How AdventHealth Is Simplifying Access to Care

00:00:00:01 - 00:00:19:12
Tom Haederle
Welcome to Advancing Health. What does it take to make primary care the foundation of a more consumer focused health care system? In this episode, we explore how AdventHealth is transforming primary care by extending care beyond hospital walls.

00:00:19:15 - 00:00:34:22
Julia Resnick
Welcome to Advancing Health. I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association. I'm here today with Brent Davis. He's the chief executive officer of the primary health division of AdventHealth. We're here to talk about primary care transformation. Welcome to the conversation, Brent.

00:00:34:24 - 00:00:35:24
Brent Davis
It's great to be here.

00:00:35:29 - 00:00:44:24
Julia Resnick
So to set the stage, how do you see the current primary care landscape in the US, and what challenges or trends convinced you that you should be doing it differently?

00:00:44:27 - 00:01:14:00
Brent Davis
Primary care I think over the last several years, if not decades, have been forced to concede their role, their primary relationship with patients. It's come in the form of reimbursement challenges or even declines or cuts. It's come with then new entrants, point solutions and folks that are looking to eat away and say, hey, you know, maybe I can do vaccines, maybe I can do your flu shot, maybe I can be your urgent solution, maybe I can be a virtual model.

00:01:14:00 - 00:01:32:04
Brent Davis
And so gradually that I think the confluence of those two have forced primary care providers to have to step back and other people coming in. And now you have this challenging dynamic where multiple people seem to quarterback and own that continuum and that consumer relationship.

00:01:32:10 - 00:01:40:07
Julia Resnick
And that's so counterintuitive because like, if you want to focus on prevention and keeping people healthy, you really need to expand primary care, not erode it.

00:01:40:09 - 00:02:02:09
Brent Davis
Exactly. Yeah. And that's why AdventHealth is so committed to expanding it. Just a few years ago, AdventHealth formed what we call the Primary Health Division, which is really designed to focus on those businesses that are outside the traditional acute four walls. What does that include? Includes urgent care, primary care, virtual care, home health hospice or so, and clinically integrated networks.

00:02:02:12 - 00:02:16:10
Brent Davis
That dedicated team, that dedicated strategy, dedicated capital has freed us up to think beyond the legacy hospital-centric view and expand some of these modalities for the communities that we are serving.

00:02:16:11 - 00:02:20:07
Julia Resnick
Yeah, and that's more of that, like health care system approach instead of just a hospital approach.

00:02:20:09 - 00:02:20:25
Brent Davis
Exactly.

00:02:20:27 - 00:02:25:03
Julia Resnick
So can you describe that model that you've built and what the strategic thinking was behind it?

00:02:25:04 - 00:02:54:28
Brent Davis
Hospital operators are running complex organizations. They're 24/7. They have thousands of people, often within those within that footprint. They're specialists. And there's a 24/7 emergency room. They have a busy and complex operating room schedule. Full transparency, I was a hospital CFO and grew through those ranks. Division CFO and I had a pretty clear understanding of how that business model worked, what a high performing hospital did and does.

00:02:55:04 - 00:03:25:18
Brent Davis
And I can tell you now, being on this side for the last few years, that I didn't spend any time really thinking about home health or around optimizing primary care, I knew I had to have it. I knew it was important, but it was important because it somehow fed my specialists who then filled up my OR. Or they were somewhere I could maybe decant some segment of my emergency room volume too, if necessary.

00:03:25:20 - 00:03:49:11
Brent Davis
I mean, maybe it was a transition of care clinic or something small, but it wasn't integral to my hospital based strategy. So AdventHealth, looking at this now over 50 hospitals, nine states, you know, what would it mean to operate some of these businesses outside the four walls, like in class competitors? Is there value in doing that? Is there a creative opportunity in those spaces?

