Outcomes Rocket_Paul Krakovitz: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Saul Marquez:
Hey everybody! Saul Marquez with the Outcomes Rocket. I want to welcome you back to our podcast. I had the privilege of recording a lot of interviews during the HLTH, that’s H L T H, conference in Las Vegas, and one of those conversations was with the amazing doctor, Paul Krakovitz. He’s the region president at Intermountain Healthcare Desert Region, spanning Nevada, southwest Utah, and northern Arizona. As President, Dr. Krakovitz drives the growth strategy, business development, and clinical operations for the desert region. And before stepping into his current role, Paul was the vice president and chief medical officer for specialty-based care for Intermountain Hospitals and clinical programs across Utah and Idaho. Prior to joining Intermountain in 2017, Dr. Krakovitz was vice chair of surgical operations for Cleveland Clinic. He also served as section hand of pediatric otolaryngology in the Cleveland Clinic Head and Neck Institute, served on the Children’s Hospital Executive Committee, and was an elected member of the clinic’s board of governors. He also held academic appointments at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve, and currently holds an academic position at the University of Utah. He’s just an extraordinary leader, and I’m excited to share some of the insights that he’s seen through the pandemic and focused on how do we span care to children as well as how do we bridge the gap in care delivery in a world where we’re relying more on technology. So you’re going to enjoy this interview that I did with Paul. Really excited to share it with you on today’s podcast. So with that introduction, I want to welcome Paul to join us. Thank you, Paul.
Paul Krakovitz:
Thank you, Saul. It’s a real pleasure to be here.
Saul Marquez:
Yeah, so there’s so much happening in healthcare, and today I’m excited to connect with you on the things that you’re up to at Intermountain Healthcare. One of the things that I’d like to start the conversations with is, what is it that inspires your work in healthcare?
Paul Krakovitz:
Well, that is an awesome question, and for me personally, it’s about mission and it’s really about helping people live their healthiest lives possible, which is our mission at Intermountain Healthcare, but for me personally, it’s about improving quality of life. And I’m a physician by background, helping people is what brought me into healthcare, and as I’ve kind of matured in my career path, I’ve realized that it’s more than just helping each individual, it’s how do you help a community, how do you improve quality of life? And that’s really what inspires me in healthcare, and it’s why I have stayed ridiculously excited about what’s going on in healthcare.
Saul Marquez:
That’s great. Well, it’s fantastic to have leaders like you that stay passionate because it’s hard, right? I mean, let’s face it, whether you’re a physician or an administrator, this environment is difficult, and having that passion, that drive is so important for success.
Paul Krakovitz:
You are correct. You’re definitely correct. Yes, healthcare is hard, but anything that’s meaningful is difficult.
Saul Marquez:
So how are you doing today, Dr. Krakovitz? How are things at Intermountain Healthcare and how are things going in Nevada, Las Vegas?
Paul Krakovitz:
Yeah, so things at Intermountain are great. Like everywhere else in healthcare, we’re faced with our challenges, but there’s so many more great opportunities, and being a part of Intermountain and being a part of Intermountain here in Nevada is actually really, really exciting. So we entered into the Nevada market about three years ago and it was after we had looked in this market for quite a while. And what really attracted us to Nevada and to southern Nevada is we really wanted to be able to test our model to see if we could bring value-based care to another area. And there’s no shock or surprise, but healthcare in Nevada has a lot of opportunity, and so for us to be able to come here and be able to provide that care has been really fun. So we acquired HealthCare Partners of Nevada about three years ago, and that was really our parlay into this community, and we have about 1900 caregivers here or over about 60 sites and currently, we’re all outpatient based. We do have some physicians that do care in the hospital, but for the most part, we’re outpatient based. We’re in primary care and specialty care and urgent care, and about half of our market is senior care.
Saul Marquez:
Wow, it’s a good mix.
Paul Krakovitz:
It’s great mix.
Saul Marquez:
Yeah, it’s great. Fantastic, well, it sounds like you guys have stepped into the region. And so what’s your read so far? You know, how are things going? Are you guys making improvements? Are you able to do what Intermountain does best?
Paul Krakovitz:
Yes, and what is great about doing it here in Nevada is that it’s forcing us to do it in a different way, for, we’re an integrated delivery network. Our health plans’ here, our medical group is here, and when we look at what’s a true integrated delivery network in a vertically stacked in Utah and like most other places, we built it primarily, and here we’re looking at it in a much different way. It’s how do we give care? How do we integrate care utilizing the services that are already here?
