July 2021New MaineHealth CEO Andy Mueller, MD, shares his first impressions of the organization and his priorities going forward. Plus, Peggy Pennoyer, MD and Don Endrizzi, MD reflect on their experiences as volunteer vaccinators at the Scarborough COVID-19 Vaccination Clinic.
BACON - Episode 27 Transcript
Julie: This is BACON, brief ACO news from the MaineHealth Accountable Care Organization, a pan seared monthly podcast for health care providers. I'm Julie Grosvenor.
Mike: And I'm Mike Clark. Julie and I are practicing physicians and liaisons with the MaineHealth ACO.
Julie: In this episode, we celebrate Maine's exemplary COVID vaccine rate and plummeting case numbers by talking with a physician couple who volunteered to vaccinate thousands of people over the last few months.
Mike: That's right. But first, we're pleased to bring you Julie's exclusive interview with the new CEO of MaineHealth. That is our Meaty Topic for this month. In April, MaineHealth board appointed Dr. Andrew Mueller as the organization's new CEO, Andy, as he prefers to be called, served most recently as CEO and president of Centra Health in Virginia. His health care management career began a few years before at Novant Health, a multi-state health system headquartered in Charlotte, North Carolina. And he trained as a physician at UNC Medical School and practiced family medicine for many years in the Air Force and in rural South Carolina. Julie spoke to him early last month.
Julie: All right and welcome. We are here now today with Dr. Andrew Mueller. He has assured me that I can call him Andy. So, Andy is joining us today as the new CEO of MaineHealth and is coming to chat with us today about his impressions of where we are and his views of where we will be going. So welcome. Welcome, Andy.
Andy: Well, thank you. Glad to be here today.
Julie: Yeah, so now you're fresh on the job here, and since you have become CEO, I know that you have done a great deal of rounding on us. So the physician in you wanted to get out there and do rounds. So you've been to a lot of the MaineHealth hospitals and practices. Have you been surprised by anything you found there, surprised by any of your care team members you've interacted with?
Andy: You know, I think probably the biggest surprise that I have found is anywhere I've ever been in health care, dating back to my days in the Air Force, North Carolina, South Carolina, Virginia, I've always found that people who work in health care take great pride in what they do and are really committed to their patients in the community. But I have to say, I think that's been taken to a whole new level here in Maine with the front line care team at MaineHealth. And pretty much every facility I've been in, whether it's a physician practice, hospital, emergency department, it doesn't seem to matter. I'm just really impressed with the degree of caring that our team exhibits and their real commitment to our patients and our communities. And that gives me just great excitement about the future.
Julie: Yeah, well, that's wonderful. So that certainly sounds like a strength of our team and our people. Any other kind of strengths or opportunities that you've noticed?
Andy: Yeah, in terms of strength, I really think having a footprint like we do with both urban, metropolitan, as well as rural facilities is a real asset to us thinking about the future. In the future, we're going to have to figure out how we can really provide care for the entire population we serve. And I think that is a great strength, an asset for the organization today. I think it's going to force us to remember that all health care is delivered locally. And I think it's going to require us to accept a degree of variation in how we deliver that care that's appropriate for the communities we serve. And I think that's going to help us be a better, stronger health care organization in the future compared to some who may only have a rural footprint or who may only have an urban or metropolitan footprint. And so I think that's a great advantage for us. I also think that Bill and Rich and the leadership team have done a great job of really exhibiting prudence in building a health care system that is largely contiguous geographically and is focused on communities in a way that makes a whole lot of sense. And so I've seen health care systems sort of scatter themselves across huge geography, which presents some real leadership challenges. And I think it's going to make thinking about caring for a population more difficult. And so as we think about the work that the ACO does, having a fairly discrete, contiguous population in geography. I think it's going to be another asset for us in the future.
Julie: Being an ACO, we're focused on value, value-based care of everyone, be they in the urban or the rural locations. And recently I hear that you had made some comments to the MaineHealth board and you mentioned that MaineHealth needs to be transformational and determine how to succeed both in fee-for-service and in value-based care. So I think those are the "two canoes" that we've been talking about for a long time. Can you expand on how you see us doing that across our geography and our populations and system?
