Outcomes Rocket_Marc Harrison: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Saul Marquez:
Hey, Outcomes Rocket Nation. Welcome back to the podcast. I’m so excited to host an amazing guest for you today. We are interviewing Dr. Marc Harrison, president and CEO of Intermountain Healthcare. He’s a pediatric critical care physician and recognized as a national and international leader in healthcare transformation. His leadership has placed him on Fortune’s top 50 world’s greatest leaders in 2019 and regularly on modern healthcare’s most influential people in healthcare. Dr. Harrison leads Intermountain 59,000 employees called caregivers to reimagine operations and ways to keep people and communities healthier. Together, their mission-driven approach fuels their vision to build a model health system that delivers the best and most equitable outcomes by providing high-quality, more affordable care, that is accessible to everyone. To support this, Dr. Harrison has embraced unconventional public-private partnerships to confront some of the most pressing systemic challenges facing communities and industry. Under his leadership, Intermountain has helped tackle issues of cost, access, care, delivery, pandemics, and more. Examples of this include the launch of Civica Rx, a partnership of 1400 hospitals nationwide to develop generic drugs, as well as Utah Alliance for Determinants of Health, a collaboration of community partners focused on addressing forces that affect people’s health often before they get sick. He also has a podcast, it’s called A Healthier Future. If you haven’t listened to Dr. Harrison’s podcast, you definitely have to. He’s interviewing leaders from an array of industries and backgrounds to explore how we could work together to improve health. It’s quickly become one of my favorite podcasts, and I think you’ll enjoy it too. Before leading Intermountain, Dr. Harrison served as the CEO of Cleveland Clinic, Abu Dhabi, Chief of International Business Development at Cleveland Clinic, and Chief Medical Operations Officer at Cleveland Clinic. He’s an all-American triathlete and even represented the US at the 2014 World Championships. He’s also a two-time survivor of cancer, with his sights currently on completing an Ironman. He’s also a loving husband and proud father of three adult children. I’m a huge fan of his work, so excited to have him here on the podcast with us today. And so just want to welcome you to the podcast, Dr. Harrison, welcome!
Marc Harrison:
Hey! It is my pleasure to be here. I’ve been looking forward to this and looking forward to a great conversation.
Saul Marquez:
Likewise, likewise. So one of the things that I’m super fascinated about, and it’s always great to know, is what is it that makes leaders tick? And so I’d love to hear more about you, Marc, tell me about your personal story and what inspired you to work in healthcare.
Marc Harrison:
So that’s a tough one. So I have, I grew up in healthcare. Dad’s a general surgeon, mom’s a social worker, granddad is a general surgeon, and I think there was almost an expectation at our house that people were going to go into the helping professions. And then I actually had a, I thought I was going to be a great river guide, I kayaked, and I spent a summer safety boating for a commercial river organization and I had a great time. But I did get tired of sleeping in the back of my truck and smelling of wet neoprene the entire summer. And I went back to college, I was like, okay, I’m going to I’m going to study really hard. And then in medical school, I was a professional triathlete for a summer. Basically, that means I got comped entries, and I won one pair of bike shoes for the entire summer. And again, I think my aspirations probably outweighed my talent, and I just loved everything about medicine. You know, I know some people can be really negative about it. It’s not a perfect profession, but it’s such a privilege to touch on other people’s lives in really profound ways and to witness their, their most intimate moments, sad and happy, and be part of them. So I wish I could have said that I, you know, I was going to be like a constitutional lawyer or an entrepreneur who was cooking stuff up in the garage. But I always wanted to be a doctor, and I’m really glad that that’s where things took me.
Saul Marquez:
Yeah, that’s fantastic. Thank you for sharing that, Marc. And, you know, a topic that comes up a lot is is this topic of, all right, I have done incredible work at the bedside and now I want to, I want to go into leadership. For the people listening that are seeking to do more, what advice would you give them?
