Episode Overview:

The way health care providers connect with patients has changed significantly since the onset of COVID. With new challenges, having care models that are consumer-focused and convenience-based is critical more than ever before. The need for a strategic focus is paramount for organizations to successfully bounce back from COVID. 

In this episode of Value-Based Care Insights, Daniel J. Marino speaks with Bill Bodnar to discuss several challenges health care organizations are facing as they transition out of COVID. Bodnar shares his insights on new challenges, including workforce dynamics, non-traditional health care models, and the pursuit of value. Key points include: 

  • The competition among primary care providers and specialists with non-traditional providers, shifting to consumer-focused and convenience-based models 
  • The use of automation and other innovative solutions to address workforce burnout and employee retention
  • The advancement of population health management and value-based contracts to improve patient care and financial outcomes 


Daniel J. Marino
Daniel J. Marino

Managing Partner, Lumina Health Partners


Bill Bodnar

Founder of The Leader’s Board and Chair of The Health System Institute


Thank you for listening to Value-Based Care Insights, a podcast by Lumina Health Partners. In this series, host Daniel J. Marino, managing partner of Lumina, talks to top experts and thought leaders in health care to help you navigate on the journey to value-based care in an ever-changing landscape of the industry. The goal of this series is to bring you disruptive success strategies by leveraging Lumina's experiences, stories, and insights from working with health professionals and organizations across the country. Before we get into today's episode, I'd like to invite you to leave us a review on Apple podcast and let us know what you think about the episode in any questions that are top of mind. Now let's get started.

Daniel Marino: Welcome to another episode of Value-Based Care Insights. I'm your host Daniel Marino. In today's episode, we're going to spend some time talking about some of the current issues that are facing our health care providers these days, and in particular what some of our health care leaders may be struggling with, as they're thinking about moving forward past COVID, improving their financial performance, continuing to connect with our patients. As we all know, there's a lot of challenges that have been facing hospitals as of recent, not only are they managing the ebbs and flows or the continued pressures of COVID, but there's a lot issues related to the workforce that has always been a challenge, but seems like it's even more of a challenge today. As well as the direction that health care organizations and hospitals need to take on improving their financial performance, many of them haven't really gotten to the point where they're at their pre COVID levels and they're still struggling with trying to make their ends meet.

Daniel Marino: My guest today, I'm really excited about, is an individual I've known for quite some time. He is an industry leader, a thought leader, a real connector with high-level individuals across the organization. Bill Bodnar, founder of The Leader's Board, has been working in the health care industry for, my goodness, well over 25, 30 years. The Leader's Board provides phenomenal networking and education opportunities to physicians across the country. Bill, welcome to the program.

Bill Bodnar: Dan, thank you, and I wish it had only been 25 years. It's been 46 years I've in this darn field and I still love every day.

Daniel Marino: 46 years, my goodness. That's great.

Bill Bodnar: Started when I was 11, I think, but, yeah.

Daniel Marino: Yeah, that's good. One thing I think we both talked about early on is we both went to Xavier University.

Bill Bodnar: We did. What a great little place that was.

Daniel Marino: Absolutely, loved it, loved it. So Bill, we're thinking about where health care and the industry is now. Lot of challenges that are facing hospitals, facing executives, facing leaders of all sorts, whether you're an executive leader, you're a physician leader, many challenges. What are you seeing? What are you hearing as sort of these top-of-mind issues with some of the leaders across the country?

Bill Bodnar: Sure, Dan. It is more challenging today than it's ever been, I think for health care leaders. Obviously, COVID created an entirely new set of challenges that in my 46-year career has never beset the industry, and I'm thinking of course about intense levels of burnout. I'm thinking about the intense levels of intermediaries or disruptors who have finally discovered or decided that health care is a pretty lucrative arena in terms of total spending, and all of the dynamics going on the workforce. It's always been. Being an administrator or board member, et cetera, of a health care system has always been a game of hundreds of operating challenges and daily whack-a-mole. But the need for real strategic focus and really to figure out sort through everything is paramount today.

