Premiere: Dr. Andy Agwunobi, UConn Health CEO

In our debut podcast, Dr. Alessi starts at the top, with “Dr. Andy” — Dr. Andrew Agwunobi, UConn Health CEO and executive VP for health affairs. Dr. Andy shares his thoughts on the state of health care delivery, what he learned from his experience in the private sector, and the big things on the verge of happening with the upcoming partnership between UConn Health and Waterbury HEALTH. Submit questions for Healthy Rounds With Dr. Anthony Alessi: [email protected] Dr. Andrew Agwunobi: https://www.uconnhealth.org/about-us/leadership UConn Health: https://www.uconnhealth.org Support from UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine Grant support from Coverys: www.coverys.com Watch this interview on YouTube: https://youtu.be/bdH6geAXAAY Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery and a grant from Coverys. It is not designed to direct your personal health care, and that should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it gives me great pleasure to welcome my guest today, Dr. Andy Agwunobi. Dr. Agwunobi is the CEO of UConn Health, as many of us know. He’s also the executive VP for Health Affairs here at the University of Connecticut. Andy, welcome to the show. Dr. Andy: Thank you, Tony. Great to be here. Dr. Alessi: Well, first of all, let me thank you for this opportunity. I mean, this opportunity would not happen without you and other people and the opportunity to produce a podcast and bring together a community of people from our community who want better health care, and we appreciate that. And especially this is our first episode Dr. Andy: Right. Dr. Alessi: So it’s great to have you as our first guest. Dr. Andy: Well, it’s a pleasure. Dr. Alessi: But let’s get started. As far as your career goes, what made you want to make kind of the switch from clinical medicine to really, to health care administration? Dr. Andy: Well, I think the short version is it probably started with my father, who was a general surgeon, British trained, but he also was a businessman at varying levels of success. I mean, he had at one time he had a pharmaceutical import export business, and at one time he was doing selling I think he had clothes that he was doing import, export, so a trucking business. So I grew up believing that you could do both, you could do sort of business and health care together and that was a normal thing. But I think maybe even more important to me was I just, I just like people and I like solving problems. And I always felt like if I could bring my, sort of, my, my, my love of interacting with teams, but use that to help solve problems in health care that would be perfect for me. Dr. Alessi: You know, several years ago you left us, and I like to think you went behind enemy lines, okay. you went and found out the secrets that they’d been hiding from us over in managed care. how had that experience helped you and what was that like? Dr. Andy: It was great. Just, for people, that are listening, I started as the CEO in UConn Health in 2015. And in 2022 I decided to join Humana which is a national managed care organization, to run their home solutions service, which basically is everything that happens outside of hospitals, so home health care, nursing homes, et cetera. And I did it for a couple of reasons. One is, I wanted to really understand that, that business, because I feel like a lot of care is going to go into the homes where meet people where they need the care. But I also wanted to see what it was like to run a national health care organization. And so I learned a lot, I enjoyed it, but it did teach me that we don’t put enough resources into making sure that the services that, I’m talking about in general, hospital industry, Dr. Alessi: Sure. Dr. Andy: but the services that we provide to patients are paid for fairly. Dr. Alessi: Very interesting, and, and since you bring up the national picture, I’d like to know, I mean, let’s face it, in the United States, we’re great at innovation, we’re great at research. But we’ve kind of failed when it comes to delivery of health care, and you’re a national leader, you understand the national perspective. How do we fix this? Dr. Andy: Well, I think you’re right. I mean, one thing I do want to underscore is how great we are in innovation. If you think about the NIH, NIH is the world’s largest funder of biomedical innovation, something like 37 billion a year. And then you think about venture capital, you think about private equity, you think about startups, entrepreneurial culture, we are sort of a center for innovation and, and entrepreneurial. And not just within our country. People come from all over, from Israel, Dr. Alessi: Absolutely. Dr. Andy: from everywhere to do that. So, that’s one piece of it. But the other piece of it is when that innovation comes into health care, number one, it comes typically at a very high cost or very high price. And it’s partly because of the way we’re set up and I think delivery of care, I mean I could talk about sort of tactically, we don’t have the right primary care, we don’t have full primary care coverage, we don’t have full insurance coverage, we have gaps in access. But I think one piece I want to highlight is when those innovations come into what is a broken care delivery system, they’re not coming, they’re coming