Ep 64: Sutter Health CEO & President Warner Thomas on Digital Transformation and the Future of Health Systems

(upbeat music) This is VitalScience, a podcast on Kodiya trends and health tech and the people shaping them. Today we have on an incredible deaths in Warner Thomas, the CEO of Sutter Health. Sutter probably needs no introduction, one of the largest health systems in the country. And Warner's had a really fascinating experience having come and joined the system from Oshner where he also led that system. Really interesting conversation around all the different ways Sutter's using technology, how a system leader thinks about the key things that really matter and a bunch of other key questions in healthcare. I think folks will really enjoy it. Without further ado, here's Warner. Warner, thanks so much for coming on the podcast. Really appreciate it. - Hey, really thanks for the invite, glad to be here. - It's a real privilege of my job that I can just get to spend 45 minutes here with the CEO of one of the most important health systems in the country. - Well, thanks for the invite. And I mean, you guys do amazing things in the investing space. And it's an interesting time in healthcare, certainly. - It certainly is. I think our listeners are inevitably familiar with Sutter given that half of them are on the West Coast anyway and probably have firsthand experience with the system. But maybe just to start, can you contextualize kind of Sutter today, the footprint, and how that's evolved since you kind of joined in 2022? - Yeah, so I've been at Sutter almost three years now. Sutter's the 10th largest not-for-profit health system in America. We really cover the full continuum of care, several hundred clinics, large relationships with storied medical groups like the Palo Alto Medical Foundation Medical Group, the Gould Medical Group, Sutter Medical Group in Sacramento, San Sam Clinic down in the Central Coast and Santa Barbara. And then we have 25 hospitals across Northern California. We have a small insurance plan with about 110, 120,000 lives. 12th largest home care company in America as well. So a lot of people don't know that and the largest operator of ambulatory surgery centers in the state. So really a comprehensive system. - I mean, you obviously joined after a really long run over at Oshner, another really large system, a different part of the country. One thing I love your perspective on is, obviously people always like to say healthcare is intensely local, right? And it's not serving the communities that are there. Maybe just talk a little bit about some of the differences you observed between what you were doing at Oshner, what you're now doing at Sutter. I'm sure there's lots of similarities, but I'm sure all the listeners love that. - Yeah, so, I mean, two really different organizations and how they were configured and started. If you look at Sutter, I think, historically, a hospital-oriented organization and was kind of hospital-driven and started from that. And so I think it's had a very hospital-oriented culture for a number of years. If you go back to the '90s and into 2000s, started to build broader relationships with physicians and with the medical groups. But I think it's really been a very different organization and how the organization integrated itself or didn't integrate certain components of the system has been pretty different. If you look at Oshner, it was really started as a physician group practice with five surgeons getting together to build this medical group and then evolved into starting a hospital and then evolved to be more of a system over time. The clinic in the hospital at Oshner merged in 2001, and that's when Oshner really started to expand and grow. So really, the history and heritage is very different of how they grew up. And I think it also is why you see, at Sutter, we're spending a lot of time on how we integrate the organization, how we coordinate it, which are things that we really started back in 2001 at Oshner when we merged a clinic and hospital together then. - Yeah, it's fascinating how these organizations can maybe look similar today, but based on where they started, it has this kind of cultural resonance down the line for many decades to come. - Yeah, and I think that history and heritage drives a lot of how you look at the world, how you think about things and how you evolve. - And one thing I think is so interesting is you were talking about even the footprint of Sutter today, the fact that you have this massive, home care component of the business, it feels like there's just so many different things going on. What are the two, three things that you think about the most right now? - Sure, I think a couple of things. One, we are very focused on how we grow our ambulatory presence in our physician network. We've added well over 2,000 physicians and clinicians over the past three years. We're opening up over 30 new locations between the end of last year, 2025 and early 2026 to be able to house a lot of those physicians and clinicians. So really building an ambulatory network and physician network, big focus. The second I would say is being much more consumer and patient oriented. We've been relentless about improving access, taking friction out of the experience for our patients. We'll book nearly 5 million appointments online in 2025. We're the number one online appointment organization. - When did that all start for you guys? - Yeah, so I mean, look, Sutter was doing some of this and had made some great strides prior to 2022. I think we just really built on top of that as a team and accelerated it. Today our primary