Speaker 1: You're listening to the Intermountain Podcast with Dr. Mark Briesacher.

Dr. Briesacher: Hi, this is Mark Briesacher. I'm the chief physician executive at Intermountain Healthcare, and I'm really excited about this conversation today because with me as my good friend and colleague, Chris Heyer. Chris is the executive director for advanced practice providers at Intermountain, we try not to use too many acronyms, but we probably will use APP for advanced practice provider. Actually, you know Chris, I think we've known each other now for a couple of years. The first time we met was actually when you were interviewing for this new position. Maybe, could you share with everyone a little bit about yourself and your professional background and your role here at Intermountain Healthcare?

Chris Heyer: Sure, happy to. Yeah, I do recall meeting you in one of the interviews that I had, and I'll never forget as you, was probably one of the more memorable interview questions I had across those interview questions. But, you asked me about my why. My why and why I've kind of led the career that I've had to this point is really, I'm really passionate about patients getting the care they need when they want it and when they need it and that it's in the appropriate setting. My background is in family medicine, working in family medicine as a PA. I went to the University of Utah's physician assistant program and graduated in 2008 and have been working in a family medicine clinical large federally qualified community health center for the majority of my career, up until a few years ago when I transitioned here to Intermountain.

Chris Heyer: You know, working in that setting, it's a setting that I'm passionate about, a setting I continue to work in, in underserved family medicine. In fact, I just got out of clinic this morning and hurried up here for this conversation. But, I just see when care is delayed, when care is not access at the right setting, at the right time, how that really impacts everyone. It impacts our system in a huge way. I'm really passionate about getting access to care for patients, and so that's really led me down my career. When I learned how to take on some leadership roles in that setting, I learned that I could impact that in a much broader sense and really became excited as I saw some of those successes start to take place, some of the changes I was able to implement in that role.

Dr. Briesacher: Let's talk a little bit more about that.

Chris Heyer: Sure.

Dr. Briesacher: Because, I remember in that first conversation you talking about how, as the medical director for this clinic, you really had brought physicians and nursing and advanced practice providers together to solve for some pretty tough issues around access. When you think about what our friends, our neighbors and people in our community need when it comes to their health care, it really does come down to great care that's affordable and easy to get.

Chris Heyer: Yeah.

Dr. Briesacher: Right? How do you approach this when you're thinking about how do we bring physicians and advanced practice providers and other members of health professions together?

Chris Heyer: Yeah, so as a brief example, growing up I had several siblings, and we didn't have health insurance actually. I remember experiencing some injuries or being ill, and really being frightened at my parents' response at having to go to the emergency room. I remember a a wrist injury my sister had and we were frightened to go to the emergency room to get the care that she needed. The part of that has translated into a lot of what I'm passionate about with my career. Being in the setting that I was, we were having significant access concerns.

Chris Heyer: Thinking about patients having to inappropriately access emergency care or urgent care when we could properly care for them in our family medicine clinic, even for chronic disease management, that we in, frankly, a crisis. We had months out for an appointment, in boxes just stacked full with work to do. We really had to lean in on each other. We had to leverage everybody's backgrounds, regardless of where they came from, what training they had. We needed to find out what they were good at, what could they do, and then how could we lean in together to start to solve some of the problems we were facing.

Chris Heyer: Frankly, that was probably one of the more rewarding things that I've done in my career, was to start to see some real inroads into that, and to see our diabetes score start to improve, and to see patients even to the point of taking in new patients who had zero access to care, to be able to bring those into our clinics and to be able to, and frankly with the huge support that Intermountain provides to those clinics, to be able to see all that partnering happen to really, probably lower the cost of healthcare for the system, was just a really exciting thing for me. When I started thinking about this role at Intermountain, whether it was going to be a possibility for me or not, I became real excited about being able to do that on a broader scale. To think about how to leverage the resources that we have in the communities that we do to even do that at a bigger scale was just really exciting to me.

Dr. Briesacher: Over this past year and a half, that's exactly what I've seen you do. We're really lucky to have this great combination of advanced practice providers and physicians that are part of Intermountain Healthcare, both with our own medical group and those that are with our affiliated practices as well. Tell me a little bit about what you've been doing at Intermountain with respect to standing up your leadership team and working with physicians and APPs and administrators to create these new teams for the future.

Chris Heyer: Sure. I really been focusing on getting more of an APP voice on different leadership teams, and that's the structure we're in the process of standing up. Where, we've now hired 32 of 42 new APP leaders so that they can be embedded within leadership teams to bring their diverse backgrounds and training and voice to the table to help really lean in and solve a lot of these similar problems that virtually all areas of medicine are facing.

Chris Heyer: But, with any specialty that we provide here at Intermountain, we're facing so many of these challenges from access, to caregiver experience, to patient experience, to safety, to delivering the highest quality care that we have access to. In thinking about some of these, some examples of some teams that have really leveraged that, the diverse training and background and voice that APPs can bring. I think first and foremost probably of one of our more successful app groups as our trauma group.

Dr. Briesacher: Oh, absolutely.

