you go. Yeah, that's pretty typical.

      Brook Ward: [00:02:44]
      And and for fun, I do a lot of photography, including sports. And so I cover the Pittsburgh Steelers from the sideline for the media just about every home game and many road games. And so I was at the game yesterday while they were losing to the New England Patriots.

      Jonathan Wiik: [00:02:59]
      Yeah, it was a tough game. I watched part of that on the highlight reel. You talked about radiography a little bit in your career. I'd like to bounce over to that. Where what's your path to CEO? I think a lot of our listeners would like to understand like what we're kind of some of the steps that you took getting into the leadership role that you're in today.

      Brook Ward: [00:03:16]
      Sure. I appreciate that, Jonathan. So as I mentioned, I started in the US Air Force as a firefighter and that got me doing a lot of things obviously related to the fire department response, rescue response, medical response. As part of that job, I became an emergency medical technician, an EMT. All right. I knew I didn't want to be a firefighter my entire career, although it's a great young man's job. But I knew I didn't want to do that my entire life. And so I was looking at something I could leverage into a nice career. My dad and my uncle were professional photographer, so I did a lot of photography growing up and my brother in law worked in radiography and I understood and learned from him that that was a two year degree. I could get in and get out and it was essentially photography done different. It's aimed at for photographing the inside of the body instead of the outside generally. And so that was what got my interest coming out of the military. I had a family I at the time I had a young son and so my wife and I were trying to figure out what can I do pretty quickly.

      Brook Ward: [00:04:15]
      And so we had applied to go to fairs where I was going to join the RADIOGRAPHY program. Now this is pre Internet pre cell phones, texting, all that, all done through the mail. And so as it turned out, I was accepted into the program. What they didn't tell you is there's a two year wait. Oh so I got all the way up there and moved my family to find out I couldn't actually start the program. But for me, they had what they called a two plus two year program. You could do two years of junior and senior year sort of business degree, along with a two year associate's in nursing, respiratory radiography, that kind of thing, and get a health care administration degree. And so I actually did. My junior and senior year classes first completed the RADIOGRAPHY program, which at the time turned out to be my internship was at Butterworth Hospital, which is now part of Spectrum Health Cool. And it was a blessing in disguise, honestly, Jonathan, because it didn't take me long Once I got doing the clinical realize I'm only going to be able to do so many chest x rays before I would personally go insane, right?

      Jonathan Wiik: [00:05:17]
      Yep. Yeah, I worked at an imaging department too, as a transporter and. I load the how many people were in the intensive care unit because I knew I'd be going doing laps for their daily chest x ray. Exactly patients in their me in the tech would lament over a cup of coffee about how crappy Saturday was going to be taking those x rays.

      Brook Ward: [00:05:39]
      So I did all that. And frankly, if that's where it had ended, that would have been a great career. But because I've gotten that bachelor's degree as part of that weight at Ferris State University, it exposed me to the other side of health care, which was the business side. So pretty quickly after graduating from the RADIOGRAPHY program and finishing my bachelor's degree, I immediately applied and got in at Grand Valley State University into their Masters of Public Administration with an emphasis on health care. And then by total happenstance, it was at that time I was finishing that degree. Butterworth and Blodgett in Grand Rapids, Michigan, decided to merge and create Spectrum Health, the giant and very well run organization that it is today. That created some opportunity for me in management. And so I moved up through that merger and acquisition into radiology management. I work my way up there and then shortly after that I was there about seven years. I got recruited to join Bronson Healthcare Group in Kalamazoo, Michigan, first as a director of radiography and then later became an executive director and then later vice president for ancillary services. And I worked there for ten years. I had an amazing run with a great group of people at Bronson, still friends with many of them. And while we were there, we won the Malcolm Baldrige Quality Award.

      Jonathan Wiik: [00:06:52]
      Sweet That's a tough one. That's very, very difficult to get. I did not know that. That's awesome.

      Brook Ward: [00:06:56]
      Exactly. And it was an amazing time in place. And while I was there, then I got recruited to come to Washington to be the chief operating officer and executive vice president. And it was never my goal nor really on my career path, honestly, to become a CEO. But after serving here for about nine years, the organization asked me to take over, and I had the honor and privilege of taking over as CEO about nine months before this little thing called the pandemic hit.

      Jonathan Wiik: [00:07:25]
      Yeah, a little distraction. Yeah, that's too bad. What research is out there that you're maybe highlighted in? Is there any papers or things that you've helped contribute on or or things that the audience might want to hear about?

