Rae Woods (00:02):
From Advisory Board, we're bringing you a radio advisory, your weekly download on how to untangle healthcare's most pressing challenges. My name is Raechel Woods. You can call me Rae. As I hope all of you know, this podcast comes from Advisory Board. Advisory Board is a healthcare business firm that's actually been around since 1979. That means for actual decades, we've been around, watching the healthcare industry evolve. I like to think of our job as being there to tell health leaders what's happening in the industry, why it actually matters, and even predict what might happen next. And you get access to those insights and that research in lots of different ways. First of all, you get access to it through this podcast, and also through the materials that I like to add to the show notes.

(00:55):
But there's another way that Advisory Board delivers its insights and its materials to leaders like you, and it's through in person or virtual discussions with our researchers and with our national spokespersons. Today I've invited Advisory Board's national spokespersons to this episode. We want you to know what our role is at Advisory Board and help you understand all of the different ways that we're in the market helping leaders like you. To do that, I want to welcome Ford Koles and Aaron Mauck to this podcast. Hey, Ford. Hey, Aaron. Welcome to Radio Advisory.

Aaron Mauck (01:34):
Thanks, Rae, it's an honor to be here.

Ford Koles (01:36):
Thanks for having me. My first visit to Radio Advisory.

Rae Woods (01:38):
I know.

Ford Koles (01:41):
Why did it take me this long? Or probably more appropriately, why did it take you this long?

Rae Woods (01:44):
I know. You can blame me, Ford.

Ford Koles (01:47):
I don't think this is Aaron's first visit, however.

Rae Woods (01:49):
It is not. Aaron is a veteran at this point. You'll get there too, Ford. I promise.

Ford Koles (02:04):
You thought to interview Aaron and me as the national spokespersons. However, why so modest? Because there's a third national spokesperson by the name of Rae Woods, so I think it's a fair question to turn it around on you and ask you how that feels. And also, Aaron and I are both wondering when you're going to woman up and get back on the road, leave the studio, leave the pillows in the green room, and get back out there and see 32 E by the crapper with the really talkative insurance salesman in the seat next door.

Rae Woods (02:33):
I am proud to be the newest national spokesperson for Advisory Board. And I'm excited to get back on the road. I'm still going to keep hosting the podcast, so my padded room and the comfort of my microphone and my sweatpants is still going to be a regular part of my weekly experience, but I am going to have to get back into seat 32 E.

Ford Koles (02:54):
Excellent. Yeah.

Rae Woods (02:56):
The three of us are the spokespersons for Advisory Board Research. What does that mean? What do you want our listeners to think of when they think of us?

Aaron Mauck (03:06):
I think a couple things, we're trying to offer a perspective on the market and our research, and how we've interpreted some of the dynamics that we've seen in healthcare today and over the course of the last 18 months or so. At the same time, of course, we're there to listen to the market, to be in conversation with folks out in the market, to hear their concerns, [inaudible 00:03:27] for priorities and find solutions for them.

Rae Woods (03:29):
And there's this tendency when people hear the word spokesperson to think, "Oh, they're just a face. They're just a voice. They're just a talking head." And that is absolutely not true.

Ford Koles (03:40):
No, absolutely not. It's always been referred to as the face of the company. To your point, Rae, there are accurate parts of that and not accurate. The truth is in this job, more people will know you than anyone else at the Advisory Board. Far more people know my name, I'm not bragging, I'm just saying a weird truth, far more people know my name than have ever known the name of the CEO of the Advisory Board, for example.

Rae Woods (04:04):
I mean, you're bragging a little bit. It's okay.

Ford Koles (04:05):
I mean, that's also, it's March and I'm at 32 trips right now, so it's not so much bragging as it is just raw exposure. Right? The inaccurate interpretation is to think that's a talking head.

Rae Woods (04:17):
Yes.

