Healthcare is Hard: A Podcast for Insiders

Dr. Mona Siddiqui says she loves solving problems at the intersection of health policy, strategy, data and operations. After earning a medical degree from Johns Hopkins, a master’s in public health with a focus on quantitative methods and data analysis from Harvard, and a master’s in engineering from Stanford, Mona has dedicated her career towards using this unique skillset to improve healthcare.She served as a resident at George Washington University Hospital, Innovator-in-Residence at CMMI, and a member of the White House National Science and Technology Council, among other prominent roles. She also became the first ever Chief Data Officer at the Department of Health and Human Services where she led the effort to connect the nation's health care data through a new technology infrastructure, organizational management of data as an asset, and an enterprise training program for data science and AI. In her current role as SVP of enterprise clinical strategy and quality at Humana, she’s applying the vast knowledge and experience she’s gained towards one main objective: creating a better consumer experience in healthcare.During her conversation with Keith Figlioli on this episode of Healthcare is Hard, Mona shared her thoughts on several timely topics including:The critical, yet unglamorous work of organizing data. Mona recounts how she experienced the pain of not having access to the right information at the right time throughout her career and in her initial role at HHS where she was tasked with thinking about new solutions in the opioid epidemic. She and her team realized the enormous amount of disconnected data at other government organizations such as the Department of Justice and the Department of Labor, and began integrating it to develop a new and unique lens into the challenges they faced. She talks about how infrastructure issues like this are not glamorous, but create incredible opportunities to make a meaningful and lasting impact.Humana’s evolution into a healthcare company. Over the past few years, Humana has forged partnerships with providers like Oak Street and Iora Health, acquired organizations including Kindred, the nation’s largest provider of at-home healthcare services, and grown many other new initiatives organically. As its track record demonstrates, Humana is considering all options in its transition to a “payvider” and remaining focused on the key objective of creating better consumer experiences and improving healthcare outcomes. Mona discusses how this long-term evolution is still in progress, while notably referring to Humana now as a “healthcare company.”Connecting in-person and digital experiences. With the digital transformation of healthcare, and especially advancements made over the past two years, technology is now an inherent part of consumer experiences in healthcare. Mona remembers her time as a clinician and how she often didn’t have the right infrastructure to give patients the support they needed. She talks about how Humana is in a unique position to think about a holistic set of experiences – not just for patients, put for providers too – and how to create them.Partnering with early-stage companies. For startups looking to make a difference in healthcare, Mona discusses what Humana is looking for in its partnerships and how to best work together. In clinical areas, she advises that Humana’s largest focus is addressing the needs of the sickest people. She also points to the need for solutions that bring caregivers and families into the conversation, and those that create integrated experiences in home and community-based settings. Overall, the goal is to become more efficient at providing the right care at the right time.To hear Mona and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Phoebe Yang holds one of the most instrumental roles at the intersection of tech and healthcare. As general manager for healthcare at Amazon Web Services, she leads a team focused on making healthcare better by enabling organizations to increase the pace of innovation, unlock the potential of health data, and develop more personalized approaches to therapeutic development and care. Phoebe also has a long history advising health systems at the board level. She previously sat on the board of Providence-St. Joseph Health and two ACO boards while in the C-suite at Ascension; and she is currently a member of the board at CommonSpirit Health, where she helps guide the $35 billion health system that has more than 700 care sites and 150,000 employees across 21 states. Phoebe also served as Chief Strategy Officer for Population Health at Ascension.Over the course of three decades, Phoebe’s career has spanned multiple industries and sectors from law and government – where she served two presidential administrations in technology and international diplomacy – to media, healthcare and technology. All that experience has driven her to a place where digital transformation in healthcare has become a central focus of her career.In this episode of Healthcare is Hard, Phoebe talks to Keith Figlioli about board dynamics in healthcare, while also sharing insight into her role at Amazon Web Services and her advice about how health systems should collaborate with tech companies. The topics they discuss include:Reshaping health system boards. Not long ago, board seats were largely occupied by health system insiders and other regional business owners in the communities an institution served. But now, a whole new set of competencies and perspectives is required, and among them, technology