Susan Weber: Good afternoon and welcome to today's Walker Webcast. Before I turn the webcast over to Willy to introduce our two guests, I'd like to announce that hearing from many listeners that they'd like to listen to the Walker Webcast on the go. Today we are launching the Driven by Insight podcast that will replay our weekly webcast. Just search Driven by Insight wherever you listen to podcasts and away you go. Thanks for joining us today. And now over to Willy.
Willy Walker: Thanks, Susan, and welcome everyone to another Walker Webcast. We've got a great one for you today. But very quickly, before I begin, a quick note on our upcoming webcasts: Next week, right on the heels of an election that was disappointing to many, and Thanksgiving table discussions with family members that could be challenging, we have two amazing researchers from Wharton Business School and the Harvard Business Review coming to discuss how to cope with disappointment, how to effectively manage conflict, and how to provide constructive and helpful feedback to your coworkers and potentially family members. The following week we have the CEO of two of the largest REIT’s in the country: Boston Properties and Equity Residential, joining me to discuss the return to the city in 2021. The following week we have BlackRock’s Chief Equity Analyst, Kate Moore, joining me to talk about the equity markets and what BlackRock sees ahead in 2021. And then to close out 2020, I will be joined by Aneel Bhusri, founder and CEO of Workday, the $53 billion market cap provider of cloud based financial planning and HR software. So, we'll go from insights on how to avoid the awkward Thanksgiving Day discussion, to returning to cities, to where to invest in 2021, to how to build a behemoth cloud-based software company. And today we have the most timely topic of all: healthcare and COVID vaccine development.
It's an honor and pleasure to have UC Health CEO, Elizabeth Concordia, join me on the webcast today. We will hear Liz's insights into how health systems across the country are currently fighting the pandemic, saving lives, and planning for the rollout of the vaccine.
Elizabeth Concordia is the President and CEO of UC Health based in Aurora, Colorado. UC Health has been ranked the Top 100 Hospital by Thompson Reuters; one of America's Top Hospitals by US News and World Report; and received Level 1 Trauma Center status in 2018. Prior to joining UC Health, Liz was the first female CEO of the University of Pittsburgh Medical Center Presbyterian Shadyside Hospital. Liz holds a BA from Duke University and a Master's in Hospital Administration from Johns Hopkins.
Willy Walker: Yeah, so, Liz, when you heard that the Pfizer vaccine needed to be stored at negative 90 degrees Fahrenheit, do you have a refrigeration capability to hold something like that, or did you have to turn out and order one immediately?
Elizabeth Concordia: So, we do have refrigeration capability. But the question is: Do we have enough, and did we have enough freezers? So, we did order more freezers.
Willy Walker: Liz, the recent Pew Research Center poll found that back in May, 72% of Americans said that they'd get the vaccine and that number fell to 51% by September. Are you concerned that Americans won't actually take this vaccine?
Elizabeth Concordia: I think there is some concern. I also think that this might change over time. The efficacy is very promising. It's not 60%, it's not 50%, but in the 90s. And I also think that as more people get vaccinated and people see that there's a positive outcome from that, those doubters, if you will, will step up and be more inclined to get the vaccination. There will always be some that that will not.
Willy Walker: So, Liz, when you think about the vaccine arriving, there are two things that come to mind. Talk for a moment about the complexity as it relates to just administering it, and then I want to hear you talk about, how are you going to create your list of who gets it first?
Elizabeth Concordia: Right, so, you know, the challenge becomes—we saw a little bit of this when we were looking for PPE and the like at the beginning of the COVID pandemic, and the complexities are knowing how much you're going to get; when are you going to get these doses; how do you identify the individuals? Every state has identified their first, second, third, fourth, and fifth tier of how they would get distributed. The challenge is, at the beginning, if you just look at the first tier of health care workers, with a limited supply, you're not going to get enough for everybody in that first tier at first.
So, I'm cautiously optimistic that when we look to inoculate all of our healthcare workers, it will give an opportunity for us to work with the distributors with regard to, how do we actually appropriately take them in? How are they delivered, in pallets? What freezers do they need to be in? How do we look to then run these, if you will, drive through vaccination centers? Which will then help identify: how do we actually do this to the broader community? When you look at the high-risk population and how you get out to the churches and the communities to vaccinate, it will be a logistical challenge.
Willy Walker: Liz, there are 73,000 COVID-19 patients in hospitals across the country today. We hadn't crossed 60,000 prior to November 10 since the onset of the pandemic, and there are about 14,313 people who are in ICUs across the country today. Can you give us a sense on how CUHealth is dealing with this inflow of patients and how you're dealing with this massive surge in the number of cases across the country?
