DGTL Voices with Ed Marx - Finding Balance: Decompressing with Nature (ft. Kevin Mahoney)

Episode Date: September 18, 2024

In this episode of DGTL Voices, host Ed welcomes Kevin Mahoney, CEO of the University of Pennsylvania Health System (Penn Medicine). Together, they explore Penn Medicine's mission, the strategic challenges the organization faces, and its commitment to becoming the most clinician-friendly health system. The conversation delves into how technology is reshaping healthcare delivery, the pivotal role tech leaders play in partnering with CEOs, and Kevin's unique leadership style. He shares valuable insights on the importance of authenticity, empathy, and collaboration in driving success in the healthcare industry.

Thanks for tuning to Digital Voices podcast, where we chat digital transformation, challenges, and opportunities across health care and life sciences. And now, your host, Ed Marks. Hey, everyone. Welcome to another edition of Digital Voices. This is another episode so happy to have because we're speaking with Kevin Mahoney, Chief Executive Officer of University of Pennsylvania Health System, Penn Medicine. Welcome, Kevin, to Digital Voice. Thank you, Ed. I so much appreciate you reaching out to me.

I'm looking forward to our conversation. Yeah, I always love to connect with Chief Executive Officers, kind of get some of their insights, because a lot of times we don't get to hear directly from you. And so it's always nice for the audience to hear your perspectives and how you view the world and health care and those sorts of things. So, again, thank you so much. Yeah, we met pretty much online in terms of,

LinkedIn and various forms of media and the things that you're doing at Penn Medicine just really caught my eye. And I thought it'd be super interesting. Plus, I do know a few of your excellent caregivers there. And so I know it's a great place. But before we get started, Kevin, the most important question we have are what are the songs on your playlist? What music do you like? So I am fairly eclectic, but I'm a little stuck, I think, in the 70s. I do.

Ozark Mountain Daredevils, Firefall, the Eagles. You know, that's how I grew up on. So that's what I listened to. Oh, my grandparents are from Ireland. So, you know, a good Irish song, a soldier story. The fields of Atharai. Like, those get me going. Yeah.

But the one thing I'm not very good in is current music. So don't ask me any. Taylor Swift songs. I'm not sure what those are. I'm sort of stuck in my music genres as well, so it's always interesting with my kids or my grandkids. But we do have a playlist for digital voices, and I think a couple that you mentioned are going to be new to our playlist. So Ozark Mountain Daredevil's great band as well as Firefall. So it brought back a few of their tunes are now in the back of my head here as we're speaking. So those are some great ads. What about life messaging?

or mantra, are there words that sort of guide you and your life? My favorite one, it comes out every morning out of the university, and it's a quote from Ben Franklin. The noblest question in the world is, what impact are you having on it? And I think because of my Irish background, we're always a little fatalistic, but I try to get up every day. You know, why am I here? What changes can I make, but impact, you know, it might be a smile to an employee.

It might be helping somebody get a doctor's appointment, talking to my children and my grandchildren, but I'm always mindful to every one of those interactions, including digital interactions now, is an opportunity for you to impact somebody's life. Like, we're not just ships in the night passing each other, but that human connection is really important to me. I love that. And the fact that you're able to broadcast that out, I imagine every employee, every caregiver in the system sees that same message, and it's kind of a good reminder.

Speaking of Penn Medicine, can you share a little bit about the history and the mission and vision? Sure. So I'll put in a plug for a book that I carry around with me. And it's Start with Why by Simon. Seneca and Penn Medicine is unique in American history and unique in the country in the world because we're the nation's first hospital, 1765, and ever since then, we've been pushing hard for more first. First approved gene therapy, first the MRNA vaccine. But doing things first, scuba diving, believe it or not, was invented at Penn. It's credited to Jacques Cousteau if you go to

Wikipedia. But Major Christensen in World War II, he was a pulmonologist at Penn, invented the breathing apparatus so that Frogmen could put bombs on the bottom of ships in Tokyo Bay and other places. So we've been first and so many things were first for a reason because we want to change the world. Back to the book, it starts with why. Like, why do we exist? I tell my employees, you're not here to be a revenue cycle person. You're not here to do desktop. If you do the job to the very best your ability, you're going to change the world. How do you change the world? 60% of the health systems margin funds research. And that allows someone like Dr. Drew Weissman, who for eight years did not get a grant.

did not get a publication, but last year he won the Nobel Prize for Medicine. Because during those eight years, when you had a novel idea, health system was able to keep funding it so that those novel ideas can turn into life-changing ideas. I love it. Yeah, that's super, super inspirational. I think you sort of answered my next question about what might people not know about Penn Medicine. And I think you just shared with us a couple of really keen insights. and, like I said, super inspirational.