Saul Marquez:
Love that, that’s great. It sounds like a creative approach to get there. Take a moment to share with us a little about your role within the organization. You’re now the president for the Health Systems Desert region. What drives your work that you do?
Paul Krakovitz:
What drives my work is really, is the passion about improving care and helping the community. So I’ll step back for a second, so Intermountain here, we’re about 1900 providers, right, or caregivers is what we like to call ourselves. You know, when we recently merged with SCL, so now we have three regions. We have our home base, which is Salt Lake, we have our region that we call our Peaks Region, which is basically SCL’s footprint, and that’s based out of Denver, and then we have what we call our desert region, which is what’s based right here in southern Nevada in Las Vegas. So across our entire footprint, we’re about 60,000 caregivers and we’re about 32 hospitals and lots and lots of outpatient, but the glue that holds us all together is, one is our mission, and the second is that our passion around how do you improve care and meeting patients where they are, digital, home, office, last resort in the hospital. That’s really where we want to be, and so it’s how do we get completely upstream? So what’s my job here? My job here is to be able to provide care to the community and to look for opportunities where care is missing in Southern Nevada and to really, back to integrating it and kind of putting it back together. There was a nasty joke in this town that McCarran Airport, now it’s the Harry Reid airport, is where you go for healthcare. And it’s funny once, but once you get here and start living in the community, it’s no longer funny. So for us, we really want to make sure that we are keeping care here in the community, and that people don’t need to exit Las Vegas to get complex care.
Saul Marquez:
Thanks for mentioning that. And we’ve been talking a lot about hybrid models of care that are both brick-and-mortar and virtual, you said it, meeting patients where they are. And then there’s the piece about equity in healthcare and making sure that the entire community is receiving care. What are you most excited about regarding the future of healthcare today?
Paul Krakovitz:
You know, the equity has come right back up is, it’s the base of the community, right? And we made equity, diversity, equity, and inclusion, we made it one of our fundamentals. So we have KPIs that are wrapped around it and we’re on the beginning of that journey, but we’re making a lot of progress and we’re looking at it both from back office and hiring, but also how do we take care of patients and do that in a clinical way? So when I think about an exciting moment and around equity, it’s about bringing people into the workforce. So if we step back for a second and think about the city of Las Vegas, we’re on the strip right now, we’re in this gigantic building, right? And Saul, my suspicion is when you think about Las Vegas, your head goes right to the strip, right?
Saul Marquez:
It does.
Paul Krakovitz:
That’s exactly where I was before I moved here. There’s 2.3 million people who maybe work on the strip, but they don’t, it’s an afterthought. It’s really about the community. And so what’s happened is, in healthcare here, is that it’s kind of gotten left by the wayside as the city grew up so quickly and focus more on hospitality. Now, when we think about the community, we’ve got to add healthcare, we’ve got to add education, and it’s not to say healthcare is not here, it is, it’s just not been built and it hasn’t kept up at the same pace as the hospitality. So when I think about DEI or about equity pieces that are there, there’s so much opportunity for new jobs in healthcare in Las Vegas, and that helps bring everything up. It helps people be able to access, but also to be a part of healthcare. And I’ll give you an example, one of the hardest things right now in healthcare is hiring, right? Everybody struggling, so we started a program called the 90-day MA program. We partnered with a workforce community out of Nevada. We partnered with Goodwill and we started a 90-day MA program where.
Saul Marquez:
What’s the MA?
Paul Krakovitz:
MA is Medical Assistant.
Saul Marquez:
Got it, okay, thank you.
Paul Krakovitz:
Now I appreciate you keeping me out of the hole of acronyms that we love so much in healthcare, so anyway, the 90-day MA program is really targeted for people who are either underemployed or unemployed and to bring them into healthcare.
Saul Marquez:
I like that idea.
Paul Krakovitz:
Thank you, and so by combining this with other not-for-profits, we’ve been able to come up with a pretty unique model. We’ve been able to get funding for it. And after the students go through basically a work program and when they pop out, they are now medical assistants, gives them an opportunity for a new job, and it’s really diversified our workforce in a really meaningful way.
Saul Marquez:
Paul, that’s really innovative, like thinking, right, and when we’re dealing with this labor shortage problem you have to get creative, and this is a great example of creativity, and it has been working for you guys?
Paul Krakovitz:
Yeah, it’s worked on a professional level and also kind of on a personal level because it’s really fun to see this new piece come in, and that’s not the only way we’re looking at how we bring in new people into the workforce. I mean, we’re all trying to get upstream working with schools and same thing, we’re partnering and going deeper with groups like UNLV’s New Medical School, and same thing with a lot of the colleges for nursing, etc., but we’ve got to continue to be creative, Saul.
