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- [00:01]
A
This is Laura Dearda with the Becker CEO and CFO video series. Thank you so much for joining us. Today we have our guest, Ivan Samstein, who's the enterprise CFO of University of Chicago and UChicago Medicine. Ivan, thank you so much for being here.
- [00:15]
B
Great, thank you. Thanks for having me, Laura.
- [00:17]
A
I'm excited for a conversation because I know there's so much happening in healthcare and particularly looking at academic medicine, a lot of different and unique challenges upcoming, but also a really exciting time with innovation and expanding access to care. And so this will be a great opportunity to spotlight the cool things you're doing at University of Chicago and your Chicago medicine. But before we dive in, I'm curious, can you introduce yourself and just tell us a little bit about your background?
- [00:42]
B
Thanks, Laura. Happy to do so. So, Ivan Dante. I serve as the enterprise CFO for University of Chicago and University of Chicago Medicine. I've been at the University of Chicago and our affiliated health system for I guess about eight years now, A little over eight years from counting. But in terms of my background, I spent the early part of my career started actually as a credit rating analyst. I worked for Moody's and then I was an investment banker for about a decade, you know, covering non profits and the municipal bond market. And I did that for some time, but ultimately wanted to make a pivot and work more as an operational cfo. I did have a detour for military leave when I got called up and went overseas in the middle in 0809. And when I came home from overseas from Afghanistan, I decided that I wanted to be more focused on operational finance. I was CFO originally for Cook County. Government was my first operational CFO role. For those who know Cook county, it runs Cook County Health, which is one of the largest public health systems in the country. It's a county that includes Chicago. And then about eight years ago moved to the University of Chicago where, as I said, I've been originally serving the university, then serving Our Health System, UChicago Medicine, and now jointly serving and overseeing the finance Functions for both UChicago Medicine and University of Chicago. So that's, I guess that's me in a nutshell. The only thing I didn't mention is I'm originally from Brooklyn. I'm not a Chicago and by nature, but I've been here so long that I, I think I'm more of a Chicagoan than a Brooklynite. More and more every day.
- [02:14]
A
Absolutely. Well, I think you can be an official Chicagoan as long as you don't put ketchup on your hot dogs is what I hear. So I think you should be in good shape. Now, when you think about, you know, everything happening in health care today, what are the top three trends that you're following in health care? What are you really focused on as you're thinking about the future?
- [02:34]
B
Yeah, I think the trends, and I talked with Becker some months back, I think the trends, two of them are the same. One of them maybe was always there, but we're thinking about more and more. And I think the first one is I think all of us are focused on the federal government and what policy changes might impact. Obviously, healthcare is a very sizable percentage of the overall US Economy and it's heavily impacted by government policy actions, both in federal actions, but state actions as well. We're thinking about Medicaid, federal state policy or federal state partnership. So I think we're all watching and trying to understand what will happen with the federal government and what policy changes will emerge. The one big beautiful bill act that passed had a number of changes around Medicaid that I think we'll all have to see how those play out. I think there are other policy changes, both in executive action and legislative that are being talked about. I think the problem, of course, with the health care finance in this country is it's a bunch of interlocked cross subsidies flying all over the place. And so you tug on one thread and suddenly it unspools something elsewhere. And I think we're all going to have to monitor that, understand how it affects our organizations and what emerges from that. So I think that's probably number one. I think all of us are thinking about it a lot every day. I think the second thing is what's happening with the insurance companies. And over the last 18, 24 months, I've seen a number of articles in Becker's where colleagues and peers have been talking about it. The growth rate in initial denials, the payers using artificial intelligence, other technologies to be a lot more aggressive on initial denials. They're up 50% across the industry and that drags our payment cycles. It frustrates patients. The word I'm hearing from the payers. I've been in meetings with some senior executives at several different payers in the last few months. They all seem to be using this word friction. But I think for patients, they don't find it as friction. They find it as really concerning when they have outstanding bills insurance companies pay. I think we're all going to have to see how that plays out. I think it's impacting the financial operations of most health systems across the country. Certainly all the peers that I have interacted with and I read the articles and Beckers otherwise are commenting on it, feeling it and noticing the last 24 months has really been a much more aggressive phase in terms of initial denials than some of the actions. And I think related to that is, you know, going to be some of the government actions that I alluded to earlier. Number one is in Medicaid, you know, as things pressure the Medicaid managed care plans, margins and their MLRs, you know, often that flows downstream to the payment mechanisms and denials that the payers will use. With us on the provider space and Medicare Advantage, I mean we've seen, you know, a growing trajectory or movement of patients from traditional Medicare to Medicare Advantage. But all provide providers are seeing meaningfully reduced effective reimbursement and Medicare Advantage largely because of the denials and other dynamics. And so I think we have to see how that unfolds. And I think many of us are taking a lot of proactive steps to deal with this changing environment. But I think there's more to come in that. And then probably the last one that I don't think I commented on last time, not that we weren't thinking about a lot, but I think it's pretty critical is the evolving pace of big data and artificial intelligence and what does it mean for patients and treatment opportunities. You know, at UChicago we've got some pretty amazing researchers who I get to sit on presentations often I don't fully understand what they're talking about, but I do understand their view that these larger and larger data sets, the use of artificial intelligence. You know, a lot of us are initially using artificial intelligence and robotic process automations and large language models to do automation really and to use these, these tools in administrative areas. I think that's what most of us are looking at the most. You know, the payers are using it to, you know, automatically denial, deny mass numbers of claims and we on the provider side are looking at it. But I think when you talk to some of our top researchers and physicians and physician scientists, they're extremely excited for targeted novel cancer treatments and other things, you know, that you know, I'm not an expert on. But they're pretty exciting. When you listen to the physic and physician scientists talk about how these kind of bigger data sets, bigger tools, machine learning can really create a lot of novel therapies and revolutionize care in a number of areas. Cancer is obviously a very big one. That we hear quite a bit about.