care appointments, 55% of primary care appointments are booked online. It's a much lower percentage in specialty, which we're working on, so. - Is that just 'cause the scheduling rules are more complex? - Yeah, I think it's a little more complicated and I think it's just where we started and kind of where the initial efforts were. So I think the consumer focus, reducing friction, better navigation, making it easier to use as a big focus. And I think the third area would be really around technology. And we were talking a little bit about AI and how we deploy technology to make it easier to work within Sutter, to care for patients within Sutter and make it easier for patients to be seen at Sutter. So I think whether it's, we were talking about a bridge and using it in ambient listening, we just developed relationship with ADOC and kind of on the radiology space and that. Or if it's using technology in what we call chronic disease management, what we call is Sutter Sync, allowing us to take care of patients at home who have hypertension, diabetes, and connect with them multiple times per week at home versus a few times per year in the office, a very different experience. So I would say it's really expansion of the ambulatory network, consumer and patient focus, and then technology and using that to care for patients in a better fashion. - So many interesting things to dive into there. I mean, I guess on the consumer side, obviously you made this huge push into online booking, a bunch of other things. How do you think about like the next frontiers of what the consumer experience looks like at Sutter as you think about the next five, 10 years for the system? - So our chief consumer officer, Jennifer Ballinger and Laura Wilt, our chief digital officer really drive a lot of this focus. And I think it's a number of things. I think it's how we help people navigate the system. Health care is complicated. And helping people navigate to know where they need to be, what specialties next, what appointments, what tests they have to have, why they have to have them. We're building centers of excellence in neuroscience and cancer and orthopedic and sports medicine and providing those capabilities in a more integrative fashion. - How do you think about the balance of like people and technology there? 'Cause I imagine you must get pitched by a million vendors that wanna, you know. - Oh, we do. Yeah, we get pitched by lots of vendors. I would say we think about it in, you know, fighting fragmentation, you know, really trying to not fragment the experience but having more integrate. And sometimes that's using different point solutions, but I think we're looking for more platform solutions versus point solutions. And, you know, that's a big focus of how we think about, you know, caring for our patients. But, you know, it's, you know, we have a point of view, right or wrong, about the future, about, you know, healthcare systems of the future. To be successful, we're gonna have large, ambulatory oriented networks. You're always gonna have hospitals, but, you know, being closer to patients, making it easier to be seen, moving more care into the ambulatory area. And that'll be coupled with an integrated with a digital ecosystem and digital capabilities that allow patients to go back and forth. 'Cause people don't want just digital. And they don't want just, you know, in the office. And look, it's hard to navigate, right, to how much should be digital and how much should be in the office. And that's what we've gotta continue to navigate and get right. But that is really our point of view and how we're trying to help people navigate between that. And some people would rather be in the office and that's fine. And some people would rather have virtual care and that's fine too. And we have to be able to tackle both of those situations to make sure we serve our patients right. - That's fascinating, this kind of like continuum of different care settings that people want and integrating that together. How do you think about what the like control panel for that ultimately looks like? Or is someone accessing like, you know, is it a person somewhere that has all that information or a piece of technology that like helps you seamlessly? 'Cause I think that seamless transition between those sites of care is obviously a real challenge. - Yeah, I mean, you know, we use the Epic, you know, IT platform, it's kind of a backbone, you know, but I think we have to, I mean, part of it is, how do you use it more effectively and efficiently? How do you utilize all the components of the system and take advantage of those? And then how you build, sometimes it's not the technology, it's the workflow and the work redesign. Online appointments is not about technology. Online appointments is all about behavior and behavior change and working with our physicians and clinicians to do it in the right fashion, you know? You know, so I think it's a mix of behavior change. It's a, you know, the component of, you know, building more systems that can integrate to Epic and use that as a platform. You know, it's what we've done with Sutter Sync is it's integrated into Epic. You know, we have, you know, devices, blood pressure cuffs, glucometers, you know, you know, scales for weight fully integrated into Epic. So there's no app, it's just fully uploaded. So the more we can make that easier, the more we can kind of build and integrate that clinical information and allow patients to have an easier experience, that's really what our focus is. - No, I love that. I mean, it's cool that the Sutter Sync, especially is such an interesting vision for