What are one or two of the most critical strategic issues that the health system faces today? I think the most critical issue facing pen medicine is the same as facing every hospital across the country, which is we got grayer and poorer during the pandemic. 65% of our patients are now paid for by the federal government, either through Medicare, Medicaid, through the exchange, Medicare Advantage.

When I started here almost 30 years ago, it was 40%. So over 60% of our patients, again, are paid for by the federal government. So as a federal budget goes, so goes health care. Our Medicare increased last year in the upcoming years, about 2.6%. Electricity costs a lot more than 2.6% gas, food, employee salaries. So we need, as an industry, to become, more efficient. And we talk about it a lot, but we haven't actually achieved it.

Together we can. So you ask what's something that people might not know about PAM Medicine. We have four sites of delivery. The hospital, everybody knows about outpatient clinic, everybody knows about home care. They've heard about digital. Where can we place that patient best for that? and best for us. An example, more than 50% of our chemotherapy and medical infusions are done at home.

That's unheard of. Yeah. But wouldn't you rather get your chemotherapy in your favorite chair, watching your TV, you know how the flipper works, your dog sitting beside you like that? That's not only humane, but it saves the health care system a lot of money. So we're going to keep pushing those foresights of delivery. If we can deliver through the iPhone, monitor patients, follow up with patients, stay on top of them, have them then communicate to us.

That improved communication will reduce the cost of care dramatically. And it's less costly. So number one issue facing me is I need to change everybody from there are no unprofitable patients, just unprofitable delivery systems. We can keep calling senators and congressmen saying raise what Medicare is paying. There's no money in the till. Between Social Security, the military, education, all the things that we have to pay for is a country, the debt service.

There's not some big hidden bowls of money, and none of us want to pay a lot more taxes. So we need to figure out how do we deliver care at what we're getting paid for for from Medicare, not we need more money. We do, but again, I think it's a leadership call for all of us to lean into it. I love that. That's great insight and great call to action. You know, before we jump into Penn Medicine a little bit deeper, and I know one of the things that you were very passionate about as well is becoming the most clinician-friendly health system, I skipped over and it was funny because I didn't mean to.

It's probably because there's a firewall song. I'm Firewall. What was the name of our band? Not Firewall. Firefall. Firefall. They didn't know what a firewall was back then. Thank goodness.

But tell us a little bit more about yourself. So I'm super intrigued. So your parents are originally from Ireland. So did they immigrate to the United States? So just let me clarify. My grandparents are from Ireland. Got you. Yeah.

But they came over late. They came over in the 1920s and 1930s. So they were after the Civil War. Several of them were very active participants in the Civil War. So they raised me to have pride in our heritage, but to deeply understand our heritage. And that shaped a lot of my thinking, a lot of how

it come from a family, eight kids, two parents, and you know, we mixed it up early on. Sadly, we also suffer from alcoholism and depression. And I've lost my mom to alcoholism, my brother,

my youngest brother, committed suicide. So it changed me. Yeah. In how I approach the world. but always great, great fun. I think I talk a lot about the summer of 1978, which put me where I am today,

and I'll go through it very quickly. But in late, I did not do well in my first year in college, and Miller's will say college, 1.98, and they told me that it's not a sustainable grade point average. I came home, my dad said, you've got to get your act together. I went out and started working for a landscaper. And three events were going to put me on the path to where I am today.

The first event is I met a developer. His name was Bill Rouse. And he wanted me to cut this cornfield because he was going to put offices up out in the suburbs. And I said, Mr. Rouse, people sleep in the suburbs. They work in Center City. He said, is that a rule, zoning, regular? I said, that's just the way it's always been. And he said to me, don't do things because of the way they've always been, do them the way you want them to be.

