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Nate Kaufman
This is Nate Kaufman with the Healthcare Bridge, and today, I’m excited to welcome a friend and colleague, Jeff Flaks, who is the CEO of Hartford Healthcare. Jeffrey, welcome.
Jeffrey Flaks
Nate. Thank you, my friend.
Nate Kaufman
It’s nice to see you. To start out, what we try to do is provide the an insider’s perspective on healthcare. But first, let’s talk about your origin story. Can you give us some of your background and something about Hartford Healthcare?
Jeffrey Flaks
Nate, first of all, I consider myself so blessed to work in this field. I love this field. I love what we do in healthcare. I think it’s the greatest place to work. We have such an opportunity to get up every day, make our community better, make the world better. So for me, I’ve been in healthcare since the beginning. I started when I was in high school. Both my mom and dad were public school teachers in southern Connecticut where I was raised, so we had a real sense of community, real sense in my family of giving back, being really deeply engaged. I started working as a delivery boy at a local pharmacy, and did it for about two years. It just afforded me a chance to see healthcare, both in community centers, FQHCs (Federally Qualified Health Centers), hospitals, nursing homes, doctors offices. It really gave me the chance to see so much about healthcare and to see so much about what it really means; I fell in love with it from that day forward. I’ve been fortunate now for about 30 years to have been able to contribute to trying to make healthcare better every day.
Nate Kaufman
In fact, I understand you are one of the modern healthcare up and comers. It’s now called 40 under 40, so you should be congratulated. There aren’t a lot of people who are actually nominated and selected for that.
Jeffery Flaks
As some may know, you were one of the truly original up and comers, because you pre-date me slightly. But for me... it was already some time ago. Also, I was working in New York at the time, and look, I was very blessed, fortunate to be in that position to be recognized at that time for contributing to our field and trying to do it in any way that I possibly could.
Nate Kaufman
Can you tell us something about Hartford Healthcare, just a little bit about the system, and how many hospitals, that kind of stuff.
Jeffery Flaks
Nate, as you know , Hartford Healthcare serves, really, the entire state of Connecticut. We’re in all eight counties. We have more than 500 locations here in Connecticut, several in Western Massachusetts and to Rhode Island, but principally serving Connecticut. We have about 47,000 people who work within our health system. We’re just approaching $8 billion this year terms of our annual operating budget, and we have ten hospital campuses across Connecticut. So we’re a comprehensive system. We have very significant programs in home care, significant programs in pre-hospital care, a very significant ambulatory network. We’ve been extremely focused on driving more access, creating more affordable options for care, improving significantly the issues around health equity and working to make healthcare better, higher quality.
Nate Kaufman
I remember in the 90s, Hartford Healthcare basically had two hospitals, and I think you contributed to the growth. What’s the difference between a great CEO and a not so great CEO of a healthcare system? What do you think really makes a CEO stand out in today’s environment?
Jeffery Flaks
To me, it’s staying really close to the organization, close to the operations, close to the community, staying really close to the purpose of the organization. At the end of the day, this is about delivering better healthcare, making it higher quality, more convenient, lower cost, more equitable. But that needs to be done from deep within the organization. So I think a leader has to listen, has to be closely engaged, has to understand the real issues that our colleagues who work here are working through to try to do their jobs to the best of their ability. [The CEO] has to really understand the issues that our customers, our patients, our residents are experiencing within our organization. So to me, it’s really staying obsessed with continuous improvement, and at the same time, staying very close to the purpose and legitimacy and realness of the organization.
Nate Kaufman
That makes a lot of sense to me, for sure. Health systems today are getting criticized a lot. You hear they’re bloated. they’re not focused on cost, they’re sponsoring sports teams as opposed to providing care to people. What do you say to folks that are critical?
Jeffery Flaks
Look, I think we have to listen, first and foremost, always. But to me, it’s really about the core of the organization. We need to be accountable, and we need to demonstrate the value that we’re creating in our organization. I talk all the time that we can’t protect the status quo. We have to change it, and we need to disrupt it, because healthcare isn’t accessible, it has not been affordable. We cannot continue to drive up rates and see these above inflationary adjustments. We’ve got to figure out ways to deliver care at lower cost, [provide more] settings that are more preventive-related care, and to move to being outcome-based as opposed to productivity-based. As we go forward, we need to recognize that healthcare needs to be better. So from my point of view, when you’re leading there are times - I’ve seen it in our own health system in the early days when we were building Hartford Healthcare - where there would have been criticism, because we were starting to bring together the different components of the health system. But we had a vision and we had a purpose, and we had a destination in mind. And people who were trying to protect the status quo to say stay the way you are, those original individual independent hospitals that became Hartford Healthcare never had the capacity to do what we do today. So when you look at what we’re building today - using artificial intelligence, using machine based learning, the capacity to manage and coordinate care differently, the ability to diversify so that we can move care to more convenient, more cost effective settings - that never would have been possible if we didn’t change. So at one level I think you have to listen and have to understand the concerns that are being expressed. But at the same time, you have to be purposeful and principled and have a clear vision and destination, and sometimes you have to just move forward and let the outcomes ultimately speak for themselves. And I think in a lot of ways, that’s what’s happening right now.
