1 00:00:01,919 --> 00:00:04,799 Every year, Becker's annual meeting brings healthcare leaders 2 00:00:04,799 --> 00:00:07,279 together to unpack the most pressing issues facing 3 00:00:07,279 --> 00:00:07,940 the industry. 4 00:00:08,400 --> 00:00:11,139 And every year, those conversations shift in profound 5 00:00:11,199 --> 00:00:12,464 and unexpected ways. 6 00:00:12,945 --> 00:00:15,185 This April, more than 3,500 7 00:00:15,185 --> 00:00:17,905 health care executives will return to Chicago for 8 00:00:17,905 --> 00:00:19,684 Becker's sixteenth Annual Meeting. 9 00:00:19,984 --> 00:00:22,945 Seven ninety five elite speakers will offer new 10 00:00:22,945 --> 00:00:25,904 lessons, new case studies, and predictions about what 11 00:00:25,904 --> 00:00:28,779 comes next. Join us April 13 through the 12 00:00:28,779 --> 00:00:29,279 sixteenth. 13 00:00:29,660 --> 00:00:31,599 For the agenda and event details, 14 00:00:31,899 --> 00:00:34,059 visit beckershospitalreview.com 15 00:00:34,059 --> 00:00:35,979 and click on the events tab in the 16 00:00:35,979 --> 00:00:36,799 upper right. 17 00:00:38,219 --> 00:00:40,539 This is Laura Dirda with the Becker's Healthcare 18 00:00:40,539 --> 00:00:42,574 podcast. I'm thrilled today to be joined by 19 00:00:42,574 --> 00:00:43,634 doctor David Marcozzi, 20 00:00:44,015 --> 00:00:46,414 chief clinical officer of the University of Maryland 21 00:00:46,414 --> 00:00:48,655 Medical Center and associate dean of clinical affairs 22 00:00:48,655 --> 00:00:50,674 at the University of Maryland School of Medicine. 23 00:00:50,734 --> 00:00:52,254 Doctor Marcozzi, it's a pleasure to have you 24 00:00:52,254 --> 00:00:54,894 on the podcast today. Laura, thanks for thanks 25 00:00:54,894 --> 00:00:56,594 for asking me to be part of this. 26 00:00:56,969 --> 00:00:59,530 Absolutely. Now I'm excited for our conversation because 27 00:00:59,530 --> 00:01:01,369 I know things are changing so quickly in 28 00:01:01,369 --> 00:01:03,210 the health care space, and I'm excited to 29 00:01:03,210 --> 00:01:04,569 learn more about some of the things you're 30 00:01:04,569 --> 00:01:06,569 doing at the University of Maryland. But before 31 00:01:06,569 --> 00:01:07,930 we dive in, can you tell me a 32 00:01:07,930 --> 00:01:09,849 little bit more about yourself and the health 33 00:01:09,849 --> 00:01:10,349 system? 34 00:01:11,105 --> 00:01:13,984 Sure. Well, as the chief clinical officer for 35 00:01:13,984 --> 00:01:14,725 the flagship 36 00:01:15,105 --> 00:01:17,204 academic medical center within our system, 37 00:01:17,665 --> 00:01:18,885 I work in partnership 38 00:01:19,265 --> 00:01:22,225 with our dyad my strongest dyad partner, our 39 00:01:22,225 --> 00:01:24,484 CNO, doctor Karen Doyle, on many portfolios 40 00:01:25,420 --> 00:01:27,040 that include clinical strategy, 41 00:01:27,340 --> 00:01:27,840 operations, 42 00:01:28,219 --> 00:01:29,280 quality, safety, 43 00:01:29,819 --> 00:01:31,200 graduate medical education, 44 00:01:31,819 --> 00:01:33,840 credentialing prefer of our providers, 45 00:01:34,540 --> 00:01:37,520 and candidly, physician alignment and care transformations 46 00:01:38,034 --> 00:01:40,275 across two campuses in our we have the 47 00:01:40,275 --> 00:01:43,075 medical center comprises two campuses and two in 48 00:01:43,075 --> 00:01:44,855 those campuses, there are two hospitals. 49 00:01:45,394 --> 00:01:47,734 So the work that I do services, 50 00:01:48,034 --> 00:01:50,594 for the for our flagship is one as 51 00:01:50,594 --> 00:01:53,100 one of the largest and most complex academic 52 00:01:53,100 --> 00:01:55,340 medical centers in the region. It delivers care 53 00:01:55,340 --> 00:01:57,100 to some of the highest acuity patients in 54 00:01:57,100 --> 00:02:00,060 the nation per Visient's q and a quality 55 00:02:00,060 --> 00:02:01,439 and accountability ranking. 56 00:02:01,900 --> 00:02:02,719 And my role 57 00:02:03,180 --> 00:02:06,620 bridges strategy and execution, partnering with physicians, nurses, 58 00:02:06,620 --> 00:02:07,840 operations, and analytics 59 00:02:08,444 --> 00:02:11,884 to translate organizational priorities into reliable, high quality 60 00:02:11,884 --> 00:02:12,944 care at the bedside. 61 00:02:13,805 --> 00:02:16,625 The medical center includes about 800 beds downtown 62 00:02:16,685 --> 00:02:18,764 and a 140 beds at Midtown. Those are 63 00:02:18,764 --> 00:02:21,824 the two campuses with over 1,200 attending physicians 64 00:02:22,044 --> 00:02:24,439 and close to 900 residents and fellows. 