This week in Health IT tuesday news Day Bill Russell
August 4, 2020

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August 4, 2020: Four months into corporate America’s working from home experiment, some cracks are emerging. Are people getting tired of it? Is it likely to affect career development? Plus exclusive insights from top executives weighing in on healthcare budget cuts. Walmart as a healthcare company, is it your competitor or ally? If you wanted to disrupt our health system, what would you do? And what can we do right now to ensure good workplace culture exists?

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News Day – WFH Fatigue – Walmart Healthcare Partner or Competitor

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News Day – WFH Fatigue – Walmart Healthcare Partner or Competitor

Episode 285: Transcript – August 4, 2020

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

[00:00:00] Bill Russell: Welcome to This Week in Health IT. It’s Tuesday news day where we look at the news, which will impact health IT. Today, we take a look at work from home fatigue, executives weigh in on healthcare budget cuts. Walmart as a healthcare company. I just thought I would drive that point home once again, actually there’s a handful of stories that linked together around that. So we’re going to take a look at that. 

My name is Bill Russell, healthcare CIO, coach. And creator of This Week in Health IT, a set of podcasts, videos and [00:00:30] collaboration events dedicated to developing the next generation of health leaders. This episode, every episode, since we started the COVID-19 series has been sponsored by Sirius healthcare.

Now we’re exiting the series and Sirius have stepped up to be a weekly sponsor of the show through the end of the year. Special thanks to Sirius for supporting the show’s efforts during the crisis and beyond. Clip notes is available if you can’t listen to every show, but you want to know who was on the show and what was said, sign up for clip notes.

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If you haven’t signed up for three extracts yet you’re missing out text [00:01:30] Drex D R E X to four eight four eight four eight and receive three texts every week with stories that will help you stay current. It helps me to prepare for the show. This is a service of Drex DeFord. A frequent contributor of the show.

Two changes you can expect this fall in the show. I just wanted to make you guys aware of this. we have a company page on LinkedIn. If you can go over to LinkedIn and look for This Week in Health IT we have that page. You’re going to want to follow that page. I personally have about 8,000 followers on LinkedIn.

So I’ve been doing [00:02:00] the show posts on my personal LinkedIn, and we got together as a team and decided. That we didn’t want to do that anymore. If you want the updates from the show, go to the show website or go to the show, a LinkedIn page, hit follow, and you’ll get all the normal, the clips, the quotes, the show information, from there, I’m going to be commenting on stuff that’s going on.

So my LinkedIn profile will be more interacting with the content that’s out on LinkedIn, as opposed to promoting the show. So a [00:02:30] great way to stay current, go over there. And follow the show. If you want to stay current on the stuff I’m doing and follow me, you can do that as well. The second change is a little more nuanced, but I’m going to be extending my shows a little bit this fall.

So, this is based on feedback in every direction. The guests feel like we have more to talk about, the listeners, you guys have told me that you would like more depth from the episodes that you choose to listen to. And I’ve personally found that I talk with everyone for probably about [00:03:00] 40 to 45 minutes.

Meaning you only get to hear about 20 to 25 minutes of the conversation, but I ended up talking to people for another 20 minutes and this will give me more time to have a natural conversation with people. Feedback is always welcome. Send me a note [email protected] All right, let’s get to the news.

Well, I have 20 some odd stories here. You can tell. I took a week off. Let’s see. Oh, let’s just get started to see how far we get. The first story wall street journal. So work from home. We’ve been doing this now for a little [00:03:30] while and it says, the title for this wall street journal story is Four months into corporate America’s working from home experiment, some cracks are emerging. Okay. So a few companies expect remote work to go away in the near near term though. The evolving thinking among many CEOs reflects a significant shift from the early days of the pandemic. Okay. I like the way these stories are written.

There’s a bunch of little stories here that sort illustrated, an executive from Canon [00:04:00] talks about the fact that they employ 15,000 people, their US headquarters in Melville, New York. houses about 11,000 of those people on a 52 acre campus with a couple of lakes. And, they have since, allowed their employees start returning voluntarily.

Now there’s a check in process and make sure they’re well, and there’s, you know, procedures they’ve put in place, but interestingly enough, 50%. Have chosen to return voluntarily, to their campus. And I think [00:04:30] that’s a, that’s an interesting stat and something to keep in mind. I think, if you pro work from home person, I think sometimes we get into that mindset that everybody wants to work from home, and that is not necessarily the case.

