Why Speed, Scale, and Data Are Redefining Healthcare Transformation: Lessons from Dan DeBehnke, MD, MBA of Premier

<p>hello everyone this is Cole from the American Journal of healthc care strategy joined by a special guest this evening with a very long and impressive uh career history and resume Dan uh Dan please introduce yourself and your current role yeah thanks Cole appreciate having the time to talk uh Dan Dei uh I'm vice president and chief phys executive uh for premere uh Premier is a global Healthcare transformation company um I've been with Premier for about uh four years I lead the Consulting uh business unit for Premiere and focus on Integrated Solutions and integrated sales uh for the organization so pleasure pleasure to be here in the chat and thank you so much for coming on we know that you have a very busy schedule I wanted to start back at the University of Wisconsin where you got a Bachelor's in it looks like zoology I want to ask what was the the spark for that you're probably one of the only people I've met who who has that undergraduate degree that's so funny you say that because back in the day so it kind of dates is that there really wasn't a Premed curriculum so you had to basically pick a you know a science science topic so um zoology is basically Premed my my uh stepdaughter gives me a hard time she's Premed right now at University of Iowa and she's like maybe I'll be a zoology major but no nobody does that anymore if if if things completely fall about part Cole I can I'm sure that I can get a job with a DNR or something like that with my zoology major so oh that is great of course that uh that's very funny yeah um because you've been in the field a long time right you I mean just to to get some context how long were you practicing as a emergency medicine physician yeah so I spent about 30 years of my career on the provider side and I would say about half of that was as a Frontline practicing Emergency Physician and then about a half of my the last half of my career was spent in various physician executive roles so I was CEO of a large um multip specialty academic faculty practice plan and then CEO of an academic Health System uh for several years so about half as a practicing Doc and about half as a administrator phys executive impressive and and so one of the questions that I have when talking to a lot of Physicians and talking to a lot of Executives is you know they they're not always the biggest fans of Consultants or Consulting agencies they're very expensive so how did you decide to move into that area right that seems kind of against what you had done for the the past 30 years yeah it's kind of interesting that you bring that up because I often talk and when I talk with our kind of our junior level Consultants I I bring that up about why why do organizations use uh Consultants I mean I got into Consulting mainly because I had just finished up uh several year stint as a CEO of a health system which was a turnaround um and so operational financial and quality turn on and I really liked that work kind of the rapid cycle moving fast um changing operations and so um was drawn to that I actually entered an organization Consulting organization in the strategy practice um where I was focused on kind of large scale academic Health System strategic plans and stuff like that but as a you know when I was a CEO and what I tell our our Consulting team now is that the reason that organizations use Consultants are several fold first is um most people have a they have a day job and so you know they've got a problem that they've got to Sol but yet they've got to do all their other work and so what Consultants bring to the picture is focus from a project management standpoint focus on key um um performance indicators so kpis and speed to value and so um really in in that when I'm when I'm selling Consulting now to organizations that's what I say you know listen you got a great team I'm sure that you guys can do this work and you've got the the people to do it what you don't have is the bandwidth um we can provide the structure and we can accelerate the process so that you get that speed to Value yeah no and and I agree when Consultants are used well I mean premier of course is one of the you know everyone probably listen to this is very familiar with them right so but the other names on your resume as well you you've been on some of the big names when Consultants are used well they really enhance the teams a lot even the Frontline physician teams because you know these Frontline Physicians don't need to be experts in all of the administrative and financial uh you know nobody at the organization needs to be that level of a subject matter expert on what's going on in the industry and that's where Consulting can really be useful did you I feel like that was an adjustment though coming over from the CEO mindset to a consultant mindset or was the transition easy no it was um it was a it was a rough road my first year of Consulting mainly because at the end of the day a lot of Consulting is sales um but we're all selling something right even as a CEO of a health system you're selling your services you're selling a brand and reputation um but it was it was a bit of a it was a bit of a um I'd say it was a bit of a difficult transition the good news was is and was that I had really good mentorship um on the Consulting side um several really good seasoned Consultants took me under their uh wing and kind of taught me the the ropes and um and you know here I am probably what maybe seven years later six or seven years later um in a really good uh organization doing really good work and uh um hopefully providing value to the members and the CLI that we're serving excellent yeah know that makes a lot of sense those those mentors are are very important it seems like regardless of the level in the absolutely so I want to talk about the work that you do now uh with you know one of the things that we were searching for when we search for guests we're looking for those that have experienced in both Industries and of course AI comes up on your profile and that was an instant you know we really got to reach out to you um so can you tell us just a little bit about your role now what is it that you do on a day-to-day basis what are you offering to the clients yeah yes so we um so I lead our performance Improvement Consulting practice um that performance Improvement Consulting practice is a series of got about 180 to 200 Consultants most of them subject matter experts in a variety of different what we would call verticals or business units um and you can think of them in kind of the