Joey Wahler (Host): Our guest is doing so very successfully, so we're discussing building a rural health network in challenging times. We're joined by Albert Wright, Jr. He's President and CEO of the West Virginia University Health System, and also a fellow of ACHE. This is the Healthcare Executive Podcast from the American College of Healthcare Executives. Thanks for joining us. I'm Joey Wahler. Hi there, Albert. Welcome.

Albert Wright: Hi, Joey. Thanks for having me today.

Host: Appreciate the time. Great to have your board. So first I want to ask you a little bit about your background and what drew you initially to a career in healthcare. You certainly have an impressive educational résumé in terms of having gotten degrees from Ohio State, the University of Florida, and also the University of North Carolina. If you don't want me to, I won't ask you who your favorite teams are in sports since you attended colleges and universities involving three powerhouses, right?

Albert Wright: Yeah. We have some good sports teams there, but yeah, they're all great. But I root for Ohio State Football first and foremost.

Host: Okay. So, what would you say it was about your background, whether it was during those experiences or prior that made you say healthcare was for you?

Albert Wright: I'm a pharmacist by background. And I don't have a great story of how I became a pharmacist other than, as I was young and looking at opportunities, I ended up picking pharmacy school, which was a spectacular option for me. And my goal long term after I got out of pharmacy school was, you know, essentially to become a pharmacy director. When you're young and looking at options, when they're giving you options of school teacher, pharmacist, lawyer, whatever the case may be, nobody ever says, "CEO of a large academic health system." That just kind of happens to you and evolves over time.

Host: So, what do you think is the biggest way in which that pharmacy background helps you as an executive nowadays?

Albert Wright: It's kind of funny, because these days my badge works everywhere in the hospital except for the pharmacies. That kind of tells you how far I've gotten away from that. But I think early in my career, it was helpful in being comfortable to sit in just about any environment in the hospital and have a clinical conversation with folks. And I worked in small hospitals to start with, a small hospital up in Ashtabula, Ohio, and a number of other small hospitals. It's kind of funny because when you work in small hospitals-- you know, and I did become that pharmacy director over time in a hospital. And then, you work in small hospitals, if the person that runs Radiology leaves, you might run Radiology for a while. If the individual in the lab goes on maternity leave, you might run the lab for a while. And what you find out is that although the widgets might be different, working with people managing budgets, working with medical staff is the same.

And over time, my career evolved from being much more pharmacy specific to a general leadership track and from small hospitals to some of the big hospitals to now being over a relatively large healthcare system here at WVU. So, the pharmacy background certainly helped from the start, but I think committing to leadership development is the key, for all of us in healthcare administration long-term.

Host: And so, you alluded to the fact that after the pharmacy background, you then held some senior leadership positions at some of the other most prestigious healthcare systems in the country. So, what would you say more than anything about those experiences or overall helped in your journey to your current CEO position?

Albert Wright: We all become reflections of our mentors and the places we worked at. When it's your turn to lead, you want to emulate what you think were the strengths of those organizations and you want to maybe avoid some of the things you thought that were maybe organizational blind spots or personal blind spots. So, I had the benefit before I came to WVU of working at Ohio Health in Columbus, Ohio, and University of Pittsburgh Medical Center based out of Pittsburgh. And those are spectacular, large, integrated complex organizations where I learned a tremendous amount from. And there were some tremendous leaders that mentored me through those times and people I still stay in touch with today.

Host: So, how about describing for us, please, the communities that WVU Medicines hospitals serve, and how do you go about building and maintaining relationships with them?

Albert Wright: Now, that's a great question and a lot of people don't realize that West Virginia is the only entirely Appalachian state in the country. And it is a very rural state to the point that our largest city in West Virginia, Charleston, I believe, has less than 50,000 people now. So, we're kind of the definition and epitome of rural healthcare.

So, how do we build and maintain relationships around the state? We've really focused on kind of two things over the last decade. And I'm housed here in Morgantown where our academic medical center is, and we built WVU hospitals, J.W. Ruby Memorial Hospital up into an 891-bed hospital in a town with about 35,000 people. So, you don't really see hospitals of that size and scope very often in a town with 35,000 people. But it is your typical academic medical center, tertiary, quaternary, organization with multi-organ, solid organ transplant, level IV neonatal intensive care unit capabilities at our children's hospital, all the things you would picture. But if you're going to have that type of hospital and capabilities in a rural state, we've additionally built a Population Health footprint that stretches entirely across the state, spills over into a couple border state counties. But we've got a network of hospitals that we've committed to helping grow and stay open throughout the state, brand it all under the WVU Medicine brand. And we do a good job of engaging with those individual communities, which is very much what west Virginia's made up of.