where things are going. I'm curious, you know, obviously I feel like if you went to a healthcare conference over the last, you know, decade, people have been talking about this stuff for some period of time. You know, it's always much more challenging to actually get it implemented. And I don't know whether there's, you know, you mentioned behavior change earlier, there's obviously technology. Does it feel like now is starting to become the time for some of these things? And how do you think about that? - I think we've been on a, I think we've been on an evolution, you know, I think some organizations lean heavier into this than others. I think I, you know, I and my team, you know, we've had this point of view of physical digital for a while. - Just being near the Bay Area helping. - Yeah, I mean, the interesting thing, when I was at Oxner, you know, six, seven years ago, we were bringing physicians to San Francisco to meet with tech companies here, meaning with, you know, private equity or venture, you know, organizations to just learn. To really just learn what's going on. So, yeah, I would say, look, AI has accelerated some of this change in a very large way. You know, I mean, I had my primary care appointment last week, had a, you know, 30 plus, you know, minute visit, I probably get a little bit more time. - It's a high pressure visit from over in the system. - Yeah, exactly, my doctor, she's amazing. Literally, she turned off the bridge, you know, on her phone and turned the computer screen and showed me the note. It was instantaneous. And I read the whole note and I was like, I mean, literally I was like, wow, this is unbelievable. And so these are game changers that are only going to get better, right? And I think that's how we have to lean into this in a very, very different way. And I think traditional healthcare organizations, ones that lean into it and embrace it and work hard at it and try to change the behavior and learn, I think we'll do well. I think others that don't, I think they're gonna be left behind. I think they will really struggle over time given the changes that are happening because, look, I mean, everything we do in our life today, banking, airlines, you know, consumer, you know, we're doing on our phone. And we're doing, you know, from our iPad or, you know, device. And so I just think this to think it's not going to happen in healthcare is just not feasible. I mean, organizations will figure it out and many have, right? And I think we wanna be on the front end of that. Here at Sutter and continue to push into it. And then given our proximity to the valley and now to, you know, San Francisco and what's happening in AI here in San Francisco, I mean, I view as the hub of AI. It's, you know, we're fortunate to be here and we wanna be a leader in this area. - It's amazing how quickly things can just become commonplace, right? It's almost like you can imagine, you know, pretty soon it's gonna be crazy to go to a visit as a physician and not have, you know, a tool like a bridge or, you know, to be a patient and go there and you're gonna be like, wait, what's, - It's gonna be common, it's an expectation. Like you've gotta be able to have it, right? And so, but those tools have to get better and better, right? Because that's gonna be, you know, we were, I believe the first one to work with a bridge to move it into the ER. You know, we're excited to be a development partner there. And look, there's lots of different tools out there. It's just, that just happens to be the one we're using. But, you know, this idea of how we continue to lean into that, make it easier to care for patients, easier place to work. You know, lower wealth, our digital officer, you know, we're tracking the saved hours. There was a million last year. It's a million and a half this year. We need to be multiples of that. And I think it will be as, you know, the million and a half is probably gonna be understated by the time we get to the end of the year. So, you know, we retooled our nursing documentation then Epic saved 20% of the time in the system for nurses. So, these are things about working smarter, about being more strategic. That's gonna allow systems to do, you know, better and to perform better. And I think that's what healthcare organizations are going to have to do in order to navigate what are gonna be some pretty big headwinds in the coming years. - What other parts of AI are you paying attention to? Obviously, it feels like the, you know, ambient documentation has been this killer use case. And you mentioned AI doc earlier and some of the stuff on the diagnostic side. But I'm sure you get hundreds of use cases across your desk. Like, which ones are you most excited to batter? - Yeah, so look, I think we're seeing new ones all the time. Right? I mean, I think looking at voice documentation into home care is gonna be a big one. I mean, there'll be a game changer in home care. I think, you know, looking at, you know, calls, you know, working in our call center and just helping our patients, you know, for things that are easier that, you know, we could do with some sort of, you know, AI generated voice recognition and technology to allow people to navigate simple things or allow our employees instead of dealing with somebody with benefit questions or pay questions, you know. So I think there's a lot of administrative work there that I do think will automate, you know, overtime. And, but I think, you know, a bunch of that will be probably with voice oriented answers versus just being, you know, text oriented. And I think that's gonna be a big, a big opportunity in the future. I