Healthcare Voices podcast series: with Jim Dover, Avera

Hello, and welcome to the Becker’s Hospital Review podcast. My name is Will Rielly from R1. Today, I am joined by Jim Dover. Jim is president and CEO of Avera Health in South Dakota. Welcome to the podcast, Jim. Thank you. Glad to be here. Let’s start by telling us, please, a bit about yourself. Tell us a bit about Avera, the community you serve. Set the scene for us. Sure. Sure. Well, I’m president and CEO. I’m about forty years into health care leadership, bacteriologist by training, and found out I didn’t want to stay in the lab all my life, so went on to get my master’s in hospital administration. Never looked back, so it’s great. VeriHealth, four states that we cover, about seventy two thousand square miles, or about a three point five billion dollars integrated health delivery system across South Dakota, Minnesota, Iowa, Nebraska. And we also have a very large ambulatory platform. We have over three hundred clinics, probably do over two million clinic visits a year, and we also have a provider owned health insurance company, along with long term care and post acute care. Excellent. Okay. What’s what’s on your mind as an organization as you go into twenty twenty six? What are some of the key the key priorities that you’re you’re looking at? Yeah, so probably about three. First, we just launched our three year strategic plan called Illuminate, and so we want to make sure that we effectively operationalize the strategic plan. Had over two hundred stakeholders write the plan, so we feel pretty good about it. Number two is we’re converting our electronic health record to a new system, and it’s really no longer an EMR. It’s an electronic health information system, not a medical record. And so the operational changes necessary for something like that across our three hundred plus sites of care is pretty phenomenal. So that’s gonna happen in the late spring. And then the third one is, we’re a Catholic health organization, and some of our legacy facilities have been in the upper Midwest for well over a hundred years. And so adapting and changing to the current environment and the future environment in a world that is becoming more and more secular, I think sometimes is a challenge for faith based health care organizations. Got it. Okay. Thank you for setting the scene. I’m sure we’ll come back to some of those things as we talk. I want to start by talking a bit about technology and new technology. Yeah. Health care’s sort of historically moved relatively cautiously when it comes to new technology. Is that still true? And is that the same with AI? Or or do you see a difference in how health care is using and adopting new technology? Well, I think the jury is still out. I think that some some health care organizations have been, you know, pretty good to adapt to new technology from partners they trust. And there but some have been too faddish, and so we all know about those scary stories of jumping on a fad too quickly and then finding out that it fizzles out. So So I think some of us are more cautious than others. That being said, I think when it comes to AI, what is truly different about AI, for me personally, I believe AI will do to data and information and health information what the Internet did, to how we communicate with each other. I think it’s that big of a sea change. So for me, I think it goes one of two directions. There are those who say, We are an AI company. We’re developing AI. And here, we want to be your AI partner. Now use our tool across your entire platform. And then there’s the other route, is our trusted electronic health record system, or HIS system. They’ve adopted AI tools. And the one we’re going to has, you know, seventy, and they’re gonna be at a hundred by the time we join them. And so do we say, nope. We’re picking AI. Now everybody’s gonna use it, or do we say, how have you as our trusted partner, whether it’s radiology, laboratory, the list goes on, how are you using AI to better the patient clinical outcomes? So I see that kind of be the two tracks. I think for us, would probably be the latter, not the former, with a few exceptions. We actually use ambient listening in all of our clinics, and the data, after a year of using and implementing it, is in. And basically, the providers, the physicians, have said sixty three percent increase in satisfaction for them from a work perspective. And, you know, physicians historically have really struggled with the amount of time it takes for the the computer piece of their job. And plus, they have it’s reduced their cognitive burden by fifty one percent. That’s a pretty outstanding result. Now there’s a company we use for that. This is their product. This is what they do, and it integrates into our electronic health information system. So I think it’s gonna be a hybrid, but it’s mostly trusted partners. How have you adopted it, and how does it apply to the needs that we have? That’s and and yeah. So that trusted partnership way is the how you’re thinking about it. Because Yeah. I wanted to ask you about there’s a there’s a couple of archetypes in health care innovation. Right? There’s there’s incumbents and insurgent. Yeah. And you’ve got the incumbents maybe who are your established, maybe players in general. Yeah. Be they providers, payers, or big technology providers. Yeah. Then you’ve got your insurgents who are, you know, knocking at the door. Right. And so the way you look at it is leaning more towards your incumbents and adapting this new technology in line with those relationships. Yeah. Yeah. I would add another nuance to it. Yeah. And this is an important nuance to me. Yeah. So there are groups that we work with, and you have to go back to organizational intent. So, you know, there’s some really large payers out there that have demonstrated through the use and adaptive AI technology, they don’t have good organizational intent for us as a provider. And