Ford Koles (04:18):
Face of the Advisory Board, representative of the Advisory Board, yes, but there's no research team standing behind us when we're at the podium, or in the conference room, or at the conference. You need to be as vested and familiar with the deep thinking in healthcare as anybody back in Washington DC or any other office at the Advisory Board. Everything at the Advisory Board, as you know Rae and Aaron, is group thinking. One of the things you have to get used to, and I had to get used to this 31 years ago when I got there, there's no one author of anything that we do. All the research, every project, every insight, every best practice is the result of multiple people taking a crack at the problem.

Rae Woods (04:58):
Yes.

Ford Koles (04:59):
So it's not, there's one person talking about it, and there's another person thinking about it, there isn't ever that situation at the Advisory Board. Everything we do is a group process.

Rae Woods (05:09):
And Ford, you just mentioned being at the podium, or at the board room, or around a conference table, and you've been in those moments frankly for several decades now. I don't want to age you too much here, friend.

Ford Koles (05:22):
Go ahead.

Rae Woods (05:23):
But my point is that you have been the voice of the industry through moments of immense change, the great recession, the passing of the Affordable Care Act, of course, the COVID-19 crisis. What's it been like in those moments of immense change where everything feels like a crisis, and you are advising real leaders in healthcare about their next steps?

Ford Koles (05:44):
It's a remarkable privilege, frankly, to be in that room to feel that energy, in moments both terrifying and wonderful in healthcare is an immense privilege. The favorite part of my job, and I'm sure, Aaron and Rae, you would say the same things, is healthcare always matters. Everybody cares about it. I mean, I was a consultant for some big firms before I got to the Advisory Board, and helping a firm deliver a package half an hour earlier, that's nice, that's good. But it's not the same things as healthcare. Everybody is going to get old, sick, and die, so this is personal to every single audience and every single person I interact with. And there's an energy that comes from that, which you can't replace anywhere else. I will tell you, Rae, that for me, there have been moments at the Advisory Board when we really did change the industry. And I want to be humble too, David Bradley would want that.

Rae Woods (06:37):
Our founder, yeah.

Ford Koles (06:38):
There have also been moments when we got it wrong, and I remember them both acutely.

Rae Woods (06:45):
Aaron, what about you? I mean, I mentioned some kind of moments in healthcare history, but chaos, change, crisis, these are constant realities in healthcare. So what has it been like for you as you've moved from a world of the researcher that is developing the insight, to kind of straddling both understanding deeply what's happening in the industry and playing more of that teacher advisor role?

Aaron Mauck (07:09):
Yeah. The challenge that I've always encountered with research is that, and this is just endemic to doing research, is that research always has the risk of being either behind the times or unrealistically ahead of the times. Right? So often enough, we are vetting things that have been peer reviewed and gone through the journals, and that's already a little bit behind the times. It's distant from some of the on the ground frontline realities that you encounter when you're out in front of an audience. Or we're prognosticating based on work that other researchers have often enough done and published. And that work has a tendency to sometimes be 20 years, 30 years in the future, just unrealistic.

Rae Woods (07:48):
Yeah.

Aaron Mauck (07:49):
We all want to be about five minutes ahead of the trends. You want to sort of attune yourself to them, help people predict on the ground where they need to go, and that's precisely the kind of thing that you get to do in a spokesperson role. You're out there in front of an audience working through problems in real time and trying to advise those solutions.

Rae Woods (08:07):
And by the way, none of our solutions are static. In order to stay five minutes ahead, as you said, Aaron, there are times where I am changing my talking points, my slides, every week. Maybe there have been times in which it's every day. I mean, I'm sure that you two have had moments like that too.

Ford Koles (08:24):
Absolutely. Aaron points out something really important that I think is underappreciated or simply not even recognized, is that one of the core competencies of this job is there are obvious ones. Right, Rae? Didactic capability, ability to facilitate a discussion, the ability to describe and teach insights, those are the obvious hit over the head. If you can't do those things, you can't do this job. But one of the things Aaron pointed out, which is the ability to understand without being less aggressive intellectually, the ability to understand how fast an organization can change.

Rae Woods (08:55):
And an industry can change.