      Brook Ward: [00:07:36]
      Well, I recently worked with Guy Masters on an article that was published with the Governance Institute around rural hospitals and surviving, being sustainable, those kind of things. And so that's out there for most people to look at. And then on occasion they speak at national conferences. So I've been invited in February to join a World Health conference in San Antonio speaking as well.

      Jonathan Wiik: [00:07:57]
      Thanks, Mike. See you there. That'd be cool. I love San Jose. It's awesome. What do you do for fun? The last kind of icebreaker question. What what's your what's your advice? Well, I love.

      Brook Ward: [00:08:07]
      Travel and reading, of course, in downtime, but probably my number one hobby is photography, and I do a lot of that. Everything from landscapes and travel to abandoned buildings and a lot of sports. And like I said earlier, I've been covering the Steelers from the sideline for the last 12 years, and in the last couple of years I've been doing Formula One races as well, covering that for the media.

      Jonathan Wiik: [00:08:27]
      Cool. Well, let's dive into some things about Washington health. You gave us kind of a high level overview, but can you tell us what you define as your community focused model and what what types of things you're doing there to kind of promote health care? And I guess we really should call it health in your community and how that how's that going at Washington Health?

      Brook Ward: [00:08:47]
      Yeah, well, it's a challenge for all health systems, there's no doubt. Right in this environment, we're all in the process of moving from being paid for value to being paid for paid for volume to being paid for value. And I always like to say we still need volume. You can't survive without volume, but value is more important than ever. And so we've done a number of things really going back the last ten years plus where we've been contracting with payers around gain sharing programs, value programs, where if we can provide great satisfaction, high quality, lower utilization and lower cost, then we share in that savings. And so like a lot of organizations, we have those gain sharing programs with payers, but we're also in an ACO with three other community nonprofit health care organizations called Bridges Health Partners, that's been going on now for about six years. We just got our 2021 results and they were amazing. And so we've been fortunate. We've made money through that program every year in its existence. And so we've done very well where others are struggled in that ACO model. And then about two and one half years ago, we joined CMI, the Center for Medicaid Medicare Innovation Unit in Pennsylvania in their rural health model.

      Brook Ward: [00:10:03]
      So this is a global payment type model where they're trying to get most insurance companies. I think right now about 70% of our payers participate in this model where they go back and take a look at what was the utilization of cost for that population of patients that we took care of at our facilities over the prior three years. And then they pay us that on a global budget going forward. And so we're now incentivized to try and drive down utilization by keeping people healthy out of the ED, out of our inpatient beds, out of inpatient surgery, and try and care for them in our physician practices, outpatient settings, try and keep them healthy. And so we still need volume. Of course, we need that to maintain a certain level of services, enough volume to take care of satisfying these or our specialty physicians, etc.. But it's not end all be all Now in that volume with that global budget, we can take time and sit back and say, How do we really work on preventative care versus sick and illness care? When people show up at our doors when they're at their worst?

      Jonathan Wiik: [00:11:02]
      Yeah, I think when you and I were prepping for this call, we talked a little bit about how that was a blessing in disguise and when the pandemic coming and you just took the reins at Washington Health, that some of those volumes were somewhat volatile, but you were able to focus on your community and delivering care, knowing that you had a somewhat predictable and consistent revenue stream. You want to talk about that a little bit?

      Brook Ward: [00:11:24]
      Yeah, sure. I mean, when I was talking to my peers early in the pandemic, when services were shut down, a lot of them were laying off people, you know, for months on end. Of course, their revenue revenue stream was cut off. And then how were they going to deal with that? As you mentioned, Jonathan, we didn't really have that issue with most of our payers because we had that consistent revenue. And so we did do some small layoffs during that time period because it didn't make sense to honestly pay people to sit here and do nothing. We tried to redeploy people during that time where it made sense, but they weren't off for long and we could bring them all back. But it allowed for some consistency, some leveling of revenue instead of that variability. And that's been true even today. You know, I talked to a lot of my peers across the country. Now their revenue is down because their utilization is down and ours is flat for the most part because of that model. For us, really, the question is, at the end of this trial period, it's a five year pilot in the state of Pennsylvania. What will CMS do? Are they going to continue this program or not? Are they going back to the traditional fee for service model? They've launched a different version of this in Georgia that's a little bit different in Pennsylvania. And I know they're having some conversation in our state about what does phase two look like. And so we're trying to participate in that, prepare for what that might mean down the road.

      Jonathan Wiik: [00:12:40]
      Yeah, I think you're well positioned. I think CMS is going to keep their foot on the gas. I mean, we my hospital when I was chief revenue officer, we had a CMMI grant for patient centered medical home as well, and they've expanded their primary care network there. And I think as you look at things like the public health emergency and the Provider relief fund dollars and some of the rural health care dollars that are going to start getting turned off if they aren't already, and then you start seeing some disruption and coverage. Cms is going to have to have vehicles like the ones you pioneered, for lack of a better word, at Washington Health to keep going. So I'm hopeful and we'll say some.