classic areas where you want to drive performance Improvement so clinical Quality Pharmacy physician Enterprise Supply Chain Services manage services revenue cycle and revenue enablement in all those areas and the beauty of Premiere is that we've got a set of enabling technologies that support those technology is only as good as the data that comes out of the technology and then how you use that data and so we always bundle those Technologies and the services with them to be able to actually drive value so when we're working with an organization and let's say we want to drive uh Workforce uh related um Improvement we've got a Workforce a productivity and benchmarking tool we've got subject matter experts and services that we wrap around that that we can really Drive uh value and so for we we we like to think of it as technology enabled clinical operating model transformation that's really the work that we do so we're coupling our technology with our Services why was there the decision to build these Technologies inhouse instead of doing what a lot of organizations do which is utilize vendors or you know form kind of vendor Partnerships because from what this looks like it's more proprietary yes so um it is and so so the technologies that we have some were built um inhouse some were Acquisitions but brought into the fold the key for us is actually the data um and you know we've got the Technologies we're a data ingestor um and that data um adjusting that data helps us then produce outputs like benchmarks and that sort of thing you know from a from a healthc care data standpoint we've got the clinical operational and financial data for about half of the acute us Hospital discharges across the United States right now so it is an extremely robust data set and from a Consulting standpoint from a services provider standpoint that's so important because you can immediately get data out of our very large uh data Lake and our tools to be able to actually take that data ingest it and provide meaningful Insight um to the clients that we're working with and so that was really the idea behind building the technology um portfolio of the company is to really build that large data set and then to be able to use that data set to to drive value I've talked with some people at sg2 about this regarding a project that we were doing where we're trying to um develop a list of of administrative Fellowship programs and how even just to get that list across the thousands of hospitals that are out there you know it's very very challenging let alone this level of data which is really impressive um I want to ask you know what H how long what if you you know I know you've only been there about three or four years right so but how long was this in development for before you you've kind of gotten up to the numbers where you are now in terms of the sheer amount of data yeah I'd say probably the technology portfolio has been being built over the last 8 to 10 years um and and I think that at now we've got a pretty steady state from a technology standpoint we're always looking for opportunities to add enhancements to those uh either that be be that through de internal development or through acquisition uh from a partnership standpoint so we're always out there looking we're always trying to understand what's out in the market and certainly now with you know with the the great surge in generative AI you know how can we utilize um AI in the tools that we currently have um that's still a work in progress It's you know it's not the Panacea that everybody has thought that it might be it probably will be it's just going to take time and that's really important because it helps us kind of put into context why we need organizations like your yours because you know hospitals cannot spend the next eight to 10 years playing catchup in a allot of these areas right they need organizations they can partner with that are ready to go because some of these institutions are falling behind and that's kind of the next question I wanted to ask of you is I industrywide right what especially in competitive markets you know I think of Philadelphia I think of Cleveland um New York La what are we seeing in terms of Trends in these markets for institutions I knew that just for me I've seen consolidation is one of the big trends but what are you seeing from your huge lens there that you have yeah yeah it's it's interesting you say that it's it's it's it's changed pre and post- pandemic you know pre pandemic um a lot of strategic planning was your pretty classic strategic planning right let's do a fiveyear strategic plan we'll have you know your five pillars and we'll have the kpis associated with that and you know my my favorite strategist Mike Tyson said youbody got a plan till they get punched in the mouth well P the pandemic punched every body in the mouth and what we're seeing now is this um focus on it's almost an oxymoron but I call it strategic um um strategic um operations or tactical strategy um and it's more focused rapid cycle work around some key um focus areas and that's where we're seeing the trend the trends are in clinical transformation human Capital Management and you mentioned one kind of corporately shared services around uh mergers and acquisition and it's um and it's all related to kind of a narrative that came out of the pandemic you know if you think of clinical transformation one of the narratives um you know during the pandemic organizations were focused on really two things keeping their people safe and and you know treating the the um really bad disease um during a global pandemic and now suddenly coming out of the pandemic organizations are saying wow our quality scores have have slipped um our margins are down because of a variety of different um issues and we've got to kind of refocus ourselves on what's our North Star um and that's probably one of the the main trends that we're seeing is organizations focusing on what is our North Star um what you know be that you know publicly reported rankings like um CMS stars or Lea frog or you know an organization that we acquired 100 top program or whatever ever that Northstar is what is the road map to actually get to top level performance and that so that's one of the focus areas the other is in this area of clinical variation so um you know not all variation is bad but unnecessary variation is bad and so organizations are looking at variation in the clinical operating model as waste uh if you think of you know Len in Six Sigma right what how do we drive the waste out and so that's been a really big area for us um is helping organizations in their Northstar planning