65 00:02:24,739 --> 00:02:28,099 We deliver highly specialized high acuity care spanning 66 00:02:28,099 --> 00:02:29,560 trauma, cancer, neurosciences, 67 00:02:30,180 --> 00:02:31,479 transplant, and more, 68 00:02:31,780 --> 00:02:34,500 and all of our physicians are faculty within 69 00:02:34,500 --> 00:02:36,599 the University of Maryland School of Medicine, 70 00:02:37,025 --> 00:02:39,525 tightly linking education discovery and care. 71 00:02:40,145 --> 00:02:42,405 We've got a high some high rankings, including 72 00:02:42,784 --> 00:02:45,105 our academic flagship scores very highly in the 73 00:02:45,105 --> 00:02:47,985 Visiant quality and accountability ranking in comparison to 74 00:02:47,985 --> 00:02:49,525 other academic medical centers. 75 00:02:49,860 --> 00:02:52,180 We've scored some of our specialties high on 76 00:02:52,180 --> 00:02:53,479 US News and World Report, 77 00:02:53,860 --> 00:02:56,340 and we're also very proud of our four 78 00:02:56,340 --> 00:02:57,639 time magnet designation, 79 00:02:58,259 --> 00:03:00,500 which is really among some very small percentage 80 00:03:00,500 --> 00:03:03,479 of hospitals across our nation for nursing excellence. 81 00:03:03,860 --> 00:03:05,905 So, Laura, a lot going on at the 82 00:03:05,905 --> 00:03:07,425 medical center, and thrilled to talk to you 83 00:03:07,425 --> 00:03:07,925 today. 84 00:03:08,944 --> 00:03:10,705 Well, that's amazing to hear. And and what 85 00:03:10,705 --> 00:03:13,604 a broad enterprise that, you have on Maryland. 86 00:03:13,664 --> 00:03:15,504 It is amazing to see all the different 87 00:03:15,504 --> 00:03:18,625 elements coming together and really truly serving the 88 00:03:18,625 --> 00:03:21,000 community in a strong way. Now when you 89 00:03:21,000 --> 00:03:22,919 think about the last year or so, could 90 00:03:22,919 --> 00:03:24,680 you tell us about an initiative that you 91 00:03:24,680 --> 00:03:26,040 led? What did you do, and what were 92 00:03:26,040 --> 00:03:26,620 the results? 93 00:03:27,560 --> 00:03:29,080 Yeah. You know, I'm gonna ask for some 94 00:03:29,080 --> 00:03:30,919 latitude. I'm gonna speak on not just one, 95 00:03:30,919 --> 00:03:33,319 but two. Our medical center is really focused 96 00:03:33,319 --> 00:03:34,919 on the highest delivery and the highest quality 97 00:03:34,919 --> 00:03:37,264 and the safest care, And we we started 98 00:03:37,264 --> 00:03:39,905 to implement a conceptual framework called HRO, high 99 00:03:39,905 --> 00:03:40,405 reliability 100 00:03:40,705 --> 00:03:41,205 organization, 101 00:03:41,985 --> 00:03:43,745 and really made it part of the fabric 102 00:03:43,745 --> 00:03:45,044 of how we deliver care, 103 00:03:45,504 --> 00:03:47,905 and made it essential to how we think 104 00:03:47,905 --> 00:03:49,585 about day to day practice. And that meant 105 00:03:49,585 --> 00:03:51,444 standardizing how leaders engage 106 00:03:51,750 --> 00:03:52,969 with safety data, 107 00:03:53,509 --> 00:03:55,129 responding to events rapidly, 108 00:03:55,509 --> 00:03:58,310 and escalating risk in accordance with our protocols 109 00:03:58,310 --> 00:03:59,049 and policies. 110 00:03:59,989 --> 00:04:02,629 This the we embedded the five principles of 111 00:04:02,629 --> 00:04:04,889 HRO into executive routines, 112 00:04:05,349 --> 00:04:06,489 unit level governance, 113 00:04:06,794 --> 00:04:09,674 and frontline workflows. So it went from the 114 00:04:09,674 --> 00:04:11,055 bedside to the boardroom. 115 00:04:11,594 --> 00:04:14,894 Practically, this included restructuring leadership safety reviews, 116 00:04:15,674 --> 00:04:17,454 clarifying escalation cascades, 117 00:04:18,154 --> 00:04:21,595 reinforcing just culture expectations, and holding dyads and 118 00:04:21,595 --> 00:04:23,160 triads. The The triads 119 00:04:23,620 --> 00:04:26,199 are nurse practitioners or PAs on units 120 00:04:26,579 --> 00:04:29,540 accountable for consistent safety behaviors at the unit 121 00:04:29,540 --> 00:04:30,600 and service levels. 122 00:04:31,060 --> 00:04:33,620 And this really anchored was anchored in a 123 00:04:33,620 --> 00:04:35,779 in a rollout that we were doing across 124 00:04:35,779 --> 00:04:38,995 our system, something called continuous learning for improvement, 125 00:04:39,214 --> 00:04:41,474 and that is education and applied 126 00:04:41,854 --> 00:04:42,354 using 127 00:04:43,055 --> 00:04:46,354 application strategies at the unit level and understanding 128 00:04:46,414 --> 00:04:47,875 lean lean strategies 129 00:04:48,654 --> 00:04:49,154 or, 130 00:04:49,615 --> 00:04:50,889 or performance improvement, 131 00:04:51,669 --> 00:04:53,289 educational training opportunities 132 00:04:53,750 --> 00:04:56,229 to be applicable at the line at the 133 00:04:56,229 --> 00:04:58,229 unit so we can have the greatest impact 134 00:04:58,229 --> 00:04:59,529 of where the work is done. 135 00:05:00,149 --> 00:05:02,250 The our results for HRO have been meaningful, 136 00:05:02,865 --> 00:05:05,185 and but we all know HRO is a 137 00:05:05,185 --> 00:05:06,004 never ending, 138 00:05:06,865 --> 00:05:09,904 effort. So we saw improvement in our safety 139 00:05:09,904 --> 00:05:10,404 reporting. 