This is Laura Dirdo with the Becker's Healthcare podcast. I'm thrilled today to be joined by Jen Moore, vice president of payer relations and payment innovation at MaineHealth. Jen, it's a pleasure to have you on the podcast today. Thanks so much for having me. Now I'm looking forward to our discussion because I know it's just such a a fascinating time in health care right now. And truly, you know, so much happening within, the care delivery space as well as the reimbursement and and payer connections and a lot of creativity, a lot of, new things happening. And so I'm looking forward to learning more about how you're approaching things at MaineHealth. But before we do, can you tell me just a little bit more about MaineHealth and your role there? What makes the system unique? Sure. Well, we're the largest health system in Northern New England. We have about 25 3,000 employees. We have a level one trauma center, which is also an academic medical center, eight hospitals. I think part of our uniqueness is the rural nature of our health system. We have five critical access hospitals. We serve the Southern Part Of Maine. We have about 2,000 employed providers in our medical group. We have an accountable care organization. I actually serve as president of our ACO. We have, senior care services, behavioral health services. This is another, I think, unique feature of MaineHealth. We have the Southern Maine's only private nonprofit psychiatric hospital and community based services. We have home health and labs. So really a comprehensive health system, but I do think it's our rural nature and some of our behavioral health assets that, sets us apart from other health systems. My my role as vice president of payer relations, I'm responsible for payer contracting. As I said, I also serve as president of the ACO. So have both have really that foot in the fee for service world and in the value based world, which is also a unique role, I think. Absolutely. No. That's a fascinating place to be. You know, it's really cool that you have visibility into, all those different aspects of the health care system and to really truly bring them together in a way that's beneficial for the community. Now I'm wondering from the last year or so, what accomplishment are you most proud of? Well, it's hard to choose just one. I I thought about this question in advance. I would say, you know, as an organization, given our focus on quality and patient safety, I'm really proud that two of our hospitals achieved the leapfrog top hospital award. MaineHealth Maine Medical Center in Portland is one of 75 top teaching hospitals that received the award, and MaineHealth Penn Bay Hospital is just one of 15 top rural hospitals. So fewer than 6% of hospitals achieved that award. So I think that was certainly a source of pride for the organization. Also really proud of care team members that have really stepped up to try some innovation solutions to innovative solutions to solving for access. We, like many systems, are struggling with patient access right now. One of the things we did stand up was virtual same day visits, so was proud to get that out of the gate. And then really more unique to my role, one of the accomplishments was the work around care variation. So we engage providers across the health system to identify variations in care and to try to reduce those variations. As a result, we saved about $14,000,000 in expenses, which hopefully is the start to really kind of curbing that cost of health care. On the value based side, again, on our ACO work, we earned about 40,000,000 in value based paper performance and shared savings. So I I cheated and couldn't name just one more, but those are some of the some of the highlights. Oh, that's amazing. You know, it really truly some big results for the health system overall. I'm curious. Could we dig a little bit deeper into, just looking at some of the the care variations and how you're able to standardize more of that, and create such big savings? I I know, you know, there's many other health systems and and hospitals across the board that I'm sure have are leaving some of that on the table or have, the potential to realize some of those same savings. So how did you go about really identifying those variations and then, creating a more standardization around them to realize those savings? You know, it's really specialty specific. So it was really engaging a group of clinicians around their service areas, looking at data and, really peeling apart the data to say, well, why is one hospitalization longer than another? Why is one episode cost greater than another? And and teasing that out, one of the things we found is, the variation around use of supplies. So that was a real opportunity to really streamline and identify a couple of supplies for a given procedure instead of the many that we may have been using. So there were certainly savings there and a lot of savings around length of stay. So, you know, how are we rounding? How are we getting lab work done? What, you know, what are those things that we can do to reduce length of stay? Of course, like so many health systems, we've been challenged by the ability to discharge to, other settings of care because, of course, our skilled nursing facilities also have workforce challenges, and they haven't been able to to take all of our discharges. So we've looked for other ways to reduce length