so as a result, just in this last year, we’ve terminated two of our provider contracts with MA plans because their intent using that technology is not to further patient care. Yeah. And the intent was the exact opposite. It was in order to enhance their stockholder premiums or payouts versus other organizations who might be a start up, and the and the ambient listening is a great example. We used a start up company That brought a great product, solved our problem, but their intent was, they go, how can we actually make the physician’s life better? And so, again, understanding what’s the intent behind why they’re using the technology, that’s who we’re gonna partner with. Yeah. And that’s who we will use. And so we always go to what’s your intent in using the technology? Yeah. And then we let the conversation go from there. Yeah. Okay. Makes makes total sense. You you brought up payer relationship there and payer dynamic. I’m curious what you think about whether some of these new technologies are going to help improve what’s been a troublesome relationship for many. Yeah. What do you think about that? Oh, I think it can. Yeah. I think it can. And we have to we on the provider side now remember, our organization, we have both a health insurance company and we’re on So we have both sides of the house on that one. So we see the AI technology on the provider side of, you know, this can get a whole lot smarter for us when it comes to, you know, if there is fraud, waste, and abuse, it actually makes it a whole lot better to get narrowed down and actually find the real stuff versus casting this net that’s so broad and everybody gets caught up in it. And then on the provider side, when it comes to population health, you know, our ACO, the chemical care organization that we have, we have saved the federal government money the last three years running. Now we have to share it with them, and then we get to keep some of it. But, you know, at the end of the day, we are using those tools to actually reduce admits per thousand ER visits and make best care appropriate and those sorts of things. So I think I think it it can actually improve our relationship versus the fractured nature that we find ourselves in today. Yeah. And and that’s through improved visibility and maybe is providing a new platform for collaboration Right. Claim adjudication, and so on. Right. And there are some there are some payers out there, quite honestly, who say, here’s your data. Here’s everyone’s data. And so that’s wonderful. And there are some that go, no. We hold the data. We’re only gonna give you what we want you to see. That goes back to organizational intent. Look, if we wanna improve it for everybody, we want to get only the correct utilization, better better clinical outcomes, reduce morbidity and mortality, give us all the data. If you don’t wanna share all the data, then why not? Yeah. Fair enough. Staying in the administrative realm, we see a shift in health care administration, financial administration in particular, from what’s been a very labor centric paradigm to much more of a technology centric paradigm linked to all of the things that we’ve been talking about. How how is that playing out for you? Well, it’s interesting. Now we’re we have a big rural footprint. Right? So you have to think about, okay, how does that work in that big rural footprint? Right. And so, you know, we’ve tried where, you know, you have this small clinic in the rural area. You only get so many dollars, and so people have to wear a lot of hats. Right. And so we experiment it with kiosks. They’re too cost prohibitive, etcetera, so we don’t do that from a technology. But the technology of kiosks might be very appropriate in a very large urban environment. So instead, what we do is we use you understand telehealth, we use teleregistration. So the clinic visit, the patient’s there, but they can actually go and see a live person on a screen, and they do their registration through our centralized registration group. Right? So we’re using technology to help utilize our our labor resources to the best way Yeah. And in another location, we actually have patients who self room themselves to the clinic room. Once they register, they’re given a they’re given a a number, and then when it shows up on the screen, it tells them what room to go to, and they self room themselves to the room. So, yeah, technology can actually help you turn that curve. Yeah. But, again, it sounds like it’s all about trying to making sure it fits in with One size doesn’t setting Yeah. The objective that you’re trying to deal with. Right. Yeah. Yeah. Yeah. Makes sense. You’ve talked about using new technology. You’ve talked about using AI technology. Has that brought any new challenges to you as a c suite leader in terms of governance and oversight and Absolutely. Yeah. Okay. Oh my gosh. Okay. So and we now and guess what? We now have a governance committee, and it’s got the right people on it and those sorts of things. But I think the most glaring example is, you know, our CIO walks into my office and says, just wanna let you know we shut it down. I mean, that’s how he opened up the conversation. It’s like, well, shut what down? He said, well, we had a couple clinics that they went and got their own ambient listening and said, hey, this works great, linked it into the system. Of course, there’s all kinds of problems, like how did they do that in the first place? But they kind of did the Sub Rosa acquisition of software and implemented it. And it’s like, love the creativity, love the initiative, but there are a few steps to go through, like a BAA agreement, and, you know, have they passed an IT security test, and and that sort of thing. So so what happens is when it starts to spread so fast and people have it in their home Right. And if you haven’t been keeping up as a system or an organization, they’re bringing it whether you want them to or not. They being our our