      Brook Ward: [00:13:18]
      Ways.

      Jonathan Wiik: [00:13:19]
      You could keep keep that stuff going because I think it's interesting and and it's very innovative. Speaking of innovation, I'm going to move over to our buddies on the payer side. You mentioned you've got some some gain share and some performance contracts there, but what have you done to collaborate with them? I'm seeing in the market a lot of of kind of antagonistic behavior where there's just not a lot of trust. And frankly, I'll call it raw hatred. There's not a lot of love. Right? Between hospitals and insurance companies. It sounds like you've at least thrown some olive branches over and poked your head up out of the foxhole to try to figure some stuff out. I'd love to hear about it.

      Brook Ward: [00:13:57]
      Yeah, sure. Well, we try and be good neighbors with everyone, including the payers. Yeah, in in our market around Pittsburgh. Of course, we have two very large regional payers, one being Highmark, which is Blue Cross Blue Shield in our area and UPMC Health Plan. And then of course we have Aetna, United Signal, all the national players in our backyard. And from our perspective, they're all integral to our future and success. We can't afford to be taking an antagonistic perspective towards them. And so we try and work with all of them because it makes sense for us and for them. Now, if I was talking to my payer colleagues, I wish they would lay off the rhetoric a little bit where all the expenses are the blame of hospitals and doctors, because we all know when we look at what's going on in hospitals and with physicians across the board, we make up a large chunk of the expenditure in the United States, there's no doubt. But that's not really where we're seeing a lot of waste and a lot of the premium dollars that go up and get passed on to employers. It's not from hospitals and doctors, it's from pharmaceuticals and other things that drive up that cost. So that would be my one area. If we can get payers to sort of reframe the conversation, that'd be important. But some of the things we're trying to do with them is we're trying to look at them with the payers, at their population right down to are we looking at Medicaid, Medicare, are we looking at their commercial line of business, know their direct or employer type lines of business? And then where is utilization happening in our area? Where are we having gaps in care that aren't getting closed? How do we drive up their HCC coding, which then helps us from a quality perspective? On the payer side, we get graded appropriately and paid appropriately, but then so do they.

      Brook Ward: [00:15:33]
      And so that's the type of dialog we're having with payers is where is the gaps in care, where's the gaps in coding and how do we collaborate. And then we're actively in the process right now with a couple of payers talking about how do we build an interface that's in the works as we speak so that we can send over to them essentially our scheduling data so they can look and say, okay, I'm Blue Cross Blue Shield. Does one of my Blue Cross Blue Shield members have a follow up appointment post discharge with Washington Health System? If so, when is that? And if not, they can help interact and intervene as well as we do those kind of things. And so it's all those little things. It's about having a productive dialog about what really moves the dial for them. And if you think about it, what they want to do is make sure utilization is appropriate. They want to make sure genuinely that their members are healthy and they want to make sure that the quality of care that those members receive when they get it is high quality and that the quality part is not only did we get the art and science the right diagnosis and treatment, but how well did we treat the patient and how efficient were we while we did it? And so those are the type of things we try and work with our payers on.

      Jonathan Wiik: [00:16:40]
      Yeah, I think we like where we started to and when we were prepping for this call, one of the things you said that kind of raised my ears was that you're trying to lower utilization in certain settings like the emergency department. I think the payers probably see some common ground there as well. They do not like paying emergency department claims. There's not a lot of care coordination in an emergency setting. And you agree with them on that perspective. Would you like to expand on what you're doing in the ED setting?

      Brook Ward: [00:17:04]
      Yeah, absolutely. Of course, you, my team and our ED physicians, you know, they want everybody to be healthy as well, but they don't always necessarily like this strategy. But from my perspective, the right thing for society is to keep them healthy and keep them out of our ed, keep them out of our inpatient beds, keep them out of all those really acute settings if we can. And there's a lot of things that show up at every emergency department across the country that could be done through telemedicine, can be done through a primary care office. It can be done with a follow up discharge appointment. It could be done with just some social work. You'd be surprised how many people show up at our door. They don't really need health care, but there's something happening from an economic or social perspective that prevents them from having what we would all consider sort of a productive day or life. And to give you a small example, we had someone brought to our door last week this true story. They were domestic violence type situations, staying in temporary housing that expired. The local authorities didn't know what to do with them. They brought them to, well, that person didn't need health care in that situation, really around housing and economics.