Elizabeth Concordia: Sure. So, we have seen, as many other hospital systems across the country, a significant increase. Just from a perspective, we have about 360 COVID patients in our hospital today. A month ago, we had 93, and two months ago, on September 18, we had 50. So when you look at the ramp up, it’s been significant. We have done a lot of work since April and planning with the expectation that there might be another surge, because we knew that the weather was going to change, and we thought that there would be a surge. Certainly, no one has predicted, and the modeling has not predicted, to the degree of the surge that we have, and how much longer it's going to go. There are a lot of good news items, though. Compared to April, we’ve got many fewer patients on ventilators. In April, every single patient that was in our ICU was on a ventilator. That's not the case today. We've had a lot of success and progress in treating these patients. With the Remdesivir, with steroids, with other components. So as hospitals across the country have prepared for this ramp up, we certainly don't want the numbers that we have, we have made and learned a lot since April. So, we've increased our staffing, expected the surge; again, the treatment; the length of stay of patients has dropped by over 50% from April. So again, if the patient’s in the hospital a lot shorter, then you can see more patients. So, we are not in the same situation that we were in in April.
Willy Walker: And any issues as it relates to either PPE supplies, the Remdesivir, from a kind of—just from the tools to fight it. I want to talk about the people in a second, but from the tools standpoint…
Elizabeth Concordia: Yeah, we've come a long way. As the numbers continue to grow and you're burning through a lot of your supplies, there may be some challenges in the future. But we're feeling pretty good right now. We're not battling PPE, all of our staff have the equipment that they need. The one challenge that we do have is testing is very important and the reagents that we need to run our lab machines are pretty much just in time, and we don't always get exactly the amount that we need. So that's the critical source, and limitation right now.
Willy Walker: How is it, Liz, that we're still this far into this and we're still having testing issues? I would have thought that by now the private sector would have met that challenge, seeing the opportunity to get rapid testing developed and deployed more quickly. Why is it that it's still difficult to get testing today?
Elizabeth Concordia: Well, I think there are two answers. One is, when you go from nothing to trying to test millions and millions of people you've got just a scaling challenge, but the reagents that you need to test that from a supply chain perspective have been more of a challenge than they anticipated in ramping up, and there are also different types of tests. So, there are the rapid tests that are really short turnaround. And then there are also tests, for example, that the colleges are using, that don't have the same specificity that you need in a hospital where you're making decisions to treat the patient off of the COVID piece. So, I think for where we were in April to where we are today, we’ve come a long way. We just still have, you know, these challenges with the supply chain. Can’t answer exactly why that's the case. But when you go from zero to tens of millions, you’ve got some challenges, which is what's going to happen with the distribution of the vaccine as well.
Willy Walker: And how’s your employee base? Any issues on retaining or hiring nurses, technicians, staff, and doctors?
Elizabeth Concordia: So, our staff’s fatigued. We're lucky here at UC Health; we have a phenomenal group of individuals and we never laid anyone off or furloughed anyone throughout the whole piece, so I think they're pretty committed to our organization. There is a national shortage of ICU nurses and med surge nurses. So, to your point, from a business perspective, you’ve got lots of agencies that are coming in and trying to pick off the staff to go to other areas, and the salaries that they're garnering are excessive and significant. So, I think there's the staffing challenge, and then there's also the fatigue. They're tired from April; now we're into November, and how much longer is the surge going to go?
Is there an end in sight, because with the vaccination, we will be able to have a solution and a way to actually decrease the number of COVID patients we have in our hospital. So, I do think some positive news is refreshing for our staff to hear.
Willy Walker: Before we turn back to the vaccine, you talked about the business. Hospitals all took a big hit when we shut down our economy back in April and May, where nobody was going to the hospital for anything other than urgent care. Have the, if you will, “normal operations” of your hospital gotten back up and going? And then I'm going to follow that up with a question as it relates to the number of procedures and analyses that haven't been done in 2020 that could lead to increased surge in 2021—but talk for a moment about, is your hospital back to normal operations today as it relates to things other than COVID?
Elizabeth Concordia: So, we were back in the September timeframe back up to about 98% between 96 and 98% of where we were from an outpatient and inpatient perspective. We now have had to dial back some of the non-emergent cases to be able to handle all of the COVID cases. So pretty much, we were back, and patients were coming back to get the care that they needed. And that is a real challenge. Delaying transplants, delaying cancer surgeries, and things like that, are really problematic. With behavioral health perspective we've seen a significant issues with our patient population.
