← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Lisa M. Goodlett, Senior Vice President, Chief Financial Officer and Treasurer at Duke University Health System
00:20:43
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- [00:02]
A
@ Athenahealth, we know your ambulatory practice wants healthier a healthier business, healthier care teams and healthier patients. But the complexities of modern healthcare tech make it hard for you and your care teams to focus on what matters most. That's where athenahealth can help our AI native all in one solutions reduce administrative burdens, streamline billing and payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients, and stronger bottom Practicing medicine is complex, but running a practice can be that much simpler. With Athenahealth, see how simpler is healthier at athenahealth.com.
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B
This is Laura Dardo with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Lisa Goodlett, Senior Vice president and Chief Financial Officer and Treasurer at Duke University Health System. Lisa, it's a pleasure to have you on the podcast today.
- [00:57]
C
Oh, thank you, Laura. Glad to be here.
- [00:59]
B
Absolutely. Well, I'm looking forward to our conversation because I know right now such a unique time in healthcare and certainly what you're doing at Duke is really interesting. We'll get into some of those themes right in just a minute here. But before we do, can you introduce yourself and just tell us a little bit more about Duke University Health System? What's been your biggest winner success story from the last year or so? Sure.
- [01:21]
C
I've been with duke for about 17 months and it's truly just an exceptionally special place. The, the focus on the culture and making a healthier, healthier humanity has just been overly impressive since I've been here. I came, you know, most recently from the Medical University of South Carolina where we did a lot of growth, growing from 2.4 billion to 5.7 billion. And this is a $7 billion organization. So the resources and the thoughtfulness as we also approach how do we get excited about growth here with the Academic Health Sciences Center? We're a care discovery system and a care delivery system. As we describe ourselves, we have two schools of nursing, a school of medicine, and focusing and partnering on our research enterprise as well as the care delivery system has four acute hospitals and one of them is within the top five largest contiguous hospitals in the United States. We we are centrally focused and that's been a little bit intentional in part of North Carolina, but we've made some moves recently to move outside of it. It's a very attractive markets that we sit in and also we have a unique part of being a safety net hospital, which for a hospital of over 1100 beds sitting in Durham County. We also serve that Role very well. So it's just a great place. Everybody's focused on really proven humanity moving the world forward. So glad to be here.
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B
Absolutely. That's amazing to hear. And you know, especially when you talk about additional expansions in serving a broader community even outside of Durham in North Carolina, I mean, what does it look like to plan for that, especially on the financial side today? I know it's really critical to make sure you've got stability as much as possible when going into those plans. So what's it been like for you?
- [03:19]
C
Well, I think the biggest thing talking about the success here that is the belief that we can grow and move outside of our geographic reasons is one of the things that's been most exciting here and that's built on. Before I got here, we integrated our faculty practice into the health system or that was about nine months old when I got here. And so how do we take these 700 new providers? Because what is everybody looking for in America but more healthcare providers, more physicians of that level? So we've been able to just have phenomenal recruiting here thanks to Matt Barber and his team. And now that enabled us to move across the states. We've entered into the Charlotte market and we have other markets that we have our eyes on. So we'll continue this growth going forward. And we believe that there's smart ways to do that. You asked specifically about how do you plan for that financially? First you've got to get that belief across the organization. After being stunned by Covid and different things that happen is how do you believe that you can take and everybody should have the right for the special quaternary care that Duke can do and what do we want to be and how do you focus on that? So we, we do that in a couple ways. We buy, build, partner. I think there's been a thought that traditionally we've gone it alone and now you see us creating partnerships and evaluating things at all levels of the organization. We don't necessarily have to build everything ourselves. Can we buy it? Or who's the right partner who matches our culture and our belief system out there that we can partner with? And we've done some really unique things with the University of North Carolina freestanding children's hospital that will jointly own together. It's been some good work. We've announced health places which are access points with us with a partner Novant. So just really figuring out what's out there in the world and who can we partner with. Then we can integrate down into financial planning and how do we make deals and things like that. So.
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B
Got it. That makes a lot of sense and, you know, is really fascinating to see that process and understand where you're at today. Now, what are the top two or three issues that you're focused on right now? What's top of mind for you as you're looking at that strategic plan and.