people. So cute. And they’re our most valuable assets. So you better keep up with them. And I think that’s been our biggest challenge. So we do have a governance committee. It’s not that big, but we have all the right representation. We have three subcommittees. So we think we have a better handle on it today, but there’s a point where it’s like, it was coming faster than we could keep up with. Yeah. Okay. And have you had new roles in the c suite or near the c c suite because of that? Or is it bit more about just like No. It it’s we all have to be ex not experts. We all have to be content savvy about AI, and then how does that how is that going to improve our future, really improve our clinical outcomes? Yeah. Now I would tell you that cybersecurity ends up being the role that we have really had to beef up that department. Yeah. Because with AI comes bad actors. Right? So we’re not sure anyone’s using AI. So the people who wanna hack, the people who wanna get ransomware, they’re using AI too. Right. And so now the phishing attempts have gotten incredibly, incredibly sophisticated, where my staff are getting they’ll get a cell phone text saying it’s me, and they’ll say, can you get a you know, go ahead and, you know, do a whatever or do a password reset and those sorts of things. So so we have to be we’re finding that we’ve had to beef up cybersecurity. Yeah. Yeah. Okay. Yep. Make makes sense. Let’s let’s round it out then with with with your maybe your your hopes. You’ve talked about using new technologies from different different vantage points. But if you think about, like, what you what you hope some of these new technologies are gonna be able to to do. What does it look like if you’re a patient or a provider or an administrator? Yeah. Well, you know, and I’ve been a patient in one of my hospitals before, where I was very sick. And I looked at all the staff who were working so hard to make sure that I made it out after nine days in the ICU. And I couldn’t help but think that if AI was looking at all my clinical data, saying, I think this is what’s going on, because they’re trying to figure out what’s going on. And they did, but I can’t help but think that AI couldn’t have turned the flywheel faster. And so what I hope for is that for our clinicians who are taking care of our patients, is that the AI becomes this assistive tool that says, you know, Doctor. James, know, your patient 230A, you know, they’re overnight, their vitals went to and therefore they’re kind of like first on your priority list to see this morning. Because what we rely on right now is our nursing team to do clinical reviews and to shift reviews, they review it, and then they go, I think I’ll call Doctor. James because I think this patient something’s not right. AI should be able to say what’s not right and be able to put it on a priority list and notify both the nurse and doctor James at the same time to and then we can use nursing for let them be even function at a higher level And not overburdening them. So I think if AI can help them with that, that’ll be great. If it’s just one more key to hit on the keyboard, I think it won’t work. So that’s one hope. The second hope that I have, so I have two hopes, and that is, when it comes to management decision making, when we make really big decisions, has anyone yet given all the input into whatever the AI technology is and say, what do you think we ought to do? Because we stand in front of boards and say, based on our judgment and based on this information, that information, you know, we made a three hundred million dollar capital decision to build something, and we never went to AI and say, what do you think our probability of success on this is? I I think there could be a way, and I don’t I’m I’m not worried about it taking away leaders. I just said, again, assistive tool if it’s a good enough assistive tool for clinicians, it should be a good enough assistive tool for leaders in terms of their decision making. So we can’t say, hey, docs. It’s good for you. Use it. But, oh, no. Don’t bring it to C suite. Doesn’t work that way. Right. Right. Other hopes or thoughts for twenty twenty six? At the start, you mentioned Luminate. Yeah. Do you wanna end by telling us a little bit more about Sure. Yeah. No. Our strategic plan, we have five pillars, and we’re very excited about it. And one of our key pillars is it’s interesting our first pillar is all about the exceptional patient and employee and community experience. Culture. And we feel that our culture is so strong that actually people are coming to look to work for us because of our culture. We may not make as much money, but we brought back the enjoyment in terms of health care and why they got into it in the first place. So that’s really important for us as an organization, and our faith based organization. And we have number of, and we have to continue to innovate, I mean, across a big, rural platform. If we’re not innovative, then we have a real tough time. Number three is our dynamic physician and provider enterprise. We employ over thirteen hundred clinicians. In forty two years, I’ve never admitted a patient. So that has got to work really well, because that’s where our patients interface with us, is with our clinicians. And then the fourth one, though, is growth. So I see us growing. We have to continue to grow organically and otherwise, because in today’s environment, size and scale matters. And when I say three point five billion, I go, wow, that’s kind of a big number. But five years from now, it’s got to be a bigger number just in order to stay a strong, thriving, independent organization. Then the last one is leadership and essentiality. You know, we have to be essential to our communities. And if we’re essential to our communities, then we know we’re doing a good job. So those are the big five. Wonderful. Yeah. Jim, thank you so much for talking to us today. Thank you for having me today. Been great.