Marc Harrison:
I think people who seek leadership for leadership’s sake, almost never do a very good job. I think that people who seek to make change because they see a real problem, they can do really great things. So I think it’s always a huge red flag when a young person says to me, I really want to be CEO of a health system. It’s like, well, how in the world you possibly know that, right? What have you done so far? What do you think it’s like? And I think for me, I’ve been always sort of an impact-driven, now I’ve always gravitated towards leadership roles because whatever I was doing, I wanted us to be impactful. And oftentimes people are waiting to be led. I think that I’m sure you’ve experienced this in your career, that seems like 90% of people or 95% are waiting for the other 5 or 10% to lead them. But I’ve never actually sat positions specifically because of a title, I’ve always thought them because of how can I make a really big difference? And as I was being interviewed six years ago, a little over six years ago for this job, the last question that was asked of me in my set of interviews, was a board member who, he was just reminding me of this the other day, he said, why would you possibly leave this great job you have right now? I was at the Cleveland Clinic at the time and I loved it and had been very successful and was moving to London and our family was happy. And I said, I want to come to Intermountain because it’s a great organization and there’s an opportunity to demonstrate in an entire region of the country how healthcare should be delivered in a high-value way, and to use it almost as a laboratory to understand how healthcare should be done, and the, all the basic pieces are here, it just needs to be tied together. And so I ended up with a CEO of a health system role, but it was less about having some fancy title, was more about how do we use the wealth of the organization experientially, philosophically, clinically to drive meaningful outcome for the millions of people that we serve? And that’s pretty frickin awesome stuff.
Saul Marquez:
I agree.
Marc Harrison:
It doesn’t get better than that, right?
Saul Marquez:
No, I totally agree. And at the core of it, I’m hearing you say be a person of value, not a person of success.
Marc Harrison:
Yeah, I would, I’ve never heard it quite put that way, but I hope so. I think value and values, and by the way, nobody ever wants to follow somebody who you don’t know what they stand for. And so I think, and there’s no right set of things to stand for, there are some clearly wrong things to stand for. But if you’re going to be a decent leader, there’s a fair amount of self-reflection that needs to occur. What are you good at? What are you bad at? How did you show up? Were you a jerk today? Or did you really help somebody out today? Are you accessible? Are you clear thinking? Can you communicate? There’s all kinds of stuff, and if you’re not always working on it, you’re never going to be any good at it.
Saul Marquez:
Well said. So you’ve seen healthcare from the perspective of, of a patient with a serious illness as well. How has that helped shape your thinking as a health system leader?
Marc Harrison:
As a matter of fact, I’ve been the parent of a patient with a serious illness. Our oldest is now an OB-GYN resident, had a really, really bad traumatic brain injury when he was 19, and ended up with a bilateral craniotomy to control his intracranial pressure, really sick guy. He has made a spectacular recovery, but just the sinking in your stomach as you sit by your intubated, critically ill child wondering if he’s ever going to wake up. And if he does wake up, what’s he going to be like? It’s just the worst experience.
Saul Marquez:
Terrifying.
Marc Harrison:
Well, it’s awful. It makes my personal go rounds with cancer pale in comparison. And so I’ve had bladder cancer in my forties, and now I’ve got multiple myeloma, this incurable blood cancer. And I’m in complete remission thanks to, to a CAR-T trial, which I think cellular therapies are miraculous. And anybody who thinks science doesn’t work is not reading the newspaper or listening very carefully. But it affects in a couple of ways, it makes you just realize how vulnerable these people who put their lives in your hands are, they’re scared to death. They actually don’t care, like percentages of likelihood of survival. They just for them, it’s binary. Are they going to, are they going to be okay or are they not? And if they’re not going to be okay, are you going to give them a quality of life so they can enjoy whatever time they have left? It’s meaningful, outcomes are measured in, in weddings and birthdays and graduations. It’s not measured in predicted four-year or five-year survival rate. And I think it really has helped me understand that, and it’s also helped me understand that if you’re a rich white person, you’re much more likely to get put into a trial than if you’re a poor black person. And these are statistically, that is true, right? And that’s not fair, and we need to do our very best to make that right.
Saul Marquez:
Wow. Well said, Marc. And you touched on a couple of different things. Number one, it’s like that language that you use to speak to people that are going through this hardship, that empathy. The second thing, it’s the stuff that works. And I know you guys are doing a lot of really cool things at Intermountain with genomics and those types of testing, so definitely interested in hearing more about that. But these things have impacted your life, your son’s life, and the lives of folks around you. I had a chance to take a listen to your interview with a lady from Walmart and some.