Well, there’s another story here. Let’s see CompuCom, which is a division of Office Depot. It’s a corporate reseller of technology and equipment to enterprise clients so more companies now envision a hybrid future. And so they talk about the hybrid future. And I think it’s interesting cause they give this concept of office [00:05:00] hours much the same way that you have office hours for a professor in college, or in a college campus.

They have office hours that we might go to that kind of model. And I’ve heard that from some CEO’s. If we’ve been talking about that, through the, through the pandemic. A final story they have here is I think another point that’s worth making this one’s from Stifel Nicolaus of Stifel Financial Corp, they’ve been renamed, the toll of extended work from home arrangements is likely to affect career development. particularly for younger [00:05:30] workers. Several executives said which employee comp kind of employs about 8,000 people. or I’m sorry employs about 8,000 people. I am concerned. The executive goes on to say, I am concerned that we would somehow believe that we can basically take kids from college, put them in front of Zoom and think three years from now, they’ll be every bit as productive as they could have been if they had personal interaction.

Okay. So, and it goes on to talk about what they have done. What’s the, so what of this story? You know, when I was a [00:06:00] CIO and a lot of you do this, you do this exceptionally well. I’m going to just tell you my story. And some of you do this a lot better than I did, but we had a team whose role was as ambassadors for certain parts of the organization.

They weren’t elected or anything like that, but they, they really were like the mayor of a group and their job was to go out and keep their finger on the pulse of what was going on. within the organization and to bring feedback to the, to the it executive team so that we can continue to evolve the co culture and do things, you know, change, the [00:06:30] work environment.

We set up a workout facility in our location. We set up an area with tables where people can work on puzzles, which, you know, sounds kind of interesting when you hear about it at first. And I was sort of skeptical when we started doing it. And then I would see people sitting around, you know, over their break building puzzles and they were talking, you know, they were, they were coming up with ideas.

They were sharing ideas and things. They were excited about it. It ended up being a really cool collaborative. [00:07:00] area for us. So, you know, as I said, most of you already do this well, but I wonder if you’ve taken the time to update those practices post COVID. Right. So we had a monthly breakfast with the CIO, which was a smaller setting for people to ask me questions.

And I’m wondering, you know, are we still doing this, you know, culture doesn’t just happen and it never stays the same. my theory is that culture is either progressing in a positive direction or a negative direction. The leader’s job is to intentionally make sure. that we’re taking steps to keep it moving in a positive [00:07:30] direction, regardless of the work situation that is sort of thrust upon us.

Right. I think the other thing is that that last comment of education and career progression are also extremely important, especially to this next generation. And I think we need to be intentional about this. We need to be thinking about getting people, the opportunities to grow and shine, and I guess, My, so what is just a reminder that that is what our job is as leaders is to make sure that that culture keeps progressing.

All right. Let’s I’m gonna hit the Walmart [00:08:00] stuff. All right. So there’s really two stories here, and then I’m going to link a couple of others, but, the first one is a CNBC article, Walmart to open six health clinics in Atlanta area by the end of 2020. And this seems like a Groundhog day. Kind of article, but I’m going to hit it, hit it anyway, because I think it’s extremely relevant.

And then there’s a story from David Chou. He wrote an article out on LinkedIn called healthcare providers must get creative and cocreate with the big box retailers. All right. So let’s start with the [00:08:30] CNBC story. A Walmart confirmed a CNBC that’s open six additional stores. We know that, the big box retailer announced this week that they will enter the Florida market next year.

And the company is hiring employees, focused on finding ways to get more customers through the door and turn the clinics into profitable and scalable businesses. Okay. So that’s going to bring the total number of Walmart clinics to 13 by the end of 2021. And some of you are probably thinking, wow, this is such a non-story 13 clinics.

What’s the big deal? And I think you’re missing the [00:09:00] point. This is, this is how innovators prove out their business model. And once it works, then you’re going to see those frightening headlines that you fear, which is, you know, Walmart to open a hundred new Walmart clinics in market X, Y, and Z, or a market near you.

Right. So here’s some more from this article. Walmart has already the largest private sector employer and the largest grocer in the US but it’s looking to become a major healthcare player as well. The clinics, as we’ve talked about before, have [00:09:30] a bunch of services, right? So primary care dental x-ray, hearing services, mental health counseling, optometry, and obviously they still have the pharmacy in the Walmarts themselves.