Host: Well, rural communities, of course, often face these unique barriers ranging from transportation and workforce shortages to higher rates of chronic disease. So, how would you say WVU Medicine tailors its strategy to address and bridge those gaps to access?

Albert Wright: I would say two things. One is-- and we don't talk about this enough-- but probably the biggest transformation we've gone through in the little over a decade that I've been here is really moving from an academic medical center in Morgantown to an academic health system that criss crosses all around the state. So, there are academic medical departments, whether it be Neurology, Hematology-Oncology, Cardiology, really view the state as their footprint. And they are constantly recruiting faculty-level physicians and subspecialists around the state, sometimes placing them in rural spots around the state in addition to Morgantown, but also utilizing telehealth and telemedicine, especially for the most remote parts of the state or parts of the state where you're really just not going to be able to put a full-time specialist so that there are care points that they can take care of people. So, that commitment to our mission to improve the health trajectory of the state and carry out the teaching objectives of West Virginia University has really become part of the fabric of who we are, especially our medical school and physician practice plan.

The second thing I think we've done is we have a somewhat of a unique financial operating model where we keep a nimble corporate oversight that I lead of five departments: information technology, legal services, big parts of finance, big parts of human resources and compliance. And we keep the expenses associated with those corporate departments at about 7.5% of our net patient revenue. So, no matter how large we grow, we don't let our corporate structures become too large and burdensome to our providers. And why that's important, and I think that's a mistake that some health systems have made, is they let those corporate functions get too big. Why that's important is each of our hospitals operate on their own bottom line. So, that any of those 25 WVU Medicine hospitals around the state of West Virginia and spilling over into those border states, if they do well financially, they keep all of those dollars in their own community for reinvestment.

So, all of the hospitals, Joey, that have joined our system are surviving on their own bottom line. And I'm very proud to say that they have all significantly increased the number of clinical services in their communities and significantly increased the number of jobs in their communities, which sometimes has actually doubled. So, that has resulted in significant more access around parts of the state than we had a decade ago.

Host: Well, saying that, Albert, you may have led me beautifully into my next question, which is what's the biggest lesson you think other systems can draw from your experiences meeting these unique rural challenges? Would it be that financial approach you just mentioned?

Albert Wright: I think that's a big part of our secret sauce is, since we don't do a corporate sweep, it actually incentivizes those hospitals to make investments. And you've got to find ways to make sure that you're reinvesting in those communities.

One of the things that we've really embraced is finding a way to make critical access hospitals successful. We have nine critical access hospitals in our healthcare system. And we consider them a key cog of what we do. So, yeah, I think it's important to create a financial model that incentivizes growth outside of your academic medical center. And maybe I'm a little bias on this one, but I really think keeping checks and balances on your corporate oversight and corporate dollars that you have to allocate out. I think that's important to be disciplined in that.

Host: Let me ask you about a different kind of challenge being rural. How does WVU Medicine recruit top clinician talent?

Albert Wright: That's a great question. And that was probably harder than it was a decade ago. And it's still not the easiest thing for us to do because unless you have a tie to the state of West Virginia or West Virginia University, most people waking up in Durham, Dallas, or Chicago aren't thinking, "How do I get to West Virginia?" So, we've got to be creative in finding ways to get people here. Because guess what? When they come and visit, there's a good chance they're going to end up falling in love and wanting to come here. And we've had great success in that over the years.

Most people, work is one of the biggest parts of their life, probably along with their family. But most of the time, when you move to a new space or relocate, you can find places to worship, great places to eat, different cultural things. We have beautiful, natural outdoor activities here. The biggest thing you've got to convince clinicians of is that you have a nimble leadership team that is going to be attentive to their needs. You're going to give them all of the tools they need to be successful in their job. And for your most advanced subspecialists, they want to know that you're committed to what they do.

