February 9, 2023
Gary Bisbee, Ph.D.: Well, good morning Andy and welcome.
Andy Anderson, M.D.: Thank you, Gary. Good morning.
Gary Bisbee, Ph.D.: We’re pleased to have you at this microphone. You’ve been a highly successful physician executive for now, 25 years or so. What did the young Andy think about leadership?
Andy Anderson, M.D.: The young Andy thought leadership was extremely important and really looked at role models. as I was in college and in medical school and, looking for leadership and trying to identify the characteristics of effective leaders. And I think there’s a tremendous amount of learning that comes from, following other leaders, understanding things they do well, understanding things. They did do well in learning from.
Gary Bisbee, Ph.D.: Did you first become interested in medicine?
Andy Anderson, M.D.: Yeah, I was always a science and math kid. And then in college as I volunteered at a hospital and really saw how patients can be, Helped in the healthcare setting. And then behind that the problem solving and the science behind it was fascinating and really drew me into the field when I was in college.
Gary Bisbee, Ph.D.: Are you still seeing patients?
Andy Anderson, M.D.: I am. I am a general internist by training. Worked as a hospitalist for many years and currently continue as a primary care physician. I work in a resident clinic and I’m seeing more urgent care type patients and teaching our residents at the same time. I very much enjoy that. It keeps me engaged and happy, and it helps me understand, what’s happening at the front.
Gary Bisbee, Ph.D.: Well, you’re both practicing and leading. What brings you joy in your work? Andy?
Andy Anderson, M.D.: I love seeing patients do well. And that cuts across their experience their quality outcomes and the safety culture that we all are trying to achieve and having those great outcomes. And seeing our team members deliver those great outcomes that’s where the joy is and knowing that we can continue to do that better and better, that’s part of the inspiration that brings me to work every day.
Gary Bisbee, Ph.D.: Well, you’re now Chief Medical Officer and Chief Quality Officer at R W J Barnabas. Can you describe R W J Barnabas for us please? And.
Andy Anderson, M.D.: Yeah, absolutely. Our WJ Barnabas is the largest integrated academic health system in New Jersey. We’re a $6 billion. Revenue company and serve about two thirds of the population in New Jersey and provide the continuum of care from our hospital setting to our ambulatory footprint. We are very focused on delivering those great outcomes. Also have really spent a lot of time trying to understand our communities. And looking at social determinants, looking at diversity, equity, and inclusion and trying to help our communities be healthier. So our mission is to achieve healthier communities and we believe we’re doing that through delivering great care as well as through prevention and promoting health.
Gary Bisbee, Ph.D.: So as the chief medical Officer and chief quality Officer, what are your responsibilities?
Andy Anderson, M.D.: I’m responsible for those outcomes. And the focus on our quality, our safety, and our patient experience. And that encompasses our entire platform of services. I’m also responsible for our academic mission. We have a very strong partnership with Rutgers and that crosses our graduate medical education programs our medical student nursing programs physician assistant and the whole allied health professional field. Rutgers is really our pipeline. And then additionally our research mission. Trying to deliver the best, possible care the latest and greatest with technology incorporating evidence-based medicine into our practice. I also have oversight of our laboratory and pathology service line, and then our population health infrastructure as we truly do try to keep our communities healthier.
Gary Bisbee, Ph.D.: Well, the obvious question, Andy, is what do you do with your spare time?
Andy Anderson, M.D.: Well, for me having time with family is the very most important. My wife and our three kids we enjoy time together. We enjoy traveling, we enjoy watching movies. So having that time to disengage is very important. And I look forward to that every day and every weekend.
Gary Bisbee, Ph.D.: How did the care delivery team at R W J Barnabas. Fair during all the covid activities.
Andy Anderson, M.D.: We were with the early wave in March, April of 2020, and we had, many of our employees suffer and some died. And so there was, quite a bit of Of challenge. I would say in the beginning to get organized around our covid response, but we did, and we were able to be innovative and we were able to do things much more quickly than we ever thought we would. We stood up a telemedicine platform and we’re doing 10,000 visits a week. Over the course of less than a month, we were able to accomplish.