Marc Harrison:
… Doctor Pegus.
Saul Marquez:
Dr. Pegus.
Marc Harrison:
She’s an amazing human being.
Saul Marquez:
Wow.
Marc Harrison:
She’s awesome.
Saul Marquez:
Yeah. And so the things that you guys touched on, on the social determinants of health and the work that they’re doing over there with Walmart, I mean, it’s real, so these, this inequity is real. Talk to us about what Intermountain is doing to address some of that access and inequity challenges.
Marc Harrison:
So whenever we run into difficult problems, we always try and understand what our swim lane really should be. And I have great respect for our elected officials, both in the states that we serve in, as well as at the national level. They’ve got really hard jobs, but they’re not clinicians and we are, and I usually try and break these problems down into things that are really relevant for our caregivers and for the patients that we serve. And try really, really hard not to back people into corners, because if you back anybody in your corner, they’re going to fight and actually try and draw them out of their corners to places where there’s some kind of common ground. And I think if you were to take racial inequities as an example, I think what you find is that, unfortunately, people will politicize that, some people will, and we actually just make it clinical. We say, look, we’re here to provide superb patient experiences and great clinical outcomes for all people who are privileged to serve. And then we actually can break down the problem and think about why it is that maybe somebody who comes into one of our emergency departments, who speaks Spanish as a primary language, has a longer door-to-needle time for their stroke than somebody who comes in and speaks English, which is actually, and we now have more than 50 clinical projects going at any given time to look at these issues because, and nobody freaks out about it because I think our, our 60,000 people are united regardless of what their political orientations are or where they live or they rural or urban. We all want our neighbors to get good clinical outcomes. And it has really sort of taken the temperature down and allowed us to focus on the things that count.
Saul Marquez:
That’s great. Yeah, it’s eliminating the, the signal from the noise, eliminating the noise, focusing on the signal, keeping things simple, I think that’s the tough part to do. You know, and one of the tough things that we’ve dealt with, Dr. Harrison, is the pandemic. What was it like leading a major US health system during a once-in-a-lifetime pandemic? What key lessons have you learned from that?
Marc Harrison:
So I’m, I’m counting on once in a lifetime, okay? Let’s hope on that one. Okay, so it was the privilege of a lifetime to lead a system through that. I got to take, at that point, it was before SCL merger, I got to take 40,000 people to war for all the right reasons. And we served our communities, we served each other, we navigated difficult social issues. We saw people demonstrate their creativity and innovation and independent thinking and collaboration. We saw all the work we had done around reorganizing Intermountain into a true operating company with a rigorous operating model, but a philosophy of pushing decision making outward, we saw that validated. We saw validation of the payor-provider model. We learned how to trial across multiple states and dozens of hospitals, so those trials weren’t just happening at big centers. We fully unleashed our telehealth and digital capabilities and saw that that was really the future and and we’re doubling down on that. So it was horrible in terms of what it did to the patients who were killed and maimed, and it was horrible in terms of what it did to our staff at times. And it was magnificent to watch people perform. And we’ve learned so much and we’ve made the best out of something that was really rough, so the privilege of a lifetime.
Saul Marquez:
Yeah. No. And how do you look at it now, Dr. Harrison? Do you look at it as COVID’s now, like the cold or the flu? We know how to handle it.
Marc Harrison:
So it’s actually not. It’s not.
Saul Marquez:
Yeah.
Marc Harrison:
And I think the thing that’s really a bit so happily, although infectiousness is way up, right, so transmissibility is way up, it’s about five times more than the original virus was, if not more. But these variants and these variants are much less likely to kill you, even people like me who are immunocompromised, which is great. But there are still a lot of people who are suffering long term sequelae from it. And so I don’t think the whole story is written, but I also don’t think people should hide. I think the behavioral health challenges we’ve seen associated with isolation, really unfortunate. And so it’s not the cold, but I think it’s something that we’re gonna have to learn to manage, and I am very much a proponent of, the mRNA vaccines have been magnificent.
Saul Marquez:
I agree.
Marc Harrison:
I think the innovation around monoclonal antibodies have been incredible. These antiretrovirals, we’ve learned so much. So I think we need to keep, stay vigilant and live our lives and do good things for other people.