Willy Walker: And I'm assuming because I use it with you all, telemedicine has to a great degree changed the way that your doctors are interfacing with their clients. I have done a number of telemedicine visits with my GP and more. And it's been fantastic that the two of us can kind of go back and forth. I can ask her a quick question without making an appointment and going in. Talk about that efficiency that you've gained and how that's changed your business model.
Elizabeth Concordia: Sure. So, we were fortunate that we were on one information system platform prior to this, so we could flip pretty quickly. But pre-COVID we were doing about 400 TeleVisits a day and post COVID it's about 4,500 visits a day. And so, you've got your urgent care sort of TeleVisits, but then the relationship you have with your physician and new visits is really where we saw the explosion. Our experience has been that our patients are satisfied with that option. It's better received and more appreciated for follow up visits than the initial visit. Patients really like to have that first visit where they can establish a relationship with their physician. And that's their preference. So what we've seen when our numbers went down a little as they would be coming in for the first visit and we're amenable to having a virtual visit for the second visit. And now we're obviously moving back towards having that initial visit be a virtual visit as well. Not everything can be done virtually.
Willy Walker: Have there been any issues as it relates to reimbursement payments from insurers as it relates to a consultation, where in the past I used to have to go and see the doctor. So I walk into the office and you bill me X amount for going and seeing the doctor. Now I'm emailing back and forth, it's virtual. Are you billing the insurance company for that and getting reimbursements? Or has that been a whole negotiation?
Elizabeth Concordia: So, it's been a mix. So, The Cares Act allowed virtual care to be billed at the same rate and with insurers that the physical visit was. But then every different person’s plan may have a little bit of a different rule. But in general, during this emergency, if you will, timeframe, it's not forever, but we've been authorized and most of us are getting reimbursed for the virtual visits for commercial insurance.
Willy Walker: So that seems to be one of the, if you will, to some degree, I don't want to say it's a positive outcome from the COVID pandemic because nothing is good out of this. But we do seem to be seeing certain things like the development of these vaccines that are taking much, much shorter and have incredible promise for the future. Is there anything else as it relates to your business and the way that you're managing your business today that has been, if you will, the silver lining to such a challenging time?
Elizabeth Concordia: So, I mean, I think there are certain things that we said we've identified as we never go back. So, there are opportunities, like you said, for the virtual visits. There also -- it's forced us to look at other components of, for example orientation and how you train your staff. How can you do that in more of a blended virtual and fixed environment. So, there's certainly have been from that perspective as well as workflow of patients. How do you communicate with them? Can you text them and get them in and out of the hospitals and the outpatient clinics to avoid the use of waiting rooms? So, I think we've learned a lot from a, if you will, customer service and retail experience, that will continue long after this pandemic is over.
Willy Walker: So, looping back to Operation Warp Speed for a second, you've obviously been in contact with the federal government as it relates to how this vaccine is going to be deployed across the country. And from our previous discussion it seems like this is going to be really challenging as it relates to sort of a prioritization of frontline workers, those most susceptible, how much vaccine, you're going to get it, what time, etc, etc. Talk for a moment just about that challenge and how you plan to work through it over the coming months.
Elizabeth Concordia: So specifically, what we're doing is we're taking care of patients every day. And we've got another group that's literally focusing on how are we going to distribute the vaccine once it comes in. So, the challenge that we have is that we don't know what we're getting and how we're getting the vaccine and when the distribution will occur. So, what's happened is, every state has identified their priorities. So, when we get our first batch the first people to get it will be the frontline workers, those nurses that are working in the COVID units, the respiratory therapist, that are taking care of these patients. But for example, when we get the vaccine it's not mandatory. And so, what we're doing proactively is, you had asked earlier how many people will get the vaccine, for starters amongst healthcare workers were actually formulating a questionnaire to say to all of our employees, if the vaccine is available, will you take it. Then if they say yes, then the next question is, are you willing to take one. Are you willing to take the Moderna? Are you willing to take the Pfizer? Because we also need to recognize that when these vaccines come in, we want to distribute them as efficiently as possible. So how do we identify even amongst our own population which vaccine we're going to get and who is willing to take it, and how do we distribute it in a very time efficient manner.
