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This is Laura Dirda with the Becker's Healthcare
podcast. I'm thrilled today to be joined by
doctor David Marcozzi,
chief clinical officer of the University of Maryland
Medical Center and associate dean of clinical affairs
at the University of Maryland School of Medicine.
Doctor Marcozzi, it's a pleasure to have you
on the podcast today. Laura, thanks for thanks
for asking me to be part of this.
Absolutely. Now I'm excited for our conversation because
I know things are changing so quickly in
the health care space, and I'm excited to
learn more about some of the things you're
doing at the University of Maryland. But before
we dive in, can you tell me a
little bit more about yourself and the health
system?
Sure. Well, as the chief clinical officer for
the flagship
academic medical center within our system,
I work in partnership
with our dyad my strongest dyad partner, our
CNO, doctor Karen Doyle, on many portfolios
that include clinical strategy,
operations,
quality, safety,
graduate medical education,
credentialing prefer of our providers,
and candidly, physician alignment and care transformations
across two campuses in our we have the
medical center comprises two campuses and two in
those campuses, there are two hospitals.
So the work that I do services,
for the for our flagship is one as
one of the largest and most complex academic
medical centers in the region. It delivers care
to some of the highest acuity patients in
the nation per Visient's q and a quality
and accountability ranking.
And my role
bridges strategy and execution, partnering with physicians, nurses,
operations, and analytics
to translate organizational priorities into reliable, high quality
care at the bedside.
The medical center includes about 800 beds downtown
and a 140 beds at Midtown. Those are
the two campuses with over 1,200 attending physicians
and close to 900 residents and fellows.
We deliver highly specialized high acuity care spanning
trauma, cancer, neurosciences,
transplant, and more,
and all of our physicians are faculty within
the University of Maryland School of Medicine,
tightly linking education discovery and care.
We've got a high some high rankings, including
our academic flagship scores very highly in the
Visiant quality and accountability ranking in comparison to
other academic medical centers.
We've scored some of our specialties high on
US News and World Report,
and we're also very proud of our four
time magnet designation,
which is really among some very small percentage
of hospitals across our nation for nursing excellence.
So, Laura, a lot going on at the
medical center, and thrilled to talk to you
today.
Well, that's amazing to hear. And and what
a broad enterprise that, you have on Maryland.
It is amazing to see all the different
elements coming together and really truly serving the
community in a strong way. Now when you
think about the last year or so, could
you tell us about an initiative that you
led? What did you do, and what were
the results?
Yeah. You know, I'm gonna ask for some
latitude. I'm gonna speak on not just one,
but two. Our medical center is really focused
on the highest delivery and the highest quality
and the safest care, And we we started
to implement a conceptual framework called HRO, high
reliability
organization,
and really made it part of the fabric
of how we deliver care,
and made it essential to how we think
about day to day practice. And that meant
standardizing how leaders engage
with safety data,
responding to events rapidly,
and escalating risk in accordance with our protocols
and policies.
This the we embedded the five principles of
HRO into executive routines,
unit level governance,
and frontline workflows. So it went from the
bedside to the boardroom.
Practically, this included restructuring leadership safety reviews,
clarifying escalation cascades,
reinforcing just culture expectations, and holding dyads and
triads. The The triads
are nurse practitioners or PAs on units
accountable for consistent safety behaviors at the unit
and service levels.
And this really anchored was anchored in a
in a rollout that we were doing across
our system, something called continuous learning for improvement,
and that is education and applied
using
application strategies at the unit level and understanding
lean lean strategies
or,
or performance improvement,
educational training opportunities
to be applicable at the line at the
unit so we can have the greatest impact
of where the work is done.
The our results for HRO have been meaningful,
and but we all know HRO is a
never ending,
effort. So we saw improvement in our safety
reporting.
We have,
tangible examples of improved relationships between our dyads
and triads and understanding what their priorities are,
broader understanding of the data and more consistent
leadership at the unit level, and then finally,
very clear ownership of safety issues and faster
escalation and resolution of risks.
The la the second thing I'll talk to
is about the work around access to the
academic
health system.
This was a really major focus for our
system and is particularly relevant for patients requiring
highly specialized
time sensitive care.
As we are all experienced across our nation,
really a supply and demand mismatch
for health care demand,
versus the the the supply that we have
to provide that care. So we took that
challenge head on by innovating how we move
patients through the system
to provide earlier access to academic level care
with a specific focus on round trip transfers
that enabled greater access
to care
without the constraint of an inpatient bed.
And, really, over the past year, the medical
center has managed hundreds of round trip transfers
for a high acuity,
high acuity care across our system.
This was done through clear standards
engaged to our physicians
in how we're gonna do this. So there's
clear expectations set.
Really, we needed to improve our systemness, and
we have very disciplined
operational oversight.
And of the 70 of of all of
our requests that were that were made to
the medical center, 70% of those requests
for round trips were successfully completed. Some of
them, the other 30%, some of them were
not needed. Some of them we managed via
telehealth.
So we're really trying to think about a
systematic way to get access to high acuity
care that our medical center can provide, but
not limited
by bed capacity.