Daniel Marino: Do you think that hospitals and how they're connecting with their patients, is it changed today? We've done a lot of work with organizations, with telehealth, thinking about different access models. Some of the organizations have really embraced that, others have sort of pushback. What are you seeing?

Bill Bodnar: Well, it's interesting. I remember back in the early 1980s, listening to tapes on the way to work at a hospital in Iowa where I worked, by Tom Peters' In Search of Excellence and thinking, "Gosh, this whole concept of a customer focus, it's pretty interesting." But it never gained a tremendous amount of traction within the executive suite until Medicare created it as a potential incentive, disincentive in terms of penalties for where your customer service scores were. That seemed to kind of kick off the focus on customer service and elevating it to a senior level of trying to understand your customers, trying to serve them better. Of course all the disruptors, they're working hard and they are, some of them know our customers is good or better than we do.

Daniel Marino: Well, that is so true I'll tell you. One of the things that have come out of COVID is this concept of increased convenience-based care, and telehealth has supported that. So if you need to talk with a primary care physician, you still have that opportunity to pick up the phone and make an appointment and maybe get in in a week or two. Or you could download the app, push one button and be connected with a primary care provider, whether it's a nurse practitioner or a physician in a matter of seconds. That has really changed the model.

Bill Bodnar: It absolutely has, Dan. I think that like everything, there are customer types go way beyond demographics. But customer types and customers who are extremely comfortable with that and others who until the day they die, they're going to demand the face-to-face visit. But the ZocDocs, the TeleDocs, they're getting to understand. I don't want to overgeneralize, but especially the younger generation who are our future bread and butter, they're understanding them perhaps even better than we do. The thought that you would go in for a physician visit, let's say you're a cancer patient undergoing radiation therapy, the fact you would go in for your 21 radiation-therapy visits but that your visits to your physician aren't on the same day, it's crazy. But it happens all over the country every day, and it's just one tiny example.

Bill Bodnar: Understanding your customers, understanding workflow using AI, which we hear a lot about, why would you use AI and how does that relate to customer experience? Well, let's think about one small example. How many times you've gone into the hospital lab draw area because you're having surgery next week? Or your PMD just ordered a lab draw and you go and you sit there for 10, 15, 30 minutes waiting for your lab draw, what in the world is going on. Why aren't you given a five-minute appointment to help spread out that, to reduce the size of your waiting room? By the way, if you sit and wait for 20 minutes with the anxiety of a lab draw, the odds are they're not going to get you on the first poke. I mean, these are tiny things, but to consumers, to customers, they're huge.

Daniel Marino: Well, you are absolutely correct. I'll tell you, it's really changed the care model. Focusing on that customer-centric approach, I think it's really going to be a differentiator. Like you said, there's a lot of non-traditional providers out there who are starting to figure it out. So when you think about the impact to the traditional health care model to hospitals, boy, if these leaders don't really think about doing things different, it certainly is going to affect their model and affect their overall financials.

Bill Bodnar: Listen, the moment a disruptor whether it's a TeleDoc or a ZocDoc or a CVS or Walmart or your insurer, once they disintegrate or disintermediate that connection between you and your primary care doctor just once, it can become the beginning of a lifetime of care for that customer. If you think your hospital, your expensive hospital and your expensive surgeons will be where that company refers those patients, you better crush your fingers.

Daniel Marino: Yeah, that's true. That's very true. I want to jump in to another topic, which I'm hearing a lot of issues about certainly over, especially over the last maybe 9, 10 months, but I think it's always occurred and that's really around the workforce issues. It seems like right now with wage inflation, with a lot of the inability to really fill positions, the competitive nature of losing say some of our workforce to non-traditional providers or maybe not even health care providers, right, the Amazons and some of the other organizations there, is really creating a major strain on our workforce on hospitals. What are you hearing when you're talking to folks around the country?

Bill Bodnar: Oh, of course, you can't talk about health care employees without talking about burnout. You can't talk about burnout without talking about more than just burnout. Just the entire mental health issues within the health care issue within the health care arena have grown exponentially because, again, because of the strains of COVID. The strains of COVID have created, of course, all of these other issues within our economy and the dramatic rise. The fast food restaurant who last year paid nine bucks an hour and now this year is having to pay 13 or 15 or 16 bucks an hour for that same employee is stripping away. Again, these are people who have a six months training and they're able to go for two, three, four bucks an hour more to work in a fast food arena where they don't have the risk of disease, where they aren't being accosted by patients who are angry about whatever is happening. They probably are working a lot closer to their home.

