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- This is Laura Dedo with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Bob Callway,
the president and Chief Executive Officer
of New England Life Care.
Bob, it's a pleasure to have you on the podcast today.
- Thank you, Laura. Thanks for having me.
- Now, I know we've got a lot to talk about.
There's so much happening right now in healthcare
and certainly just some really fascinating, um,
things you're doing there at New England Life Care.
But before we dive into my questions,
can you tell us a little bit more
about yourself and your background?
- Yeah, sure. Let me tell you both about me
and a little bit about my company,
because we're a little bit different than the, uh,
than the typical healthcare organization.
So, um, as you mentioned, I serve as the president
and CEO of New England Life Care.
Uh, my background, I was originally trained
as a medical laboratory technologist
and worked in acute care laboratories for a number
of years early in my career.
Uh, but most of my background,
I hold advanced degrees in healthcare
administration and in public health.
Uh, and most of my background has been in, uh,
large academic medical centers
and physician group practices.
And most recently
before joining New England Life Care, uh, I worked
with Atrias Healthcare,
which is a very large physician practice here in, uh,
eastern Massachusetts.
Um, and one of the first participates in the, uh,
pioneer Accountable Care organization, uh, which is, uh,
where I spent most of my time, uh, working with
and developing programs
to perform favorably in an accountable care organization.
And that's in part what drew me here
to New England Life Care and for New England Life Care.
Um, as I say, we're a unique organization.
Uh, we are organized as a, not-for-Profit
Hospital Services Cooperative, um, under Section 5 0 1 E
of the IRS tax code.
Um, and what that means in practical terms is that, uh,
we provide a designated service, in this case it's, uh,
home infusion services, uh, to, uh, not-for-profit hospitals
that are members of the cooperative.
And today there are 70 hospital members, uh,
in the cooperative located in Massachusetts, Maine,
New Hampshire, and Vermont.
Um, and, uh, an interesting feature of the cooperative is
that the member hospitals actually
own New England Life Care.
So we serve, if you will, as the infusion department, uh,
for the 70 hospitals that, uh, that we represent.
And internally, I maintain 70 profit
and loss statements for all of the hospitals
that are a member, member of the cooperative.
So, uh, very interesting structure, uh,
but in providing a really important services
to the not-for-profit hospitals located
in the region that we serve.
- That's amazing to hear,
and definitely, you know, a very big responsibility
to be serving that community in such a, a large area
of diverse population as well.
From your perspective, what are some
of your top priorities right now?
What are you really spending most of your time on?
- Yeah, it great question.
Um, you know, we, we conducted, um, in the last few weeks,
um, our town hall meetings where we bring together all
of our staff who are spread all over New England, uh,
to update them on what's going on with the business
and what are our priorities at the moment.
Um, and in that we shared with folks that, um,
we had hoped coming out of the pandemic
that things would settle down a little bit.
Um, but in fact, the opposite is true
that the market is changing so quickly both
after effects of the pandemic,
but just changes in the marketplace
that it's really caused us to take a step back
and reevaluate our strategic plans, um, over the course
of the next couple of years,
and in fact, shorten our strategic horizon
because the market is changing quickly enough
and new threats are emerging fast enough
that it's really shortened our, our, um, our visibility.
Um, so the things that we're working directly on now are the
things that frankly, many
of our member hospitals are dealing with today.
So first and probably foremost is the shortage
of qualified labor, um,
to support the healthcare organizations.
You know, lots
and lots of people left healthcare during the pandemic.
The pipeline of replacement staff isn't adequate
to support the needs of the marketplace.
Uh, and we've got a large, uh, population
of healthcare workers who are approaching retirement.
So we're innovating strategies around how do we continue
to grow the organization in an environment that where,
where there will simply not be enough staff
to facilitate that growth.
And that's taken on a number of different strategies.
So that's sort of number one.
The second is really a focus on driving
interoperability and starting to deploy newer technologies
that have come out in the marketplace,
and particularly in the last six months or so.
