Healthcare is Hard: A Podcast for Insiders

Dr. Farzad Mostashari’s extensive resume doesn’t fully convey the true value he brings to reimagining healthcare. He’s the former National Coordinator for Health IT at the Department of Health and Human Services, served as assistant commissioner at the New York City Department of Health, was an Epidemic Intelligence Service officer at the CDC, a fellow at The Brookings Institution and a resident at Mass General Hospital. Yet, with all that experience, he says living through the Iranian revolution before moving to the U.S. at age 14 is what fuels his ability to see things differently.As he told Keith Figlioli, “seeing an actual revolution does something for your sense that things can change; that you can be looking at one reality one day, and a different reality the next day.”In this episode of Healthcare is Hard, Farzad talks about how he’s never been totally comfortable inside – or even leading – the grand institutions he’s been part of, and at some level, has always felt like an outsider. He describes his ability to see the insider and outsider perspective, his natural disposition to see things differently, and how this trait led him to found Aledade.Most of the industry looked at the Medicare Shared Savings program in the Affordable Care Act and assumed that hospitals needed to be at the center of creating and sharing in savings. But after noticing the law didn’t require a hospital, Farzad began building a network of primary care doctors who could treat people upstream, reduce hospitalization and lower costs.Seven years later, Aledade has assembled 800 practices in 35 states and has $12.5 billion in annual medical spend under management. It’s helping independent physician practices deliver better care, reduce overall costs and preserve their autonomy in communities all across America.Farzad brings his outsider mentality and inclination to see things differently to his conversation with Keith Figlioli on this episode of Healthcare is Hard. They cover a number of topics including:Dis-economies of scale. Farzad talks about how healthcare is one of the few industries where organizations tend to lose money as they get bigger, and how it all maps back to fee-for-service. The main driver of consolidation in healthcare has been the need to build leverage at the negotiating table. But he says if you change the rules of game – including what’s being valued, rewarded, and compensated – you actually see that the small guys do better.Independent vs. Institutions. Farzad sees this as a proxy battle. He says if you’re betting fee-for-service will be the future of healthcare, bet on consolidating health systems. But if you’re betting on value, bet on the independents.Trust in policy makers. As someone who has lived on both the public and private sides of healthcare, Farzad sees that many people in the private sector are highly skeptical of healthcare policy makers. But in his experience, smart policy makers are motivated by evidence and doing the right thing to help improve care and lower cost. He says leaders in the private sector who understand this are in a better position to navigate the potential regulatory risk impacting their business.A decade of vision driving real value. It’s taken a long time to build much of the infrastructure that started under Farzad’s leadership at ONC almost ten years ago. And now, the combination of new incentives with data-driven capabilities the industry has talked about for a long time are very real. These elements have already created billions of dollars in value that couldn’t exist before, and that impact will continue to multiply.To hear Farzad and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.