Saul Marquez:
That’s great, that’s great. What’s the big news from Intermountain right now? What’s the organization focused on?
Paul Krakovitz:
We remain relentlessly focused on the community and on value-based care. And for us, value-based care is making sure the quality is the highest level possible, making sure our costs are something that our communities can afford, and the mechanism we prefer to do that is through full risk, so taking clinical and financial risk.
Saul Marquez:
Yeah, you know, as a vertically integrated system, you guys are I always say, hey, if change is going to happen, it starts with the vertically integrated audience, and so you guys are doing such a great job. Tell us about Intermountain efforts to improve access to care to Nevadans. What opportunities exist today?
Paul Krakovitz:
Yeah, so that’s a great question because when you look at Nevada, one of the major issues we have is the shortage on providers. Now we talk a lot about physician shortages, but we have nursing shortages, etc. and that’s why the outcomes in the state are some of the lowest, right? It’s a difficult situation. So the way we’re hoping to focus on this is, same thing, approaching the sort of value-based approach and then thinking innovatively about how we approach the community. So digital and tele’s a big way, particularly when we talk about rural care, right? How do you get out to rural care? How do you do that in an affordable way where you don’t bankrupt the rural community? You know, and for us, a lot of that’s around tele and around being really judicious with the way we deliver care.
Saul Marquez:
That’s great. And so there’s a lot of conversations continuing to happen regarding population health and the push toward value-based care as you’ve been talking about. How does Intermountain view these as priorities?
Paul Krakovitz:
We believe that it is the model for healthcare. Now, we all live in a fee-for-service world as well as a value world, but the more that we focus on it, the more we’re going to be able to remove the waste and improve the quality. You know, and I think about healthcare and people always talk about the incentives, and particularly when you look around a place like this, because there’s a lot of startups and people who are somewhat new to healthcare, and the dollar is looked at as the major incentive to bringing people forward with that, when most physicians, there may be a little bit of that, but the overwhelming majority of them are how do I improve care? How do I give the best possible care to a patient? And that is kind of the ethos of what we surround ourselves as patients, patient first, if I borrow a term. So it’s continuing to focus on the patient. Now back to that payment model, the fee-for-service world is there, but the more we focus on value and the more that we’re able to take full financial and clinical risk, we believe that that’s the best way for us to be able to take out excess waste and be able to deliver the best healthcare at the most reasonable cost to the community.
Saul Marquez:
Yeah, and you know, as it relates to incentives, Paul, I think there’s an advantage being a vertically integrated provider payer, those that are not struggling because they’re doing everything in a rearview mirror and like, how do you incentivize somebody with, hey, 12, 18 months from now you might get something for doing something better, instead of something, like you guys could do it quickly on a monthly basis, hell, on a weekly basis. So I think there’s value there, but ultimately it’s clear, the patients, right, like improving care is fundamental. And so that’s the main driver for physicians, but that agility, I’ll say it’s an advantage.
Paul Krakovitz:
Yeah, well, thank you for saying that. And that’s another reason why we acquired HealthCare Partners, because they were and they are, and I’m biased, but I’ll say probably one of the best at delivering full care to seniors. And we’re fortunate that we have the health plan, we’re very fortunate and we’re very fortunate that we’ve had CEOs and executive leaders that have always been very forward-thinking about value-based care, and we’ve had the flywheel go in for a while and it’s been a big advantage. But you know what? When we think about this, it’s our responsibility to also help bring along other healthcare systems to be able to do the same thing. So we may have an advantage, but at the end, we’re all after the same thing, which is trying to improve care.
Saul Marquez:
Well said, Paul, well said. So tell us about Intermountain’s focus on community health as a system. What does this mean for patients and the general public in both Southwest Utah and Southern Nevada?
Paul Krakovitz:
So we’re a not-for-profit, and so we do a community health needs assessment and we’re always looking to see from a community health, what is needed? Now, when we entered into Las Vegas, we started as a for-profit, the acquisition was a for-profit, and we’ve gone through the somewhat painful steps of transferring that into a not-for-profit, but that’s our mission, so completely worth it for us to be able to do that. We came in with the community health needs assessment and from there we partner with other not-for-profits or other community assets to be allowed to do that. So this won’t be a surprise to you at all, Saul, but mental health jumps right to the top. Pediatric mental health jumps right to the top. Complex care here in southern Nevada jumps right to the top. So for us to be able to help the community, we use our KPIs, we are very strategic, and we start to focus that way. So for us more in southern Nevada, it’s around how are we going to improve care for mental health, how do we partner to do this? We can’t do this on our own, no one can.