think online coaching, you know, whether it's, you know, mental health or whether it's, you know, chronic disease, like we talked about, you know, we've got in our chronic disease, you know, they're an avatar that you can choose the language, you know, choose what you want your avatar to look like that, you know, looks more like you, right? And kind of deals with health patients, kind of be educated, helps them understand what's happening with their, you know, with their results and that sort of thing. I think ref cycle, supply chain, I think are big opportunities for AI and coding, you know, we've got to do it in the right way, but I do think all of those will be big opportunities for AI. - Yeah, as fascinating as it feels like, even if you just froze the capabilities of these models today, there's so many things you could go build within healthcare, but then also every three, six months, there seems to be a whole new set of capabilities. And so it must be a fascinating as a leader of one of these organizations to figure out, like, you know, it's like you have to have the plasticity of every three months, there's probably some new set of things that weren't possible before that now are voiced. I think being a great example of that. - Yeah, and I think, you know, part of this is, and I think a challenge I have, and I know a lot of my colleagues have is, you know, how do we stay current? How do we learn, you know, and how do you stay in front of this? And that's, I spent a lot of time, you know, listening to podcasts or, or, you know, reading and then talking of folks in the industry because it is, it is, you know, just, it's exciting and also challenging, you know, the speed of change. We have a lot of startups that listen to the show and I'm sure you've, you've been through your fair share of pitches and maybe seen people do things that didn't go as well, you know, in terms of kind of aligning with you guys. Any advice you have for folks out there or things you've seen people do that may be common mistakes folks make? - I think one of the things that happens is everybody thinks about, they're going to solve this one little thing in the healthcare equation and, you know, we're going to do it extremely well and like, why don't you think we're amazing and it's like, because there's 50 things we got to solve, not one. And now, you know, how do you get to 50? You get one done and then you move from there. But I think it's the idea of, you know, is it, is it going to work across a continuum? Is it going to help us solve multiple issues? And, you know, I think, I think sometimes startups can get so focused on their one thing that they're solving and they're like the best point solution for this one thing and we're thinking, yeah, but we got to solve a much broader set of issues and your solution is really not going to help us in that continuation. I think the other thing is, does it work and integrate with our existing legacy systems that, you know, we're not probably going to trade out like a work day or like, you know, epic, you know. So, and I think, you know, thinking about how that's going to work, the other thing is, you know, if you've always got to, you know, nobody wants to have like 50 health apps on their phone. You know, I think it gets back to, we want it to kind of integrate through the Sutter app and make sure that becomes the gateway of where people, you know, get to information. So I think those are things that people just need to think about when they're pitching or, you know, looking at, you know, these single point solutions is many times there's a broader agenda we're trying to solve for. - Yeah, and obviously, you know, I imagine the, the most effective ones can pitch some sort of entry that is really effective for something, but kind of paint the picture of like, hey, this is applicable and, you know, 15 other things within the system. - And it's how we see it going and, you know, and I think the other thing is, and we want you to be part of how we develop this and we're willing to do this with you. And so that becomes more interesting, right? Versus, hey, we just want to, you know, we just want to sell you something and, and then we're going to kind of move on. That's probably not as interesting, especially if it's a, you know, a smaller kind of startup organization. - You mentioned some of the headwinds kind of facing the health industry earlier and I think we're talking about, you know, some of the looming Medicaid cuts. Like, what does that actually, you know, as you as the CEO of a system, like, how does that kind of impact the, you know, what the future looks like for Sutter? - Well, it certainly creates a lot of uncertainty for lots of organizations, not just Sutter. And, you know, I think the way, I mean, look, the, you know, the July 4th bill, single largest healthcare cut ever. You know, so it's going to have an impact on states as well as, you know, healthcare institutions. So, you know, we are building our plan at Sutter of how we, how we, you know, you can't, the cuts, so material, you can't shrink your way through that cut. You have to grow your way through that cut. So yes, we got to be more efficient. We got to look for cost savings. We got to look for efficiencies. But at the same time, we have to grow and expand and, and, and, you know, look at, you know, new patients we can serve, new areas we can go to to be able to mitigate, you know, those changes. So I think it's going to be really tough for rural entities. I think it's going to be really tough for some urban entities that are really, you know, relying on a Medicaid or a Medi-Cal