And this has improved flow across our University
of Maryland system
and region, and it puts what we feel
is that it puts care at the right
location at the right time for our patients.
So that's just two efforts that we've embarked
on. We've embarked on a lot of efforts,
but those are two I wanna highlight today,
Laura.
Well, that's amazing to hear. You know, both
are impressive in terms of looking at the
scale that it takes
to, really have some of the those changes
on the clinical workforce team, make sure they've
got the right,
structure in place for safety, reinforcing that culture,
and bringing them all together for high reliability
organization. And then secondly, looking at the things
that you were talking about in terms of
making sure expanding access to care, managing transfers,
and and doing things a little bit differently.
The results are impressive. I think in both
cases, it seems like it took some change
not only from the,
process and and procedure side, but also I'm
sure from the culture side and how, you
know, the the,
clinicians were approaching their work. So how do
you do some of that change management with
the broader teams and just make sure that
everyone is on the same page and and
doing the right things?
Yeah. Clarity of expectations and roles was really
one of those key fundamentals
of who owns this,
what is the work that needs to get
done, how do we support that work to
assure that the data is is understood,
and then drive
what I like the term I like to
use quite often in many meetings that we
have
is decisive collaboration.
So in academia and certainly academic medical centers,
we we sometimes wonder who's making the decision,
how is the decision made, and the process
for that decision.
And what we all have started to anchor
on is we we embrace a who is
the lead for this decision,
how are we collaborating to make that decision,
but we will make a decision to move
forward in a and and allow us to
continue to evolve, and we're not paralyzed by
indecision.
And that was really one of the things.
And then when we put on that the
priority of HRO,
it was much clear understood from a structure
standpoint
how we're gonna make decisions and who's making
them. From a process standpoint, a prioritization standpoint,
what the process and the priority was, HRO
and highest quality.
And then the outcomes we're seeing throughout our
hospital of folks understanding and escalating concerns,
and it's having really a broad impact to
patient care across our medical center.
That's amazing to hear. Thank you so much
for digging a bit deeper there. Now looking
ahead,
what are some of the big priorities and
headwinds you're focused on for 2026?
Yeah. Laura,
Maryland is quietly doing what the rest of
the country continues
to think about,
and we are using what's called the Maryland
model, a waiver that was granted by the
federal government, CMS,
to support a statewide health care global payment
and accountability
system for our state's health care. And that
has substantively
shifted volume to value, and it has better
aligned
hospitals with physicians and communities.
And the emphasis for this Maryland model has
been around keeping people healthy,
and assuring
that our quality is the highest within our
state. And lastly,
our the Maryland model has demonstrated also it
is starting to bend the cost curve, and
Maryland continues to push that envelope forward. And
in partnership with our federal government,
we are we're gonna be soon,
to innovate further than what we've done historically
in the Maryland model and adopt
the all pair evolution of the ahead model.
For more than a decade, our state has
demonstrated it is possible to control health care
costs
while improving quality and addressing population health outcomes.
And that's a result that we feel as
though many states and federal partners now view
as a blueprint
for national reform.
The upcoming ahead model, I'll just quickly speak
to that because a lot a lot of
folks know about it, but our state is
certainly embedded,
in executing this successfully. The upcoming ahead model
builds on the foundation of that Maryland model
that I spoke to around total cost of
care
by providing and expanding the accountability beyond hospitals
to total cost of care,
quality, and equity across defined populations.
It now makes even greater emphasis on prevention,
care coordination,
and appropriate utilization where that utilization
is best
served by the patient and the care providers.
And finally, it holds systems accountable for those
outcomes
that extend far beyond simply the hospital walls.
So really, Maryland is innovating. We realize ahead
is a new frontier for us. It our
Maryland model continues to evolve, and we think
we serve as a potential,
beacon for how we can shape health care
delivery across our nation. So what's that mean
for our our medical center?
We're continuing to evolve how we deliver care.
In fact, it's an imperative.
Tighter clinical integration,
stronger partnerships across
the continuum of care from the outpatient side
to the inpatient side and then back to
our outpatient community.
We really need to double down on how
we're thinking through patient flow.
And lastly,
we have we we have to have a
disciplined approach
to limiting
care variation, so standardizing care models, clinical practice
guidelines, putting those in place. I'm not gonna
didn't make any it's it's the the financial
pressures are real. Workforce fatigue continues.
Rising acuity, as I mentioned, the medical center
is the second highest acuity,
medical center academic medical center in the nation.
But so we have our challenges. I'm not
gonna say that we don't, but the challenge
is executing at a high level locally while
helping shape a model that could inform health
care delivered nationally.
So we feel as though we're really at
the the tip of the spear with regard
to where health care is going and really
take that
responsibility on
with great excitement.
That's great to hear. And I think, you
know, super exciting, around both initiatives. I think,
as you mentioned, it's something that so many
different
hospitals, health systems, and and states have been
trying to figure out how to do smartly
and in the right way. And so,
it's fascinating to hear a little bit more
about how you're doing things in Maryland and,
you know, the outcomes for for patient care.