Gary Bisbee, Ph.D.: Well, how about the medical staff in particular? How did the physicians fare during Covid?
Andy Anderson, M.D.: Yeah, the physicians really stepped up and helped tremendously. We had physicians who were doing work that they normally wouldn’t do, for example. We had physicians normally who would spend the majority of their time in the outpatient setting coming into the hospital to, to help take care of patients. So it was amazing to see the physicians really step into it. We purposefully tried to make sure that we were supporting, recognizing, know, reaching out to our physicians because it was a tough. And we continue to have some element of surges in infectious diseases. And if anything, I think it, it has built some great resilience and some systemness and people helping each other out where maybe they wouldn’t have done that before. So it created a network of relationships of our physicians that it really strengthened us as a health system.
Gary Bisbee, Ph.D.: Let’s turn to. Specifically leading physicians, could you share with us what’s the history of physicians being employed by health systems or large hospitals and health systems?
Andy Anderson, M.D.: Yeah there’s been a trend, I would say, over the past 10 to 20 years of physicians becoming aligned with health systems. The days of. Putting up a, a shingle and having your private practice by yourself is those days are behind us. COVID brought some of that out. It became economically challenging to survive as an independent practitioner and having yourself really tied into a health system was value added. And I think that is the trend that we’ll continue to see. And I do think it, it helps bring that coordinated, integrated care to patient.
Gary Bisbee, Ph.D.: Is that different orientation? In terms of let. Employed at a health system versus in private practice. Do you think that influences the type of person that wants to become a physician and go to medical school?
Andy Anderson, M.D.: I think the underlying motivation is as it has been and it is to help people. Being a physician, being in healthcare, it’s a noble profession and we’re all after the same thing. And that’s to make people better and to keep people well . I think the motivation continues. I think integrated health systems are a better way to, to have that coordinated, integrated care so that physicians and nurses and other health professionals can truly see their patient being cared for by a comprehensive team of experts and with the patient at the center of that. It creates the best outcomes. I think if anything, the movement of healthcare to become more organized around systems of care is gonna be very motivating and it’s gonna draw more people into the field.
Gary Bisbee, Ph.D.: Yep. That’s good to hear. This is a general question, Andy, as opposed to specific to R W J Barnabas, but what’s the difference in role between a chief medical officer and let’s say the president of the medical staff?
Andy Anderson, M.D.: The president of the medical staff and the CMO of a hospital, as an example are very close partners in trying to, for one, make it, easier for physicians to, to do the work that they do and to provide the support, needed in the hospital and or in the ambulatory setting to, to be able to do that. Tackling issues together. I think is what we’re all after and trying to solve them so that we can help our fellow physicians is what the goal is.
Gary Bisbee, Ph.D.: Would it be fair to say that the chief medical officer is more focused on delivery in the hospital and the president of the medical staff is more focused on just delivery in general terms? Is that fair or not? Andy?
Andy Anderson, M.D.: I think the lines are blurred appropriately. And I do think the chief medical officer role is quite important in terms of delivering the care, making sure the outcomes are where they need to be. And then the other place I’ll pull in here is the partnership with the rest of the team in the hospital. So the CMO in particular must be a close partner with the chief nursing officer, the chief operating officer, the CEO of the hospital, and the support services, in the hospital themselves. The medical staff president in many ways is the representative for the physicians and the voice of the physicians. But my goal is always to bring as much alignment as possible. I think the overlap of objectives and goals and outcomes is, they are 90% of the time, and if we all can row in the same direction together, as I’ve seen happen in my system and in other systems, the outcomes are truly.