140 00:05:11,025 --> 00:05:11,685 We have, 141 00:05:12,464 --> 00:05:15,585 tangible examples of improved relationships between our dyads 142 00:05:15,585 --> 00:05:18,740 and triads and understanding what their priorities are, 143 00:05:19,279 --> 00:05:22,079 broader understanding of the data and more consistent 144 00:05:22,079 --> 00:05:24,819 leadership at the unit level, and then finally, 145 00:05:24,879 --> 00:05:27,680 very clear ownership of safety issues and faster 146 00:05:27,680 --> 00:05:29,939 escalation and resolution of risks. 147 00:05:31,024 --> 00:05:32,785 The la the second thing I'll talk to 148 00:05:32,785 --> 00:05:35,105 is about the work around access to the 149 00:05:35,105 --> 00:05:35,605 academic 150 00:05:35,985 --> 00:05:36,805 health system. 151 00:05:37,185 --> 00:05:39,105 This was a really major focus for our 152 00:05:39,105 --> 00:05:42,625 system and is particularly relevant for patients requiring 153 00:05:42,625 --> 00:05:43,524 highly specialized 154 00:05:43,824 --> 00:05:45,060 time sensitive care. 155 00:05:45,620 --> 00:05:47,959 As we are all experienced across our nation, 156 00:05:48,259 --> 00:05:50,279 really a supply and demand mismatch 157 00:05:50,660 --> 00:05:52,439 for health care demand, 158 00:05:53,939 --> 00:05:56,680 versus the the the supply that we have 159 00:05:56,819 --> 00:05:58,944 to provide that care. So we took that 160 00:05:58,944 --> 00:06:01,024 challenge head on by innovating how we move 161 00:06:01,024 --> 00:06:02,245 patients through the system 162 00:06:02,785 --> 00:06:06,084 to provide earlier access to academic level care 163 00:06:06,305 --> 00:06:09,444 with a specific focus on round trip transfers 164 00:06:10,064 --> 00:06:12,084 that enabled greater access 165 00:06:12,785 --> 00:06:13,444 to care 166 00:06:13,810 --> 00:06:16,310 without the constraint of an inpatient bed. 167 00:06:16,689 --> 00:06:18,449 And, really, over the past year, the medical 168 00:06:18,449 --> 00:06:21,269 center has managed hundreds of round trip transfers 169 00:06:21,649 --> 00:06:22,789 for a high acuity, 170 00:06:24,289 --> 00:06:26,389 high acuity care across our system. 171 00:06:26,735 --> 00:06:28,435 This was done through clear standards 172 00:06:29,214 --> 00:06:30,595 engaged to our physicians 173 00:06:30,975 --> 00:06:33,134 in how we're gonna do this. So there's 174 00:06:33,134 --> 00:06:34,675 clear expectations set. 175 00:06:35,055 --> 00:06:37,375 Really, we needed to improve our systemness, and 176 00:06:37,375 --> 00:06:38,514 we have very disciplined 177 00:06:39,160 --> 00:06:40,139 operational oversight. 178 00:06:40,680 --> 00:06:42,600 And of the 70 of of all of 179 00:06:42,600 --> 00:06:45,000 our requests that were that were made to 180 00:06:45,000 --> 00:06:47,500 the medical center, 70% of those requests 181 00:06:47,800 --> 00:06:50,439 for round trips were successfully completed. Some of 182 00:06:50,439 --> 00:06:52,404 them, the other 30%, some of them were 183 00:06:52,404 --> 00:06:54,324 not needed. Some of them we managed via 184 00:06:54,324 --> 00:06:54,824 telehealth. 185 00:06:55,444 --> 00:06:57,125 So we're really trying to think about a 186 00:06:57,125 --> 00:07:00,725 systematic way to get access to high acuity 187 00:07:00,725 --> 00:07:02,725 care that our medical center can provide, but 188 00:07:02,725 --> 00:07:03,464 not limited 189 00:07:03,845 --> 00:07:04,904 by bed capacity. 190 00:07:05,350 --> 00:07:07,750 And this has improved flow across our University 191 00:07:07,750 --> 00:07:08,730 of Maryland system 192 00:07:09,189 --> 00:07:11,269 and region, and it puts what we feel 193 00:07:11,269 --> 00:07:13,110 is that it puts care at the right 194 00:07:13,110 --> 00:07:15,209 location at the right time for our patients. 195 00:07:15,750 --> 00:07:18,069 So that's just two efforts that we've embarked 196 00:07:18,069 --> 00:07:19,750 on. We've embarked on a lot of efforts, 197 00:07:19,750 --> 00:07:21,645 but those are two I wanna highlight today, 198 00:07:21,645 --> 00:07:22,145 Laura. 199 00:07:23,165 --> 00:07:25,004 Well, that's amazing to hear. You know, both 200 00:07:25,004 --> 00:07:26,925 are impressive in terms of looking at the 201 00:07:26,925 --> 00:07:28,064 scale that it takes 202 00:07:28,444 --> 00:07:31,665 to, really have some of the those changes 203 00:07:31,805 --> 00:07:34,205 on the clinical workforce team, make sure they've 204 00:07:34,205 --> 00:07:35,289 got the right, 205 00:07:35,689 --> 00:07:38,910 structure in place for safety, reinforcing that culture, 206 00:07:38,970 --> 00:07:40,910 and bringing them all together for high reliability 207 00:07:41,129 --> 00:07:43,769 organization. And then secondly, looking at the things 208 00:07:43,769 --> 00:07:45,449 that you were talking about in terms of 209 00:07:45,449 --> 00:07:48,089 making sure expanding access to care, managing transfers, 210 00:07:48,089 --> 00:07:49,789 and and doing things a little bit differently. 