Ngozi Ezike, MD (Host): Hello, everyone. I'm Dr. Ngozi Ezike, and thank you for tuning into another episode of More Than Medicine. Today, I am super, super excited to be joined by Jennifer DeCubellis, the President and CEO of America's Essential Hospitals, the national organization that represents hospitals and health systems that care for many of our nation's most vulnerable communities.

But before stepping into this national leadership role, Jennifer served as CEO of Hennepin Healthcare in Minneapolis and previously held senior leadership roles in Hennepin County, overseeing health and human services programs. Jennifer, thank you. I know we've already had lunch. Thank you for joining me in this podcast this afternoon.

Jennifer DeCubellis: Thank you. It's an honor to be here. I appreciate so much having the chance to come see Sinai Chicago, and the hearts and minds that drive this place every single day. So, it's an honor to be here.

Host: No, we're super delighted to have you, and I'm super excited that you're in this role. You are our people. You know what we live, breathe, and deal with every day from being on the front lines yourself to now be our representative in DC, like this is where the magic happens. So, thank you.

I know you have spent more than 30 years working across healthcare and public health and human services. I usually like to start asking my guests, like, how did they come to where they are now. So, how did you first get started in this work? And what initially drew you to serving communities through these systems?

Jennifer DeCubellis: I would say very non-traditional path. I think so many of us come into safety net healthcare because we care about people, we care about our communities, we want to make a difference and we want to make a difference every day. And I would say that's where I started out. I am actually by training a special education teacher, working with children with emotional and behavior disorders. I actually started my career here in Chicago.

Host: Oh, I didn't know that.

Jennifer DeCubellis: Okay. I worked for an alternative school. And it was a school system that was serving young people who were not successful in the Chicago schools at that time. And what I found is that I jumped in and worked on some behavior programs for these young people. I had a classroom of eight to 21-year-olds all in one classroom—imagine that—often rival areas in the community. It was a classroom that I really believed needed some structure. And I put some programs together with my psychology background and ended up on the cover of The Star for turning around the classroom and really getting these young people invested in their own education and doing homework and really seeing some success points.

I was immediately thinking, "I'm young, I'm 21. I've arrived. I've made a difference." And I got called into the administration's office and was told I needed to stop doing what I was doing, because I was teaching in a Montessori school. And if you know the Montessori philosophy, it is about young people, if given the right opportunities, will teach themselves.

So, being 21 living in Chicago, I resigned on the spot and said, "I won't trade in my values when I know this is a programming that makes a difference for young people." And I think that taught me at an early age. I didn't know how I was going to pay my bills. I didn't know what I was going to do. But I was really invested in working with the young people and their families, to say, "This might not be the right school for your young person." And it taught me early on the passion of we've got to stop as a nation putting people into programs. And we need to do right by the communities we serve and wrap the right supports around people. And that led me into really caring about program design, redesign of our public programs, and let's make sure our public dollars are spent wisely, but invested in the communities where that investment is driving the outcomes that our communities need.

So early on, that got me involved. I went back to school and went into clinical psychology, got into health and human services, and really have spent my career working on how do we design public programs to work for the communities we serve. At the end of the day, it shouldn't be convenient for me as a team member. It should be what makes a difference. And that's what I find at essential hospitals, places like Sinai Chicago. It is where people are here for the right reasons. They're doing everything they can to make sure that healthcare shows up, how the community needs us to show up, not how our payers want us to show up, or the regulatory authorities, but truly making a difference for the community.

Host: Oh, I love everything about that. I mean, what I heard was that it's not about the programs. What's at the center is the people. And then, the programs need to work for the people that we're trying to serve. And I'm just so grateful for you just being a woman of honor who said they're going to lock in on their values and do what is right. And so, that's probably carried you all the way through and is going to be exactly what's needed in this critical role that you are in at this critical time.

So, let's go back a little bit to your time in Minneapolis. I know you're actually from there. So, you were literally on the front lines of safety net healthcare there in Hennepin County as a CEO of Hennepin Healthcare. And now, of course, you're advocating for us nationally in Washington. But from your perspective, how are the federal policies shaping the realities that are facing the safety net hospitals today?

