Carving Out Primary Care: AdventHealth's Standalone Division Experiment | Brent Davis, CEO, Primary Health Division at AdventHealth

Welcome to Claims Denied. One man's quest to learn everything there is to know about the business of healthcare. I'm Blake Matten, your host and creator of Hospitality, a healthcare newsletter and ecosystem discussing the latest in the business of healthcare transformation. Each week on Claims Denied, I sit down with healthcare leaders and peers to talk shop about emerging trends in health systems strategy, health tech startups changing the game and scalding hot takes on the future of the industry. A hundred million Americans lack access to primary care. Patients feel lost on the system and clinicians feel buried by it. Tom is an AI platform that powers primary care as a service. See the difference that makes at lumeris.com/platform. All right. Welcome to Claims Denied, a hospitality podcast talking about the business of healthcare and the transformation involved. Today, I'm super excited to be joined by Brent Davis, who's the CEO of AdventHealth's Primary Division. Brent, thanks so much for being on. Absolutely. So Blake, just so you know, it's the primary health division. Just since we're on the mic, we've said AdventHealth's Primary Division. It might be a little bit, some of my colleagues might feel like they're not primary. But we already have a little of that, but it's a primary health division. So just I appreciate that. Just getting out all the wiggles. Yeah. You know, it's funny. I have that, you know, your little infographic of primary health division pulled up and I still failed to say primary health. So I appreciate the distinction. You know, I tried to rename it several times. It's so far it's sticking with primary health at this point. Yeah. No, no, it's great. So, um, but you know, on that note, I'd love for you to just jump in. Maybe you provide a little bit of your background. Now you got to Advent and more about the primary health division. Sure. Sure. Yeah. Happy to be with you today. It's, it's a, a surprising to be here actually with you on this topic because when I came out of school, I was an accountant. I was, I got my CPA license. I started with Ernst Sin Young and, and was auditing public technology companies up and down the west coast. It was a fulfilling start to the career and, you know, my family and a bunch of other people have been involved in healthcare. And so categorically, it was excluded from any career aspirations that I personally had. But, you know, as I was introduced to so many other companies, so many different other industries through public accounting, I grew to really appreciate or my, my appreciation for healthcare expanded significantly. So, when an opportunity came to, to join a local hospital as a director of finance, it was really compelling. Personally, because as we know, healthcare is a very large industry within the company. It's very complex. And I looked forward to taking what I viewed as kind of this, you know, I was going around talking to a bunch of different companies about this surface level or, or I was, I was going selectively deep on, on various topics specific to audit and financial reporting integrity. But this was a chance to partner with an organization and actually make it real and actually apply my skills and, and turn it into something different. And so, I joined it. Now, I, I then continued, I spent the next about 10, 15 years now in the industry, all through that finance track. And even as recent as the primary health division, I served as the division CFO and have now been the CEO for just over a year now. So it's been a wonderful journey up through an industry that I never expected to be in. And, and while, you know, the sizing complexity was what originally captured my interest, it's not why I'm still here. I'm still involved in healthcare for, for several reasons. One is that it's incredibly local. Like that, that provider, that patient, that system, consumer, that community relationship happens between person to person, interaction by interaction. It's such a local, locally focused pivotal relationship as well as an employer. It's a massive part of each, a part of the economy when I'm in a grocery store or when I'm on a restaurant and I'm wearing some admin health swag. Everyone has a story. My kids were born there. I had a surgery there. My dad said, you say my dad's life, I spent some nights in the hospital last week. You know, and there's a tremendous involvement that I feel personally connected to. I'm very proud of, proud to be part of a small part of that local care delivery. Two, as a Christian, our faith-based heritage within Advent Health through the 7th Adventist Church, as we look to extend the healing ministry of Christ, matches my own personal beliefs and values and the chance to connect professional work with personal values is really become special to me over the last many years now in health care. And then just on a personal note, as I age, you know, historically, I didn't have really many interactions with the health care system, but as time wears on, now my father has since gone through hospice and passed away. My mother has gone through significant cardiac care. My grandparents and cousins and a number of other people are interacted with services now to the point where it's no longer just a product. It's personal now. And so for the few of those reasons, I still find myself very engaged and excited to be within health care. So Blake, that's just a little personal story. You asked also how Advent Health is set up and how the primary health division fits in within the whole. So as I mentioned, Advent Health is guided by our mission statement of extending the healing ministry of Christ. It's a $23 billion plus system over 50 hospitals across nine states. And within that, the primary health division was formed just a few years ago to focus on the ambulatory parts of our businesses, really focusing on urgent care, primary care, virtual care, home health hospice, hospital, home population health services, and clinically integrated networks and how we can strengthen the longitudinal relationship with our consumers in delivering our brand promise to ultimately a fuel hole. So that's a little bit of context of my own personal journey within the industry, how Advent Health is organized and where primary health division is set up. I'm really looking forward to the conversation today. Yeah, and that's fascinating. I appreciate that backdrop. And so it sounds like you guys have created this interesting division within Advent Health. And how does that, how does communication work? How do you decide what to prioritize and kind of fit into the overall grand strategy, so to speak? One of the advantages of starting a new division is that we get to author those. We get to create those. And so the primary health division really, every initiative rolls up under three specific initiatives. One is primary care preeminence. That means access. That means quality. That means engagement. That means navigation. That means a host of things where we believe that goes into a longitudinal relationship with a patient quarterbacked