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- This is Laura Zido with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Dr.
Pam Oliver, chief Medical Officer at Novant Health.
Dr. Oliver, it's a pleasure
to have you on the podcast today.
- Well, thank you for having me, Laura.
- Now I know we have a lot to talk about,
and I'm excited to really discuss further Novans News Center
for Public Policy Solutions.
But before we dive into that discussion,
can you tell me a little bit more
about yourself and your background?
- Sure. Um, I am Pam Oliver.
I'm Executive Vice President
and Chief Medical Officer at Novant Health.
I'm an OB GYN physician, um, by training at heart.
I should probably leave with that.
Um, we are a not-for-profit integrated health system in
North Carolina and South Carolina with 19 medical centers,
um, more than 850 locations across our network.
Over 2000 physicians, um,
and about as many as match practice, um, providers
who are caring for our communities in the Southeast.
Um, as Chief Medical Officer, I now have the, uh,
responsibility and take great pride and our safety
and quality, um, health equity across our organization,
medical education, including our graduate medical, um,
education programs, clinical research, um,
and that drives me as a woman of color, a physician driving
outcomes for our communities, uh, in a holistic
and a comprehensive approach is, um, really what my team do.
Um, and so, you know, I have a platform that I don't take
for granted, you know, in my role.
Um, and try to make sure I think that, that I leverage that
for good, which is why I really appreciate you, um,
having me here today.
- Uh, the pleasure is all ours.
Now, uh, from your perspective,
could you tell us about novo's New Center
for Public Policy Solutions?
Why did you launch it and what are your you focused on?
- So, Novan Health has been on a journey for many years to,
um, address several things related
to the care our teams provide.
One of those was, um, addressing burnout,
and another was tackling, being real tactical in
how we think about what is getting in the way
of our teams doing the good care
that we already know that they do.
So we've been on a journey of listening
and engaging, um, our physicians, our nurses
and advanced practice providers, to really appreciate
what it is that gets in the way of us delivering,
of having the best impact we can have
for the great care we already know that we deliver.
So we put together the Navan Health Center
for Public Policy Solutions in 2023 as an extension
of some work that we had already undertaken, um,
and wanted this to really be about developing actionable
policy with patients and clinicians at the center.
So right now, across our organization
and almost every organization, we are facing burnout related
to just the load of what gets in the way of,
of physician being able to take care
of the patient in front of them.
And so our goal with this was we'd done a lot
of work already to remove barriers
and to do what we feel like we could do.
We saw a lot of work that was being done.
We were listening to our clinicians,
and this was our way to really think about how
to bring together those thought partners,
those really smart people who are experts and understand
and appreciate every aspect
of the challenges that they're facing.
Put those smart minds together, help us
to identify the highest priority areas
where we can have real impact.
And when we have impact, it will not just affect
and benefit Novan Health,
but it will benefit all those across the country.
And so pulling together the Center
for Public Policy Solutions was a way for us to get
beyond some of the macroeconomic challenges
and weeping reforms that get caught up
and have maybe less of a chance of, of success,
and to get into the weeds, identify very specific solutions,
drive real change,
and see an impact during the careers of the physicians
that are facing these challenges today.
- That's amazing to hear.
And you know, what a, a really cool philosophy
to have in terms of being able to affect real change, um,
in the moment in being able to tackle those things
that can be dealt with, um, over, as you mentioned,
that kind of timeframe, um, within a physician's career,
or the time that there was no one to be able to, um,
really see the results.
That's so cool. Um, what are some
of the big healthcare policy
challenges that you're seeing right now?
- Oh, the, the, the one that we're targeting right now,
and one that is core to the challenges that we have
as physicians is overregulation.
Um, we go to school, we learn all the best medicines.
We believe in best practices.
We see patients,
and there are so many things that get in the way
of us being able to just take care of that patient.
And when, when we look at the studies nationwide
and they say two and three scary, that two
and three physicians and one in two nurses
report experience and burnout.
And it's not because of the, the care we're delivering, the,
the actual practice of medicine, it is
because of all the other stuff that's getting in the way.
And a lot of that is driven by policies, regulations, rules
that physicians have to jump through hoops to be able to do
what we know our patients need
and what is best practice for our patients.
So when we started, we've been on a journey for many,
many years to, as we looked at burnout
and we put together programs to address burnout affecting,
like looking at the both internal, what can I do
as a physician myself being present, working on, you know,
my my own, what I can control.
And what we really started getting into these external
factors that affect burnout.
And this falls into that external, as an organization,
we identified, we had a project called Getting Rid
of Stupid Stuff that some
organizations have done across the country.
And we, we looked at, we asked our doctors,
what are the things that you feel are just stupid
that are getting in the way that, um,
that block bog you down in a day,
take you away from patient care?
And we addressed hundreds of those over the course
of the first year even.
And we continue it year over year, removing clicks,
removing popups that don't drive value, um,
simplifying, um, workflows and,
and optimizing our, um, electronic health record.
And we did that. And that was
to take our doctors from the norm of spending two hours
for every one hour, two hours, documenting
and charting for every one hour patient care,
which is insane that that's the balance now that nationally
to reducing that time.
So we drove as much as we could.
And what we realized is sometimes we would send out a,
you a, a notification that to our teams
that now this is a new requirement or you need to do X or Y
and we started putting a y behind it.
Why are you being asked to do this?
And we need, need it to be clear.
Is this something that we as a system have chosen to,
to ask you to do?
Or is it something that someone else, a payer,
the government, um, the state is saying
that we now have to do?
