The Commitment to Accessibility and Affordability in Healthcare

Outcomes Rocket – Rob Allen : Video automatically transcribed by Sonix

Outcomes Rocket – Rob Allen : this mp4 video 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 the podcast. Today, I’m super excited to be joined by the outstanding Rob Allen. He’s the president and chief executive officer of Intermountain Health. Everybody knows Intermountain, but just a quick blurb, it’s a leading nonprofit health system headquartered in Utah. I don’t need to say anything else because we’re all familiar with it. Look, Rob has been with Intermountain for 27 years in various executive leadership roles, most recently as the CEO, but previous to that, the chief operating officer. He was named one of the top 25 COOs in healthcare by Modern Healthcare. And just an extraordinary leader who’s helped propel Intermountain to national recognition as a leader in really just healthcare innovation and wellness solutions. So I’m excited to have him here on the podcast. Rob, so grateful that you made the time to be with us today.

Rob Allen:
Saul, my pleasure. Thank you for this opportunity.

Saul Marquez:
Absolutely. And so, Rob, before we dig into the work that you’ve been so focused on your career at Intermountain, tell us a little bit about you. What inspires your work in healthcare?

Rob Allen:
Oh, that’s a great question. And you know, for me, it goes back to my early days growing up on a dairy farm in Western Wyoming, and my mother was a nurse, and what inspired me first in healthcare was watching her. And this was a tiny rural farming community, 15-bed hospital that served this long valley about 40 miles long, with 12 little communities in it, and I just remember watching her constantly. When the ambulance would go down the highway, she would run to the house and call to see if they needed help at the hospital. This was a tiny hospital staffed by only two nurses 24 hours a day, and one doctor in the community that lived 30 miles away on his cattle ranch. And so, you know, they just banded together to make sure patients were taken care of. And as I got into college and was getting my business degree, thinking about, what are you going to do once you get out of college? And healthcare really became intriguing, and I’m sure it was because of her example and my interest in, what can I do that helps serve people, that helps the community where I live? And healthcare became intriguing, and what inspires me today really is the heart of our caregivers. We have 64,000 caregivers across about 630,000mi², where we serve here in the interior West. And when I looked at what they do every day, they come to serve, they’re committed to do good, and then I look at the good they do, the patients that they serve, and what that means in the lives of individuals every day. That inspires me, and it drives me to look at how can we improve that and do even better.

Saul Marquez:
I think that’s wonderful. And thank you so much for sharing that story, Rob. The roots in that community, I’m sure, help you have that perspective to serve the community in a way that they need it. When you think of Intermountain, you know, as an organization that likes to, you know, put patients first, that that likes to take care of your clinicians, how do you add value to the healthcare ecosystem?

Rob Allen:
You know, I like to believe that the first value we add is a keen focus on our mission, which is helping people live the healthiest lives possible. And so if what we do every day with 64,000 strong force of caregivers focuses on that, then I think that does make a difference in our communities and really helps us deliver in an effective way what our caregivers got into healthcare to do. And sometimes we get lost in all the minutia of the work every day. Pandemic challenges everything that we can go back and talk about, but with that focus on the mission, it brings us back to why we’re here, and what we’re here to do. And then, when I think about Intermountain’s journey in trying to make a difference in this space. One of the key things Intermountain has focused on over the years is accessibility and affordability of services. And how do we create a network of services that meet people where they are? And so you think of things in the context of our telehealth services, which have been launched years back, and really looking at access points and connecting with people at the right level, the right time so that you don’t need to be in an ER if you can actually get your care somewhere else. And how do we drive that accessibility so people can access what’s right for them and, therefore, the right level of cost as well as service? I think of our network of instant care that have been set up in our long journey decades ago, looking at access points within certain numbers of distances from where people live, to, again, give you that option before you need to go to the ER. And, of course, if you need ER, we want you there, but too often, people use the ER because it’s an easy access point, rather than that’s the level of care they need, and then it’s more expensive for them. It actually can clog it up for those who really need that level of care and can create challenges. So trying to create those access points, along with a strong network of primary care clinics as well, and then setting up other outpatient services. You know, we think of traditional hospital campuses with acute care services for people when they really are in crisis, and that’s important. But satellite imaging is something we’ve launched in recent years, which is a low-cost imaging access point for CAT scans and MRIs that are more accessible. They’re in community settings, you know, you don’t have to navigate a big hospital campus to go get your imaging, and often, it’s even less expensive because the model is a less expensive model. I think of things we’ve done in partnerships in communities to try and advance the cause. Civica Rx is one example where that is a pharmaceutical company that was the brainchild of Dan Liljenquist, our chief strategy officer at Intermountain, and actually set up, in essence, as a public trust, almost where there’s partners who started it and funded it to address the shortages in generic drugs. And Civica is now making a huge impact. One of the most recent was just the announcement of producing insulin, actually moved the market from 300 plus dollars a shot to down under $100 a shot just by the amazing would start producing it and selling it at, you know, lower prices for people to have access to those drugs. And so we continue to build partnerships, one of our newest is with UC Health in Colorado, in the Denver area, looking at how we bring value-based care approaches there and actually creating a clinically integrated network with an insurance arm, contracting with other insurances, and we’ll launch in January, start product sell this fall, but actually start delivering under that arm in January. And those types of things where we can influence markets towards value, where we can play a key role in creating access for our communities in the right way, the right time, the right cost, the right care, I think are important. And those are things Intermountain has focused on for years and continued to drive forward to deliver.