Jennifer DeCubellis: I think we have some positive opportunities. So, that investment in health and wellness, I think COVID taught us that. I took Hennepin Healthcare as CEO two weeks before COVID hit. Four months later, we had the murder of George Floyd. Two weeks following that, we had the city of Minneapolis on fire. I've never seen such committed people leaning into pain, leaning into community, and leaning into doing right by each other. And I think there's very few of us that would disagree, that we want America healthy. COVID taught us when everybody is healthy, if everybody has an opportunity to shelter in place to care for themselves, their neighbors, their loved ones, we all do better when we all do better.

So, I am encouraged by that investment in primary care, that investment in prevention, early intervention. I would say what I'm worried about in the public policy landscape is we are not going to cut our way out of healthcare. So, I started by talking about care redesign, and healthcare redesign is just as essential. We know we can't sustain the cost of our healthcare system across the United States. But we're not going to cut our way out of it. Exiting people from access to care might save us in the short term for a budget year. It's not saving us in the long year, because then we have people that don't have access, that have chronic disease that we could have prevented, we could have avoided. We see them in emergency departments. We see them in acute care. So, whole communities can be left behind with policies that focus on short-term gains, such as budget cuts.

And so, I think that is the biggest concern I have, is that we have to transform healthcare. But it's through investing in the right spaces, not just cutting. So, that one cut lever, actually I believe will cost us more, and it will cost lives.

Host: Yeah. Yeah. That's chilling. But we know that those are the facts. And so, as we think about America's Essential Hospitals, it might be a trade organization that many people are not familiar with. Can you tell us about the mission of this organization and how exactly does AEH work with safety nets like Sinai, Chicago to promote and ensure equity and the access to care that the communities need?

Jennifer DeCubellis: Absolutely. So, I like to say America's Essential Hospitals is a boutique organization. So, there are some large associations that represent people nationally. We tend to be smaller. And what I appreciate about that is we are very aligned in our values that I started off speaking to. So, we represent almost 400 members across the United States, and those 400 members are typically academic medical centers. They serve a trauma safety net function. And that trauma is whether it is a burn center, whether it is special specialty ICU care, a lot of mental health, a lot of addiction, they are the systems that are very mission-focused and committed to serving everyone in their community regardless of ability to pay.

I recently spoke about they tend to be our firefighters when you talk about a safety net system, and you eloquently have talked about this in past TED Talks, I've watched as well about that invisible safety net. It is those firefighters who run in when others are dropping care, when they see access in the community. So, whether that is dropping of maternal health, pediatric care, mental health, addiction, all of those services that we know create wellness, safety net hospitals are the ones that stand up those systems to make sure they're there when the community needs them most. We call them essential hospitals because that's exactly what they are.

Host: They're essential.

Jennifer DeCubellis: They are essential. They're not just essential for their own business. They're essential for communities who rely on them. They're essential for other healthcare systems who also rely on the services and the mission that they provide. So, what we do as an association is we advocate. We help raise up their voices and make sure that that story is told of who they are, who they serve, why they matter. So, we do a lot of advocacy. We do a lot of spread of best practices. So, how can we learn from each other when we're all trying to figure out how do we invest in our communities with prudent use of public dollars, spend our dollars smart, learn from each other. There's a lot of innovation and best practices that happen as well.

And then, there's a lot of leadership development. How do we grow the next generation of leaders that come behind you and I? And America's Essential Hospitals really invests in who are those next generation leaders to make sure that the mission of the organizations we serve continues for generations to come.

Host: Yeah. And so, just putting a fine point on that, like, these hospitals are so alike. They're so similarly mission-minded. And, you know, it's only 6% of hospitals nationwide that are considered safety nets. But they provide more than 30% of all the care for those in need and 40% of the level one trauma care.

So, given the critical role—and I like what you said, like we are not just essential to the communities we serve. Like my line is that these other hospitals can't do what they're doing if we're not doing what we're doing. And so, the intricacy and the interconnectedness is so critical. If we know that we rely on each other, why do you think there's still a disconnect in the public understanding about our role and how critical we are?

Jennifer DeCubellis: I think you don't necessarily know the role of a safety net health system until you've experienced it and not everybody has had that experience. I know personally, I've had family members that have hit trauma points where I have never been more grateful that my local safety net hospital was there, because they save lives every day, they have a specialty that others don't have. So, I do think it is a little bit of the complexity of healthcare. Healthcare is so complex and where we get our information from is either our personal experience or it's whatever social media we tend to follow. And right now, the misinformation that is out there is tremendous.