Saul Marquez:
You know, that’s so great that you said that. And we’ve been having these podcast conversations all week and one of our guests mentioned, Yeah, you know, like if HealthCare Partners, more things could happen faster rather than trying to do everything yourself. You know, it’s a simple concept, but I think to act on it is hard because you kind of want to have control of the entire process, like can’t help it. But it’s great to hear you say that you guys are thinking partnerships and ways forward to accelerate what you’re trying to do here.
Paul Krakovitz:
Yeah, control is a big challenge for everybody in healthcare, you know? I used to say this about physicians or like, why won’t a physician do X, Y, or Z? I said, you know, it’s time, money, and control is what most of them want, at least a little piece of, and it’s no different for a big organization or for anything else.
Saul Marquez:
I agree. Thanks, Paul. What’s Intermountain doing to address the issues of access to care and inequity challenges?
Paul Krakovitz:
So access is a big challenge for everybody around the country. And, you know, I’ve been in multiple organizations and access was even in what we would consider the best of times, ten years ago, if we consider that the best of times, was still a challenge, and then the pandemic has made it more difficult. And then you look in a more, we’re located here in southern Nevada, where we have one of the lowest numbers of providers in the country, we’re a number of 50 for primary care, and the same thing is true for nurses, etc. And then you have a rapidly growing.
Saul Marquez:
Why hasn’t it evolved? I mean, why?
Paul Krakovitz:
I love the question, and the reason is because, I’m going to take you back in history. Ready for your time machine? Okay, it’s 1970 and you’re sitting in Las Vegas. Take away all the ugly things you’d be thinking about being in the back of a station wagon, but the population here was 250,000 people. Fast forward 50 years, it’s 2.5 million, and hospitality is what grew this city up, and the city grew up with a singular focus around hospitality. What got left behind was healthcare and education. And because of that, there really wasn’t a pipeline that could get filled fast enough to bring in educators and to bring in healthcare, and that’s really what got southern Nevada behind the ball.
Saul Marquez:
Got it, makes sense.
Paul Krakovitz:
Yeah, now, a lot’s caught up since then. So UNLV started a medical school here, they just graduated their second class.
Saul Marquez:
Nice, that’s awesome.
Paul Krakovitz:
Toro, which is another medical school. It’s a DO school, it’s great school, they are now graduating. I’ll get the number wrong, about 160 medical students a year, so we’re seeing the growth that’s happening. We’re also seeing a lot more nursing programs and tech programs, so we’re starting to see that catch-up, but boy, the pipeline can’t get filled quick enough.
Saul Marquez:
Wow, that’s a good call out. And you’re here, your sleeves are rolled up and you’re ready for the challenge, you’re making things happen here, Paul, so kudos to you.
Paul Krakovitz:
Well, thank you, Saul.
Saul Marquez:
So if listeners are interested in careers with Intermountain Healthcare, where should we direct them, Paul?
Paul Krakovitz:
Yeah, to our website, which is IntermountainHealthcare.org/Nevada.
Saul Marquez:
Love it. Folks, check that out and we’ll make sure to put all the resources and links of things that we’ve discussed with Dr. Krakovitz here today in the show notes, so make sure you just go there. Click on them, learn more. There’s always an opportunity to make things happen. We do these podcasts as a way to help all of our listeners learn about what’s going on, and once you learn, the point is to do something about it, not just to listen and go on to the next thing. So make sure you do that. Anything else you’d like to add today, Paul?
Paul Krakovitz:
Nevada’s an extremely exciting place to live, to work, to raise a family, and as it comes to healthcare, you know, this is a very diverse community. So as you’re thinking about your next career or your child’s next career, your neighbors, encourage them to look in Las Vegas and to look in southern Nevada. Needed and welcomed, it’s a great, great, great community. And Saul, just thank you so much for having me on. It’s a lot of fun chatting with you and, you know, staring across these microphones. So thank you, I really, really appreciate you giving us the opportunity.
Saul Marquez:
Of course, Paul, it’s been a pleasure. Folks, check out Nevada. You know, I mean, there’s opportunities here and the opportunity too, like help tax structure is decent over here. So there’s a lot of benefits to being in the state, join Paul and his team, and if you’re interested in exploring more, remember IntermountainHealthcare.org/Nevada. It’s in the podcast show notes, so check that out. Paul, thanks for your time today.
Paul Krakovitz:
Thank you, Saul.
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