This is Madeleine Ashley with Becker's Healthcare podcast, and I'm so excited to be joined today by Nick Barcelona, CFO of WVU Medicine. Nick, thank you so much for being on today. Thanks, Madeleine. It's great to be here. Wonderful. So before we begin, I would just love to have you give a little bit of an introduction about yourself to our listeners and tell us about your background and a little more about WVU Medicine. Happy to do so. Yeah. So I am the CFO for WVU Medicine. I've been here for, a year and a half or so now. I came, to West Virginia from Philadelphia where I was the CFO at Temple Health, the system CFO there. So it's it's been a nice change to to to get over to West Virginia and and, join this team. We so about WVU Medicine, we're a a large and growing health system. We're about a $7,000,000,000 system. We have 25 hospitals across 4 states, predominantly in West Virginia, but we're also in Ohio, Pennsylvania, and Maryland. We do have our our own insurance, plan, which is Peak Health. We have little north of 3,000 physicians. More than half of those are employed physicians, and we have, over 30,000 employees. So we, we continue to be a a growing health system, for this region. Wonderful. And, you know, I think I told you before when we've talked, I love West Virginia near and dear to my heart. I'm actually from, around that area. So I was, lived in Beckley for a while. So I love that area. It's a lot of good, hiking and biking up there or down there. It is beautiful here. I was just down in Charleston earlier this week, for the new governor's inauguration, not too far from Beckley. And, yeah, the more I learn about West Virginia, the more it impresses me. It's just an absolutely beautiful state. It really is. So kind of, you know, looking at right now, shifting things back from West Virginia and its beauty to maybe health care now. So just kinda curious if you could share with me some of the top three trends that you are following right now in health care and and kind of how they're impacting WVU Medicine. Yeah. So, you know, I think couple things. One is certainly the the increase in employee benefit costs and and, you know, a lot of that is is fueled by, increasing drug costs as well. This is not a surprise likely to you. I'm sure you're hearing this from others. It's it's a real challenge. Right? Because one of the other continued challenges that we've maybe experienced since the pandemic is is really agency costs and and recruitment and retention of of our team. And so when you think about employee benefits, that's a critical component, right, of how you create a a welcoming and healthy culture for your employees. It's something we're proud of and something we continue to invest in. But you have to manage it. Right? You have to manage it effectively, and so that's something that that we really view as a continuing headwind or challenge for us and something that we're watching, pretty closely. You know, another key strategic area is is, you know, working with insurance companies and then, you know, specifically in the realm of Medicare Advantage. And, you know, I I mentioned peak and peak health and what we've done there, and that's really a critical component of our strategy. And, we've been very successful in peak. Right? We're we're now in year 3 of of operation with with peak health, and that's something that is on track and growing. But, also, really, I think gives us a unique opportunity to do something different to to serve the the patients and the families in West Virginia and beyond. Right? Our goal is to improve the health trajectory of all that we serve, and and we view that as a key vehicle, for the future to be able to deliver care in a different way, to think about things, you know, like prior authorizations or other sort of barriers, red tape, administrative burden that often comes in that, friction, if you will, between the provider and the payer side. And, you know, I don't think we've we've perfected it yet, but I think it's certainly, the the best opportunity that that we have to continue down that path, and that's our mission. Right? And so that's something that we're really heavily investing in and focused on. So when you and I talked, in October of 2024, we kind of dove deeper into the acquisitions of WVU Medicine. You guys have acquired, I believe, 12 hospitals over the last 3 to 4 years. So you guys have a portfolio right now of about 25 hospitals. So just kinda curious, you know, maybe what you're most excited about right now in 2025. Any acquisitions in your future, any other exciting plans for the system? A lot of growth that you've seen Yeah. You know, so we did complete the Weerten transaction. That's our most recent. We actually completed that on January 1st of of this month. Okay. So that's sort of the newest addition to the family, and that's something we're very excited about. You know, as it relates to continued, m and a activity, you know, I think obviously, can't make forward looking statements. But, yeah, I I think for us, we are always looking to to grow and and looking to figure out how we have the network that can best serve our population and the surrounding communities that we serve. You know? And and I think specific to that, couple things I'll say. 1, for us, you know, you're seeing a big shift, as we've