      Brook Ward: [00:18:13]
      And so instead of keeping them here, which is what people wanted, you know, we actually paid for a hotel room for a couple of days and then we could work with the county government, some of the local nonprofit organizations. But how do we get this person appropriately placed? And then how do we wrap social work and casework around it so that that person gets some of the life skills they need, some of the coaching and support they need so they don't end up at the. Ed One of the other things we do and have for almost two decades is we help supply money. And local homeless shelter. They run a medical clinic. We provide some supplies and we provide some physician staffing to them for free. And they see quite a few. I think it's like 10,000 clinic visits a year at that clinic. That's all in an effort to try and make sure that that population of people in our community gets the care they need. But it's not needy because they're not necessarily emergency department patients. If they need that, of course we're here. But if we can take care of them, then in that clinic, then that's better for everyone from an organization perspective, from the patient's perspective and from our community perspective.

      Jonathan Wiik: [00:19:22]
      Yeah, completely agree with that. I mean, I had a respite program at my hospital as well, and I think it paid back itself in spades just having those those frequent fliers and patients that may have been drug seeking or needed some kind of social economic support that was beyond the walls of our hospital, those partnerships with those warming shelters, because we're in Colorado, some of the homeless shelters and having outreach resources, we used home health and leverage that quite a bit as huge. The social workers and case managers were were angels. I called them in the ED to try to make sure we didn't do unnecessary things to patients and made matters worse by admitting them to a deck upstairs and then figuring out how to safely discharge with a disposition that was appropriate versus finding resources at a time of getting ahead of it. That's awesome.

      Brook Ward: [00:20:12]
      Yeah, we've even we've even gone so far as to take a couple of our frequent fliers in the ED that are in these programs. Had a conversation with them about why are they coming to our ED so often, sometimes daily, why are they showing up daily? And then we've assigned them a caseworker or social worker. And we said, okay, if you're even thinking about going to Ed, call this person first and they can help coach you through whatever the issue is. If you need to come to Ed, Great, We'll come pick you up, We'll get you here, but we'll figure out what's really going on. And that drove down when we first started that a couple of years ago, that Ed utilization for that group by like 90% overnight, they just needed to know that they had someone that they could call to get something taken care of. Those kind of things. Sometimes it's the small things that help. But those small things, as you know, Jonathan, take a lot of work it takes and that's all care. Of course, that's uncompensated. No one's paying us to have a social worker call these people and manage that case. We only get paid generally if they show up at our door and we care for them. And so again, we're trying to leverage those local budget models, those gain sharing models and try and use our resources. Smart.

      Jonathan Wiik: [00:21:18]
      Yeah, that's awesome. Speaking of resources and smart allocations, you guys recently completed your Sakena or Community Health Needs assessment. And what types of things did that tell you? That's a three year process that's required for Rowan Community Hospitals or where's your focus? What were some things that you maybe couldn't address that you wish you had? But I think lots of hospitals, when they finish that report, they're like, Well, this is a long list. We're going to set the priorities on it. What can we work on? Share that with us.

      Brook Ward: [00:21:45]
      Yeah. So fortunately, we were focused in the past were on diabetes and breast cancer and that actually improved. I mean, that was our focus the prior two cycles. And it's gotten to the point where our communities are actually performing better than most of Pennsylvania in the nation. And so you're right, this time it identified a whole slew of things, a lot of which are out of our control. You talk about food deserts, access to healthy food, transportation, safety at home, all of those things. And some of those we can impact, some of them we can't. But this time around, where we decided to focus was really focused on colon and lung cancer, because those two, for whatever reason in this most recent community health needs assessment, our population got worse. And because we did a better job improving cancer and diabetes, now we're going to shift our focus over the next three years on those two.

      Jonathan Wiik: [00:22:34]
      Nice. Are there other populations besides those are geographies or socioeconomic areas that you think you're going to focus on for steady engagement and progression over the next few? Or are diabetes and breast cancer kind of the tip of the spear, or where are you going to focus otherwise?

      Brook Ward: [00:22:50]
      Well, with these two focus on lung and cancer, that's where we'll put most of our effort. We're not going to I hope we're not going to lose focus on breast and diabetes, even though we've improved it. But I think some of the biggest needs in our area really come down to access to healthy foods, food deserts, healthy living, transportation. And so we're not likely to be trying to conquer the world there. But there are a lot of other community government, nonprofit organizations that focus on that. So now we're talking about how do we partner with them in ways that make sense. So for example, we recently partnered with a local food bank where we're taking boxes of food, we're putting them in our primary care offices. And as patients come through, we're having a dialog around do they have adequate food at home, healthy food, and where they meet the criteria, we can send them home with a box of food. So it's going to be things like that where we're not going to be leading the charge, maybe on trying to food solve hunger in our community, but we can help identify those people, have that issue, and then participate in the delivery, the identifying of them, and trying to help them get connected to the right agency.