by a primary care provider. And that then those services range from virtual care, urgent care, traditional primary care, detailed primary care, and all the way up to full risk senior care. We also have then our second initiative, which is winning in the home. And that comprises both home health and hospice. Also hospital at home is something that we're that we're early in. Obviously a new service to our industry across the country. And then the last initiative is value based care competence. And this is really how we can expand our preview on not only caring about fee for service business, but looking at outcomes, looking at how our networks, how our solutions, both Advent Health owned and as well as independent physicians and other services come together, really to meet the needs of specific populations. Those could be employers. Those could be specific plans or specific geographies. So everything that the primary health division does really rolls up into those three primary care preeminence, winning in the home, and value based care competency. Yeah, that's very interesting. And so I'm curious, it's not to put you on the spot, but it sounds like traditionally speaking from a health system profitability standpoint, primary care economics are difficult. And so you've carved out all these extremely important functions and put them into your division. And so have you ever dealt with kind of friction around that, that makes sense like the economic part versus the need part? Yes. Well, you know, you go back to what created negative unit economics and primary care. This has been a long time coming. You know, when we look at how the country pays for health care, how the country prioritizes primary care, primary care is consistently received rate reductions while hospitals and specialists have often seen rate increases. And so over time, that's forced primary care providers to concede their leadership role. If it's after hours, you might need to go down and see the local urgent care or emergency room. If it's a vaccine or shot, you know, maybe just pick that up at publics or your local pharmacy. We don't haven't been able to keep up with the expansion of services and really to keep that relationship intact over time. And so that financial erosion over over time has really forced the primary care to continue to concede more and more of that primary care relationship. At hospital systems are not immune from that and often many hospital systems subsidize primary care as part of their total offering. It's obviously an important way and an important access point into the system. It's an important service to every community that we're in. And so each market that we operate in has extensive primary care. And at the same time, it's given that it's run out of net subsidy. It doesn't always enjoy the same positioning in the mind of some other system operators. That's not pejorative. That's not a critique. It's just the realities of as businesses operate with fixed resources and fixed time and other constraints, decisions are made. That was one of the reasons why the primary health division was formed is to help separate that. So we were given a specific tranche of capital. It's totaled about $500 million for this six year period from its inception through almost 2030. And it's really designed to free us up to perform and ultimately close that gap. So we're aggressively working to reduce the subsidy required in primary care. And we're doing it through a multiple, a myriad of ways. We talk about co-locating physicians and providers in boxes where they can go from instead of having one and two providers per location you can start to have seven, nine, eleven, twelve or even more. And there's synergies of scale. You think about the support services. You think about the front desk. You think about answering phones. You think about so many of the other services that can then be done at scale rather than spread across many smaller locations. We talk about that as a country, there's not enough primary care physicians coming out of training to keep up with the increasing demand. And so it's really critical that we start to be an APP in advance practice provider employer of choice and to help them be a key element, a key part of that care team. As well as other care solutions. So there could be behavioral health, it could be nurses, it could be MAs, it could be the front desk. There's a strengthening of that whole care team coming around and operating as efficiently and effectively as possible. So when we do those things as well as a host of other tactics, we've enjoyed some success. I'll give you some numbers. When we started a couple of years ago, the net subsidy for our total division was around $150 million a year. That's operating EBITDA that was being invested in these service lines. And over that time period, we've reduced that subsidy from $145 or $150 million down to about $110. So this is really exciting work over the last couple of years. And at the same time, we started with about 2.4 million visits. And as of, we just closed 2025, we're up to about 2.9 million visits. And next year, we're budgeting 3.4. So over that time period, if we can increase annual visits by a million and reduce operating subsidy by $40 million, that's the trajectory that primary health division was committed to was set up to achieve and we're excited to continue that trajectory. Yeah, that's fantastic. So your subsidies going down, your access to patients to, you called them consumers. I'd love to wrap back around to that point at some point in the future. What, if you had to boil it down, you kind of brought up a few different things like integrating behavior health or like the co-located physicians or the APP expansion. What would you kind of attribute the major successes to so far, or mostly those things or anything else you'd add to those? Yeah, so there was those key strategies. Those are some big ones when you think about leveraging a broader care continuum, putting them together in boxes, giving them enough exam rooms to run the right number of patients through to be efficient with their days, making sure that scheduling templates are consistent with the provider's schedules and have that be available online. Things are, there's just, there's an effective scale and process standardization that really results in the significant efficiency and outcome. So those have been good. I think there's an intangible blake that I'd share is that, you know, we talked earlier about how primary care has been forced to concede some of their leadership role and their relationship with consumers. And I think what, an intangible of the primary health division is that it's helping to restore that. It's a dedicated group of leaders and operators, strategic capital, operating support, IT alignment, facilities, optimization, and just everything coming together. And it starts to restore a sense of pride in the work. It starts to strengthen the network's perspective and the primary care's reputation within that broader network. It's something that is tough to pin down, but now when people come in to their clinics, there's a tangible sense of increased pride, engagement, momentum that