Saul Marquez:
Thank you. I appreciate you addressing that. So you’ve spoken a lot about the pressing need for US healthcare to shift from fee-for-service to value-based care. Why is that important and how are you guys doing it?
Marc Harrison:
So look, I know in your day job you work for a company that believes in value and Medtronic probably has been the leading medtech company in that space for, for quite a while. And it’s important because ideally we’re in the, we’re in the business of keeping people as well as they possibly can be for as little money as possible, and in the least restrictive environment they can be … How they live, they want to live their lives. And the healthcare system is currently set up to put people in hospital beds and really expensive facilities and do lots of stuff to them that our data suggests that 30% of that’s completely unnecessary or even harmful, and that’s really unfortunate. And if you go back to the pandemic, the reason the US did so terribly from a public health standpoint is probably less around anti-vaxxers versus vaccines or anti-maskers versus maskers, it has a lot to do with how unhealthy our population is. We’re obese and we’ve got diabetes and we’ve got congestive heart failure and COPD, and we don’t exercise enough and we eat terrible food. And all of those were huge risk factors for poverty, lack of education, these are all independent risk factors for doing poorly in the pandemic. And I like the idea, look, I’m an ICU doctor, I love critical care medicine, I love it. And I would like to keep as many people out of our ICUs as possible. We have hundreds and hundreds of ICU beds across the system, we want people out of those beds and only to be in them if they absolutely are necessary. And that’s what value-based care is in my mind. And if you take full clinical and financial risks for a patient, then you’re you’re incentivized, everything is aligned to do as little as possible to that person to keep them well, and that’s the beautiful thing.
Saul Marquez:
Yeah. And do you feel like we’re, we’re heading in that direction, Marc?
Marc Harrison:
No.
Saul Marquez:
What have we got to do? What do we have to do about it?
Marc Harrison:
Well, so actually, the federal government has done a nice job, I think. Most Medicaid at this point is actually managed Medicaid, which is a good thing. The growth of Medicare Advantage, it’s not a perfect payment mechanism, but it has really driven a lot of innovation and it’s taught a lot of folks how to use and value. Commercial payers and systems both need to be forced to take risks, full upside and downside risk, incrementally increasing over the years. And I’ve been really vocal with the CMS leadership that I don’t think systems or payers should be allowed to either engage in Medicare Advantage or get if you’re a payer or to actually take any Medicare or Medicaid money at all if they don’t engage in risk. And the reason I feel so strongly about it is patients get better outcomes, they lead better lives, and the cost of care goes down. And people who say it’s just too hard to do, they’re full of it. And the pandemic demonstrates that how unbelievably capable providers and payers are at adapting to difficult circumstances. So it’s simply laziness and selfishness, it’s keeping us from it at this point. And I’d like to see lots of products and tools we built that actually makes it easier. I’m not saying it’s simple at all, that I know, I know we can do it because I’ve seen extraordinary things over the last couple of years.
Saul Marquez:
What call to action would you give to leaders wanting to get better there or maybe they need to think about getting better there.
Marc Harrison:
So I think they need to ask themselves who they’re actually serving. Are they serving their communities and their patients or are they serving themselves? And I think a lot of them are actually kicking the can down the road and hoping nothing changes until they retire. And I’d say to all the health system board members who are listening that they should either get a CEO and a leadership team who can actually start to transform towards value because a lot of these systems are not for profit, and the mandate of these not for profit systems are to serve their communities. And volume-based healthcare is not serving their communities the way it should. And so they either need to find a leadership team that can do it and they should demand that they do it or they should get a new leadership team.
Saul Marquez:
Well said. And something for everyone listening to, to think about it is those tough questions, answering them the right way that will help us move it into the direction of value-based care. Thank you, Dr. Harrison. Intermountain recently merged with SCL Health, you guys are expanding your footprint, West and Midwest. How’s the merger going and what does it mean for patient care, especially in areas such as telehealth?