Dr. Sachin Jain says he got a silent education about healthcare and medicine around the dinner table from his father, an anesthesiologist and pioneer in pain management. But he still wasn’t sold on a career in healthcare until the end of his junior year at Harvard when he took a course on the quality of healthcare in the U.S. taught by Dr. Howard Hiatt and (one of this podcast’s first guest) Dr. Don Berwick.That decision kicked-off a career where Sachin has packed experience from nearly every angle of the healthcare industry into the last 20 years. Immediately following his junior year at Harvard, Don Berwick offered him a summer internship with the Institute for Healthcare Improvement (IHI) working on its Pursuing Perfection Initiative. This provided an opportunity to visit and study the nation’s best health systems at Don’s side and opened the door to a tremendous network of national healthcare leaders.A few year later, Sachin landed in Washington, DC as Special Assistant to the National Coordinator for Health IT during the Obama Administration and then Senior Advisor to the CMS Administrator (his mentor, Don Berwick). He then jumped back to the provider side as a resident at Brigham and Women’s Hospital in Boston for four years, before seeing healthcare through the pharmaceutical lens as Chief Medical Information and Innovation Officer at Merck. In 2014, he was recruited to the west coast by Anthem Blue Cross Blue Shield, where he was CEO of its subsidiary, CareMore Health, a care delivery system for Medicare and Medicaid patients, and CEO of Aspire, a large palliative care provider that was acquired by Anthem in 2018.In July 2020, Sachin became CEO at SCAN Health Plan, a non-profit founded as the Senior Care Action Network in the late 70s that’s now a Medicare Advantage HMO with 220,000 members and revenues over $3.5 billion.At SCAN, Sachin has continued his commitment to disrupting the status quo in healthcare. On this episode of Healthcare Is Hard, he discussed many of his ideas with Keith Figlioli, including:Making hospitals less necessary. A few years back, Sachin was in the running to lead a nationally-known integrated health system and laughs at himself when he thinks of his final pitch to the board. He argued for revenues to go down, fewer beds and facilities, less fee for service revenue, and more risk-based revenue. While he fully understands how this goes against everything driving health systems for the past two decades, it aligns with his fundamental belief that healthcare needs to focus more intensely on outpatient management of people with chronic diseases to keep them out of hospitals as much as possible.Medicare advantage as a blueprint of Medicare for all. Sachin says he doesn’t think Americans trust the public sector to fund and provide healthcare, but he believes people could get behind healthcare that is government funded and privately delivered. With elements like a coordinated network, transparency around quality, incentives for consumer experience, and rewards for higher participation, he believes MA could be a solution to full coverage.Islands of innovation. While Sachin sees lots of creativity and reinvention around individual verticals and addressing single diseases, he’s frustrated with the lack of connective tissue between them and thinks this will get worse before it gets better. He says the next phase will have to be focused on connecting all these pieces to treat the full patient and that it will be incumbent on private markets to think creatively about deal structure to incentivize it.To hear Sachin and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.

Improving patient experience has been a driving focus for Winjie Miao during her twenty year career at Texas Health Resources, where she’s now senior executive vice president and chief experience officer. Texas Health cares for more patients in North Texas than any other provider through 350 access points including 27 hospital locations and a network of outpatient facilities, Neighborhood Care & Wellness Centers, preventive and fitness services, and home health services.After joining Texas Health, Winjie spent 15 years in hospital operations – first at one of the system’s largest hospitals and then at its smallest. She then embarked on a unique opportunity to build a new hospital where she planned, implemented and piloted new technology in a way that wouldn’t have been possible at an existing hospital campus.In 2015, Winjie joined Texas Health’s executive leadership team and a year later played a significant role developing its 10-year strategic plan, Vision 2026, which made patient experience a central focus. In three phases, Texas Health planned to understand everything it could about healthcare consumers, build new capabilities to activate consumers, and finally capture value for both consumers and the health system itself.Nearly halfway through its strategic plan, Texas Health had already piloted virtual primary care by the beginning of 2020 and planned a phased rollout through the rest of the year. Then COVID hit.In this special episode of Healthcare is Hard, recorded as part of the Digital Health Innovation Summit (DHIS) Virtual Spotlight Series, Winjie talks to Keith Figlioli about what Texas Health has learned through this process and how she sees the future of home health unfolding. Their conversation covers a number of topics, including:One giant pilot. While Texas Health was well on its way to piloting and implementing options for virtual primary care at the beginning of the pandemic, Winjie talks about how the first two or three months of going almost entirely virtual were still a huge learning experience. She says it forced significant changes from the original plan.Barriers to integrated virtual care. When it comes to telehealth, Winjie sees it becoming an integrated part of the care workflow within the next three years, but she discusses internal and external barriers to overcome first. These include ensuring that equal reimbursement rates for in-person and virtual visits remain permanent, and determining where new business units or processes need to be newly created, and where old ones can be adapted.A thoughtful and measured approach. Winjie points out the importance of recognizing that home health is right for certain groups, and not for others. Without reliable internet, the ability to connect multiple at-home remote monitoring systems, a support system or family member who can be there and be part of the care team, and other essential variables, home health is not the best form of care for many people. But it is absolutely the best place for others, and that determination needs to be made in a very deliberate and pragmatic manner.A fast start, but long road to home health. Many people, both inside and outside of the healthcare industry, look at the progress that’s been made due to the pandemic and think telehealth has arrived. But Winjie talks about all the work that still needs to be done, especially when it comes to connecting different types of virtual care platforms that have all matured at different rates. She says connecting them in a way that’s meaningful for the patient and the care giver is still a few years away.To hear Winjie and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.

