This is Laura Dierda with the Becker's Healthcare podcast. I'm thrilled today to be joined by Greg Poulson, senior vice president and chief policy officer at Intermountain Health. Greg, it's a pleasure to have you on the podcast today. Great to be with you, Laura. Now I'm really looking forward to our conversation because I know Intermountain is one of the most innovative health systems out there and truly is on the forefront of a lot happening not only in technology and innovation, but also in how you're growing your system and thinking about health care as a whole. So, you know, I'm excited to learn more. But before we dive in, I'm wondering, could you tell us a little bit about Intermountain as it is today and what makes it unique? Sure. I'm not sure we're really unique, but I think we may be a little bit unusual in the sense that, although we're a a relatively large hospital organization with 33 hospitals across five states, I think, and, and a large number of of physician practices that participate with us and a broad array of ancillary services. We've been in the health insurance business now for about forty years, and we're the the the largest, insurer in our primary communities. And that, makes us think about the world somewhat differently and has given us some focus around, when we talk about, providing value, it gives us some additional, both some additional thoughts, but also some additional tools that, that that have given us, I think, a different kind of focus that maybe some would have. Absolutely. And I think that's just such a really great point because having that ability to understand the provider side as well as the health plan side, puts you in a a spot where you can make, progress towards what I know we've been talking about for years and years now. We need to think about value, think about, caring for populations, and really truly figuring out how to find that happy medium where everybody is, able to work up to the best of their abilities, it seems like. I think that's right. And, at least from my perspective, one of the really lovely, components of that is that for for so many of our friends, the relationship between the payer and the provider is one of of tension as opposed to one of coordination and focused cooperation. And I think we find that there are tremendous, innovative opportunities, when the two sides are able to bring their collective strength together and be able to, take a a focused approach on helping people live the healthiest lives possible, which is both our our mission and our tagline. Absolutely. Oh, you know, and what a great segue into, you know, thinking about from the strategy down to, you know, the the execution level. What is the accomplishment that you're most proud of from the last year or so? Well, you know, we've, we've we've not done anything that's a radical departure from our history in in the last year. We continue to focus on proactive care, which is the the term that we use for sort of value based care. But but value based care has morphed in, so many different ways in terms of what what people mean when they say it and when they hear it. And so we wanted to, to to have a term that we could, understand at least within our own internal discussions. And so, we've we've used the phrase proactive care, as as a definition of what it is that we really want to, want to do, which is to help people proactively, to be as healthy as they can and avoid the need for some of the very expensive and unpleasant, health care experiences that, that otherwise would would be coming their way. I guess, what the the other thing that I would well, let let me stay with that for just a second and say that, you know, that that happens not only when we have people who are within our own insurance world, but it also happens with, other Medicare patients, other commercial patients that come to us. And it helps us, I think, to, have a more holistic view of what we might be able to do that would be effective in their lives and and help them to move forward. So that's sort of, you know, a continuation of what, what we've been doing. Something that we've been trying to do in the last year with, with with some good results is simplify, the the whole health care process, both for our, our members and patients, but also for our caregivers. And we see enormous complexity serious approach. Our our CEO, Rob Allen, has decided that, the the one of the legacies he'd like to leave behind is a is a simpler organization, easier to navigate, easier to understand, easier to participate in. And so those are our two big foe OSI this last year. That's helpful to know and understand. I I know no easy task really to, make the complexity of health care simpler in bringing you into a space where, you know, you're really able to care for patients and and make the experience better for them. From looking ahead, where do you see some of the big growth opportunities in the next twelve months or so? Oh, you've you've kind of hit a hot button for for me at least. And and and let me just head down this path, and and I I hope that, that I there won't be too controversial here, but I think that it's really important to note that growth should never both be a primary goal or strategy in at least my perspective, and I think our organizational perspective. Goals and strategies should be built around value enhancement for stakeholders, you know, those that we serve and those that help us to do so, our patients' members, the community broadly, and the caregivers that, that we work with. So I think the statement that if you're not growing, you're dying is extremely common, but I think it's extremely wrong. I think it's caused a remarkable amount of over the last couple of decades, and the road to growth for its own sake is is, as we all know, littered with wreckage. The wise and virtuous strategies that we should be building are around value creation for patients, beneficiaries, and caregivers. And at least my perspective is that such strategies may well include growth either as a component part of the strategy or as an outcome of the successful implementation of that strategy. But to speak of growth as the strategy, I think, is neither wise nor virtuous. I do wanna be clear that growth is very often both necessary and beneficial, but only as part of the goals and strategies that create value. This is why I'm disturbed when growth is discussed as the goal. I think that misses the mark both strategically and consequentially leading to outcomes that serve neither the organization or its stakeholders, and I think we've seen lots of examples of that over the last decade or so. Let me give you an example, though, that I think may may focus it for for some of us, and at least it focuses it for us at Intermountain. I think, some of your listeners may be aware of Civica, which is an innovative value adding generic drug company. It was created to provide generic drugs that are overpriced or in short supply or often both at the same time. If Intermountain had viewed the provision of generic drugs to the market as a growth opportunity rather than as a way to increase value for shareholders and stakeholders, shareholders meaning broadly the communities and people we serve, we would have approached the development in a much different way and I believe a