Gary Bisbee, Ph.D.: Let’s turn to data for a moment, and the electronic medical record is a core source of data. How has your job in terms of quality and measuring quality and outcomes, how’s that evolved? And as the E M R has evolved,
Andy Anderson, M.D.: Yeah, I think we’ve all seen the E M R as the ultimate, solution, but we haven’t quite gotten there yet. And we continue to see it get better and better. And part of what we’re after is real-time data. And so as we look at. Things like Leapfrog, c m srs, US News, the, the data that goes into, to those numbers and grades, is old data. And so in some ways you’re looking at the past and what we need is looking, real time at what’s happening right in front of us. And The EMR, ideally, is gonna be the source of that data realtime. And again, it’s gotten better. But I think, what I’ve been pushing at is trying to make sure we get physician level, realtime data so that physicians can truly know how they’re doing and compare themselves to others in their field. And then also I’ll call it unit level data. For example, a hospital Florida, that operating unit within a hospital should have real-time data. How are they doing? Has there been a pressure ulcer? Has there been a central line infection? Those things, again, we’re getting better and better at, at tracking them, but I think there’s still room for improvement. Data is extraordinarily important. It provides transparency, it provides benchmarking. It really can be motivating. Physicians are very competitive, and so when they see data and they see themselves compared to others it spurs them into action, which is a good thing.
Gary Bisbee, Ph.D.: There’s been a lot of criticism. Through the years about the number of quality measures and there’s just too many of them, and the amount of time and energy to collect data for them exceeds any value. How would you think about that, Andy?
Andy Anderson, M.D.: I would agree. There are too many and I think about that every day in terms of how to simplify. And part of what I’m trying to do is to focus on those elements that are the most important elements. For example, hcaps are patient satisfaction survey data For us it applies to, to leapfrog SEMA stars, US news, paper performance, and of course it’s the right thing to do for our patients and families. And so pulling out, hcaps as a focal point. For our health system has been part of my role. There are other elements of quality that are also, impactful like mortality. That’s the ultimate outcome. And so hcaps and mortality are two areas that our health system is hyperfocused on to make sure that we.
Gary Bisbee, Ph.D.: So our WJ Barnabas. Academic medical center, certain health systems aren’t necessarily affiliated with an academic institution. Is there greater kind of quality requirements because you’re an academic medical center or not?
Andy Anderson, M.D.: Well, the grading, if you will, from CMS stars, US News and Leapfrog looks at objective criteria no matter what type of hospital you are. And so in many ways, for an academic medical center, Where you tend to have more complicated patients, that does make it even more of a challenge and the responses that we staff to, that we make sure that we have the expertise, the technology, the support structure to be able to care for those patients and get those great outcomes. Our health systems is a mix of community-based hospitals and academic-based hospitals. And, part of our overall fabric is to spread the teaching and research mission generally across the system. And if anything, over time, I think we’ll look more alike than we look different as we deliver standard best practice.
Gary Bisbee, Ph.D.: Yep. How about the board of directors? Is the board intimately familiar with the quality data and trends that you’re running into in terms of quality data?
Andy Anderson, M.D.: We’ve made an effort to be sure that they are. And some of our board members are very articulate, very, skilled in quality and safety, which for us is, it’s very helpful. It, it actually is a blessing, if you will, for the. For the board to pay attention to, to call it out as one of our core, areas of focus. It creates energy, it creates accountability. It helps us to deliver better outcomes when our board is engaged and tracking these outcomes with us. So I value that. I welcome that. Transparency me is a powerful motivator. It makes us all get.
Gary Bisbee, Ph.D.: One of the major trends we’re seeing now is that large, big cap companies like C V S and Walgreens and Walmart, and. Optum and now Amazon are elbowing their way into primary care. At least they’re trying to elbow their way in. What do you think about that trend, Andy?
Andy Anderson, M.D.: The last thing we wanna do is fragment care. So having the integrated, coordinated, connected system of care is the ultimate model that’s gonna work best for a patient. To your question I am concerned about, fragmenting care. There’s a role for things like urgent care for problems that can be fixed quickly, but in, in the management of chronic disease and in the promotion of health. Having that integrated system around you, I think is extraordinarily important.
