Speaker 1 (00:05):

Welcome to Hospitals in Focus from the Federation of American Hospitals. Here’s your host, Chip Kahn.

Chip Kahn (00:15):

Hello and welcome to Hospitals in Focus. We appreciate your listening. Our guest today is working to reshape the current provision of healthcare and using cutting-edge technology to make the care continuum more patient friendly. Marty Bonick is the president and CEO of Ardent Health Services, one of the largest tax paying health systems in the US. He is also a current federation board member and past chair. Thanks for joining us, Marty.

Marty Bonick (00:44):

Thanks for having me, Chip. Glad to be here with you.

Chip Kahn (00:46):

Marty, to get started, unfortunately here in Washington, policymakers and influencers sometimes focus on cost, not care. But at the end of the day, we do have to worry about costs, and I know that you are working hard for your patients to reduce their costs. Can you talk a bit about that?

Marty Bonick (01:07):

Yeah, Chip, costs are something we all have to contend with across this industry and across the world. We’ve all experienced the impacts of inflation. We’re seeing how that’s playing out with interest rates. We’re seeing how that’s playing out with salaries, the supply chain, and the costs are a day-to-day reality for the healthcare system. It’s something that we’re all very much focused on. How do we take costs out of the system and at the same time, as you said, provide quality of care to the patients that are relying upon us? It’s a real balancing act, but it’s an imperative, I’d say, for the industry and for us at Ardent in terms of making sure that we’re doing things in a cost-effective manner, while still providing the patient care and the quality and the accessibility that our patients expect and deserve from us.

Chip Kahn (01:51):

Marty, I hope I’m not speaking out of school to say that you recently were a patient yourself after a serious accident. Can you tell us a bit about that experience? What happened to you and what did you learn from actually being in a hospital and being, in a sense, at the front line, not as a provider, but as a patient?

Marty Bonick (02:12):

Yeah, Chip, it’s something I’ve talked about pretty openly, and after 25 plus years in this industry of leading health systems and working in health systems, to actually be a real patient for the first time in my life outside of a doctor’s visit or an ER visit or something like that, it was really eye-opening.

(02:31):

Short story, I was training for an Ironman race and I was in a bicycle accident, was hit by a car actually, and ended up in a local hospital’s trauma unit for a few days. And what the experience really, the impression that left on me is that we’ve got great caregivers, we’ve got great nurses and technicians and physicians that are all just trying to do their best to take care of patients. And this was still a little over a year ago during the sort of peak of the COVID pandemic. So people were really busy, and yet they were still super attentive to my care, my needs, and just doing the best they can with the resources that they have to offer.

(03:07):

But what it caused me to realize is, as I reflect back on the experience, and particularly once I was discharged from the hospital and still had to access outpatient services for MRI study, for an ASC visit, for physical therapy, et cetera, is just how cumbersome the system is to deal with. Trying to get a insurance pre-authorization to be able to get care that’s obviously needed is just a hurdle. The runaround that caregivers have to go through to be able to provide the care that they want to and yet still deal with the administrative billing burdens are just clunky. The technology hasn’t caught up to where it is on our iPhones where we can just really control our lives from pretty much anywhere we are.

(03:50):

In healthcare, we still have historically been in this, pick up the phone, dial a number, navigate a phone tree, be put on hold, get disconnected. We’ve really made it cumbersome for people to access services. I can go online and book a haircut. Why can’t I go online and book a physical therapy visit or a doctor’s visit?

(04:07):

So I know a lot of health systems are focused on this, including Ardent, but for me, the wake-up call was we really have to provide that customer accessibility, that customer focus, as if we’re treating consumers, not patients. Patient, it’s Latin for somebody that’s being acted on, but nobody really wants to be acted on. We are actively involved in the care that we receive and we want to be treated where our voice is heard, our input is sought out, our time is valued, our money is valued. And historically that’s not how the system’s been set up.

(04:38):

So there’s all this talk about what health systems are doing to take costs out of the system. Well, it starts with taking the friction out of the system. We do have to rely upon being able to work with payers and other constituents inside the industry. But for us at Ardent, we want to make our facilities the easiest, friendliest, most accessible and cost-effective services that people can access. And they’re doing it on their terms versus our terms. Just because we built these buildings, if people can access in a virtual way through telehealth, then we need to make sure that that’s an option. And if we don’t, there’s disruptors out there that are going to come and try to take that business away from us.