00:03:49:11 - 00:04:28:15
Brent Davis
And it turns out there is. Secondarily to that or actually equal to that is AdventHealth really desires to be a preeminent, faith based, consumer focused clinical health care system. And that's only possible if we actually extend the continuum. And so the primary health division is, is really how can we operate those things we have, but also to extend outside the four walls along the full continuum from whether you need us in a virtual setting or a primary care relationship, a longitudinal relationship all the way through home health, transitioning out of your acute care stay and even end a life with our hospice services.

00:04:28:21 - 00:04:41:01
Julia Resnick
I want to tap into your CFO brain about this a little bit, because the financial side of it is a little bit trickier. So how do you make that value case that investing in primary care is the right thing for health care systems to do?

00:04:41:03 - 00:05:07:23
Brent Davis
Sure. We of been on a journey for these last few years to really enhance that value proposition across the board, so it's enhanced for our communities and consumers. It's enhanced for our physicians and APPs, it's enhanced for our team, and it's enhanced for the system. From a purely financial perspective, there are multiple reimbursement models, the largest being fee for service and value.

00:05:07:25 - 00:05:41:05
Brent Davis
The majority of our reimbursement comes through a fee for service model today. And in that work, we found a rich environment of opportunities to really enhance that primary care model. And bottom line up front, we've been able to take the support the subsidy just in in direct terms of a primary care physician and APP in half over the last couple of years, just because of, we've figured out how to engage the right people at the right point and give them systems to make that easy.

00:05:41:05 - 00:05:53:03
Brent Davis
And it's been exciting work. When we've cut that subsidy in half, it means we can afford to be twice the size. And that is a tremendous value equation to all those stakeholders I mentioned.

00:05:53:05 - 00:06:02:03
Julia Resnick
Fantastic. So I know that a key component of this is really consolidating primary care. Can you tell me about what that looks like and how they advance your vision?

00:06:02:07 - 00:06:38:03
Brent Davis
When we started this work, we found that a large number of our physicians and APPs were in small locations. You've probably driven through some of them. Some of the communities in or some of the neighborhoods in your community where you'll see almost it looks like a house and it'll say, well, Dr. so-and-so's office. AdventHealth, we purchased those. This came together over decades and we had a hodgepodge of locations across our communities. As we went through this work of saying, how can we make primary care more effective and more efficient,

00:06:38:04 - 00:07:07:05
Brent Davis
it turns out that scaling support resources, clinic resources, those are scalable, meaning that you need the same level of effort to support a location with one, two and three providers, as you do with seven, ten, 12, and 14. And at the same time, there's tremendous efficiencies to be gained both on an operating model, but also from a consumer standpoint, because then there's going to be someone there.

00:07:07:10 - 00:07:30:16
Brent Davis
If your provider's sick that day, you don't need to reschedule because their care team is there. If the physician or APP goes on vacation, it's okay because they have a large care team ready to really provide a high continuity experience during those just normal ebbs and flows of life and business. And so that's been an unlock for us.

00:07:30:16 - 00:07:46:03
Brent Davis
We've been blessed to be able to capitalize a number of new locations. And getting primary care people together, like any team, it brings energy. It brings focus. It brings really strong results. And so it's been exciting to see that come to life.

00:07:46:07 - 00:07:53:10
Julia Resnick
That's really fantastic. And I'm sure it's not just better for the providers, but better for patients who can have their whole care team in the same location.

00:07:53:11 - 00:08:16:13
Brent Davis
Right. Right! You know, like one thing, for example, I was talking to my grandma. She's 91, and she was talking about her primary care relationship on the West Coast and loves the clinic, great reputation. The community loves her physician and the care team. Love so many things about it. But she said it's really hard to call them.

00:08:16:16 - 00:08:33:27
Brent Davis
That's what she does. She doesn't have a lot of other tools that are disposable, so she calls and she gets routed to a call center. Now she may be calling in error, talking to a bot for all I know, but in her mind, she's calling a large central call center one that doesn't know her physician or her care team or her location.