Daniel Marino: Yeah, I agree.

Bill Bodnar: Four bucks an hour is a lot of money.

Daniel Marino: It is a lot of money and then when you think about kind of the strains that health care puts on individuals. Now, again, there's a certain level of satisfaction that comes with the position, which is I think the reason why you and I are in health care. But when you counter that with higher salaries, increased benefits, maybe a little bit more of a work-life balance, that's hard to compete for hospitals.

Bill Bodnar: It is hard to compete for hospitals. I think that the question is there are a number of people who want to cling to the past. They want to think, "Well, we got to have people at the bedside. We got to have people mopping the floors. We have to have people coming to work." I mean, I remember the tremendous amounts of key space in a hospital had to be devoted to the business office or the medical records department. Of course, that all can be offloaded and outsourced now. But the question I think is going to be what else can you be doing. In terms of automation in every other industry, there's a certain price level or cost level of doing something and automation becomes a better option. It's adopted and it's adopted relatively quickly. The adoption rate in the health care field has been very slow in the uptake.

Bill Bodnar: Why RNs across the country, every RN doesn't have a heads-up display of the medical record available to them instantly? Why they don't have a virtual scribe? So does it walk from room to room? Or even while they're in the room, they are doing the scribing there instead of back in an office to maximize their time and their functionality and maybe even their accuracy. It doesn't make a lot of sense if you're looking at the industry from the outside.

Daniel Marino: I agree. I think health care leaders are going to have to figure out how to incorporate innovative approaches, different types of working environmental issues to address the needs of our workforce. Otherwise, they're just not going to be able to compete if we stay in our current traditional model. It's just not going to work. Especially for the non-clinical staff, I think we really do have to think about it differently and address those specific work-life issues.

Bill Bodnar: Obviously, we need to move to more and more hybrid. I was thinking this morning before this call, how much rounding by a nurse could be done by a robot nurse.

Daniel Marino: Yeah. Wouldn't that be great? Yes.

Bill Bodnar: The nurse is sitting at home and she can do her scribing and she's got the medical record, you just wonder about that type of thing happening to give a different type of work life balance. But one of the other issues I think is big within this industry is the culture of the organization. I think that organizations are at a real turning point where they're going to have to decide and make a very conscious decision about what their future culture will be. During COVID, many organizations moved to a command and control culture and it was what's necessary. It's what's necessary in a time of war and certainly a lot of hospitals have found themselves in a warlike environment with COVID.

Bill Bodnar: But the question is what would be the next iteration of their permanent culture and what do they want to drive? Do they want to return to many were driving, working in consensus-driven cultures, which take a lot of time and probably water down a lot of great ideas? Do they want to be highly decentralized with a high level of accountability? Do they want to return to maybe a completely clinically focused kind of culture where the customer really is a second place? I think that these are all options, but will take a long term commitment from hospital systems as well building up the pipeline for the future.

Daniel Marino: Yeah, absolutely, but the culture is so key. Bill, you are spot on. As I've talked with many HR leaders, they're focusing on changing that culture and trying to really push some of the accountability, some of the decision making, getting an implied ownership to that middle manager level so they can specifically address the needs of their staff and do it quick. It's just certainly a key area.

Daniel Marino: But one other area of culture that I'd love to hear your thoughts on and it's around burnout and in particular maybe physician burnout, staff burnout. Physician burnout has been in health care certainly for the last 10, 15 years. I guess you can probably draw a lot of that alignment to the implementation of the electronic medical record. How is burnout different now? Do you see it being worse? Is it the same? How are organizations sort of addressing the issues of burnout, both of their physicians and their staff?