Chris Heyer: Yeah.

Dr. Briesacher: Super impressive.

Chris Heyer: Yeah, I know one of those surgeons on a personal level. I've known him for several years, and he was an incredibly busy surgeon and I knew that that service was struggling. I've worked in this area for my whole career and have a friend that hired on right out of school with that team, and to see how they really started to leverage the APPs was a really, really exciting thing that I saw, at least in my friend and in this trauma surgeon, and I think they were really able to start to deliver on some of those ideas and that diversity of thinking and how to care for patients because they had APPs into their leadership meetings, into their planning meetings, into their development meetings, and different ideas have popped up. You know, "As an APP, I can do that. I can help with this.

Dr. Briesacher: Absolutely.

Chris Heyer: "I can perform that a particular procedure and let's partner in how we can get the best care to the patient in the most efficient way possible, and I can offer those things." I think that voice was huge for that group.

Dr. Briesacher: What I'm so impressed about with that group is, you know, the day I was out rounding at Intermountain Medical Center and stopped in on the trauma meeting, and one of the PAs from the trauma team was giving the presentation on their work to reduce opioid prescriptions, the amount of tablets they prescribe for orthopedic trauma patients. These are a group of patients that have a lot of pain after their injuries, and I mean, their results are really impressive. Not only are their patients getting the right pain control they need, but boy, they're completely de-risking the chance of addiction and other things that are associated with the opioid epidemic. Even more importantly, they're blazing the way for other teams.

Chris Heyer: Yeah.

Dr. Briesacher: And, showing that it is possible to take on this pretty tough problem and we've had an almost 40% reduction in the number of tablets that we prescribe after procedures, and it's due to great leadership from that team of physician assistants, nurse practitioners, physicians, nurses that are making that possible.

Chris Heyer: Yeah, great example. I think this kind of touches on what I was mentioning previously about having that leadership voice and having an organization in order to carry out something like that. This is one of our service lines or groups of APPs that is organized, and that outcome came from a meeting where they were all together and I came to that meeting and was able to share a system level initiative, a big goal that Intermountain has had, and I was able to share that with them and immediately that group, they went to work. Phenomenal results, but that was because we had an organization, we had APPs meeting and coming together to just work on a goal, a collaborative, an initiative, and the results were fantastic.

Chris Heyer: Having those organizations stood up has been a big part of my vision, is to have more of that occurring across the system to where we have an APP leader who has a physician leader partner, a nursing leader partner, an operations leader partner, and a group of APPs and physicians and nurses that they can lean in on an initiative together to move that forward. Frankly, to this point, we've lacked some of that in the APP space, and so this is just a really exciting time for me.

Dr. Briesacher: Yeah, completely agree. It's also a great example of leading change, which in healthcare I think is one of the most important attributes and competencies for leaders. You have to have that ability to step in and take on hard things and lead a group through change. Being thoughtful of and curious about what people's needs are, what are all your key stakeholders and their needs are, and being nimble and flexible and agile in your approach. Communicating like there is no tomorrow, especially around the why. Right?

Chris Heyer: Yeah.

Dr. Briesacher: Why is this important? Why is this important to me personally? Why is it important for our patients and to the organization? Without a doubt that's exactly what that team did.

Chris Heyer: Yeah, and I think leading change does require a diversity of thought.

Dr. Briesacher: Yeah, absolutely.

Chris Heyer: To actually be effective with that change, I mean, we can change a lot of things, but if we want to change it to where it actually has results, I think it does require diversity of thought. I really hope that our APP voice is gonna really start to deliver in some of those areas.

Dr. Briesacher: You know, the other thing that I see in these teams is this great amount of trust and respect that they have for each other. I've experienced that personally in practice as well. I'm impressed with how you've been working with your leaders and talking about how important it is that this is a big focus of the work.

Chris Heyer: Yeah, no, I think that that trust and that respect is a huge driver of safety, quality experience for our patients, for our caregivers. If we don't have an environment where that exists and as the APPs, as trusted partners, as trusted leaders, having that leadership voice, that trusted, having APPs as trusted partners, as trusted leaders, now will really help us deliver on the fundamentals of extraordinary care. I continue to harp on access, access is king, but I think that that's really where we'll start to deliver.

Dr. Briesacher: Yeah. You know, Chris, you mentioned our fundamentals of extraordinary care and that experience is a big part of that. Right?

Chris Heyer: Sure.

Dr. Briesacher: Safety, quality, experience, access, stewardship, all in the context of engaged caregivers coming together around a common purpose of helping people live the healthiest lives possible. It strikes me that today, at least what I'm hearing from friends and neighbors, and we know this was a really important topic within the recent, the 2018 midterms and even the runup to the next election. Healthcare is a big, big issue and a lot of it's on healthcare access and affordability. You saw this in your work, well, in the work that you do today clinically. Almost one in two Americans worry that if they have a significant health care problem they might go bankrupt. Right? Even the story about your sister and the wrist injury, the worry about what that meant.

Chris Heyer: Yeah.

