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- [00:03]
A
According to the World Health Organization, health is a state of complete physical, mental and social well being and not merely the absence of disease. Health is a positive concept. Right now, we have a healthcare system focused on disease. What does the future of health and healthcare look like? And how will precision medicine and artificial intelligence transform health? Hi, everyone, I'm Lynne Thoman and this is three Tay Takeaways. On three Takeaways, I talk with some of the world's best thinkers, business leaders, writers, politicians, newsmakers and scientists. Each episode ends with three key takeaways to help us understand the world and maybe even ourselves a little better. Today, I'm excited to be with Sam Hazen and I'm excited to learn about the future of health and healthcare. Sam is the CEO of HCA, one of the largest healthcare providers in the world. HCA has nearly 200 hospitals and more than 2,000 additional sites of care, including surgery centers, freestanding emergency rooms, urgent care centers, and physician clinics. They provide health care in 21 US states as well as in the United Kingdom. And they have more beds than any other US Hospital, including the Cleveland Clinic, Mount Sinai, New York Presbyterian, Weill, Cornell, Yale, New Haven and others. They treat over 40 million patients each year. Welcome, Sam, and thanks so much for joining three Takeaways today.
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B
Thank you, lan. Glad to be here.
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A
It is my pleasure. What are some of the opportunities in healthcare that you're most excited about?
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B
Well, you said it. Healthcare is a dynamic space, Lynn. And for HCA healthcare, we play a role in a very large industry and area of healthcare. Our role is more in delivery. We're in the delivery system. We provide hospital services, as you mentioned. We provide clinic services, emergency room services, all these different services to patients who need us whenever they have an illness or an accident or deliver a baby or whatever the case may be. It's interesting. I've been with a company 42 years and I've seen a lot of different cycles, different experiences, different things start to impact the industry. I do think our industry, at least in our space, is at an inflection point. And the inflection point is really driven by these emerging technologies that exist. And in our company today, we take care of a lot of different patients. But those patients have these enormous patterns where if you're a mom delivering a baby in Miami, it's similar in many respects not identical to a mom delivering a baby in Dallas or Denver or Salt Lake City or whatever the case may, or London, England, where we have services also and the opportunity for us to learn from these patterns through machine Learning and artificial intelligence and then bring those learnings, those insights, if you will, back to the people who are delivering the care. A physician physician or a nurse or an other caregiver is really a powerful moment in time. And for me, in 42 years, Lynn, with our company, I've noticed it's nobody's fault. It's just somewhat organic that there's a lot of variation and a lot of bespoke care that's given to people simply because it's individuals making individual decisions as best they can with their training, their experience, what have you to the patient. And if HCA can use its data to help those decision makers, those support caregivers, with all of these learnings from the patterns, again using artificial intelligence in the emerging technological capability that that presents to the bedside in the moment when decisions need to be made. I think it's going to lift up quality in a very significant way. It's going to create greater transparency for the patient and it's going to make the whole system more efficient. And those are all object that everybody has, government has that, employers have that, patients have that as objectives. And we think we can be a part of the solution with our abilities to use that technology, use the unique attributes of HCA and help move the organization forward.
- [04:49]
A
That's wonderful for healthcare. What kinds of improvements are you seeing in advanced diagnostics and treatments?
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B
We partner with a lot of vendors, we partner with drug companies and others. Clearly in certain components of our business, oncology care, for example, we continue to see new drug development. HCA Healthcare, its research institute, the Sarah Cannon Research Institute, which does a tremendous number of clinical trials for new drug development in the oncology area has generated more first in man new drug development of any entity. So that entity continues to grow and we see opportunities for more research and more clinical trials to support patients and hopefully new drugs there. On the technology side, certain robotic solutions have allowed physicians to be able to operate on patients in ways that they couldn't before. And this has created extended life for cardiac patients. It's improved patients who had certain problems in their stomach area where things can get to because of robots. So that's an example I think on the diagnostic side and I'll end with this because diagnostic testing with computerized Connecticut scanners, MRIs are so advanced so fast now and they can produce such clarity for physicians that in many instances it's starting to replace more invasive diagnostic procedures, more time consuming diagnostic procedures for patients and allowing them to get an answer and start their care process if they need it more Timely and more economically. So those are some examples. There's way more than that. There's so many smart people in this space. There's so much research that goes on. So I'm excited about the future for healthcare.
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A
Can you talk more about robotic surgery and how that represents a better solution or a better outcome for patients?