00:08:33:27 - 00:08:58:11
Brent Davis
And so she'll get routed through that phone tree and that service and ultimately gets what she needs. But by putting this work together, we have now been able to bring phone calls back into each one of our practices. So when you call your practice, you're actually talking to someone at the front desk. It seems it's something we all grew up with, but today that's a rare find.

00:08:58:12 - 00:09:20:07
Brent Davis
And we've found that that really helps accelerate the connection and solutioning. Script refills. It helps reduce some of the inboxing. It helps people get in much faster than they ever were able to before, and were able to do that because we have enough size and scale in each one of our locations to accommodate that staff and that service.

00:09:20:10 - 00:09:23:03
Julia Resnick
And I'm sure it helps people feel better connected to their care team.

00:09:23:07 - 00:09:23:23
Brent Davis
They love it.

00:09:23:24 - 00:09:34:24
Julia Resnick
That's great. So continuing to think about like that patient perspective, what does the model look like and feel like as patients move through it? And how does that differ than how primary care was traditionally practiced?

00:09:34:27 - 00:10:03:11
Brent Davis
AdventHealth as a whole has a strong emphasis on consumerism. We believe that we are here entirely because of and for consumers. So we desire to make it easy to access and simple to use. Ultimately helping our consumers that we serve feel whole. That is our AdventHealth brand promise. In primary care that looks like you call your provider and sure enough, your location answers the phone and is likely able to connect you quickly and easily.

00:10:03:12 - 00:10:28:27
Brent Davis
We introduced a same day promise in 2025 and new patient wait times or current wait times, you know, I'd like to have a primary care provider, but I've never waited a month for my new patient appointment. So I don't have one when I get sick or when I need it. Other people said, hey, I'm finally sick and I'd like to see my doctor, but the first appointment I can get is four days or five days or seven days from now.

00:10:28:29 - 00:10:55:00
Brent Davis
I'll likely go to urgent care, I'll seek out virtual or something else. And so being able to get in access is such a huge part of meeting your consumers needs. That's been a big focus of ours. Once you're there, we've talked about this care team model, and we have different primary care models built for different consumer types. So the type of care that the primary care I wanted or needed in college is different than it is today.

00:10:55:00 - 00:11:21:21
Brent Davis
And that's different than my mom, who just turned 65. And it's different than my grandma, who's 91. And what we found is that people have gravitated towards several of our different primary care models. They've self-selected. And by honing in on what makes that model especially effective, especially efficient, we've been able to connect the right consumer with the right provider type in the right business model.

00:11:21:28 - 00:11:43:03
Brent Davis
That is a then a virtuous cycle. That flywheel starts to turn. So what we found is that by creating access overall, but then creating access to the right care with the right team, that's been really exciting. I'll just continue this because I'm so excited about this point. You know, you're at the dentist when after you're cleaning or even maybe they're still finishing up.

00:11:43:03 - 00:12:01:12
Brent Davis
Someone comes in and says, I'd like to schedule your next appointment. And when was the last time that happened in your doctor's office. It happens in the vet. It happens a number of other places. But for some reason, in primary care, it's been like, you know what, give us a call if you need anything, right? And so we've taken a proactive approach.

00:12:01:12 - 00:12:16:25
Brent Davis
And so when you're still in the room, we'll go ahead and book your next appointment. We'd like to see you again. Maybe it's to review your labs. Maybe it's true of you some of your imaging tests. Maybe it's hey, in another six months and another nine months. You know what? In 12 months, let's be back here and let's go ahead and make that happen.

00:12:16:28 - 00:12:39:22
Brent Davis
So we do that. Additionally, when you walk out, just like, you know, many other services, there's someone there to connect you to the next stop, not just to take your money, but hey, let's go ahead and add this on. Let's connect you to that next part of your care continuum. And so we now have referral coordinators in our primary care clinics that have the ability to direct book you into your specialist.

00:12:39:28 - 00:12:47:29
Brent Davis
Now we go ahead and make that easy. And they walk out saying, I have my three next appointments scheduled as well as my next touchpoint with my primary care provider.