It seems like it's been really beneficial. So,
you know, when you were making these transitions,
what did you have to do or what
did you learn about going from the traditional
fee for service to to more of these
types of payment models and ways of thinking
about care
episodes?
Well, I yeah. Thanks for asking that question.
I think that one of the things that,
you know, Maryland we when when folks interview
for positions here, we are one of the
questions we always ask is, do you know
Maryland's different? And we always you know, the
our our so our physician colleagues are nursing
someone will ask,
wow. And I said, well, the Maryland model
really governs how we think about delivering health
care about better outcomes, higher quality, but also
around how that's linked to cost,
and, and and how that cost curve can
be bent by better outcomes, greater access into
the ambulatory
sector so the patient who receive care in
the inpatient sector are the folks who really
need that care, but supporting health overall outside
the four walls of our hospital is really
a mind shift,
change for folks who might be coming in
here in a typical fee for service model.
One thing I'll just highlight is the emphasis
around how our physicians and our hospitals work
together to achieve what we're talking about now
is improved outcomes.
So our hospitals across our state are capitated,
so we have a global budget for our
hospitals.
Our physicians are still fee for service. So
it really emphasizes the importance of the work
that we all do for physician leaders inside
our state to align how our practices and
our our physicians
think about delivering care inside
our hospital infrastructure that is that it has
a global budget, and then aligning not only
care quality, operations,
and system design
with how we our practices
are delivering care inside their walls, and and
that synergy
has to be thought about with every decision
we make with implementing, you know, the models
like we have with the Maryland model and
the head model upcoming.
So it to me, the model helps
importantly
recognize the partnership
between providers and hospitals moving forward. That's been
one of the anchors that I found in
this job that that is really essential
to moving health care forward.
That's helpful to understand. I mean, you know,
really, really interesting context to think about how
Maryland is doing things differently and and what
it means for the patients. Now when you
look at the next year too, what do
you think the hardest thing that you'll have
to do will be?
Yeah. Well, I just mentioned we have got
a lot of we got a lot of
changes in health care coming, and I think
health care one of the only thing I
one of the things I quite often say
is the only constant thing in health care
is change.
And that's where we're so this year upcoming,
I think the hardest challenge will be continue
to innovate at a time when everyone in
health care is carrying some degree of fatigue.
You know, the need to evolve, as I
just spoke to clinically, operationally,
technologically is unavoidable. It's
all driven by the access pressures, workforce constraints,
and new accounting but new accountability models just
like ahead. But at the same time, we
must be delivered about how we introduce change
and how it's paced,
And that balance is so critical.
Our team members are our most vital strength,
and sustained performance depends upon their well-being.
The work ahead requires prioritization
that truly matters, eliminating low value work,
and ensuring that innovation makes care better
and work more sustainable,
not harder.
Leading through that tension with clarity and empathy
will be one of the most important responsibilities
this upcoming year, Laura. So balancing
innovation
with assuring that we have workforce support and
wellness
is one of our one of the gauntlets
that we make sure we carry is the
medical center leadership team moving forward.
That makes a lot of sense. You know,
it is really a helpful foundation to think
about,
preparing your teams for any types of uncertainties
or new things that
come your way. So
that's really, really helpful to to see. Now
when you think about growth as well, where
do you see some of the best opportunities
for the health system in the next year
or so to continue growing?
Yeah. I think
my perspective maybe I'll triangulate some of the
things we've kinda talked about to previously in
the conversation to for for for for this
question. I think one of the strongest opportunities
lies at that intersection of
workforce sustainability,
implementation of the AHEAD model,
and an a concept around automation.
You know, AHEAD is gonna require us to
think about total cost of care, not only
inside the hospital, but outside the hospital,
assuring highest quality and ensuring we address a
degree of workforce support to do that work
moving forward and implement so we're able to
have a successful implementation.
Key to this will be,
how we think about where the right work
is done by the right person at the
right time.
Automation and responsible use of AI could allow
us to redesign care so clinicians and staff
can operate at the top of their skill
set. I don't think we think we we
are embracing that entirely as health care delivers
care right now. You know, for patients, this
means improved and easier access,
smarter triage, navigation across our care continuum,
and multimodal
forms of communication.
For care teams, it means decision support for
triage,
diagnosis,
and management planning along with automation of low
value administrative work that can that contributes to
our staff's burnout.
I think our efforts will directly support workforce
retention if we're able to implement the things
I'm speaking to, Because when team members spend
more time delivering care and less time battling
administrative systems, our engagement rises,
turnover drops,
and folks are just happier coming to work.
And as we adopt the AHEAD model, triangulating
that with the AHEAD model moving forward,
changes like this in
in concert will be essential to maintaining a
stable and supported workforce, which is to me
fundamental
to our imperative for high quality care
and our provider and staff wellness.
Absolutely.
Well, fantastic.
I I think thank you so much, doctor
Norcosi, for joining the podcast today. I really
appreciate your time and effort, and I look
forward to seeing you at our annual meeting
in April. I know you'll be speaking at
the event, and so,
this will be a great opportunity for us
to share and continue to learn more about
everything that's going on in Maryland.
Laura, appreciate you. Happy Wednesday. I look forward
to seeing you at the conference.