And it was eye-opening
because it really helped us to see the amount of
external influence on the workload of our clinicians.
And so we set up a clinician, um, uh,
clinical partner engagement team, educating our doctors on
what are the, what is happening in the policy world.
We started engaging them more writing letters
to get feedback to CMS to the state, inviting them
to be active advocates.
And so as we pull those poly solutions together,
and we started talking about the biggest cha one of the, one
of the biggest challenges right now,
what they see in taking care of patients in front of them,
the overregulation topic that rose to the top was the idea
that when we see patients for a specific type of visit,
specifically a preventative visit, that um,
we are limited in what we can provide to
that patient without that patient having, um, to pay more.
And it then becomes a,
almost like the physicians in the middle is a
confrontational, um, situation that develops.
So the Affordable Care Act requires that insurers
cover annual checkups, annual preventative exams,
that those are visits in our world that are in the, in the,
um, insurers world that are designed to be, um, coming in
to get checked out, um,
and just do the routine preventative things
that is different than a po a problem visit
when we see patients.
And a lot of patients don't speak that language.
They don't understand, and I don't think the payers do a
great job of informing them
of the nuances of their coverage.
They see this as a free visit regardless.
So when the physician and when they have problems
and our teams do the right thing
and we address those problems at the time,
the patient then incurs a separate bill
where they actually have to pay something
and it leads to lots of anger.
And, um, the patients are, are, are upset
with their physicians and,
and their, their anger is directed to the wrong people.
'cause this contract is with their payer
and this is driven by the payers
or the government in some ways.
And we just, we need that to change.
We need to be able to take care of our patients
and do what we need to do.
And we would do the same thing for them if they came back
for a problem visit, it would be the same.
It's just that the pa we are not,
we are either prohibited from doing it without
applying the charge or we're asked to do it
and not charge so that we don't upset the patient.
And that's not fair to our physicians either to not be that,
to not value the time, the energy they're doing it,
or to be put in a situation where we ignore something
for a patient or, or have to have them come back knowing
that that might impact the outcome.
So overregulation the multiple rules that vary
by insurer, but this specific topic of, for our, uh,
especially our primary care physicians rose to the top
as something that if we can move the needle on,
they really felt would benefit them from an, um,
from a career burnout perspective.
- Well, that's fascinating to hear
and certainly, you know,
as you were describing this whole situation, um, I,
I can imagine extremely frustrating for the physicians
as well as patients and trying to figure out how to manage,
um, all of the, the different rules
and regulations from different payers, I'm sure as well.
Um, obviously you outlined a few
of the steps you've been taking,
but, um, how have you seen any of the response
or have you been able to move the needle at all, um,
within some of your conversations
with payers in, in that regard?
Or, um, is it still a work in progress?
- It's definitely still a work in progress.
Uh, we expect that some of this will take, you know, time
because there are so many parties that are involved, right?
There's, there are levers that the government obviously can,
um, pull to influence payers in this space.
Uh, individual payers may be willing to partner, um, and,
and, and make these changes.
There's not a, there may not necessarily be a single
solution that, or, you know, swipe
of a pen solves it for us.
Day one. Um, we put together, we did a white paper, um,
on this subject and released that, um, in the fall
with the input of our physicians
and our, um, leadership teams.
Um, and so we still are very much early in this,
but continuing the advocacy for, um, pulling in those,
like continuing to engage our physicians
and more, I will tell you that has had an impact that, um,
I don't want to understate is physicians feeling seen
and heard and knowing
that we are advocating on their part is priceless.
- Absolutely. That makes a lot of sense.
You know, and it's great that you've been able to, uh, fill
that space and fill that voice
and give them a platform in order to really, um,
make a difference, um, within the patients
that they're working with as well
as just the healthcare system overall.
And I'm curious too, when you look at, you know,
what you've been able to do at Novant Health
and, um, how health systems across the board are,
are really dealing with many of the same challenges.
What opportunities are there for those health systems
to really influence legislation
and public policy in the future?
- I think we have, um, there's, there's,
there's huge potential there.
And, um, it's really about starting with just listening
to all of all health systems, while we have similar
overarching challenges, um, have a unique opportunity to
use those experts that we work with
and partner with every day to inform us on
what the challenges are and to truly listen.
We bandaid and we, we fix things
and try to make it work within this complex kind of,
you know, I don't wanna say it's broken,
but really challenging system that we all, um, work with
and listening and, and, and, right, um, raising those voices
and pushing that forward so
that it becomes not just Novant Health who is identifying
and challenging and seeking solutions,
but there is a sea of, there are c it's a sea of voices that
all can sing and inform about these challenges.
I think that that is, that could be incredibly powerful.
Um, I do think that the more like our, our,
the more our clinical teams have an opportunity to engage
with lawmakers, um,
and that's across any health system, the better.
Um, that I've often found myself when, when
advising or speaking with, um, members of Congress
or state legislators, um, they're open and willing to listen
and don't always appreciate
or know some of these nuances and challenges.
So as, as health systems, we have both the ability to
and the duty to pull in our teams to do the best we can
to inform those who are setting these policies, having an,
um, have an opportunity to change these policies over time.
And we truly believe that our organization
will be a great resource, um, as timely policy,
timely policy changes, um, are on the horizon
and other health systems will follow suit.
- Well, Dr. Oliver, thank you so much
for joining us on the podcast today.
This has been such a fun and informative conversation
and I look forward to connecting with you again soon.
- Well, I look forward to updating you
as we can see progress from the great work we're doing
and I appreciate you having me, Laura.