Uh, and particularly starting to deploy
artificial intelligence and robotic process automation
into our workflows, frankly, as a strategy
to support the fact that there aren't enough staff available
to do the work and grow the organization.
So part of our strategy around dealing
with staff shortages is working to make sure
that we provide the tools that allow our staff to be as
efficient as they possibly can
and allow taking kind of the mundane work out of the work
that they do and allowing them to work at the higher end
of their licenses or their capabilities.
So that's been a big change as well.
Um, but I would also reflect it as both a curse
and a blessing because while the drive
for interoperability is really critical, both to kind
of support the organization
and to develop a patient-centric approach in managing care,
um, the flip side to that is the rapidly increasing
incidents of cyber attacks.
Uh, we were a victim of a cyber attack earlier this year,
and thankfully we're able to respond to it quickly.
Uh, but a lot of time
and effort has to go into protecting our information systems
and keeping ahead of what is a burgeoning crisis in terms
of, uh, the, the ability for, uh, threat actors to be able
to invade systems that we use to care for our patients.
Um, and then lastly, a big focus for us, particularly
as a not-for-profit, um, is operating profitably.
So, you know, we've seen both in an inflationary economy,
but also as a result of sort
of ongoing supply chain disruptions, both in terms of
supplies, but also in pharmaceuticals,
relatively rapid increases in the prices for, um,
for the products that we purchase
and that we use in patient care.
Uh, and, and candidly, uh,
third party payer reimbursement is
not keeping pace with that.
So this, we find this eroding our margins together
with higher labor costs
and needing to look at ways to make sure we can continue
to generate sufficient margins to support the operations
of the business and continue to grow.
- Absolutely. I think that's fascinating and,
and certainly a lot of the issues that you touched on, um,
are top of mind for healthcare executives across the board.
Certainly when you're looking at the
labor shortages and challenges.
Um, love to hear, you know, working on some of the AI RPA
and, and other digital transformation aspects
that can boost the workforce.
And then, um, the supply chain disruptions too,
it just seems like, you know,
or continue a one-two punch of yeah, really just trying,
trying to hospital financials and trying to figure that out.
Um, you know, when you look at all those things,
obviously bringing technology and can make a big difference,
but how do you incorporate that into the broader culture
of the organization and making sure people, um, you know,
are, are working to the top of their abilities,
but then also comfortable with the, um,
digital transformation strategy?
- Yeah, well, I think it's a great question.
Uh, I sort of express that in terms of, um,
our strategies
or our tactics for dealing with, um, staffing shortages.
Um, and we've really got kind of five approaches, one
of which speaks directly to the question you're asking.
So number one is that we, we recognize that we have
to be much more innovative in recruiting
for the limited staff that are available in the marketplace.
And part of that requires us
to make the organization an attractive one
for healthcare professionals to want to join, right?
So, um, you'll hear threaded through these strategies,
the goal of what we refer to as creating allies
with our employees, right?
Embedding them and engaging them actively, um, in
how the business is run.
Um, creating an environment where people feel connected
to the purpose, where their voices matter
and where they feel connected with, uh,
where the business is going and how we're gonna get there.
Um, that will in fact,
I think ultimately also make it an attractive place
for people to wanna come to work.
Um, that gets to the second piece,
which is really focusing on staff retention,
keeping the good staff that we have.
Um, and that gets back to what I was just talking about
around ke keeping people connected, having them feel a sense
of purpose and commitment
and engagement with the organization, uh,
that their voice matters
and that, that their folks listening to their points
of view on how the business should re run.
But there's also a big focus on our part around
preserving staff wellness
and identifying, reducing the signs of burnout,
which we're really endemic during the the covid period.
Um, you know, third for us is improving the efficiency
and the productivity of the staff we have,
and that's where I mentioned starting to apply things like,
uh, artificial intelligence and robotic process automation
and, and frankly, modern information system.