Nate Kaufman
Yeah, and you’re very energetic about healthcare, as opposed to me, who was a little bit less energetic. I mean, I hate giving my speech, because when I talk about healthcare and the new beautiful bill and 340 B - which is a regulation, a loophole - is being challenged and site neutral - another loophole - is being challenged, these are all necessary for us to compensate for the under-funding of care. I mean, how do you maintain your optimism in the face of all of these potential headwinds?
Jeffery Flaks
Nate, I have to tell you... and I understand what you’re saying because I go to different meetings with my peers, and listen to thought leaders like yourself and others. There are many people who are focused on the headwinds we’re up against today and the headwinds are real. The issues around Medicaid restructuring at the federal level, tariffs, are having a huge negative impact on health systems in many ways, because so much of our supply chains are global, issues around eligibility and different aspects of payer reform, payer relations. There are many different things that are on the horizon that have the potential to create vulnerabilities for health systems. Now that being said, there are always issues in front of us, some more significant than others. We will work through these types of things and get through to the other side. My premise today, there’s never been a better time in healthcare. The reason I believe this is the best time we’ve ever had in healthcare is because we’ve never been able to get better faster than we can right now. Historically, Nate - and I know that you know this better than anyone in healthcare - you’d add new technology, and it would make doctors and nurses lives more difficult, and it would make them slower, less efficient, more administrative, pull them away from the bedside or the patient; add technology and make healthcare more expensive, that was true for a long time. Today, what we’re seeing is that the improvements for healthcare are making people’s jobs easier and better, and allowing them to recenter their purpose back to why they’re doing it, their love for it and using their expertise to help people get better. So I’m such a proponent right now, that now and into the future, we have an opportunity to really address things that were historically intractable, just problems that have been here since the beginning of time, and we’re now able to address them, and we’re able to really get better faster. So I am very optimistic, and I’m encouraged. Nate, think about the iPhone, the first iPhone comes out, and it got panned. I have a copy of it in my office. People were talking about... well, they were criticizing it because it didn’t have a keyboard. And Nate, I know you were a huge BlackBerry guy back in the day. You had two of them, and you were quick as could be in texting. They [were saying] well, how could you have this without that? Why does it have a camera? Version one of the iPhone had challenges. There were change management issues, it had bugs within the software, but look at what it is today. I look at where we are in healthcare, in many ways, the improvements today, they really are great. I mean, we’re seeing some incredible differences being made using AI and using machine-based learning and seeing improvements, but this is the beginning of the beginning of the beginning. Imagine what it’s going to look like in three and five years. We just have to keep projecting forward, staying the course and be about working to be the best at getting better. Get better tomorrow than we are today, be better next year than we are this year; that’s the goal. Just keep getting better.
Nate Kaufman
And it’s amazing from my perspective, knowing you, that you’re able to tolerate all this without medication, [laughter] I mean, I couldn’t do that, I have my strength twice a month, which is at three o’clock on Mondays.
Jeffery Flaks
I know never to call Monday afternoons. I understand exactly. [Laughter.]
Nate Kaufman
So just in close, advice for patients. What is your advice for patients with respect the to the healthcare system right now? It’s hard to negotiate or navigate. It is expensive, and I would blame some of that on the payers who have changed plan design to make higher deductibles and co-payments. I mean, what is your advice to patients?