the future is brighter today than it was a year or two ago. And I think that starts to win over some hearts and minds and what used to be obstacles are now opportunities and what used to be something that was a dim view of the future is now something that's brighter. I can't quantify that for you, but just from my seat, as I round through the division, as I get to talk with our, with folks at multiple levels, both in and outside of PhD, there's just that tangible energy and momentum that I think when an organization makes a specific decision and resources it, I think leadership can really matter. And that's what I'm excited that seems to be happening across the entire division. Yeah, that's great. So I'm curious, like within all this, you go to the board meeting or the C-suite meeting, what are kind of your metrics for success? Because I've talked to Baylor and they've talked about how the patient is a consumer. And so because of that kind of framing, we think about retention and loyalty metrics and those sorts of things. So are you kind of infusing components of that into your metrics or what else, what are you guys kind of tracking within the primary health specifically? Yeah, absolutely. So we already talked about that overall subsidy for the division and overall visits, right? So at the highest level, if the system can operate an expanded ambulatory platform, a broad front door, an integral or an integrated home care service line, both so pre and post that acute care specialist episode, then that's what we want to do. We believe that if we can reduce that operating subsidy, we can afford to do a lot more. We can grow a lot more. We can expand all those services much faster and broader than historically work. We work because we were seeing subsidies going the other way, in fact, and it was creating some friction and challenge to how we could expand. So I think overall, the system's view that we can expand ambulatory access. And we can afford to do that, that it can perform and engage consumers, engage providers in specific clinical models. I think that's at the highest level the biggest win. And that really comes down to really that access, that access promise can we deliver access to services for our consumers. After all, that's why we're all here. So I think that's the singular metric and everything then goes into supporting that. There's other metrics within each business. So one of the things that we uncovered is that for instance, in primary care, as I described, there's multiple models, right? There's traditional, but there's also retail. There's also senior primary care. There's urgent primary care. There's virtual primary care. And so as we explored those, we added some science to it to say, you know, why do we have multiple models? Do we have the right models? And how do we organize ourselves to really capitalize on that difference? And so we loaded thousands of our consumers records into a system and to one of these systems that help target or Home Depot or Walmart, you know, place their big box stores, right? There's data companies out there that'll say, hey, I bet I know what Blake reads where he gets his news. I bet I know what he drinks. What, you know, does he stop by Starbucks or Dutch Bros or somewhere else to get his coffee? Or where he is the Annapolis or an Android user? Is he, you know, and they'll have all these data points on you. And based on that, they'll try to find other people like Blake. They'll say, hey, you know, if Blake does all these things, I bet there's other people like him. And then we can infer that if he likes Starbucks, they like Starbucks too. And we can all appreciate that there's a bunch of Starbucks lovers. And another part of town, let's put up another location. And so we took that approach with our primary care models. And so we started to see natural groupings within our population. We said, oh, so there are target consumers that like urgent care. It's a 40 year old mother, usually with a couple kids. And the ability to stop on the way home from soccer practice and get an x-ray or after school and get a prescription is something that me, that is her primary care for her and her family right now. That is the preferred solution. And so if we can find moms with couple kids on the way home from school and there's groupings of those around the geographies that we serve, that's a place where we believe our urgent care product will be successful because it's been proven out in 50 other locations across the state. I see that. Yeah, that's fascinating. And so similarly, each of our other models then say, you know, here's then the provider type, the consumer type, and the right business model and the right location to really to optimize each of those products. And so you can appreciate as we think about KPIs or operating metrics, each of those is just a little bit different in how we optimize. But they fall within those three categories, primary care pre-eminence, winning in the home and value-based care competency. But then within that, the nuances of each model are of high interest. So lots of scorecards and KPIs and performance reviews, you know, it's sure we're an operating company like many that are listening to this podcast. Yeah, and that's interesting. So to put it in kind of video game or sci-fi fantasy terms, it's like you've identified these archetypes of people or whatever. And they're in these groupings and then you go, okay, there's a critical mass here and geography A and they like urgent care. So we need to hire for five AVPs and one medical director or whatever it is. And that's kind of how the hub and spoke kind of node works. That's right. And so in Florida, we have an appreciation for that. But when we talk about Denver, we load in consumers that have chosen specific models there. And we find out that there are some similarities and some uniqueness. We can all appreciate the people that live in Denver, moved there to climb mountains and ski down them and run marathons and walk their dog. And those consumers might be different than those that are coming to order. Orlando coming to Tampa or somewhere else in the state of Florida. And so there are the science and art that we've brought to some of these businesses continues to evolve. I would never promise that this is the BL end all, but it's been fun to identify some real key themes, some real key consumer preferences and provider preferences and bring that together in a model that's purpose built for them both to connect in both to succeed in delivering that sacred transaction of care delivery. Yeah, so it's kind of like you're solving a puzzle, right? And maybe not all the pieces are the right are even shaped yet and you're kind of shaping them to fit certain molds. And so I'm curious, has there been, as you look across your various markets and conduct your research, are there kind of new emerging archetypes? There have been any kind of interesting insights as like as you guys have gone down that path where you're like, hey, we're really deficient here. You know, maybe it's like text-based pediatric care or something like that. I'm curious are there kind of new models emerging that you're interested in? The couple