Carl Maronich (Host): Welcome to the Healthcare Executive Podcast. I'm Carl Moroni, and with me today is Werner Thomas Werner is President and CEO of Sutter Health from the American College of Healthcare Executives. Werner, welcome to the podcast.

Warner Thomas: Hey, great to be with you, Carl.

Carl Maronich (Host): I know you've done these before, so you're an old pro. So we'll just go ahead and dive in and I'll start with asking leadership challenges are you facing these days when it comes to healthcare leadership?

Warner Thomas: Yeah, I think it's a really unprecedented time in healthcare today. first of all, obviously with the OBBA bill Pass on July 4th, putting, one of the largest cuts in the history of healthcare, kind of, In place over the next several years, that's gonna cause a lot of change and challenge for organizations, especially if the a CA subsidies are not extended.

And certainly the Medicaid reductions over time, that's gonna put a lot of financial strain on facilities and, systems. I think the second, which I think is probably, the second biggest macro issue that I see out there is the fact that. 11,000 people age into Medicare every single day and every day that that happens, if those folks have been on commercial insurance, every hospital or physician in America takes a payment reduction.

And That is also gonna cause significant stress and strain from an economic perspective. So I think these big economic forces are going to really push organizations to adapt. Change in dramatic ways, and I think it is gonna be, you're gonna see more from a digital perspective. You'll see more move to ambulatory.

I think you'll see capital allocation evolve over time. So definitely a time where there's lots of change and lots of challenge in the industry.

Carl Maronich (Host): And as the CEO, what is the, premier thing that you look at with all those changes heading your way and all, the uncertainty there is, what are the one or two things that you're really keeping a focus on to make sure your organization maintains the quality it needs to?

Warner Thomas: Well, always go back to our purpose of why we exist and our mission, which is patient's first and people always. So we're very focused on how do we serve. The communities, each and every day in the best way possible. How we can expand and serve more patient's and grow because we think expansion will be important over time.

We're very focused on our people and our talent development, our leadership development, making sure we are training people in the right way. Helping them have the right skills, challenging them to increasingly, improve on a, week to week, month to month, quarter to quarter basis. Because, all of us have to continue to get better from a healthcare perspective and from a service and a quality perspective.

making sure that we keep that paramount And in front of us each and every day. So I think these are things that are critically. Important, to healthcare organizations. And the last one I would just mention is I think with the continued expansion. Of Medicare patient's And the continued expansion of Medicare Advantage patient's.

I do think more and more organizations need to, And we are thinking and, evolving to moving more upstream to accept more financial risk and more global payment risk. that's a new capability for lots of organizations. But, one that I think is gonna be critically important over time as we see a larger and larger piece of our patient base.

Age into Medicare. And generally Medicare fee for service is not sustainable for many organizations across the country. So trying to figure out how you change that up. And I think risk is one way that you can do that, to manage it effectively, to, yield a better economic result over time.

but that's a different skillset for many systems and one that we are leaning into in a heavy way.

Carl Maronich (Host): Sure. Yeah. having been in the CEO chair, the, these changes that are things that are happening now, change isn't new for healthcare leaders. Certainly. how has your role, evolved over the years as you've been in the CEO chair?

Warner Thomas: Well, I think one of the things, as a CEO is you have to continue to, evolve and lead through ambiguity. To lead during uncertain times to lead when there's a lot of stress and strain in the industry And the country And in the organization. And to, really work to pick a clear path, to be clear about, where you're going and why you're going there.

But then have the capability to adjust and to, modify over time. I think that's a critically important, piece of strategy is a critically important piece of how you need to plan for the future. So picking a path, if, your assumptions change or if the market changes, modifying and going in a different direction, critically important to have that flexibility And that adaptability.

Carl Maronich (Host): Yeah, innovation has always been a, key component of healthcare. what innovative strategies are you implementing to really. Keep a focus on patient care.

Warner Thomas: Yeah, I would say overall, we are, very focused on how we build our digital. Our consumer strategy, our Chief Consumer Officer, Jennifer Bollinger, our Chief Digital Officer, Laura, will partner to work hard on this each and every day. You know, we see, now for the trailing 12 to 15 weeks, about 32, plus percent of our, patient visits in our ambulatory areas are booked online.

connecting. And we. Evaluate how connected we are to patient's and look at kind of digitally engaged patient's. We see that being about 65% of our patient base today and growing each and every quarter. we are also working hard to look at the navigation and how people, can navigate the system.

