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Becker’s Healthcare Podcast
Andy Mueller, MD on Redesigning Primary Care and Advancing Affordable Healthcare at MaineHealth
00:16:35
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- [00:02]
A
The most important healthcare decisions don't happen in isolation. They happen when leaders come together. Becker's 16th annual meeting brings together more than 3,500 hospital and health system executives this April in Chicago. With 800 speakers from Ascension, Cleveland Clinic, Common Spirit, and more, the conversations get real. Leaders will share how their scenario planning for policy shifts brief breaking through value based care barriers and building clinical teams that translate new ideas into real world care. Join top decision makers in the room April 13th through the 16th. For the agenda and event details, visit BeckersHospitalReview.com and click on the Events tab in the upper right.
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B
This is Laura Deardle with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Dr. Andy Mueller, President and Chief Executive Officer at MaineHealth. Dr. Mueller, it's a pleasure to have you on the podcast today.
- [00:58]
C
Hey, thanks for having me.
- [00:59]
B
Absolutely. Now, I'm excited for our conversation because I know it's always such a pleasure to speak with you. You've got so many great things going on there at Maine Health, and healthcare is such a dynamic field. That'll be great to get your perspective on your future as well as some of the cool things that you're doing. But before we dive in, can you introduce yourself for our broader audience and talk a little bit about MaineHealth?
- [01:20]
C
Yeah. Hey, I'm Andy. I'm a family physician and I have the privilege of serving as CEO of Maine Health. Maine Health is 24,000 care team members who are really committed to our communities and patients in Maine, both our urban setting in Portland, our rural communities, and then of course, Carroll County, New Hampshire, where we have both a hospital and physician and app practices as well.
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B
That's great to hear. And you know what a huge area that you're serving in. Definitely seems like a very dynamic market. So what was the most important initiative that you led last year? What did you do and what were the results?
- [01:59]
C
We did a lot last year. And I think there really. It's hard for me to. It's like having children. I don't know that I have a favorite among them, but there are five things that we always focus on that are really important, and I think these are really important whether you're talking about healthcare today, whether you're talking about healthcare tomorrow. And that starts with the engagement of our care team. It includes quality and safety, the care we deliver, the experience that our patients have in visiting our facilities, their ability to access that care, and then the financial health of the system. And fortunately, over the last four years, we've actually made great progress on each of those five things. We kind of refer to them here as the five pack. And you know, I think if we can always make sure that we're doing well in those five areas, then it gives me great optimism and hope for the future. That's sort of the non negotiables for us. Those are the things that we do, not necessarily strategic pillars, but just sort of the things that we feel are just the table stakes in delivering care for our patients and communities. But in addition to that, I think one of the big things we've done over the last year is we've really made sort of an educational foray into sort of what capitated primary care looks like. And we've done that with a little spinoff that we've done called Trellis Health that was inordinately successful last year. But we've also taken one of our existing primary care clinics and flipped it to a synthetic capitated model and also saw some really interesting and improved results as well. And so that really gives us a great deal to kind of a lot of optimism and confidence in thinking about expanding that to the rest of our health system.
- [03:38]
B
That's great to hear. And you know, how interesting having, as you mentioned, those primary care spaces where you're doing some different things that capitated primary care, as well as, you know, how you're looking at that. Can you talk a little bit deeper on what that looks like for you, how you're able to work with your teams in order to create these programs and what are some of the tangible results you're seeing?
- [04:01]
C
Yeah, for sure. So I can't say enough good things about our MaineHealth primary care team broadly in general. We've got some amazing clinicians and care team members delivering really, really good care. And at the same time, it was really a couple years ago, after hearing about just some of their, you know, justifiable challenges. I'm a family physician myself and appreciate some of the real challenges they're facing. Sort of in a moment of frustration, thought, my gosh, it would almost be easier to sort of blow up primary care and start with from scratch. And we kind of thought, well, why don't we try it? And so we went to market, hired an incredibly successful serial entrepreneur from Silicon Valley who joined us to open sort of a de novo new way of thinking about primary care. In fact, sometimes we even hesitate to call it primary care because we don't want to conform to anything that exists today. And there were really two rules, one of which was you can never accept a single penny of fee for service payment. The second was it's got to have a standalone P and L that's positive within two years. And I think we've demonstrated we can do both. And in fact went from nothing to seeing the first patient in that new payment model in 11 months. And since that time, we've been able to see some pretty incredible results for our team that uses it. We' offered it as a benefit option to some of our care team members. We've had about a thousand use it during the first year. So we can look at that data for our own care team members and benefit members who use Trellis versus those who don't. And in an age and acuity adjusted fashion, we're seeing about a 16% reduction in admissions per thousand in the Trellis population, about a 35% reduction in ER visits, 37% reduction in specialty referrals. And for about 1,000 of our care team members on the benefit plan, it's resulted in a savings of about $600,000 relative to those who don't use it, with a 90 net promoter score and quality and safety outcomes that are outstanding. And so we just really see that this is part of the future. As we were building this, it started giving us confidence that we wanted to experiment with one of our existing practices. We've done that. And while the results aren't quite as dramatic as with Trellis, and Trellis only sees the commercial population, of course, a regular practice see everything, the results are still pretty impressive. And I think what's been most impressive are the results around patient experience and care team engagement in that clinic as well.