at a very expensive cost. And I’ll just give you an example, just hypothetically. Dr. Alessi: Sure. Dr. Andy: when startups pitch to hospitals and they pitch to clinical groups, they’re typically pitching a high price, no risk, per click, fee for service for an innovation, Dr. Alessi: Sure. Dr. Andy: and that can drive up the cost of health care instead of being a solution. Hopefully AI will be different. Dr. Alessi: When we think about it, and you brought it up in terms of health care delivery, what are the biggest touch points? Is it pharmacy benefits? Is it physician fees? Is it hospital costs? If you were to attack this, people like to just pick one target, and I understand there are a lot of targets here, Dr. Andy: Right. Dr. Alessi: But where do you think our biggest failing is? Dr. Andy: So, you’re right. I mean, costs are, there’s so many pieces to our system. So for example, hospitals are 30% of costs. Pharmaceuticals are, although they’re only sort of 10% of costs, they’re growing at a rate faster than all of the other cost categories, particularly hospitals, et cetera. And if you look at our pharmaceutical prices compared to other developed countries, we are double what their cost are, right? Dr. Alessi: Sure. Yeah. Dr. Andy: So we could look at all of those. And even when you look at physician prices their costs are like 20% of the total long-term care is like 25%. So there’s a, there’s a lot of categories. One of which, by the way, is administrative burden, when you, when you take both payers and providers, and you put the administrative costs, and we’re talking about things like billing costs, revenue cycle management costs, HR, prior authorization, you take all of those, denials management. Dr. Alessi: Sure. Dr. Andy: You take all on both sides. You take all of that, that’s 15% of the costs, right. Dr. Alessi: Wow. Dr. Andy: So, and by the way, they believe it’s, it’s studies have shown that of the total, which is about 950 billion, about 260 billion of that is wasted, right. So, so there’s a lot of categories, but, but getting to your question, if I had to choose one, I would choose misaligned incentives. Because if you think about it, there’s a lot of money in health care. But the insurance companies are maximizing their margins, the hospitals are maximizing their margins in order to deliver care, doctors who are not employed by hospitals are doing the same. And so if, if we all got together and if, if there was trust and we came together and said, okay, wait a minute. How can we best spend this money so that we’re not 17.9% of the, the economy of the United States and growing. How can we get it down where, where we’re not wasting anything that we don’t need to waste and we’re delivering it? I think we could, we could make big headway. So I would say misaligned incentives are the biggest piece. Dr. Alessi: I think that’s a, it’s a great point. It, what it brings to mind is the VA. Dr. Andy: Mm-hmm. Right. I’ve worked in a VA system for a while when I was at the University of Michigan at the Dr. Andy: Right. Dr. Alessi: And if we look at that as a socialized system, for example, they had really the first efficient medical records, right? Dr. Andy: Yes. Yes. Dr. Alessi: In the 1990s, a vet could go anywhere in the country. Dr. Andy: With great medical record. Dr. Alessi: And their records were there. Dr. Andy: Yeah, perfect. Dr. Alessi: But they couldn’t afford to keep it up. Dr. Andy: Right, right, right. Dr. Alessi: would that be the kind of system we should strive for? I hate to use socialized or universal, but in at the VA, right, everybody is kind of aligned, I mean, from that standpoint. Is that a kind of system we should be thinking of or? Dr. Andy: Yeah I, I do think directionally that’s the system in the sense that studies have shown that when you have, that in countries that have universal health care, their access to care, their equity across different socioeconomic groups, their costs are less per capita than the United States, so I do believe that. But having said that, the, the problem is our foundational system, again, going back to misaligned incentives is so, I don’t wanna be doom and gloom, but it’s so broken. Dr. Alessi: Yeah. Dr. Andy: That just laying on universal health care on top of that would not work. Dr. Alessi: Sure. Dr. Andy: So there has to be fundamental design changes. And also you want to avoid, we need to learn from others, and one thing we, one thing we can learn is to not have the wait times that they necessarily have in the UK or maybe even have in Canada for certain types of care. Dr. Alessi: Absolutely. Dr. Andy: By the way, I wanna say this. Even though in terms of the other countries, we have higher costs per capita costs is about 14,000 per person versus 7,000 average for those countries, we do have the clinical quality and the clinical capacity to do something really special because what we’ve seen is that the care processes we’re number two when it comes to care. So that’s like safety. Safety and like prescribing. Dr. Alessi: Sure. Dr. Andy: We’re number two. We’re not at the bottom like we are in Dr. Alessi: Absolutely. Dr. Andy: In sort of life expectancy and things like that. Dr. Alessi: And that’s the point, right? I mean the life expectancy issue is surprising, right? That we spend so much money and we’re not living