experience is a must have. Phoebe explains how it’s the board’s job to “look around corners,” anticipate every scenario and ensure the organization is thinking strategically in order to ensure near, mid and long term success. Without technology expertise at the board level, she says health systems will be disadvantaged in their efforts to engage patients and consumers as everyone’s digital lives expand.Two-way doors driving decisions. Phoebe believes the most mis-understood calculation in healthcare involves the notion of risk. She points out that everything in healthcare has traditionally been seen as a binary calculation of life and death, and shares an alternative strategy used by leaders at Amazon Web Services. She says they often look at whether decisions are a one-way door – one you can’t walk back through – or a two-way door. She says most decisions, even in healthcare, are two-way doors where you don’t need 100% of the information in order to make a decision. Acting on the information you have is better than being paralyzed and inactive. If something doesn’t work out, you pivot and adapt.Dealing with outside disruptors. From her role inside one of the biggest tech companies, Phoebe has sage advice for health systems. She says to remember that you are in the prime position and have spent decades building trusted relationships with your patients and communities. Remember that the biggest asset in healthcare is trust and think about how to use the trust you’ve built to better serve your customers. Most importantly, don’t obsess over what everyone else is doing because they would love to be in your position. What you should obsess over is your customers: it’s how Amazon Web Services operates and Phoebe says how health systems should too.To hear Phoebe and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Since the beginning of the pandemic, Dan Michelson has held at least three to five zoom calls per day with hospital CFOs across the country. As the industry navigated the most disruptive and uncertain times in modern history, healthcare leaders turned to Dan for his insight and advice because of the unparalleled visibility he has into the market through his company, Strata Decision Technology. Strata provides financial planning and analytics software for more than 400 health systems and 2,000 hospitals – in other words, about half the U.S. healthcare provider market.While health leaders turn to Dan on an ongoing basis, he’s also become known for articles every January that analyze the top trends and topics discussed at the annual J.P. Morgan Healthcare Conference. In fact this year, Dan published two articles – one in Fortune and one in STAT News – and for the third year running, joined Keith Figlioli to dive even deeper with a discussion on the Healthcare is Hard podcast.What surprised both Dan and Keith the most at this year’s event is the fact that COVID was not really a focus. CEOs and CFOs from some of the nation’s most prominent health systems that presented during JPM’s non-profit track barely mentioned it because it’s now become a normal part of every health system’s operating model. COVID is no longer a specific focus because it’s an intrinsic element in everything they do, and they’re prepared for it.But Dan’s articles touched on some of the other major topics from JPM that he and Keith talk about in this episode, including:Staffing. Staffing. Staffing. The headline of Dan’s article in STAT News captured the mood best: “Covid-19 is no longer the biggest issue facing hospitals. Staffing is.” Workforce issues dominated JPM this year and most presenters recognized these issues as their biggest focus and challenge. Dan and Keith discussed how health systems are thinking about staffing differently and how they’re thinking about deploying technology differently to ease staffing demands and burnout. They also discussed some of the new challenges providers are facing as the market evolves – such as competition for new talent from virtual care companies, specialty providers, payers and many others – and new strategies for training, recruiting and retention a result.Top strategies for the future. With COVID becoming a normal part of operations, health systems are finally thinking about the future again with a clear eye towards strategy. In Dan’s Fortune piece, “The greatest comeback in the history of health care,” he talked about the severe financial strains health systems faced over the past two years, with volumes down 30% to 40% in the early days of the pandemic. But now that the industry has weathered the storm and proven how critical and resilient it is, the focus is the future. From what Dan heard at JPM, he sees strategies falling into five critical areas that he and Keith discussed: M&A, investing in innovation, value-based care, creating destination centers, and deploying virtual care platforms.To hear Dan and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Bryony Winn is a Zimbabwe native and Rhodes Scholar who says her background growing up in the developing world contributed to her innate desire to pursue a career with an element of social impact. And she says that background had a fundamental impact on the voice she brings to the U.S. healthcare market and to her leadership style.Bryony spent the first decade of her career at McKinsey & Company providing strategic and operational counsel to a wide variety of clients across Europe and Africa. After relocating to the U.S. in 2011 and being named a Partner in McKinsey’s Chicago office, she worked with the Center for Medicare and Medicaid Innovation (CMM) and advised