Healthcare is Hard: A Podcast for Insiders

Bryony Winn is a Zimbabwe native and Rhodes Scholar who says her background growing up in the developing world contributed to her innate desire to pursue a career with an element of social impact. And she says that background had a fundamental impact on the voice she brings to the U.S. healthcare market and to her leadership style.
Bryony spent the first decade of her career at McKinsey & Company providing strategic and operational counsel to a wide variety of clients across Europe and Africa. After relocating to the U.S. in 2011 and being named a Partner in McKinsey’s Chicago office, she worked with the Center for Medicare and Medicaid Innovation (CMM) and advised numerous healthcare CEOs and government leaders seeking to improve systems of care and transform payment models.
After leaving McKinsey, Bryony spent two years as Chief Strategy Officer at Blue Cross North Carolina and then joined Anthem as Chief Strategy Officer. In September 2021, she was named President of Anthem Health Solutions where she is now responsible for ensuring that the more than 45 million consumers in Anthem’s family of health plans have access to high-quality, affordable care.
On this episode of Healthcare is Hard: A Podcast for Insiders, Bryony shared her perspective with Keith Figlioli on a number of topics, including:

• The Fundamental roles of a payer. In Bryony’s view, there are two central issues that define a healthcare payer and its ability to deliver higher quality, lower cost care: how it partners, and how it pays. She points out that organizations signal what they value by the way they pay for care. For example, how paying for care that drives affordability and quality incentivizes collaboration.
• Innovation inside incumbents. There’s a misconception that innovation is not occurring inside large incumbent healthcare organizations, according to Bryony. She says startups do not have a monopoly on smart people taking thoughtful approaches to the complexities and challenges of the U.S. healthcare system that have developed over decades. While the journey may be slower in these organizations, she says the difference is that they have a longer track record for sustainability – one of the most important factors in U.S. healthcare. She believes in approaching the market with a deep sense of humility for the people and companies that have come before us.
• Advice for entrepreneurs. Bryony says so many potential partners and vendors looking to do business make promises on issue like financial savings or Medicare star ratings. She jokes that if she added up these promises, Anthem would be a 23-star plan. When asked how entrepreneurs and startups can work best with Anthem, she warns of the importance of honesty – but says it needs to come from both sides of the table. Startups should expect honesty from a large company on things like payment and implementation cycles. But they need to be honest about what they have actually delivered versus what they hope to deliver. Don’t pretend you have a track record when you do not, because if you’re honest about what you hope to deliver, a company like Anthem could work closely with you to help make it happen.

To hear Bryony and Keith talk about these topics and more, listen to this episode of Healthcare is Hard.

Advocate Health is the nation’s fifth largest nonprofit health system, operating 67 hospitals and more than 1,000 sites of care to generate revenues topping $27 billion.
This new entity was formed by combining two like-minded, not-for-profit health systems in December 2022: Midwest-based Advocate Aurora Health and Southeast-based Atrium Health.
While this was among the biggest mergers ever in the nonprofit healthcare ecosystem, it wasn’t the first for Scott Powder. In the early 1990s, Scott began working for Evangelical Health System, a pioneer of horizontal integration, which later became Advocate Health Care. Over the next 30+ years serving in various strategy and planning roles, including overseeing the 2018 merger of Advocate Health Care in Illinois and Aurora Health Care in Wisconsin, Scott had a front row seat to the growth and development of the healthcare ecosystem.
Scott is now President of Advocate Health Enterprises, where he is responsible for advancing Advocate Health’s whole person health strategy by investing in solutions that complement the health system’s core clinical offerings and broaden its business portfolio.
In this episode of Healthcare is Hard, Scott talks to Keith Figlioli about the strategy behind creating Advocate Health, and the market forces driving it. They discuss topics including:

• The shifting mindset on geography. One of the most unique things about the new Advocate Health is its geographic footprint. While Illinois and Wisconsin are neighboring states, the company now also serves communities much further away in North Carolina, South Carolina, Georgia and Alabama through the merger with Atrium. Scott talks about the traditional mentality that all healthcare is local and how he doesn’t believe that is the case anymore. He discusses the role geography still plays in high acuity care, and how technology is enabling so many more elements of healthcare to be delivered practically anywhere.
• The debate over scale. There’s concern in the market about some health systems becoming too big, and a debate about whether or not these organizations are truly optimizing the value of their scale – or if they ever will. But Scott points out how scale is relative, especially in a fast-evolving healthcare market. For example, he raises the point that even if the five largest nonprofit health systems in the country were combined, they would still only generate half the revenue of a company like CVS Health or United Health Group, and only a fraction of the revenue of players like Amazon. He also talks about ways health systems can create scale outside of traditional M&A, such as joining forces around issue-specific consortiums.
• Dual transformation. Scott compares the difficult decisions facing healthcare to other industries like automotive, where companies have made commitments to move away from the core of their business – the internal combustion engine – in favor of investing in electric vehicles of the future. He talks about the capital-intensive demands of operating a core clinical care delivery business, and how challenging it is to divert money from those operations to invest in other areas. But he says it’s the only way incumbent health systems will survive.
• Care in the home. A lot of Scott’s focus at Advocate Health Enterprises is around a thesis that a person’s home will be a center for care delivery in the future. He believes there will always be a need for hospitals, but that they’ll look very different in the future, and he talks about acquisitions Advocate has made to marry personal care, clinical care and technology in the home.

To hear Keith and Scott talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Dan Michelson’s recap of the JP Morgan Healthcare Conference in Becker’s Hospital Review has become a must-read over the past few years – whether you attend the conferences or not. Dan’s organization, Strata Decision Technology, works with more than 1,000 hospitals from hundreds of health systems on their financial planning, analytics and performance. And as CEO, he has a unique view across systems that allows him to neatly unpack and bring clarity to the various sessions and conversations that occur throughout the JPM conference.

Dan’s insight is especially welcome when it comes to the conversations that happen in the secluded confines of the thirty-second floor of the Westin St. Francis Hotel during JPM week. That’s where dozens of CEOs and CFOs from the nation’s largest health systems gather to hear presentations from their peers about high-level strategies in this rapidly changing market.

If you’ve read Dan’s articles and wondered how he got started writing them, or if you’ve wanted to hear directly from him with more context on his thoughts, here is your chance. In this episode of Healthcare is Hard, Keith Figlioli’s conversation with Dan brings his JPM recap to life. This year, based on all the provider presentations and many one-on-one conversations, Dan outlines the 10 questions that health systems should be asking and answering to guide the future of their organizations. He and Keith take a deep dive into these questions, discussing topics including:

• Performance. Looking at whether a leadership team should spend their time focusing on performance or building a budget is one of the important questions Dan outlines for health systems. He explains the choices systems have in more detail, using OSF Healthcare as an example. The Peoria, Illinois-based provider shifted away from traditional budgeting processes in favor of a rolling approach and according to Dan, saved 20,000 hours of leadership time and more than $1 million in spend.
• Market share. Dan says providers need to change their mindset and think differently about how they define market share as healthcare evolves. In addition to the “share of cup” analogy Dan explained in his written recap, he talks about his experience hearing Walmart’s head of healthcare discuss the retail behemoth’s view of the market. While providers believe they own the patient relationship, he points out how only half of Americans say they have a primary care provider and among the other half, two-thirds haven’t visited their primary care provider in years. With that data, what does Walmart have to say about the market and the patient-provider relationship? “Alright, we’ll take the other 84%.”
• The “other five” questions. While Dan’s article framed the ten questions providers should be asking, Keith calls him to task for adding another five at the end of the piece without full explanations. Dan says his point is that the ten specific questions health systems are asking themselves doesn’t really matter; what really matters is that they’re asking tough questions like these at the executive level. However, he explains why he thinks questions about affordability are the ones that leave health systems most exposed right now.

To hear Dan and Keith’s conversation, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Through its work with more than 41,000 healthcare facilities and the industry’s largest database of patient feedback, Press Ganey gives organizations the data and insights they need to put the human experience at the center of healthcare.
Since it was founded nearly 40 years ago by Professors Press and Ganey at the University of Notre Dame, the company has built a reputation for being the prominent source of patient feedback, but it hasn’t stopped there. Its solutions capture the voice of the patient, physician, nurse, and employee to keep healthcare focused on people by enabling organizations to address safety, clinical excellence, patient and member experience, and workforce engagement.
Pat Ryan became CEO of Press Ganey in 2012 after more than 30 years working with healthcare leaders and providers, including a dozen years as a Press Ganey client. Pat has served on several health system boards and has worked throughout his career to improve the quality and safety of care while lowering cost and achieving caregiver resilience to deliver truly patient-centered experience.
In this episode of Healthcare is Hard, Pat spoke with Keith Figlioli about the increasing focus on human experience in healthcare transformation. Drawing knowledge from his career and from Press Ganey’s unrivaled understanding of patients and the professionals who serve them, Pat shared his perspective on topics including:

• The link between patient experience and financial success. Pat shared what he says is a little known fact – that health systems across the country with the highest margins also have the highest patient scores. He talked about how the two are linked and how value leads to long term community loyalty. He cited his time on the board of Beth Israel Deaconess Medical Center where they looked at patient data first and financial data second. He says health systems today need a comprehensive view that also includes safety and employee engagement data in order to identify opportunities for improvement.
• Redesigning healthcare from the outside in. Any consumer business would start with the needs of the customer first and work backwards to design systems that add value. But healthcare wasn’t created that way and was built from the inside-out. Pat discussed the need for healthcare organizations to continue the long journey of recognizing that consumers comes first, and talked about how workforce engagement will be an important component of that as the industry evolves.
• The trust factor. Pat describes how organization can map trust in order to understand where it breaks down by identifying friction points within the customer journey. He talks about how important it is to build and maintain trust in all relationships – not just a patient or family’s trust in an organization, but also nurse, clinician and employee trust in their organization and leadership. He mentions how important this is for payer organizations that are especially susceptible to unfair or inaccurate perceptions.
• Opportunities for innovation. When discussing areas where healthcare organizations can improve, and where innovators in the space can help them, Pat’s focus during this conversation was mostly on two issues – home care and the shift towards value. He says figuring out how to care for more people at home is going to be critical and sees opportunity around redesigning the healthcare workforce for the gig economy. He also talks about how slow the movement to value-based contracts has been and how a major break in the system may finally force congress to act if adoption doesn’t pick up.

To hear Keith and Pat discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

It’s a difficult time for health systems who are struggling with financial pressures brought on by rising costs, patient volumes that continue to remain below pre-pandemic levels, and a host of other issues putting their balance sheets in the red. But at the same time, the need for innovation has never been greater. New technology will be essential to streamline operations and meet consumer demand for new care delivery models while staying ahead of big tech, retailers and others adding pressure for providers to evolve and transform.
How can providers focus on getting business fundamentals back in order, while also looking to the future and accelerating their focus on innovation?
On this episode of Healthcare is Hard, Sara Vaezy, chief strategy and digital officer at Providence, talked to Keith Figlioli about the need to address both of these issues at once – and how to do it. Some of the topics they cover include:

• New economics for providers. While there may have been an initial hope about getting through the pandemic and getting “back to normal,” it’s now clear that the fundamental economics of healthcare – especially for providers – will never be the same. Sara says the industry is starting to get comfortable with the notion that provider economics have eroded in a long lasting way. Recognizing this fact and finding new ways to diversify will be essential for providers to thrive.
• Building beyond acute care. Health systems are being forced to choose if they want to focus on being the center of acute care in their communities and be part of a larger network of services, or broaden beyond that to provide more elements of the network themselves. Sara says not every hospital or health system has the resources to expand on their own, but sees Providence on a path to becoming a “health company with a care delivery arm.” She talked about how this model could even give providers national scale, as opposed to operating within a geographic footprint.
• The importance of partners. Innovation is essential for every health system in one way or another, and Sara admits that it’s hard to do on your own. Those who cannot drive meaningful innovation themselves will be forced to consolidate or partner with others. Those who can and have been driving innovation will continue to do so, but Sara predicts that even they will form more innovation consortia and financing partnerships to focus on key areas where reach and scale will create a more efficient cost structure for innovation. This will also create more opportunities for entrepreneurs to work directly for or with health systems.
• The advantage of incumbents. It’s easy to be critical of healthcare incumbents, but Sara points out how important it is to not forget that they still deliver the vast amount of care at scale in the U.S. This is a significant advantage that can be amplified even more when incumbents work together. As she says several times, it’s difficult to drive innovation and the transformation of healthcare alone. Collaboration will be critical.

To hear Keith and Sara talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.