here in California. We are a very large provider to, to Medi-Cal. So it's a, you know, it's a, it's a large, you know, change for us, but we feel like we got a good plan and we can navigate that. But I don't think others are, will, will maybe be able to do that because it may be too material or maybe they don't understand the magnitude of the change. And so I think all of this is, you know, people really need to try to make sure they can quantify it, understand the magnitude. And then, you know, today, start, you know, we've started, you know, going into 26, like what are the things we're going to change now as we go into 26 and then 27, then really, you know, 27, 28 is when the real major changes start. Make sure we are getting ready for those changes and can navigate them over the next couple of years. - When something like this happens, you know, is there, had you guys had kind of a plan as in like, hey, there's a possibility this, you know, there's always possibility policy wins change. And so we have a plan here, or is it like you get in a war room and kind of figure it out? - No, I don't think everybody has like the plan that they pull off the shelf of, okay, this is how we're going to-- - That'd be nice if it worked that way. - Yeah, the Medicaid cuts. I think you have to be flexible. I think you have to be agile. I think you got to, you know, be decisive. And frankly, we like to think about it as managing point to point. You've got to pick a path, keep moving, and then reassess. And then if you got to readjust, you readjust and move in a different direction. And that's kind of how we think about, especially when you're going through times of big change or times that are uncertain. I think sometimes people get frozen, they don't make decisions, and that's not good. You know, that is making a decision if you don't make a decision, right? So pick a path, make a decision, keep going, keep reassessing all the time. And not that you're going to totally change course, but, you know, we'll know more in three or six or 12 months than we do today. And so as we learn more, like, what could we do? What would we do different? But, you know, as we, you know, set out our path and our strategic plan for the past couple years, that the fundamental direction is not changing. You know, the speed we do things, or the prioritization of how we do things may change. You know, projects, you know, come up, and some may accelerate to the top, some may drop back. But the direction of what we're trying to accomplish in those three areas that we hit earlier around, you know, expand the network, you know, and then tackle our consumer and our patient issues, and then tackle the technology, those are going to be really consistent. - Well, what else are you paying attention to on the policy side? - If you look at healthcare in general, I mean, state and federal government are two of the largest payers that we have. So you have to pay attention to advocacy on a local, state, and national basis. And so, you know, it's interesting. I've been asked over time, like, what are the big things that I worry about? And I always say, you know, some major change from a policy perspective is always something I really worry about. 'Cause, I mean, with a, you know, with a stroke of a pen, it can have a very material impact on you. And I think in this situation, that's what happened. And once again, lots of different and good reasons for things and things, you know, people decide, and, you know, our political leaders have to decide and, you know, pick pass, and then we've got to adjust to that, you know, appropriately. So I think that's what we're working to do. And then working to advocate maybe modifications, or maybe things weren't quite exactly right and are the ways we could modify the bill going forward, or things could be, you know, tweaked or whatnot. So hopefully we will see, you know, some changes in that legislation over the next couple of years. I mean, you know, now we're talking about, you know, the ACA subsidies and maybe those get extended a little. That would be great, right? So I think we'll see how this really plays out over the next couple of years, but hopefully there's some modification to provide, you know, more flexibility and more time for health systems in the future. - And one thing I think is interesting about this market is obviously you, you know, compete against a bunch of other great systems. And I'm wondering how you think about like the vectors of competition there and what like ultimately, you know, allows you to kind of win the hearts and minds of patients, you know, versus these other great systems. - Yeah, I think one of the ways that we think about it is that, you know, we have to have our game plan and go out and execute on what we have to do, you know, and, you know, for our patients, for our, you know, physicians and clinicians for our team members. And if we do those things well, I think we'll be fine, you know, so I don't think we don't develop our plans kind of looking at our competitors. And because they have different, you know, things that they need to focus on, they need to do. So I would say that we, you know, once again, we keep our patients and our employee and team members and our physicians and clinicians at the heart of how we think about where we're going. And I think if we continue to just be excellent at getting better and better at that, implementing technology, navigating the policy and the payment issues, I think we'll be fine. I mean, if you look at Sutter, we've got a very large, you know, geographically dispersed impact, you know, which is, so we're not