Healthcare Voices podcast series: with Lynn Fulton, Maui Health System

Hello, and welcome to the Becker’s Hospital Review podcast. My name is Will Riley from r one. I am here today with Lynn Fulton. Lynn is the CEO of Maui Health System. Welcome to the podcast, Lynn. Thank you, and good morning. Morning. Lynn, to start us off, can you tell us a little bit about, your role, Maui Health System, and the community that you serve? Yes. I’d be happy to. I joined Maui Health two years ago, as the CEO, and Maui Health is the only hospital on Maui. We operate actually three facilities. Maui Memorial Medical Center, we have Kula Hospital that’s in upcountry Maui, and then Lanai Hospital on the island of Lanai. So we are the gateway to health care really for our community. We partner with a lot of the independent physicians and physician groups on the island as well as with the systems that are on Oahu and the other islands. But if you need care on Maui, hospital care, you’re going to come to Maui Health. Got it. And tell us about the community that you serve. I imagine it’s an interesting mix of residents and visitors. What does it look like? It is. Maui enjoys a robust visitor presence that, you know, we love having our tourists. However, when we look at the demographics for most of the individuals that come to Maui Health, they are our residents. And so we feel deeply about our commitment to our community. We serve the entire island of Maui as well as the island of Lanai. So we’ve we view that as our service area. However, our emergency department does see a fair number of visitors as they come on vacation and maybe partake a little bit too much on what the island has to offer. Okay. Okay. Like, how many people live on Maui roughly? Like, what Hundred and fifty thousand Okay. People call Maui home. Okay. Okay. Got it. Got it. And, like, what’s the make makeup of that in terms of, like, the population from a medical perspective? Are they old? Are they young? Is it Medicare? Like, what does that look like? It’s very similar to other rural communities, honestly. You know, before coming to Maui, I served the OSF Health Care System in Bloomington, Illinois, and that’s in McLean County. Very similar demographics for number of people as well as what we have on Maui. You know, we are an aging demographic Just like a lot of areas are. However, we do have a number of young families as Hawaii enjoys multigenerational living. A lot of people that were born on the island wanna stay on the island and stay close to family, because that’s our culture, and we love that. And that’s really been an opportunity for us to be able to bring them into health care fields so that they can continue to treat their friends, family, and neighbors. Got it. Yeah. Okay. I wanted to ask you about workforce, actually, because one imagines, you know, everyone would want to live on Maui, but perhaps that’s probably not as simple as that. How what’s it like attracting a workforce on maybe both the clinical side and the administrative side? You know, it it is both. You know, there’s people I I don’t know if a day goes by when I’m on the mainland that people don’t say, oh, it must be wonderful to live on Maui, and it is. It’s a beautiful place. However, it is it’s not always easy to live on an island. And when you’re recruiting from the mainland, our costs are higher. You know, today, about ninety percent of the food on Maui has to be shipped in, and so that can that just shows you, you know, the increased cost of living for the people that live there. So that is an added hardship as we’re recruiting. So what we’ve really done is look at how can we train on island so that we’re able to really promote from the community that we serve. And we’ve had a lot of success in that. You know, we coming from Illinois going into Maui, I was actually really happy when I looked at our fill rate for nursing vacancies. And we have, we have really great nurses, at Maui Health, and we have a wonderful training program that’s in partnership with University of Hawaii. So in that area, do really well. Now in the areas that we don’t train on island, that’s where we have a hardship. So respiratory therapy, imaging technology, and today, physicians. You know, though, that is one thing that we do have a strategic initiative that we’re starting so that we can offer, eventually, training for physicians on island. And how about on the administrative side? If you think about, I don’t know, like, patient facing functions, scheduling, and maybe revenue cycle functions and and so on, how does that work out from a staffing perspective? That that can also be difficult, you know, because we, I hate the word competition, but we do compete with all of the hotels and the resorts For a lot of that talent. Sure. And so we have to be competitive. Yeah. But sometimes people would rather work in hospitality than health care, and so we really have to look at that. We try to keep as much as we can on the island so that we are employing the people that depend on Maui to live. However, in some areas, we have had to outsource and or allow people to work virtually from the mainland. I was gonna ask you then about technology because one would imagine then in that kind of environment that technology be could be quite a good enabler potentially of different ways of working both again, clinically and administratively. Are exactly correct. We have had to really expand that even just in the two years I’ve been there, allowing some of our employees to work remote. Now when you deliver healthcare, that is still very much a human experience, which is why I always say our first choice is always to have somebody there. But where we can’t do that, we do have areas that we allow people to work remote, if their role is completely non patient facing. Got it. Yeah. Okay. And what kind of technology infrastructure are you using, to to help make the health system run and make all that work? Well, we have, you know, the usual. You know, we we, operate off the Microsoft Office suite. And with Teams, you can do almost everything remote. I’m sure you join me. And how many Teams meetings do you have in a day with individuals, sometimes in the next office and then sometimes across the Pacific Ocean? We do enjoy great connectivity on Maui, which is something that I’m very thankful for. So we are able to connect with our partners that are on the mainland. Got it. Got it. Got it. What about, like, new