Ford Koles (08:57):
And an industry, right. It doesn't do us any good to be so far out ahead of the industry that it's ridiculous and unrealistic. But at the same time, nor do we want to underestimate their ability for change. That's a core competency for the three of us, and one that is actually not particularly recognized or talked about. David Bradley always said to us in the old days, "Assume the audience is as smart as you want them to be and they always are." This is not a way of me discounting the insights, but there is a practical argument to Aaron's point about how fast change can happen.

Aaron Mauck (09:30):
Speaking of how quickly things can change, Ford, maybe you want to regale us with the story of the 2016 election.

Ford Koles (09:37):
I showed up at a very nice hotel in Philadelphia to speak the board of Inspira, which is a favorite client of mine. It's a regional system in southern New Jersey. My mother grew up in Bridgeton, so it's sort of a personal thing for me to speak to Inspira and help them. We'd had to make a bet that week as to who was going to win the presidential election in 2016. We were not taking sides. As you both know, we never do that at the Advisory Board. We are strictly nonpartisan.

Rae Woods (10:01):
Yeah, but we needed to talk about the healthcare implications of ... Yes.

Ford Koles (10:04):
Yeah, I have to describe the health plan of one of these two people. And we bet, as did most pundits, on Hillary Clinton. So I showed up in Philadelphia, Aaron, with 60 slides on Hillary Clinton's plan for healthcare. And at some point in the middle of the night, I called the CEO and was like, "Why don't we talk about primary care strategy?"

Rae Woods (10:25):
And did he let you get away with that?

Ford Koles (10:29):
Oh, no. Oh, no. And this is a buddy of mine, and he was like, "No, Ford. You said State of the Union and I'm getting the State of the Union." Literally, that's a quote. So I went down the next morning and put my slides up, and I was like, "No, no, maybe." At the end of the day, and I'm sure you two have these experiences too, it turned out to be one of the most fun mornings of my professional life because it was just wide open. What's going to happen here? What's this guy going to do? How's it different than the plan that we were making? And so it's turned out to be really creative and intellectual.

Rae Woods (11:02):
Folks that know Advisory Board, and frankly folks that know you, Ford, know us as being an advisory to hospitals and health systems, especially in our 40 year history, there have been a lot of moments of relative power for health systems in this industry. But we know that healthcare is a lot more than hospitals. The three of us, as well as all of Advisory Board, works with medical groups, with health plans of all sizes, with the device makers, the pharma companies, the employers. I could go on. How do the two of you go about shifting messages about the state of the industry, or even about a particular problems within healthcare, to wildly different audiences?

Aaron Mauck (11:42):
One of the central functions of what we do is serve as effectively a translator, a translator and a bridge to communication between folks that often enough don't communicate well or don't communicate at all. And historically, that is something that we've done between competing health systems, for instance, or across the provider space. But now in a very complex ecosystem, where we encounter lots of players pursuing their own directions, often enough not working together, even when they need to, it becomes all the more important for us to be that kind of translator. Then of course, it's a lot of work. You have to understand a lot about the different segments within the overall healthcare space, how they're changing, how they're evolving, listen to their challenges very closely and try to be that bridge. That is I think the central function of what we do.

Rae Woods (12:34):
Translation is exactly the word that I was thinking of. I'll tell you, sometimes I think of my role as being the person there to push, especially when one stakeholder starts just blindly pointing fingers at another stakeholder that is not in the room. And a lot of times what I do is point out incentives, the business model. My job is to push back when the tendency is to go, "It's not me, it's that other stakeholder over there. That's the problem."

Ford Koles (13:00):
I mentioned earlier that to have credibility, we have to stay strictly politically neutral. Let me expand that. We also have to be neutral in the different players in healthcare. Right?

Rae Woods (13:09):
Sure.

Ford Koles (13:10):
Because to your point, Rae, it doesn't really do us a lot of good to say, "That's a bad actor and not a good actor."

Rae Woods (13:15):
And today, I would argue that the solutions that we need the most don't come from one side at all. They come from many sides coming together.