For an 18-year-old kid, it had a big impact on me. It might have been a 15, 20, 30-minute conversation, but it really got me thinking about how I approached life. I then went to cut this cornfield, as Mr. Alas asked me to. I fell off the tractor on the tractor and the farm tractor ran over me. I ended up in the hospital on a ventilator with the priests given me last rights. you know, everybody thinking I was not going to make it. Ed, what is amazing out of that experience, though, is I loved every day being in that hospital. The fact that everybody was taking care of me, everybody from top to bottom, all they wanted to do was to take this egocentric teenager and make them better.

And I'm like, this is just, this is what I want to do with my life. We already established them a lousy students. So being a physician, being a neurosalced, those things were out of my reach. So I didn't know what I was getting in the hospital, but I knew I wanted to be in that environment. And then later that fall, November 10th, I went back to Millersville State College to meet my friends. And I walked into a room and I saw my wife, my current wife, she listened then. But that was, we've been married 41 years together, 46 years. And Pam is the reason I am where I am today.

because I run hot, I run Irish. She is calm, cool, and collected. I come home, I can't believe the way the world is. And she says, well, let's change it. So she's the yin to my yang. Yeah, that's a beautiful story. Thank you for sharing with us. And I can see how shapes your leadership today.

So back to Penn Medicine. And as I stated, one of your passions is to become the most clinician-friendly health system. Tell me why that's important to you in the organization. So a couple of reasons. One, I revere physicians and I watch what they have to go through. Pre-authorization. I-C-D-9 codes, you know, like just malpractice attorneys after them.

And we need doctors. It's a noblest profession. and instead of elevating them and letting them do what they're trained to do, you know, we pull them down, we put more regulations on, we put more things on their back, and, you know, frankly, they're getting burnout. The other thing is we are facing 100,000 physician shortage in the country by 2030. If we don't start making it easier to be a doctor, like, why go into FinTech? You know, Elon Musk today announced that, you know, we're going to fly.

of Mars within two years and like, do that. Like, don't come work and just click away on your computer. So I think we want to be the most clinician friendly for two reasons. One, our clinicians deserve it. And second, we won't be able to take care of the growing, you know, the growing demographics of older people that need health care. if we don't create a more efficient system. We talk about clinicians, we also include in that respiratory therapist, nurses.

Like, I want to be the place where you can come practice your profession, practice your craft, and not just be a box checker for an insurance company or some other regulatory agency. We think technology can get us out of where we're in. Technology's kind of got us in the corner because the EMR, Without the EMR, we couldn't have done, you know, ICD11. So the EMR enables things that actually increase the burden. They don't improve the burden on the practice.

So we're committed to making the difference. No, I love it. Can you share an example how you might leverage tech to be on the helpful side? Yeah. No, I mean, sure. And everybody, you know, is talking about ambient listening, AI and the like. but, you know, who has time to go through all the data? So we're trying to put in place, we call it Tickle Me Epic.

After Tickle Me, I don't know, like, can we be going through the medical record every night? You know, they told Kevin Mahoney get a colonoscopy, he didn't get it. So text them. You know, not the doctor has to go through the chart, tell the front desk, call this person, but truly goes through and identify and using communication methods that we're used to right now, which is texting. You know, I don't know what the future will be, but it's sure not call a landline. It's sure not the U.S. mail.

I mean, texting is the, so how do we use, again, AI technology to go through the medical record to identify patients that need us before they may know they need us? I mentioned my Irish grandparents with them came a tendency for colon cancer. My grandfather suffered two of my brothers and sisters who had to have had to have surgery. So you call, you read the paper, you told everybody, you know, 50, you got to get a colonoscomy. Now we move it to 45, now we move to 40. But it's a very blunt instrument. How do we use technology to identify, all right, you know, Kevin comes from a family that gets colon cancer.

The CA gene is present in that family. Let's get them in first and not first come first serve. And I think that technology will make us faster, quicker, and better, and more efficient. The other thing that we're trying to eliminate use in technology, preauthorization, again, is a blunt instrument. in the building I'm sitting in just in this building, we have 51 employees who do nothing but pre-authorize x-rays. And there's at least 51 people at the insurance company doing the same thing. Less than 1% get turned down. So I'm spending 5 plus million. They're spending 5 plus million for what? So we worked with Independence Blue Cross or local Blue Cross provider to gold

card physicians. You know, if you've proven... Yeah. through your ordering pattern that you don't abuse the ordering, you get a gold card. You don't have to do it anymore. But that requires going through the technology, going through the AMR and finding out the ordering pattern. It can't just be, I went to Penn, therefore, you know, I get a gold card. No, you need to prove it over time.