grown very rapidly. Right? You referenced it, 12 plus hospitals in the last 3, three and a half years. And we we are very, intense and focused on making sure we integrate those hospitals rapidly. Right? So sort of rip that band aid off, get them on, you know, our electronic health record, get them integrated into all of our systems, ERP, etcetera. And so with that, we've been focused a lot on integration over these past few years, and it's really trying to shift that mindset from integration to optimization. And and in parallel with that, really investing in breadth and depth across all these new members of this WVU Medicine family. And so sort of what does that mean? You know, it means really that we're we're looking at regionalization. Right? And how can we care for and provide specialized services to the regions and areas that we serve, closer to home. Right? So it's you know, everything doesn't have to funnel in, to the mothership where I'm sitting right now, in Morgantown with with Ruby and WVU Hospitals, but really thinking about how we create this integrated seamless network, because that's what the patients want. That's the experience they want, and the outcomes prove that out too. So that's that's really our focus is is, you know, figuring out how we can continue to optimize. You know, but as it relates to specific m and a, you know, nothing nothing really exciting that I can share at this point in time. Hey. That's okay. I know it's it's literally January 17th. So, you know, obviously, there's probably some more exciting and fun things to come, but just keeping your options open. Right? That's right. Definitely. And kinda to that point, you know, and you just mentioned the Weirton Medical Center acquisition, what does integrating, you know, seamless integration of even just the employees look like to you? And and how do you ensure that? And especially even looking to, like, the like you were mentioning, the Epic, EHR system. How do you ensure that is is a seamless, integration? Yeah. Well, I think it starts with open and transparent communication because Yeah. When I say seamless, that sometimes could be interpreted as perfect. And I can tell you, having done this for a number of years now at this system and others previous to this, it's never perfect. Yeah. You get yourself into trouble sometimes if you tell the employees nothing's going to change. It's all gonna be the same or it's all gonna be smooth. I think you have to be open and honest. You have to set realistic timelines and expectations, then you have to stick to them. Right? And that that's something that we really focus on, and I I think we we deliver on that. Right? So when we're when we're doing this, we're making those changes. For example, our EPIC implementation, you know, for for all of our other facilities, we typically complete those within 1 year, of the integration, and and we're doing the same thing with Weirton. Right? So we we want to to rip that mandate off, as I said before, get everyone comfortable, get them trained, and deal with those things that pop up, those unexpected surprises. The changes. Change is hard. Right? And and we wanna you know, we don't wanna fool people into thinking it's gonna be, you know, all, you know, sunshine and cupcakes, and and it's not, but it will be worth it. Right? It's that optimization that comes after the integration. That's the the payoff, and and that's really the way that we try to navigate this with the employees. Right? We want them to understand what we're doing, understand some of the challenges, but also the why of why we're doing it. And then, ultimately, it will be better for them and for us in the long run. Looking to Pennsylvania, you know, we're seeing hospital consolidation continue to gather this momentum across the country. But in Pennsylvania specifically, we are seeing more mergers and acquisitions. And WVU Medicine does have a hospital, in Pennsylvania. So would love to hear your thoughts on why you think maybe hospital consolidation is booming in that state and maybe how you foresee, you know, that landscape evolving in the next few years. Yeah. It's a that's a great, great question, and one that we we do get quite frequently. We are we're you know, in in Morgantown, we're only 5, 6 miles, south of the Pennsylvania border. So they are very much our our next door neighbor, and you referenced it with Weirton as well. Right? Weirton is on a 4 or 5 mile stretch right in that northern panhandle, really between very close to Pennsylvania and very close to Ohio. So we we certainly, you know, live and work in that market. You know, we do have Uniontown Hospital. That's one of our more recent, additions to the family. We just opened up OB and and women's, services there, so we're we're doing deliveries. We had our first baby. Well, set of babies now, but, first baby, born there a few weeks ago at this point. So it's just it's really exciting for us. That market is challenging. Right? It's a hypercompetitive market. You have some large health systems. You have a number of independent hospitals and and providers in that market as well. So I would describe it as hypercompetitive, and it's a sort of a microcosm of what you're seeing at the national level where if you follow any of the other reports that come out related to sort of the