Saul Marquez:
Yeah. Thank you, Rob. You guys are certainly working on a lot. Access sounds to be at the front of the agenda, whether it’s simplifying care so that it’s more accessible or making it more affordable through partnerships or economies of scale, certainly is. It sounds like you guys are doing a great job. How is what you do different or better than what’s out there today?

Rob Allen:
Well, we like to believe we do well in this, Saul. I would say, there are a lot of good partners out there that I think are trying to do similar things. And frankly, for the healthcare world, we’ve got to lock arms and do them together. So we think a lot about this concept of open source. How do we share what we do and what we know, and how do we learn from you what you do and what you know? Because I think we all have to lock arms if we’re going to change healthcare to a way that it’s even sustainable and a way that hopefully is better, more accessible, and all of those things. But when I think of Intermountain and what we’ve brought to the table, that helps that it starts back in 1975 when Intermountain Health was formed and The Church of Jesus Christ of Latter-day Saints in Salt Lake City gifted 15 hospitals in Utah, Idaho, and Wyoming to the community. And with that gift, they formed a board, not-for-profit board, which became Intermountain Health. And they gave one charge with the gift, they said, be a model health system. And that has driven our board and our leadership from day one. I’ve talked with Scott Parker, our inaugural CEO here recently, and explored the history with Scott a little bit, which I love to do. I worked at Intermountain early in my career when Scott was the CEO and somebody I’ve always admired, and he talked about that journey and how when he was hired, that was a charge given to him. He was asked, will you work to deliver on this charge? And he said, that hit me so deep that everybody I hired to my leadership team, that was the question I asked them. And in the interview, will you commit to helping deliver on this charge? And it just struck me how deep that resonated from day one. And then, you look at the journey of Intermountain and our innovation over time to become an integrated delivery network early on. So we were formed in 1975. In the early 1980s, we formed our own insurance company, which is now under the name of Select Health. That was novel, that was crazy in the minds of some. And yet the concept was, can we bring together the pieces that can create a smoother, more integrated approach to serving our community? And that vision and the fortitude to stick with it, because it was not easy times in those early years of starting an insurance company, the early years of having a medical group that we owned, a large number of doctor practices, all of those were challenges. But the vision drove us forward, it kept it going together, and today, we’re blessed with this long history of being integrated in our approach to care. And then we’ve added to that the new components. The telehealth is just one example to really expand our ability to serve holistically. And I think Intermountain brings a very mission-driven, holistic view to how care is and should be delivered. And we have pieces that are where they need to be, we have pieces that need to develop further, and we need to find new pieces for the future, Saul, and look forward to working with our colleagues across the country on those fronts.

Saul Marquez:
Yeah. You know, and it’s powerful. Like, I felt the power of the mission when you said it, Rob, like, you know, to be a model health system, to take care of the health of people. Like I felt it from you, and it’s very palpable, and so, kudos to you for keeping that alive. The power of a vision, you know, like the good book says, without a vision, the people perish. You got to have something to believe in. And you’re certainly giving us something to believe in here, with your leadership there. Nothing great gets built without setbacks. Can you point to anything that you’ve learned majorly from that you feel like now is part of the fingerprint of Intermountain?