numerous healthcare CEOs and government leaders seeking to improve systems of care and transform payment models.After leaving McKinsey, Bryony spent two years as Chief Strategy Officer at Blue Cross North Carolina and then joined Anthem as Chief Strategy Officer. In September 2021, she was named President of Anthem Health Solutions where she is now responsible for ensuring that the more than 45 million consumers in Anthem’s family of health plans have access to high-quality, affordable care.On this episode of Healthcare is Hard: A Podcast for Insiders, Bryony shared her perspective with Keith Figlioli on a number of topics, including:The Fundamental roles of a payer. In Bryony’s view, there are two central issues that define a healthcare payer and its ability to deliver higher quality, lower cost care: how it partners, and how it pays. She points out that organizations signal what they value by the way they pay for care. For example, how paying for care that drives affordability and quality incentivizes collaboration.Innovation inside incumbents. There’s a misconception that innovation is not occurring inside large incumbent healthcare organizations, according to Bryony. She says startups do not have a monopoly on smart people taking thoughtful approaches to the complexities and challenges of the U.S. healthcare system that have developed over decades. While the journey may be slower in these organizations, she says the difference is that they have a longer track record for sustainability – one of the most important factors in U.S. healthcare. She believes in approaching the market with a deep sense of humility for the people and companies that have come before us.Advice for entrepreneurs. Bryony says so many potential partners and vendors looking to do business make promises on issue like financial savings or Medicare star ratings. She jokes that if she added up these promises, Anthem would be a 23-star plan. When asked how entrepreneurs and startups can work best with Anthem, she warns of the importance of honesty – but says it needs to come from both sides of the table. Startups should expect honesty from a large company on things like payment and implementation cycles. But they need to be honest about what they have actually delivered versus what they hope to deliver. Don’t pretend you have a track record when you do not, because if you’re honest about what you hope to deliver, a company like Anthem could work closely with you to help make it happen.To hear Bryony and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.

Walmart is the world’s largest retailer with revenues surpassing $120 billion and more than 10,000 locations across the globe. With nearly 5,000 locations in the United States, 90% of Americans live within 10 miles of a Walmart store.No conversation about the role retailers are playing in healthcare disruption would be complete without including Walmart. So to close a thee part series of retail interviews that also included the Chief Medical Officer at Walgreens and Chief Strategy Officer at CVS Health, Keith Figlioli spoke with Walmart’s Chief Medical Officer, Dr. John Wigneswaran, for this episode of Healthcare is Hard.Dr. Wig, as he‘s known, says he never expected to be working at Walmart when he was in medical school. And in fact, even though his father was a pediatrician, a career in medicine seemed to be a remote possibility early in life when he was following his passion for music and signing a record deal. But since then, Dr. Wig has led an impactful career with a variety of roles in the pharmaceutical, medical device and healthcare services industries, after more than a decade of clinical experience as a practicing nephrologist.Before joining Walmart this year, Dr. Wig was CMO at Express Scripts. He also served as CMO at DaVita Rx, VP of Market Development at Fresenius Medical Care, and Medical Director in medical affairs at Johnson & Johnson (Scios Inc.), among other roles.Dr. Wig’s conversation with Keith Figlioli about Walmart’s growing role in healthcare covered a number of topics including:Meeting people where they are. Dr. Wig says that finding ways to fit health care into peoples’ day to day activities is a core focus for Walmart. This allows people to avoid rearranging their lives around traditional healthcare structures, and also expands the type of care available to them. Walmart’s omnichannel capabilities can provide the flexibility that people need – especially when it comes to complex and costly interventions around chronic diseases. For example, this could include a person with diabetes being educated about healthy foods or a telepharmacy encounter for someone with an educational need.Building community trust. Most retail settings are about more than just shopping, according to Dr. Wig. People go to their local Walmart store for many reasons, some to simply walk indoors for the exercise, but overall for a sense of community. Dr. Wig says trust is becoming much more local and recognizes the opportunity and responsibility Walmart has to be a place where people can turn for their healthcare needs.The power of data. Walmart has long been known as a pioneer in the way it uses data to improve operations and better serve customers. The company can apply that same know-how and discipline to using data in way that can improve healthcare. Dr. Wig says the company is very focused on the privacy and security aspects of healthcare data and determining how to bring its many sources of data to bear in a safe and responsible way.To hear Dr. Wig and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.