- [07:19]
A
Absolutely. That's an amazing analysis of so much that's going on right now. And certainly looking at technology becoming more and more part of the healthcare delivery system, whether as you mentioned, looking at the revenue cycle or clinical care delivery, some really exciting things there and then as you talked through, just that relationship between the payers and health systems and obviously patients in between and in the middle of that is so critical and contentious in many ways right now. When you look at, you know, thinking about the future and trying to forecast everything that is happening, what you are aiming to do over the next few years, how do you balance all of the unknowns with whether it's the payer denials or legislation, what could happen with Medicaid? I know that's an important aspect of what UChicago medicine does as well. How do you think about all those things and prepare for just about anything that could come up over the next 12 to 24 months?
- [08:14]
B
You know, I will say that most of us in the CFO chair have been doing more dynamic forecasting is the is the word or the term du jour than we have. Many of us have done much of our careers, obviously Covid and other periods 0809, you know, we've. We've had a number of pretty dynamic periods where we've had to focus on how to think about our forecast processes, their complexities. But I think right now the range of outcomes is pretty broad of some of the impacts of some of the things we're talking about. And I think we all need to be pretty focused on how to be reacting, how to react quickly, how to set up our teams and work with colleagues in government affairs and other areas, understand implications, understand react quickly, make sure we understand what we're talking about, make sure we can dialogue with our various stakeholders on an intelligible basis of what the implications of changes are happening and how we think about that. And then fundamentally we owe it to our organizations to do dynamic forecasting. As I said, it's the term to be short, but it's really critical that we're looking at scenarios. We understand upside when there is upside in various pieces, and we understand downside and the best case, the worst case, the most likely case, and what are the things that are happening. I think that's pretty critical for most leaders of senior management. Certainly the finance function of this environment. I think if you organize your team accordingly, you've set yourself up to provide those kind of scenarios. You're thinking it through. It certainly positions you to React and hopefully take advantage of opportunities that arise, but also react to some of the challenges. There's definitely more uncertainty and headwinds. I mean, there's always uncertainty and headwinds in healthcare. I think there's arguably probably a little more uncertainty and headwinds. And in a traditional year right now, I think all of us are trying to make sure we're organizing our teams to be reactive and to be forward thinking and thinking in advance of challenges rather than reactive after the fact.
- [10:17]
A
That's such a great point and, you know, really helpful to think through what's going to make for a successful organization even through some of these intense, intense periods. Now, I wanted to ask on the opposite end of the spectrum, what are you excited about? What's really top of mind you think about, you know, the cool things that you're doing. At uchicada Chicago Medicine, we have really.