So a lot of services there. And they’re also looking to differentiate themselves from Amazon with a thing called Walmart Plus, I’m not going to go into that too much. You know, again, they’re just standing these things up standalone clinics, prove the model and then they’ll grow them.

So David Chou of that article [00:10:00] essentially wrote something and he challenges us as CIOs to consider partnerships with big box retailers. And he’s right in that we should always be looking for strategic win-win partnerships. Right. And, you know, as a case, in point, I’ve talked about Best Buy and this, and he talks about best buy.

And I think it’s a great example of an organization that has really a natural connection, the health systems, as we move into the home and need to wire up the technology though, and you know, there’s going to be [00:10:30] a aging in place. There’s going to be a whole bunch of technology that we want to get into the home.

Not only that, we have workers that are now working at it home. And, and you know, that geek squad is really well positioned. To go into the home, set up technology, make it work for our staff, as well as our potential patients. But, but you know, before we go off really half baked on this, we really have to put on our business hats for, for just one second.

Right. We have to know what we bring to the table. I’m [00:11:00] not going to get on the phone and call, you know, the NFL and say, Hey, I’d like to do a co-sponsorship agreement with, this week in health it and the super bowl. Because I really bring no value to the NFL. I don’t bring any clients to the NFL. And, I just there’s, there’s no real, partnership.

The key metric is who influences the customer buying decision or the value, the cost over quality equation of the service. Right? It’s easy to assume that we have that, that health systems have acute services and [00:11:30] they need acute services. Cause they’re not going to do that. Therefore we have a match.

But the calculus for each of these partnerships is very different. and you may want to identify Walmart either as a competitor, as somebody you’re going to cooperate with, coopetition, whatever the word is there. it’s a made up word to begin with. So whatever the competitor, or partner, if you will, it really depends on what you bring to the table and who you think has the most influence in the buyer’s behavior.

[00:12:00] But I want to make this case. You know, Walmart is payer, they’re setting up  an insurance product that they’re going to take out to their, customers. Walmart’s also creating a one stop shop for a range of services that we just talked about, which includes some of the profitable services from healthcare and I think by definition would make someone who’s taking profitable revenue from us as a competitor. They’re going to do care navigation and utilize their, and I’ve heard this talk many times from, [00:12:30] the, the Walmart people, right? Talk about the database of information they have. They’re the largest employer they’ve been sending their employees to, various physician groups and physicians and health systems around the country for many years.

And they have a great. a read on which providers are the most customer centric, which ones provide the best care. What’s the best cost and the quality equation. They have that information. So they’re going to utilize that to really do care navigation with that [00:13:00] database, right? And they’re going to guide their customers to the highest quality, lowest cost and most customer friendly experience.

And you may want to position yourself as a place. They send their customers to but, but know this, that the point you become a supplier of acute services to women, Walmart, you know, Walmart got to be Walmart because they’re masters at managing the supply chain. If they own the customers, they will control the customer experience and you we’ll play by their [00:13:30] rules either way.

I would put Walmart in one of the competitor categories. Even if they refer patients to you, you may want to start building out, the sepcific experience for your customers. And the one that they’re looking for, an easy to understand insurance product, transparent pricing model, that values the patient’s time, more than a physicians, high quality healthcare, and affordable costs with an ever improving, not only physical experience, but also a digital experience.

Right? So, And, you know, again, I [00:14:00] think this is something I would keep a very close eye on. If I were you, in healthcare today, what is Walmart doing and where are they going with this? All right. I’m going to drive this point home a little bit, drive the point home a little bit more. the next article is really a shout out to Ed Marks who’s been a guest on the show and he wrote an article on LinkedIn called “Disintermediation of hospitals begin”. And I, you know, it’s, it’s a fantastic article. I’m gonna encourage you. I’m not going to cover it in detail. [00:14:30] I’m going to encourage you to go out there, find it on LinkedIn, disintermediation of it. hospitals begins. he starts off with, in the classic and time-tested predictable formula. Retail and payers are aggressively disrupting at the core level of health care today. Primary care is the battlefield. And we’ve talked about that on the show. That is absolutely true. Why is primary care of the battlefield?

It’s because that’s where the customer relationship lies for healthcare and all these, all these players are trying to get in between [00:15:00] right there, actually take over primary care there. And then they’ve established that they’re the point of relationship. And if they’re the point of relationship. Then they can direct care in the best way for the consumer, but also in the best way for them and not necessarily for the best way for the healthcare provider.