      Jonathan Wiik: [00:23:55]
      That's awesome. I loved hearing that. You know, Fin Thrive. We're producer of some of that socioeconomic risk or social determinants of health data where you're looking at insecurities in nutrition or income or transportation, as you mentioned. And one of the most common things we hear back from our provider community is it's it's great that that score tells me that Ward is is malnourished or doesn't have access to a vehicle. But what do I do next? What I love hearing about what you're doing at Washington Health is that you've you've turned keyed that to the extent you can, you've actually put little mini food pantries or pharmacies in primary care physicians offices. So when you're actively screening, you're coupling that insecurity with the solution where you can. And I think that's a lot of what hospitals have to do is dive in and leverage that data and that insight and actually make a difference in your community. And I'll bet you're seeing good outcomes from that, too, in terms of both your physician and your acute communities in terms of utilization and and just your communities getting healthier instead of just treating the revolving door of acute things. As you mentioned.

      Brook Ward: [00:24:57]
      I hope it's a little early in that program's history. I know, but I hope and sometimes as many of your listeners will know, it's just a matter of having a conversation with some of the local nonprofits that are trying to tackle this thing. They often have ideas about what the right strategy is. They just might not have the means to deploy it. They might need a corporate sponsor. They might need the network of our team members to get the word out. And so sometimes it's easy, sometimes it's hard. But we won't know unless we have the dialog with them, and then we can marry that up to OC based on what we're seeing with our population, this makes total sense. And then how do we integrate that into our processes? So it's hardwired for our team members as well.

      Jonathan Wiik: [00:25:37]
      I completely agree. Those partnerships with those community resources were huge. They were huge at my hospital and they're not funded well and the hospital is usually not funded well either. There's usually not a claim of tax, so there's a lot of bubblegum duct tape and rubber bands kind of making those programs work. But the downstream effects, I think, are absolutely going to be measurable and it'll be great. I'm sorry, Go ahead.

      Brook Ward: [00:26:00]
      I say the way I often see those start is we'll talk with a nonprofit and the first thing they want to do is how are you going to fund this? And I'm saying, that's not why we're here. I'm just trying to we've got our own issues, but we're here to partner with you to figure out how we can make it work. We're not here to drop $100,000 of whatever this program is or whatever.

      Jonathan Wiik: [00:26:18]
      That's right. That's awesome. Those partnerships are huge. You know, speaking of measuring, I think that's a great, great segue into this next question. You know, what? What do you think you're going to make an impact in on two years? Is it within a specific area or are there some modalities? It sounds like you're doing a lot of preventative kind of community care things. You know, if we have another interview, and I hope we do and a podcast in two years from now, what do you think we'd be talking about?

      Brook Ward: [00:26:45]
      Well, we're trying to really make sure that at least locally we have good ob gyn care and having enough providers in our area is a struggle. And so during the middle of the pandemic, we renovated our inpatient labor and delivery unit and our dining unit $7 million investment. And we didn't get a chance to really promote that during the pandemic. It happened. The open house happened at a time when you couldn't have an open house. So getting the word out on that, but then recruiting and stabilizing our group and then making sure that women get the appropriate prenatal care. I'm always shocked at how many women in our community show up at the ED the day of delivery and have never seen a doctor before that point. Now, we do partner in have for almost two decades with the Washington health system, Teen Outreach. This is another nonprofit we've worked with for a long time where we help provide some. Funding. They go into the schools and they're in every public school in our area trying to prevent teen pregnancies. And our teen pregnancy rate in our community is lowest in the state. That's all I want to take credit for that. I don't know if it really is all our doing, but I know before the organization was involved in that two decades ago, it was a problem in our county. And so we're trying to make sure that we prevent teen pregnancy where we can for those mothers, those teen mothers who have child. There's a program built into that about how do we get them through high school and launched into their profession so they're not left on the wayside as well. How do we prevent teen pregnancy? But then again, those women who get pregnant, let's get in for prenatal care and then take care of them.