that we're working on right now, first is menopause. It's all over everywhere, right? Once that black box was taken off, hormone replacement therapy, everyone wakes up to say, I know my wife, my grandma, my daughter, my neighbor, my aunt, my, you know, everyone knows half the population that are going, will go through, have gone through menopause. And so being able to transition a primary care workforce in multiple models to be able to serve that population differently, to answer questions differently than they historically have been trained to is a big pivot. And so I think there's several ways to do that. We can integrate some level of services into all of our existing models. We can set up a menopause specific type of location or care pathway, care plan. And that could be done both bricks and mortar and virtually. And in a mere several ways in between. So we're exploring quickly different opportunities there. So that's an example. You know, there's some folks working in concierge medicine. We're evaluating if that fits with our mission and in brand promise and operating models. We talk about our seniors and the growing number of seniors as a percentage in our country. We have some senior care clinics that are doing well, but are they built? Are they capable of managing the volumes and the needs of our seniors going forward? So those are a few examples, but it's an active conversation. It's one of the fun parts of innovation within the division to make sure that we're keeping up ultimately within the needs of the community. Yeah, yeah, for sure. And I can tell you the whole hormone replacement. That just seems like the Wild West right now. And even Dallas, which I think you guys have some presence here as well. There's meds, faws popping up on every corner and the body specs and all the sorts of things that you can imagine as, you know, seems like a lot of consumer focused elements on like very specific parts of healthcare, which is interesting. And if primary care doesn't show up ready or willing to have that conversation, consumers will get a elsewhere. You know, it'll be chat GPT. It'll be a local regenerative health clinic. It will be a women's care clinic. It will be an influencer. It will be. So, you know, we got to keep up with the needs of the community. It's one thing to say, you know, this is exactly what I do and what I don't do. And here's those, that's all a vent diagramming. But as that changes, we need to change with it to be relevant and to continue to maintain that relationship and ultimately to live on our brand promise to feel whole. And to that point, Brent, I'm curious for your perspective just because the rate of change has been so rapid, especially lately with AI, which, you know, this is a podcast. So of course, we're going to talk about AI. Good. But how do you, like, what behavior change is and has been needed, like within your organization to match up to a more kind of consumer forward approach? That is a big question, Blake. And I'm not being the expert within the company. I can't give you a full comprehensive answer. Sure. I'd say, you know, we're doing a few things. One, we're keeping up with our platforms that Admin Health has invested in. So we're an epic shop where we just went live on Workday, HR and Finance. We have a number of other big platforms across the company that we really try to standardize on and then realize the benefit of size and scale and efficiency and quality and everything else. So there's that. And each one of those has elements of AI in their roadmap. So that's probably the safest, most, you know, complete answer there. On the primary care side specifically or home health or, you know, some of the other more value based services, I mean, there's tremendous work there. We are actively working with a number of groups on specific use cases to enable our, the provision of care and to support our team members. We are walking a delicate line. There's no interest that within PhD to outsource or AI, to reduce the need for people. I think people are an really important aspect of our care delivery model and that will continue. And at the same time, there's a ton of work in our processes. There's a lot of forms. There's a lot of calls. There's a lot of follow-up. There's a lot of elements, I think, that could be really accelerated and enabled in a different way by emerging technologies. So excited about that. I talk about it every day or two with internally or with a vendor. So it's a very active conversation, but we're probably a little premature before being able to say we have completely identified the three things we're taking forward into 2020, 26 beyond the AI roadmaps and the overall IT roadmaps that the company has planned for word invested in and blessed. Yeah, yeah, it makes sense. And as we're recording this, I think maybe this is the week of the JP Morton Conference and it seems like everything is getting announced to start the year. Just curious for your thoughts on these kind of broader AI announcements, like the chat GPT for health and then Anthropic did their own kind of clawed for life sciences and health, those sorts of things. And it seems like they're trying to create the personal health record which has been tried before, will be tried in the future. Just curious, you probably haven't had time to digest it fully organizationally, but maybe for just your thoughts as these consumer primary care focus pushes come out, what that means for your organization. You're right. I haven't fully digest those. I watched for the results coming out at each day at GPM and we have some great colleagues there who I keep in text and I talked with one of them just before I got on this podcast. But it was about AI actually. It was like, hey, we got to connect with those. See what they're doing, how we can learn and assess. So you would say just like the general thought from you guys internally is optimism and excitement around collaboration of tips. Absolutely. Absolutely. I'm bullish on continuing to learn and try. I think the primary health division sets us up for that. You know, we're pioneers within the organization. We're tasked with challenging the status quo, with investing in an area that historically maybe wasn't viewed with the same level of opportunities as other parts of our network or within the industry. And so I think we're wired for it. I think we're wired to try and innovate and plug in. There was a phrase, I just read it this morning. It's an old healthcare phrase and it was something like this and bear with me because it's just, I just read it. It was something about heal sometimes, relieve often and comfort always. It was attributed to an old French healer and later to a physician who set up TB clinics and specialty clinics in the 19th century in the US. But it was, I think it's remained here because when you think about what AI does, it can be empathetic. It can be available 24/7. It can be in a consumer's pocket. It can be in a provider's pocket. You look at some of these solutions built for both provider and consumers and we have within them, have a health provider that are using their solutions and consumers that are using theirs. So figuring out how we can