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B
I think it's less invasive for patients so that the patient has less recovery time as a result of that. That's number one. Number two, it's allowed, as I mentioned earlier, Lynn, physicians to be able to get to parts of the body they couldn't get to with their hands previously. So the ability to move the robot inside of a person's body is advanced, and it has more capability. So they can get to a tumor, they can get to something else and remove it in a way that is better. The third thing is it's more efficient and it's gotten to where physic are really capable on robots, the teams are really capable about transitioning. So all three of those things have yielded, I would submit, good value for the system. And I think that will continue to grow because robotic surgery is starting to be more pervasive in other areas, in orthopedics, in spine, in neuroscience areas. So I think that will continue to grow and help physicians as they continue to find new ways to deal with patients.
- [08:00]
A
HCA is unique because of its scale. The fact that you treat 40 million patients each year. Can you talk more about some of the advantages of that scale?
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B
I tell our teams this all the time, Lynn. Having scale is one thing, using it effectively is another. And I think as we've evolved as a company, we're almost 55 years old, HCA Healthcare, we've learned over time how to use our scale more effectively. And I mentioned earlier, the next iteration of scale for us is using our data more effectively through machine learning, artificial intelligence, and bringing all these insights. That's a perfect example of where we are in our life cycle as a company is what's the next opportunity to use scale. But historically and today, I would say there's three areas that we have been able to leverage our scale effectively. One, and these are basic areas, is we've economized where we can. In other words, we have a lot of redundant functions across 185 hospitals or so, and a bunch of outpatient facilities, administrative functions like our billing office or our purchasing offices or accounts payable, what have you. We've consolidated those and really created a lot of economies for the company and lowered our average cost. That's the first area. The second area is on again, another business term. And it's just we've been able to aggregate our resources and our access to capital as one sort of consolidated entity allows us to get, you know, sufficient capital at a reasonable cost so we can invest in our business. We're a heavy capital intensive business. Hospitals require a lot of capital. Buildings, technology and so forth were labor intensive also. And having sufficient access to capital through our scale has allowed us to invest in our business really at record levels. The third thing which is really exciting is something I call intellectual capital, Lynn where we're like a one trick pony. We have a hospital in, as I mentioned, in Miami. We have 20 in Miami. Actually, we have 20 in Dallas, we have 10 in Denver. They all do a lot of the same things. And we learn from each other all the time. And we challenge ourselves as a team on how do we take these learnings and share them across the organization to be a better employer, to be more engaged in the community, to partner with our physicians differently, to provide a better care process for patients. So best practices, harvesting those is really powerful for us being a better organization. And I think if I had to add a fourth, it would be our culture. We have a unique culture in our company. We try to do the right thing, we try to do it consistently, but we're disciplined, we're detail oriented. And that culture permeates our management teams, it permeates our leaders. And we think it adds value to our patients because one patient only wants the details around what's going on with them. They're not worried about the other 42 million in HCA. And so the disciplined approach, trying to do the right thing for the patient, allows us to get outcomes that are at best on par with the industry, but in many instances above the industry.
- [11:36]
A
Sam, how is artificial intelligence a game changer for hca? And can you give some specific examples?
- [11:44]
B
That's what I'm most excited about, Lyn. For us, artificial intelligence has application across a host of what we do as an organization. So I'm going to give you the two boring ones. First, in the administrative side of our equation, we have to do a lot. Healthcare is heavily regulated and it's complicated because there's third party payers, insurance companies and so forth embedded in the fabric of the industry. All these administrative functions have real potential to be done better and more efficiently. So we have a dedicated domain, if you will, to eliminate some of the friction that exists in our administrative functions. The second boring area is operationally and again, this will help our patients? We believe so. We have to manage patients in our emergency rooms. As an example, Lynn, we see 10 million emergency room patients a year. We see 4 million patients in our urgent care centers. And we think artificial intelligence can help us with throughput, getting a patient through the emergency room faster. And there's not one of those 10 million patients that wants to stay long in our emergency room. They want to get the heck out of there and go home. And so if we can infuse demand predictions, staffing, ancillary test handoffs that go on. If you've ever been in an emergency room where you're waiting on the lab person to bring the lab test back so the doctor can give you a sense of what's going on, we think we can enhance the speed, the transparency, and the effectiveness of those processes operationally and really make our throughput better, helping the patient get to where they want to be, which is hopefully home, the last area. And it's the holy grail for us. And this is the exciting area. And Lyn, this is where we get to leverage the data sets, the standardized data sets that we have in our company. Of every interaction that a doctor, a nurse, a respiratory therapist, a drug has happened on a patient, all of that will be de identified. We won't know it's you or me, but we'll know that it's a total joint patient who had their knee replaced, a mom who delivered their baby, and see all of what went into the care. And was it a good outcome? Was it an okay outcome or not so okay outcome and learn and learn and learn. Because it's nothing but patterns. And as we learn those patterns using artificial intelligence and bringing that to the foreground. And that's what I see artificial intelligence doing is grabbing all of this information from the background of these patterns, the background of the medical record that you or I would have if we were in a hospital to the foreground, so that the decision makers, the caregivers, can interact with those insights and then adjust, not usurp, but adjust the process of delivering care for that patient and nuance it possibly in a way that is informed differently from these learnings that exist inside of these incredible patterns that we have. And if we can support that human intelligence with artificial intelligence and then make the human intelligence that much better, then our patients are going to benefit in ways that I don't even know if I could explain. So I'm unbelievably excited about that. Those would be the three areas that I would share with you, Sam.