and then in driving out unnecessary waste in the clinical operating model and so that's the you know that's one of the trends um the other trend is around um around Workforce so human Capital Management and um you know one of the things that was very clear in the narrative coming out of the pandemic was you I mean just unbelievable use of um of contract labor driving expense uh contract or labor expense you know through the roof and you everybody said well we want to drive out contract labor um and that that premium that that premium labor price and the issue is that I think that things have just kind of stabilized at a point where we're still seeing pretty significant use Across the Nation when we look at our data of contract labor use um and I think it's just probably new Norm um and it and you know there's a pipeline issue yeah absolutely um and you know partnering with nursing schools and that sort of thing are going to be really important to build the supply from a nursing standpoint but a lot of the work right now and the trends that we're seeing in Workforce is really just basic blocking and tackling do you have a workforce management program are you Staffing uh to demand and the other is around length of stay if you can decrease length of stay from a hospital standpoint you don't have as much need for the clinical Workforce and so we're seeing a lot of work and Trends in that area the same in the ambulatory environment is really thinking about physician productivity access those are things those are big big areas where health systems are really focusing especially if they own uh a a large position practice is really maximizing the investment uh in those practices and then the third and you you alluded to it is around this corporate and shared services there's better Resurgence of kind of this merger and acquis acquisition activity in the market and consolidation interesting the The Twist on that right now is is that often times one of the parties uh in those transactions is distressed in some manner usually financially distressed and so as those organizations are coming together we're seeing an emphasis on you know kind of that back office corporate shared services looking for economies of scale HR it rev Cycle Supply Chain even to the point of Outsourcing um some of those making those what have been classically been fixed expenses within an organization somebody else's variable expense right and so uh we're seeing those Trends as well as some organizations taking the opportunity especially if they're a leader in their Market to kind of packaging those things in our manage services type of uh opportunity where they can then actually franchise that and offer it out to um Affiliates or potential Partners without actually having a capital outlay for a full acquisition right it's kind of a acquisition light providing Services REM cycle it those sort of things to Affiliates to be able to bring them into the fold but not have that large capital outlay from a um from a acquisition standpoint so those are things that we're seeing in in the markets now every Market's different from its you know nuances but those are the major flavors and themes uh that we're seeing and are basically aligning our services and our Technologies around you know it makes a lot of sense just looking you know by notes at what we're talking about in terms of that uh elimination of waste when we start to get to economies of scale right I mean we've we look at kind of where SpaceX is excelled compared to NASA and because if you build something really large right uh you reduce those margins a bit easier to kind of reduce the waste that's involved at a really large scale and that seems to be where Healthcare is heading um and and also I've talked to someone at Seaman's health and years about that elimination of contract labor coming up with these unique um you know unique ways of getting nursing staff but one of the things that I wanted to talk about which I have not really talked about before is when we're talking about rapid cycle time this is something that organizations that provide into intelligence like yourself uh probably are very familiar with which is how do we adjust rapidly to new data that comes out Healthcare as you previously said it's slow right fiveyear plan we usually gradually adjust we usually have this time to kind of sit and wait things out post pandemic we're seeing merger acquisition uh we're seeing you know new hospitals new institutions be formed new technologies come out very quickly my question is not so much of how do we get the ex executive staff on board because I think we're seeing more and more Executives really on board with this but how do you go from new data all the way to Frontline change I I still don't understand how that's going to work because there's a lot of people in between the seite and the Frontline staff at at these institutions yeah yeah it's a great question um we've we've looked at it in a couple of ways one is that you have to make the data and the work necess to improve the metrics translatable to Frontline staff um and so you know if uh if the highlevel board uh kpi is reducing um let's say reducing inpatient mortality that's the high level kpi and you've got reams of data um to to analyze and to drive performance Improvement what is it that actually is important to the Frontline staff what is the kpi that they're thinking about is it you know rounding is it you know executive you know executive rounding is it you know sepsis bundle compliance so you've got to translate that highlevel board kpi or executive kPa down to something that's tangible and and influenceable by Frontline staff and oftentimes what we F what we found is is that if if you if you think of that in one you know that that whole Continuum you can get really really scared because it's like boiling the ocean how do I go from there to there and so we often focus in really small Sprints and we'll say we'll do a small Sprint around um sepsis bundle compliance that's translatable to the nursing staff in the ICU it's a couple of weeks of you know intense activity and not only does that drive a meaningful change that's palpable to the organization and to the Frontline staff it starts to develop muscle memory in performance Improvement um and it's it's it's we we almost we often refer to it as teaching somebody how to fish right you do these rapid cycle um Sprints and the project management and the um processes to do that is transl able to a congest a heart failure project or to readmission and so it's those sort of things I think building that muscle memory then actually then allow you to engage