- [05:33]
C
Expansion and more three things underneath. What's really capturing my attention today? And the first one I call footprints. And to me, that's got an internal and external thought to it. Not only where are our locations, but also on internal part is how are we using our workforce with generative AI? How do we digitize and really work to top of scale, make life easy for our providers? We've had good recruiting years for the past couple, but how do we keep that going forward Here at Duke, we even have a sole focus on it. We have a Chief Digitation officer, Jeff Ferrante, who's just fabulous. But what does our workforce look like in the future? We don't want to leave people behind. We're deeply committed to our economic mobility program. So we may not need someone to check you in. And we can have kiosks or pre check in all the, all the automation that we've deployed and have that there. But how do we take that workforce and train them up to do other roles that we need within our health system? And then as you continue to think about, you know, our birth rates have declined. They're about half what they were when the baby boomer generation came along. So thinking through with less people who are going to be here and the baby boomers hitting that, that need, how do you provide for those caregivers? So streamlining what we do with our clinicians, we have partnerships for dictation, ambient listening, I should say, and different ways to leverage technology into the conversation. Upfront coding, just things that we can look at, at that piece for providers, but also for nursing, you know, virtual nursing, exploring innovation units. What work feels good for our care team? How do we take some specific knowledge to Duke and have sensitized to say, here's the most acute patients you have. How do we focus on really making sure we're paying attention to those at the highest, best level during the night, when sometimes we, as most hospitals do, have a lower base of staffing in place? And then again the front office staff or the administrative functions, do we really need to do it the same way that we always have? So lucky to be here, Duke, that we can invest in those patient monitoring, patient prediction, patient profiling systems on that. So that's one. I call that the footprints again. Right. Locations. Where do we go across the state. The second part I call consumer health relationships. And as really thinking through it's not as transactional, which has been something we've been working on, but precision medicine, cellular and gene therapy. How does that change the lifetime of our relationship with the patient? You know, the adaptation used to take 17 years to adapt new technology. That's down to two or three years now. And people want things in their phone. So how do we lever the special qualities and care that Duke can provide and use that in a more effective fashion going forward? And that leads us into partnering. How do we, you know, we can compete with people and collaborate on the same day with them? How do we leverage technology and industry? We sit in the middle of the research triangle, one of the most fabulous places in the world for innovation. How do we think differently about payers and the use of technology? And the third part gets into if you go very forward looking, what is the reality of having a Medicare reimbursement system for healthcare going forward? How do we redesign again those relationships with the consumers, with the employers and think through what's really the smart way? I think there's a lot of disruption that we can learn from other industries and bring into healthcare.
- [09:27]
B
Absolutely. I think that's an excellent point and I appreciate you touching on so many different areas because I think certainly as you mentioned, trying to understand how healthcare is transforming with the different demographics as they evolve with technology, as it advances. And then two, looking at how the legislative environment is changing, how payment environment is changing, you know, brings a lot of things together that are transforming health care today. When you look at those disruptions that, you know, come from other industries, what inspires you most? How do you look at things and think, you know, application to health care could make a lot of sense?
- [10:06]
C
Yeah, I think it's, you know, wayfinding. Let's start there. Hospitals are typically built in the most securitious fashion as funding arises. So it's not very smart from that piece. So our, our digital team here is put QR codes so you can easily find your way through a building, which is simple and I like it. It saves a million dollars of let's do all this different kinds of wayfinding and stuff like that. But using that adaptation and a phone very similar to what you do at Disney World or Universal, how can you sign up for fast passes is similar to self scheduling. I think with the. I've always been fascinated when banks came out with the ATM card, how do you just have your entire health record in something that you could insert in a credit card machine? And you're controlling as your data, but how do you make that more shareable versus always having to go in epic or different things like that? So I think there's a, a lot that we can learn from from those pieces. Flow logistics. You know, if you think about what some of the delivery companies are able to do, you know, some disruption from a frequent store that people buy from to FedEx to UPS, but how do we really maximize our existing facilities that we have now with patient throughput and that scheduling and that care coordination, which we like to call them care algorithms, is how do you make sure you have the providers and the patient teed up at the right time? So you're not going up to pick a patient up for an imaging scan and for some reason they're doing something else on those pieces. So I think there's a lot of that niche stuff we can pick the best out of other industries and learn from.
- [11:48]
B
It's really helpful to understand and know and it is really cool to think about as well and how that can make a big difference within the health care system. And you know, you mentioned the reality of Medicare reimbursements as well. And I know private insurers and other organizations trying to understand all the policy changes and updates in what's ahead, you know, can be a mind boggling prospect sometime. So when you look at Medicare and especially as you said again, you know, the aging population increasing, where do you really focusing in on how are you preparing for what could happen with Medicare as well as Medicaid in the future?
- [12:27]
C
Let's talk about Medicare. So roughly across the nation, 50% of the people when they sign up for Medicare, sign up for a Medicare Advantage program, which can be good programs. Sometimes they limit, you know, access or choice and in different ways, if you carry that forward, that future Choice will be 60% will pick Medicare Advantage program. So as a CFO of a health system, you're watching the tsunami come at you and you've got to react to it and do something different. So that again goes back to our consumer health relationships. Are there different ways that we can think through that? Either partnering with an insurer, but developing our own product, or really getting that stickiness with the customer that they want to stay with us? As we think about that differently, I think we have to. If you look on the private side and look at where it's almost like when you solve a mystery, you know, you always look to see where the money flows if you're doing forensic accounting. So Medicare Advantage programs have taken some hits over the past couple of years, but over a long run, they've been some businesses that have been successful. So how do you have the fortitude to stick through with something? I think is something to be thought about, but also if you look at just normal private payers, you know, there's a lot of money sitting in their reserves or in their annual operating. Is that really something that's relevant in today's world? If you do direct contracting or have those direct relationships, do you need a middleman or can health systems rethink their, their ways of doing business? So those are some of the things that are top of mind that we're exploring to figure out. We have a broken system now. It does incredible things, but it's expensive. So how do we suspend our biases and learn and morph into something new in the next 10 years?