- [06:28]
B
That's fascinating to hear. You know, really cool to have an understanding of how you're seeing these actual models play out and how it's making for better care for patients as well as savings for the health system. So really, truly impressed. And you know, when you started working on the pay models, as well as, you know, bringing some of these changes into how the clinicians are thinking about things, did they embrace it or was there a change management period where they had to, you know, do things a little bit differently, but ultimately found it was better overall for the system?
- [07:04]
C
Well, it's interesting. I think Trellis in particular was a little bit different because it's a, it's truly a. It's a subsidiary of Maine Health, it's its own startup. And so I think people who joined that team recognizing they're going to be doing something very and embrace that, but for our regular practices, I Think there are a couple of things. I think there was general enthusiasm for trying something different. Although, you know, change is hard in the moment, particularly when you still have the demands of seeing patients in the environment. And so I think they did an amazing job of figuring that out. And then I think among the rest, we've been very transparent with our medical group around what it is we're trying to accomplish. I think there's been mixed receptivity. I think there are some who are really interested, really, because I want to go do that type of work to those who really are still struggling to understand why we're doing something different like this and everything in between.
- [07:54]
B
Absolutely, that makes sense. And I'm sure it's, you know, similar for pretty much any new initiative that you're working on or, or change that occurs. Looking ahead to 2026, what are some of the big priorities or headwinds that you're focused on?
- [08:06]
C
You know, I think one of them that we all have to be focused on is affordability. And how do we think about that, and how can we really work to change how we deliver care, to make it more affordable and accessible for our communities? Maine is not a particularly affluent state. New Hampshire is a more affluent state. But nonetheless, it's a challenge for the individuals to figure out how they're going to pay for care, particularly in the current environment. So that's going to be an area that we're going to continue to have to focus more and more on. And in some ways, that means rethinking how we engage with payers around some of our services, our own pricing, what that looks like. In some cases, it's really around how do we appropriately manage utilization, much like Trellis or our Project Horizon are doing that we referenced earlier. And then in some cases, it's around continuing a lot of the good work that's been ongoing here around appropriate reduction of clinical variation, which has the benefit of both really improving quality and safety outcomes, as well as reducing the cost to delivering that care.
- [09:10]
B
That makes a lot of sense and, you know, really is helpful to understand that kind of focus. I think looking at the affordability of care, there are so many factors that go into it and how you can really expand access and access points to the community. So from your perspective, when you think about healthcare, when you think about being able to continue to, you know, close some of those gaps or make sure it's accessible, how are you? How does that look, I guess, in the next couple of years, what are some of the things that you're planning to do in order to make sure that, you know, healthcare is still something that's affordable and accessible for the community.
- [09:46]
C
So there are a couple of things. I think one of the, one of the most important quality metrics that we probably don't talk enough about in our industry is the total cost of care on a per capita basis. I think that's something that we're going to be focusing on increasingly as a metric to hold ourselves accountable to making improvements there. The other thing we've really been doing is having a lot of conversations, but also doing a lot of listing with those purchasing care, whether that's at the federal level, whether that's at the state level, and certainly with the employers, brokers and in our community and trying to understand their frustrations, their needs, their concerns, their worries, and really trying to take that feedback and put that back into the healthcare system for improvement. And those are things that we'll have to continue to focus on. Clearly, drug costs are going to be a big area of focus. And so I think we're going to continue to work with our own pharmacy team, special pharmacy team, to think about how we can manage that, certainly not just for all of the employers in the community, but also for our own care team. You know, we're, we're a large employer and we have, you know, we're seeing the increase in drug costs and impact us as well. And so that's something we want. Going to have to figure out. And then of course, we're going to have to think about some of the other externalities that are going to impact this and frankly, put additional cost pressure on us. Some of that's going to include both the cost risks and opportunities that exist with artificial intelligence, as well as continued development of precision medicine, genomics and biomarkers that are going to really impact how we think about delivering care.