So, healthcare is complex. It's highly regulated. People often believe that if you've seen one health system, you've seen all health systems. All it takes is walking the hallways here to see the mission in the eyes of the team members here, to see the patients and the gratitude for the safety net services you provide to them every day, to know that this is different healthcare.

Host: It's an honor to be a part of this. And I know that healthcare is complex and it's changed in terms of what the expectations are for healthcare systems. I don't know that 60 years ago, it was the healthcare system that was thinking about, "Oh, transportation. You saw the Sinai vans outside." Like, "How do we connect you to food?" You know, all those social determinants that we understand now are so wedded to people's health. So as we are having actually greater need in our communities for, you know, these wraparound services, that means that we have to be this anchor and we have to address housing and food in addition to behavioral health.

So, how do the leaders balance these enlarging, growing expectations, with the financial pressures that threaten our livelihood, our existence on a regular basis?

Jennifer DeCubellis: Yeah. So, I would highlight the statistic you called out earlier, which is essential hospitals represent 6% of the nation, but 30% of the charity care. We play by the exact same rules as all hospitals. The funding is a little bit lopsided, because heavier—about 70% of the patients our members serve are in public programs. And we know for Medicaid, for example, it pays about 60 cents on the dollar, depending on the state, for your expense. So, think about any business, if I build buildings for a living, when I build a building, if I knew for every dollar I spent, I was going to get paid 60 cents, most people wouldn't do that.

Host: It's not a business, it's not a sustainable business.

Jennifer DeCubellis: You can't stay in business.

Host: Yeah.

Jennifer DeCubellis: So, this is a compassionate service that safety net hospitals provide to our communities, and yet it is woefully underfunded. So as we go into an environment where we're talking about cuts, you think about that six times the impact is what essential hospitals will face. And to your point, they're also trying to provide the transportation resources, the childcare, the housing, the employment supports, all of the good things that we know create health, which create—

Host: On 60 cents on the dollar.

Jennifer DeCubellis: Sixty cents on the dollar, which create workforce, which create economic development. So, these are often the economic engines. That support whole communities in getting our workers to work. Because if I'm not healthy, it's that much harder to work. So, that balancing act, I think, is our biggest challenge, is if we take a short term goal of a budget year and solving a state budget or solving a federal budget. And if that's what we're doing and we're cutting our way out of it, we're missing the whole point of essential hospitals, which is how do we invest in the right things so that people are successful so that we can drive whole community wellness? And that is a huge opportunity.

So, I think the challenge leaders face is it's really hard to invest when there's policies that are cutting and cutting .And a fact you haven't mentioned, which is hospitals across the United States are running about a -6% margin. Essential hospitals are -7% on average. So, that ability to invest in that very community that we care so much about is becoming harder and harder over time.

So, I think for leaders it is strategic partnerships. It is how do we all think differently about healthcare and think about it together. How do we band together as whole communities to say how can we invest and who do we need at the table? Because essential hospitals won't be able to do it alone. We absolutely need government partners. We need community partners. We need other nonprofits. It is how do we pool our resources to do smarter and better because it matters so much to whole communities.

Host: And I love the idea of bringing all the different partners together. And let's not forget our corporate partners, right? What corporation doesn't want a healthy workforce, right? And so, really bringing them to the table and thinking about what their role is to support this work is going to be an important path to sustainability. So in Congress, there's been this growing discussion about creating a formal federal designation for safety net hospitals. What does that mean for essential hospitals across the country and how and why is that conversation happening now?

Jennifer DeCubellis: Really excited about it because I do see it being critical right now, and we've seen it play out. So, the designation is if we don't know who safety net hospitals are—some states like Illinois have a definition. But if we haven't formally designated it at the federal level, it's really hard for them to know who needs the support. So, who needs that six times the impact? Who needs that additional support? We have to define who they are so that we can get some interventions. Examples are during COVID. The federal government put out safety net funding because they knew disproportionately essential hospitals were hit, because so many of our patients, they were the essential workers that were having to show up. They couldn't shelter in place. They were often unstably housed, unstably employed. So, it was an impact. We know people of color. We saw the illness for COVID and the detrimental loss in the mortality rates, hitting that community harder than others.