much less desirable way, and the overall outcomes would have been far less. So I think that that we always need to put, growth into a perspective of what it's doing to further our mission, further our ultimate goals, and further the value that we provide. Otherwise, we can get distracted and head off in, in ways that, are not contributory to to the overall benefit of the, folks that we have responsibilities for. And that's, you know, a really fascinating way to look at it. And, I appreciate your thoughts on growth here because, you know, you're right. Having that ability to focus in on what's creating value for those stakeholders, especially the patients, but, you know, really, everybody, who's involved in the process makes a big difference. And that example of Civica two is so prudent right now, especially as, so many organizations are finding it challenging to, keep their, supplies seeing their expenses rise and those kinds of things. And so, you know, when you look at it through that lens of value creation, and from your role as, being the chief policy officer. What does that look like for you? How do you, navigate the the world around you when you're trying to, primarily stay focused on creating value for the patients and caregivers, involved in the health care delivery process? Well, it's a it's as as you, certainly imply, it's enormously challenging to not be distracted by, by by many of the the factors that can, dilute our focus on on value for the folks that we care for. The the biggest advantage that that that I have seen is our board, and I hope boards, across the across the country, who are there to represent, at least in the case of not for profit organizations, hopefully, through there to represent the, the folks that we serve, the patients, the members, the communities. And though the our board has been very effective at constantly requiring of us that we report the benefits that we're achieving with our strategies in terms of helpfulness to the communities, helpfulness to the, to the individuals that we care for, and, hopefully, good stewardship with the resources that have been entrusted to us. So, certainly, our board is is very, very helpful, and and that trickles into our daily reports that that that come up when we're looking at what are we providing to the to the folks that we're caring for. Are we being as as cost effective as we can be? Are we being value effective in in helping people to avoid the need for, what what could be rendered unnecessary services if if appropriate interventions are taken earlier. And that oftentimes, is not compatible with revenue generation. So there's there again, having having a board that represents the, the the community interest, the, the interest of the patients that we see is is a is a good help and a reminder, to to keep us from always believing that the bottom line is the bottom line. What an excellent point. Thank you so much for digging in a little bit deeper there. Now I know a lot of opportunities ahead, but challenges as well. What are the the challenges or potential headwinds that you have your eye on most closely right now and and anticipate navigating through over the next year or two? Well, we're certainly seeing dramatic changes or potentials for dramatic changes in federal policy, and I think they're evolving in ways that are at least are not yet clear to me. And so being light on our feet and being able to be responsive to to changing dynamics at the regulatory level, at the payment level, at the, particularly in the Medicare world and very likely in the Medicaid world, being ready to, to to adjust the way that we think so that we can work effectively and effectively meet the needs of the beneficiaries that that depend on us, I think is going to be a big challenge over the next particularly, probably the next eighteen months or so. On a more very specific one, I think rationalizing the expanding pharmaceutical expense is is one that I think is enormous. I mentioned civica early, and for, generic drugs, that's at least a a tool that we and others, have now shared in creating to to to be beneficial there. But in terms of the, drugs that are are not generic, that are are, increasingly capable I mean, wonderful technology, wonderful capabilities, capabilities, wonderful new opportunities that can help people to have healthier and better lives. But we need to also find ways to make that cost effective and and cost beneficial. It's our constant hope. It's my constant hope that we can find ways to bring Moore's Law or some analog of that to bear in health care so that we can take very invasive and expensive procedures that we provide today, replace them with something that is much less invasive, much less risky, and hopefully also lower cost that'll allow people to, to live effective, healthy lives, with less medical what what we think of as medical intervention, but allow us to, to actually liberate them from some of the, the the burden that they face with disease and some of the the the high impacts that they may have to go through through our current health system. But we need to find ways to do that that that really also meet with the financial imperatives that, that we're seeing in in our country, really throughout the world where the cost of health care is increasingly, becoming challenging as populations age and, we have greater numbers of people with chronic diseases. There need to be ways that we can meet those needs technologically, much like we have in computer and communications, with Moore's Law. Absolutely. I think that's really helpful to understand and, great to kind of think through things on that lens because, you know, you're right. There's not really a clear picture of how, some of these federal policies will change. But, ultimately, you know, looking at where the health system's at right now in providing that, pathway for as much as possible the financial stability, to continue operations and serving the community is a huge challenge. So, you know, I think there's a lot there and a lot to unpack, but especially, you know, from of the leadership perspective, being able to look ahead, but also, not too far ahead so you can still make sure you've got the problem solved for today to keep you, stable for the future. Absolutely. Excellent. Well, before we wrap up here, I'm wondering, could you talk a little bit about the number one thing that you're doing right now in order to set Intermountain up for that long term success? Well, I'm going to to morph the one thing into two things because I think that, again, keeping a focus on proactive care, which we think is is at the very core of what, what what what we're expected to do by our community and what, what we should be expected to do, I think, is essential. But in order to do that in a in a more effective way and to make it easier for both our our patients and members and caregivers, the simplification processes that we're trying to, pursue right now, that we are pursuing right now, I think, are are key. So I really would put it in both of those two areas, proactive care and simplification. Absolutely. Well, Greg, thank you so much for joining us on the podcast today. This has been just a really helpful and insightful conversation, and I look forward to connecting with you again soon. Well, thank you.