Jeffery Flaks
I’ll tell you, Nate, if you look in this moment or even back just a short period of time, you could see incredible improvements. If you were to go to one of our urgent care centers today, you could go online on the app, make your appointment, tell them why you’re coming. It tells you which one to go to, and you can make an appointment, or you could show up, obviously, without an appointment, but if you make the appointment, it tells you what room to go to when you get there. The portable X-ray equipment is there. The radiologist is in the ceiling and on the speaker phone, interpreting the results for you real time, your electronic health record is up on a 42 inch screen, they have all of your past images in front of them. They have all of your medications and allergies. They know who your other providers are and what your past experiences were. If there’s anything of relevance or concern that didn’t exist five years ago. Today, it’s become standard. Today, you can go on an app and download HHC 24/7 at the Apple store, and you can get in a queue to get a primary care visit this minute, and that queue will probably be in seven minutes. Or you can make an appointment for two o’clock this morning or Sunday afternoon, or whatever time is most convenient for you. And you can pick your provider, and you can set up the parameters of which you have that primary care experience, 24/7, and they prescribe labs and imaging or whatever type of ancillary services you need. That didn’t exist six months ago. Today, we’re seeing hundreds of people every day in that process. So to me, the advice for patients, is we’ve got to engage, and we’ve got to recognize that we’re moving every day to getting better, more coordinated care, more well-navigated care, and able to drive care to more affordable, more convenient settings, working towards getting to more prevention and more outcome-based services, as opposed traditional fee for service. So sometimes you have to step back and look from above. The improvements have been massive, but now the benefits - the improvements on top of these - compound on the ones that have already been made. So I believe that we are on the precipice of making healthcare so much better. And Nate, from a quality standpoint, the things that we call never events, they still happen, but they happen less now than they ever did before. You look back at the Institute of Medicine study from the early 2000s, the improvements have been extraordinary between then and now. Basically over two decades, over a generation of time, the improvements are incredible, but they’re not where they need to be, because we still have things happening in institutions that should never happen, but they happen less than ever before. So quality is better, safety is better, the amount of surgery centers in the community that don’t charge hospital rates, the level one, level two visits from emergency departments that now happen within the community, the ability to manage imaging in communities and so forth, so that we can drive care where people want to be, where they live or work, or hours of the day or night that they prefer. It’s better than it’s ever been. And yet, Nate, I guarantee you it’s going to be so much better next year than it is now. Again, that rate of improvement, the rapidity of improvement, this is like we’ve never seen before, because the technologies and the enabling type of support systems are so good. So I am an optimist. I believe that we’re on the precipice of just continued and even more substantial improvements. But we’re not without headwinds. The headwinds are significant. They’re disruptive. They could set us back, depending what they are. They could stymie innovation. They could delay some of the advancements we’re making if we don’t have the investment capital or the operating margins to support these types of investments. So we are fraught with risk and challenges, at the same time, there are great opportunities around us. There is a dynamic tension, it’s not a panacea, but if you can see around that tension, there’s great opportunity.
Nate Kaufman
And that’s what I think a good CEO has to do, is not get hung up on the headwinds. You’ve got to keep moving forward. Anything else that we should cover that we didn’t cover in our little brief visit, Jeffrey?
Jeffery Flaks
No Nate. First of all, let me say this, you’re a great thought leader, and I always consider... people talk in sports terms, they say who the GOAT is, they debate about who’s the greatest of all time. You’ve had such a distinguished career. In the course of my entire career I’ve attended your speeches countless times at national meetings, I’ve read your commentary so many different times. You have continued to be such a positive influence on everyone, challenging the conventional, forcing people to see certain realities, to think differently. You’ve counseled - I couldn’t even tell you how many - boards of directors across America over the course of decades. You’ve helped make healthcare better, and you’ve certainly caused everyone, at times, to step back and rethink what they’re doing. You don’t always go with the norm, you’ll challenge that conventional thinking. So we’re grateful for everything you’ve done. You’ve helped Hartford Healthcare - with full disclosure, from a transparency standpoint - as a tremendous advisor. I’ve also always respected that while you’ve had this major focus on thought leadership, you continue to work with physician clients across the country, and you’re a huge advocate for the practice of medicine and physicians and advanced practitioners in particular. So I’m appreciative. You’ve been a mentor to me in many ways. I’ve learned a lot from you, and I’d like to think that you’ve learned some from organizations like mine, working as closely with us as you have.
Nate Kaufman
[Chuckling] Every day, I learned something new, Jeffrey, but most significantly, I can tell you, with all that, I could never do your job. The ability to have patience, optimism and focus are not traits that I possess. But anyhow, this was fun. It was a brief talk with Jeff Flaks, who is the CEO of Hartford Healthcare, and really the driving force behind healthcare in Connecticut. Jeffrey, I appreciate your time.
Jeffery Flaks
Grateful to you, Nate, thank you, my friend.