So I think that's an important component of how we think about innovation and doing things differently. I talked about the. payment model changes of global payment, that's gonna drive a lot of clinical innovation, especially around the management of chronic diseases. we see so many people that are age, 60, 70, 80 plus who have multiple chronic diseases.

And, in many cases, healthcare organizations have not had the right focus on chronic disease management. And it's an opportunity to have number one, care for our patient's in a better way. Two, reduce unnecessary utilization, for, ER visits or hospitalizations that frankly are preventable if we did a better job managing chronic disease.

I think a third area is how we, integrate, connect, and move people across our system. Sutter has one of the largest. Home care platforms in America. We have a very large ambulatory platform as well as our inpatient component. how do we effectively move people through, the different components of the system?

when I got to Sutter, now a little over three years ago, our, many of our ambulatory surgery centers were on, many different IT systems. I think 16. Our home care, services, were on a different platform. Our inpatient ambulatory was on Epic, and we've moved to move all of those services onto our Epic platform to provide a more integrated experience for patient's And for our caregivers, in the organization to allow them to see patient's.

So I think this idea of how we continue to evolve and do things different, is gonna be critically important. And I think the other way we've leaned into This is really, obviously, you can't. Pick up, any sort of news outlet or look at any new news outlet without seeing ai.

You know, we've leaned hard into AI for ambient listening, for predictive capabilities of ai. we're using it now a partnership with AOC that we're using it in our radiology area. So I think these are just gonna continue to evolve and get stronger in the future.

Carl Maronich (Host): Sure. All these kind of, technologies and advances people are experiencing them in all areas of their lives, right? and healthcare is now certainly a big part of that. So there's a, mindset shift maybe in some regard with the use of these things, how we're scheduling things not only with our physicians but in other areas of our lives.

how important has it been or how successful, maybe I'll ask has it been to make sure that your workforce within the healthcare organization is shifting their mindset to keep up with all this? 'cause that's a huge part of it. Obviously the culture within the organization, making sure they're ready for these kind of changes.

Warner Thomas: I think how you engage your workforce, how you engage your leadership, how you align them. Is critically important. I think, far too many organizations don't spend enough time thinking about the alignment of their people, the alignment of their organizations. And we spend a lot of time here at Sutter Health.

tomorrow we have our top 500, which we get together on a quarterly basis. the week after that we'll bring our top 4,000 leaders together, to do kind of a year end. Update for them as we kind of finish out 25, in January, we'll have our kickoff meeting for our top 4,000 in-person.

when we communicate our goals, our objectives, we celebrate the prior year. We talk about the challenges, we talk about the environment so that people understand the context of why we're making changes, versus being, well, why are, quote unquote, they doing that. Versus, Hey, This is what's happening in the environment.

This is what's going on in Washington. This is what's going on at our state capital. This is how we need to evolve as an organization and why. And so I think these things around, how we educate our leaders, how we align our organization, how we have transparent communication that's frequent.

Open. it is really important dialogue and a really important strategy to be able to drive the change you need to drive through the organization and to be able to adapt and to change, with a changing environment.

Carl Maronich (Host): Yeah, absolutely. I know you're, CEO so I'm gonna ask you to get out your CEO crystal ball and maybe look five years down the road, what do you see as the, things that are really gonna be top of mind need to be top of mind, in say five years.

Warner Thomas: Yeah, I think the impacts of ai, which, a lot of folks talk about today. I think maybe in the short term they could be. A little optimistic. I think in the long-term, over the next five, I think we're gonna see massive change in the world, in our country And in our industry.

so we are leaning big time into that area and I think it's really important, I think the patient experience, the connectivity we have with patient's, how patient's expect to, interact with their health system. looking at other companies they interact with in other industries, they're gonna expect that, within healthcare.

and some systems are gonna lean in and do that in a really, great fashion and some won't. I think the ones that don't are going to be challenged. I think they're going to lose patient's to other systems that lean into these capabilities And also have the size and scale and ability to invest.

I think what we're gonna see around leadership, is gonna continue to evolve. I mean, we have, these are large, complicated organizations. healthcare is a complicated, part of our economy. We need leaders that can navigate these changes, that can drive these changes. And I think any organization that's not trying to continue to upskill all of their leaders to help them navigate what is a very challenging time, I think is missing a real opportunity for improving.

Performance in the future. So I just think this change is gonna accelerate, not slow down. and I think there's some, honestly in the industry that are just. Hoping it goes away or thinking it's just not gonna change this time or thinking, well, it's gonna be like in the nineties or in the two thousands when we said there was gonna be change.

