The Becker's team is excited to announce the launch of our new CFO and Revenue Cycle podcast. Tune in for conversations with finance experts from the top hospitals and health systems. We'll discuss key trends and ideas to drive meaningful change in the industry. Look for Becker's CFO and revenue cycle podcast wherever you listen to episodes. This is Andrew Pass with the Becker's Healthcare podcast. I'm thrilled to be joined today by doctor Sunny Eben, president and CEO of the University of Vermont Health Network. Doctor Eben, it's a pleasure to have you on the podcast. Thank you for having me. Before we begin, why don't you tell us a little bit more about your background and that of your health system? Sure. So I'm an anesthesiologist by training. I really focused clinically on OB. So I was an o obstetrical anesthesiologist for the last twenty five years. I moved here to be the CEO of the University of Vermont Health Network two years ago, a little more than two years ago. And we're a large rural health care academically centered health care system that takes care of about a million unique patients a year in Northern New York and the upper two thirds of Vermont. And so we have all of the challenges of, health care that are going on today with the added challenge of being in a very, very rural area of America. Mhmm. What would you say is your biggest headwind your system is facing right now, and how are you addressing that challenge? Question. And I think the biggest challenge that we have is just added on to all of the pressures that we see in health care in America. That is the shortage of our workforce both on the caregiver side as well as all of the support staff, the larger expenses in pharmaceuticals and in our workforce as well as devices that we're seeing all through the country with the inflation that we've seen over the last few years and the reimbursement rates not keeping pace with that. We've got the added challenge of a elderly patient population that continues to grow older, more complex, requiring more care and higher acuity care. And so our ability to deliver care equitably and efficiently to that patient population is probably the biggest challenge that we have. Mhmm. Now you are a rural health system, but you're still taking care of a million patients a year. That's still, quite a large number. Do you think there's any unique challenges to being a rural health system or being a larger rural health system? Sure. So those million patients are scattered across, a very large area. So the unique challenges that we see in that rural space are twofold. I mean, two different sides that you can look at. One is on the patient side. Those patients are typically older. They require more care. They have less transportation choices and difficulty trans transporting themselves, longer distances when they do need care. We also have challenges with technology so that broadband and other ability to connect virtually for this patient population or this population in general is significantly more challenging than it is in other urban areas. So shifting that space out into that area makes it makes it much more challenging. And we know that when we think about the quality of health care and the outcomes that are associated with rural America in general, all the causes of death, the mortality rates, the top five, top 10 causes of death, they're all higher in rural America. So when you look at all of those challenges, and then on top of that, a poorer base of the population that makes it particularly hard for us in our rural state states. Now 2025 is just underway. What are three of the top trends that you're following right now? Yeah. So it's always hard to get them to top three, but I think when you look at the big trends that are going on in our country, I think AI, really big. I think the the trend that I'm trying to really keep track of is there's the promise of AI and the expectations that we have and where AI is going in all industries and where is it in health care. And so the two sort of different ways that I think about that are what are the things that it can do really on its own? How can we use AI? Things like the backup, really what I think of as the back office work, billing. Can it make phone calls and prep work? Can we use it in a way that's gonna enhance the care that's happening sort of behind the scenes? And then there's the front of the the workplace with our caregivers. You know? How is it gonna help our caregivers deliver the work that is going to be, really an aid to our patients. So can it actually take on some of the work and really be the copilot for our patients as we move forward? So that's a really big I'd say the top thing that's out there. And so the things that we need to put in place today to really get us moving in that direction. We have a huge advantage, I think, because we've had considerable experience over the last five to ten years in Vermont in particular because we were part of a pilot, all payer model. So we have considerable experience in managing, Medicaid and Medicare populations, and so we wanna continue that work. And, number three is the new medications that are coming in. The GLP ones, you know, it has such positive potential for changing the way that we deliver care and the care that our patients get, particularly if you look at diabetes or weight management. And the challenge on the other side of that is the expense. How much will our government be supporting that type of delivery of care, or are we gonna have to manage that privately? So I think if I think about the top three, those are certainly it. I think overlaying if I could throw one more in, Andrew, is the overlaying all of this is are the changes that the new administration will bring in and is that gonna impact us? There's a big unknown, but that we're paying really close attention to. As a health system, how do you keep track of everything that is changing with the new administration? With a lot of help, I would say. We do have folks that are, you know, focused on the government relations arm and the communications arm. So we're trying to track very actively what is happening and the impact that it would have on our patients and what we would need to do. And so I think we've got, a regular cadre, a group of our our team that are focusing on that, and then