When a group of hospitals came together to form North Country Healthcare, it offered several benefits to its member facilities. Not only did it help with recruiting talent and offering more services to patients; it also meant being able to negotiate better contracts.
For Darrell Bodnar, it means no longer having to play “bad cop,” because now NCH had an individual who specializes in contract negotiations and purchasing who can “look at GPO contracts in-depth and push those vendors.” It also means he’s able to focus on maintaining vendor relationships.
Recently, Bodnar spoke with healthsystemCIO about the many ways in which being part of a multi-hospital system – and not a standalone – has changed his team’s approach. He also talked about the journey they’ve been on to move to an integrated EHR platform, how Covid has transformed their virtual care strategy, what he believes is the biggest threat for rural and small organizations, and how brewing beer has become his “therapy.”
LISTEN HERE USING THE PLAYER BELOW OR SUBSCRIBE THROUGH YOUR FAVORITE PODCASTING SERVICE.
- One area where Covid made a positive impact? Helping to erase “the historical stigma in healthcare that people had to be onsite.”
- Since becoming a three-hospital system, North Country Healthcare has been able to secure better contracts and negotiate better pricing, says Bodnar. “It made our partnerships much easier.”
- Having an individual who specializes in negotiations and purchasing and can “look at GPO contracts in-depth and push vendors,” helps remove some of the pressure and enables Bodnar to focus on maintaining relationships.
- “I’m not looking for a vendor, I’m looking for a partner, and that partner needs to really offer something up.”
- For Bodnar, being part owner of a brewery has helped him stay connected with the community — particularly during Covid — while pursuing a “passion.”
Q&A with CIO Darrell Bodnar, Part 2 [Click here to view Part 1]
Gamble: For things like surgical follow-up, virtual care really does seem like a good option, but as you said, it all comes down to reimbursement.
Darrell: It does. From a surgical piece, sometimes they’re looking at bundling in surgical services as a predictable model. We have one provider that’s piloting a piece for this where he is doing his remote follow-ups virtually. As post-surgical visits are done virtually with patients to follow up, the concern isn’t as much as patient outcomes as it is reimbursement, particularly with a bundled payment for an OR service. There are opportunities there if we look at how we model these. When it comes to virtual care, I believe prevention and follow-up are the prime opportunities.
Gamble: That makes sense.
Darrell: We have an elderly population, and so when you think about even the tele-assistance model where we’re monitoring them at home, it can help with safety concerns. It can be safer if you have those things in the home. And we’re not talking about the ‘I’ve fallen and I can’t get up’ button; we’re talking about real-time monitoring of patients.
And I’m not going to delve into what I would call artificial intelligence or machine learning, but there are clearly algorithms that we can use that can help identify patterns or inconsistencies that can alert the provider or clinical staff immediately if a patient falls or takes a turn for the worse. It could be even a longer period of time; if you start to see a decline in a patient’s O2 saturations, you can report those back and make sure someone sees it so that outcomes are much better.
Gamble: It’s really exciting to hear about algorithms and how they can be used. There are so many pieces that have to be in place, and there’s a divide between organizations that are knee-deep into this, and those who don’t have those resources, and that’s definitely a factor.
Darrell: I think they need to be looked at by use case. As I hinted at before, we’re piloting those piece. For a patient who has been discharged by an orthopedist, it’s a risk to get up and move and do things, but you can check in with that patient remotely, which is probably more effective.
Behavioral health, as we’ve seen, plays to that comfort level much more than perhaps somebody who is coming in for a routine primary care visit. Areas like oncology and wound care don’t play into this realm at all; you may not even want to offer it in those areas. But those are the types of things you have to look at.
Gamble: Switching gears a bit, when North Country Healthcare was created, some of the goals you mentioned were around being able to attract physicians, recruit or retain IT staff, and work with vendors, has it made a difference?
Darrell: It clearly has in terms of recruitment, not only for clinical staff but for IT staff. The other thing that helped with that was the historical stigma in healthcare that people had to be on site, even in a clinical role — Covid helped in that area too. We had to bring on a data analyst, which was something we didn’t really have. We had worked with data analytics, but we didn’t have somebody completely dedicated to it, and we were building a department from it.
But that was a very tough recruit for us, unless we could make sure that the individual could work from anywhere. It’s been extremely successful and I don’t think that would have been welcomed prior to COVID. The system needed this, and we were large enough now that we could attract people to come in.
I do think, from an IT perspective, it has helped us. The ability to work remotely and repurpose space for clinical service delivery — which we’ve done in one of our affiliate members that was constrained by space — has been a key component to that. It allowed them to be able to pivot people out from an accounting and financial perspective that weren’t in place anymore. Those were all positive.
We’ve been able to get better contracts because of being a system, and we’ve been able to negotiate pricing a little bit better overall in our contracts, including our payer contracts, which is where you get real money. The GPO on cost savings is one thing, but when you can start getting your reimbursement adjusted accordingly, that helps as well. It has made our partnerships much easier.
When we worked with some of the tertiary facilities that we partnered with in the past, it was very difficult. With three hospitals, we could provide a good level of service, but when you’re a three-hospital system, it makes it much more interactive because you’re getting single points of contact for these communications. And it allows us to improve on not only on the referrals but the patient transfers that we have to do. We retain more because we have better in-house services, but when we do a patient transfer, it’s better for the patient and it’s better for our relationships with our tertiary care providers.
Gamble: It’s really interesting what you said about operating as a three-hospital system instead of the three individual hospitals — I can imagine that comes into play quite a bit in dealing with vendors as well.