technologies? Are you introducing any exciting new technologies as you as you make this all work? It’s a a great question, and we have a lot on the horizon. You know, when when we look at our since I arrived two years ago, you know, one of our first objectives was to solidify our workforce. You know? How do we make sure that we have the right people in the right pipeline so that we can staff our all of our facilities? And we’ve done a pretty good job with that over the last twenty four months. We still have some work in some areas. However, we’re feeling a lot more stable in that. And so now as we move forward, we’re looking at areas for technology. You know, one of the things that we’ve been evaluating is the instance of Epic that we’re on today, knowing that it may not be what we want for the future, you know, we we would really enjoy a more what I would call out of the box Epic because as Epic brings on their AI tools, we want to be able to deploy those, for our clinicians as well as our support staff. So we’re really looking forward to that in the future. Right. Okay. Okay. Very good. Can you talk a little bit about the the payer landscape that you work in work within? Just break it down for us, perhaps. Sure. You know what? Again, it’s it’s the same and then different from what I was used to. You know, in Illinois, we had especially central Illinois, we had less managed care than what we have out in the West Coast and in Hawaii. You know, predominantly, Kaiser Permanente and Blue Cross Blue Shield are the the two large commercial payers, in Hawaii. We have others, but those, I would say, the dominant. And then, of course, Medicare, Medicare Advantage, and then Medicaid. Now the state of Hawaii has been very progressive, in their support of health care for people on the islands. And so our, our Medicaid, we are reimbursed fairly well for Medicaid. They did some parity work between Medicare and Medicaid that have helped us, and the hospitals, in Hawaii. Got it. Got it. And is there a tension in the dynamic there? You said not perhaps, unusually, with with the government payers, but on the commercial side, or is it a is it a collaborative? Well, I smile as the best way to answer it. And I would say with the with h r one, big beautiful bill, whatever you wanna call it, you know, there is I have a a lot of discontent with where that’s going to bring us over the next twenty four months, especially, you know, when you look at three forty b and some of those those programs that we rely heavily on as a rural hospital serving an island. Yep. Now with the payers, you know, the payers are up against similar mountains that we are in health care. Right? As you look at the numbers of individuals that are entering the commercial market versus the aging and the increased acuity that we’re seeing in the hospital, their costs are going up as well. So I think there’s always that push and pull between hospitals and payers. I now I would leave it at that. That’s that’s probably best described describe it. We want more money. They wanna give us less. Sure. Sure. Sure. Sure. Sure. How how what what are some what are some ways through that? I mean, you you talked about, like, your Epic upgrade, for example. Is technology gonna help you with that in terms of maybe automating processes or increasing visibility into things? Like, what are what are some things that you can do? It absolutely will. The other, initiative that we’re working really hard and also partnering with our our Kaiser Permanente partners on is what we call care without delay in better managing patients through their episodes of care and their post hospitalization. You know, when you look and if a patient is supposed to have a one point o ratio for their hospital stay and you’re at one point two, that means you’re zero point two over what that patient needed. And so you’re expending additional resources to care for a patient that should have been discharged. And so we’re really looking at what parts do we need to own as a health system. Did we need to get them into imaging faster? You know, were we able to begin their care process as soon as possible? Were we actually planning for their discharge when they were admitted to the hospital? So we have a number of what I would call operational efficiencies that we are looking at. And we’ve been able to make a lot of progress over the last year, but that’s really what we have plotted out for the next twenty four months is to continue on that road because that will help us. It’ll help with staffing. It’ll help with bed availability, and it’ll help us with our cost infrastructure. Got it. Yeah. Okay. What about partnerships within the community? Like, how how how do they help you run an effective health system? You know, they’re really imperative. I I went to the opening session today, and the CEO from Providence spoke a little bit to partnerships. And I I couldn’t agree more with everything that he said. And as I look at Hawaii as a whole, you know, there’s not a lot of population. And so we really do need to lock arms together so that we can care for the communities that we serve. And that’s really what we’ve been doing. You know, how do we meet with our hospital association, and how do we leverage the data that we have to be able to connect to care? And also to the non hospital partners. You know, we have a lot of nursing homes, for instance, skilled nursing facilities. We have rehabilitative care. All of those providers are really imperative for us to be able to treat our patients effectively and then get them on to their healing outside of the hospital. Got it. Yeah. Okay. Let’s wrap it up with your, perhaps you could us a few of your key priorities for next year. You talked a little bit about technology. What else is on your agenda? You know, one of the number one things is our culture. You know, there’s a lot of changes coming to health care. And at the end of the day, we are people taking care of people. And so the culture and how we connect with each other is really the most important thing that we do. And we’re going to lead with that over the next year on how do we better connect with all of our employees so that we can hear their ideas, their thoughts, and a little bit of connecting that why with them as we move forward and continue to advance care on Maui. Wonderful. Lynn, thank you very much indeed. It’s been a pleasure talking to you. Thank you. Thank you. Thank you.