Frontline staff but then drive towards those larger organizational goals that are important from an executive from a board standpoint does that does that make sense it does but I I have a question because I I know that some of the nursing staff might hear this and I've discussed similar topics they're going to say I don't have time to do these sprints my my team doesn't have time to do them it's too much right uh so can you just talk a little bit about the scale of the Sprints and then how organizations with with Staffing challenges or that are using these contractors which might not be as invested in the the organization as a whole to do these these Sprint activities right um I know in uh you know um it's not Six Sigma it's the other one that that programmers use uh that involves Sprints and uh and whatnot right it requires a lot of Buy in so I guess that's the issue is how do you get this Buy in from everyone on the team yeah I think probably the key is one having an internal Champion somebody who is really invested in making that happen and that somebody needs to be um I think translatable to the Frontline staff it's probably not going to be the CEO it's probably going to be a you know a shi supervisor or a nurse manager uh in the unit and you also have have to make it make sense to their workflow the minute you start to throw something on technology or anything in somebody's workflow that doesn't that adds more work and doesn't um provide any other value it's going to be doomed uh for failure and the other is and you know was maybe a Shameless push for Consultants but you know people that can roll up their sleeves next to that staff and at help with some of the obviously not the patient care comp component but help with some of the nonv value added component to that Sprint to be able to take the weight off of the Frontline staff once you start getting results and and people see those results they actually become super engaged in doing the work and that's one that was actually my my next question was at What stages in these processes of implementation um are you guys involved with right because we know some Consulting agencies they come in at the the very top to the CEO and their their you know committee there they give their suggestions and then they leave and then others are involved much longer and that goes back to that question where some of the clinical staff they get a little upset with Consultants because they make these decisions without actually sticking around to see what happens or or help them through it so can you just you know tell us a little bit about where you're involved yeah yes so we're certainly involved at the high level in setting the high level strategy and Direction but we're a performance improvement company from an advisory standpoint and from a technology standpoint so we we view that as a partnership um and so we really do become that partner um you know aligning beside you know if you if an organization already has a good performance Improvement structure we just align with that from a project management standpoint from a subject matter expertise and we you know our engagements are usually long-term engagements I mean several of the engagements that um that we're doing right now are five or sixy year uh engagements where we almost become part of that staff uh in a way um we obviously are always preparing for um that that staff for the time where we're not going to be there any longer through tools and processes and leave behinds and that sort of thing um but we're about implementation and it doesn't do us any good to come in and have highle recommendations and not have a plan for implementation that either an organization feels they can do themselves or that we can line line up aside and actually help as well nice that is excellent um really appreciate that a lot and then now we're going a little bit over time but I have a personal kind of question that's changing gears a bit and it it comes to the situation of mergers and Acquisitions I'm a big lay you know lay person in the space don't know a lot about even though I'm an NBA candidate haven't gotten to those courses yet uh and so part of the question is it almost seems like at least in the area that I'm in in unless you're a large institution almost like a large multi-state institution you're not going to be able to survive in the next five or ten years is that true and if not why why isn't it true what are you seeing yeah I mean I think that it is a it's a fair statement and it's been a and it's been a statement that's been around for a while and and I remember early on in my phys executive um years there was a statement that said I think in in five years and this was probably 10 years ago in five years we're going to the healthcare is going to be probably five or six large healthc care companies of you know multi-state health systems that hasn't come to provision for a variety of reasons but there is benefit to economies of scale there is benefit to size from an overarching um you know decreasing waste and back office and all of that sort of stuff um so smaller independent organizations are at a disadvantage and many as I said before are looking for partners what's really interesting is is that if you look at the literature around mergers and Acquisitions what looks really good on paper from a economies of scale and synergies standpoint is really hard to actually see and from an execution standpoint and because on paper it says oh yeah well we're you know we're merging five Health five hospitals together we've got five HR departments we've got five it Departments of course it makes sense on paper when I look at the performer that we're going to consolidate to one and we're going to have the abilities to you know decrease cost and drive cost out of the system it almost never turns out that way in reality because you got people right and you've got culture and you've got all of those sort of things and so um some of the the synergies and benefits that have been touted from emerges and acquisition standpoint have not actually panned out to the degree that people have thought they W they they would which is why I think we don't have five large healthc care companies nationally but um but I think we're going to see in this space more consolidation especially uh around distressed assets organizations that because of the pandemic because of financial challenges because of the workforce related things are having financial difficulty and and and but are really important to their Community both as an employer and as a provider of care and these consolidations I think will help in those areas</p>