Last year tested nearly every aspect of the healthcare system, making the 2021 J.P. Morgan Health Care Conference like none other in its 39-year history. But there’s at least one constant from the past few years – the insight Dan Michelson, CEO at Strata Decision Technology, offers in the recap he writes for Becker’s Hospital Review.With a customer base that includes 2,000+ hospitals and 400+ healthcare systems, about half of all U.S. healthcare flows through Strata’s financial analytics and performance platform. Needless to say, this gives Dan a unique vantagepoint to observe and add context around the discussions healthcare’s most influential leaders have at JPM every January.Dan’s biggest takeaway this year? While the pandemic stretched providers to the limit – placing extreme demand on care delivery and untold pressures on their financial stability at the same time – the system proved that it’s too vital to fail. But If providers want to be able to say the same thing ten years from now, they’ll have to look and operate much differently than they do today.Just like last year, Dan talked to Keith Figlioli for a special Healthcare is Hard episode where they dissect the ideas from JPM that set the stage for the months and years ahead. They talked about what was lost and gained by holding the event virtually, but more importantly, what they took away that will help health systems – and everyone that supports them – build back stronger. Some of the topics they discussed include:The Mindset for 2021. Everyone thinks the future is hard to predict, but at this point in healthcare, Dan says it really isn’t. Strata has been working with a cohort of about 50 health systems throughout the pandemic to study patient volumes and utilization, publishing findings every two weeks that have become a monitor for the financial and operational impact of Covid-19. Based on the data, he expects volumes in 2021 to remain at their current levels (which are down across the board from 2019) through most of year and begin to pick back up in the fourth quarter. He says the mindset health systems have this year is to “keep it going as best we can” and that 2022 will be the year they expect a return to “normal.” Proving the Payvider Model. As the disconnect between payer and provider continues to cause frustration for consumers, integrated models that align incentives have provided relief, offering a better experience at a lower cost. And the financial stability that integrated systems experienced through the pressures of the pandemic offered another very important proof point for the future of the payvider model. Dan points to Intermountain Healthcare – and former Healthcare is Hard guest Bert Zimmerli – as an example to emulate. The Year of Digitizing Operations. Dan expects to see a very big swing back to managing costs and driving productivity through automation and digitization in 2021. There was no time to worry about cost last year, but as volume remains low and the payer mix impairs profitability, innovation and efficiency are coming back into focus.Following the Money to Home Health. Out of necessity, the pandemic pushed home health and telehealth years ahead of where they would otherwise be. But Dan talks about how health systems won’t maintain their support for home health unless financial incentives align. The speed with which this shift happens will depend largely on CMS taking the lead and putting the right incentives in place.To hear Dan and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.&a

Before the term Value Based Care existed, Blue Cross Blue Shield of Massachusetts (BCBSMA) unveiled one of the nation’s first risk-based payment models – its Alternative Quality Contract (AQC). Patrick Gilligan joined BCBSMA in 2007 to oversee the AQC’s rollout after spending nearly 14 years negotiating contracts on the provider side at Partners Healthcare (now Mass General Brigham). He left BCBSMA for a three year stint at CVS, where he led health system alliances, and is now back at Massachusetts’ largest private insurer as chief commercial officer where he is responsible for all market-facing functions for the health plan and its 2.8 million members.This episode of Healthcare is Hard taps into Pat’s unique view of the healthcare market that spans payer, provider, and pharmacy/PBM. He talks to Keith Figlioli about the market factors influencing the cost and quality of healthcare, and shares a payer’s perspective on current challenges and the path ahead. They dive into a number of topics including: The downstream impact of deferred care: While the COVID-19 economy translated into nationwide job losses – and therefore a reduction in BCBSMA’s membership – the slowdown in elective services is the more challenging, complex, and long-term issue for payers. Like many other payers, BCBSMA issued rebates to