of stay, and, those really supplies and length of stay were the two biggest drivers of those savings. No. That makes a lot of sense, and that's fascinating to hear. I I know that length of stay, again, like you mentioned, just as something across the board, that can make a big difference, both for the patient care as well as, just the efficiency of the hospital and health system. So when you're running into that situation where there might not be that post acute, spaces available, how do you manage those patients, or have you done anything differently in the last few years, to, really control for that and continue to, alleviate, some of the patient flow issues and those kinds of things? Well, it's it's really tricky to do that. The the capacity is is kind of what it is when there's no options to send them to to skilled. We end up keeping them in the facility, which then is just another bed that we can't offer to someone else that may need it. So, it's challenging. Having said that, we partner really closely. In fact, we staff many of our skilled nursing facilities. So we we continue to try to work with them and partner with them to see in what ways we can, support them in their efforts to build their workforce and improve the capacity of care that they have. That's great to hear. Now, looking ahead, what are some of the big organizational goals for 2025? How are you thinking about the next year, and what type of, path forward do you see for yourself? Well, you know, as an organization, we'll continue to focus on quality and safety. Right? That's always a top priority. So continue to focus on the no harm index, improving patient access is still a huge priority for the organization. In fact, just this morning, I learned of an effort to improve patient navigation services. Really trying to get more specific about the ways that patient patients enter our system and the difficulties that they have, whether it's with scheduling or getting prior authorizations, and what are some of the efficiencies that we can employ to free up our caregivers so that are there things that we can do to help these patients navigate that don't take the time of our caregivers and thereby we could improve access just by freeing up that time. So so so nice to hear all of the, the innovative efforts in that regard. What, again, on that care variations work, I think we'll continue to build upon that. And I think for me, the most exciting thing, and again, this is maybe more with my value based hat on, is that the the pandemic, the aging population, the workforce challenges, they're all driving us to consider how to reimagine care delivery. And so I'm excited to see what that will look like. I'd like to see, you know, more of our virtual services be expanded, and I know we have plans to do that. You know, we have thoughts around new sites of care and home based models. So when you talked before about skilled nursing, a sniff at home is a model. Is that something that we can could stand up to really alleviate some of the pressures in the skilled nursing facility? So I'm excited about what's possible. And, again, I think there are many forces that are driving us to think differently about how we provide care. That really truly makes a lot of sense. And, it is fascinating to kind of look at, you know, the different ways that over the next twelve months or so, you'd really be able to, make a a big change in how patients receive care, how they have access to care, and continue to improve that, especially with the value based, thought process front and center. I know value based care is not by any means a new concept, but, it just seems like, recently, in the past eighteen months or so, there's really been gaining a lot more traction and steam, and and organizations have the ability to do more with data and information than ever before. So, it's been exciting to see much more movement in that direction and, especially, as you mentioned, for MaineHealth to be at the forefront. It seems like a really unique opportunity. Agreed. But, you know, in addition to those opportunities, I always know that there's headwinds. So I'm wondering, you know, what are some of the headwinds or roadblocks they're anticipating for the next year or two? Well, I think the reality is that workforce challenges are gonna continue to be a struggle indefinitely, probably. Right? We we have an aging workforce, and that shortage makes it really difficult to make already slim operating margin goals. You know, particularly, we're we're still gonna rely on contract labor. And so, you know, when we're we're we're trying to claw back to, you know, a 3% operating margin is the ideal state, and that's not really it's not a large margin. Right? And so when we're far short of that, that's our greatest headwind as as a health system. At the same time, we see our payers that are putting a lot of pressure on hospitals really, certainly not just us, nationally around rate negotiations, increased number of denials, steerage to lower cost settings. So a lot of headwinds that we're facing. At the same time, when I put my value based hat on, I see a lot of challenges there too. We're seeing an uptick in utilization likely from COVID bounce back. So we're it's not we're the likelihood of making up losses on the fee for service side is on the value based side. So I think health systems are gonna have to adapt. We're gonna have