- [10:38]
B
Invested in growing our system over the last few years. So our partnership with Advent Health, I think I talked about the last time I met with Beckers, that continues to go gangbusters in the western suburbs and bring academic UChicago medicine care to communities that haven't had access to it. Clinical trials we've rolled out since the last time I spoke to Beckers, we've rolled out a number of clinical trials in cancer across the western suburbs and patients have access to. I think we're very excited where that's going. Our facility in northwest Indiana is doing fantastic. We've seen patients respond with incredible demand. Out in northwest Indiana, there's not an academic medical center, you know, for a few hours drive, we're the closest, we're about an hour away. And then there's, you know, the next closest outside of Chicago metropolitan areas a few hours away. So I think we're seeing a lot of demand there. I think that's pretty exciting. And I think all of that comes back to, you know, where we have been really focused on, which is building a we have a first comprehensive cancer center in the Chicago market which will include both novel therapies. Our physician signs, our cancer service leader physician and Dr. Kumea Dunci and how did he think about bringing novel therapies inpatient, outpatient, all under the same roof, same integrated cancer center that will open in 2027. And I think for us, as we've seen the demand and expanded network access in the western suburbs radiating out through northwest Indiana, when we think about that folding into the cancer center, it's pretty exciting. And then go back to what I was saying before. I mean, when you sit with people like Dr. Duncy and others and you hear about how they see the ability to use these large language models, these big data sets to revolutionize, tailor cellular therapies. Again, I'm not an expert on this, but tailor them in a way that can really treat metastatic disease for patients in ways that they've never been able to do before. I think we're pretty excited. We're pretty excited to be at the forefront of that with some pretty amazing physician scientists who are here. We have a. Of this. We have physicians here. UChicago as an enterprise, manages the Argonne and Fermi research labs for the Department of Energy. A number of years ago, it was our physician scientists at BSD who felt that there were some opportunities, radiated earth and worked with our school of engineering here on UChicago. Some of those faculty had joined appointments out of Argonne who had the ability to look at rare earths that could be irradiated, travel through a patient's body. That's now the field that's called theranostics, where they see the diagnostics, they see the cancer, and then immediately zaps it with these irradiated earth. It's pretty amazing to watch some of these folks, their excitement around these novel therapies and all of that, building a network, building this comprehensive cancer center and then coordinating with our physician scientists who really see themselves at the precipice of the treatment of metastatic cancer in a way, you know, through novel therapy that just hasn't been possible prior. It's pretty amazing to be around and to watch it. It's hard not to be excited when you're, when you're with these folks.
- [13:46]
A
Oh, absolutely. And you know, that passion really is coming out here today. And it's amazing, you being a finance operational leader, but still having such a foundation background in the clinical care and what's happening and understanding of the, you know, really innovative things that you're doing. Is that something you go out of your way to do as a CFO and you know, what kind of drives that aspect of you? Kind of rounding out your background there.
- [14:11]
B
UChicago is a little unique. I mean, we're all unique in our own way. We're all special, right? In our own way. But one thing that is pretty foundational at UChicago is, you know, we are an academic medical center integrated into the university. We share a campus, we're next door. You know, we have big data guys from our booth school of business who are next to women who, you know, the biological Science division or, you know, the Pritzker School of Meckley Engineering. We have all these fantastic researchers who are kind of interspersed in a way. We're centrally located in UChicago's campus. And so one of the kind of nice things about UChicago is this sort of interconnectivity between the different areas. And I think a lot of that comes from geographical location, and it allows everyone to really feel and experience that type of dynamic that you're asking about. For me, it's what makes it so exciting to come to work every day, because you're connecting and listening to your research colleagues, who obviously are expanding fields and others that aren't my strength and my skill set. But because we're so integrated, I think we get probably a little more exposure than that than some other peers. Where I sit at the moment, the hospital's two blocks away. The Booth School of Business is two blocks away. We have our Butcher School of Black Engineering, where we've got folks who are literally doing teleportation experiments in the basement. And a lot of these faculty are able to do things together. That's pretty amazing. And I think a lot of that, because it's all so close and proximate, I think even as a cfo, you get a decent amount of exposure. I mean, obviously not like I'm not doing teleportation in my spare time, but you learn about it and you see a lot of these presentations. That's pretty fun. And it's hard not to be excited, as I said.
- [16:08]
A
Yeah, absolutely. That sounds like an amazing setup you have there. Before I wrap up, I wanted to ask about growth. How are you thinking about growth in the next year or so? And where do you see uchicagos continuing to expand?
- [16:20]
B
Yeah, I mean, what we have seen is the demand for our services, both in the west suburbs, particularly around cancer, but also in northwest Indiana, has been pretty phenomenal. What we see is physicians templates when they open up and offer clinics in some of these areas for some of the especially care that we're known for have been. It's been phenomenal. I think Advent has been an amazing partner. We have a joint venture together in the western suburbs, and they've been. Advent Health, obviously, you know, is a very, very seasoned and very, you know, impressive operator themselves. And our joint venture, we just see a lot of demand. And I think the way we think about is continuing to grow across these areas and these geographies grow. Our, you know, our access for our patients to subspecial care and a lot of that will just position us for when, you know, so over the next 12 months, I think that's really where the focus is. But a lot of that will be critical to position us for, you know, 24 months from now when the Comprehensive Cancer center, you know, enters the market and opens its doors. I think for us, they're all kind of interconnected continuum, if you would.
- [17:29]
A
Oh, that's amazing to hear. Ivan, thank you so much for your time today. This has been such a unique and fun conversation, and I look forward to connecting with you and again soon.
- [17:37]
B
Great. Thank you. Laura, thanks for your time today. I appreciate it.