Just say the primary care foundation is quickly shifting from the hospital to payer, retail, and virtual, without primary care foundation to direct patients and secure contracts. Unprepared hospitals will wobble. [00:15:30] New entrance will work their way up the value chain from this basis. Surviving hospitals will become centers of excellence and compete nationally for patients at the direction of retail and payers, payers, and retail direct care, a role reversal in one generation.

Initially stealth-like experimenting with their own large employer base. The invasion has begun to open that whole paragraph could essentially become from that story right before it, right. That, that is Walmart. That is the Walmart [00:16:00] story. That’s what they’re doing. And they’re not the only ones. As we know a remaining hospitals will specialize in high acuity care.

Hospital chains will centralize everything from operations to clinical care via digital command centers. There will be no urgent care. There will be limited primary care. And he goes on to the next section is titled digital is no longer a differentiation. It is survival. So I’m going to point you to the story.

You’re going to want to check it out. And it goes into detail and offer some quick hits. On what can be [00:16:30] done here? it is really thought provoking piece and I believe it’s a it’s spot on, you know, so what’s my, so what, if I were in a system that isn’t, isn’t really talking about digital or asset light, reducing debt and competing for the customer mind share, I would, I would be concerned and I’m going to try to be pragmatic here.

Cause I’ve seen this, this exercise really work. there’s a question that we use sometimes to get people, to start thinking in a disruptive way and throw this question out the next time you’re having a [00:17:00] conversation with him. Exactly. and the question is put them in the other role. So they now work for your health system, put them in the other role and say, if you going to disrupt our health system, what would you do?

It’s a great question. I’ve seen it used several times. The team gets all ramped up. They, they really enjoy the process of being the underdog and they come up with about six ways to disrupt the health system. and then when they, when they get done and you, you, you grabbed those six things. You might want to remind them that every one of those, those [00:17:30] ideas that they just came up with are probably already in motion.

And well-funded by disruptors. And it might be time for your organization to start thinking like a disruptor. And I found that question to be a really good one, really thought provoking. Sometimes people do it and they sit back and they go, Oh gosh, this is, it’s not that hard. As hard as I think it is. We don’t have our mode is not as big as I think it is before people get to our, you know, the castle wall, if you will.

Alright, so. [00:18:00] piggybacking on one of Drex’s points from last week that, M and A has started in earnest. there’s another story out this week, Huntington hospital signs an agreement with Cedar Sinai. I’m not going to go into the article, that’s it? I mean, Huntington hospital signs an agreement with Cedars.

Yeah, I’m, I’m just letting you know that it has, has begun, Drex covered a story last week in Seattle. There’s a story out of LA. This isn’t a small deal either. Huntington runs as a standalone hospital, it has a significant presence in LA County. [00:18:30] It covers the Pasadena area. It’s one of the primary providers in that market.

I think there are well over a billion. This is a great move by Cedars and one that further consolidates their market. And I know what you’re thinking. I can hear it now. I can hear the questions. Wait a minute. Aren’t you saying that we need to disrupt the big business of healthcare just a minute ago, and now you’re saying, Hey, this M&A has started and it’s a great move for Cedars.

Yes, I did. But I also think that, you know, health systems should play to their [00:19:00] strengths. the other thing is, I think you need to, when one of the concepts I was introduced to in healthcare was essentially reality. And it’s essentially a market share kind of metric, right? Essentially reality is a great equalizer in healthcare.

We had a market where we had 70% market share of all the healthcare spend in that market. Well, if there was a blip in any direction, we were sort of insulated cause we were getting 70% of that market either way. We were the dominant player. [00:19:30] And, you know, I’m sort of saying that this is a great move for Cedars, because if anyone can we get to about 35% market share in LA County, they’re going to be insulated from a lot of the factors that are coming after healthcare.

Essentially reality is a great equalizer. but you know, not only that Cedars is also a destination medical center, they’re also an innovation hub. they really have it all going on, but I think the most important thing is to get. Direct relationships with as many customers and potential patients as you [00:20:00] possibly can.

And this move accomplishes that goal. All right, let’s see. All right. This is going to be the final story. Final story is a Turkish group. I don’t know how I got this. Somebody sent it to me. It’s a great, It’s a great piece. Chartis group did a survey and it’s a, the title of the PDF is health system and financial recovery survey finds a challenging balancing act.

