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Becker’s Healthcare Podcast
Expanding Community Access and Building the Future of Care at NorthBay Health with Mark Behl
00:19:30
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- [00:00]
A
This is Laura Dardo with the Becker's Healthcare Podcast. I'm thrilled today to be joined by Mark Bale, president and chief Executive Officer at North Bay Health. Mark, it's a pleasure to have you on the podcast today.
- [00:10]
B
Oh, thank you, Laura. Appreciate it.
- [00:12]
A
Absolutely. Now, I'm excited for our conversation. I know we'll go through a lot of some of the things that you've been working on over the last year, as well as your perspective on the future. But before we dive in, can you just tell us a little bit more about yourself and North Bay Health?
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B
Yeah, absolutely. Yeah. So I'm Mark Bale. I'm the president and CEO of North Bay Health, as you said. And we are a independent, locally governed, nonprofit health system that is in Northern California and our area. You always describe it sort of in between Sacramento and San Francisco. We have the four counties of Napa, Sonoma, yolo and Solano county is our main presence that we have today. We've been in the area for 67 years, and really just a kind of a simple focus of caring for our neighbors and strengthening the health of the communities we serve by being really sort of, you know, sort of closer to home where people live, where they. Where they also where they sort of work and don't have to travel over bridges to get their care, you know, in the. In the cities of Northern California.
- [01:23]
A
Absolutely. I know that can be quite a trek to get to some of those more urban areas. And so having that care close home is so critical for many people within these communities. Now, could you talk about an initiative that you did in the last year or so? What did you do and what were the results?
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B
Yeah, absolutely. So for the last couple years, I would say our most important strategic priority has been delivering on our ambulatory network strategy, which is really rethinking how and where care is delivered across these communities. And like many health systems, we recognize that care just can't be centered only around the hospital anymore. Patients need convenient access points in their neighborhoods. And over the past year, we've been very intentional about building a network through urgent care, primary care, and specialty clinics really embedded in the communities, particularly in areas where access has historically been limited. So as part of that work, we've opened up seven new neighborhood locations to help you, you know, sort of meet the growing community need. And also we're very proud about going into areas that have not had health care available without driving long distances and sometimes up to 30 minutes to get to the next healthcare clinic. So we've added these locations and they're really designed to not just deliver care every day for those communities, but also a way to connect with the communities, to really become part of them, to be a fabric of those communities in a much different way. So it's been really exciting to do that, and we're going to continue that throughout 2026.
- [03:07]
A
That's great to hear and, you know, so beneficial to be able to quickly stand up some of those new locations and bring care that's very much needed into those communities. Now, you know, when you're looking at some of those special clinics, urgent care, other locations that are coming up, how do you make the decision about where to locate them and what does it truly take on the resource side to bring some of these things to life?
- [03:30]
B
Yeah, so it's a great question. And we spent a lot of time really before we've started implementing this strategy of trying to understand, looking at the clinical demographics of each of these communities. So our goal is to have primary care within 15 minutes of every resident of the communities we serve. So really understanding what. When you look at those communities, what their needs are, and they're a little bit different by community. Right. Because some communities may have younger families, it may require more pediatric services, it may have more women's health services. And so the needs of that community are going to look different from, say, a retirement community where you have an aging population with chronic conditions and they have much greater needs in terms of specialty services and, you know, screenings and other services. So we tailor them according to how we see the needs of that community. And that's where it gets back to really embedding within the community and understanding from those. Those people that live there of really what their challenges are. And then, you know, in terms of resources, it is a significant investment because you have to. It's not just the buildings themselves and the improvements that go into them, but oftentimes it's. We have to recruit physicians and advanced practice clinicians who can go and work there. We're fitting each one of these with telemedicine. So the technology needs to be in at least one of the rooms out there available to, you know, sort of be very progressive in the care that we provide and specialty services in the future. So a lot of infrastructure that goes into that, and then again, our own internal resources just standing up. You know, each one of these, it takes, you know, a certain amount of effort and time, you know, from, you know, recruitment to licensing, to accrediting, you know, just to marketing and communications that goes along with this. So it is a heavy lift, but we've seen great results, and the impact has been pretty measurable here. Across our ambulatory network last year, we saw over 320,000 patient visits. Over 30,000 of those were urgent care visits. Expanded our primary care substantially by almost 45 new providers, physicians and apps. They did over 95,000 visits, and then about 200,000 specialty visits. So encouraging improvements. We have a lot of work to do and still really kind of focusing on how to create the best experience in those areas and again, expanding that telehealth that I've talked about. But it's been a lot of fun, and I think the communities have really, really been excited to see, you know, us make that investment in their community.