its customers and members in 2020 as a result of lower than anticipated health care costs during the COVID-19 public health emergency. Pat talks about the necessity of managing risk over the long term and the expectation for higher future costs that all payers will have to navigate.Elements of VBC success: When Pat first joined BCBSMA to introduce the Alternative Quality Contract (AQC) to providers, he insisted on sharing both upside and downside risk from the outset. Pat credits the universal approach to risk sharing as an element of AQC’s success. He also points to the long-term nature of the contracts BCBSMA offers to providers. A traditional one- or two-year contract can make it difficult for providers to fundamentally change their business – particularly as government rules change – so BSBSMA has entered into three-, five-, and even seven-year AQC agreements. Lastly, he talks about the importance of sharing data, identifying gaps in care, and truly working together once payer and provider interests are aligned.Unintended consequences of integrated models: As the lines blur between payer and provider, Pat warns of the potential for losing sight of the mission to improve affordability and quality. He uses pharmacy benefits managers (PBMs) as an example, and how a company like CVS which is traditionally a pharmacy that now operates an integrated model, will make more money prescribing than managing care. He talks about being careful to not deviate too far from what the expertise of a health plan should be and always focusing on the best interest of employers and customers.The end goal of experience: Throughout the conversation, Pat returns frequently to the theme of patient/member experience. He talks about driving better experiences through deeper partnerships and how every player in the market offers something important. This includes payers and providers recognizing each other’s core competencies, but also considering where consumer-savvy and digital-first managed care providers are trying new approaches that everyone can learn from.To hear Patrick and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

As someone who has been in the middle of healthcare policy and reform in the U.S. for decades, John McDonough has a unique perspective on how the rapidly changing political climate in Washington will impact the healthcare industry.John’s dedication to public health began in 1985 after he was elected to the Massachusetts House of Representatives where he co-chaired the Joint Committee on Health Care until 1997. He later played a key role in the passage and implementation of the 2006 Massachusetts health reform law as Executive Director of Health Care for All, the state’s leading consumer health advocacy organization. With that experience, the U.S. Senate tapped John as Senior Advisor on National Health Reform from 2008 to 2010, where he worked on the development and passage of the Affordable Care Act. John is currently Professor of Public Health Practice at the Harvard T.H. Chan School of Public Health and is the author of three books including, Inside National Health Reform and Experiencing Politics: A Legislator’s Stories of Government and Health Care. In this edition of the Healthcare Is Hard podcast, Keith Figlioli asks John to draw upon his years developing and implementing healthcare policy to reflect on the outcome of the recent election and the implications it will have for the healthcare industry. The topics they address include:Steering a divided government. John talks about how historically rare it’s been for a Democratic president to take office without majorities in the House and Senate – something that hasn’t happened since Grover Cleveland in 1884. He discusses what that will mean for a Biden administration, unless Democrats are successful in their longshot bid for two Senate seats in Georgia’s runoff elections.Presidential regimes that define decades. John shares a theory about how era-defining presidents set a course that lasts well beyond their terms to cross decades and multiple administrations. The last era began with FDR who changed the national discussion and tone when he took office in 1933, and lasted until the end of the Carter administration. The Regan revolution set a new tone in the 1980s, rooted in competition and capitalism, that has impacted all areas of society including healthcare. Historically, each era has ended with a national calamity – the Great Depression during Hoover’s term, the energy and Iran hostage crisis for Carter – and a one term president. John ponders whether the coronavirus pandemic and President Trump’s single term could be the beginning of an era-defining Biden administration.The ACA’s little secret. After more than 10 years, John believes the ACA has stood the test of time, causing changes in delivery systems, accountable