- [11:21]
B
That's helpful to understand and I really appreciate you digging deeper into some of those things that will have more of a focus in this year, especially when you're looking at some of the different challenges, whether it's access to care, financials and more. So that's really interesting to hear. What do you think the hardest thing you'll have to do next year will.
- [11:40]
C
Be, I think, just helping our care team with change. I think we recognize that we can't keep doing things the way we've done them and expect that we're going to solve these challenges. And we've got an amazing care team deeply about their patients, their communities in each other. And they've already been Through a lot of change. We've been through a lot of change as we've continued to think differently about the healthcare system moving forward. You know, one of the. Another example of how we're going to have to think about things differently side of service and making sure that we're delivering things in the lowest acuity setting that's appropriate, and that changes the way we've done things historically as a system. And so that's a lot for our care team to continue to try to navigate. But the reality is we don't have the luxury of time. We have to move quickly. And so I think one of the things that keeps me up at night is just really trying to help everyone through the amount of change that we've necessarily had to inflict on our organization.
- [12:36]
B
Absolutely. I think that is such a critical point. And, you know, it can mean the difference between doing it right and being able to weather some of these storms or having, you know, additional storms internally as well. So that makes a lot of sense. And I think when you look at that culture, being able to build teams that are adaptable to change, is there any overarching messaging that you share with them or prepare your leadership team for so that they can, you know, have that kind of team and mindset in place?
- [13:06]
C
I think it's a couple things. So I think first and foremost, really continuing to try to give the why behind the change. I don't think any of us want to make change for change's sake. It's too hard and not really beneficial. So if we're, if we are changing something, there has to be a good reason why. And so really making sure that we understand that why. And I think really we've got opportunities to do a better job equipping our leaders with that. And that's something that we're going to continue to be focused on here in the short term. And then I think sometimes even in the midst of all the change, redirecting people back to the things that really don't change. And I go back to the five pack, the focus on engagement, quality, safety, patient experience, access, and financial health. Those things never change. And so how do we continue to find those opportunities, focus on those things that will benefit us without having to do something dramatically different is also helpful.
- [13:58]
B
That makes sense. Thank you so much for digging a bit deeper there. Now, before we wrap up, I wanted to make sure we talked about growth as well. Where do you see some of the best opportunities for organizational growth in the next year?
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C
Yeah, it's kind of interesting. So we don't want to ignore growth by any stretch of the imagination. At the same time, we really kind of want to start focusing on making sure we're being authentic to our mission and not necessarily chasing the top line for chasing the top line sake. And I think that if you do that in a way that's not necessarily careful, it puts a lot of stress on the health system and the care team. So we want to be really thoughtful about that. And at the same time, we've got to get really thoughtful about how are we managing and thinking about the per capita total cost of care for our community. Sometimes those two things are at odds. What we realize in our current environment is Maine is the oldest state in the nation on a relative basis, and we've just got insatiable demand for our services at the moment that really outstrips our capacity. Some of that is just an aging population. Some of it's a little bit of growth in the state of Maine. And some of it is that our other health system partners in the state have struggled a bit and had to reduce some services. And so we're feeling the brunt of that, particularly in Portland, although we're feeling uncomfortable about our system. And so we've seen really close to, you know, near double digit growth in terms of volume over the last couple of years. And that's going to continue again this year. We believe that's not going to continuously be sustainable. And so that's why we think we're in a really unique position to really be able to focus on avoiding unnecessary utilization and reducing duplicative care. And so that's going to continue to be a big area of focus for us as well.
- [15:39]
B
Fascinating. Andy, thank you so much for joining us on the podcast today. This has been such a fantastic discussion. I've learned so much and, you know, appreciate your time here today and I'm looking forward to seeing you as well in person at our annual meeting coming up in April. I know you'll be speaking on a panel and, you know, it'd be great to catch up a bit and learn a little bit more as well about how things are going and where you see healthcare really changing and making the biggest impact in the future.
- [16:03]
C
You bet. Looking forward to it. We'll see you then.