Ford Koles (13:23):
Yes, agreed. Our rich history on the provider side is useful in the sense of that's still the biggest part of the spend. If you step back from healthcare and what the country spends on healthcare, the biggest part of that spend is still in the provider sector. That's not an accusation or a congratulations, it's just a simple fact. So the Advisory Board does serve payers, we serve Pharma, we serve device companies. We serve architects who design hospitals. And of course, we serve physicians and hospitals. But I will say it's very useful if I'm talking to a diagnostic company, or an architect, or a payer, or an employer, that rich history that we have in the provider sector is always of interest and helpful because it is still the biggest spend. It's still the biggest nut that we have to crack.

Aaron Mauck (14:10):
Yeah. And I think it helps to remind ourselves that in the end, this is about patients receiving care. Right? It's a person delivering care to another person. Essentially, that is a foundation of what we're doing. To your point earlier, Ford, this is an issue that touches all of us. No one is free from worrying about healthcare all the time, of course, [inaudible 00:14:29] in our lives. And essentially, we have to kind of keep that true North in mind, no matter whoever we're serving.

Ford Koles (14:35):
Let's also acknowledge the task of this job is not to sort of approach it with a Pollyanna view. Right?

Rae Woods (14:42):
Yes.

Ford Koles (14:42):
We know that several parts of this industry are in conflict, and that's actually the design of it. It's like the American courtrooms, designed to be adversarial. There's a lot of design of the American healthcare system, which where insurance companies and providers are designed to be in conflict. And again, that's not right or wrong, but we have to deal with that reality as we try to fix things. We can't just pretend, oh, let's all hold hands. There is going to be tension in the system, and that's part of dealing with it as well.

Rae Woods (16:09):
I wonder if we should take a moment and just tell a few, maybe I'm going to call them war stories, from our time on the road. I know that you have them. Ford, you already shared one from 2016. But I'm thinking about moments where something stopped you in your tracks, or you had a particularly impactful conversation, or you had to steer an organization in a completely different direction than where they were intending to go, and you had to be the bad guy to deliver that news. What are some examples of that for you?

Ford Koles (16:52):
One of the funny things about this job, you could blindfold me and drop me in a room, Rae, anywhere in the country, and I think within five minutes, I can tell you where I am based on the audience's approach to me. Let me give you the two extremes. If I'm speaking in New Jersey or New York on Long Island, I will take five questions before I start, questions like: Why are you ruining healthcare? And what the hell gives you the right to be here? Right? If I'm speaking in Hawaii, it is considered the absolute height of rudeness to ever interrupt a speaker. So I will say, "Do you have any questions? Do you have any questions?" They will literally just stare at me the entire time, and then five people will follow me to the car in the parking lot because they actually do have questions, but they're not going to interrupt you during the talk. That's been a fascinating lesson in this job, are the regional cultural differences of audiences in the United States.

Aaron Mauck (17:42):
Yeah. That's been my experience as well. I recall a situation in the Northeast, where two very senior physicians stood up in the room and started yelling at each other, and I thought they were going to come to blows because they were [inaudible 00:17:55] some issues related to the allocation of resources. These are the things that happen. And part of this is the sort of gritty truth of boots on the ground healthcare delivery, you're going to encounter these kinds of experiences and issues related to it.

Ford Koles (18:10):
I've never done particularly well at altitude, Rae. And I was speaking at the Brown Palace Hotel in Denver, very beautiful, old grande dame hotel in Denver. And I swooned and actually crashed into the podium because I wasn't breathing enough. I actually fell onto the podium. I didn't fall to the ground. The podium stopped me and I recovered myself, but I have actually passed out.