In the United States, 85% of the population resides within 10 miles of a CVS Pharmacy. Through continued growth and expansion since its founding as a health and beauty products retailer in the early 1960s, CVS Health has now become America’s largest health services company. That expansion accelerated over the last two decades through acquisitions of companies like MinuteClinic, Caremark and Aetna that embedded CVS even more deeply into the U.S. healthcare system and communities across the country. Josh Flum has played key roles in CVS Health’s transformation and healthcare strategy for nearly 20 years. After Yale Law School and a few years as a white-collar criminal defense attorney in Washington, DC, Josh decided on a career change and landed a job at Boston Consulting Group where he first crossed paths with CVS. In this episode of Healthcare is Hard, Josh tells Keith Figlioli about one project at BCG where he was begrudgingly selected to spend two weeks virtually living at CVS pharmacies learning everything there is to know about how they operate. That assignment proved invaluable for the rest of Josh’s career. Since joining CVS in 2004, he has held several senior roles including leading pharmacy operations and overseeing Enterprise Product Innovation and Development teams. He also co-founded and leads CVS Health Ventures, and is currently CVS Health’s Chief Strategy & Business Development Officer.Josh and Keith covered several pressing topics during this Healthcare is Hard interview including: The next evolution in pharmacy. Josh talks about fundamental shifts in the pharmacy business that have occurred in his career and what he thinks is in store for the future. While the deeply personal connection between people, families and pharmacists has always persisted – and will be integral for the future – the pharmacy business has moved from being about medication fulfilment, to clinical pharmacy care including medication adherence, to other aspects of medical care such as testing and immunizations. Josh says the future will be about pharmacists practicing at the top of their license and balancing clinical care interventions with new technology and the consumer relationships that pharmacists have always maintained.The retail threat. Keith posed the same question to Josh that he asked Walgreen’s CMO on last month’s Healthcare is Hard episode: how should incumbent healthcare delivery players think about the emerging role of retailers? To Josh, it comes down to how a company fits into three trends: patient as consumer; care in community, home and virtual settings; and technology. Josh says CVS feels very well positioned to play a big role in the future of healthcare as these trends continue to evolve, while recognizing that the company still has much more to do and will need to work in partnership with the broader healthcare system to make the kind of change that is necessary.The flip side of innovation. Through his role at CVS Health Ventures, Josh sees many of the exciting developments that are going to make care easier and more ubiquitous, but sometimes wonders if the pace of advancement could overwhelm consumers. Putting himself in the consumer’s shoes, he says it’s all about trust. He believes consumers will turn to the people and organizations they know and trust to help navigate new experiences – organizations like CVS Health. For its part in the innovation ecosystem, Josh says CVS Health Ventures is currently focusing on investment themes including care delivery, consumer centric healthcare, whole person care and disruptive tech enablement that crosses all these domains.To hear Josh and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.

Since its first store opened in 1901, Walgreens has been embracing innovation in the retail pharmacy space, fueling its expansion to become a neighborhood health destination with more than 9,000 locations. As the healthcare industry navigates major structural changes – and a global pandemic – Walgreens is staying true to its roots of innovation and guiding what the future of healthcare looks like in America.Kevin Ban joined Walgreens as Chief Medical Officer in January 2020, and by the end of February was already being thrust into pandemic planning and response. In the short time since, he’s implemented guidelines to ensure customer and team member safety, launched and expanded COVID-19 testing services across thousands of stores, and rolled out COVID-19 vaccinations, all while focusing on Walgreens’ long term goals for the strategic role it will play in healthcare.During this episode of Healthcare is Hard, A Podcast for Insiders, Kevin draws on these experiences – as well as past roles including time spent as CMO at Beth Israel Deaconess Medical Center, CMO at AthenaHealth, and Professor at Harvard Medical School – in a wide-ranging discussion with Keith Figlioli. They touch on a number of topics including:Decades of VBC Lessons – While value based care in America is still in its early days, Kevin has been a student of value-based arrangements for two decades. He describes time he spent in Italy in the early 2000s where he was exposed to the single-payer model, and what he calls the epitome of value based care. For example, he remembers the Italian health system being exceptionally good at delivering care outside of the hospital in a way that the U.S. health system would have never imagined. He also talked about how that background prepared him to become involved with one of the nation’s first VBC experiments – Blue Cross Blue Shield of Massachusetts’ Alternative Quality Contract – at a time when his peers showed little interest. (for more on AQC, listen to the Healthcare is Hard Episode with Pat Gilligan, Chief Commercial Officer at BCBSMA)Pairing primary care and pharmacy. In his time at Beth Israel, Kevin says he was amazed at how often plans for patients fell apart because of the challenges with medication management after discharge. These experiences formed Kevin’s beliefs about the imperative for getting medication reconciliation right. He says that any time you can pair primary care and pharmacy together thoughtfully, it will drive better outcomes, and talks about different strategies for ensuring synergy in the future.Community care and retail’s role. Kevin knows how important the last mile of care is and says that connecting with people outside of the hospital was a continued source of frustration during his time at Beth Israel. However, that paradigm is completely different at Walgreens. People trust their pharmacist because they’re accessible and deeply knowledgeable, but overall, they’re an underutilized resource within the health system. While not long ago, it’s even difficult for Kevin to remember a time before pharmacies administered flu shots. And now, people go very comfortably to their local pharmacy for vaccines and testing, making them an important new site for primary care – just as Walgreens is delivering through its investment in and partnership with VillageMD.To hear Kevin and Keith talk about these topics and more, listen to this episode of Healthcare is Hard. 