kind of, you know, just in one area, we're in a lot of different areas. So that's the strength. You know, you look at our clinical capabilities, you know, versus maybe some of the academics here who are amazing and fine institutions. But I mean, if you look at some of the things that we do at Sutter, I mean, our outcomes and capabilities are rival, you know, and are as good if not better in many areas. And so, you know, if you go to some of the academics, they're gonna be dealing with a esoteric, you know, specific thing that maybe is not our area of expertise, but, you know, 95, 97, 98% of the things we can take care of, and we do take care of, and people would rather have that integrated experience. And then, you know, our physician model is open. You know, we've got these large, storied medical groups. We have thousands of community physicians that we work with. So we have a little bit of a different system, you know, and if you look at Kaiser, I mean, Kaiser Great Organization, it's more of a closed system, you know, and you can't really leave the Kaiser system. So, you know, if you look at Sutter, more of an open system, you have options to go to different places. So I think that geographic coverage, the clinical capabilities, the physician network and model, and then the integration and the digital capabilities that we're building, I think really help us differentiate ourselves in the market. - I love that. I guess, you know, obviously being in San Francisco, you hear a lot of kind of, you know, very ambitious visions for the future of healthcare and what it looks like in 2025 years. I'm curious for someone who's been much more grounded in, you know, both what's possible now, but also seeing the frontiers of all these technologies. What do you, you know, to what extent does healthcare look completely different in 25 years, pretty similar to what we're doing today? - I think healthcare has to look different. And I think for a number of reasons. This, you know, we talked about technology, we talked about consumer. The single biggest macro issue happening in healthcare right now is the aging of the population. You know, 11,000 people, 11,500 I think is the exact, you know, age into Medicare every single day. Every single day, you know, for years. It's happened in the past, you know, three, four, five years and it'll happen in the next several years. You know, probably decade plus. And every day that that happens, every hospital or physician in America has a payment reduction. That's just the reality of the world. And now we've got the July 4th bill. So there's Medicaid or Medi-Cal payment reductions. So those two headwinds are so material that you've got to be able to navigate and tackle those head-on. So, you know, we think over time, you know, global payment or global budgets in Medicare will be much more prevalent. I mean, we see that some, but we are building the capabilities to be much more oriented to a global payment in Medicare, you know, Medicare Advantage, if you will. We got, you know, two great partners in Alignment Health and SCAN that we work with in the Medicare Advantage space. And, you know, we just think that that is a better payment model over time because it unleashes innovation, allows you to take care of patients without just having the limitations of straight fee-for-service. But not all organizations are great at that. There's a reason they call it risk, it is. And you have to build the capability. You know, we hired a, we have a great DIA team, a partner, Burry, who came out of the CIGNA organization, Ram Medicare Advantage at CIGNA, Conrad Vial on the network side that are partnered to really drive this work. And, you know, a specific team, we're building that capability. But I think, you know, a lot of organizations are leaning away from this. I think the challenge is I just don't believe Medicare fee-for-service will be the answer long-term. So I think as we think long-term, I think this is just something we have to get good at. And that'll be, and we'll see. But that is, I think that's a big macro. - That's fascinating. It's basically more and more the population moves. Medicare at the same time, you think long-term, more and more of that Medicare moves to value-based care. - Yeah, right. And more value-based care drives digital, drives connectivity, drives prevention. You know, so yes, I think with those things, you will see a different approach to the health system. It drives more care into the home. So we've got to be more connected to the home. And which is why, you know, it's great that Sutter has a big home care, you know, footprint. You know, and so I think these things are really important as we think about how the health care system will evolve over the next five, 10, 20 years. - And it's fascinating 'cause I feel like there's all these different groups that are emerging that are like, you know, we could help take on risk for, you know, this population. There's folks that are more wrap-around care around primary care services, primary care docs, systems. It feels like there's all sorts of different organizations that, you know, potentially could be really good fits. But certainly the more comprehensive your services are. - And I would say that, you know, this is one of the things that I think we did really well, our team did really well at Oxner. Most of the Medicare business at Oxner was under, you know, some sort of global risk or global budget. And the team there, you know, Eric Gallagher, kind of Bo Raymond, that lead that today. I mean, they did a great job. Phil Orvitz is there still. They do a great job and I think that organization learned how to do this in a very effective way. You know, here at Sutter, we got, you know, we're a little behind that curve right now. We're catching up quickly and we've got the right team members in place. But I think as many organizations that just, they don't necessarily see that they can navigate this. They think, you know, fee for service is gonna, you know, just fundamentally be funded differently in the future, which I don't think that's true. And, you know, I think, you know, working with an organization that has size and scale, that can navigate these things, I think will be a real benefit for, you know, folks over time. But, you know, you know, sometimes it's, and we see the insurance companies, you know, building the delivery networks or integrating the delivery networks so they can tackle this issue. 