to be thinking about other ways to support our revenue streams. And it may be what we talked about earlier, some new siting new sites of care, new settings of care, new services, and it may be outside of the traditional patient care realm. So I think people are trying to get creative. Some people are selling services that they think they can perform well to other health systems. We'll probably have to do something similar to thrive. Yeah. That's fascinating to hear. And and definitely, as you mentioned, you know, so many different challenges from different directions. I appreciate you talking about the workforce because it's, just such a a challenge, especially in the health care space and in the slim operating margins too. I know I've seen the reports that, that will likely continue for most health care organizations, into the foreseeable future. But in your role, especially on the payer relations and thinking about payment innovation side, what are the conversations with payers been like? Have you seen any progress, you know, in the last few months or so? Or are you anticipating just continued, challenging conversations in the next twelve months? I anticipate continued challenging conversations in my I try to meet regularly with my counterparts with the payers, and they have their own headwinds. And so even though their operating margins are much larger than ours, and it doesn't seem like a a fair comparison, they're struggling too. Many of the plans that have Medicare Advantage plans, they've they've seen a lot of headwinds on the MA business, and so that's that's impacting the commercial side as well. So I think they're they're really trying to figure out how to partner differently, what's reasonable for rate increases for providers, and how they can possibly support the employers who are in the background, the employers and the individual consumers were saying they can't continue to pay the the rising cost of of insurance. And it's more challenging because of that aging workforce and the fact that we have more and more governmental, reimbursement, which we can't negotiate. So and and declines. And so it puts a squeeze on that commercial book of business, that really small book of business, and it's not sustainable, to from from their perspective, it's not sustainable for us to continue to have the increases that we need to make up for that governmental business. And so something certainly has to give. Again, I think revenue diversification is part of that answer, but I think we'll have to figure out how to partner better with payers too. What are the way what are the barriers that we have to providing care in our community? How can a payer come to the table with us to help support and and solve for some of the access issues or, gaps that we have in care delivery in our state. That makes a lot of sense, and I really appreciate you going a bit deeper in there, because it it's a a really big challenge, a really hard one. And so it'll be interesting to see how those, relationships and those conversations continue to evolve within the next year. And, you know, speaking of those changes, it it takes a, unique leader in order to continue to, see success even as there's so many moving parts within the health care system. It continues to become more complex and, you know, there's new opportunities that we've talked about, but also, some really big challenges ahead. So how are you continuing to evolve as a leader to meet the needs of the day? I think the name of the game is agility in this day and age. I I feel like I've always recognized how important it is to be agile, but never so much as it is in this environment. So the ability to roll with the changes just like REO Speedwagon said is gonna be key to our success. I also think in a time of fast moving change, it's important to be transparent with your teams and highly communicative. And so we try to do that. We hold regular town halls. We make sure that our teams understand the change that we're going through and the excitement about what could be on the other side of this change. So really trying to paint the picture that change is always hard. It really doesn't matter the kind of change. It can be tough to work through it. But I think if you have a vision for what it can be like and what it can solve for and get people really, you know, swimming in the same direction for sure. I also think I've done a better job at trying to connect with other leaders within my system. I it's important that I know initiatives that are going on throughout the system so that when I'm at the table with payers, I can communicate with them, to really help them understand the work that we're doing and the value that it has for the patients that we jointly serve. And then externally, with my counterparts at at, whether it's at the payers or with other health systems. Just there's so much to learn. There are so many people that are doing innovative things in the health care industry that, it would be foolish to sit here in Portland, Maine and not try to connect with others and and learn what they're doing. So I think that's, one of my biggest growth in the next year ahead. That's amazing to hear. Well, Jen, thank you so much for joining us on the podcast today. This has been a really fun and interesting conversation, and I look forward to connecting with you again soon. Thanks so much, Laura. I've I've enjoyed it.