Rae Woods (18:33):
Oh, no. I wonder about experiences with the audience. Right? I'm thinking about the physicians yelling at each other. I'm not going to lie, that has been a common experience for me as somebody that spent a lot of time kind of exclusively working with physician groups, very real finger pointing has happened. I also remember this moment that when I say it stopped me in my tracks, I mean it really did. I was talking to a room of physicians, all coming from different organizations, about primary care, the future of primary care. And somebody stopped me in the middle of what I was saying, in the middle of a sentence, and stood up and said, "Can we all just agree that primary care as we know it is dead?" What would you do as a facilitator if somebody said that in the middle of your talk? I'll tell you what I did, but I want to hear what you two would do.

Aaron Mauck (19:20):
I've encountered situations that are designed to mic drop like that. Often enough, of course, you have to ask them why they think something like that and open up a conversation.

Rae Woods (19:28):
Yes.

Aaron Mauck (19:30):
It can be a kind of crucial moment to get real, to have a much clearer understanding of precisely the terms on which the folks in the audience are speaking. And often enough, those tense moments really open the door to solutions in ways that a ho-hum talk, where there aren't any tense moments and everybody seems to nod their head and agree, really don't necessarily yield as much great conversation and solution driven work that can kind of come out of it.

Rae Woods (19:58):
It was the best thing that could have happened in that meeting because we all started talking about it. What is status quo primary care? What is happening in our industry now that might make us think that way? Do we have enough primary care physicians? Wait, why aren't we thinking about advanced practice providers? I was able to basically ignore my slides and have the same conversation I wanted to have because this person was willing to stand up. It was like he was a plant in the room, even though in the moment, when somebody had a bit of a Kanye, Taylor moment with me, my heart dropped for a minute before I said to myself, "Oh, I can use this."

Ford Koles (20:35):
I had a board member and a CEO confront each other along the lines of the board member said, "You keep crying about how Medicare only pays us 75 cents on the dollar, and eventually, you're going to have to figure out how to run this hospital on that because that's the future, and the aging baby boomers, and so forth." And the CEO said, "Nobody wants to go to that hospital." It's just one of those amazing moments where both of them had a point and I had to sort of use the moment like you did to further the strategic conversation.

Rae Woods (21:04):
Yeah. What has changed for you personally in terms of your philosophy about the way that you teach insights to the market, the way that you bring yourself into the boardrooms, the podium presentations, the intimate conversations with leaders?

Ford Koles (21:21):
One of the most important changes is the building of relationships. We were actively discouraged from doing that in the old days of the Advisory Board. The idea was that what Advisory Board person you see, that person can deliver exactly the same value as anybody else on the team. In fact, you were discouraged from building personal, deep, personal friendships in the industry because that was seen as, all of a sudden, it's about you, not about the Advisory Board. You were supposed to disappear and the Advisory Board was supposed to come forward. Right? We were all just elements of that. That's gone. We are very encouraged now to build deep networks and relationships in the firm. And I think that's actually exactly right and a good evolution. These are critical conversations we're having with impactful leaders about very dicey topics, and there needs to be a level of relationship and trust in that, that we didn't have when I got here in 1992. That evolution, I think is a really good one. I also think it's just ... I'm almost never, Rae, a podium at the Four Seasons Hotel in Chicago with 300 people in the room.

Rae Woods (22:26):
Never. If there is a podium, I ask them to take it away. I say, "Please, don't. I don't want it."

Ford Koles (22:31):
I do the same thing. I'm like, "Do you have a high stool or something I can ... " You know what I mean? I don't, because I'm not going to walk around the whole time, but I almost never use a podium now. It was always designed to be conversational, but I ensure that it is now.

Aaron Mauck (22:44):
And I think that drive for a more conversational sort of approach reflects not just a change in philosophy for us, but changes in the reality of the market, in particular the rising volume and velocity of information. Right? And under those circumstances, often enough, what it requires is us to be really tailored in the conversations. One way doesn't work because we're going to hear on the ground so much unique information from an audience member that a conversation is really right answer in terms of how you would deliver insights and how we garner information back before we can share with our researchers to ensure that we're really kind of capturing what the future of healthcare's likely to [inaudible 00:23:27].