care organizations, bundled payments and the value-based care revolution to become embedded in the structure of the U.S. healthcare system. The secret about the ACA, he says, is that both Democrats and Republicans support this approach and don’t want to see it dismantled because they don’t have ideas to replace it.Strengthening CMMI. President Obama’s administration used the Center for Medicare & Medicaid Innovation as a vehicle for change, and John expects a Biden administration to rely on it even more. He sees a new administration testing the limits of executive authority and being aggressive at using CMMI to take risk and demonstrate feasibility of ideas that can then be implemented more broadly.To hear John and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Robert Musslewhite has viewed healthcare innovation and the lifecycle of a healthcare services company from nearly every angle over the past two decades. He joined The Advisory Board Company because it was a small but fast-growing organization where he felt he could make an impact, and where he ultimately became chairman and CEO. Under his leadership, the company quadrupled in size to serve nearly 300,000 leaders in over 5,500 hospitals, health systems, and universities worldwide. In 2017, Robert led the successful merger of the Advisory Board Company with Optum – while spinning off its education business – and became CEO of OptumInsight. At OptumInsight Robert is focused on a societal need for strong partners and new solutions for a more modern, high performing and simpler health care system.In this episode of Healthcare is Hard, Robert shares experiences with Keith Figloli that will resonate with both healthcare entrepreneurs and leaders of large healthcare organizations. He provides valuable leadership advice, offers predictions about how the healthcare industry will evolve over the next decade, and recounts his unique vantagepoints over the past twenty years including:Building a high growth startup. When he joined The Advisory Board, Robert’s mandate was to find new growth vectors. He approached this challenge with the realization that nearly every business that undergoes major transformation takes something they’re doing well and finds new ways to apply it. For The Advisory Board, this involved leveraging its world-class research and relationships with hospital leaders, and wrapping technology around them. The timing of this endeavor couldn’t have been better – Robert talks about how this occurred right at a massive boom period for healthcare analytics, how his team capitalized, and the lessons he learned in the process.Navigating a multi-billion acquisition. Under Robert’s leadership, The Advisory Board expanded its focus beyond healthcare and into education. Ultimately, he orchestrated the sale of both sides of the business at the same time. Robert talks about the process to seek and identify a potential market partner on the healthcare side, and how Optum – building one of the world’s most comprehensive, digital, information and AI-enabled care platforms – was an obvious fit after the first discussion. He saw how Optum’s capabilities would enable The Advisory Board to broaden its reach beyond hospitals into the changing healthcare market, and how The Advisory Board could help channel Optum’s many capabilities to further modernize health care with a focus on lowering cost while improving the experience for providers and their patients.Becoming the acquirer. Now, as CEO at a $10 billion business unit of Optum, identifying innovation inside and outside the business is a key part of Robert’s strategy, and traditional M&A is only one avenue to pursue. For example, Robert’s team works closely with Optum Ventures to get more exposure to startups it might otherwise never see, or it might consider taking minority stake in a company to first bridge gaps in expectations and/or prove a value prop in ways that couldn’t be achieved otherwise. Either way, the key is finding opportunities that provide real and rapid value. Real value because all innovation in healthcare has to be focused on expanding access to coverage, reducing the total cost of care and making the health care system simpler. Rapid value because speed to market in health care can and must be radically reduced so the impact of innovation can be realized quickly.To hear Robert and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