- [06:17]
A
I love that, and I think that investment is so critical and cool to understand everything that goes into those decisions. Now, looking ahead for 2026, what are some of the big priorities and headwinds that you're most focused on?
- [06:30]
B
Yeah, so 2026 is going to be a very exciting year, but also a very challenging year. You know, one of the areas I would say I sort of think there are, is probably similar to a lot of organizations. Expanding access to care continues to be our main focus. There's a significant demand out there for health care today. So we're going to continue to focus on ways to expand our access and reach. Driving operational transformation. I mean, that's part of it, I think, with the challenges that we have throughout the industry, with the. Just, I say some of them are challenges, but some of them are opportunities in the sense that the challenges will be in the workforce and how we must work differently, more efficient, try to find ways to reduce costs. But there's also opportunities. I mean, obviously, AI. We're, you know, it seems like every day we're talking about how AI could potentially enhance and transform the way we do things. So we want to continue to focus on that. So. And then the third bucket, I would say, is maintaining our financial stability. You know, we have had a positive operating margin now here for the last three years, which is a really strong performance, especially when you consider, you know, across the country and across Even California, almost 50% of hospitals are underwater. It just speaks to the challenges we all have. And with HR1, you know, and the declining reimbursement, there's people that are going to be without health care access with insurance. And so those are all things that we're going to have to focus on together. But, you know, I would say just access remains the major focus. And again, how do we Transform this so maybe we can deliver a different model of care that's going to be more efficient, that can help address some of the financial challenges. And then lastly, I would just say this is not a small thing, but our transition to epic. So we are going through that transition about the end of this year and of course there's a lot of work that's led up to being able to do that. And so that's obviously something we have to keep moving, ensure we're on our timelines to do that. But it's going to be a better experience for our clinicians and our patients. And so for that reason, I'm really excited about that as well.
- [08:49]
A
I love it. I think going through those EPIC transitions, incorporating more technology and really finding ways, I know we talked a little bit earlier about virtual care and ways to incorporate that into the care delivery model. Seem to be exciting opportunities. And when you look at AI, when you look at technology, you know, how are, are you incorporating that and really developing the plan for, for that for North Bay Health, especially given some of the financial challenges that are abreast?
- [09:21]
B
Yeah, I think that, you know, first of all, I do think we have to really get to the people that do the work and ensure that they're the ones that help improve the work. And so that those AI solutions that we're thinking about, I really, we're going to spend a lot of time and ensuring that we get the input from the people that are going to use that or be impacted by that, you know, so we can really understand what the solutions are that, you know, what the top priorities are. I think it's hard to invest in solutions. You know, take the, some of the revenue that we do have, you know, not directed to patient care, but directed to these types of improvements. So doing that has to be done in a way that it's actually going to deliver a better experience for the people that are either, you know, delivering the care or receiving the care. And so we can't afford to have a lot of false starts on this or we can't really afford to be, you know, sort of way out in front of our, of our caregivers on this. We need to keep be hand in hand with them. So we've put a lot of infrastructure in place just to make sure that these are great ideas and there's a really exciting opportunities. But how do we include our teams in the process of identifying what the top priorities are so we invest in the right places.
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A
That makes a lot of sense. And, you know, it's really critical to have that type of alignment organization wide now. What do you think the hardest thing you'll have to do in the coming year will be?
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B
I think that, yeah, I think for a lot of systems, certainly top of mind for me is how do we continue to grow and how do we take, you know, our strategies that we have and you know, not only to grow but also to innovate with the financial realities we have facing health care today. You know, our communities need us. They need more access to care, they need more services, they're asking for more innovation. But the economics of healthcare are incredibly challenging. Right. So for us, the challenge will be continuing to invest the areas that matter most and like I said, expanding that access, seeing the difference that can make in the communities and really how that's changing, you know, our ecosystem here for the healthcare system in Northern California is encouraging and exciting. And when we hear that feedback from our communities, we know we're on the right track. And so advancing the technology like epic, you know, again, supporting our workforce, those are all big bets for us, you know, but they're for the things that we think are going to change those communities and also change the environment for, for all of our caregivers. So that's going to be the challenge is we're going to be hit with pressures. You know, we already see it. We see a lot of our medical enrol. Enrollees that are dropping off, you know, that won't have coverage. And I think the travesty of all this is that the poor and vulnerable are the ones that are going to be most impacted by this. You know, so that's who's being left behind. And as a community based healthcare system, you know, we don't just have a membership model, we don't just have a focus on commercial patients. We, we are absolutely committed to taking everyone, regardless of what's going on, you know, with their, with their, in their lives. And so for us, we're not going to leave them behind. We're going to have to figure out how to do that. So that's, that's probably the hardest, you know, sort of, you know, the challenge that we have ahead of us is how do we continue to focus on that access and growth and innovation and balancing. How do we design systems that are not leaving people behind? And, and I think that's going to be a challenge for everybody. But I also think that there's a need for a change in the way we do things, you know, in healthcare and across the systems. And so this is going to challenge Us. But I think if we approach it from the standpoint that we can do better than what we have today and we can do that alongside our communities and trying to figure this out together as a community. I just think that we're going to find ways to get through it.