Marc Harrison:
So first of all, we are really privileged that SCL Health wanted to join us. They knew we were open for business, we had we had done three major either acquisitions or I guess they were all acquisitions, three acquisitions over the previous. And Lydia Jumonville, who’s the CEO of SCL Health, approached me and we had done, just a really very quick and very collegial decision to come together, and the negotiations went smoothly, largely because of her expertise and our reasonableness. And we could just see that our values were the same service to the community, high quality, low cost. And they recognized that they needed to move towards the ability to take for clinical and financial risk. And we had that and they had a really interesting footprint, including a large rural catchment area that we love for medicine of a difficult to serve and incredibly rewarding population. And it was sort of a match made in heaven. And again, credit Lydia and Tawana Hudson, who was their chief strategy officer, those two are leading the integration and having done Cleveland Clinic, Abu Dhabi, I’m sort of a nerd for mega-project management and these two are doing a phenomenal job, incredibly organized and principled and with great milestones and clear, tough decision-making that not everybody loves but it’s fair. And we are bringing the organizations together, and I would say we’re on time, on schedule, on budget. And actually what I love especially is the clinicians are super eager to collaborate with one another. You know, all the plumbing and wiring behind the scenes is not very sexy and but incredibly necessary.
Saul Marquez:
Yeah.
Marc Harrison:
The thing that gives me joy is when a neonatologist in Billings, Montana, says, hey, I really want to chat with those folks at Primary Children’s because they’re doing some super cool stuff. Or when the heart surgeons on the front range feel like they have something to teach the cardiac surgeons in another part of the system and vice versa. Hey, that’s beautiful. I mean, that’s, this is what it’s all about.
Saul Marquez:
Yeah, that collaboration is key, and it doesn’t always happen. So what is it about the culture there that enables that, would you say?
Marc Harrison:
Well, first of all, we have amazing people. And I think one of our leadership behaviors that we, we talk about explicitly, we say that we want people who are mission-obsessed. And if you want to be a leader here, we want you, not to the detriment of your health or your family, but we want you to be all-in on driving what we need to drive, so I’d say that that’s a major factor. Look, structure and function, just like in biology, they go together and business and organizations as well. And soon after I got here, about a year after I got here, we completely reorganized Intermountain into an operating company and we got rid of redundant structures, we flattened the organization and we started to live an integrated operating model that, not very creatively but effectively, we call one Intermountain and we hold people to that. And we killed competition between parts of our organization. And when I got here, there were some great stuff going on, but I remember going to hear some neurosurgeons in St. George, Utah, talk about how what a great job they were doing building their service and they were doing a terrific job. And I said, oh, where are the patients coming from? And they said, oh, we’re getting them from the other Intermountain hospitals. I’m like, oh my gosh, you know, like Vegas is like an hour and 15 minutes from here. Like, don’t you want to compete with from there because you are doing it? And so we kind of now it’s really, it’s a, you know, we want people to be agnostic about where the patients are as long as they’re within the system and as long as they’re getting great care. And I’m super proud of the teams over the last couple of years, we’ve taken the entire system, which is now a 33 hospital system, and we’re top decile, excuse me, we’re 89th decile, 89th percentile performance from quality and safety across the whole system. And we’re having trouble breaking the 90th percentile because so many of our hospitals are already up in the top 10%. So for me as a clinician, to see people collaborating and getting great results makes me feel really good.
Saul Marquez:
That’s fantastic. And you know, it’s that all-in mentality, you apply that in your personal life, here you want to do a an Ironman now, is that true?
Marc Harrison:
Yes. So this would be my eighth Ironman.
Saul Marquez:
Oh, so you’ve done them before you. This is going to be your eighth.
Marc Harrison:
Yeah. So I haven’t done one since. I haven’t done a full distance race since before I got bladder cancer back a long time ago now, I think that was in 2009. And I really did have a very close call a couple of years ago with the myeloma, and I just was so lucky I got into this clinical trial. So I’m racing the Hawaii Ironman on October 8th to raise money for Primary Promise, which is our first enterprise wide philanthropic campaign, and we’re building a second children’s hospital and spreading children’s services across the Intermountain West. And I think I personally, with the help of our foundation, of course, which is an amazing group of people, I think I’m on for almost $4 million dollars that we’ve raised from my race on October eighth.
Saul Marquez:
Amazing.
Marc Harrison:
I’m getting…
Saul Marquez:
What’s the goal?