- [14:20]
B
Absolutely agree. That's a fascinating way to put it, especially looking at, you know, the opportunities for partnerships as well as what, you know, you need to do in order to think differently about the business of healthcare. And I really appreciate your perspective on that now looking ahead too, I know there's a lot of big opportunities for growth and development. I want to touch on that as well. How are you thinking about growth and where are you seeing additional ways to expand in the future?
- [14:48]
C
Well, I think it gets down. You've got to know your organization flows. You're really your book of business. And by flows, I mean where's your employee base, where are your providers located, where your patients located? And how can you deploy technology and AI in different ways to expand and be efficient on that? There shouldn't be any boundaries to healthcare. You should come into a bricks and mortar system when you need it. If you think about perhaps getting on the monorail system at Walt Disney World, how do you stay if the monorail system is virtual care, how do you get everything you need through your phone and then you can stop and get off at, you know, Disney World proper if you need to get some medicine, or do you go to Epcot when you need surgery and then pop back on the monorail? So I think we've got to think about how we're in the right place at the right time to give the right care and also that preventive medicine that can happen with precision genetics. So that gets into, how do you partner about that? It takes a lot of energy to fund the computing systems that we're going to need in the future. How can we partner with someone out of industry to get those things that can run our care algorithms and help us make those decisions? And stickiness. There's a lot of private equity money out there. How does it get tapped into? There's a need for returns from retirement plans who want the stability of something. So somewhat similar to bond market. But how do you, you take in a capital partner who's passive because they may not know healthcare. Learn what you can from them and create some kind of new dynamic way to interface with patients and meet them where they need to be.
- [16:38]
B
Absolutely. That, you know, it's so critical and having that outlook and ability and then technology infrastructure too. When you are looking at the possibilities for technology partners or those who can help achieve what you were talking about here, what do you as CFO look for? How do you approach those decisions in conversations that you're having internally and with potential partners as well?
- [17:02]
C
It's really got two pathways. You know, first we see agility and nimbleness. Long gone are the days when we have two years to think about and deploy something. We've got to be much more nimble. So how who's best at in the space? Who's who can we influence and design together? We have a part of ourselves that we've called blue tech and that's really how do we invest and we will take a percentage of equity, but how do we deploy and use resources commonly together to create things. So those can be small companies, up and coming companies. And then when we get to things that we perceive that we perceive that we're going to need for a long time, you know, an energy source, well, we'll partner with. How do we get that? Duke Power has been a great partners of ours to make sure that we have that, that electricity we need to keep everything running, which is, it's so much more important now to have a strong energy source. It's always been needed, but just for what it's going to consume as we step further into a computerized environment with AI generation. And so there we're looking for a longer term relationship. We're looking for a lot of stability, a lot of financial wherewithal and then the relationship with the leaders of those companies, are they stable, are they predictable? When you're looking for those long term.
- [18:25]
B
Investment partners, that makes a lot of sense and is helpful. Thank you for digging a bit deeper there. Now before we wrap up, I wanted to ask you about leadership. What do you think it will take to lead a thriving organization over the next five years, especially given everything we talked about today as the industry shifts and as expectations of patients as well in the community are becoming more and more acute.
- [18:47]
C
Yeah, I think three things, moxie, gravitas and curiosity. So going back to this is a time like any other I've seen. If you throw Y2K together, we had that uncertainty with the changes in reimbursement, the crash of 2008 and Covid. Those were all very uncertain times. We have all that happening together now without the assurance of funding from the government. So it's a very trying situation. But I think with the right moxie, the right leadership presence, be curious, listen, you can learn so much not only from your team, but outside, and lead with heart and a dose of reality, and you will be very successful moving forward, I believe.
- [19:35]
B
Absolutely. Well, Lisa, thank you so much for joining us today. This has been a really fun conversation and I'm excited to see you in November as well. I know you'll be speaking at our CEO CFO Roundtable. It'll truly be a pleasure to keep this conversation going and then dig a bit deeper, too, into all the cool things you're doing at Duke and how these growth areas are going.
- [19:53]
C
All right, well, thank you, Lara. It's great to be with you.
- [19:58]
A
At athenahealth, we know your ambulatory practice wants healthier a healthier business, healthier care teams and healthier patients. But the complexities of modern healthcare tech make it hard for you and your care teams to focus on what matters most. That's where athenahealth can help our AI native all in one solutions reduce administrative burdens, streamline billing and payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients, and stronger bottom line. Practicing medicine is complex, but running a practice can be that much simpler with Athenahealth. See how simpler is healthier@athenahealth.com.