Rae Woods (23:28):
I also just try to bring my whole self to these conversations a lot more than I felt comfortable doing 10 years ago. I mean, I'll be honest with you, Ford. I remember trying to be like you. I remember trying to emulate you, and there is no way that I can be a six, four, redheaded man.

Ford Koles (23:46):
Six, five, Rae.

Rae Woods (23:47):
Six, five, redheaded man, commanding attention in a room, and that has been a challenge sometimes in my career. But I have tried to get to a place to embrace bringing my whole self into a room and the value that it provides.

Ford Koles (24:03):
That's always been the goal, I think. People would often say to me, and I totally get it, Rae, because I was the head of speaking at the Advisory Board for decades. Right? So of course, everybody was like, "To be successful at the Advisory Board, you got to look like that guy." But what we've always taught is exactly that, bringing your own self to the podium or to the front of the room because that's the electricity. Right? If you're present, then it's electric because you're taking risk, you're committing personally to the things you're saying, you're committing personally to the organization you're trying to help. You're not reading from notes.

(24:38):
Yeah, it helps to be tall and to have a deep voice, and to wear this suit. But at the end of the day, if I feel like they're still noticing me three minutes into the talk, it's a failure. In other words, it's the ideas that are coming forth, not my suit, not the glasses. That's the whole thing is that ... And that comes in every shape and form.

Rae Woods (24:59):
And we've been talking about how those ideas have changed over the last several decades, how we have changed to evolve to match those ideas in the changing industry. The last question I want to ask you is: What do you think the future holds for healthcare? And what is our role and Advisory Board's role in that?

Ford Koles (25:17):
I'm inspired and hopeful when I look at the American healthcare system because for all of its problems, we have unrivaled expertise, unrivaled technology, and we spend a fortune on it. And I do hope at some point, you get what you pay for. I look at the American healthcare system, and I don't mean this in a condescending way, but it's a little bit like the ugly duckling, that every minute could be a giant, unbelievable swan because all of the pieces are there. We just need to figure out how to maximize the talent, the tech, and the money that we have, but it's all there.

Aaron Mauck (25:57):
Yeah. People always talk about healthcare being in crisis. I don't think there's one time in the history of healthcare probably for the last 100 years, where there hasn't been some element of crisis being perceived. But the tensions that exist today, to Ford's point, are what you could describe as birthing gains for very new system that is likely to emerge, which will have much better alignment and hopefully lead to some of the resolution that Ford was just alluding to, a much better system coming out of that if we can get really aligned on some of the incentives and the tech, there is a lot of room for a future that is much more effective and equitable in terms of care.

Ford Koles (26:41):
What about you, Rae?

Rae Woods (26:41):
I get a lot of personal joy in the role of teacher in delivering the insight to the room. And where I think the future is for the industry, and frankly, for me personally, is learning to step back from that and helping leaders learn from each other because there's a lot of untapped potential there. And I like the moments in which I'm not in the front of the room, I'm not walking around the room. I've actually moved to the back because I want others to learn from each other. Well, Ford, Aaron, thanks for coming on Radio Advisory.

Ford Koles (27:19):
Thanks for inviting me, Rae.

Aaron Mauck (27:21):
Thanks very much.

Ford Koles (27:22):
It was an honor and really fun. And I look forward to my next visit.

Rae Woods (27:26):
No pressure. Aaron said something really important in this conversation, which is despite all the fun that we've had on the road, despite all of the difficult and real moments that we've had as we're out in the market, the most important thing that the three of us and frankly, all of you, need to keep at the center is making healthcare better for real people. And remember, as always, we are here to help.

(28:03):
If you like Radio Advisory, please share it with your networks. Subscribe wherever you get your podcasts, and leave a rating and a review. Radio Advisory is a production of Advisory Board. This episode was produced by me, Rae Woods, as well as Katy Anderson and Kristin Myers. The episode was edited by Dan Tayag, with technical support by Chris Phelps and Joe Shrum. Additional support was provided by Carson Sisk and Leanne Elston. Thanks for listening.

(28:29):
But one of