health of the industry and your organization is an organization that puts out some of those reports, so I'm sure you're familiar with it. But, you know, you you've kinda seen margins, stabilize, if you will, since the pandemic, but you have to you have to dig a little bit deeper and kinda scratch that surface and and go down a couple layers, because what you're really seeing is sort of some health systems do extremely well, and other health systems that aren't doing well continue to face greater and greater challenges. Right? So you're seeing this, you know, wide variation in in performance. And, you know, when you take an average or when you look at a median, it kinda looks like, well, everything's fine, but you have to dig a little bit deeper than that. And I think, you know, you're only seeing those challenges continue and and sort of escalate. Right? And so, you know, we we work very hard to make sure that we're maintaining margin, that we're stabilizing and strengthening the balance sheet, that we're delivering from a cash flow perspective, and, it is not easy to do so. This is not an easy, industry that we have all chosen to to work in, and I think that hyper competition that you see in in in Pennsylvania, really in both the eastern and western, sides of the state, I I think just makes it that much harder. And so you have sort of a case where you have some winners and then you have some losers. And and and, you know, unfortunately, it's kinda hard to say it that way, but I I think that's the reality. And and that translates into I think you're gonna see more of this. Right? You're gonna see more of this consolidation, because of those challenges. Yeah. No. A lot of really great insights here, and it will be interesting to watch things play out even over the next few years. So thank you for sharing that. As we kind of look, you know, to the next 12 months at WVU, I know you don't have a crystal ball and we can't do too many forward thinking statements. But how are you thinking about growth? Are sure you're excited, like we said, a lot of wonderful momentum going into 2025 from from the acquisitions and growth that your your systems all ask. Yeah. So I'll I'll answer that. It's sort of a 2 part answer. On the provider side, you know, we we had our big sort of $400,000,000 announcement this past year in 2024, with specific investments in Morgantown, in Fairmont, in Elkins, in Princeton, in Bluefield, and that was, certainly exciting. And those are projects that are sort of underway and will will, you know, sort of deliver future, growth opportunities for us. But that's that investment in breadth and depth. Right? And and, you know, we would look to see more of that. Right? We wanna be doing those types of announcements every year, and continuing to invest, in our physical plan and in the communities as we, you know, sort of regionalize as I mentioned earlier and and continue those investments. So that's one big part of our strategic focus. I think the other big part, which I you've heard me mention multiple times now, is our insurance, strategy, right, with peak health. And, you know, we we so we launched peak health 2 years ago. We started our Medicare Advantage Plan 1 year ago, so that was 1 124, and we are continuing to grow, the number of covered lives in there. We're continuing to focus on how we can expand and provide the best care for the regions we serve and, ultimately, to serve more regions, with that. And so I think those are the the really the two main areas of focus. Right? It's it's continuing to invest on the provider side, and it's really fueling significant growth on the insurance side so that we can partner those 2 together, and and we think that gives us the best tools to to thrive from a population health perspective, to manage and control our own destiny as it relates to how we're investing and and really providing the best care for our patients. Well, Nick, it sounds like a lot of really strong growth over at WVU Medicine. I truly thank you for joining us today. It's been a pleasure speaking with you, and I look forward to connecting with you again down the line. Yeah. Thank you for having me today. You know, I think it's it's a period of rapid change, and, you know, we're evolving and growing, and we're an organization that's never satisfied. Right? We're we're looking we're always looking to improve. We all the things we're working on are focused on the future, you know, which which, you know, to be candid can be exhausting, I think, sometimes. And so for me as one of the leaders part of, you know, as one of the leaders that's part of this great team, it's it's really our culture is key. That's our secret sauce for future success. And I sort of embrace that, and I embrace my role. Right? I'm, you know, chief change officer, if you will. Right? Like, my goal is to be excited about this change and to get the team excited about it because we have a lot going on, and I know that it's not easy. It's a lot of hard work, but it's also very exciting to to be able to to sit here across from you and and talk about this this change and and really the trajectory of of our system. So thank you again. Wonderful. Well, I am excited to see all of the awesome things you guys do this year as well. So thanks again. Thank you. Have a great day. You too, Nick.