I mean, I think we are going to see very significant change and we've already seen it over the past few years, and I think you're gonna see even more in the future. and some will navigate that well and some will not.

Carl Maronich (Host): Yeah. your talk about, leadership in the future leads me wonderfully into the next question, and That is, what role does the American College of Healthcare Executives play in helping to shape future healthcare leaders in your mind?

Warner Thomas: Yeah, I think a CHE is, so critically important to, educating our health executives, providing an avenue for connectivity and dialogue and sharing of best practices to be a convener. of the, fact that, investment in each other, investment in ourselves is critically important to being a great healthcare executive and being a great leader.

so I just think a CHE has really just continued to, improve its offerings and improve its capabilities and improve its meetings. I think you see it, I think you see it in the attendance. I think you see it in the, in the engagement. Of the members. So, I think it's one avenue that, many will, kind of go down, but I think it's a critically important one for people to, continue to build on their skillset sets.

I mean, I think once again, the organizations that will be successful are gonna be learning organizations, they're gonna learn faster than their competitors or other's. And, nobody has all the answers today, but who's gonna learn faster? Who's gonna adapt faster? I think a CHE plays a critical role in, in helping executives navigate those challenging

Carl Maronich (Host): Yeah, maybe you could talk a little bit about the importance of diversity and inclusion in healthcare leadership.

Warner Thomas: Yeah, I think inclusion and belonging is critically important, to. Our organization, to, healthcare in general. And I think especially in how we serve our communities and serve our populations. And so we have our, uh, Sutter employee resource groups. We have thousands of people in these groups that connect, that we do education events.

we'll be having our first inclusion summit, in 2026. It's gonna bring, folks together from all walks of life, once again to, understand how we can be, aligned around inclusion, how we can be aligned around serving, our patient's, And also be aligned around how we help each other and work together as a team and understand that, in a learning organization, you're trying to understand others' viewpoints.

You're trying to come to compromise. You're trying to, understand if someone else is doing it different. Like, how can I learn from that? Not how I, how do I criticize that, right. Or find fault with it. So our focus on how we continue to build a very inclusive organization and how we continue to, build the.

The fact that people feel that they belong here at Sutter Health, that they feel like they're a valued member of the team is critically important to Sutter and critically important to any organization?

Carl Maronich (Host): Sure. two important words to the patient population, accessibility and affordability. Maybe you could talk a little bit about how you're handling those things at Sutter Health.

Warner Thomas: sure. we've made significant investments over the past three years around building a much larger ambulatory. Network around Northern and central California. We are opening up 26 new locations. we've hired, well over, 2,500 new physicians over the past, three years. We have more locations coming in the future, including a major expansion into urgent care.

and you'll see us continue to. build on and expand, our ambulatory platform in the future, we've made big investments in what we call our advanced care centers or centers of excellence like cardiology, cancer. orthopedics and sports medicine. You know, we're building, new cancer centers in several of our markets.

We just, announced and we'll be building a new ortho and sports med center in Sacramento, new Neuroscience Center in San Francisco. This idea that, really kind of. Providing a more integrated experience for our patient's that have these diseases and really cross multiple components of our system. it's critically important to the future.

and I think part of, accessibility is also, 24 hour. On demand visits, online appointments, all these things are critically important to kind of get us in the right, place around affordability. we are working hard to continue to move care to a lower. Cost environment, transitioning more and more of our surgeries to outpatient, transitioning, more of our chronic disease patient's that don't need to be in the ER or don't need to be in the hospital to receiving home care.

And also, building more digital connectivity to the homes around what we call suter sync, which is our chronic disease platform. right now focused on hypertension. But diabetes will soon come out. maternal and, women's care will be on that platform as well. And you'll see us have a mental health option on that platform as well.

So these are new ways that we're connecting with patient's, which we think are lower cost, easier to use and ultimately will create a more affordable health system in the future.

Carl Maronich (Host): Yeah, a lot of innovation happening. That's great. Let me ask a little bit about where you see the role of, large healthcare organizations like yours in helping the, provider landscape going forward. the need for physicians continues to be a, concern. What do you see the role, again, as the large organizations to help with that aspect of healthcare?

Warner Thomas: Yeah, we set out, back in early 2023 to, Grow our graduate medical education programs by four to five x over the next five years, And so we had about 220 residents and fellows. We'll be closer to 900 plus. When we get to 2030, we're opening new programs in several of our medical centers.

We're expanding programs that we've had that are existing. We're adding new specialties and capabilities in those areas. And I think it is really about training the next generation. It's about, helping to tackle the physician shortage. It's about pro providing, And we know there's many folks that they don't get.