Rob Allen:
Well, that’s a great question. I’m going to go deep in my history, and maybe it’s my fingerprint more than Intermountain’s right now, Saul, but I took on leadership roles in hospitals very young. I became a CFO when I was 25, small hospital in Wyoming, and went to school at night, got my master’s degree, and three years later, I was named the administrator at 28 years old. So, you know, here I am, you know, wet behind the years, just not really able to navigate everything, but it was a small hospital, and I was given this opportunity, and I was grateful for it, but I had a lot to learn, and I learned through experience there. And I’ll share one of my early experiences and what an imprint that made for me. Right after I became the administrator, this hospital had one general surgeon on staff, and that general surgeon notified us, you know, 6 or 8 months into my tenure that he was leaving the community for another opportunity. So here I am, faced with no surgical coverage at this small hospital. The community needed it. I mean, our closest hospital for next-level care was 85 miles away. And yeah, I needed to go get a surgeon, that was my job. And so I aggressively began recruiting, and I found a surgeon that was interested in coming. And in that process, I did some reference calls, I tried to listen carefully to things, but I heard all the things I wanted to hear. The surgeon is, you know, capable. The surgeon, you know, is somebody who wants to go to that area and, you know, wants to be in that type of a scenario. And so I recruited the surgeon. And as time went on, what I learned was some of the nuances in my recruiting calls that I didn’t pick up on being inexperienced in the process around this surgeon’s desire to really narrow his practice around things that were kind of moderate level of care, and here you are in a rural community where you’ve got to take care of trauma and all kinds of things in the ER. It became a battle over time, and the surgeon was competent in what he did, all of those things were true, but it wasn’t serving the community’s needs. And what I learned in this journey was the decisions you make are important. And as a leader, I stayed at that hospital, I was there for 14 years. So three years as the CFO, you know, then, this journey, being the leader of the hospital, and bottom line, I had to live with my decisions. I learned to live with my decisions, Saul. And the imprint on me was a deep understanding that the decisions you make are important, and you need to look not just at the problem you’re solving today, but how does that play out over time. And I had the experience both through this one piece that didn’t go well, and many others to learn the impact, good and bad, of decisions we make as leaders. And as I look back now at Intermountain’s history and the decisions that early leaders made, we today are beneficiaries of that early, strong leadership that set the stage to create this network that allows us now to build on today. So number one, I’m grateful for that history, but personally, the imprint was, you know, make decisions you can live with. And I think as I look at my heroes in healthcare leadership, which were the early leaders of Intermountain Health, they did that. Those were things they did. Now they were much wiser than I was. I’m sure they made fewer mistakes than I’ve made along my way. But as a leader, we need to set the stage not just for our solution, for today’s problem, but are we facilitating the next generation of leaders with solutions that will allow them to build on and take care of the challenges of the next generation?

Saul Marquez:
Well said, Rob, and it’s something that we all should be thinking about, folks. What are we doing to stick with our decisions, right? Rather than thinking about the next thing, are we thinking long-term? Are we making the decisions like Rob has just shared with us? He was there for 15 years. He saw it through. And so, Rob, I appreciate you sharing this story with us because it really hits home with me. We’re in a different environment today where there’s technology filtering into the health system. There’s consumer companies, you know, coming into the health system. What’s a healthcare trend or technology that you think is going to change healthcare as we know it today?

Rob Allen:
Well, I’m excited about AI and what AI brings to us. Now, you know, AI has lots of risks to it as well, and we need to have appropriate guardrails in that process. And we’re working with others, hopefully, to help create some of those guardrails that will help assure AI gets it right, right? And if I’m writing a research paper and I’m using AI, and it doesn’t get it quite right, the consequences aren’t too big. If I’m taking care of a patient and I’m relying on support tools in clinical decisions, and I get it wrong, consequences can be severe, so we need to be really careful. But the promise of lifting the administrative burdens off of people in healthcare, I think, is really impactful for our future. And I think of the challenges our people face, and let me share some perspective around that, and I’ll come back to how I think this starts to apply, but, you know, two-thirds of Americans say they believe the healthcare system was intentionally designed to be confusing. That’s a remarkable statistic. That we’re so complex, people think it was intentionally designed to make it hard for them to navigate, and we have to fix that. If we truly want to be people’s partner in their health and wellness journey, we have to make it more consumable, easily connected. We have to have services that people can find as part of their life’s journey instead of this maze they have to get through when they need a certain service from us, you know, an x-ray, a lab, you know, whatever that might be. As we look at that and we think about the complexities in healthcare, so much of it is administrative burden. It’s projected 25% of the cost of healthcare is administrative process, that’s actually not needed for the clinical work that’s done, or the outcomes sought. Another 27% of the cost of healthcare is projected to be for providing services for things that are preventable. And you think of our challenge in healthcare, Saul, and the dollars that go into this, a huge part of our economy is eaten up in the healthcare world, and we have a chance to look at up to half of it. That could be avoided by going upstream, keeping people healthy, by actually streamlining the administrative functions, and then start to look at what our doctors and our nurses go through. And you have a nurse who spends 30% of her or his time at the bedside. I don’t know, a nurse who went to school to be a nurse who wanted to spend 70% of their time doing paperwork, but that’s what they do in a hospital setting. So how does AI then come in and help us solve these issues? I’m really intrigued with ambient dictation that’s coming out. We’ve trialed it with our doctors, 97% of those through trial that liked it. And what that does, it saves our doctor’s report up to two hours a day of charting time. That’s life-changing. I have a doctor I was talking to down in one of our rural communities in central Utah, a doctor I’ve known for a lot of years, and he said, you know, ever since I’ve had computers, my life is I come to this hospital early in the morning. I round on patients. I have clinic all day long, I go home, and have dinner with my wife. He said, unless something’s really big going on at the moment, that’s something we do in our home. And he said, and then I opened my computer, and I spend 2 to 3 hours doing my charting for the day. Well, if these ambient dictation tools can actually capture that as you’re charting, you actually have a life again. You can spend your evenings with your family, with your hobbies, with whatever you want and rejuvenate for tomorrow. We think of nurses, and we’re trying some things in one of our hospitals where we have in every patient room, diagnostic capable cameras and sound system, mics and speakers, etc., so that our telehealth can come into the room and help care for patients. Well, why can’t the technology of today use those tools in the room to read everything and do the charting for the nurses? Instead of a nurse coming in, sitting with the patient, writing down all these things on little sticky notes they put in their pocket, and then go to a computer and do their charting. Why can’t that be done with maybe a Siri-type function overlay, right, where the nurse can trigger recording and actually pick up and do dictation? And I think these tools afford us the chance to rebuild healthcare at a time when we can’t hire enough people to fill all the jobs we have. Well, let’s redo the jobs. Let’s, for once in healthcare, use technology to actually gain efficiency. You know, heard a few years ago an interesting quote. Now, is it right or wrong? I don’t know, but I found it fascinating, and that was there are three industries who have never found a way to use technology to gain efficiency. Those industries were healthcare, of course, you would expect, as I’m talking about it, government and education were the other two, and we need to find efficiencies, make it easier for our caregivers, make it easier for our patients, make this process more streamlined. And I think this technology holds so much potential. Again, Saul, and I would emphasize the importance of guardrails as we deploy it. And we’ve got to figure that out, but we need to use technology for the benefit it can bring now. Streamline, simplify, make this process easier and more impactful for those who need it.