      Brook Ward: [00:28:16]
      Another area we're spending a lot of time focused on is just around orthopedics in general. Again, making sure we have appropriate orthopedic coverage for all of the community and then transportation. When it comes to ambulance services, we spend a lot of time and money over the last couple of years on that. It wasn't a service that we owned and operated up until a couple of years ago. It's all been sort of privately owned. Ambulance services sometimes run by the fire department, sometimes owned and operated by individuals. A lot of those are struggling. And so about two years ago during the pandemic, we made an investment. We bought one of the privately owned ambulance services that was under ownership with the same individual for a long time. And and she was looking to retire. And so we've been investing in that because not only can it help provide transportation to the hospital, but out of the hospital, which is just as important. And prior to that investment, we'd often have people who are here admitted and needed to go to a skilled facility, a personal care home, hospice, whatever, and there was no ambulance service or vehicle to take them. And so we've been working on that as well. And then, of course, as you said, we're always working on all these gain sharing programs to make sure utilization stays appropriately low while we keep people healthy and keep them satisfied and safe. And at the same time, part of our vision is to be a national leader in health care, quality, safety and value. Our board defines that word leader in our vision in the top decile.

      Jonathan Wiik: [00:29:43]
      Nice.

      Brook Ward: [00:29:43]
      But when we talk about quality at our level, we're talking about again, do we get this the right diagnosis and treatment, but did we efficiently take care of them and were we nice while we did it? Those are the three elements that we consider quality. And so we had an internal team over the last couple of years work on developing what we're calling the Washington Health System Patient Safety score. These are 60 patient and quality indicators that we can nationally benchmark that are important when someone's admitted to the hospital critical. And we're trying to get every one of those 16 in the top decile performance across the country. This last year, we finished ten of 16 and the top decile performance nationally this year, we're trying to up our game on that and now we're trying to focus on how do we create similar indicators for our outpatient patients. And so we're trying to figure out what would those indicators be, what makes most sense, And then we're not quite sure yet how we marry them together. Do we have two different measures that are measuring quality, or do we somehow blend them together and have an inpatient outpatient measure, which I think is the ultimate place to be, right? Yeah. The payers, as the payers are paying us to take care of people and provide quality. We can't forget about the outpatient side and so we're working on that on that as we speak as well. And honestly, we've received more quality recognition nationally over the last couple of years than we have in prior years, and I think that's going to get better based on our effort and focus there.

      Jonathan Wiik: [00:31:04]
      Yeah, that's great stuff. You're going to be a busy man. Your hospital's going to be very busy, I think, to working through all of those things and those quality initiatives. And what I love hearing throughout that is that you're measuring it. You're trying to understand like what is the benefit of doing this? And and sometimes those measurements aren't necessarily one of finance. They're more of, of of outcomes and mortality and morbidity and those types of things, which is great.

      Brook Ward: [00:31:28]
      Well, that goes back to Baldrige, right? If anybody's been involved with the program, they don't tell you how to run your business. They just had a set of criteria for you to evaluate your business. But when you're looking at the data, they're always encouraging you to sort of benchmark your performance compared to national standards compared to your past performance, to see what your levels and trends are. And then how do you integrate the learning from that across your entire organization. And so that philosophy works well for us. It works well for anybody who's using Baldrige to improve their business, and we try and leverage that where we can.

      Jonathan Wiik: [00:32:02]
      That's awesome. Well, you're a CEO, and I can't leave any CEO on a call without talking about money, even though your CFO is not sitting next to you. I would love to hear, you know, what's going on financially at your organization. What types of things are you focusing on to make sure your doors are open and and what are some strategic priorities that you have? You talked about labor a little bit. And unfortunately, layoffs, I think, are top of the list for a lot of hospitals in 2021 and into 2022, even just with how volumes have been. But what are. What are you doing to keep your eye on the ball to make sure that your revenues are solid and you're going to provide a financially viable hospital into the next decade?

      Brook Ward: [00:32:42]
      Well, I think looking at the revenue side, just again, making sure utilization is appropriate, we don't want patients over utilize it. We also don't want them to avoid care if they need it, specifically that preventative care. And so it's a follow up with our patients that we are attributed to to make sure that they're cared for on an expense side. Of course, we're dealing with inflation like everyone else and trying to manage that well. You know, we use a national GPO. We also have a joint venture with a couple of other local nonprofit organizations where we do physician preference items that you can't always leverage and get the best deal through a GPO, and that's worked out to our advantage, those kind of things we just wrapped up and it's been a long road. Terminated our pension program and so we froze that plan during the Great Recession. And we've been actively working on sort of advancing funds to that proactively. And so we've been for years putting more money into that program than required. And about six years ago, we took out a $25 Million loan, dumped it into that program, sort of gambling a little bit that the market was going to go up. And it did. And then over the course of those six years, we paid back that loan. So the organization didn't just shift the liability from one spot to another, but that allowed us those five or six years for that to grow in the market to the point where earlier this year we were well over the threshold to have that program fully funded.