Darrell: It does, and we discover more and more every day. Every time a contract comes up for negotiation at a single entity, we evaluate the contract to determine whether it should be what we would call an NCH contract. Most follow those unless it’s a particular piece of equipment, which we would then take to a service level, look at the anniversary date, try to reconcile those into a single contract, and negotiate the price overall where it’s usually a cost savings.
Gamble: As far as negotiating contracts, is that a skill you’ve built up over the years through lessons learned?
Darrell: I’ve always been big on contract negotiations — looking at those and trying to make sure we’re partnering with our vendors. When you’re a small rural hospital, cost optimization and cost savings are always a big piece. It’s always present and top of mind. What historically stopped me in situations where we might be able to do a contractual negotiation was a lack of resources. As a system, we’re now able to bring in someone who specializes in contract negotiations and purchasing, who can then look at the GPO contracts in-depth and work with those vendors. If we’re dealing with a vendor that’s not part of a GPO, because we’re larger and can purchase more as a system — even though we may have been doing it individually prior to that — it comes as a full representation. We’re able to get those additions to the GPO contracts or get access to portions of the contracts that we didn’t have before.
From my perspective, I’ll evaluate contracts go through those with a fine-toothed comb looking for caveats, like those 5-year renewals with a year’s notice. But to then start negotiating prices, having somebody on-board who can do that without damaging a relationship with a vendor is really helpful.
Gamble: I can imagine. And as far as trying to maintain a good relationship with vendors, what would you say are keys to doing that?
Darrell: I believe in full transparency. I always tell my vendors when we first get on the call that I’m not looking for a vendor; I’m looking for a partner, and that partner needs to offer something up. We switched security assessment vendors, and the relationships that we had now are far from corporate. It’s a level of intimacy about our systems and where we are. If there’s a value add, they’ll say, ‘ok, we’ll do that.’ We’re looking at doing some executive report-outs for board members; we can build those things out for you and you can tweak them the way you want to, when historically that might have been an additional cost. But because we’re partnered and we have three hospitals as opposed to one, there’s a value-add that comes from those, as long as they’re willing to be partners.
And if they’re not willing to be partners, there’s enough competition out there that we can look for someone else. We’ve been successful in being able to do that. Like I said, it’s always nice when it comes to price to have a bad cop out there to say, ‘I’m sorry, but I have to run this through my purchasing group now’ that we have a purchasing as three hospitals. It takes that off of me and allows me to maintain those relationships.
Gamble: Very interesting. I’d love to be a fly on the wall for some of the conversations. The last area I wanted to touch on is that I read on your LinkedIn that you were involved with a brewery. Is that still the case?
Darrell: It is. Copper Big Brewery is in its third year. And we’ve actually been voted number one brewery in New Hampshire three years in a row. We’re a small brewery; we manufacture our own beers and ciders on premise, and we have a pretty good food menu. We sit along the Israel River.
We always believe in giving back; we’ve done a lot since the start of the pandemic. We did a hospice ale that was donated as part of an auction where the highest bidder could pick the beer, help us manufacture it, and name it after a loved one, and all of the net proceeds go to that individual. We also did commemorative growlers that sold at a high price, all of which, all the proceeds go immediately to the home care agency.
It’s a lot of fun. It gives us purpose. It grounds us into the community. For a while we were doing discounts for essential workers, offering 50 percent off meals a couple of days a week. It’s been a huge hit in the community. And it’s not just healthcare workers; we offered discounts to people who worked for grocery stores, who were overlooked during the pandemic. These are the people who were stocking our shelves and being paid the minimal amount. And so we offered discounts to each of those and honored those for a few months. In the spring, we offered 30 percent off for anybody who came in and told us about a good deed they did for somebody else. And we encouraged others to give discounts as well.
We feel like we really embedded in the community and we’re part of the community. We were able to survive COVID relatively unscathed because of the community participation and support. Even though we had limited seating, we had a huge amount of curbside and to-go foods going out, including beer. To me, it’s the best of both worlds. I get to work in healthcare, and I have my side gig where I get to serve and pour beer. Even though I don’t have much time during the day, I occasionally get to brew beer, which is my real passion. It’s a wonderful thing.
Gamble: That’s great. It’s such a cool way to be involved in the community. Speaking as a consumer, I know that when I saw businesses that were trying to help others out during Covid, I was much more likely to support them. And I love that you have a brewery — we have a few that have popped up in New Jersey during the past 4-5 years and it’s been great.
Darrell: Breweries are just interesting. They’re so unique. One of the things we did was, as soon as the pandemic hit, the schools — even though they were remote — decided to do lunch deliveries, because they realized that many of these lunches had already been paid for, and by families who were struggling. And so the school busses would go and deliver food to all the students who needed it, every single school day, even though they were at home.
But then we discovered that there was a gap on the weekends for these people, especially if they were unemployed. So we figured that since we’re cooking anyway, we offered free children’s meals during the first 3 or 4 months of the pandemic. And when we did that, all of a sudden some of the other businesses started to chip in, whether they threw in some cookies or drinks. It became this whole thing where it didn’t really cost us that much, but we were able to help support the people as a community. I think a lot of that helped in our long-term survival.
Gamble: Sure. And it seems like this is something that’s really important to you personally having this passion you’re able to share. I’m sure it helps on a lot of levels.
Darrell: It does. It’s like its therapy. There’s nothing better than when you have a bunch of providers who have struggled with the EMR — and of course, the EMR is something that the organization chose, but they blame you because you’re the face of it — and dealing with financial struggles of the organization, and you’re able to pour them a beer and chat. That’s therapy to me.