CommonSpirit Health created one of the largest health systems in the nation by merging Dignity Health and Catholic Health Initiatives in early 2019. It now operates 137 hospitals and more than 1,000 care sites across 21 states, with revenues of nearly $29 billion.Extending its reach into more communities across the country has enabled CommonSpirit to leverage scale as a means to advance its core mission of expanding healthcare access to all, advocating for those who are poor and vulnerable, and innovating how and where healing can happen.If a person’s personal journey and early years are what guide them to their calling in life, as CommonSpirit CEO Lloyd Dean believes, it’s no wonder why he and SVP and Chief Strategic and Innovation Officer, Rich Roth, are key parts of a leadership team charged with seeing this mission through.In this episode of Healthcare is Hard, Lloyd tells his inspiring story of growing up the son of a factory worker who experienced racial inequalities firsthand and saw the impact they have on basic healthcare and life expectancy. He shares his personal journey from being the first in his community to attend a university, to becoming the CEO of one of the nation’s largest health systems and how these experiences drive purpose in this role. Rich Roth recounts his first exposure to the healthcare industry cleaning doctors’ offices where his mother worked as a receptionist, his later roles cooking and cleaning at nursing homes, and ultimately his first job out of college stuffing envelopes and answering patient questions in the billing department of a hospital.With the foundational influence of these experiences, Lloyd and Rich talk to Keith Figlioli about their role in fulfilling CommonSpirit’s healing mission and how it has changed in the wake of COVID-19. They cover a number of topics, including:COVID-19 as the great equalizer. Rich explains how certain elements of a health system like home care, pharmacy or community benefit have historically played a secondary role – part of a strategy, but not leading it – and are now starting to be central components of a system’s identity. COVID-19 has revealed the true vulnerabilities in our healthcare system and these are the things CommonSpirit is thinking deeply about to create the next chapter of healthcare delivery. As Lloyd points out, if we don’t see the inequalities now and address them in a demonstrable way, history will chronicle that as one of the greatest missed opportunities the nation has ever seen.Personalizing care for individuals. The U.S. health system has done a poor job personalizing primary care to meet individual needs, according to Rich. For example, behavioral health might be the primary need for some people while food or housing is the biggest concern for others. And different groups of people – women, seniors, Latinx, and many more – need more services specific to them too. The next evolution of care must move away from the “one stop shop” and will require services that understand and better serve each person individually.Being part of a community, not just “in” a community. Lloyd shares his prediction that care delivery from health systems, hospitals, clinics and other providers that currently occurs IN the community, will transform to be a bigger part OF the community. And providing a robust health infrastructure with broad access to care will not simply be understood as a moral imperative, but as an economic imperative as well.To hear Lloyd, Rich and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Tal Heppenstall has a dual role at UPMC. He’s been treasurer of the $21 billion dollar health care provider and insurer since 2003, where he’s responsible for the day-to-day cash needs of an organization that integrates 90,000 employees, 40 hospitals, 700 doctors’ offices and outpatient sites, and a 3.9 million-member Insurance Services Division. In addition, Tal is president of UPMC Enterprises, where its mission is to create products and businesses that make life changing medicine happen.In this episode of Healthcare is Hard: A Podcast for Insiders, Tal talks to Keith Figlioli about the elements that have created this unique, world-class organization and how it will continue to adapt in a post-COVID world. They address topics including:A Culture of Risk. According to Tal, one defining factor that sets UPMC apart from other non-profits is its tolerance for risk. It’s a theme he points to throughout the interview, talking about how the organization’s high risk tolerance enabled its success on the payer side, but how it is also an inherent characteristic of an academic medical center. Innovation is why UPMC exists, but Tal believes that without the willingness to take risks, it’s just a word.Constant Reinvention. Another important part of being rooted in an academic medical center is the bias towards discovery and reinvention. This has always been core to UPMC, but especially in the current environment as big tech, retail and others enter the market, innovation is not optional. However, Tal is quick to point out that the corporate venture operation under UPMC Enterprises is not a fund. It’s not about short term returns, but rather a reinvestment to make sure the organization is successful in its mission.UPMC’s Best Startup