Investments in digital health hit an all-time high in 2020, only to surpass the new record within the first six month of 2021. Needless to say, there’s never been more attention placed on digital health innovation. But it makes for a crowded market, putting providers and health system CIOs in a challenging position where it’s impossible to vet the wave of new technologies and determine what will really help reduce costs and improve care. For 25 years, KLAS has helped providers navigate the increasingly complex healthcare IT landscape through research that’s focused on amplifying their voice in the market. With a rigorous process of collecting and assembling feedback from the people who actually use healthcare technology, KLAS forces technology vendors to face, act on, and improve from critical feedback, and gives providers a venue to seek advice from their peers.In this episode of Healthcare is Hard: A Podcast for Insiders, Keith Figlioli talks to the CEO and co-founder of KLAS, Adam Gale. They discuss his firm’s role in the digital health industry over more than two decades, and touch on topics important for providers, vendors, investors and others playing a role in the industry’s future. They cover a number of issues, such as: The beginning of health tech innovation. KLAS was established at what might feel like the beginning of digital health innovation – even before Meaningful Use was implemented – but once again Adam feels like things are just getting started. He talks about being in the right place, at the right time, to be a trusted voice during the nationwide rollout of electronic health records, and the uncertainty KLAS felt for the future once EHRs were in place. But he also talks about how being at the front edge of technology right now reminds him of those early days, and the limitless possibilities that lie ahead.Forcing change through public policy or private markets. Touching on a theme from the last Healthcare Is Hard podcast with ONC’s Steven Posnack, Keith and Adam discuss the levers for implementing change in healthcare IT. Adam shares a conversation he once had with Secretary for Health and Human Services, Mike Leavitt, where they both expressed envy for the other’s ability to help implement change. While Adam pictured government as a body capable of setting the course, Secretary Leavitt revealed how difficult this actually is. A slight move in any direction, according to Leavitt, creates waves of pushback from multiple angles. But as a private organization with influence over both vendors and providers, KLAS is in a unique position to drive change and improvements across the industry.Advice for entrepreneurs. Adam shares insights throughout the interview that are valuable for digital health startups and entrepreneurs, while providing direct advice at times too. For example, he talks about the strategic importance for early-stage companies to invest in their first customer relationships to develop one or two health system customers that will become good references. He says this might be a slower path to success, but stresses the power that word-of-mouth has in the healthcare industry and how this approach builds real value.To hear Adam and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.