'Cause they don't see the healthcare delivery system doing it. You know, I think that's something once again, that we are tackling directly. I think Oxford did a nice job, you know, kind of throughout Louisiana, you know, is figuring out how we partner with the insurance companies to do this in a constructive, integrated and positive way. - Well, we always like to end our interviews with a quick fire round where we stuff a bunch of things that we can't fit into the normal interview into the end. And so maybe to start, what's one thing you've changed your mind on in healthcare in the past year? - I would say the impact that, you know, and I think this is a little bit around leadership as well. You know, I think, you know, I think sometimes, I mean, it always takes a team to get things done, but, you know, individuals can drive massive change, you know, positively and negatively. And I mean, the impact of a single leader who really kind of can get people around them, put together a vision and drive change can really make big things happen. I see this with lots of people that, you know, I work around. And I think vice versa. I mean, there's folks that can't tackle that and don't get that done. So that's been a little more, I mean, not just kind of healthcare specific, but I think, you know, leadership, you know, specific. And I wouldn't say I've necessarily changed my mind, but I would say that I think the speed of technology change in healthcare, which has been slow for a long time. And I think has there's been, you know, limited benefit yield in many cases, I think is really gonna start to prove out to be very, very beneficial. - It's really fascinating to see, 'cause I'm, you know, do journal AI investing. And I feel like healthcare is usually, you know, one of the last entries to adopt a lot of these technologies. And in AI, it's really been one of the, you know, one of the first, and I think, you know, maybe healthcare and legal at scale have been the earliest adopters, which is great to see. - Yeah. And I think one of the things that we need to do in healthcare, and I try to do is, let's keep looking at other industries. Like look at other industries and what they're doing and how they're using technology and how they're approaching things and why they're approaching things. And I think, and then think about that application in healthcare and how we could do it different. You know, that's, I think that will open up our thinking to maybe tackle things that maybe we wouldn't have done if we were just looking at through our pure healthcare. - Is there another industry like you've taken inspiration from? - I mean, I think, look, I mean, I think lots of industries. I mean, airlines and like on my phone, on my app, I can change my flight. I know where my bag is. I know where the plane's coming from. I know whether it's on time. I mean, I know everything, right? We're gonna learn a lot from just that in healthcare, right? You know, the, on the consumer side and, you know, Amazon, you can buy pretty much anything and, you know, kind of where it is when it's coming or... So I just think this, I mean, knowledge and predictability is important. And once again, I think even people can wait if they know, like, when something's gonna happen. - Yeah, totally. - Right? - But just having that information. - Yeah, I mean, just having that information. And, or if they gotta wait, they could pick another path if they don't, you know, wanna do that. So I think, you know, I joke around sometimes with, you know, some of our physicians and clinicians and employees that, you know, hey, if United tomorrow has said, hey, we're gonna shut our app off, but don't worry, we're gonna add a lot more customer service people on the phone and you can only buy certain seats, but we'll talk to you eight to five, you know? I mean, people would be like, that's insane. I'm like, well, that's what we do in some cases, right? So let's tackle that, let's take that on. And, you know, buying an airplane seat isn't the same as getting the right appointment with a clinician and I fully understand that. And there's more complicated issues around that. But I do think we can learn from that and think about how it can be applicable and what pieces could we do? And that's why we've gone from, you know, two and a half million visits to five million visits over the last couple of years. And I think that will just continue to escalate. - What's an example of something that you thought would work at Sutter, but maybe it didn't, or conversely, maybe something you didn't think much of that actually ended up being a huge success? - I think there's certain locations that, you know, we thought, or projects that we thought, you know, would be the best and we ended up, you know, having to shuffle them and move on to