as long as people, for example, in the UK. Dr. Andy: Right. Exactly. But, but I think ’cause there’s always this sort of a dissonance where people are like, well, but yeah, but people come to the United States for care and I think that’s because we do have quality. Dr. Alessi: Yeah. Dr. Andy: We just don’t have coverage for everybody. We we don’t, we have a fragmented insurance system and we don’t have the primary care that we need. We don’t have enough pri-, we don’t have enough general practitioners. Dr. Alessi: Absolutely. Dr. Andy: And by the way, I’ll put a plug in to say, people say, well, what’s the solution for general practitioners? I think the solution for general practitioners is to pay them more. Dr. Alessi: Absolutely. Dr. Andy: Right? Dr. Alessi: I mean, that’s what they do in Canada. Dr. Andy: Right, if you pay them more, people will go into that profession. People don’t realize that a medical student can choose anything he or she wants to choose. And when you have such a difference between a specialist hard work Dr. Alessi: Sure. Dr. Andy: I mean, really hard work in primary care relatively low pay, you’re not gonna get people going into it. And loan forgiveness on its own is not going to work. So, so anyway, I, I don’t wanna go on a tangent. Dr. Alessi: No, I think it’s a good point and, and I think one of the issues in primary care is the paperwork. My gosh. They get dumped on more than anybody with forms and things like that, that people need. But, but I wanna move on a little bit. Dr. Andy: Right. Dr. Alessi: UConn itself, let’s drill down on UConn. Academically, how do we get ourselves into more of a national conversation? Dr. Andy: Mm-hmm. Dr. Alessi: Right? I hate to use the example of US News and World Report ’cause I think that’s really a PR move than anything… Dr. Andy: Mm-mm. Dr. Alessi: …but how do we get to that level? Or, or are we there Dr. Andy: Right. Dr. Alessi: and I’m just missing it. We are there in, in, I think pockets, but Dr. Andy: Right. Dr. Alessi: Not as an overall institution. Is it funding? Is it the fact that we’re not a private institution like Mayo Clinic or someplace like that? Dr. Andy: Right. Dr. Alessi: How do we get there? Dr. Andy: Yeah, I mean it’s a good, good question. I wish we had our, our Dean here as well, Dr. Alessi: Sure. He’s Bruce Liang and Dr. Lepowsky. But I do think part of it is, well, first of all, our schools, Schools of Medicine, Schools of Dental Medicine are extremely strong, right? Dr. Alessi: Absolutely. Dr. Andy: Which is the basis, right? I mean. They had something like 5,600 applicants for 112 slots in the, in the medical school, and 1,600 for 50 slots in the dental school. So we’re very competitive. Great academicians, great researchers and scientists. But I think maybe some of it is focus and really trying to carve our own niche for what are we best known for.  one of the areas that myself and Bruce have been working on is translational research, particularly since our clinical enterprise is so strong right now, growing faster than any other health care system in Connecticut. Leveraging that for translational research, clinical trials. And the other piece that I think we can really sort of supercharge a little bit is our commercialization of research. So I think we just we do a lot really, really well and we can talk about things that we are nationally known for, but I think we can, there are some areas that we can definitely strengthen and Dr. Liang is, is helping lead that. Dr. Alessi: I’m gonna put a plug in for my department over in Orthopedics. But I mean I came here from private practice. Dr. Andy: Right. Dr. Alessi: And I’ve worked with a lot of institutions over the years, Dr. Andy: Right. Dr. Alessi: … and our sports medicine people, I mean, as evidenced by our success in sports, Dr. Andy: Yes. Dr. Alessi: it doesn’t just happen. And Bob Arciero, Dr. Andy: Yes. Dr. Alessi: And, and the whole crew over there have done such a phenomenal job, but, I, it’s an honor to work with them. Dr. Andy: Well, I wanna thank you for your leadership and them, because there’s so many areas that we stand out in. If you think about things like Geriatrics Dr. Alessi: Sure. Dr. Andy: You think about Orthopedics, Sports Medicine. Think about Neurosurgery. I mean, I could go down the list. Dr. Alessi: I know, absolutely. Dr. Andy: but it’s, it really makes me proud. It’s one of the reasons I came back. I came back because I was sort of like, this is such an amazing academic medical center and the sky’s the limit in terms of the future. Dr. Alessi: Well, let’s talk a little bit about the future. You know, we’re going through this, I don’t know, purchase or alignment with other hospitals, Dr. Andy: Right. Dr. Alessi: Is that crucial to us moving forward? Dr. Andy: Yeah. Dr. Alessi: And is it because bigger is better? It gives us a better, I mean, now that you’ve been on the other side of Humana, does it give us more power? I, and I’m assuming that’s it, I don’t know? Dr. Andy: So yes, I think that this is a key part of our strategy. Now, it doesn’t mean that it’s only expansion outside. We also are doing what people call organic, which is inside expansion of all our different departments. But the reality is that we’re small. We’re one of the smallest academic medical centers in a consolidating market. So you have