Bill Bodnar: Dan, that's a really interesting question. For a second at a flash of memory, my father was an orthopedic surgeon. Back in those days, he left the house at 7:00 in the morning, came home for dinner somewhere between 6:00 and 9:00, and then went back and made rounds on his surgical patients for the next day. He loved his job. He worked hard. He was completely engaged until the day he had his first malpractice case and he almost quit because of it.

Daniel Marino: Wow. That could be life changing, especially for your first one. It has to be really, really tough.

Bill Bodnar: But you fast forward today and you kind of make the arc to the challenge, the constant challenge that physicians and caregivers are facing today. It's not just over COVID or just over COVID, maybe they'd be able to handle it. But it's the challenge of many decisions every day that physicians are facing in their offices or a patient walks in with the 30 pages that they printed off from some unusual internet site. It might be the challenge that families who are totally unprepared for the death of a patient and they want you to do everything. As one says, "Keep doing the miracles that they believe American health care is designed to do."

Bill Bodnar: Physicians know that there is no viable hope of recovery for a patient, but they're being challenged by families. They're getting pressure from every side. But then this whole COVID thing and the number of hours and the pressure and again the frustration of knowing that almost every patient in the hospital today in an ICU who's going to die of COVID, it could have been prevented. It's really gut wrenching for these folks.

Bill Bodnar: What I want to say is, well, that's all the negative. The positive is to find ways to reconnect people to their mission, as you mentioned earlier. Because we know that high employee engagement is directly related to high customer satisfaction, and that it's a symbiotic dynamic relationship. It's this thing of why do we focus on customer service. Because it makes for happy customers, which helps make people more satisfied in their job.

Daniel Marino: Yeah, and I couldn't agree with you more, Bill. That is spot on. All of us went into health care, at least most of us went into health care with the idea that we wanted to make a difference. You want to help people. Somewhere along the way, sometimes that gets lost. I think to your point, the more you could provide that connection back to the mission, sort of the why we got into this in the first place, that really then helps to define the purpose. It doesn't solve all the problems, but it makes it a little easier to overcome a lot of the challenges that we're facing.

Bill Bodnar: Yeah, yeah. It's certainly a challenge, too.

Daniel Marino: So one of the other areas that I'm hearing as a focus is how we want to approach moving into value. Before COVID, population health value-based care had a fair amount of momentum. A lot of organizations were investing in different initiatives around population health. There was a lot of contracting and activities that were occurring. I think post COVID, if COVID did anything and highlighted the challenges within fee-for-service, but I'm not hearing the same level of momentum moving into some of these value-based care arrangements as I have before. Everybody I talk to feels like value is the way to go to be able to really manage costs and improve outcomes. But I'm not seeing a lot of big momentum in terms of movement, infrastructure, creating some of these arrangements and so forth. What are you hearing?

Bill Bodnar: Absolutely, I think that there's been a slowing of the move of the march towards value. I think that population health management, there have been a lot of people who have been involved in that arena who were pulled away back into clinical roles. There's been less of a focus in a number of organizations, but what's fascinating is the disconnect. Because when you look at the organizations that have done really well during these past two years, it's been those organizations that have taken or assumed a high level of risk.

Daniel Marino: You're absolutely right. I mean, those organizations that have been able to make themselves through COVID especially when elective procedures were either significantly decreased or stopped, those organizations that had their value-based contracts that were managing the population that had these non-traditional care models in place, these were the ones that were successful and were able to get themselves through in a fairly reasonable way.

Bill Bodnar: What's interesting, Dan, is the concept of, I guess, the first stepping stone in any value-based contracting or move towards population health management is to address clinical variation. When it came to COVID, of course, we started with total clinical variation because nobody knew how to treat this darn disease effectively. But the learning was such a rapid learning scale and the death rate was cut by 200% within the first three months because we learned, "Oh, let's put people on their stomach." Somebody came up with that idea and it worked. That's where organizations have to start and that's tough work. You have to have a gifted CMO and a dedicated CEO who are willing to take those risks, as well as the CFO who's willing to jump off the fee-for-service train. Whether you jump in with just a toe in the water or you jump in head first, every organization who is not doing it needs to be doing it.