- [15:21]
A
You've talked about some of the opportunities ahead, especially AI. What challenges do you see?
- [15:27]
B
Well, at a macro level, I think there are a couple of big challenges. One is cost. There's concerns in the US especially with health care costs being roughly 17% of the GDP now. I think there are reasons for it that are in fact real that explain some of it. But nonetheless, there is a concern that there's not enough value for that cost. So that creates pressure on government from a fiscal standpoint, because government sponsors a lot of healthcare in the U.S. and so you've got government budgets under pressure, you've got a growing component of the healthcare industry that's influenced by government policy. So that would be the first thing. The second thing would be workforce. At least in our area, we're in the people business. I mean, we have people taking care of people. And to the extent we can use scale, we can use best practices, we can use technology to help people, that's a better formula. But workforce is needed. And so policies around workforce development, nurses, doctors, other technicians, are important to people having access and the quality care they deserve. And so those would be two big areas. Now, HCA Healthcare is focused on workforce development. We are the largest educator of physicians in the country, with roughly 5,500 physician residents training at over 70 teaching hospitals in our organization that will grow. We're doing the same thing with nursing. The Galen College of Nursing is a nursing school that we acquired in 2020. And by 2027, the end of 2027, we will likely be the largest educator of nurses in the country. So we're very excited about that. So those two areas, plus some other components of workforce are really important to the future. I think of health care in the US and between private solutions and then public policy, coming together to support enough capacity for workforce is going to be very critical, I think, to long term success.
- [17:42]
A
Sam, what advice do you have for patients?
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B
Well, you know, my mother passed about eight months ago, Lynn, and I'm sorry. Well, thank you for that. She was almost 95. She was a wonderful woman. She had a great life. And she's like no. 1 prize for me. I've had almost 95 years, but just watching the process, not at an HDA hospital, but at another hospital. I think for patients, they need to do a little homework in advance of just interacting with the system, understand their rights, understand their insurance coverage, understand where they may need access to certain components. Because a lot of patients are what I call reluctant purchasers. They don't want to purchase healthcare until it's time to purchase healthcare and then they're sort of in the dark. That would be the first thing. The second thing I would say is ask for transparency, ask questions. What's next? How might I best navigate this system? Transparency is important to patients and we're trying as a company, Lynn, to create as much transparency as possible in helping them navigate the system, understand their information, and support them once they leave. So those would be two things I would suggest.
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A
Sam, what are the three takeaways you'd like to leave the audience with today?
- [19:08]
B
One, hard work matters and you have to have a work ethic. And if you're in a leadership position, you have to be willing to solve problems so your organization, your teams can be successful and you have to work hard to do that. That's the first thing. The second thing is you've never arrived. Keep learning. I mentioned that we try to learn from each other. Well, I try to learn from ourselves as well as learn from other organizations. So I think this desire to keep learning is critically important. And then the third thing my parents taught me, again, pretty basic stuff, but it has powerful implications, is just treat people right. And we're in the people business where people taking care of people and we get into complex decisions and I'm like, well, what are we trying to do here? We're trying to take care of a sick person. Let's focus on that and then we can figure out everything around it.
- [20:07]
A
Sam, thank you. Thank you for your time today and thank you for improving healthcare for so many millions of people.
- [20:16]
B
All right, Lynn, have a great day. Thank you for having me.
- [20:19]
A
If you're enjoying the podcast, and I really hope you are, please review us on Apple Podcasts or Spotify or wherever you get your podcasts. It really helps get the word out. If you're interested, you can also sign up for the Three Takeaways newsletter at3takeaways.com where you can also listen to previous episodes. You can also follow us on LinkedIn, X Instagram and Facebook. I'm Lynne Thoman and this is three Takeaways. Thanks for listening.