Yale New Haven Health System, you have Northwell, you have Hartford Health care, you have Trinity, all of which are huge, right? And then you have UConn Health and a few independent hospitals. Dr. Alessi: Sure. Dr. Andy: And so it’s important that we expand and expand why? Because of economies of scale, right? Where we can Dr. Alessi: Absolutely. Dr. Andy: We, we have the top line growth, we have revenue growth, we have patients. Dr. Alessi: Right. Dr. Andy: We’ve tripled our patient revenue in the last 10 years, but we’re out of space. So our surgeons don’t have space to operate. You know, they have space but they don’t have… Dr. Alessi: I understand. Dr. Andy: … extra space to operate, right, and so on and so forth, so continuing to grow that top line revenue, but doing it in an efficient way, right? Not as a state organization, but as a public private partnership. So those hospitals we’re talking about, Waterbury being the first. Dr. Alessi: Sure. Dr. Andy: These are going to be private. They’ll be a community network, private community network that we have influence on and can make sure that we’re proud of, the quality of care, the safety of care, and make sure that patients come back to those hospitals. But one of the other things that’s really important is what we’re doing for the state. We’re a public health system. We’re the state’s only acute care academic medical center, and the state wants to make sure that hospitals don’t close Dr. Alessi: Sure. Dr. Andy: because then that decreases access to care, but also that the economies of those communities remain. And so they’ve looked to us and said, you guys are doing such a great job, help us, the state, to do this. And it’s a huge responsibility and one we’re proud of. Dr. Alessi: When, and, and I think you, you actually brought up the topic already and that is when you merge or kind of work with these other hospitals, there’s always a problem of merging the culture. Dr. Andy: Mm-hmm. Dr. Alessi: It sounds like you want to keep the culture there ’cause obviously there’s a different culture in Waterbury than there is at Day Kimball Hospital, Dr. Andy: Mm-hmm. Dr. Alessi: or Bristol Hospital. So it sounds like you don’t want to bring, kind of destroy the local culture, Dr. Andy: Right. Yeah. Yeah. Dr. Alessi: Is that, is that the idea? Dr. Andy: Well I, it’s a tricky balance. Dr. Alessi: Yeah. Dr. Andy: Because we wanna do a couple of things. One, respect the local culture, but two, bring a level of specialist care to those hospitals that elevates their quality and their safety and everything that’s necessary in their patient experience. And we also want to treat them the way we believe they should be treated in a partnership. So there’s going to be some sharing and blending of cultures, but without losing either our culture or losing their culture. So it takes, it takes a little bit of it’s gonna be tricky, but again, I think leadership is all about working within ambiguity as opposed to clear, clear guidelines. Dr. Alessi: Andy, in closing, if we were to do this podcast 10 years from now, what does UConn look like? Dr. Andy: So, 10 years from now, UConn Health will be much bigger. It will be a model for the nation in terms of how you do public-private partnerships with state academic medical centers in the right way, where it benefits everyone, it benefits the state, and it benefits those private organizations in community networks. We will be independent on the clinical side, independent of state support. And by the way, last year that was $60 million was coming to us on the clinical side. This year, we’re down to about 10 to $15 million, but we would be independent of the state, so in other words, the state funds the schools… Dr. Alessi: Absolutely. Dr. Andy: … which it should do, schools and the research. But clinically we’re able to fund that through patient revenues, et cetera, and diversification of revenues. But I think most important to me as a physician is that we’re providing that we’re the best in the state, and I hate to be competitive, but we’re the best in the state in terms of quality, patient experience, and safety because ultimately that is the business of clinical health systems is patient care. And then you touched on it on the academic side, we continue to be a fantastic, high ranked, even higher ranked in terms of our schools, but have a national stature in terms of research, particularly related to clinical trials and translational. I think if that, if we did that alone, that would be, that would be enough. Dr. Alessi: Andy, listen, thank you. I want to thank you for your time today, but more importantly, as a physician practicing here, I want to thank you for your leadership. It’s great to have you back. I’m glad we got you back from Humana, and I look forward to the future with you. Dr. Andy: Well, I look forward to the future with you, and I wanna thank you and your colleagues for your leadership too. And thanks for doing this podcast. Dr. Alessi: Many thanks to my guest today, Dr. Andy Agwunobi. If you have questions or ideas for future podcasts, you can reach out to me at [email protected]. Jennifer Walker is the executive producer of the Healthy Rounds podcast. Chris DeFrancesco is our studio producer for the Healthy Rounds podcast. Until next time, this is Dr. Anthony Alessi. Please stay healthy.