Marc Harrison:
My goal is to get my sorry butt across the line before 17 hours are up. Hopefully I’ll do a little bit better than that. But it’s a, the process has been really interesting. In May 2020, when I got out of the hospital and after an ICU stay in the hospital, I could really walk, you know, quarter mile, half a mile.
Saul Marquez:
Wow.
Marc Harrison:
And to read, and I’ve raced since 1982, I’ve never missed a year of triathlon, and to rebuild from barely ambulatory to right now I’m doing 17-18 hours of training a week and I’ve already put in 2 hours this morning and going to get this thing done. It may not be, it may not be pretty, but I’m going to get this sucker done.
Saul Marquez:
That’s incredible. Good for you, Dr. Harrison. And we’ll make sure to get a link to your fundraising. Anybody interested in.
Marc Harrison:
Oh, please!
Saul Marquez:
Yeah, and collaborating.
Marc Harrison:
Every dollar counts in.
Saul Marquez:
Yeah.
Marc Harrison:
Look, you can’t go to a community in the western United States that a kid hasn’t been cared for at primary or children’s. And we’re working so hard to push that care into their communities so that the kids only come to us when they absolutely need it. And that old model of medical colonialism, where you extract kids from or patients from a community to enrich a big fancy hospital system is very outdated, and I think it’s actually wrong. So we’re trying to do this totally differently.
Saul Marquez:
That’s awesome. Well, folks, we will keep a lookout for Dr. Harrison and his Ironman. We’ll be rooting for you, and we’ll also include the link there to the contributions page for the money that he’s raised.
Marc Harrison:
You have a long time to root for me on the eighth. It’ll be, I’ll be out there for a long time, I’ll be out there for a long time.
Saul Marquez:
Oh, man. Inspiring, inspiring. So we’re getting to the end here. What are you most excited about today?
Marc Harrison:
I would tell you I’m excited about, so you might expect, you know, cellular therapies, new technology, use of AI to improve people’s lives, the importance of digital, that’s not so good. I don’t know how many people in their, in their twenties who you know, they’re amazing. So this next generation is switched on, their mission-driven, they’re kind of a pain in the neck at times, they’re pretty sure they want your job like tomorrow. They got big ideas, they’re quick to share them. I actually think that the world is in good hands going forward, and I’m really excited to see them begin to exercise their capabilities on behalf of society. So I am deeply and profoundly an optimist. And when I see our young caregivers and some of the young people I know in other parts of my life, I think that’s what I’m most optimistic about.
Saul Marquez:
That’s awesome. Yeah. There’s there’s so much that we could do to work together across generationally and so many cool things that could come out of that. So this has been incredible fun, Marc, I’ve truly enjoyed having you on the podcast.
Marc Harrison:
It’s my pleasure. Thank you for the privilege.
Saul Marquez:
Yeah. Before we conclude, share a closing thought and where the listeners can get in touch with you and learn more about you.
Marc Harrison:
Sure. So they can they can follow me on, on LinkedIn. There are a bunch of people who do, and I think there’s some good content that comes through there. I’d say my closing thought is I’d like for people to think about how they can make a contribution, I don’t mean a financial contribution. How can they help another person fulfill their potential? Probably the thing that I’m most proud of that we’ve done at Intermountain in the last couple of years is now all 60,000 of our caregivers have access to really significant educational benefit, 5200 dollars a year to spend on themselves, to develop themselves. And if they can’t use it, they can give it to their domestic partner or their kid. And that is a way that we’re trying to do something for other people without any strings attached. And for everyone who’s listening, if they can help one other person with no strings attached, do something in their life that’s meaningful, the world would just be a better place.
Saul Marquez:
I love that. Dr. Harrison, I appreciate that. And folks, I hope you took some great nuggets. And I’ll be hitting rewind on this podcast with Dr. Marc Harrison. Make sure you check out the links below. Check out A Healthier Future, that’s his popular podcast where he’s interviewing some amazing leaders. Check them out on LinkedIn, where Dr. Harrison has over 320,000 followers and he regularly posts just the great thought leadership content. So Marc, can’t thank you enough, really look forward to staying in touch.
Marc Harrison:
Great. Have a great day. Thank you so much.
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