have that be, what's now seemingly to be pervasive within both communities, help them both feel like they can have conversations together, enabled and supported by, not replaced, but augmented. There's such so many use cases. Remind me to ask my physician about this, hey, help me keep track of my records this or that. We aspire to do that. That's what EHR and the Epic system and other things are designed to do. But this could potentially continue to change that. I think it already has, frankly, changed that. And so us leaning into that potential, leaning us to that relationship potentially helps that aim. There's something that hands that therapy, that prescriptions, that other things are designed to do to actually heal and relieve symptoms. But there's something about this comfort element that I wonder could be supported, led by physicians partnered with physicians in APPs, but also supported by AI. There are use cases. I saw something in the UK where they're leveraging that and so forth. Boy, maybe a year from now, maybe six minutes from now, you should have a totally different conversation, but I look forward to it and it's a brave new world out there. We're excited. Primary care is broken. Patient struggle with physician shortages and gaps in care access. Tom helps close both. Tom continuously reviews patient data at a speed and level of detail humans can't do alone. Identifying rising risks and care gaps earlier to providers, allowing them to keep patients engaged. Tom delivers responsive access to providers, less inbox noise for clinicians and more time for medicine. See how at lumeris.com/platform. Yeah, maybe Advent Health just across the company is connecting everything to chat GPT and you're going to be completely removed from the equation in five minutes. Not me too. Yeah. Yeah. It's what's possible. And I think approaching it with a, I think if you approach it with leaning forward, I think that gives us a better chance. I think there's a protectionist approach that says, hey, we're never going to even utter the word AI or chat GPT and this is, we're going to run primary care and we're going to run traditional primary care. And that's the way it's going to be. Or you could say, hey, we're going to do that. But we're also going to keep identifying what new opportunities allows us to connect with our consumers in a different way. How it can help us reach more consumers, more efficiently, more effectively. And I think that's the responsibility we have as a care provider. Ultimately, we're here for the community and availing ourselves of what's now electricity or so many amazing inventions that we've had in the past washing our hands with soap. We take advantage of those technologies every day. AI might be one of those in the future where we look back and say, we can't imagine doing this without it. And certainly there was growing, there was learning, there was change, but look at what we've been able to do together. We wouldn't go back. So I'm excited. You and I both have a long time to work in the industry and continue to learn and grow in developing these spaces. And so this seems like an important responsibility for us today. Absolutely. Absolutely. Lots of responsibility. And so I'm curious, on that note, is there anything about AI or conversations with vendors you've had recently where you're skeptical from a compliance standpoint or something that may you say no or raise yellow or red flags? Anything kind of in that realm that comes to mind? One of the greatest assets I have as a leader within Advent Health is we have a large group of experts that help keep me well between any potential ditches on either side of the road. So we have legal and compliance and tech and so many people running on with me and ahead to make sure that we stay well within any guardrails. Advent Health is safe, trusted and organization and we have every intention to keep that reputation and keep building on that trust that we've been given and earned over the time period. So in short, yes, when I hear about potential use cases or how people would like to access certain types of data and how they'd like to leverage it, absolutely. I think it'll be interesting to see how it grows up. Advent Health is, and I'd say that's one of the reasons why we often don't try to be on the bleeding edge and I use bleeding intentionally because there's sometimes some bleeding on that front edge and we like to be ready to be judicious and capitalize on opportunities but not at the expense of patient care, consumer relationship, consumer trust or even internal trust. So it's a delicate balance. I think it's a tightrope. I think it's a name the example, but it's, I think you're, as we talked about responsibility, I think that's what it comes down to, but I don't have any specific instances to share, probably just to protect the innocent, but it continues to change each time we talk together with these folks because what was once an opportunity even a month ago now has changed and is morphed to something new. Yeah, and I bring that up just to say when I have conversations with folks, there's certain companies that are trying to do something within employer, for instance, like a director employer type thing, they call it longevity based startup and the employer who is a larger employer basically said, "Hey, we can't do this because you're not compliant. You're not HIPAA, no kind of sharing protocol, like those sorts of things," which all that's over my head anyway, so I'm with you there, but I just find that kind of talking point interesting. Yeah, you think about the data needed to train models, to engage with models, to, you know, it's so, so rich and I think in the right hands and the handled the right way can be incredibly powerful and if not, it can be the opposite. Yep, absolutely. You know what the great Uncle Ben once said from Spider-Man, "Great power comes great responsibility." Right. I think he coined that phrase actually. Love it, love it. Well, I would love to shift back to, you know, just primary care and strategy real quick, just because a couple of things you've said, both around AI but also just economics in general are interesting to me. And so something that I've talked about with some other health system executives and folks in the industry is this idea that AI can really have the ability to expand panel size drastically. And that's, you know, one way that you guys will look to potentially expand access is, you know, maybe a provider today, you know, an APP has 2000, you know, physician has 5,000 other panel or something like that, whatever it is. Those numbers might not be correct, but to, you know, expand that to 10,000 or those sorts of things. And so within like the context of things like that and in talking about how, you know, your subsidy has decreased, is there anything that you can contribute to as far as AI and technology specifically concerns that has lowered that subsidy or like expanded margins, so to speak, or volumes, right? If that makes sense. Sure, sure. You know, there have been some things when we talk about just standardizing processes with technology, but also without technology that have led to a significant amount of