Ever. Innovation has resulted in a financial difference at UPMC, but one startup stands out in Tal’s mind – the health plan UPMC created in the late 90s. It’s now the largest medical insurer in western Pennsylvania with revenues of $12 billion. Tal recounts an environment in the market where one payer dominated for years and how competitive rates forced UPMC to do more with less. UPMC in turn became a very efficient organization and, as Tal puts it, is why they chose to do more with less of their own money instead of relying on another payer.The Pervasive Impact of COVID-19. Tal and Keith’s discussion reflects the fact that COVID-19 has permeated into every aspect of healthcare and is not a single topic of discussion, but an important part of every topic for the healthcare industry. Throughout the interview Tal shares his thoughts about COVID including how it has accelerated digital health, the challenges it has created for payers and providers, and the role government will continue to play driving change in response.To hear Tal and Keith talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Michael Allen has unique expertise in healthcare finance. He’s been chief financial officer at four different health systems and is national chairman of the Healthcare Financial Management Association (HFMA) where he regularly interacts and shares knowledge with peers in the 56,000-member organization.Michael calls HFMA his side hustle and is going on his second year of a one-year term since the organization froze its leadership to provide stability during the COVID-19 pandemic. His primary role is CFO at OSF Healthcare, a faith-based health system in Peoria, Illinois with 23,600 Mission Partners in 147 locations, including 14 hospitals.Since the pandemic started, the Healthcare is Hard podcast has explored how health systems are dealing with it from multiple angles including from the CEO, CIO, regulatory, governance and supply chain perspective. In this episode, Keith Figlioli talks to Michael Allen to learn how finance leaders are supporting the healthcare industry and their organizations through this trying time.Michael talks about how healthcare has historically not been very agile because realities like fixed costs, reliance on bricks and mortar and steady organic growth meant that it didn’t have to be. But he talks about the new need for agility, how OSF is adapting, and how some steps the organization took before the pandemic put it in a better position to respond. The topics Michael and Keith discuss include:Supporting quick decisions. Through its emergency operations center created to navigate the pandemic, Michael says OSF learned how slow the organization had previously been at making decisions. This wasn’t an issue before because it worked, but COVID forced a need for change. Instead of including everyone in every decision, Michael talks about how OSF learned to rely on small groups to make decisions, vet those decisions with the larger group, and then move forward quickly.Spending less time in the rear view. Michael is working to flip the traditional model of healthcare finance. Instead of looking backwards and planning based on previous experiences, Michael is directing his team to spend most of their time looking forward. For example, no one in healthcare knows what their future revenue stream will look like as the payer mix shifts and the average payment rate for services is likely to decline. This is why it’s critical for finance teams to spend more time forecasting and ensuring they’re nimble enough to respond to any situation.Eliminating the annual budget process. OSF entered its fiscal year starting October 2019 without a traditional budget. Michael and his team still updated their long-term financial plan and set financial targets on an annual basis, but spent less time on individual line items. Instead, they focused more on forecasting and dynamic planning, including measurement and processes for reacting to issues. This proved to be invaluable when the pandemic hit and as the healthcare industry faced rapid change, enabled OSF to quickly gather the information it needed, build forecasts, and move quickly.Creating an environment where innovation is inherent. Another area that bolstered OSF’s response to the pandemic is its focus on innovation – something Michael says has always been an integrated part of the organization versus a separate entity. In OSF’s venture arm for example, investments are never solely made for their financial benefits, but must also be doing something positive for the organization and be endorsed by clinical leaders. As the response to COVID-19 placed digital touchpoints first, this gave OSF a running head start in how it adapted.Hear Michael and Keith dig into these topics and more in this episode of Healthcare is Hard: A Podcast for Insiders.