(05:15):

So my personal experience really was a wake-up call and gives me a platform as a leader with Ardent in our eight markets that we provide service in across the United States to be able to focus on delivering that consumer experience that they experience everywhere else in their life, and being able to do that in a fairly accessible service-oriented way.

Chip Kahn (05:36):

I think you’re getting at it a bit, but in a sense, how did that experience change your vision for Ardent as Ardent’s CEO?

Marty Bonick (05:44):

We are looking and really reevaluating how we do business across the board. One of the tangible outputs is every health system nowadays has an EMR system, but it’s amazing how much paper we still have in our system. So we have a ban the clipboard committee. Anybody that comes into our facility should be able to access us digitally. We have Epic as our EHR provider and they’ve got a great patient app called MyChart, and you should be able to do anything from that without having to go and fill out paper forms. You think about how much PHI, or I call it PFI, personal financial information, end ups getting passed around in clipboards. And we wonder when systems experience breaches and things like that, in the world that we live in, how that plays into it.

(06:30):

So we want to make sure that we’re providing friendly, accessible here, a digital front end to our system, and then accessing our system, whether that’s a hospital, whether that’s a clinic, whether that’s an AFC urgent care center, that we have accessible ways for people to access our schedules online, to message providers securely online, and just to take the friction out of that care experience that’s historically existed.

(06:55):

We’ve had this mentality as an industry, I think, for far too long, that we have built it and you must come, kind of this Field of Dreams mentality. And we really have to understand how the consumer thinks, what they value and how do we provide that service to them. So everything that we’re doing is really focused around this consumer mindset, where they receive services, how they receive services, and doing it in a digitally enabled and connected way.

Chip Kahn (07:19):

Marty, as you take these processes to that other level and make them truly seamless for patients and their families, what do you think the effect of technological innovation, like machine learning, artificial intelligence, ChatGPT is going to have on that patient experience and maybe even have some implications for reducing costs?

Marty Bonick (07:44):

The promise is certainly there. It’s up to us to seize that opportunity, to accept that the change needs to happen and the technologies like AI and machine learning can be a part of that solution. It’s not going to be an immediate sea change. It’s not going to be a silver bullet. But if we don’t embrace these technologies, others are going to figure that out.

(08:05):

So a few examples that come to mind, in terms of improving the patient experience via outcomes, we’ve partnered with a company called BioIntelliSense, and this device is a small patch about the size of a silver dollar that will replace blood pressure monitoring, EKG tracing, respirations, pulse ox, et cetera. So all of the core vital signs that our caregivers are having to go around and collect from patients on a routine schedule three, four, or five times a day, this little button, it’s called the bio button, can record all of those vitals, document them in the charts. So we’re making life easier for our nurses, but from our patient’s perspective, we’re actually improving the outcome.

(08:48):

So if a patient is improving quicker, then we might otherwise notice if we’re only taking vital signs three or four times a day. This little bio button is collecting vital signs on a minute-by-minute basis and we can detect if somebody’s improving quicker and hopefully get them home sooner, which is what everybody wants. It’s better service to our patients and it’s more cost-effective care.

(09:11):

At the same time, if somebody’s deteriorating, oftentimes we don’t see that as quickly as we’d like to, and a patient ends up in a rapid response situation, or worst case, gets admitted to an ICU because their conditions deteriorated. We’re going to be able to see that. And this bio button can involve machine learning and algorithms to detect that improvement in the patient’s function or not. More efficient for our nurses. They’re not spending time collecting vitals. They’re able to analyze what the information’s saying. We’re getting more of it and ultimately to benefit the outcomes for our patients. All of that actually helps us reduce our cost of providing care as well. The quicker we can get somebody well and get them home or prevent something more serious, a complication from occurring, that’s all better care, better outcomes, better cost.

Chip Kahn (09:59):

Yes. And maybe even some patients can get a full night’s sleep-

Marty Bonick (10:02):

Exactly.

Chip Kahn (10:03):

… in a hospital-

Marty Bonick (10:03):

Exactly.