211 00:07:50,464 --> 00:07:53,024 The results are impressive. I think in both 212 00:07:53,024 --> 00:07:54,785 cases, it seems like it took some change 213 00:07:54,785 --> 00:07:56,384 not only from the, 214 00:07:56,944 --> 00:07:59,185 process and and procedure side, but also I'm 215 00:07:59,185 --> 00:08:01,584 sure from the culture side and how, you 216 00:08:01,584 --> 00:08:02,644 know, the the, 217 00:08:03,310 --> 00:08:05,389 clinicians were approaching their work. So how do 218 00:08:05,389 --> 00:08:07,389 you do some of that change management with 219 00:08:07,389 --> 00:08:09,230 the broader teams and just make sure that 220 00:08:09,230 --> 00:08:11,389 everyone is on the same page and and 221 00:08:11,389 --> 00:08:12,449 doing the right things? 222 00:08:13,310 --> 00:08:16,509 Yeah. Clarity of expectations and roles was really 223 00:08:16,509 --> 00:08:18,214 one of those key fundamentals 224 00:08:18,594 --> 00:08:19,974 of who owns this, 225 00:08:20,274 --> 00:08:21,634 what is the work that needs to get 226 00:08:21,634 --> 00:08:23,875 done, how do we support that work to 227 00:08:23,875 --> 00:08:26,375 assure that the data is is understood, 228 00:08:26,914 --> 00:08:27,974 and then drive 229 00:08:28,274 --> 00:08:29,794 what I like the term I like to 230 00:08:29,794 --> 00:08:32,115 use quite often in many meetings that we 231 00:08:32,115 --> 00:08:32,519 have 232 00:08:33,000 --> 00:08:34,700 is decisive collaboration. 233 00:08:35,320 --> 00:08:38,139 So in academia and certainly academic medical centers, 234 00:08:38,519 --> 00:08:41,960 we we sometimes wonder who's making the decision, 235 00:08:41,960 --> 00:08:43,960 how is the decision made, and the process 236 00:08:43,960 --> 00:08:44,940 for that decision. 237 00:08:45,434 --> 00:08:47,595 And what we all have started to anchor 238 00:08:47,595 --> 00:08:49,835 on is we we embrace a who is 239 00:08:49,835 --> 00:08:51,855 the lead for this decision, 240 00:08:52,315 --> 00:08:54,815 how are we collaborating to make that decision, 241 00:08:55,595 --> 00:08:57,835 but we will make a decision to move 242 00:08:57,835 --> 00:09:00,259 forward in a and and allow us to 243 00:09:00,259 --> 00:09:02,740 continue to evolve, and we're not paralyzed by 244 00:09:02,740 --> 00:09:03,240 indecision. 245 00:09:03,779 --> 00:09:05,639 And that was really one of the things. 246 00:09:05,860 --> 00:09:07,379 And then when we put on that the 247 00:09:07,379 --> 00:09:08,840 priority of HRO, 248 00:09:09,700 --> 00:09:12,019 it was much clear understood from a structure 249 00:09:12,019 --> 00:09:12,519 standpoint 250 00:09:12,875 --> 00:09:14,794 how we're gonna make decisions and who's making 251 00:09:14,794 --> 00:09:17,855 them. From a process standpoint, a prioritization standpoint, 252 00:09:18,154 --> 00:09:20,894 what the process and the priority was, HRO 253 00:09:20,954 --> 00:09:22,014 and highest quality. 254 00:09:22,315 --> 00:09:25,195 And then the outcomes we're seeing throughout our 255 00:09:25,195 --> 00:09:28,254 hospital of folks understanding and escalating concerns, 256 00:09:28,639 --> 00:09:31,200 and it's having really a broad impact to 257 00:09:31,200 --> 00:09:33,139 patient care across our medical center. 258 00:09:33,840 --> 00:09:36,159 That's amazing to hear. Thank you so much 259 00:09:36,159 --> 00:09:38,240 for digging a bit deeper there. Now looking 260 00:09:38,240 --> 00:09:38,740 ahead, 261 00:09:39,120 --> 00:09:40,720 what are some of the big priorities and 262 00:09:40,720 --> 00:09:42,980 headwinds you're focused on for 2026? 263 00:09:43,634 --> 00:09:44,455 Yeah. Laura, 264 00:09:44,995 --> 00:09:47,235 Maryland is quietly doing what the rest of 265 00:09:47,235 --> 00:09:48,375 the country continues 266 00:09:48,675 --> 00:09:49,654 to think about, 267 00:09:50,035 --> 00:09:52,274 and we are using what's called the Maryland 268 00:09:52,274 --> 00:09:54,595 model, a waiver that was granted by the 269 00:09:54,595 --> 00:09:55,975 federal government, CMS, 270 00:09:56,830 --> 00:09:59,730 to support a statewide health care global payment 271 00:10:00,190 --> 00:10:00,929 and accountability 272 00:10:01,309 --> 00:10:03,549 system for our state's health care. And that 273 00:10:03,549 --> 00:10:04,769 has substantively 274 00:10:05,149 --> 00:10:08,269 shifted volume to value, and it has better 275 00:10:08,269 --> 00:10:08,769 aligned 276 00:10:09,315 --> 00:10:11,335 hospitals with physicians and communities. 