Saul Marquez:
Yeah, thank you, Rob. There’s a huge opportunity. And today’s clinical workforce, they’re looking for this type of opportunity, right? To do more of what they signed up to do is take care of people, you know. So I think it’s awesome that you’re focused on reducing that administrative burden. The promise is huge. Look, we’re here at the end. I could stay here all day and chat with you. And this has been a lot of fun, Rob. Leave us with the closing thought. What does the future look like to you, and where can the listeners learn more about you and about Intermountain?

Rob Allen:
Saul, thank you. I’ve enjoyed our chat today as well, and I could go on and on and continue our discussion and would enjoy such. But let me leave a couple of closing thoughts, and then I’ll give the contact point that you asked for. Healthcare is in challenging times, and when I got into healthcare, I remember my mentor and others who’d been in the industry for a while saying, why do you want to get into healthcare? It used to be fun. That was the comment that came, It used to be fun, and it made me pause. I had really had this drive to get in, and I’d finally gotten in, and the first thing I heard is, wow, why are you here? You know, this this used to be fun, now it’s going to be a hard slog for you, and I loved it from day one. I wanted to be a part of it. Now, I find some of my colleagues of my generation saying to the younger folks coming in, gosh, things are so much different and harder than they used to be. And, well, first, I think we romanticized just a little bit the history. I don’t think it was always as easy as we like to believe and think it was. But that said, I cannot think of a better time to be in healthcare and to be getting into healthcare, Saul. We have huge challenges. Worst year on record last year for financial performance for health systems and hospitals. We’re faced with all of these challenges of technology, how to deploy them, workforce shortages, high increasing inflation against fixed revenue streams that are coming, all kinds of things that are easy to look at and get discouraged by. I would say this in my parting comments. I have never been more optimistic about the opportunity and the future of healthcare than I am today. It will not be without challenge. It will absolutely be a challenge road ahead. But if we keep our eye forward, focused on why we’re here, to take care of our patients and our communities, use the technologies and tools available for us today to build the model for the future, we can create a leap forward that is built on this great work of all those that have gone before us, coupled with the tools today to go to a space that serves much better, that’s much easier to navigate, that helps keep people healthy and well, and that is a cause worth joining. And so, I’m excited to be a part of that cause and look forward to the journey with my caregivers and my colleagues across the country. For contacting Intermountain, Saul, ContactUs@imail.org. On our website, IntermountainHealthcare.org, you can reach out if you like, our team can pick up those messages, respond, and it has been a pleasure to be with you today, Saul. Thank you for the opportunity and the discussion.

Saul Marquez:
A true privilege. And Rob, again, thank you for the inspiring close. I’ll close with the listeners and say, run toward the fire because that’s where the opportunity is. And you know, in today’s health system, we need leaders like you, Rob, that run toward the fire, that help us regain hope in what the future looks like. So I can’t thank you enough for being with us today.

Rob Allen:
Saul, thank you.