Gary Bisbee, Ph.D.: Yeah, some of those companies are actually buying or employing physicians either individually or ac acquire. In groups of physicians, do you see that trend picking up steam or continuing Andy, or is that kind of a short term trend that will lose Its lose its steam over time?
Andy Anderson, M.D.: As this evolves, I think that primary care network is gonna have to interconnect with the specialty care network, with the hospital setting, with the ambulatory surgery setting. So it’ll be interesting to see how that plays out over time. I do think the ultimate winner in the healthcare sort of game will be the integrated health system. I think that is the best model for providing patient-centered care and to achieve those best outcomes. So I do think over time we will see more of that sort of large integrated health system network as being the place of choice for our patient.
Gary Bisbee, Ph.D.: Well, let’s turn to innovation in. Care and particularly the term precision medicine, which has been around for a while and probably hasn’t lived up to what people had hoped but seems to be gaining steam here as we have more data and more precise data in other technologies. What, how do you view precision medicine, Andy? Where are we today relative to maybe its promise.
Andy Anderson, M.D.: Well, I remember learning about precision medicine in medical school 30 years ago, so we’ve certainly been, speaking about it for quite some time. And I do think we’ve made quite a few advances. As a healthcare institution in our country, and we’ve gotten better at in areas such as cancer and making sure that we know which chemotherapy drug is gonna work for which particular patient, depending on their genetic profile. The challenge is the cost of personalizing medicine is a, it’s a big cost and so we wanna make sure. There’s availability across, all of our citizens in this country for the therapies that are gonna work. And so over time, the costs tend to come down as some of the therapies get commoditized. So I think it’ll be a, an evolution that’ll take, years to play out. But I do think that is where we have to go. We have to make sure that as an individual, you’re getting the best possible treatment depending on who you are and what your genetic profile looks.
Gary Bisbee, Ph.D.: Andy, this has been a terrific interview as we expected. By the way I have two. Final questions, wrap up type questions. The first one is, what advice do you give people that approach you that might be interested in medicine and they’re trying to sort out whether they do want to go to medical school or nursing school, perhaps. What advice do you give someone like that?
Andy Anderson, M.D.: So I encourage individuals to go into healthcare when I think about it from the professional level. . I often will see medical students who are, eager to move into, I’ll call it the business of medicine. And my advice always is become a great doctor first. Become a great nurse first. Make sure you’re clinically competent, that you’re able to deliver, the best possible care in your field and that enables you to be a better decision maker. In the business of medicine, as a leader you have more credibility, you have more knowledge, more experience, and you’re able to make change as a leader in the long run. So becoming a, an excellent indivi individual in your trade really is step one that everyone needs to do.
Gary Bisbee, Ph.D.: Second. And the final question in this category is, what advice do you give to healthcare leaders? Be they a physician or not a physician that are interested in becoming more involved in health system leadership. What advice would you give an early up and comer.
Andy Anderson, M.D.: I’ll go back to where we started and really encourage everyone to find great mentors. And. There are many mentors out there who would love to be teachers, coaches, really trying to help develop the next generation of leaders and you learn so much by following and learning from great leaders. Secondly is. Reading voraciously, trying to make sure that you understand the field of play and the different elements that are happening across the healthcare industry. The more knowledge that more knowledge you have the more likely you’re gonna be able to apply that knowledge as an effective leader. And then thirdly is understanding the different fields and not thinking of your own field in a silo. As I mentioned before, partnering with nursing. Social work, physical therapy, dietician, et cetera. Trying to truly understand those different fields and how they all interconnect and really come back to the patient and trying to make sure the patient is getting that comprehensive array of services that they need for their health and their healthcare.
Gary Bisbee, Ph.D.: Great advice, Andy. Thank you for your time today. Terrific interview.
Andy Anderson, M.D.: Thank you, Gary.