efficiency and it expanded access. That being said, Blake, I don't, there's nothing today that has been executed today, nor in the immediate roadmap that has significant increases in panel size. I'm not saying it won't happen, but they're given our track record with designing, again, specific models with specific provider types for specific populations. That, that model will, will continue. And so if there is a business model, an operating model and a provider model that, that comes together to say, hey, this population needs can be met at scale with AI and that allows for a change in panel size. I think we'll be excited to explore it. We're early on that today. You know, we've seen some examples or some potential promises or use cases where that, you know, could come in the future, but I'm able to say that we're able to achieve the current expanded access and support models as well as the immediate future in 2026 without significant increases in panel size. Yeah, that's great. Glad to hear it. Good for you guys for, you know, developing the right strategies and growth to meet your goals internally. I am curious around, so I've noticed, you know, Advent Health just to enterprise-wide, you've seen a little bit of turnover at the top with CEO and new CFO. How has that affected you guys? I would love to hear more about, you know, leadership change and whether that affects the mission or the culture or anything like that and how things have kind of shaken out with you. Yes, absolutely. Because in many organizations it can and does. You know, there's been a number of high profile changes and we watch those and see there can be significant changes in strategy and direction and structure approach, tone, culture and other. So I am so grateful to report that at Advent Health there was a very concietious, conscientious, very specific plan that was put together by then CEO Terry Shaw and Paul Rathman, the CFO to orchestrate a smooth leadership transition. There had been a lot of work that went into Vision 2030, our set of aspirations that have guided us for this 10-year period from 2020 to 2030. There's been a lot of work that's gone into creating our capital model and balance sheet model and a lot of systems that at the corporate level and at the region or operating unit level to maintain consistency and the integrity of operating performance and care delivery. So with that transition, our new CEO David Banks has characterized it largely as a baton pot, baton pass rather than a rebuild, a new initiative, a start and stop. This has been a smooth, you know, he's been with the company for over 30 years. Paul's been here for almost that and the new CFO Todd Goodman has been here for decades as well. So we are blessed with leadership that has deep experience within the industry and at Advent Health and was part of creating the systems and models and aspirations that continue to guide us today. So it is felt remarkably smooth. I have great relationships with them and in fact, it doesn't hurt that David Banks was actually the founder of our division, the primary health division just a couple years ago. And so he and I enjoy a very great relationship. I came on as his CFO and we started the division and to have him in his seat continues to be a great tailwind, but also a great challenge as he continues to dream and push for what is possible and what the future demands of ambulatory care delivery. So I'm really excited and blessed to be able to share such a smooth leadership transition and I admire and am grateful for and just can't share thanks with those gentlemen enough for the work that they put in to orchestrate such a smooth transition. Yeah, that's great. But you know, one caveat is if I've ever learned anything from watching US track and field Olympics, is that the baton pass can go terribly wrong? Yes. I'm just teasing, but. Yes, no. The dropped baton is a tragedy. You see them in such orchestration and that thing just that metal tube hits the ground and it's just the wind comes out of out of years and years of training and work and diligent work. So yeah, no, they have in my estimation executed a baton pass so smoothly, so effectively that avid health is that's the least of avid health worries or energy is on internal leadership transitions. It's really continued to focus on consumer aspirations where we hope to be in the future where we need to be to meet those those community needs. So it's it's it's been a blessing out here. Yeah, and to your point, it sounds like, you know, avid health is not an organization that is dealing with constant and executive turnover. You know, you have a lot had a lot of continuity and stability and there's a lot of organizations in health care that do not have that. Yes. So it sounds like, you know, you guys have credit to those guys and stilling the right culture from the top down and creating that continuity and you know, the next phase for you guys. So it's exciting. Absolutely. Awesome. Okay, I'd love to, you know, round out the rest of our conversation and talk just a little bit more about value-based care. I speak as I, you know, we talked about this at the hospitality retreat a little bit. But to round up the conversation and the current state of things, you know, in 2026, there's been some new models that have been announced. I think team has started, right, effective Jan one this year. That's right. And then there's other, you know, CMMI's putting out things like access and other other models. I think they announced the next phase of ACR reach potentially too. That's right. From your perspective, what are you paying attention to within all of those kind of realms? You know, it continues to, I continue to learn and evolve along with, with the industry and with the news that we, that we receive. I think different systems take different approaches and tax towards value-based care. Some of my colleagues are, say, the value-based care is the only way the future comes to be that at some point, fee for service will be a minority percentage of our reimbursement and value-based care, some, some model, some structure, some type of it will be the dominant reimbursement model. That could be true. Others index highly to their employer population or their, the plans depending on where you are, your local commercial plans might have a lot of leverage. Other places they might not have much leverage. You might have tremendous amount of MAPenetration. You might not. I bring all these up to say that each market is unique and different and I cannot speak for folks and how they're approaching value-based care at each of their respective organizations and in their markets because after all this time, while I used to believe there was some grand unifying theory under value-based care, I'm currently of the, of the belief that it really is something that needs to be market-specific and created to optimize that care delivery within the structure that they operate in. So let me give you a few examples. Within Advent Health, we have a broad portfolio where nine states and we have a number of CINs, 15 of our facilities are mandated in participants and team. We have some optional programs and enrollments in various MSSP