So we'll be going through, uh, an upgrade
of our electronic medical record in the next 18 months
to provide a more ma modern platform that allows us
to better, better digitize our, our systems.
Um, and in AI
and RPA, we've applied it in a couple of places already.
So, um, we were able to, uh,
to use robotic process automation
to basically digitize order entry coming into our
organization, uh, which had an enormous benefit.
So historically, our orders came to us generally by fax, um,
but were sometimes available through hospital's use
of post-acute, uh, discharge software.
Um, but all of that was ultimately converted to paper
that our staff then end up having
to reenter into our electronic medical record.
And you can just imagine both the, the labor requirements
to do that and the degree of error that comes
with anyone trying to transpose information from, you know,
a written document into an electronic record.
So we actually use robotic process automation
to receive those incoming faxes, digitize the results,
and load it automatically into our
electronic medical record.
So we eliminate all of that manual data entry.
Uh, we're applying that in some, in a number
of areas also within our billing operations.
And again, the goal here is trying
to identify the mundane parts of the work that all
of our staff do, whether professional staff
or administrative staff,
and remove that use technology to support that.
So to your question about staff acceptance of that, um,
there, you know, kind of two pieces to this.
One is staff view it as incredibly valuable, right?
We're looking for small wins here to show
how the application
of this technology can make their work lives better,
because no one wants to have to do all of that mundane work.
Uh, staff wanna be using kind of a higher level of judgment
and capability in the work that they, uh, that they do.
So we're seeing acceptance there from that point of view,
um, and two,
by actively engaging our staff in utilization of the software.
So we were really clear as we went into this,
we're not developing this, this software to replace anybody.
This, this is not gonna eliminate jobs.
Um, what it will do though is turn the trajectory
that will require us to have less labor as we continue
to grow, um,
and it's labor working at, at a higher level
of competency and capability.
Um, so that's where our AI models come in.
And then, you know, we're also looking at
alternative staffing models.
Uh, you know, given
that there aren't enough infusion nurses, for example,
to be able to support the healthcare marketplace, starting
to look at places where, um, other kinds
of staff can do the work that
infusion nurses are, are not available to.
So for example, here in Massachusetts, we're now using, um,
LPNs to do IV line management.
It's within their scope of practice.
Um, and instead of having to deploy expensive, uh,
infusion nurses to do that, so again,
it's using the right folks at the right end of their scope
of practice and their capabilities.
Um, and then lastly, we're really starting to look at
how we develop staff, right?
And this will include training programs designed
to create a clin, a pathway within the organization
that allows staff to stay here, develop new skills,
and move into increasing levels of, of, um,
of capability within the organization.
So we are looking at training, for example,
our own pharmacy technicians so
that they can work in the clean room taking folks without
having that experience
and actually building the training programs here.
So multifaceted in terms of how we're gonna accomplish that,
uh, and all rely on one another.
But the essence to this, in, in the answer again
to your question is you can't be successful in doing this
unless you're engaging staff at every level to know
what you're trying to accomplish as an organization
and them feeling a part
and engagement in achieving those goals.
- Absolutely. That makes a ton of, of sense,
and I, I really love it.
Um, love that strategy there.
Now, looking into the future,
how do you see New England life care
evolving over the next few years?
What do you see as accelerating and changing over time?
- Yeah, that's a great question too.
Um, and you know,
my answer would've been different if you had asked me that
during the, uh, during the pandemic,
but one of the things that we saw, um, really prior
to the pandemic and,
and sort of on steroids, if you will, during the pandemic,
was, um, more migration of care out
of acute care settings and into the home.
And where that really got wheels, if you will,
during the pandemic is, you know, one was CMSs, um,
expansion of the hospital without laws
or the hospital at home programs
and providing reimbursement for those programs that, um,
you know, that created just a waterfall of organizations now
that are implementing their own hospital at home programs,
bringing care into the home.
Uh, that was sort of one, uh, one op uh, one, uh, feature,
uh, of the pandemic.