277 00:10:11,875 --> 00:10:14,035 And the emphasis for this Maryland model has 278 00:10:14,035 --> 00:10:15,735 been around keeping people healthy, 279 00:10:16,274 --> 00:10:17,254 and assuring 280 00:10:17,715 --> 00:10:19,875 that our quality is the highest within our 281 00:10:19,875 --> 00:10:21,254 state. And lastly, 282 00:10:21,875 --> 00:10:24,959 our the Maryland model has demonstrated also it 283 00:10:24,959 --> 00:10:27,439 is starting to bend the cost curve, and 284 00:10:27,439 --> 00:10:29,600 Maryland continues to push that envelope forward. And 285 00:10:29,600 --> 00:10:31,459 in partnership with our federal government, 286 00:10:31,919 --> 00:10:33,620 we are we're gonna be soon, 287 00:10:34,079 --> 00:10:37,139 to innovate further than what we've done historically 288 00:10:37,199 --> 00:10:39,059 in the Maryland model and adopt 289 00:10:39,424 --> 00:10:42,084 the all pair evolution of the ahead model. 290 00:10:43,024 --> 00:10:44,784 For more than a decade, our state has 291 00:10:44,784 --> 00:10:47,105 demonstrated it is possible to control health care 292 00:10:47,105 --> 00:10:47,605 costs 293 00:10:47,985 --> 00:10:52,259 while improving quality and addressing population health outcomes. 294 00:10:52,799 --> 00:10:54,480 And that's a result that we feel as 295 00:10:54,480 --> 00:10:56,399 though many states and federal partners now view 296 00:10:56,399 --> 00:10:57,139 as a blueprint 297 00:10:57,600 --> 00:10:58,980 for national reform. 298 00:10:59,839 --> 00:11:01,919 The upcoming ahead model, I'll just quickly speak 299 00:11:01,919 --> 00:11:03,360 to that because a lot a lot of 300 00:11:03,360 --> 00:11:05,440 folks know about it, but our state is 301 00:11:05,440 --> 00:11:06,339 certainly embedded, 302 00:11:06,925 --> 00:11:10,205 in executing this successfully. The upcoming ahead model 303 00:11:10,205 --> 00:11:12,285 builds on the foundation of that Maryland model 304 00:11:12,285 --> 00:11:13,965 that I spoke to around total cost of 305 00:11:13,965 --> 00:11:14,465 care 306 00:11:14,925 --> 00:11:18,545 by providing and expanding the accountability beyond hospitals 307 00:11:18,605 --> 00:11:19,919 to total cost of care, 308 00:11:20,399 --> 00:11:22,899 quality, and equity across defined populations. 309 00:11:23,679 --> 00:11:26,500 It now makes even greater emphasis on prevention, 310 00:11:27,039 --> 00:11:27,860 care coordination, 311 00:11:28,480 --> 00:11:30,740 and appropriate utilization where that utilization 312 00:11:31,120 --> 00:11:31,940 is best 313 00:11:32,365 --> 00:11:34,465 served by the patient and the care providers. 314 00:11:34,925 --> 00:11:37,245 And finally, it holds systems accountable for those 315 00:11:37,245 --> 00:11:37,745 outcomes 316 00:11:38,125 --> 00:11:40,865 that extend far beyond simply the hospital walls. 317 00:11:41,245 --> 00:11:44,365 So really, Maryland is innovating. We realize ahead 318 00:11:44,365 --> 00:11:47,080 is a new frontier for us. It our 319 00:11:47,080 --> 00:11:49,340 Maryland model continues to evolve, and we think 320 00:11:50,200 --> 00:11:51,419 we serve as a potential, 321 00:11:52,440 --> 00:11:54,759 beacon for how we can shape health care 322 00:11:54,759 --> 00:11:57,240 delivery across our nation. So what's that mean 323 00:11:57,240 --> 00:11:59,179 for our our medical center? 324 00:11:59,559 --> 00:12:01,634 We're continuing to evolve how we deliver care. 325 00:12:01,634 --> 00:12:02,774 In fact, it's an imperative. 326 00:12:03,554 --> 00:12:04,695 Tighter clinical integration, 327 00:12:05,154 --> 00:12:06,855 stronger partnerships across 328 00:12:07,154 --> 00:12:09,875 the continuum of care from the outpatient side 329 00:12:09,875 --> 00:12:11,955 to the inpatient side and then back to 330 00:12:11,955 --> 00:12:13,174 our outpatient community. 331 00:12:13,955 --> 00:12:15,475 We really need to double down on how 332 00:12:15,475 --> 00:12:17,095 we're thinking through patient flow. 333 00:12:17,990 --> 00:12:18,730 And lastly, 334 00:12:19,029 --> 00:12:20,789 we have we we have to have a 335 00:12:20,789 --> 00:12:21,850 disciplined approach 336 00:12:22,389 --> 00:12:23,210 to limiting 337 00:12:23,590 --> 00:12:27,350 care variation, so standardizing care models, clinical practice 338 00:12:27,350 --> 00:12:29,590 guidelines, putting those in place. I'm not gonna 339 00:12:29,669 --> 00:12:31,590 didn't make any it's it's the the financial 340 00:12:31,590 --> 00:12:34,345 pressures are real. Workforce fatigue continues. 