tracks, REACH and all these other models that are coming out from CMMI were evaluating each one and underwriting each one and learning more as we go. We have a number of commercial programs that have value-based care elements. We have P for P or pay for performance. We have shared savings contracts. We have neural network relationships with some employers and health plans. So we have a broad swath of what that looks like across this, across the company's geography and scope. And so this last year, we took the time to partner, to put together PHSO, our primary health, our population health services organization with our managed care leaders, as well as market leaders and went market by market to make an assessment, a full inventory of what we had. So, does this market have exchange products in Kansas? No, but in Colorado, yes. So that's an example of some market nuances. And so we have a specific list by contract, the number of lives and the key metrics and the opportunities within each contract that we have today by market that's laid out. And so with that, then we can start to organize each market's efforts and the teams to start to say, hey, if you connect to this, if you close this care gap, if you get in this person in for an annual wellness visit, if you can create an opportunity for preventative cancer screenings for them, you know, there's specific initiatives that are tied to achieve specific metrics and then perform in each individual contract. So that goes for government programs, commercial risk and a number of those other contracts. So that's, I'd say, one kind of a leg of the stool, one set of initiatives that go into understanding what's happening in the non-fee for service arena within each market. The second one is what we call employer solutions or employer and plan solutions. So, Advent Health buys a billion dollars of health care each year for 140, 150,000 planned members, right? We're a self-funded employer, a self-funded plan. Gotcha. And so we look at that billion dollars and we say, you know, how can we start to use this as a proof point, as a case study, as a proof of concept that we can actually start to be accountable in a in a higher way for outcomes, for cost, for that overall value equation, for access, for preventative cancer screening compliance, for primary care, alignment and attribution. How can we take all those all those principles within population health management and bring them to life in a plan where we really have that provider network? We are the plan and ultimately it's for us, it's we, it's for us, we are the beneficiaries. And so how do we how do we take advantage of that triangle and create something that really demonstrates and creates new value that we can realize and recognize ourselves, but we're also able to then go to the marketplace and share as employers continue to talk to us and say, what can you do to help me? Was it well, these are some of the things that we've done ourselves, some of them are easy, some of them are challenging. All of them can create potential, a different outcome than what you're seeing today. What can we do together? And so it's been exciting. We've set up a new narrow network plan. We've set up incentives to get people into primary care. And this first year, 2025 was the first year of that program in Florida. We're doubling that in 2026 and expanding to Colorado and looking to continue to innovate in our own health plan as well as some of the specific relationships we have with with a few pairs in that second category. So that's number one and number two. And then the third category of value-based care initiatives we have is really ambulatory access. Right now that's focused on the primary health division. We talked about, you know, the expansion of primary care and urgent care, doubling or even more expansion across each one of our markets as well as continuing to maintain that relationship with home health and hospice. Having that longitudinal view, say, hey, once you leave the hospital, we care about getting you home all the way through helping you and your family navigate end of life care. And so that ambulatory expansion is a key part of positioning of that health in each market for success both today and into the future as we look at site neutrality as we look at, you know, significant increases in the elderly population and also more continued change in the employer space or neural network plan space. And so those, I would say, really comprised the large three buckets of our current value-based care strategy. They're very tangible. They're quantifiable. They're very real. I don't show up and threaten my hospital colleagues with emptying out their EEDs or that they won't ever get another referral from primary care. At some point in the future, if that comes to be, we'll get to have that conversation. But today, in the markets that we're in, it's much more of a collaborative. Let's align ourselves really to optimize quality, documentation, utilization management, preventative screenings, a primary care engagement. And we think through those results, we will actually bend the cost curve. Yeah, yeah, fast and I love that. Thanks for breaking that down. And kind of like that second category is very interesting to me because it seems like lately the kind of provider-sponsored health plan, at least on the MA side and managed care in general has experienced a huge beat down. Right. And you guys are standing up, that product, and for yourselves internally, right? But also you're thinking about, is this kind of like a direct contracting model with employers in your local markets? Is that kind of how you think about it? You know, it could be. We have a few relationships. Disney is a, we have a very close relationship with, but historically, we have not had a broad product for employers in our community. And it's partially because when they ask for help, we'll respond with, have you seen our bright shiny new DaVinci robot? Have you seen our new cancer center? Have you seen our quality scores? And those are value. Those are investments that have been health made in the community in for them. It was accessible for them. But it doesn't necessarily scratch the itch that a lot of them are feeling. They're watching their revenue increase by 4.5, 4 to 5%. They're watching their healthcare premiums go up by 8, 9, 10%. And that's creating some real pressure. And you know, it's not top of mind, I think for some of our hospital operators or system operators, is that a big percentage of our commercial book is our self-funded employers. Some is fully insured by United or any of the other book repairs, but a large percentage, sometimes 70, 80, 90% of different books can be self-funded employers and our ability to help them remain solvent or help them remain competitive. Mean that our communities will be stronger going into the future. So I think it's a, I think it's an opportunity. I think it's a responsibility. But we'd like to, someday in the future, be able to share exactly what we described. Something that says, hey, we, we had the same challenge. We were seeing cost inflation for all our healthcare spend increased at a, at a, unsustainable rate as well. And so we