Um, you know, organizations were realizing that a lot
of the care that is provided in acute care settings can be
provided in the home, and we're simply lacking a
reimbursement mechanism for that.
Um, and we're also now seeing in large part,
to compete favorably in accountable care programs.
Uh, more and more programs aimed at trying
to avoid patients going into acute care settings
or being unnecessarily hospitalized for services
that could be provided in the home.
And home infusion is a big part of that,
because it's not uncommon that patients go
to the emergency room to get a line installed
to start their antibiotic treatment, for example,
and then get admitted for
that when in fact those services could be
provided equally well and equally safely in the home.
So we expect that expansion's gonna continue.
Uh, you see it in, in a number of the disruptors that are,
that are moving into the marketplace.
You look at places like Amazon and Optum
and uh, so forth
that are really focused on both the pre acute
and the post-acute settings, recognizing
that more care is gonna be happening in the home.
So for us, that means both a, a a, you know,
significant growth in the services that we provide, uh,
but it also means that, uh, we've gotta think about
how we do di things differently, right?
Because, for example, providing home infusion
for a hospital home patient, uh, is the same as we've done
for many years for a, you know, a patient
that has been discharged from an acute care setting.
The difference here is the turnaround time.
These are hospitalized patients,
so you've gotta build your operation that allows you
to prepare compounded medication
and infusion supplies in a requi
relatively quick turnaround.
So that's a big change for our organization is trying
to keep up with that, uh, with that pace of change.
Um, I think the other thing we expect to see is that, again,
the, the, um, pandemic taught us that many more therapies
that we always assumed could only be
provided in acute care settings, um,
can in fact now be done in home, in the home.
So, you know, you're seeing in the marketplace, for example,
more movement of, um, cancer treatment
for patients in the home, including some types
of chemotherapy now
provided in the home, um, that's supplemented by another,
um, uh, service that emerged during the pandemic,
which is the application of telemedicine
and patient telemonitoring.
Uh, right. And that emerged very quickly out of necessity
during the pandemic, but that's gonna survive now,
that will sort of be the platform that allows us
to provide more services
to the patient in the home environment.
So, big impact for us, as we're, I mentioned at the outset,
that the market is changing really quickly for us,
and it's those areas where we're really starting
to see the pace of change, um, just moving very,
very quickly and many competitors,
mo including not-for-profit competitors, um,
and big tech moving into this area to try
to capture a piece of the pie.
- Absolutely. That's such a great point.
And, you know, so interesting to think about how that pace
of change has really made a difference, um, you know,
over the past couple years.
And certainly one of the things you mentioned at the top
of our conversation too, is there being new threats as,
as part of the reason why you're needing to, um, shorten
that strategic horizon
and looking at, you know, um, what's happening there.
And so I was wondering, you know, is
that typically looking at some
of these non-traditional healthcare entrants or,
or what other threats do you really see as arising now that,
you know, may not have been there
or part of that strategic process before the pandemic?
- Yeah, it's a great question,
and you're right that, you know, all of this environment,
um, has really shortened our strategic horizon
where we typically would've looked out two
to three years in our strategic planning.
You know, it's, right now it's impossible
to look at the market and determine where it's gonna be
and what the threats will be three years from now, uh,
which has kind of shortened that up.
Um, but the, you know, we, we see as the principle threats,
the, so I mentioned, um, really a rapid invasion, um,
into the, particularly the post-acute in the home
marketplace, um, uh, again, by very large organizations.
So, you know, you're seeing entrants around things like,
you know, Amazon, Google, uh, Optum, um, most recently,
um, you may have seen that Costco has announced
that they're entering the primary care market
and they're gonna be offering telemedicine and,
and pri uh, uh, primary care services through their,
uh, big box stores.
Um, that's a momentum that's underway.
And, um, the, the, the reality is that part of this is
recognizing the patient centricity to care
that these are organizations that are very much focused on
what do patients want.
And, you know, the marketplace is changing quickly, right?