341 00:12:34,965 --> 00:12:36,965 Rising acuity, as I mentioned, the medical center 342 00:12:36,965 --> 00:12:38,345 is the second highest acuity, 343 00:12:39,205 --> 00:12:41,544 medical center academic medical center in the nation. 344 00:12:41,684 --> 00:12:43,605 But so we have our challenges. I'm not 345 00:12:43,605 --> 00:12:45,799 gonna say that we don't, but the challenge 346 00:12:45,799 --> 00:12:48,440 is executing at a high level locally while 347 00:12:48,440 --> 00:12:50,840 helping shape a model that could inform health 348 00:12:50,840 --> 00:12:51,980 care delivered nationally. 349 00:12:52,519 --> 00:12:54,519 So we feel as though we're really at 350 00:12:54,519 --> 00:12:56,679 the the tip of the spear with regard 351 00:12:56,679 --> 00:12:58,860 to where health care is going and really 352 00:12:58,919 --> 00:12:59,580 take that 353 00:12:59,955 --> 00:13:00,615 responsibility on 354 00:13:01,154 --> 00:13:02,215 with great excitement. 355 00:13:03,235 --> 00:13:04,754 That's great to hear. And I think, you 356 00:13:04,754 --> 00:13:07,555 know, super exciting, around both initiatives. I think, 357 00:13:07,555 --> 00:13:09,495 as you mentioned, it's something that so many 358 00:13:09,795 --> 00:13:10,295 different 359 00:13:10,675 --> 00:13:12,720 hospitals, health systems, and and states have been 360 00:13:12,799 --> 00:13:14,419 trying to figure out how to do smartly 361 00:13:14,639 --> 00:13:16,179 and in the right way. And so, 362 00:13:16,559 --> 00:13:18,799 it's fascinating to hear a little bit more 363 00:13:18,799 --> 00:13:20,899 about how you're doing things in Maryland and, 364 00:13:21,439 --> 00:13:23,919 you know, the outcomes for for patient care. 365 00:13:23,919 --> 00:13:26,894 It seems like it's been really beneficial. So, 366 00:13:27,054 --> 00:13:29,235 you know, when you were making these transitions, 367 00:13:29,934 --> 00:13:31,215 what did you have to do or what 368 00:13:31,215 --> 00:13:33,535 did you learn about going from the traditional 369 00:13:33,535 --> 00:13:35,215 fee for service to to more of these 370 00:13:35,215 --> 00:13:38,014 types of payment models and ways of thinking 371 00:13:38,014 --> 00:13:38,835 about care 372 00:13:39,375 --> 00:13:39,875 episodes? 373 00:13:40,959 --> 00:13:42,799 Well, I yeah. Thanks for asking that question. 374 00:13:42,799 --> 00:13:44,480 I think that one of the things that, 375 00:13:44,480 --> 00:13:46,399 you know, Maryland we when when folks interview 376 00:13:46,399 --> 00:13:48,080 for positions here, we are one of the 377 00:13:48,080 --> 00:13:49,519 questions we always ask is, do you know 378 00:13:49,519 --> 00:13:51,600 Maryland's different? And we always you know, the 379 00:13:51,679 --> 00:13:53,440 our our so our physician colleagues are nursing 380 00:13:53,519 --> 00:13:54,465 someone will ask, 381 00:13:55,024 --> 00:13:56,785 wow. And I said, well, the Maryland model 382 00:13:56,785 --> 00:13:59,665 really governs how we think about delivering health 383 00:13:59,665 --> 00:14:02,404 care about better outcomes, higher quality, but also 384 00:14:02,625 --> 00:14:04,565 around how that's linked to cost, 385 00:14:05,264 --> 00:14:08,144 and, and and how that cost curve can 386 00:14:08,144 --> 00:14:10,759 be bent by better outcomes, greater access into 387 00:14:10,759 --> 00:14:11,340 the ambulatory 388 00:14:12,200 --> 00:14:14,360 sector so the patient who receive care in 389 00:14:14,360 --> 00:14:16,759 the inpatient sector are the folks who really 390 00:14:16,759 --> 00:14:19,960 need that care, but supporting health overall outside 391 00:14:19,960 --> 00:14:22,200 the four walls of our hospital is really 392 00:14:22,200 --> 00:14:23,100 a mind shift, 393 00:14:24,144 --> 00:14:25,904 change for folks who might be coming in 394 00:14:25,904 --> 00:14:28,485 here in a typical fee for service model. 395 00:14:28,705 --> 00:14:30,945 One thing I'll just highlight is the emphasis 396 00:14:30,945 --> 00:14:34,144 around how our physicians and our hospitals work 397 00:14:34,144 --> 00:14:36,705 together to achieve what we're talking about now 398 00:14:36,705 --> 00:14:37,845 is improved outcomes. 399 00:14:38,519 --> 00:14:41,320 So our hospitals across our state are capitated, 400 00:14:41,320 --> 00:14:42,919 so we have a global budget for our 401 00:14:42,919 --> 00:14:43,419 hospitals. 