Residency spots, across the country. So we believe that's gonna be a very important investment for Sutter Health. It's gonna build our pipeline, allow us to hire into our community physician practices, into our medical groups, and just continue to allow us to have a major impact on healthcare here in Northern California.

Carl Maronich (Host): Yeah. Great, great. Thanks. let's talk a little bit, cause you can't avoid this circumstance, and that's crisis communication and crisis decision-making. how do you handle that within your organization and what's your advice to other healthcare leaders in that regard?

Warner Thomas: Well, I was, fortunate to spend 24 years in New Orleans, leading, Ochsner Health and, amazing institution, amazing team members there. Um. And we went through several crisis events there, whether it's Katrina, many other hurricanes, the oil spill that happened in the Gulf. COVID and I think that, a lot of those lessons I learned there are brought to Sutter around, you know, how we think about approaching this.

I mean, number one, I would say it is all about continuing to build the capability of your leaders so they make good decisions. They make decisions and they know what to do and where to go and tackle issues, and they work together as a team. Because when you're in a crisis, you've gotta have people that can make decisions and work together as a team.

I think the other thing that's critically important that we've really been working on is building our communication systems in the organization. one of the things I would say through crisis management is you need to fundamentally change the speed of change in your organization. And the level of communication in your organization when you go into a tough time, which is why I think today with all the changes going on in healthcare, if as a leader out there, if you're not upping your communication level with your team And the people in your organization or your department or your hospital that you operate, if you're not upping the communication level, don't be surprised if they don't know what's going

on or nor know where to go or how to navigate. The challenges of today. I mean, you can't take it for granted, right? So I think it's idea changing the cadence, You know, when you're going through a disaster. historically we'd meet three times a day, with our top, a hundred, 200 leaders.

We'd meet multiple times a day as an executive team, because you have to be constantly solving problems, assessing the situation. tackling the next set of problems to kind of get your way through that crisis. So, we've been implementing a lot of those systems here at Sutter. once again, I mean, Oxford Hill is probably one of the best in the country on disaster planning and how to, manage through this and have the right leaders that know how to navigate that.

And, you know, I was fortunate enough to be part of that and to bring some of those lessons here to Sutter.

Carl Maronich (Host): Yeah, the things you, talking about are, specific, kind of regionally, but something like COVID, which, hit everyone. Kind of at the same time, I'm sure there were some valuable lessons learned in that and really reshaping some elements of healthcare even. what are your thoughts as we're in the post COVID time now, what impact that's had and continues to have going forward on healthcare?

Warner Thomas: Yeah. What I would say is that, COVID is a different disaster than. a hurricane or a wildfire or, some other terrible event. But the concepts of having great leadership, the concepts of speeding, your communication, the concepts of owning the message and having transparency and clarity and thinking. Are the same regardless of the disaster you go through.

And so I think Those are important lessons and important steps regardless of kind of what you deal with. I think in today's post COVID environment, there's still a lot of stress and strain in our, country, right? And there's a lot of stress and strain in our organizations and, the more we can help people understand, where we're going, why we're going there, And what the environment is.

Giving them information, the more people will understand and have more calm or have a better understanding of kind of, what we have to do and where we have to go. And if you have a, vacuum there of knowledge, don't be surprised if people worry or are negative about, the future.

Because it's challenging. So you have to, as the leader, own the message. be clear about, where you're going and why you're going there, and, be repetitive and have a consistent rhythm of communication. I think that's critically important in a post COVID environment. And it's critically important in a, time of tremendous change of which we are in today.

Carl Maronich (Host): maybe you can discuss a little bit, the impact of policy changes on healthcare delivery.

Warner Thomas: obviously there's been a lot that's changed, coming outta lots of state capitals over the past, several years. And I think we'll continue to see policy changes in the future. I just think that, organizations, in healthcare like other industries. You need to basically lean into that and not lean away from it.

be part of your associations, meet with your various public officials, understand, make sure they understand kind of the challenges you have and why you're doing what you're doing. make sure they understand the facts about, issues that are out there in the industry. and once again, Be repetitive about it.

And we're not owning the message with our government officials, then that's on us, not necessarily on them. I think we need to continue to be leaders in an advocacy way and be leaders And sharing the message about what hospitals, what physicians, what health systems need from Washington and our state capitals and our local government officials, as well as how we can help.

Those processes.

Carl Maronich (Host): What, organizations, would you recommend other healthcare leaders stay in tune with to make sure they're staying up on what's going on in Washington, at their state level and other entities?