So, if you think about the complexities of us not knowing what we're going to get tomorrow or two days from now, and then if we only get 200 in our first batch, for example, do we give it to one clinician in every single one of our COVID ICUs, or do we focus on one hospital first. So those are just some of the logistics that are out there. I think that it's going to be a challenge. I'm cautiously optimistic for a couple of reasons. We have a history of vaccinating you know children with MMR and the like. We do have experience with flu vaccinations. Within our employee population we require flu shots. So, we know how to distribute amongst our own. And so, we can perfect or learn the glitches as healthcare providers providing the vaccines to our own. Hopefully there'll be a lot of learnings. How do we efficiently work with the federal government and the state agencies and public health agencies to distribute it, but it will require coordination that here to for we have not seen
Willy Walker: The idea that people are supposed to understand enough about the differences between a Moderna vaccine or a J&J vaccine and then sort of check the box for it, is unbelievable to me and just how much education needs to go into that. And I guess the other thing that I'm just sort of thinking about in my own mind is just, okay, I've gotten my first shot, I'm headed towards my second shot 21 days later, am I still wearing a mask during that period of time and then once I've gotten my second shot, am I still wearing a mask? Or the moment I've gotten my second shot, I'm done with this mask stuff and I'm back to business as usual?
Elizabeth Concordia: So, from a care perspective we will be wearing masks for a long time. Shots or not. I think that from a public health perspective, it's going to be very interesting to see, is there going to be federal direction that says after you've gotten the shot for the second time this is the comfort level you should have. Or is it going to be communicated by state and within the county with regard to what are the regulations. So, I think there's a lot of unknowns there.
Willy Walker: Very much so. And what about getting it to rural areas? We talked about the difference between the Pfizer vaccine and the Moderna vaccine and that you've got refrigeration capability in Denver. What about in more rural communities that the UC health serves?
Elizabeth Concordia: So, we're coordinated with the state. So, we have a couple of rural hospitals; we actually are putting one of those high-tech freezers in one of our rural hospitals. And then I think the facilities that have those freezers will get the Pfizer. I mean that's, again, the question Willy, are we going to even be able to coordinate, who gets what, or is it just we're so anxious to get these out that we want to make sure from a distribution perspective that all the rural areas or anyone can accept any vaccination that comes because we want to make sure we don't waste any doses.
The health systems everywhere where I work, not just here in Colorado, we all feel an obligation to our rural hospitals and to partners. So, we will coordinate and assist them in the distribution, and you know couriering them, and supplying them and you know, also the whole concept of tracking, who gets the vaccination. If they go to one place to get the first dose and they go to a second place they get the second dose. How do you track that these individuals have had it? And is there trust that we're getting 1,000 shipments of this vaccine today that in another month we're going to get another thousand to be able to give to the individuals that got the first dose.
Willy Walker: And Liz, as you're in on these conversations, all the time, is there any -- you know we've had plenty of people come on the Walker Webcast who said we basically shut down our economy to try and essentially protect the elderly population. Because they're the most vulnerable to this virus. And that if you really look at it and its impact on the working population it's not nearly as damaging, and not nearly as dangerous to the working population as to the elderly. As you think about vaccine deployment, is there any thought. I mean, I think everyone now says frontline workers and then the most vulnerable. Has there been any discussion that says no, the people who actually out to get the vaccine -- frontline workers first but then the working population so they can keep things going? And then you get to the most vulnerable later? Or is that not, is that just so sort of politically out of the realm, if you will, that everyone's like, no, we got to go to the most vulnerable to this thing first?
Elizabeth Concordia: I think that the expectation is that it goes to the most vulnerable first. I do think that to your point, the challenge that we have is the school's not being open has been a total travesty for our children. And I'm fearful as many of my colleagues that we're going to see the impacts of this for years. We have a significant behavioral health issue, as a result of this. And we need to get the kids back to school. And I think part of the question then, Willy, is if the most vulnerable are vaccinated, are we then comfortable having the children go back to school because we know that if they get it, until we get them fully vaccinated, the consequences are not nearly as challenging. So that's been I think the mindset. We are very focused on trying to get kids back to school. The episodes and the challenges that we also have, and we've seen since the epidemic started with domestic violence and abuse is very disheartening.
Willy Walker: I want to, I want to jump on that mental health issue in a second, but just on that thought, how do we get teachers classified as frontline workers?
Elizabeth Concordia: Think that'll be State, by county by county. I will certainly be advocating from a public health perspective here that we need to get teachers vaccinated so that they're willing to go back to work.