Bill Bodnar: The fear of the unknown is huge, but it's the starting point of Medicare Advantage or an employee workforce or a direct to employer contract, start small, get your feet underneath. You find a good partner who knows what they're doing and do all the back office operations and help you project the financial implications and modify them during the first couple years. But organizations have to do it or else they won't survive in this.

Daniel Marino: So moving into 2022, do you think there's going to be more momentum for hospitals to move into value-based contracting, risk-based contracting?

Bill Bodnar: I think that's a good question. It's going to be tough because a lot of organizations have huge backlogs of surgeries. They stopped doing a whole lot of testing via either diagnostic or the routine screening stuff that I know they feel needs to be crunched through. I know they feel that it's probably an opportunity under the fee-for-service model to crunch a lot of volume through. But again, the big picture, the long-term horizon really has to be considered and maybe no better time than a time that we're coming out of a good, hard focus on clinical variation reduction that we move into some real strong population health management.

Daniel Marino: Yeah, I agree. I think to your point, I think the opportunity is there now to engage differently with providers, maybe direct to employers, certainly with payers. So you establish more of a collaborative approach versus a competing approach, which is typically inherent in the fee-for-service world.

Bill Bodnar: Absolutely. We don't know it all, but there are a lot of people who have been doing it for a number of years and we certainly can learn lessons from them.

Daniel Marino: Well, Bill, this was great. I guess last final question for you. If you were to give some advice based on your conversations with other leaders, if you were to give some advice to health care executives, whether they're physician leaders or administrative leaders, what are the top two, three, four things that you would recommend that they focus on going into 2022? Any thoughts?

Bill Bodnar: Well, first, just to take a deep breath. A lot of people, they are in the middle of a war. They feel like this war may never end. But I really encourage people to take a deep breath and look back at what they've done the past two years. They have been involved in the biggest change in American health care, the biggest challenge to hospital systems and health care systems that this country's perhaps probably ever faced or at least certainly in the last century. They need to take solace in the fact that they've done a great job as great a job as they could.

Bill Bodnar: Second, they need to just find time right after they finish kind of patting themselves on a back and look at that and decide on a couple of real key touchstones. We've touched on three here. I'm sure there are others, but find a focus. Find a focus, do it really well and turn off some of the noise of the hundreds of other things that you could be doing and focus on the things that are really going to matter for the next 5 to 10 to 20 years.

Daniel Marino: Yeah, that's great. I agree and I like your suggestion around taking a broad, slowing down, and really finding the direction for hospitals in terms of really being able to move forward past COVID. As we start to move forward with this, it's going to be really important for hospitals to have these quick wins, right, reestablish themselves and I think address some of these issues that are top of mind in the organization. I think the quicker that they can begin to move forward with a plan and a direction, it gives a sense of calmness for the whole organization.

Daniel Marino: Well, Bill, I really want to thank you for your time today. This was great. I appreciate your insights. Clearly, your knowledge of the industry and your discussion with other leaders is really critical as we start to think about how we provide insights going forward to other health care leaders. So I really appreciate your time.

Bill Bodnar: I appreciate everything you guys are doing to connect with some good thought leaders. I enjoy your podcast.

Daniel Marino: Well, thank you, appreciate that. So in closing, Bill brought up a couple of really key issues that I think our leaders really need to consider as we're moving forward. I think the one that I really enjoyed was the focus around being very customer-centric, thinking about how we need to reconnect with our patients, taking into considerations maybe some non-traditional approaches, as well as then really focusing on the workforce and in particular addressing the issues of burnout, addressing the issues with work life balance, almost creating more of a competitive nature for us within our workforce and how we can and continue to provide value and reconnect our staff, our employees, our teams, back to their mission. Then lastly, I think the best advice is that we really need to slow down, take a deep breath, think about the great things that we've been able to do and have a clear focus for us going forward.

Daniel Marino: So again, I want to thank Bill Bodnar for his time today, wonderful discussion. Until next time, I'm Daniel Marino. Thank you and be safe.

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About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners.

Daniel J. Marino

Podcast episode by Daniel J. Marino

Daniel specializes in shaping strategic initiatives for health care organizations and senior health care leaders in key areas that include population health management, clinical integration, physician alignment, and health information technology.