- [13:29]
A
I love that. I mean, it's such an important point that you're making, but also inspiring way to look at it and really navigate through the challenging times that we're facing today and truly prepare the organization not only only to overcome those challenges and continue to provide care, but then be in a position to thrive in the future. I'm curious, you know, when you look at some of those financial pressures and obviously the need to innovate, how do you prepare for, you know, kind of those medi cal cuts and those kinds of things? I mean, are you looking at additional revenue streams or where are the dollars do you think going to come from?
- [14:08]
B
Yeah, yeah, I think that's. That's a great question because we talk about it all the time. Like we're going to have to find ways. You talk about diversifying our revenue. That is one aspect of it. We're going to have to find what services that we can provide in a way that, you know, we're looking at grants, you know, we're looking at community partnerships. We're looking at, you know, ways we can work with other healthcare partners to come together. We do that today with Kaiser Permanente working very closely with them on some of the behavioral health needs that are in the community here, working with our counties, working with, you know, our elected officials and trying to help ways to come together. And that's kind of the spirit of all of this is that this is a community problem, right? And so it can't be solved by one healthcare system. It's not gonna be solved by, at the federal level. And so it's going to have to be communities coming together. So we really engage with these communities to help, you know, really come together to try to find solutions. But, you know, I also do think it speaks to building out a model that's going to be more efficient than we have today. And when you have hospital based systems, you have to support the hospital based infrastructure. And so if the only way you can drive that, you know, more revenue and diversify revenue is getting more and more people into a hospital setting, I think that's going to be very difficult for, for healthcare systems to really survive long term. They're going to have to find a way, develop a network and a model that can be more in a value based capitated model. And we have a lot of our revenue that comes in from capitation. And so you have to have a network that can manage that and an infrastructure to manage that. So this part of what we're building is really going to help us prepare for the future. So it's not only doing good today and connecting those communities differently, but it's also preparing us that we can change our healthcare financial model by allowing us to get revenue more than just what comes in the hospital. So it's really, I think twofold. There is how do we come together to address the current needs, but how do you also keep making those investments on the future needs and future model transformation that has to occur?
- [16:22]
A
I love that. I think that's such a balancing act that so many leaders are figuring out today and you know, no one right solution, but certainly a lot of opportunities in that space. And you know, to your point, before we wrap up here, I did wanted to ask you to dig a little bit deeper on growth. Where do you see some of those best opportunities for organizational growth, for continuing to evolve the organization into the space that you've been mentioning in describing for the future?
- [16:51]
B
Yeah, well, I think it comes from, again, part of it is, I do think, building partnerships and expanding services in ways that your community needs. You know, looking at those almost every, right, you can see almost every business model, every industry where there's been some paradigm shift, it usually comes out of something that was needed that's not being provided. And then you fill that, you know, as an organization, as a company, you come in and you fill that need. So for us, you know, we're really looking at where those lie within the communities. And, and the reality is that almost every community, and really this could be across the US when you talk to most healthcare system leaders, they all say the same thing. The demand is higher than the supply we have. So it's really when you're trying to figure out how to provide more hospital supply, more surgeons, more interventionalists, you know, more technical, you know, resources, you know, I just think that's not really where the opportunity's at. I think the opportunity that's really asking to be filled is really upstream in that primary care in the general specialty, you know, sort of services, threat managed chronic conditions that really are not surgically, you know, treated. And so for growth for us, it's really going into that area very, you know, with a very intentional investment to provide services that are needed upstream in those primary care and general specialty, you know, medicine specialties. Rather than surgical specialties. And that's, that's hard to do because you really most of the revenue comes in on the hospital. But that growth, the growth really is going to be, you know, in that space.
- [18:47]
A
That is fascinating to hear. Mark, thank you so much for joining us on the podcast today. This has been such a fun conversation. I know we covered a lot of ground, but inspiring to think about what the future may hold. I appreciate your time today and I look forward to seeing you as well at our annual meeting in April, just a few weeks away. It's always great to see you and catch up and then continue this conversation and dig deeper as well.
- [19:08]
B
Oh, thanks Laura. And thanks for giving us a platform here as an independent sort of regional based healthcare systems. We sometimes get lost with the bigger systems and the urban systems. So thank you for giving us a platform to talk a little bit today. Always enjoy talking with you and look forward to seeing you in a few weeks.