Marc Harrison: Hi, this is Marc Harrison, CEO of Intermountain Healthcare. Today I'm with Anita Harding, who's an accounting specialist on our payroll team. Anita, please tell us a little bit about yourself, and then I'd like to hear whatever's on your mind.

Anita Harding: Thank you. I've been with the corporate payroll team for 10 years, a second career for me. I lived here, and worked on the east coast, and commuted back and forth for about 15 years.

Marc Harrison: What did you do back there?

Anita Harding: I worked in the recruiting industry for engineering.

Marc Harrison: So, you've had an interesting life — an interesting set of careers.

Anita Harding: Yeah. And so, I found a happy home here. I actually have a daughter who has been a nurse with Primary’s. So I really liked Intermountain through her and it was one of the three companies that I targeted when I decided I wanted to change careers. So there you go.

Marc Harrison: Well, we're glad you're on the team.

Anita Harding: Thank you.

Marc Harrison: So, what's on your mind today? I think it's affordability, right?

Anita Harding: It is affordability. My question really is, how can we increase affordability and bring down pricing. Specifically, I had an experience with products through oxygen CPAP that I get through us, and I also purchase those over the internet. And I've found that our pricing is not as competitive. And so, I guess my question is, what can we do to bring that pricing down, being more competitive, make life easier for us and for our patients.

Marc Harrison: It's a very good question, Anita. In fact, I got an email from somebody, about three or four days ago, who… There was something that, at discharge, had been recommended to them and they went to our DME (durable medical equipment) store and they paid about $55 for the item. And they went on Amazon, they found it for $25. And so, this may sound familiar to you.

Anita Harding: It does.

Marc Harrison: So, I'm going to first tell you why I think that's the case, but I'm not making excuses. When you have bricks and mortar locations — we've got multiple locations to serve folks -— it costs more to run those than it does to run a warehouse that you churn tons and tons of volume through. We also accept insurance and often times the online retailers don't. You'll be able to submit for insurance yourself on the backend, makes them much more competitive on the price front.

Marc Harrison: Now, I think we've also had some laziness on our part. I think it hasn't been as competitive or consumer centric in the past. People didn't ask these very hard questions, and they also didn't have high deductibles which made this very much an acute issue for them. This is money right out of their own pockets. What this tells me is, what we're doing right now is not sustainable and we need to go ahead and become more competitive on the cost front.

Marc Harrison: Now, here's where it gets hard. If we take enough cost out so that we're competitive on that front — and we are doing things like working on an online catalog for all the things that-

Anita Harding: Common things.

Marc Harrison: Common things. Where do you think that cost comes from?

Anita Harding: I really don't know.

Marc Harrison: Elsewhere in the company.

Anita Harding: Yeah.

Marc Harrison: And it's the right thing to do. But as we're working on our One Intermountain restructuring, there's been some people really unhappy. They say, "Look, when you take cost out, what are you doing with it?" Well, we're doing a lot of things. But clearly, based on what you're telling me, it’s still not enough. So, we're doing things like we've dropped the price for normal vaginal deliveries that people pay cash for by about a third. That's terrific. We now, because we're getting better and better at keeping people well, SelectShare, which is one of the insurance products which is based on wellness, we've guaranteed no more than a two and a half percent increase in premiums year on year. We have worked on things like Civica Rx, the not-for-profit drug company, which will begin to bear fruit, we think, in 2019 with its first product.

Marc Harrison: All of these things either cost money to do or they require that we are able to provide a service when being paid less. In order to do that we need to take out cost elsewhere.

Anita Harding: Its true.

Marc Harrison: What program needs to change? What kind of staffing needs to change? They're really hard choices to make and they all have real and human implications that I feel in my soul every day when we make these decisions. One of the things that I've said before is, we touch people about eight million times a year across Intermountain. We also have 37,000 of the best human beings that we get to work with. But when we make those changes around cost, it also affects how their jobs work.

Anita Harding: It does.

Marc Harrison: So, this is a really tough balance and it's something that I personally wrestle with. But I think it's of importance, because what you're telling me is our care is still too expensive.

Anita Harding: It's interesting when ... I purchase from both avenues, from on the internet and through Intermountain ... because I use more of those products than what we're allotted. And so, it's really hard to look at it and say, "Hey, I'm better off just buying this than I am to run it through our system," because it's the same.

Marc Harrison: It is.

Anita Harding: And it costs my insurance company less, and then that equates to a lesser premium for me.

Marc Harrison: You're doing the right thing. Please, I don't what you to interpret it in any way, there's any criticism.

Anita Harding: Oh, no. Not at all, not at all.

Marc Harrison: You're doing what you need to do to live your healthiest life. And part of living that healthiest life is being financially in a good place and not wasting money, or spending money unnecessarily. That's your right, your privilege, and, I'd say, your obligation. What our obligation is, is to run Intermountain as a model healthcare system for 2019 and into the future, and that means we need to be more affordable, as well as high quality, and a great place to work, and safe, and engaging, etc. This is the tension as our whole industry is going through these changes, we're needing to morph ourselves more rapidly than healthcare ever has before. So, I really appreciate your asking the question. You need to know that we are completely dedicated to providing the best experience for you, both as a caregiver and as a patient. And part of that experience is making sure your care affordable.

Marc Harrison: Do you want my job?

Anita Harding: No.

Marc Harrison: I love my job. I'm honored to have my job. This place where you are right now, this is the hardest piece because people do want their care to be as affordable as possible. And I know that as we work on doing that, I need to take cost out elsewhere in order to do that, because it's not like we have money just lying around.

Anita Harding: No.

Marc Harrison: Isn't that interesting, though?

Anita Harding: It is.

Marc Harrison: It's really tough decisions.

Anita Harding: I mean, you brought up some points I hadn't thought of and it helps me understand a little bit more.

Marc Harrison: It's funny, I remember when our kids were little. I worked full-time. My wife worked half time. For some complicated reasons, we thought it was best for our kids to go to private school, which was a huge stretch for us, huge stretch, and we didn't have very much left over. Not, "Poor us," we are very lucky people. We were privileged that we could send them to the school that they needed to go to.

Marc Harrison: I remember, one of our kids said one of their classmates was going to Europe over summer vacation. Could we go too? And we had a popup trailer in the driveway, that was our summer… I mean, it was interesting explaining to them that you have to make choices.

Anita Harding: The economics of it.

Marc Harrison: The economics of it are real and we're facing those tradeoffs every single day. And boy, it's hard. Because even if people can see it and feel it intellectually, the emotional piece still can feel something really different. Then people get angry, and they blame and they ... It's hard.

Anita Harding: It is.

Marc Harrison: Well, I appreciate the conversation and we will work as hard on this as we can. I promise.

Anita Harding: All right.

Marc Harrison: Thanks, Anita.

Anita Harding: Thank you.