partnered. We, we made some decisions. We tried some, we tried some things and, and through that, we've, we've yielded some benefits and we think we could offer you something similar. So, you know, we haven't seen all those come for fresh and yet we just completed that first year, really partnering with the plan and have some early results to continue to expand that within our own health plan. But potentially in conversations of the future, we'll be able to share. This is, this is what we've been able to identify and do together and how that value can then be shared and accessed by, by others. Yeah, maybe, you know, next year, if AI hasn't taken over everything, sit down and have this conversation again. Okay. So look differently. Yeah, just very curious. Just, it seems like there's a lot of themes of, you know, that consumerism and direct contracting, you know, the cons years care and meeting people and, and their own archetypes, right, and their own communities, right? So I just, it's fun that all, a lot of triangulating forces coming together, it seems. So that's why that's why I ask. You know, history, I can say that, you know, in, in my previous years, sometimes I've, as a hospital, healthcare operator, viewed our industry really through a supply-focused lens. Hey, if I open up a new building, if I open up a new tower, if I open up a new service, if I hire a new provider, I want to fill that provider. You know, hopefully there's enough of that demand in the community to meet the supply. But I view it as a supply-focused and, and what Advent Health is, is really leaning into in this consumer focus aspect of this, you know, this, this is why we're here. We're only here to meet the needs of the community. We're only here to connect with consumers. We're only here to provide services and comfort and healing and everything to help people achieve their goal. And, and we believe that's the data's I had to feel more whole. And so, as we transition our thinking to more of a demand focus, talking about things like our health plan are really fun topic because we now are the customer. We are now the patient. When I go to the doctor, what's my experience? When I need a referral to a specialist, when I need a script, when I need a, when I need a lab draw, when I need an imaging study, when I need, what is my experience like? And if that's my experience, what is the experience of my neighbor? What's the experience of my parents? What are the, what are the experience of my kids friends at school? And how can we make that better? And so, I think viewing, getting the opportunity to view our services as consumers and then turn around and say, if we want this for us, this, this outcome, this quality measure, this access point, this ease of contacting, whether that's through AI, through phone or text or my charter, you know, there's, I mean, this is, this is the work. It's easy to sit and talk about these amazing grand visions or hopes and dreams for the future. But when my wife calls for an appointment and she doesn't, the phone doesn't get answered or her call doesn't, her message doesn't get returned in a day, it's, it doesn't work for her. It doesn't, she doesn't, she doesn't say I feel whole, she doesn't say my, my solution's been solved. She says, Brent, why can't your system actually just deliver what you guys actually are just there to do? And that's a very humbling experience for me every time it happens and it's a great reminder. But, but things like that where we have an opportunity to, to remind ourselves to engage. And so, I think value-based care is, is that great opportunity to figure out how, how can remain in touch, how we can remain really oriented around consumers their needs, our physicians or APPs, our team members and, and an expanded way that, that continues, I think, to put the right things first. Yeah, love that. I love that breakdown too. Thanks, Brent. It's very humbling and profound. So, that's, that's a great thought. I think, I think that's a great spot to end the healthcare-specific conversation. So, thanks for all of your insights, but I do have one non-healthcare question just to end up the podcast. Let's do it. What's a recent or non-recent, non-healthcare piece of media or content or book that you've consumed recently that's changed how you've perceived things? You know, we, I was, I was, David Banks actually introduced us to Gary Hamill. He's a benefuturist for a long time, a strategist for a long time. Teachers at the London School writes for Harvard Business Review and a number of other things. He, I have just gotten lost in a bunch of his podcasts and now a couple of his books, Strategic Content and a recent one, Human Ocaracy just came out with a new edition not too long ago. And, and it's, and, and it's a really a neat set of, I think he, he's been around the industry for a long time. He's, I shouldn't say the industry. He's not healthcare-specific. He's worked with, you know, Nokia before they, before they were known. You know, we've all known that they're, but on a cycle he worked with, you know, so many of massive companies in so many different verticals and so many different spaces, but, you know, he, he talks about ambition deficit disorder. Are we dreaming big enough? Are we actually trying to innovate to meet the needs that our communities are actually facing? You know, the hard questions that he poses really force me to think more broadly. I think it's, I think it's easy for me to get into this incremental, you know, we have the three things and then we have the pillars here and then let's execute on 26 and then we can get to 27 and deploy this capital and then we open those boxes and then we repeat, you know, it's, it's easy to get into that cadence. And so I really enjoy his, his lens in, in talking about so many examples about other companies. Again, non-healthcare specific that have have, have navigated those significant transitions or they missed in those significant transitions and now they look entirely different than they once, once did. So that's just my latest. Again, you can, lots of podcasts, but there's several good books and articles and he's been a prolific content producer. So I'd encourage anyone that's interested to look him up and engage with him. Really an amazing guy and continues to be a source of inspiration just in the, in the time I've known of him. All right, very good. Definitely adding that one to my good reads, my collection grows. Yes. So thanks for that. Absolutely fascinating. All right, thanks so much, Brent. Really appreciate your time coming on the podcast today, talking about Advent Health and Strategy and best of luck to you guys in the primary health division in 2026. Excellent. Thank you, Blake. It's always a pleasure to join you. Thank you for what you do. All right, appreciate it. Thanks for listening to this episode of Claims Denied. Stay up to date with news and trends in health care by subscribing wherever you get your podcasts. You can find more resources and apply to join the Hospitality Community at hospitality.com. Also, if you love Claims Denied, please tell a friend and share it with a colleague. Until next time, Hospitalityists. [BLANK_AUDIO]