Willy Walker: And so on that as it relates to what I would call the contagion effect of the COVID virus -- other illnesses not being treated as early as they need to through diagnostic testing and through things like radiation or chemo for cancer because people are staying away from care centers. As well as the mental health impact as you just mentioned. What are you seeing along those lines? Are we set up for both illness numbers as well as mortality rates in 2021 and 2022 that we've never seen before?
Elizabeth Concordia: So, I think the positive is that with the masking and the different protection that we put in place. Patients have been more comfortable coming back to health care facilities for care. So, I think what we saw in April, May and June is very different than what we have seen after, when you were asking how the volumes came back. So there certainly was a delay, but it has not been an eight-month delay in treatment. Will there be impact from later diagnoses? Absolutely yes, and it will vary by region because some regions didn't have the surgeons that that others have had. I think that no one has specifically projected what the impact of those delays will be. We certainly know there was more patients came in to the hospitals in full cardiac arrest, in full blown sepsis, as a result of ruptured appendix than ever before, during the shutdown.
Willy Walker: Fascinating, fascinating and on the mental health side of things you're seeing increased incidence of that given lockdown and the lack of social interaction and domestic abuse and things of that nature?
Elizabeth Concordia: Yes, absolutely. And also challenges just in acting out of the patients towards our providers. Just from the perspective of a patient is on a floor and has had some behavioral health challenge because they've been isolated. And so, we've got more challenges. The nurses and the clinicians are stressed enough in just caring for all these people and a lot of the patients are also acting out as well. So, it's a double whammy for them and we were doing as much virtual behavioral health as we can. And we've committed millions and millions of dollars to free virtual health for our employees and trying to reach out to the community, it is it is a challenge.
Willy Walker: It's interesting as we head into this time of the holiday season when people are, you know, not spending time with family members, and not traveling, what people could potentially do to try and reach out to people in their community and help with that issue to any degree. I'm assuming that any help is very welcome. But I guess the question is how do you apply it? And how do people actually make an effort and make an impact on this issue at such a critical time?
Elizabeth Concordia: Yeah, I mean, and it can be as simple as loneliness is a huge challenge. And so even reaching out when you look at the elderly, that have been isolated in these nursing homes there's a lot that people can just do to reach out to people that they know are alone and engage them in conversation, even on the telephone. As simple as that can be a valuable intervention.
Willy Walker: So, I have two final questions for you. The first one, when do you think I'll get the vaccine. So, middle aged healthy person trying to keep on working, when does someone like Willy Walker, get the vaccine?
Elizabeth Concordia: Can't answer that question, but I think that Moderna and Pfizer and, you know, the more vaccines that are approved, the more vaccines that we can get on the market. Obviously, the sooner -- I think it'll be a while for people like you and I.
Willy Walker: And so, should I set my sights on next June, a year from now, or sometime in 2022. I mean, I just, like, expectation management is huge in all this stuff. I'm not gonna hold you to it. But what's your thinking is you look at the amount that’s going to go out? You've been involved with the deployment of the vaccines. Where should I have myself kind of focused on?
Elizabeth Concordia: I'm optimistic that that you know the first six months of next year, that will be able to have access to at least the first dose.
Willy Walker: Love to hear it. I'll take that optimism and run with it.
The final one is, given this huge surge Liz in cases across the country, and ICU units having record numbers of people, what's the breaking point where the health care system says “no moss” and that then forces governments to shut back down? I'm you know, a lot of people have said we're not going to go back into shutdown mode. That we're going to figure out, there'll be pockets of outbreaks. But this thing is gotten to such a widespread number now and it's not just isolated in New York City as it was, you know, the greater metropolitan area there, it's all across the country. Is there, is there something there where you're looking at number where you're going to pick up the phone and call Governor Polis and say to him, look, we just can't handle it. You gotta, you gotta tamp things down.
Elizabeth Concordia: So, ideally, not. So we've got 90 hospitals across Colorado and we certainly have significant positivity rates, just under 20%. Our goal is to figure out how we can continue to handle the surge and not be on point for making a decision of whether it shuts down or not. We are trying to be as conservative as possible in making sure that we have all of the supplies and the staff that we need. But we are not looking forward to, or have any expectation of calling the Governor, and making that kind of a request at this point.
Willy Walker: Well, I first want to thank you for taking time to join me today. I second want to thank you for all that you and your team do to protect lives and to help all of us get through this exceedingly challenging pandemic and health crisis. And so, thanks for all you do every single day and I'm just deeply appreciative you joining me today.
Elizabeth Concordia: Thank you. Have a good day.
Willy Walker: Great to see you. Thanks everyone. See you next week.