      Brook Ward: [00:34:03]
      We had allowed some participants and members who were term vested, etc. to get out if they wanted a while ago and then this late this spring. Then in early summer we bought annuities then for all of those employees and past retirees. So they'll be guaranteed their retirement pension money without it being on our balance sheet. That's obviously a risk with the market. And so that was important. And then of course, we're always paying down debt. We don't have a lot of debt for our organization, our side, but we're actively always trying to lower that as much as possible. But probably the number one expense item we're working with right now and everybody is you mentioned, is workforce labor. And so we have more vacant positions now than we ever have, but we're spending more on labor, and that's because of the Great Recession or great resignation, people leaving those things. We took a little bit different tactic on tackling that than most organizations. And what I mean by that is of all of our positions open there, all of them are important. Otherwise you wouldn't hire the person, right? It doesn't matter if they're a housekeeper, a doctor, and every one of those jobs is critical. Critical. But an area of focus for us, like it has been a lot of hospitals is how do we find enough friends to staff the organization. And we made a decision last fall when people started resigning in droves and in our case, frankly, retiring, we see more retirement than we do anything else.

      Brook Ward: [00:35:29]
      How do we fill that gap? And we decided we did not want to go and get contract agency locum staff. They cost a lot of money, as you know, Jonathan. Committed to our organization long term. They're usually here for 13 weeks or so when they leave. You know, it creates a morale problem because, you know, you've got this person making a lot of money next to your normal hourly nurses. So you get this morale issue. You know, by the way, it's a safety issue. They don't know our processes, they don't know it, they don't know our physicians, etc.. So instead of going out and get outside contract agency staff, what we did is we went to our nursing departments and said if our nurses will volunteer to pick up an extra shift a week, we would bonus them in a way that accumulates over time and so they can stop at any point, of course. But if they did that and we originally did a 12 week agreement at the end of 12 weeks with their regular pay, their overtime in this bonus, it would get them almost to the amount of money they would have made as a traveler. Not quite, but close. But they get to stay here as an employee, keep their seniority, keep their benefits, stay with the family that they know and work with every day. They still get paid well. But it's it's good for us as well.

      Brook Ward: [00:36:41]
      The traveling companies charge you 150, 200, sometimes $300 an hour. Well, less than half of that goes to the employee. The rest that's going to the travel company. Right. So in our case, we could leverage and essentially bonus our own people. Now, the problem there is they have to work a lot and they get hired over time. So we've adjusted that over the last year or so. So when we are utilization has been down, we've ratcheted it down. This fall, of course, we were worried about potentially the pandemic surge coming back. And so we sort of ramped it up, but we're trying to leverage our internal team. And so 125 years into our organization's history, we've never once used a travel agency nurse as well, and we still have not during the pandemic. And know when we go out and talk with our nurses, their one comment is if they're tired. Admittedly, they've been working extra, but they would rather us do that than bringing these strangers. And not that travel. Nurses are bad people. They're not they're just not our family. Right. And so that's a little bit different strategy compared to most hospitals who've been stuck in this sort of treadmill of rehiring and hiring these travel nurses at huge rates, which is hurting their bottom line. And so that's one way we've tried to minimize the impact of that by keeping our people here, incentivize them to stay and still take care of everybody. We need.

      Jonathan Wiik: [00:38:02]
      To. Yeah, that's awesome. I mean, one way to not have an exit strategy for travel or premium labor is to not enter it in the first place, right? Exactly. This is what you've done, which is great. And I you know, I have seen kind of a state staff stabilization strategy work at lots of organizations as I talked to them, to where they're let's just try to maximize the resources we have but not burn them out and try to get them as pay equitable as we can, given the resources we have and get really creative. And that's great. You're on the right track and I think that's awesome. You're probably better positioned than those guys trying to turn down that. Hospitals in the Colorado region have had to set caps and said to these traveling companies, We can't afford that. That's not sustainable for us. And they said, well, then we don't have anybody to give you. And then that's just kind of rock and hard place for them, which has made it difficult.

      Brook Ward: [00:38:50]
      And of course then they're just being leveraged against the other hospital. You're not willing to pay? Probably. I'll send it up to road. They are, and you're just caught. You know, the other nice thing about our program is voluntary. So not every nurse has has to or wants to do it. And if they don't, we're not pressuring them to do that. It's only for those who want to participate. But as of this week, for example, we have 120 nurses who are signed up for the most recent program, which means they're working one extra shift a week that allows us to staff about 30 extra inpatient beds that otherwise would be unstaffed, which means that our EDI gets backed up. We have people waiting in the ED and so it's those kind of things. Working with the executive team here, our medical staff, our nursing leaders that we've been trying to be creative around.