402 00:14:43,799 --> 00:14:46,199 Our physicians are still fee for service. So 403 00:14:46,199 --> 00:14:48,679 it really emphasizes the importance of the work 404 00:14:48,679 --> 00:14:51,240 that we all do for physician leaders inside 405 00:14:51,240 --> 00:14:54,345 our state to align how our practices and 406 00:14:54,345 --> 00:14:55,485 our our physicians 407 00:14:55,785 --> 00:14:57,884 think about delivering care inside 408 00:14:58,345 --> 00:15:00,904 our hospital infrastructure that is that it has 409 00:15:00,904 --> 00:15:03,544 a global budget, and then aligning not only 410 00:15:03,544 --> 00:15:04,924 care quality, operations, 411 00:15:05,350 --> 00:15:06,730 and system design 412 00:15:07,110 --> 00:15:08,809 with how we our practices 413 00:15:09,269 --> 00:15:12,389 are delivering care inside their walls, and and 414 00:15:12,389 --> 00:15:13,370 that synergy 415 00:15:13,909 --> 00:15:16,070 has to be thought about with every decision 416 00:15:16,070 --> 00:15:18,325 we make with implementing, you know, the models 417 00:15:18,325 --> 00:15:20,004 like we have with the Maryland model and 418 00:15:20,004 --> 00:15:21,225 the head model upcoming. 419 00:15:21,605 --> 00:15:24,504 So it to me, the model helps 420 00:15:25,044 --> 00:15:25,544 importantly 421 00:15:25,924 --> 00:15:27,225 recognize the partnership 422 00:15:27,764 --> 00:15:30,644 between providers and hospitals moving forward. That's been 423 00:15:30,644 --> 00:15:32,085 one of the anchors that I found in 424 00:15:32,085 --> 00:15:34,850 this job that that is really essential 425 00:15:35,230 --> 00:15:36,610 to moving health care forward. 426 00:15:37,470 --> 00:15:39,629 That's helpful to understand. I mean, you know, 427 00:15:39,629 --> 00:15:42,429 really, really interesting context to think about how 428 00:15:42,429 --> 00:15:44,350 Maryland is doing things differently and and what 429 00:15:44,350 --> 00:15:46,315 it means for the patients. Now when you 430 00:15:46,315 --> 00:15:47,554 look at the next year too, what do 431 00:15:47,554 --> 00:15:48,954 you think the hardest thing that you'll have 432 00:15:48,954 --> 00:15:49,934 to do will be? 433 00:15:50,475 --> 00:15:52,154 Yeah. Well, I just mentioned we have got 434 00:15:52,154 --> 00:15:53,115 a lot of we got a lot of 435 00:15:53,115 --> 00:15:54,875 changes in health care coming, and I think 436 00:15:54,875 --> 00:15:56,315 health care one of the only thing I 437 00:15:56,475 --> 00:15:58,394 one of the things I quite often say 438 00:15:58,394 --> 00:15:59,914 is the only constant thing in health care 439 00:15:59,914 --> 00:16:00,654 is change. 440 00:16:01,110 --> 00:16:03,029 And that's where we're so this year upcoming, 441 00:16:03,029 --> 00:16:04,629 I think the hardest challenge will be continue 442 00:16:04,629 --> 00:16:06,789 to innovate at a time when everyone in 443 00:16:06,789 --> 00:16:09,110 health care is carrying some degree of fatigue. 444 00:16:09,110 --> 00:16:10,789 You know, the need to evolve, as I 445 00:16:10,789 --> 00:16:12,490 just spoke to clinically, operationally, 446 00:16:13,304 --> 00:16:15,164 technologically is unavoidable. It's 447 00:16:15,705 --> 00:16:18,845 all driven by the access pressures, workforce constraints, 448 00:16:19,225 --> 00:16:21,625 and new accounting but new accountability models just 449 00:16:21,625 --> 00:16:23,784 like ahead. But at the same time, we 450 00:16:23,784 --> 00:16:27,004 must be delivered about how we introduce change 451 00:16:27,225 --> 00:16:28,365 and how it's paced, 452 00:16:29,000 --> 00:16:30,779 And that balance is so critical. 453 00:16:31,159 --> 00:16:34,139 Our team members are our most vital strength, 454 00:16:34,839 --> 00:16:37,580 and sustained performance depends upon their well-being. 455 00:16:38,360 --> 00:16:40,379 The work ahead requires prioritization 456 00:16:41,625 --> 00:16:44,605 that truly matters, eliminating low value work, 457 00:16:44,985 --> 00:16:47,804 and ensuring that innovation makes care better 458 00:16:48,264 --> 00:16:49,644 and work more sustainable, 459 00:16:50,585 --> 00:16:51,644 not harder. 460 00:16:52,264 --> 00:16:54,925 Leading through that tension with clarity and empathy 461 00:16:55,259 --> 00:16:57,679 will be one of the most important responsibilities 462 00:16:57,899 --> 00:17:00,160 this upcoming year, Laura. So balancing 463 00:17:00,700 --> 00:17:01,200 innovation 464 00:17:01,899 --> 00:17:04,619 with assuring that we have workforce support and 465 00:17:04,619 --> 00:17:05,119 wellness 466 00:17:05,580 --> 00:17:07,500 is one of our one of the gauntlets 467 00:17:07,500 --> 00:17:08,779 that we make sure we carry is the 468 00:17:08,779 --> 00:17:10,880 medical center leadership team moving forward. 469 00:17:12,194 --> 00:17:13,795 That makes a lot of sense. You know, 470 00:17:13,795 --> 00:17:16,275 it is really a helpful foundation to think 471 00:17:16,275 --> 00:17:16,755 about, 472 00:17:17,315 --> 00:17:19,714 preparing your teams for any types of uncertainties 473 00:17:19,714 --> 00:17:20,775 or new things that 474 00:17:21,154 --> 00:17:22,934 come your way. So 475 00:17:23,410 --> 00:17:25,809 that's really, really helpful to to see. Now 476 00:17:25,809 --> 00:17:27,490 when you think about growth as well, where 477 00:17:27,490 --> 00:17:28,869 do you see some of the best opportunities 478 00:17:29,009 --> 00:17:30,529 for the health system in the next year 479 00:17:30,529 --> 00:17:32,070 or so to continue growing? 