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Speaker 1: Hello, everyone. Welcome to the Becker's Healthcare Podcast. I'm Scott King, thrilled today to be joined by a very special guest, Tony Keck, chief transformation officer with Ballad Health. Tony, how are you? Thanks so much for joining us.

Speaker 2: I'm doing well. I really appreciate the the invitation to talk.

Speaker 1: Of course. You know, we're gonna need your expertise on on a lot of topics here. Always a lot going on in health care, but especially now. But before we do that, Tony, I was wondering if you could please just tell us a little bit about yourself and your, you know, your journey in in health care.

Speaker 2: Jerry, you mentioned, my my chief transformation officer title. That that's just a couple weeks old. I, I now have responsibility for strategy and analytics and IT and digital services and operational excellence and project management and our research department. That's a big change from, just a few weeks ago when I was our chief population health officer at our growth group, also had behavioral health. But, you know, every few years in Ballad Health, we switch around executive responsibilities.

It's a succession planning exercise, which gets us exposed, you know, to the entire organization, but it also brings new blood, new ideas into different parts of the the system. So, been with Ballad Health since its inception, was with one of its predecessor groups, Mountain States Health Alliance, for three or four years before that. And prior to that, I was in government for about seven years working for Bobby Jindal and Nikki Haley. So, I I've been really honored to be able to work with communities for a long time.

Speaker 1: You don't really hear about a lot of providers or or health systems doing that. Is that right? They're just, like, switching up the, executive responsibilities every now and then?

Speaker 2: Yeah. We we put a lot of time into succession planning because we we know it's a tough business that, increasingly, you need to have a lot of specialization, but at the same time, you have to have a broad view of what's what's going on in the world. And so if if you're looking at the trends that affect, health systems, you gotta under be able to understand and work in the government space, the payer relations space. You have to understand strategy. Increasingly, you really have to, be able to operate in the IT space as a leader.

So unless you're getting exposure to all of those, we we just don't think it's, it it it's possible to to develop a leadership team over time that's sustainable, not just for five or ten years, but for thirty, forty, fifty years.

Speaker 1: Yeah. I I think it's so interesting and so great that, you know, everyone, when they switch, kinda understands or gets a sense for what everyone else has been doing and what it takes to keep the system going. So I think that's wonderful. And now let let me ask you about trends in health care. Which ones are you paying attention to right now, Tony?

Speaker 2: Well, I I hate to start out with probably the answer of the day, but certainly AI and and cybersecurity. I think they probably go hand in hand. You know, we wanna be able to focus on AI as a tool to improve our clinical outcomes and patient experience, but I think we will be just as busy fending off the bad actor threats that AI is, increasingly make making possible. You know, separately from that, we have to be able to keep up with the payers' use of AI that goes beyond what we think is reasonable to control fraud, waste, and abuse. In that sense, we're really, in many cases, also the patient's advocate because, you know, many of these payer decisions increasingly being made with with AI impact patient health and and what they ultimately pay.

I think, more more broadly, affordability. You know, I've been around long enough to have seen several major shifts in payment and practice starting with DRGs. That's how I got my start in health care. And we're in the middle of, I think, one of these big shifts right now. But no matter how much technology and and how many payment incentives and how many legislative programs we seem to throw at health care, it's still outgrowing the ability of many families to to pay for it.

And it sort of feels like a big Jenga tower right now. And it's a you you know, and the problem is it's a zero sum game. We try to save money in one sector by shifting it to another sector, and and that just doesn't work, or it hasn't worked. It doesn't reduce cost to consumer ultimately, and maybe we just need to to start start over.

Speaker 1: What are you most focused on and excited about right now in health care?

Speaker 2: Well, you know, going forward, I'm really am excited about what what AI is gonna be able to bring bring to the to the table. And so, you know, in my previous population health role, we were focused on one of our North Star goals, which is to reduce the years of potential life lost in our community. And, you know, that's a statistic that's tracked worldwide and in The United States county by county. And it it basically is a a measure of early death. And not surprisingly in the Appalachian Highlands, we have more early death than in most of the rest of the rest of the country.

And and so, so we got a goal to to reduce a 100,000 years of early life lost over the, the next next decade. So, to do that, we we've been really doubling down on the things that we do well and then trying to do do more of that. And so a good example is screenings. We do a pretty good job of screenings right now. But if we can go the extra mile and, you know, increase our screening rates by five, ten, fifteen percent, we know that we're gonna save lives.

We've made a heavy investment in smoking cessation, You know, COPD, pulmonary disease, lung disease is it's a it's a big deal in this region. One, because we have really high smoking rates, two, because, of black lung from from the coal mining industry. And so we've been putting a lot of investment into catching lung disease early, helping, prevent it, and we're really seeing that gain a lot of traction. So, you know, I'm I'm excited about what, AI is gonna continue to bring to the table to be able to to better do all that. And it's not just AI.