Chip Kahn (10:04):

… that they can’t get right now because of those visits into the room, appropriate visits for taking vitals every X number of hours. And that actually moves well onto our next topic, which is related to this, which is the monitoring and other factors are leading to a new disruption, whether we want to call it hospital without walls or hospital at home. There are many concepts now, and you alluded to it earlier, that there’s a stretch now beyond the hospital as a single institution and for some patients, where it’s appropriate, taking what’s done in a hospital and doing it in a much friendlier, easier environment for them. How do you see this disruption? What effect do you think it will have? And frankly, are hospitals or are systems like Ardent going to be ahead of the game here, or will it fall to others to carry out this disruption?

Marty Bonick (11:02):

Well, Chip, I’ve been asked this question before and my answer is this. This is ours to lose. And when you think about disruption, I was listening to another podcaster, Scott Galloway, if anybody’s heard of him before. He is up in New York. He was talking about disruptors and all the focus and attention that goes on them, but he says, “Really, the real emphasis on who is the one that the disruptor is disrupting?” That’s where the focus is.

(11:28):

And I think, again, going back to what we talked about earlier, healthcare systems have had this mentality that everybody has to come to us. They need to receive care the way we want to do it. And disruptors are saying, “It shouldn’t be like that.” And frankly, I’d agree with them. And again, from my patient experience, that’s how I felt.

(11:46):

So it’s up to us to embrace this new way of thinking. And so I think health systems are really in the prime position to benefit from this disruption, but we need to do it to ourselves. And at the end of the day, I’ve said I’m not afraid of an Amazon or a CVS or an Optum coming into our markets and providing little point solutions, niche solutions like a telehealth offering. We provide telehealth services at our system. So Amazon’s not bringing anything new to us when they spent a lot of money buying One Medical Group and are now broadcasting this telemedicine platform across their Amazon website.

(12:24):

We do the same things. But what happens when that patient needs something beyond a telehealth visit? So many of our patients today are really sick. They’ve got complications and comorbidities and they end up in a position where they need a lab test or they need an imaging study or some type of follow-up from that telehealth visit. Well, we’ve got a self-contained ecosystem where we can provide all those services and procedures for them. So we’re really completing the loop.

(12:48):

So again, at Ardent, the way we focused on this is really changing the narrative and not looking at ourselves so much as a hospital company, but really a health services organization focused around the consumer and their needs, including hospitalization if that’s what they need. But I think that’s where the health systems really need to focus and it is going to be a shift. We’ve historically been an industry of heads and beds, or we’re tracking admissions and surgeries and adjusted admissions, but there’s so many services that people need. In the absence of the healthcare systems embracing that, there has been room for “disruptors” to come into the industry and offer a different solution. But to me, that’s all opportunity for us to provide better continuity of care, better stickiness with our patients, and leading with our physicians who know what those services are that our patients need, but historically, as health systems, we might not have focused.

Chip Kahn (13:42):

Consistent with this, and as you mentioned, Ardent was an early adapter of virtual nursing and other smart patient technologies. How does this work, and what has been your experience so far with taking new technologies and integrating them either into the current structure or trying to push them in to new kinds of services that you want to replicate in other settings like you described?

Marty Bonick (14:09):

Yeah, two thoughts come to mind there. One is we’re trying to make our hospitals smarter. Technology is our friend. And historically, I would say that maybe in our industry we’ve seen technology as a bit of a burden that has been pushed onto our providers and the providers have to work for the technology. I think we’re at a tipping point and where technology really can help our providers do their jobs better, more effective, more efficient. If we don’t have enough nurses out in the industry, and this is going to be a problem for some time to come, then how do we embrace technology that’s going to make it easier for them to do their jobs and truly have technology working on their behalf?

(14:47):

So we have embraced virtual nursing and virtual attending services where we can bring nurses into the patient room and do some of those activities that take our bedside nurses away from truly taking care of patients, but have to be done. Admission notes, discharge notes, medication reconciliation. These are time-intensive, important activities. But if a nurse has multiple patients they’re caring for, they can’t be spending 30 or 45 minutes with one patient and then potentially missing a call light or a medication administration or something else with their other patients.

(15:21):

So this is a way to extend the workforce, zoom the nurse into where they can be most helpful to supporting the nurses that are at the bedside, and helping to extend the work. And again, this isn’t about taking jobs away. This is more dealing with the reality is that we can’t find enough nurses as it is today across the industry. Nurses are at a premium. They’re very hard to find. So we want to create systems where we make it easy for nurses to want to work for us. We’re giving them the support tools, whether it’s technology or other nurses at a virtual setting to help come in and take care of our patients and create a new team environment where we’ve got technology and people working together to provide the optimal care to patients that need them.