Dr. Briesacher: The choice, people are choosing, "Do I buy groceries or do I have this health care issue addressed?" One in three Americans are rationing their prescription medications, and I think one in four are actually skipping and not getting necessary healthcare treatments, all because of cost. What role can APPs play in our workforce of the future, our teams of the future, and how will they be part of solving for the these things for those that are counting on us?

Chris Heyer: Yeah. You know, it makes me think of an experience recently, that it was shared with me by Jessica Carlyle, one of our executive nurse liaisons who, her role in helping different people find access to care from different walks of life. Right? She just said that she was working with somebody who needed to see somebody in the cardiology area and just really paid a huge compliment to our APPs that work in the cardiovascular services, and how she was able to help this person navigate the appropriate level of care.

Chris Heyer: They were immediately able to get in to see one of our advanced practice providers for a concern that ended up not being that big of a concern. I think that that's what consumers want. Be it somebody who has access to a ton of resources or somebody who doesn't, they, everybody, we all are humans and we have the same worries and concerns. To be able to have access to somebody who can tell me that my problem's not that big of a deal in the right setting, not in an incredibly expensive setting, is a really big deal.

Dr. Briesacher: Yeah.

Chris Heyer: I really think that APPs make that possible in a lot of ways. Keeping, additionally, our physician colleagues working at the top of their training and license and experience managing the more difficult cases, the more surgical based cases.

Dr. Briesacher: Right.

Chris Heyer: I think that APPs, again, in a well designed, physician partnered team can help deliver that care to where a patient appropriately accesses care. They don't delay on a med refill or a chronic disease management follow up visit or a problem that potentially could become much bigger problem down the road. If they have confidence, which I think our APPs are really well trained at instilling that in patients, they're going to access care in a much more appropriate way, which is going to save the system a lot of money.

Dr. Briesacher: Yeah, I couldn't agree. It strikes me that the experiences that we're competing against are, it's no longer the experience with another healthcare system or another clinic, it's the experience that I and others have when they use an airline app to schedule a flight or a coffee house app to order my skim milk extra hot sugar-free vanilla latte that I like to order, and I go and swing by and there it is. It's waiting for me. I've already paid for. The friction is out of that. Right?

Chris Heyer: Yeah.

Dr. Briesacher: What I hear in that story and in many others that you tell about our teams here at Intermountain, they're taking friction out for people. They're making it easier to get the care they need. That's the pathway that we have to be relentlessly on going forward.

Chris Heyer: Yeah, and I think friction's a great word. It's a word I've wanted to yell at the top of my lungs sometimes. But, that I do, I think it's something we experience as providers of healthcare, whatever our role as caregivers of people, in that, healthcare is not a convenient thing. Accessing healthcare is, a problem that you need to deal with with your health is not convenient. Any little improvement we can make to make that more efficient is just huge.

Dr. Briesacher: You know, that reminds me about another thing that I've observed in watching you and your team. Laser focused on improving how we care for people, but you actually also are laser focused on the experience that your providers have.

Chris Heyer: Absolutely.

Dr. Briesacher: Now I think, you told a story about the last time that you were involved in a real estate transaction, you signed all the documents on your phone.

Chris Heyer: Yep.

Dr. Briesacher: You said, "Why can't we do that for credentialing and privileging?" We have multiple consumers. We have patients, we have families, we have our community, but boy, our caregivers are a really important one as well. Thank you for that focus as well. You've what, you've carved or shaved off, like, 11 days or so.

Chris Heyer: 11 days. I still think those are pretty modest results.

Dr. Briesacher: Yeah, we got a ways to go.

Chris Heyer: A ways to go, but yeah, and especially as we stand up some of our, or especially we stand up APP leaders that are going to have these leadership roles, one of their transitions they're going to have to make is, they've been trained to care for people in their settings that they do. But, now they've got to learn how to care for the people that they're going to support as their employees, as essentially their family members, people they probably see more than their family.

Dr. Briesacher: Right.

Chris Heyer: But, how can they support those people? And so it's another friction point, right, as you talked about. I've heard a lot about credentialing and privileging. How can we economize that process? We've already implemented some processes that I think will really, and frankly that comes down to actually, what that delivers is actually more patient care at the end of the day.

Dr. Briesacher: That's right?

Chris Heyer: Getting a provider in clinic in the hospital setting to provide the care they're trained to do 11 days faster, multiplied over the system that is Intermountain is a ton of care, a lot more care that we're going to be able to deliver in a more efficient way. I'm real excited about that work. I've had some great partners in that work from our continuous improvement department and some of our other leaders. It's an exciting work.

Dr. Briesacher: Well, Chris, you're doing a great job. Making care better for people, making care better for the communities that we serve here at Intermountain, and really focused on fixing things for those that you lead, so thank you so much.

Chris Heyer: Sure, absolutely. It's a pleasure. It's been a ton of fun. You know, this past year it's been a roller coaster in a lot of ways, but it's been a ton of fun to really start to see this start to come together now.

Dr. Briesacher: Yeah.

Chris Heyer: Thank you for the time. I have really enjoyed it.

Dr. Briesacher: Thanks.