Andy: Yeah, I think we're going to have to recognize that we're going to continue to see peer pressure to accept more risk for the care of our patients. And I think as state and federal agencies in the wake of our COVID experience are going to be forced increasingly to try to balance their budgets and manage the costs of care. Some of that transference is just inevitable. And we're going to continue to see that. I think we're also going to find that there's probably some opportunity on the commercial payer side to take advantage of taking more risk. And so I think we're going to have to be prepared to do that. And I think one of the areas that we can focus our attention is on those things that we know create value in both a fee-for-service environment and a population health or value-based payment environment. And those are things that are just important to do. So those are things like our quality and safety, which is incredibly strong. Things like the experience of our patients. Things like the accessibility that our patients have to our services. And ultimately, I think it's going to force some conversations around things like pricing in the future. And that's not to say that we're not going to have to have a willingness to accept sort of what I would call the beauty of the end, right, so we're going to have to think about how we think about our pricing strategy at the same time, think about how we grow revenues. So we may force ourselves to be in a situation where we have to kind of do both and not choose between the two. And so I think that will be part of our collective leadership challenge in the future.
Julie: Well, you've got a great committed team and you've got some big challenges. What are you most excited to get to work on right away?
Andy: You know, I'm excited about our vision: working together so our communities become the healthiest in America. And to me, that was a real hook as I really contemplated this role and seeing evidence of where the organization has invested in strategies and structures like our ACO to enable us to actually achieve that really got me excited about this opportunity. So I'm sold hook, line and sinker on our vision statement. And at the same time, I think the immediate thing that we need to be spending a lot of time, energy and effort on is our people. We're only going to be as good as our people and to steal from Southwest Airlines, I don't believe we're in the health care business, I believe we're in the people business and we happen to operate an integrated health care delivery system. And I think that's really true at the end of the day. Fundamentally, we're a big group of people caring for another group of people and each other. And so we've really got to get that part right. And I think there are a lot of things that we do well, but I think there's some opportunities, too. And so I'm spending a whole lot of time with my direct reports and our leadership team on thinking about our culture and the things that we can do to really enable everyone to do their best and create an environment where everyone can succeed and feel really empowered to care for that individual patient sitting in front of them at the moment.
Julie: So, you know, speaking of people and taking care of them, you're a person, too, and you've got a big job and you need to take care of you as well. What are you going to do with any free time that you get or how are you going to take care of yourself?
Andy: So my wife Courtney and I, Maine is relatively new to us. We had spent a collective afternoon in Maine prior to interviewing for this role. So we have just been so excited to explore the state and see the sights. And we're just, I mean, there's so many beautiful things to see, so many places to go and experiences to have. We think there's going to be more for us to do than we'll ever be able to accomplish in our lifetimes. And so I think we're overcoming a bit of our remorse that we haven't been here sooner because it really is a special place.
Julie: Well, very good. Well, welcome to Vacationland, Andy. And we look forward to hearing more from you and working with you to to make our population the healthiest in America.
Andy: Thank you very much. Thank you.
Mike: As we record this episode, the COVID pandemic is waning and Maine finally puts daily reported cases in the teens. That's down from 600 per day in January. The reason for that dramatic decrease, well, certainly among them is Maine's exemplary vaccination rate. 68% of adults, Julie, in Maine are now fully vaccinated, one of the highest rates in the nation.
Julie: Well, that is amazing and something to be proud of. So how did we pull that off?
Mike: Well, certainly central to the vaccination effort have been hundreds of volunteers, including, of course, providers who are part of the MaineHealth ACO. And for our Sizzle segment this month, our producer Paul Santomenna spoke to Dr. Peggy Pennoyer and Dr. Don Endrizzi, a dedicated physician couple who put thousands of doses in arms over the last few months.
Paul: Don, you're just retired, is that right?