So when the government worked to step in and provide safety net funding, they didn't know who we were. So instead of waiting for a crisis, let's define it now so that before that next crisis hits you know exactly who are those firefighters running in and you're arming them with the tools to run in. I see opportunities when we talk medication shortages, supply shortages. If we get into competitive bid wars, those -7% margins mean you can't get the supplies you need. And remember, these are often our high specialty care. It is our burn centers, it is our trauma centers. They are the folks that other systems don't even provide that level of care. So, we need to make sure.

At Hennepin, I was worried about the saline shortage, is a great example. Down the street from me, I had an athletic group that was doing rehydration of athletes. And I was working with our teams to count the bags of saline we had, worried about the next helicopter that landed on my rooftop that was a burn victim that I might not be able to save a life. A designation allows us in those critical moments to say, "Here's who we need at the front of the line. Here's who we need to make sure." And everybody should care about that, because it can be any one of us as a burn patient coming in that didn't know that I'm entering a hospital where that shortage is happening, yet those athletes down the road are doing just fine.

So, the designation will allow us to make sure we're protecting that critical infrastructure with your public health background. It's like what is the public health approach? Yeah, it is to say, "Let's identify it now so that we can be there when the communities need us most."

Host: It seems so basic. You want the fire trucks to know where they're going. But, you know, like we heard that there's a fire, but we don't know where to go, right? And be able to hone in already have us mapped out, these are the ones we've got to tend to. That is such a great strategy, and I know that you will get that over the finish line.

You mentioned partnership and collaboration. It's more important than ever, right? And as we think about partnering with our policy makers, with our community organizations, other health systems, how can they actually strengthen the safety net care and how does AEH help to promote and curate those partnership and collaborative opportunities?

Jennifer DeCubellis: Yeah. You are absolutely right. I often talk about healthcare as an ecosystem. That we have reliance on each other. And so, identifying who those critical partners are, who needs to be at the table. You know, we're working at the state and the federal levels to make sure that we are the problem solvers. So, we don't actually want legislators to solve what needs to get solved in healthcare, because we're the experts. So, we want to use our voices and lean in together.

Those strategic partnerships and the work that AEH does is we are looking at how do we align with one voice? How do we make sure we've got an ability to spread some of those best practices, but then where do we see partners that we do need them to lean in differently? Whether it is insurance companies, and let's make sure we all agree bills need to be paid the right way the first time, because if all of us only have to touch those things once, more dollars actually go to patient care, because we're doing it smarter and we're spending our dollars for that patient interaction, not the administration of that. And I think there's some huge opportunities there to get more dollars to that patient interaction, which is where I think everybody in the United States wants their dollars going, and less on that complexity of the administration.

The partnerships you've done here around housing are incredible. if there's a community need and we can bring partners together to solve a problem, then let's get creative, roll up our sleeves, get to the table and do that. So, what we do is we do a lot of highlighting of where we've seen those partnerships working, spreading it and making sure that people know that we need to identify the problem. But as I tell my kids, identify the problem, be the solution. Be the ones that lean in, roll up your sleeves. And get the work that the community needs us to do done.

Host: Yeah. And then, that's so fair. As well meaning as our legislative partners may be, like, they're not the experts, right? We're the boots on the ground, we're the experts. And so, really being able to not just say, "Here's the problem and here are the ways that we think we can tackle it. And we want to help guide you so that we can do the right thing for you."

Jennifer DeCubellis: We're bringing our partners with us, because it's going to take all of us giving up a little bit, doing things different and being open at the end of the day to saying if our community is better off, who's against that?

Host: Yeah. Again, putting those people at the center. Speaking of a program that really puts our patients at the center, let's talk about the 340B drug pricing program. We know that that's critical for safety net hospitals. Can you help our listeners understand why protecting a program like this is so critical for the communities that we serve?

Jennifer DeCubellis: Absolutely. So, 340B, great program developed at the federal level, really intended to provide the support so that nobody has to forego medication. That was the impetus. It was to say, "Let's provide a vehicle to make sure that no matter my financial situation, no matter where I show up for care, nobody has to decide between do I get my cancer medications or do I not?" So, the 340B program really was intended to make sure that a medication decision doesn't have to be made for a patient at the end of the day that we make it accessible. And it was meant for essential hospitals. And I think they've done an amazing job.