So, when you look at our academic medical center, a decade ago, it looked like big general Hospital. It now looks like a collection of five or six sub-specialized institutes around Heart and Vascular, the Rockefeller Neurosciences. We just built a beautiful new children's hospital. We're pursuing NCI designation for our cancer center, and we've made great attempts and strides at putting people, programs, and physical plans together to maximize the capabilities of our physicians. So, that's helped to recruit a lot to Morgantown. Simultaneously around the state, as we talked about becoming an academic health system and recruiting faculty to what I'll call our regional hub hospitals, our 250-bed hospitals in places like Wheeling West Virginia, in places like Martinsburg, West Virginia. Those are things that when we put those faculty out there, it really creates a tether and a tie to the university that I think allows people that might not want to move to a more rural site like that, they'd be a little more concerned if it didn't have that tether and tie to the academic medical center in West Virginia University itself. So, those have been some formulas that have worked well for us.

Host: Gotcha. A couple of other things. Switching gears a little bit. WVU Medicine launched its own health plan several years ago. So, how's that going? And Albert, how do you envision it advancing WVU Medicine's Population Health goals going forward?

Albert Wright: That was a very heavy lift. We created our own provider sponsored health plan from scratch. We're the majority owner and operator, but we did it with a couple partners of Marshall Health based out of Huntington West Virginian Valley Health based out of Winchester, Virginia, or our partners in owning Peak Health. And we did that because we really believe that if you're ever going to truly lower the cost of healthcare or improve outcomes, at some point, you have to have financial alignment between the people that pay for healthcare and the people that provide healthcare. And so, that's what we're really trying to accomplish. We're doing a couple neat things.

I think with Peak Health, we're not the only healthcare provider that has become an integrated delivery and finance system. But a couple things we're doing that I think are neat and unique is we're processing all of our claims in Epic, which is also our electronic medical record for our clinical activity. So, it gives you absolute real-time interoperability between everything that's being provided on a clinical standpoint and everything that needs to be paid for from a claims processing standpoint. So, we've got greater visibility than before.

Two is we're really treating Peak like a cost center rather than a profit center, which allows us to break the traditional back and forth between payers and providers in a fee-for-service world. You know, Peak exists to support the healthcare system and our mission to improve the health trajectory of the state and surrounding areas. So by removing that fee-for-service mechanism, we're actively doing this in our Peak Medicare advantage population right now, and we're going to spread it to even more of the patients we're caring for through Peak Health, but we're really able to create alternative payment models where Peak facilitates paying our health system in a capitated way that allows our clinicians and our leaders to really be incentivized to keep our patients as healthy as possible and in the lowest cost setting in order to maintain our financial viability. So, by being incentivized to keep people as healthy as possible in the lowest cost setting, it really gives us degrees of freedom to invest in things like the social determinants of health. It gives us freedom to invest in behavioral health and home monitoring.

So, we're early in this journey. We're a few years in. I like to equate it that we built a Ferrari that we're driving in first gear right now. But in time, I'm very excited that we're going to create an experience where we have much less administrative burden in the provision of care and that we're going to be able to start to make investments that change the health trajectory of our population from one that's historically had significant challenges on almost any health metric you look at in West Virginia, you know, heart disease, diabetes, obesity, addiction. Two, we want to change to a population where we have top quartile outcomes. And that's why we've gone on this Peak Health journey.

Host: Sounds like a win-win for everyone. And Albert, I think everyone can appreciate a good Ferrari analogy, right?

Albert Wright: I hope so.

Host: Absolutely. And finally, in summary here, and we ask this question of all of our podcast guests who are fellows of ACHE. Indeed, how has your FACHE credential help to advance your healthcare leadership career, would you say?

Albert Wright: Yeah, I think it helps to solidify dedication to the profession of healthcare leadership, healthcare executive management. It allows me to network with like-minded colleagues. And being a part of ACHE and having the FACHE credential always ground you in making sure you're achieving high quality healthcare outcomes, you're grounded in fiscal responsibility and that you're doing things in an ethical fashion to get there.

Host: Well, folks, we trust you are now more familiar with building a rural health network in challenging times. Albert, so interesting to meet and speak with you. Keep up all your great work, and thanks so much again.

Albert Wright: Thank you for the opportunity.

Host: Absolutely. And for more information, please do visit healthcareexecutive.org. Now, if you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for being part of the Healthcare Executive Podcast from the American College of Healthcare Executives.