So I’ve told you on this show that we’re in the midst of two crisis right now, we’re the pandemic and the [00:20:30] subsequent financial crisis, which followed our, our actions. As we stepped into the public health void, you know, it was expensive and it took time to recover and Chartis went out and interviewed a whole bunch of executives, which was great. Let me pull this thing up. Otherwise it’s gonna be hard to talk about without looking at it. There we go. health systems and financial recovery survey finds a balancing act. So here’s some of the key metrics that they found as they talked to these healthcare executives.

[00:21:00] 85% of health system executives surveyed identified cost reduction is one of their top three priorities. All right. That’s probably not a huge surprise. 90% of the respondents aim to meet their cost reduction targets in less than 12 months, 90%, less than 12 months. That’s aggressive. Alright, so let’s delve into this a little bit.

So key findings cost reduction is critical to recovering from the initial shutdown and mitigating future uncertainties. So one of the things that you’re saying is essentially that a volume retail after a loan will not be [00:21:30] assisted sufficient to return to prior levels of liquidity. Okay. So they think it’s going to take a little while, at least about 12 months to return to those, those, same volumes that we were looking at.

And they say, it’s not going to be enough. We’re going to need to pursue other cost reduction strategies, in parallel to strengthened the balance sheet. next thing they intend to reduce their expense base by more than 10%. Which is what I’m hearing in the industry. I’ve got some, some of my coaching clients are coming in [00:22:00] at five to 10% and actually that’s pretty much the norm for my coaching clients, but there are others that are looking at 10 to 15%.

We’ll get to that in a minute. I’m about 90% into cheese of cost, and less than 12 months, we talked about it earlier and now a successful execution. And I think that’s, worth taking a look at we’ll dive into that a little bit. So the volume recapture alone. So let’s see. Let’s just say it was a March timeframe.

We were talking about how long the COVID impact would hit the [00:22:30] volumes for healthcare. And, back then, back in March, I said about 18 months and that would put it at six months, past March, around September of 2021, to have return. So here we are in July and pretty much 80. 90 90% of the people are essentially saying by July of next year, we’re going to return to a, the same volumes about 38%.

Think it’s going to be about 12 [00:23:00] months, 33%. Think it will be within the next six months and 21% think it will be within one month. And I would, you know, again, that essential reality thing, I think plays a role here. You might be able to get back. To the same volume levels given what’s going on in your market.

Let’s take a look at the cost reduction targets. So there’s five categories while they’re all right. There’s four categories. The fifth category is unsure. There’s 3% of the people that aren’t sure what target they’re going to set for our cost reduction strategy. And I would [00:23:30] call them laggards and, potential MNA candidates candidates.

At this point, if you can’t make a decision FS, it’s not like this is snuck up on us. We’ve known about this since. Late, fall of last year. And, we had a good idea of how it was going to impact us financially probably by, May. So May June, July, you’ve had three months to figure out what your target is.

It’s a little slow if you’re not sure, but the good news is 90. Some odd percent are shore and it’s a classic bell curve, right? One to 5%, 14, [00:24:00] 14% of the organizations or executives are interviewed. I think one, 5% cuts, 38% are at five to 10, a 36% are at 10 to 15 and 9% are at 15 to 20. So classic bell curve for those kinds of reductions.

And that’s what I’m hearing in the industry as well. so, that’s pretty, pretty. accurate. So cost reduction strategies. So they listed six cost reduction strategies [00:24:30] and they vary from 50% saying we’re going to do that to down to 26%, the highest one being streamlined management structures. there’s been some, title bloat, within healthcare.

That’s not a shock to anyone, but it also exists  within health IT. You may want to start asking the question if you could do with or without one chief or without one VP, which one would it be? that’s what they mean by streamlined management structures. rationalized clinical programs. We were doing this, I don’t know, decade ago.

I would [00:25:00] assume that this is going to only increase in, in its velocity, rationalizing clinical programs across the, health health system. I reduce fixed asset base. This directly impacts health. It. we are a significant contributor to the fixed asset base. I had a conversation today about operating versus capital.

I think, our, our appetite for capital w well, it’s insatiable for that. I mean, the appetite is insatiable, but I think our access to capital, [00:25:30] I was going to go down as a result of COVID and I think more and more of the it operation, it’s going to be an operating. A budget, not only because of the move to cloud, which operationalizes a lot of that budget.

but because I think the CFOs want to see it there. Right? It’s more manageable if it’s in that, in that category of operations, plus the, it doesn’t matter. You’re going to depreciate it eventually and that’s real dollars that you’re depreciating it again. next one, optimized informatics and technology that is directly related to a health.