The accelerated pace of innovation in digital health, record-breaking investments in the sector and even some of the technology developed to navigate the pandemic wouldn’t have been possible without groundwork laid by The Office of the National Coordinator for Health Information Technology (ONC). And there’s probably no one who understands ONC’s past, present and future role better than Steve Posnack.Steve is a fixture at ONC, joining a year after it was formed in 2004 and serving for the past 16 years in various capacities through four administrations. Since 2019, Steve has served as Deputy National Coordinator, playing an integral role in policy development, technology initiatives and investments, budget prioritization and industry-wide coordination.In this episode of Healthcare is Hard, Steve gives a background and history of ONC, explaining how it fits into the Department of Health and Human Services and the overall role it plays in the federal government. He shares insights that anyone in the healthcare innovation ecosystem should understand and his conversation with Keith Figlioli covers a number of topics including:Wins and regrets of ONC. As someone who has been at ONC for nearly its entire history, Steve has a rare vantagepoint to reflect on initiatives that have gone smoothly and lessons-learned for those that haven’t. For example, he discusses successes and challenges of Meaningful Use, recognizing its imperfections, but all the innovation that it made possible as well.Cybersecurity in healthcare. Steve entered ONC after earning a dual master’s degree in cybersecurity and health policy from Johns Hopkins University, giving him a unique skillset to address the security issues with healthcare IT that are becoming increasingly more critical. He talks about the need for better cyber hygiene industry-wide and shares thoughts about meeting that goal. But he doesn’t predict any federal mandates for security in the near future.Improving data quality. According to Steve, poor data quality is a sore point for public health professionals and an area where the private sector can help in order to benefit everyone. He says the people tasked with tracking and consolidating data spend precious time doing “data detective work,” and it’s been especially challenging through the pandemic. This requires looking upstream to know where data is coming from and where it’s going to figure out how gaps occur and how to address them.The future role for ONC. Taking all of ONC’s accomplishments into account, Keith and Steve discuss if there’s more work to be done, or if the public sector should start taking over. From Steve’s perspective, there’s a lot for the private sector to build on, but he also says there’s a lot the industry is still asking ONC to push forward. As just two examples, he talks about how work around the social determinants of health and the convergence of clinical and research operations still need broader coordination.To hear Steve and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.

In the United States, more than 90% of the landmass is rural. And in rural communities from coast to coast, the challenges in delivering healthcare can be very different than the urban and suburban centers that get most of the attention.There’s untapped opportunity in reimagining healthcare business models and the technology that will enable them in rural areas, according to Ballad Health CEO, Alan Levine. And he should know – in the three years since Ballad was formed by merging Wellmont Health System and Mountain States Health Alliance, it has had exceptional success rewriting the rules of rural healthcare.Among some of its visible and measurable improvements, Ballad Health has decreased pricing by an average of 17% for urgent care and other physician-based services, cut its mortality rate for trauma in half, reduced low acuity admissions by 16,000 per year, and saved the region in which it operates more than $200 million per year in healthcare costs. And it’s doing this with only a 20% commercial payer mix.In this episode of Healthcare is Hard, Alan talks to Keith Figlioli about how Ballad Health is achieving these milestones by better understanding the dynamics of rural healthcare and making big structural changes to address them. He shares specifics about many of the changes Ballad has already implemented and his plans to continue down this revolutionary path. Their conversation covers topics including:Trading competition for regulation. In the areas of Tennessee, Virginia, North Carolina and Kentucky where Wellmont and Mountain States operated, only 50% of hospital beds were occupied and rates were declining. To survive and give it stability, Wellmont looked to be acquired by an outside system, until Mountain States stepped in with a unique solution to merge. But the FTC opposed the merger every step, forcing legislation in Virginia and Tennessee followed by approval from both states’ governors, attorneys general and health commissioners. Against significant odds, the merger was approved with Ballad agreeing to cap pricing and price increases at a rate well below the hospital consumer price index (CPI).Eliminating duplication. Many of the structural changes at Ballad Health revolved around reducing duplicate services. Intense competition between Mountain States and Wellmont forced one system to always keep up with the other. As a result, a small town like Greenville, TN had two hospitals a little over a mile apart which had both lost $70 million at 30% capacity in the years leading up to the merger. One of Ballad’s key goals is to implement a more rational approach and business model that makes sense for rural areas.Transforming from hospitals to health improvement. While reducing duplication, Ballad is thoughtfully applying the resources it saves to improve the health of its communities upstream. For example, in one region where it consolidated hospitals, it converted one building into a residential facility for women who are pregnant, homeless, drug addicted or have other needs. It gives these women housing security, food security and resources to help ensure their babies are born into a healthy situation.The new competitive landscape. Alan says his biggest competition is no longer the health system or physician group down the street. It’s the tech-enabled company across the country or a retail chain that could provide primary care. And unlike health systems in urban areas that can offset the loss of a patient with populated growth, there’s nothing to replace that loss in a rural area. This is why technology will play a significant role in the transformation of rural healthcare.To hear Alan and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.