we've got the finance individuals that are looking at the financial impacts. And so we get together weekly to talk about those concerns and what's coming up. And, of course, if we need to, we'll get together, and quickly have a huddle. But, typically, every week, we go through and and outline if there are any significant changes. Mhmm. Now what are you most excited about right now? Well, that that's a great question too. I think that our opportunities are kind of overlapping with the trends that we're following. So when I think about the new technology that's out there and how it can support our caregivers, I'm I am really excited, on the caregiver side and on the patient patient care side. So let me give you a couple examples if I can. One is our ambient listening project, which we've rolled out to all of our primary care physicians, and that is really helping them to be able to document their conversations without having to type, without having to dictate later. So ambient listening has helped them cut down on their documentation time and and reduce pajama time where people are we can see that people, the need that they have, our docs and nurses to go home and document what happened during the day has largely gone away or been greatly reduced. That is really exciting because I think we're making their lives better in reducing burnout. On the patient side, it also has a great opportunity in the same space because now the doctor or the nurse practitioner is sitting there and looking right at the patient and having a conversation. So the patient feels like they're being connected to in a way that is different than if someone is taking notes or or putting things into their computer. So I think that's a really great opportunity. Very excited about that. Using that same technology bend for our patient side of that, things like leveraging econsults so that all of our emergency rooms across our network are connected. And so if people need an immediate consultation for an expertise or an area that they do not have locally, they can connect with us. And that applies, you know, in the emergency rooms, like I mentioned, across our network, but even outside of our network with tele NICU, for example, for places that are delivering babies that are outside of our network, but they need to connect with the one NICU that's in our health service area with it which is within our network. They can do that now on on on wheels. So I think those are really exciting opportunities using technology. We've got that in cancer care as well. The other thing that I'm really excited about we touched on earlier, which is the opportunity to change the way we deliver care in the rural areas, and that really is around high value care. How do we change the model so that we try to keep and work hard at keeping our patients out of the hospital, out of the emergency rooms? And what that means for me is is really looking at how do we deliver care at home? How do we deliver virtual care? How do we ensure that our patients have access to primary care, pharmacists, social workers getting involved in the care, and changing the relationship in a way that is gonna be really significantly different but better once we get there. And that relationship that I'm talking about is the care the relationship between a patient and the doctor. It's always been a patient doctor relationship, and what we wanted and need to shift to is a patient practice or a patient office relationship that involves nurses and pharmacists and social workers and community health service workers to really work in conjunction and work together to be really delivering what the patients need and being much more efficient and effective about it. So I think those two things are are really exciting as I look forward to this year and beyond. And then lastly is is really leveraging and bringing our network together and thinking about how do we most efficiently leverage the expertise across our integrated care system better to try to deliver care as close to home as possible whenever possible. So those are those are really big things that I'm excited about. Mhmm. And building on that, last question I have for you is how are you thinking about growth otherwise over the next twelve to twenty four months? Yeah. So that that that is an excellent question over the next next year or two of what we're going to do. The challenge for us is, of course, that we are trying to keep costs down. And so we need to grow in a very focused way and really primarily looking at access for our patients, access to what they really need, sort of the nuts and bolts or the blocking and tackling of of delivery of care. And for us, that really means access to primary care and very specific specialties and try to deliberately grow those in the area so that we can deliver that care close to home. And I'll just give you the one example in primary care, which I think I'm I'm I'm really excited about and we're gonna try to do, which is we've rolled out risk adjusted primary care panels to all of our our physicians and, nurse practitioners and PAs all involved in primary care. And by doing that, what we've tried to do is spread out the complicated high acuity patients with the more otherwise young healthy patient population so that their practices can look and see how many patients can I actually take care of? Because some of those patients are gonna get are gonna get seen every three months. Others may only need to be seen once a year or once every other year. And so we're bringing that in to be able to increase access. So, like, a really very focused area that we're looking about and how do we grow our patient population in that way. And then the second piece is just really looking for centers of excellence, focusing where we need to bring expertise in a geographically focused area, and then having folks come there for that care so that we don't duplicate care so that we can be most effective and efficient with the care we deliver. So those are those are two very specific areas that we're trying to grow in. Very interesting. And, that was all the questions I had for you today. Thank you so much for joining us, doctor Ipan. It's been a pleasure speaking with you, and I look forward to talking with you again in the future. Me too. Look forward to seeing you again. Thank you so much.