It, [00:26:00] and that’s just a, an acknowledgement that we are not as optimized as we could be. In those spaces, a restructure provider enterprise is the fifth category. And then the second develop a corporate services model. okay. How quickly are you aiming to meet your targets? Six to 12 months. 55% within six months, 36%.

So there’s, you’re a majority of organizations are thinking this way, very short term financial focus. Okay. if you sell into healthcare and one of the things I’ve [00:26:30] been telling vendor partners, Is a really tight ROI models, crisp tight ROI bottles. Think about one year return. What are you going to give back in a year?

If you’re trying to sell a big capital intensive, a big bang type project, this is going to be a tough year. I think there’s going to be a lot of, financial scrutiny within health. It, there’s gonna be a lot of M and a work. I think there’s going to be a bunch of contracting work. To be honest with you.

One of the odd. Paradox [00:27:00] is that as you go into these things, when you’re not able to our employees, when there’s a hiring freeze, the number of contractors actually does go up and, I don’t know. Well, actually, there’s a lot of reasons for that. I’m not going to go into them. Here’s the, and I thought this was, and this is the last thing we’ll cover.

Internal factors may delay or derail execution while organization simultaneously managed tool systems. Of care and potential COVID-19 surgery. So these are the factors with the greatest potential to delay or derail a successful execution. I, number one, [00:27:30] managed future COVID-19 surges, right? So this is smart.

we, we don’t know where this is going to go. There could be another, pullback from elective surgeries, which would, Significantly impact the financial outlook for health systems. We’re going to have to see how this gets managed in some of the places that are surging right now. And if they pull back and if they have to pull back, you know, do they have the capacity to handle that?

43% of the executives are saying, Hey, that’s a, that’s a significant concern. So let’s just hit the rest of them real quick. [00:28:00] we have a lack of resources, bandwidth to manage implementation. A lot of organizations have furloughed employees or even made some of those furloughs permanent. And so there’s a concern.

Do we have the staff to continue to do the, the level of projects that we have? This is why I continue. To, to encourage health it executives to, look at platforms that require less maintenance that require less handholding. you know, [00:28:30] when you, when you are looking at a new technology platform, one of the biggest costs you should always consider is labor.

And this is one of the challenges I have with an Epic implementation is that the labor costs on it alone is extremely high, especially for a small health system. and, and it’s just required. I mean, if you, if you want to be on honor roll, if you want to be, you know, copacetic with, with Epic, you have to have that staff.

And I’m not saying you don’t need that staff to run Epic. I’m just saying if you’re running Meditech, [00:29:00] that numbers half, it just is. and I, I can back it up because I, I lived it. So, and I’m living it on both sides. I have clients that have Epic. And I have, and I’ve run a extremely large, a Meditech shop in the United States.

So, so anyway, consider the labor costs, find platforms that, you know, look for creative deals. We’re gonna, we’re going to have some of these, interviews over the next couple of months. with some, some organizations that are offering some [00:29:30] creative solutions. And I think it’s a, I think it’s a, that’s what we need to be looking at, going into next year, a lengthy multilevel.

Okay. Decision making process, 20% think that’ll derail it. That just means we make decisions too. It takes us too long and too convoluted, competing priorities. And, we struggle to keep our priorities aligned, poor data or lack of information to support decision making and monitoring. A lack of alignment with strategic priorities, engaging providers as part of the solution.

[00:30:00] So these are the things that could derail, any projects that we, you know, that we come up with to reduce our costs. you know, I think that’s sobering this, the, so what on this is, you’re not alone. I’m telling you what you already know. There’s going to be a cost pressure on healthcare for the next, at least 12, 12 months for most health systems, you’re going to see some health systems.

You know, show a profit HTA just showed a profit, but if you dig into those numbers, you’re going to realize that they had a, you know, a 10 to 12% reduction in [00:30:30] their overall volumes. the profit really came from cost reductions and it came from, it came from the government money, quite frankly, $500 million goes a long way in, writing the ship.

So that’s where their profit came from. I think that’s going to be true across the board. you know, your, your healthier systems are going to be able to show a profit with that government money. some of the, less healthy systems are going to struggle. Operational excellence, will show itself in the next 12 months.

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