I think there's so much we can do. We have issues like a lot of hospitals in America, of the emergency room being overcrowded, overburdened. And, you know, I talked to the doctors like, watch it, you know, discharge the patient home and have them get their test, you know, next week. And I'm afraid they're not going to. You know, they have transportation issues.

They don't have a nuclear family, so I'm afraid they're not going to get the tests they need. So I'm going to admit them to make sure they get the test. That's something we should be able to fix with technology. remote patient monitoring, following patients at home, following through the cable box, following through the iPhone, as opposed to you have to go sit in a bed upstairs so we can follow you. Kevin, I love your insights and would love to hear from you concerning how tech leaders, like CIOs or chief digital officers, those type of people, should best work with CEO.

So I know you're very fortunate. I know your CIO and your chief information. security officer, both them pretty well. They're great leaders. So you're really blessed in that sense. But how, what would you say, you know, half our audience are sort of tech digital leaders? What would you say to them the best way to work with the CEO? Yeah. So Mike Rastusha, who's our CIO, we've been together for almost 30 years working. And Michael has learned to talk my language, not necessarily talk his language. And, you know, the cloud, the edge of the cloud, bandwidth, with like these are all words that get thrown around,

but I'm trying to solve problems. I'm not trying to get educated in technology. So when you're working with your CEO, what is it we're trying to solve? How can we do it as opposed to a lot of jargon and tech speak or we want to be the first in the cloud? I don't want to be the first in the cloud. I want to be the first health system that solves a problem,

you know, lower cost. And so what might get you on the, the cover of CIO magazine, it's not necessarily what motivates me as a leader. So again, back to start with the why. Why are we here? What are we trying to solve? I think also we need to do a better job of articulating, you know, frankly, are we spending enough in technology right now? So I'm proud at Penn. We spend, you know, four and a half, five percent of a net patient revenue on IT. benchmark performance across the country, I'm not sure it shouldn't be double.

Now, where am I going to get the money to put into that as far of the challenge? But if we're going to live in a digital world, we need to make sure that we're making the right investments. And I think the last thing is empathy. And, you know, we're not all tech wizards. Yes. I'm certainly not. But, you know, just building something and assuming people can use it,

as opposed to more human factor design, education. And, you know, then the last thing I think is critical, again, from an academic medical center, is that the doctors and nurses work with our CIO. if we have a good idea to share it with everybody. Like, don't hold on to it. If we figured out a solution, let's help everybody out. Not Penn has a solution or Washu has a solution,

but the world has that solution. Yeah. Love it. Let's pivot to leadership in our last couple of minutes. I would love to better understand, although I think we have a pretty good sense of it already just in our dialogue thus far, but your approach to leadership. How do you look at leadership? It's an old, but I try to be authentic.

You know, I want people to trust me, to believe in me, but they're not going to do that if they think you're a shyster or you talk, you know, out of both sides of your mouth. So I try to make sure, you know, that old saying from Mark Twain, you know, don't tell a lie or whatever it was, but if you tell the truth, you never have to worry about what you said to the person before because you're going to be saying the same thing. So authenticity, I think, is critical. And then again, understanding Stephen Covey's seven habits of highly effective people,

empathy is the only one that I think is important. Understanding where people are coming from, understanding why they're not taking their medication, understanding, you know, they maybe have trouble coming to work because they're taking care of three generations of their family. So that empathy has been really important to me. That also means you have to listen. So during the early days of the pandemic, I was given all kinds of pep talk to our employees, wear your mask, say six feet apart and everything will be fine. And I was walking across the bridge of the hospital and one of the employees saw me and he said, Can I be honest with it? I said, sure. He said, you sound stupid. And I said, why? And he says,

I have five kids living in one bedroom. Staying six feet apart may be a privilege that you have, but it's not what I have. So when I hear you talk and stay six feet apart, well, I'll be fine. What I hear you saying is my family's going to die from COVID. So again, understanding where people are coming from, I think, is just so important to be a leader. But it requires you to dig underneath and to really live it, not just, not just. Yeah, that's a powerful moment for sure. So you've been at Penn Medicine, as you mentioned. What did you say? 30 years now? 27. Yeah. So he's ran around around. Getting close. So obviously there's something that has kept you there so long, and we did talk about the mission and vision and just how powerful that is.