I have traveled with America's Essential Hospitals. I've traveled the nation over the past six months and seen incredible stories about patients' lives saved, chronic disease kept at bay, because somebody was able to get their medication, whether it was the systems, that 340B funding and they put it towards outreach so that we can outreach to people who haven't picked up their medications to say, "We noticed you missed your medications. What's the barrier? If it's that $5 copay you've got, we're going to make sure you get your medications. We're going to get it to you." It is the people that say, "I can't afford to undergo this treatment." It is the patients who maybe have lost benefits because of an incarceration, a long hospital stay. You don't want to discharge them to the streets or to home and not have their medications.

So, the program is meant to reduce costs to keep people healthy, to invest in wellness and to overcome barriers that patients have in getting the healthcare they need. So, it's working. And what we have to do is protect it and tell that story of the lives behind the medication decisions that we used to have to make before 340B, and the difference it's making. So, I go back to that. We want to make a difference every day, and that is what essential hospitals are about. And getting people their medications when they need it most is a critical part of that.

Host: Yeah. We're really excited for what we've been able to do in the city of Chicago. We've had two major, like wholesome events, like the community being at the forefront of these 340Bs, you know, rallies, if you will, to really raise the volume on how critical this is. And hearing the patient's stories, we had a cancer patient stand up and say, "That's a false choice. Do I get my cancer medicines or not? That's a false choice. And people shouldn't have to make that." And so, hearing directly from the patients that's hopefully going to touch the hearts and minds of the people who are making the decisions to say this is a good program. So, we are keeping our fingers and toes crossed that this great work and this great program will continue, because it is an important lifeline for the patients and the hospitals that are serving these patients.

Jennifer DeCubellis: And what I hope is people can put themselves in the shoes of others to say, if this was me, if this was my loved one, if it was my mother, my father, would I want them to have access to that medication? Absolutely.

Host: It's a matter of health justice. It's a matter of health justice. And we hope that everyone believes that we all deserve access to the care and the medicines that we need. And we just got to act on it now. It's not just a mantra, it's something that requires action. So, this has been such a great conversation. And I always like to end on a super high note. And so, from where you are from being on the front lines to now being essentially our national advocate, what gives you hope? What gives you hope for the future of essential hospitals and the communities that we are so blessed to serve?

Jennifer DeCubellis: Walking the hallways. Walking places like Sinai, Chicago. You see the mission. You see the commitment and you see the compassion, and that's how healthcare should show up every single time. So to your point, this isn't a business. It is an investment in the communities that essential hospitals serve. And on my hardest days, that's all I have to do is tour one of these facilities to see the people that show up every day to invest in health and wellness in their communities to make a difference. Even when it's hard, even when there's threats of cuts and hard times coming, they continue to roll up their sleeve and show up because it matters so much to the community.

Host: No, thank you. Thank you for all that you've done. Just through your life's work, you are the right leader for this time. And so grateful that you have been in this role already. Just six months, but crisscrossing around and just the perfect advocate for such a time as this.

Jennifer, I just want to thank you so much. Thank you for taking on this role. Thank you for joining us today and just for your extraordinary leadership. Your perspective from all the things that you've done is going to offer an important reminder to everyone of how vital safety net systems are. And there's no better leader to amplify our voices.

At Sinai Chicago, we see firsthand the critical role that safety nets play, And we are committed to ensuring access and advancing equity and caring for those who need it the most. So, thank you for partnering with us in this work. And we are so grateful for America's Essential Hospitals. And we are grateful for the protection that you're offering to institutions like us.

So, we can't wait to see some of the things that you're going to get done. And I love the idea of you sharing best practices as we figure out the solutions, some of the things that have worked across the country and sharing that. You've connected me with other people, our facilities people who are dealing with our aged infrastructure. You've connected our facilities people, our general counsel, you know, figuring out how we're going to exist in this new AI world. We appreciate that partnership and collaboration. And I just say thank you and thank you for your leadership and thank you for joining us here on More Than Medicine

Jennifer DeCubellis: And thank you. It will take all of us across the entire nation, because healthcare touches everyone. And we appreciate all the partnership to make sure we get this right.

Host: Awesome. Thank you.

Jennifer DeCubellis: Thank you.