Chip Kahn (16:06):

This is really exciting. But at the same time, we’ve got some groups out there representing labor groups at organizations that represent some nurses, and other groups that in a sense are raising red flags about the emerging technologies and seeing them as meaning less care rather than more. And in some ways, I think they see an alternative universe from the one you just described. But we’ve got to face up to the fact that they’re out there, they’re making these arguments, they’re arguing for nursing ratios and other approaches. How do you respond to the labor group’s criticisms of what seems to be a trend to make caregiving better for the patient at the time that it focuses the nurse away from a lot of the busy work they’ve had to do historically?

Marty Bonick (16:57):

Chip, I don’t know how to say it nicely, but I would just say that the groups that are thinking like that are just a bit tone-deaf to their membership. If there were more nurses out there to be had, we’d be hiring them. I don’t know a system out there that isn’t looking to hire good quality nurses. And again, as I said before, our investment in technology is not to reduce the nurses at the bedside or to reduce ratios, it’s really to support and augment the care and think about delivering care in different ways.

(17:26):

Some of the nurses that we have in our virtual nurse program are people that couldn’t physically do nursing at the bedside anymore. They couldn’t be on their feet for 12 hours. We had some that were long-term employees with us, that their spouses got relocated out of the market and they wanted to work with us, and now we’re giving them a way to be able to continue to work with us in that way. So again, this is about job creation, about delivering care in a different model, and understanding the labor market as it is that we’ve had twice as many retirements as we’ve had new nurses come in over the last couple years.

(18:01):

The pandemic has really paid a toll on this industry. It’s also created opportunities for nurses to find jobs outside of the traditional healthcare system roles, either acute or post-acute. And we just have a reckoning that we have to deal with. So I think we have to find ways, again, of embracing technology to support our caregivers, to make and create facilities that nurses want to work in because they know they’re getting the support and the help from smart technology that actually is a help and not a burden to them delivering care.

(18:30):

So again, I hear the criticisms, and I just keep saying that this is not about trying to take nurses away from the bedside. It’s just about how do we better support them in delivering the care that they want to deliver to their patients and that their patients deserve?

Chip Kahn (18:44):

Marty, as we close out, what do you see next as the great challenges for Ardent and in a sense, what comes next for Ardent?

Marty Bonick (18:53):

Yeah. We’re seeing millions of patients every year, and that’s one of the things that we’re really focusing on, is how do we, again, put that consumer need at the center of everything we do and realize that we’re more than hospitals? We are a health services organization, so we are really focusing on growing outside of the four walls of the hospital. Our hospital is our core and ultra important to what we do in delivering care. But so much of the care that patients are needing is in an outpatient arena. And for us to be relevant and for us to be sustainable for the future, we have to make sure that we’re providing that continuum of care and creating the relationships to have those opportunities to serve patients in other modalities, whether that’s physical or virtual.

(19:35):

O we’re investing in technologies like telehealth, as I mentioned before, but also remote patient monitoring, chronic care management, really focusing on our physicians as the tip of the spear from our value-based care networks, and understanding what our patients need and what’s the right setting, what’s the right cost-affordable setting for them to receive that care. And it may not always be the hospital. And again, if we don’t embrace that thinking, then others are out there trying to do that. And then we’re left with fewer and fewer patients.

(20:03):

So for us at Ardent, it really is about being that consumer-driven health services organization focus, including hospitals, but most importantly, thinking about the patients’ needs from their perspective first and delivering those services in the most appropriate setting.

Chip Kahn (20:19):

Marty, thank you so much for joining us today. It’s so good to hear from the real world about what’s happening in healthcare and what’s important and how we’re all working to improve patient care.

Marty Bonick (20:30):

Thanks, Chip. It was great to be here with you today and to be able to share our story.

Speaker 1 (20:38):

Thanks for listening to Hospitals in Focus from the Federation of American Hospitals. Learn more at fha.org. Follow the Federation on social media @fahhospitals and follow Chip at Chip Kahn. Please rate, review, and subscribe to Hospitals in Focus. Join us next time for more in-depth conversations with healthcare leaders.

Marty Bonick
President and Chief Executive Officer, Ardent Health Services