      Jonathan Wiik: [00:39:31]
      That's awesome. One of the things you said when we were prepping and we've talked about a little bit, but I'd love for you to dive deep on it because it's pretty controversial, is I don't hear many CEOs talk about having utilization go down at your organization. Can you walk me through that strategy?

      Brook Ward: [00:39:48]
      Yeah, sure. So really, this goes back to the rural health model, the global budget, right? So we're getting a set amount of money to take care of a set amount of people. Now, within that program, there is what they call service line expansion. So if you're growing orthopedics, for example, OB or whatever, there's the ability to work with the rural health model to expand the revenue to cover that. Conversely, if the population shifts or decreases, the revenue goes down as well. So you're not protected. You can't just take the allotment of money and then ask the patients to go to your competitor as a way to try and keep utilization down and keep all the money. But it allows us to do what we all going into health care. What you'd want to do to begin with is just to keep people healthy, prevent them from getting ill and having serious illness. And so if we can work with them on. Illness and disease prevention staying healthy, then we can keep them out of our ED, out of our inpatient beds. It's the right thing to do from a society perspective in the sense that whoever is taking care of me, including myself, hopefully we can keep me healthy and keep me out of there is good for all of us. It's good for the system and frankly, for everybody who's been in health care. If we were going to design it from scratch, that's what you'd want, right? You want to prevent what you'd want to illness prevention, disease prevention, strategy. You wouldn't want what we've done in our country for the last five decades waiting till someone gets seriously ill and then trying to fix them at the end.

      Jonathan Wiik: [00:41:11]
      Absolutely. Well, we're about at time, so I'll just ask you one more question, Ward, and this has been awesome. I think people are going to get a lot of content out of this just in terms of what they could do at their hospital financially and and from a community need as well. What advice do you have for other community hospitals as we continue to come out of the wake of COVID and labor and inflation? What strategies would you tell a fellow CEO on the golf course or at a michigan game if you were sitting next to one?

      Brook Ward: [00:41:41]
      Well, I think, you know, switching around a little bit, I think the advice I would give is don't make some of the same mistakes I've made. And where I've made mistakes is sometimes a delay of action. So I can think of some examples where trying to get everybody here on board and get a 100% consensus has not worked. Or while we try and figure out what makes sense politically, we've delayed hiring someone. And then when we finally get around to making a decision to do that, it's too late. They're gone. And so and I think the other advice I'd have for a lot of hospital CEOs is just being willing to say, no. You know, there's a lot of demands on every leader's time. Yeah. Everybody wants a little bit of your time, not only internally but externally as well. And so trying to decide where is your focus, what's important to the organization, what's important to you personally, and get involved in those things and be willing to tell people no otherwise, I think are important tips and wisdom and things I wish I had done more of in the past, that kind of thing. And then, of course, just get a little time with your family and friends to relax. These jobs are extremely stressful. You know, the last three years during the pandemic, these workforce shortages, everything else has not helped. Stress and burnout is true across the board. Right. And we hear a lot about it from a physician nurses perspective. But personally, I believe it to be true for our housekeepers. The people that work on taking care of our facilities, our management teams, etc., because we're all here. In our case, our mission is to provide great patient care. We're all here to do that, whether we're hands on or not. And so I think finding time to decompress, you know, get a little resiliency built into your routine is important as well.

      Jonathan Wiik: [00:43:23]
      I love that word resiliency. And I mean, and I think, you know, I used to say to my teams, too, you've got to take care of you before you can take care of your patients in your community. If you're not right, everything else is off. I just came back from a RAF trip over the weekend and fully refreshed and recharged and was knew I was going to ride this pony today with you on the on the Washington health system journey and really enjoyed it. Ward I took a ton of notes and I'm sure folks on the call probably will take them as well. And just really appreciate your time and thank you so much.

      Brook Ward: [00:43:54]
      I appreciate it. Thank you. Jonathan and Finn. Thanks for having me. I hope the audience got something out of this. I know I enjoyed it and it's been an honor being here with you today.

      Jonathan Wiik: [00:44:03]
      Cool. Well, that's it for today. I really enjoyed spending time with Brooke Ward and the folks at Washington Health. They are doing some really innovative things in the value based care and ACO space. I think we could all learn a lot from lowering utilization where it shouldn't be and focusing on where it should be. And Brooke, certainly shared lots of what's going on at Washington Health. We should watch them closely as we move forward. Stay tuned for additional podcast from the Rethink series. I think it's going to be awesome as we look at things like denials, labor reports and talk to other executives and leaders of the industry about some pretty provocative topics and try to really rethink how health care is being managed and delivered in our country. Have a great rest of your day. And I'm Jonathan Wick with Drive. And please tune back in for the Rethink Health Care podcast. Take care.

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