00:12:48:00 - 00:12:51:07
Julia Resnick
I love that just reducing barriers that might prevent them from getting the care.

00:12:51:12 - 00:13:08:11
Brent Davis
That's it. Hold their hand. You know, like it's challenging enough. What a gift to be able to offer navigation and actual support, to say there's a plan that we've made together and we're going to make this easy for you.

00:13:08:15 - 00:13:16:16
Julia Resnick
Absolutely. So you've made all these changes. How are you? How are you measuring the impact that you're having? How do you know that this is the right direction?

00:13:16:17 - 00:13:41:13
Brent Davis
Sure. We've talked about the subsidy. So taking the support that the system has been putting into primary care. And that's cut in half. And we believe that there's more opportunities ahead, which allows for the amount of growth that we've already committed to. So really excited about just that cycle and the financial relationship and the resources that it takes to deliver this type of care at scale.

00:13:41:16 - 00:14:03:23
Brent Davis
Across other domains, we've looked at consumer engagement, consumer satisfaction, likelihood to recommend so are consumers happier in the new model compared to where they started? We were at the 51st percentile when we started this work. And that's right in the middle, right in that bell curve. And we had some locations that were good and some that weren't, but we were hovering right there.

00:14:03:27 - 00:14:29:12
Brent Davis
It's exciting that now we're consistently in the top quartile, sometimes even pushing mid 80, 85, 84 percentile. And that's really indicative of the of I think the solutions and the care models that has been brought to bear. From a clinical standpoint, we've really targeted blood pressure. That was something we said you know what can primary care own? There's so many content care conditions that are rolling through our clinics.

00:14:29:15 - 00:14:51:16
Brent Davis
Is there something that touches a large percentage of our population?. And blood pressure is one of those. And so we've been able to reduce high blood pressure and get people connected with that next step. It could be medication could be work with specialty. And so we've we feel like we've started to move the the dial on some clinical measures.

00:14:51:18 - 00:15:15:23
Brent Davis
We have some value based care measures that are headed in the right direction and starting to show it's starting to bear fruit. And, you know, the team engagement is really important too. So we've talked about consumer engagement, but the engagement of our physicians, our APPs and the front line practice managers practice the people that are picking up the phone, people that are building the building.

00:15:15:24 - 00:15:30:04
Brent Davis
All those team members are quantifiable, more engaged and happier with their time working with and for AdventHealth. And so I'm just very excited that across the domains, our work is continuing to bear fruit.

00:15:30:05 - 00:15:42:15
Julia Resnick
Amazing. It sounds like you're moving the needle in all the right dimensions. So to close, you've been doing this for a little while now. What words of advice do you have for other hospitals that are thinking about transforming how they're delivering primary care?

00:15:42:17 - 00:16:14:04
Brent Davis
When I think about the results that we've been able to drive across, the stakeholders that we've discussed for the consumer, for the physicians and APPs, for the team member and for the system at large, it really starts with the intention of the system to be a broader solution than we were before. As a hospital-centric system, before we had high performing hospitals and in great results to show for that.

00:16:14:04 - 00:16:43:06
Brent Davis
And yet we weren't able to show up as a more robust, full continuum solution. And so by giving primary health division the autonomy, the capital, the dedicated time and focus to create and deliver on a strategy to extend to those, whether you're in an urgent care or virtual care setting, all the way through end of life and hospice and all that in between, is what's been the unlock.

00:16:43:12 - 00:16:51:16
Brent Davis
And I'd encourage that systems and teams consider what that opportunity could potentially mean for their organizations.

00:16:51:18 - 00:17:01:29
Julia Resnick
Well, that is fantastic work. And I'm so just impressed with how you're reimagining what primary care can look like for your patients and for your communities. So thanks so much for chatting today. It has been an absolute pleasure.

00:17:02:04 - 00:17:04:10
Brent Davis
Pleasure is mine. Thank you.

00:17:04:12 - 00:17:12:28
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.