It's it's really some of the new biotechnologies that are coming out and so on. I mean, we're really at a, I think, a pivotal point where, we we finally have the technology to do a better job, a more personalized job, getting down to the genetic level, in improving people's health. And so that's a, you know, that's a huge sea change. And, I think you're starting to see some of it with, GLP ones. That's you know, most of our admissions are due to heart disease, or some aspect of it.

And, you know, you trace that back to obesity and diabetes and so on. And, by fundamentally changing that through GOP ones, from a population health perspective, it it it it could be as as big of an intervention as we've ever made in public health. So that's, I think, I think pretty exciting. You know, something I'm proud of that we've done in in this organization is we we've really improved our balance sheet over the years and our operational efficiency. But at the same time, we've been making these really heavy investments in in not only access, which lots of people are doing.

You see, you know, cranes in the sky in almost every major city around the country. We don't have major cities. We have small cities, but we're still, investing in access. We just built a brand new, addition onto our children's hospital. Our our NICU programs expanded and modernized.

We're expanding our ED at our level one trauma center where we just added new beds to one of our hospitals that was, you know, full to the top. That's all great, but we're also investing in sort of going beyond beds and thinking about being a true community health improvement organization. And so the major investments we've made in behavioral health moving from a hospital based program to a community based program, has has been, I think, really impactful. We've invested lots of money in in our nurses, and and, you know, our turnover is now the lowest that it's ever been. We're reaching out to people who are most vulnerable and enrolling them in, care programs that have shown, three to four return times return on investment, in terms of, the the money that we spend on on uninsured folks who, frequently visit the ED, and we've gotten ninety 1% of them connected with primary care on a regular basis.

So it's a win win for everybody. So those are some of the things that we've really been working on, and we're just gonna build on them in the future going forward.

Speaker 1: What are some of the things that that helped yield that kind of growth, Tony, where you can help there's so much expansion and and so many more patients can be helped now.

Speaker 2: Well, I think the the the merger between, Wellmont and Mountain States was a big contributor to that. We had a lot of unnecessary duplication in the region. We had hospitals that were two to three miles apart that were 20 to 30% full, losing, tens of millions of dollars a year, that just went out the door and didn't benefit patients at all. And and by eliminating that wasteful duplication, we were able to take those dollars and reinvest them in these programs. By the time we get through the first ten years of our merger, we'll have invested well over 300,000,000 of incremental dollars in, in these new new programs that, again, go beyond putting heads in heads in beds.

I think, we've also done a lot of, work just generally becoming more efficient. We are a Medicare breakeven organization. A lot of organizations around the country set that as a goal many years ago, but very, very few have actually been able to attain it, and and we have. We have to be because we we're reimbursed less than almost every region in the in the country from Medicare and other payers, and so we have to be incredibly efficient. And and we are, and so, again, when, when you're able to to build on, that efficiency, you're able to potentially invest some of it in in, some of these these new ideas and new new services.

Speaker 1: Absolutely. And, Tony, the last question I have for you, how have you evolved as a leader, and what advice would you give to to leaders that are evolving now?

Speaker 2: Well, I always look at myself, you know, ten years in the past and think, man, you just did not know what you thought, you know, back then. Right? So it it never it never it never stops. And, I, I just took an AI course with my my son at the University of Michigan. Both of us took it together because he's at the beginning of his career.

And I said, you know what? AI might be threatening your career, path as a, you know, a a sort of a young professional. And and me as a, you know, an older professional, I need to keep up with what's going on. So we both took that course. And I think being lifelong learner and making it fun, is is really critical.

I, you know, I work with a lot of students from the University of Michigan, and and the East Tennessee State University School of Public Health and, mentor quite a quite a few of them. And one of the things that I, am always, I'm full of all sorts of advice, but, one of the things that I'm always strongly suggesting is is that they get experience actually laying hands on people. You know, there's there's plenty of times as a as a management student or administrative student in health management, public health to get experience going to meetings and doing spreadsheets and all that stuff. But but working as a CNA, a transporter, community health worker, EMT, even even in volunteer roles is really an incredible is incredibly important to understanding the constant stress and uncertainty that's present, not only in our patients' lives, but but our our team members' lives. And so I I say that, you know, for that group, but it extends it extends to all of us as as professionals regardless of when we're in our career.

We're putting a lot of effort internally into management rounding, into starting, every meeting with a mission moment, and system wide tiered system wide tiered safety huddles, where they start on the units, you know, early in the morning. And by 09:00, in in the morning, it reaches the executive level about what's going on in every single unit, in in the system that potentially is a safety issue. So those are all things that keep us really close to the work. And I think, it's easy as a manager with everything that's going on being constantly attacked, you know, under payment changes from the federal government, from the payers, cyber threats. I mean, all the things.

It easy to get distracted from what's really happening on the ground with the people that are are basically generating all the outcomes for you. And, so that's probably one of the most important pieces of advice I can give is just to be consistent about that.

Speaker 1: Absolutely. And, look, that's fantastic advice. Really appreciate you sharing that with Evolving Leaders, and thanks for sharing all your insight with us on the podcast. It was a great conversation. I look forward to working with you again soon.

Speaker 2: Thanks for the time.