Don: Yeah, we both just retired. So the original plan for me was to retire last April, but I extended that until August in great part because of the administrative duties. The pandemic was kind of shutting down the orthopedic department and there were constant things that were changing. So I helped and stayed on with the administration until the end of the summer. And then Peggy also at the end of the summer closed her practice. So as of September, we were both fully retired. And we spent the fall going up and enjoying the woods where we weren't going to get exposed to other people who had COVID and we really had a great time. But then when December hit and the vaccine was available, well, we said, you know, let's get involved. And so we've been vaccinating since mid-December.
Paul: So, OK, tell me a little bit about your initial experiences vaccinating, the first time you went into the clinic. What were you expecting? What was it like?
Peggy: We were waking at 3:30 to get into the hospital in the morning so we could help get some of the staff . . . we were taking some of the early morning shifts figuring that we could help out best there. But boy, was it early and that's the first thing I remember. But also how just exciting it was to be on board and doing this.
Don: And I agree there was an excitement to it. And I imagine it probably was not unlike when people first got polio vaccines because, you know, polio in the same way was a virus that didn't affect most people significantly. But the few people that it did, it could be deadly and lead to significant morbidity. So getting the vaccine to as many people as quickly as possible seemed really, really important to us.
Paul: So you started by vaccinating MaineHealth staff and then you transitioned over to Scarborough. So what was that like, that transition?
Don: Well, I think that there was a certain, even starting at Maine Medical Center. There was a certain camaraderie in the providers and volunteers that develop, you know, everybody felt like there was a real positive energy, wanted to get as many people done. But it definitely was a transition because you went from people who were all health care providers to the the lay folk who needed a little bit more explanation sometimes. But it really was, it was impressive because the volume increased so significantly from the medical center. Particularly, we were in the Scarborough facility a lot. We actually both worked in the Scarborough in the Westbrook facilities. But the Scarborough facility was huge, getting 1,500 people through a day and the leadership of people to organize that was really impressive. Equally to the people who created the facilities, you know, from nothing, really, they created this big facility. And so I would say that I was impressed by the organization. And people had to be flexible throughout the whole thing. There were constant changes in recommendations and changes in the facility. So, you know, the processes kept changing and evolving each week. You know, you'd come back, you do a shift and then come back a few days later and something in the process had changed as people figured out this was the way to do it. So it was impressive, honestly.
Peggy: I would echo that. I also, because of what I'd done as a subspecialty, allergy, I was working with the Department of Health and Human Services on their work groups for allergy questions. And there was so much in the employee situation that we just didn't know about it as this was just being rolled out December. So I got very involved in the allergy part of it and recruited poor Don to run a special allergy clinic one day for the specialty vaccine problems. So Don and I sat right outside the ED with Mike Baumann working on getting all the employees we could their second doses or their first doses, as the case may be. We felt very passionate about getting people done and vaccinated.
Paul: And what surprised you about your experience?
Peggy: I just remember the emotional part of it, you know, especially at first with the ICU staff, I had, you know, a couple people and notably one nurse that just dissolved into tears. I just wanted to hug her, but we couldn't at that point. We weren't vaccinated. And, you know, everybody was being so careful at that point. But I just remember the emotional feeling that surrounded being able to protect these people that had been putting themselves in harm's way for such a while. It was just such a relief and it felt so good.
Paul: Do you have any particular moments that you that you remember that you can carry with you from this experience?
Don: Well, I think the whole experience is is memorable, right, from really the very beginning to the end. And it's just so unique an experience in our medical careers. You know, both of us finished our training more than 30 years ago. We were in practice for 32 years, 33 years for Peg, and in that period of time, we never had a public health emergency quite like this. And I don't think any of us will really soon forget it,
Peggy: You know, and we'd made plans to retire before the COVID epidemic struck and so it was awful to be sitting on your hands, unable to help initially with this. That I think is the part that I remember most is I just couldn't have sat this one out. I needed to be helping.
Julie: Thanks for listening to BACON this month. You can find all our episodes on your podcast app and at our webpage, MaineHealthACO.org/BACON. If you have questions, comments or suggestions, we'd love to hear from you as always. So please email us at Bacon@mainehealth.org. That's Bacon@mainehealth.org.
Mike: BACON is produced by the MaineHealth Accountable Care Organization with help from MaineHealth Educational Services. Thanks for joining us. See you next month.
Julie: See you next month.