We're now seeing, um, the majority
of the population in the United States at least,
or Gen Xers, gen Ys, and they have very different, uh, needs
and wants, uh, in the healthcare marketplace.
They want immediate access, they want immediate contact,
they don't wanna wait in line,
and they don't wanna wait six months to get services.
Um, and if you can't provide them as an organization,
they're gonna go somewhere else.
Um, so a lot of folks entering the market to try to be able
to build on that desire
that you're seeing coming from the, uh, population.
Um, so we're looking at that both in terms of
how do we deploy, how do we deploy technology to, to try
to mimic that and meet that demand in our, in our members,
but it's also gonna require some association
with these organizations to really start
to build partnerships to figure out how to do that,
uh, collectively.
Because, you know, if you're not doing it as part
of a partnership, you're going to lose that part of your,
uh, your care healthcare spectrum.
- Absolutely. I, I love that.
And, you know, really sets a, a really strong kind of, uh,
vision in motion for how you're able to tackle some
of these big challenges and leverage partnerships
and connections creatively, um, within the industry to,
to really deliver care and make sure people
have access to care too.
Um, I love that.
Before we wrap up our conversation,
I'm wondering if you could talk through what is something
that you or your teams have done differently
that has really made some great results?
- Yeah. Um, well, I mentioned one already, um, which was,
um, our first effort in applying, um,
robotic process automation to improve the efficiency
and the timeliness of order entry and processing.
Uh, that was a huge success for us.
So, um, we allocate, you know, roughly four to five
FTEs a day within our organization, uh, simply, uh,
taking orders and entering them into our electronic medical
record and an untold number of errors that come
with just anybody entering information
or transposing information.
Uh, so the application of RPA,
there was an enormous success for us, right?
It really took a huge demand off of the staff that manage
that and dramatically reduce the, the number of errors
that we see with the input of
what is frankly, critical data, right?
No one wants to put a, a, um, an order in incorrectly
'cause that can result in direct patient harm.
So that was a big success both in terms
of improving the efficiency and productivity of our staff.
Uh, this was by the way, a staff driven initiative.
So the suggestion came from one of our staff to look at this
as a, as a model.
So, um, it accomplished our goals
around engaging our staff in, in moving this forward,
but it also accomplished the goal of ensuring
that we keep our patients safe
and provide good, effective safe care for them.
So that was certainly one area.
Uh, the other, uh, um, option I would,
or the other, uh, project that we're working on that not
yet complete, but I have very high hopes for, um, is
where in the latter stages of a trial using
artificial intelligence and natural language processing
as the front end for patients calling into our organization.
Um, specifically one type of patient where,
which is on a therapy called TPN,
it's a nutritional, uh, therapy.
Uh, and often this requires a lot of management
with these patients, uh, to make sure
that they are not getting readmitted back to the hospital.
So we're using a front end ai, um, uh,
avatar if you will, to receive incoming patient calls,
answer the standard questions that are roughly 80% of the,
of the, um, calls that come in,
and then triage those calls that can't be answered over
to a registered nurse who
before was answering all of these calls.
Uh, so, uh, we've had some really interesting
and really good acceptance by patients in the trials, um,
to using this model.
And, um, if it's successful here, we expect to deploy
that in a number of different areas
where our organization comes into contact with patients
around the patient service interface.
Uh, and that has promise for, uh, enormous cost savings,
uh, and value.
Because, you know, one of the values
of AI here is it's learning, right?
The more data I'm giving it, the more it's learning how
to respond to even the unique questions that,
uh, patients have.
So it's a really exciting time, um,
to be rolling things out like that.
And we have very high hopes
that this is gonna be a big win for us.
- Absolutely. That sounds amazing.
And, and those results really speak for themselves.
Bob, thank you so much for joining us on the podcast today.
This has been such a fun and interesting conversation,
and I look forward to connecting with you again soon.
- It's my pleasure. Again, thank you for having me.
- It's so important for leaders at the top of organizations
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