Anything else that has kept you there? Yeah, I tell everybody that come into my office, give me career advice. The one bit of career advice I give people is pick your organization first and your job second. You have to believe in your organization. And I, you know, this is only my fourth job since I got into health care. and I tend to stay in a place a long time because I work hard at picking that organization. So could I have moved and become a CEO sooner? Probably. I don't think I'd be any better off than am today because, again, I live our mission every day.

I communicate our vision. I communicate what it means to be at Penn. It is a magical place. I know. When we're hitting on all cylinders, again, you know, COVID knocked us back just like everybody. But, you know, we're back in the game. We opened a clinical trial the other day. It was in Australia.

But it'll revolutionize cell therapy, which we had the first cell therapy approved. I have, you know, a dozen doctors trying to make it better. And it just, it motivates me, it gets me up in the morning. It's not just on Nobel Prize. It's also Dr. Shrinivost, Dr. Hirshberg, inventing heart safe motherhood, which is an app for postpartum eclampsia, which has reduced maternal morbidium mortality in black females dramatically. And, you know, it was a lot of blood, sweat, and tears, but the total investment is probably less than 100,000. but people are alive because of it, just like the multimillion dollars of investment in life sciences.

So it's both ends of the spectrum, but the people at Penn motivate me, the history of Penn, you know, we talk about walking on the shoulders of giants, you know. Dr. Rush back in 1765 started to publish on mental health way before anybody else. And that history motivates me. Yeah. No, I didn't mean to interrupt earlier, but I was just, I'm so excited myself for Fed Madison just listening to you and your leadership and the great things that your organization has been doing for since earlier than anyone else. So it's super exciting. So obviously, CEO, a lot of responsibility, been doing it a long time.

How do you decompress? What do you do to sort of, and it sounds like your wife is awesome and helping you with that as well. But what do you do? Yeah. So walking. I mean, I love to be outside, whether it's cutting the grass, working in the yard, hiking through Valley Forge Park, hiking on the rail trails. I mean, that's what I like to do. We get back to Cape Cod, you know, every summer, and that centers me because that's where I went as a kid.

but I would say decompression happens through nature for me. Yeah. But I think it's important if we're going to be healthy, whether it's reading. If you like to read books, read books. You like to ride your bike ride, but you have to have something that reset your brain. So, Kevin, this has been a great conversation. Learn a lot about you. I sense this great passion for what you do, which is great.

And as a CEO of a great organization, so it's not surprising that the two are together. We talked a lot about sort of your formative years and how you got into health care. And then we talked about some of the firsts that are being done at Penn Medicine and just the way that you look at digital and the different care settings and moving people to the appropriate care setting that's best for them and best operationally. And then, Kevin, the other thing that you taught us was the best way for a CIO or tech leader to interact with the C-suite and the CEO. and that's to speak the language of the business, the language of the clinicians, not to be super techie.

And of course, empathy is kind of the key to all of that. We talked about your approach to leadership and authenticity. And then I love what you had to say about picking an organization first. When I asked you about why you've stayed so long, you picked the organization first, and the job second, I love that, and just the importance of decompressing. So we covered a lot. Is there anything I missed or anything you want to double down on? I'll give you the last word.

So I'm a capitalist at heart. I love competition. I think it makes it better. I do worry that the American health care system has taken competition versus collaboration and cooperation a little too far. So you see we dropped out of the U.S. Noodles World Report rankings, you know, it depends nine or eight or one. Like, what are we doing to make our patients better?

And there aren't, in Philadelphia, there aren't Jefferson patients and Penn patients and Temple patients. They're just patients. So trying to find things that we could cooperate on more health equity, behavioral health, food and security, and not back some of that natural competition that we have, that would be an important legacy for me. Yeah. That's very, very, very well stated. a great way to end our program. Kevin, thanks again for being part of digital voices and sharing yourself with us. Thanks very much, Ed. I enjoyed it. Hey, that wraps up another edition of

Digital Voices. Thanks for listening. Thank you for listening to Digital Voices podcast with Edmarts. If you enjoyed this episode, subscribe on your preferred streaming service and leave a rating and review. And most importantly, thanks again for listening.