Warner Thomas: I would say all the trade organizations like American Hospital Association, American Medical Group Association, if you're a physician, obviously, the, uh, American Medical Association. A CHE does a nice job of that. so I think there's comprehensive information on those websites. all those organizations send out, updates all the time, and be part of staying up to speed on that read, read Modern Healthcare, read health leaders, make sure you're kind of in the know and making it your.

Priority to be a learner, to understand what's happening versus, just sitting back and thinking it's gonna be someone else is gonna take care of it.

Carl Maronich (Host): certainly helpful in that, regard, as well as relationship building throughout those organizations as well. just reading about it probably isn't quite enough, but maintaining the relationship so you're directly in touch with those folks, I think would be helpful. Also,

Warner Thomas: Absolutely, you've gotta have relationships. I mean, you don't want to be starting to build a relationship when, you need something, right? You wanna be, Building relationships, ongoing, spending time and updating folks. And then when you, need something or need to have them, take a position, you've got, credibility, you've got, the ability to really, know these folks that are leading our government entities.

And to be able to have a, clear discussion around what you're trying to get done.

Carl Maronich (Host): I'm gonna back up a little bit and go to talk about innovation earlier, telehealth maybe, that's something that has really, come on in the last few years. Maybe you could speak a little bit to how you're seeing the current state of telehealth and where it's going.

Warner Thomas: I mean, I think Telehealth's obviously, one way to think about it, I would say virtual care. So Virtual visits is one way that that could happen. Remote patient monitoring is another way that that can happen. I think you're gonna see, diagnoses or essentially, triage tools from a AI or other perspectives be used in the future.

So I would say it's more remote care. And remote care management as well as Televisits. I think that's one avenue of that, but I think that whole area is gonna just continue to grow and expand.

Carl Maronich (Host): Sure. And as where do you see the importance of making sure patient's understand and are comfortable with that advancing technology? Do you see that as a, significant concern?

Warner Thomas: I think what we see is that patient's want it. They want an easier opportunity. They don't want wait. weeks and months for, appointments And in many cases, they'd rather have a virtual visit or if it's just a checkup and they, if you think about someone having their blood pressure taken quarterly, they'd much rather do that virtually with a connectivity to their doctor and, being managed kind of over the phone or in a virtual message than to have to just go into.

The physician every quarter. So I think in many cases there's many people that they want this type of, new approach to care.

Carl Maronich (Host): Maybe you could talk a little bit about sustainability in healthcare And what steps are being taken at Sutter Health in that regard.

Warner Thomas: Yeah, I think sustainability is, critically important. obviously around our country, the more we can be, reduce our carbon footprint, the more we can be mindful of, how we impact, what's happening in our environment, how we work with our. vendors and our partners around, what they sell And what we buy.

I think it ha you just have to be very aware of it, constantly focused on it. and I think, frankly, probably healthcare's generally behind some other industries, but I think healthcare is catching up in a very quick fashion.

Carl Maronich (Host): Warren, you've a lot of great thoughts insights you've shared. One last question I'll have for you is what advice would you have for young professionals aspiring to become healthcare executives?

Warner Thomas: I always tell folks, and I, assuming somebody's already in, healthcare, I mean, the best way to get the next job is to do an amazing job in the one you're in. Too often I find people are looking for the next job, And then you try to get them to, explain what they've done in their current job and they've been in it a year or, six months or 18 months, and it's like, can you show a track record and have you been able to drive change?

so I think that's critically important. You do a great job where you are. Two, be a constant learner. how are you continuing to, better yourself, stay up in the industry, learn. I think it's critically important. And then three, I mean, I look for a great mentor or sponsor, someone who you can stay connected to, someone who, can help you and help guide you.

I had, couple great mentors, Tom Wilhelmson, who I worked for up at Southern New Hampshire Health System in Nashua, New Hampshire. Pat Quinlan, who I worked for at Ochsner. I mean, great. Mentors to me, taught me a lot, helped me continue to evolve myself. And I think these folks are so important in our lives and have a big impact.

And I think the extent, if you're a leader out there evolving, if you can develop one of those relationships, really, uh, critically important.

Carl Maronich (Host): Very good. Werner Thomas, president and CEO of Sutter Health. Thanks so much for all the great information and insights today.

Warner Thomas: Carl, thanks for the opportunity. Great to be with you.

Speaker: For more information, go to healthcare executive.org. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library. For topics of interest to you, I'm Carl Marone, and This is The Healthcare Executive Podcast. Thanks for listening.