480 00:17:33,250 --> 00:17:34,070 Yeah. I think 481 00:17:34,450 --> 00:17:37,105 my perspective maybe I'll triangulate some of the 482 00:17:37,105 --> 00:17:39,664 things we've kinda talked about to previously in 483 00:17:39,664 --> 00:17:41,904 the conversation to for for for for this 484 00:17:41,904 --> 00:17:44,005 question. I think one of the strongest opportunities 485 00:17:44,785 --> 00:17:46,404 lies at that intersection of 486 00:17:46,705 --> 00:17:47,684 workforce sustainability, 487 00:17:48,730 --> 00:17:50,269 implementation of the AHEAD model, 488 00:17:50,569 --> 00:17:52,909 and an a concept around automation. 489 00:17:53,529 --> 00:17:55,609 You know, AHEAD is gonna require us to 490 00:17:55,609 --> 00:17:57,929 think about total cost of care, not only 491 00:17:57,929 --> 00:17:59,950 inside the hospital, but outside the hospital, 492 00:18:00,329 --> 00:18:03,210 assuring highest quality and ensuring we address a 493 00:18:03,210 --> 00:18:06,465 degree of workforce support to do that work 494 00:18:06,465 --> 00:18:08,465 moving forward and implement so we're able to 495 00:18:08,465 --> 00:18:09,765 have a successful implementation. 496 00:18:10,705 --> 00:18:11,924 Key to this will be, 497 00:18:12,545 --> 00:18:14,465 how we think about where the right work 498 00:18:14,465 --> 00:18:16,144 is done by the right person at the 499 00:18:16,144 --> 00:18:16,829 right time. 500 00:18:17,630 --> 00:18:20,589 Automation and responsible use of AI could allow 501 00:18:20,589 --> 00:18:22,750 us to redesign care so clinicians and staff 502 00:18:22,750 --> 00:18:24,349 can operate at the top of their skill 503 00:18:24,349 --> 00:18:26,669 set. I don't think we think we we 504 00:18:26,669 --> 00:18:29,730 are embracing that entirely as health care delivers 505 00:18:30,029 --> 00:18:32,375 care right now. You know, for patients, this 506 00:18:32,375 --> 00:18:34,315 means improved and easier access, 507 00:18:34,694 --> 00:18:37,835 smarter triage, navigation across our care continuum, 508 00:18:38,214 --> 00:18:39,034 and multimodal 509 00:18:39,414 --> 00:18:40,554 forms of communication. 510 00:18:41,255 --> 00:18:43,494 For care teams, it means decision support for 511 00:18:43,494 --> 00:18:43,994 triage, 512 00:18:44,720 --> 00:18:45,220 diagnosis, 513 00:18:45,920 --> 00:18:48,880 and management planning along with automation of low 514 00:18:48,880 --> 00:18:52,240 value administrative work that can that contributes to 515 00:18:52,240 --> 00:18:53,539 our staff's burnout. 516 00:18:54,240 --> 00:18:56,960 I think our efforts will directly support workforce 517 00:18:56,960 --> 00:18:58,720 retention if we're able to implement the things 518 00:18:58,720 --> 00:19:01,144 I'm speaking to, Because when team members spend 519 00:19:01,144 --> 00:19:04,285 more time delivering care and less time battling 520 00:19:04,505 --> 00:19:07,724 administrative systems, our engagement rises, 521 00:19:08,184 --> 00:19:09,325 turnover drops, 522 00:19:09,944 --> 00:19:12,269 and folks are just happier coming to work. 523 00:19:12,589 --> 00:19:14,609 And as we adopt the AHEAD model, triangulating 524 00:19:14,830 --> 00:19:16,609 that with the AHEAD model moving forward, 525 00:19:16,910 --> 00:19:18,450 changes like this in 526 00:19:18,830 --> 00:19:21,230 in concert will be essential to maintaining a 527 00:19:21,230 --> 00:19:23,869 stable and supported workforce, which is to me 528 00:19:23,869 --> 00:19:24,369 fundamental 529 00:19:24,830 --> 00:19:27,250 to our imperative for high quality care 530 00:19:27,549 --> 00:19:29,944 and our provider and staff wellness. 531 00:19:31,125 --> 00:19:31,625 Absolutely. 532 00:19:32,484 --> 00:19:33,224 Well, fantastic. 533 00:19:33,525 --> 00:19:35,285 I I think thank you so much, doctor 534 00:19:35,285 --> 00:19:38,164 Norcosi, for joining the podcast today. I really 535 00:19:38,164 --> 00:19:40,164 appreciate your time and effort, and I look 536 00:19:40,164 --> 00:19:41,605 forward to seeing you at our annual meeting 537 00:19:41,605 --> 00:19:43,125 in April. I know you'll be speaking at 538 00:19:43,125 --> 00:19:44,190 the event, and so, 539 00:19:44,589 --> 00:19:46,429 this will be a great opportunity for us 540 00:19:46,429 --> 00:19:48,190 to share and continue to learn more about 541 00:19:48,190 --> 00:19:49,569 everything that's going on in Maryland. 542 00:19:50,109 --> 00:19:52,829 Laura, appreciate you. Happy Wednesday. I look forward 543 00:19:52,829 --> 00:19:53,970 to seeing you at the conference.