other things that, you know, were better opportunities. You know, I would say that the adoption, you know, of change, you know, through the organization, which has been actually very, you know, great and the team's done an incredible job. But there's pockets where, you know, there's resistance. And even if it, you know, we can paint the path and people see it, but there's always, you know, reasons for resistance or whatnot. But I would say that's something that, you know, has been, you know, a little challenging from time to time. I think people when you, and within the organization, when you really lay out clarity and you're transparent and you help people understand the why behind things, like why are we doing this? Like, like, why is this really gonna be great for patients? Why is it really gonna be great internally? Anything people, you know, really can get behind something versus, I think lots of times we tell people what we're going to do or how we're gonna do it. But people wanna know the why. I mean, you know, Simon Sinek talked a lot about this, you know, years ago, but it's still applicable today. And I would challenge us all to think about, you know, you know, lead with the why and the what and how can kind of come behind and then people can kind of get behind it. And it's interesting looking at, you know, some projects that, and some leaders that really, they jump right into the solution and the how versus getting to the why. And that's, I think that many times, you know, it's limiting. - Yeah, I guess on this theme, I mean, obviously you've been a hugely successful health system exact for a long period of time now. As you think back on all the things you've learned and if you could go back, like, you know, 30 years and give your younger self some advice, you know, what would you say? - We all go to that school, the school of hard knocks, right? You know, we kind of learn things that don't go well. You know, I think one of the things is, I mean, look, it's a constant kind of evolution for myself is the only person you can control is yourself. And you need to spend a lot of time thinking about that. And, you know, your attitude, your energy, your outlook, your choices and, you know, self-limiting thinking, you know, it's interesting. I remember when I took over as a CEO at Auctioner and I was talking to this person as a friend of mine, she was a banker and I was talking to her about, you know, well, this isn't quite going right and that's not going right. And, you know, we got this issue and that issue and she's like, well, aren't you the CEO? I was like, yeah, yeah, I am. She's like, well, you better get going, you know? And I was like, yeah, right. I mean, we all do it. We all have this self-limiting, you know, and I always say to folks, well, tell me who's stopping you from doing that? Like, we're going to call them right now. I want to call them right now and help you. And I'll do this in like a leader education, you know? And they'll say, like, what is really, you know, slowing you down? And then people, you come to find out, like it's their own thinking. And all of us do it. I mean, so I think this idea of like, you know, control yourself, be thoughtful about how you manage yourself. And that's an evolution. Like, I mean, it's, you know, and I think the other thing I would say that, you know, it took me a while to figure out, frankly, is, and Pat Quinlan, who is the CEO at Oxford that I worked for for a number of years, is this idea of tying to purpose? Like, what is your purpose and what are you trying to accomplish, you know? And getting in healthcare, it's pretty easy to see what the purpose healthcare is, right? So when you start talking to people about, hey, we exist to take care of patients. Like, that's what we do. We change and save lives every day. It's easier for people to kind of get excited or motivated or want to change because of that, right? You know, I mean, it may be more difficult in some other types of industries, right? But if you can tie back to the good you're going to do in the world and the impact you're gonna have as that leader in the world, I think it just creates a lot of clarity around what you need to tackle. And I think those would be things that, now, I may tell my younger self that, now, whether I could actually understand it or not, that's a whole another conversation. But I think that would be what I would try to help my younger self understand. - Yeah, I love that. I mean, I think it's the perfect note to end on. I guess maybe I'll just leave the last word to you. Like, where can folks go to learn more about you, Sutter, anywhere you want to point them? - Yeah, so I would say, you know, obviously our website, you know, at, you can look us up on the web and there's a lot of information on there about Sutter, about me, it's really not about me. I mean, what I would say is that our team is incredible and our physicians and clinicians have been incredible. And, you know, learning about them and learning about what they do and learning the impact they're having, that's all kind of sits on our Sutter website in our press room about the great things that are going on in our strategic initiatives. And I think other thing is look at our annual report. 'Cause I think we really try to highlight the great things going on in our annual report in our, which is really a report to the community. So take a look at that. And we have a lot of great things that came through 25 and we'll be posting the 25 report in early 26. - Amazing. Well, thanks so much for doing this. - Hey, thanks for the opportunity. Great to be with you. (upbeat music)