Finding Balance: Decompressing with Nature (ft. Kevin Mahoney)

Ed (00:01)
Hey everyone, welcome to another edition of Digital Voices. This is another episode so happy to have because we're speaking with Kevin Mahoney, Chief Executive Officer of University of Pennsylvania Health System, Penn Medicine. Welcome, Kevin, to Digital Voices.

Kevin Mahoney (00:19)
Thank you, Ed. I so much appreciate you reaching out to me. I'm looking forward to our conversation.

Ed (00:23)
Yeah, I always love to connect with chief executive officers, kind of get some other insights, because a lot of times we don't get to hear directly from you. And so it's always nice for the audience to hear your perspectives and how you view the world and healthcare and those sorts of things. So again, thank you so much. Yeah, we met pretty much online in terms of LinkedIn and various forms of media and the things that you're doing at

Penn Medicine just really caught my eye and I thought it'd be super interesting. Plus I do know a few of your excellent caregivers there and so I know it's a great place. But before we get started, Kevin, the most important question we have are what are the songs on your playlist? What kind music do you like?

Kevin Mahoney (01:04)
So I am fairly eclectic, but I'm a little stuck, I think, in the 70s. So Ozark Mountain Daredevils, Firefall, The Eagles, you know, that's how I grew up on. that's why I listen to. All my grandparents are from Ireland. So, you know, a good Irish song, Soldier Story.

Ed (01:12)
You

Kevin Mahoney (01:33)
The Fields of Atharai, like those get me going. But the one thing I'm not very good at is current music. So don't ask me any Taylor Swift songs. I'm not sure what those are.

Ed (01:36)
Yeah.

sort of stuck in my music genres as well. So it's always interesting with my kids or my grandkids. But we do have a playlist for digital voices. And I think a couple that you mentioned are going to be new to our playlist. So what was our Mountain Daredevils? Great band as well as Firefall. So it brought back a few of their tunes are now in the back of my head here as we're as we're speaking. so that those are some great ads. What about life message or mantra? Are there words that sort of guide?

you and your life.

Kevin Mahoney (02:17)
My favorite one, it comes out every morning out of the university. And it's a quote from Ben Franklin.

the noblest question in the world is what impact do you have on it? And I think because of my Irish background, we're always a little fatalistic, but I try to get up every day. You know, what am I, why am I here?

Ed (02:45)
Yeah.

Kevin Mahoney (02:45)
What changes can I make, but impact, you know, it might be a smile to an employee. It might be helping somebody get a doctor's appointment, talking to my children, my grandchildren, but I'm always mindful that every one of those interactions, including digital interactions now, is an opportunity for you to impact somebody's life. Like we're not just ships in the night passing each other, but that human connection is really important to me.

Ed (03:14)
I love that. And the fact that you're able to broadcast that out, I imagine every employee, every caregiver in the system sees that same message. And it's kind of a good reminder. Speaking of Penn Medicine, can you share a little bit about the history and the mission and vision?

Kevin Mahoney (03:32)
Sure. So I'll put in a plug for a book that I carry around with me.

Start with Why by Simon Sinek. And Penn Medicine is unique in American history and unique in the country and the world because we're the nation's first hospital, 1765. And ever since then, we've been pushing hard for more first. First approved gene therapy, first the mRNA.

vaccine, but doing things first, scuba diving, believe it or not, was invented at Penn. It's credited to Jacques Cousteau if you go to Wikipedia, but Major Christensen in World War II, he was a pulmonologist at Penn, invented the breathing apparatus so that frogmen could put bombs on the bottom of ships in Tokyo Bay and other places. we've been

First and so many things were first for a reason because we want to change the world back to the book. It start with why? Like why do we exist? I tell my employees you're not here to be a revenue cycle person. You're not here to do desktop. If you do the job to the very best of your ability, you're going to change the world. How do you change the world? 60 % of the health systems margin funds research. And that allows

Ed (04:48)
Yeah.

Yeah.

Kevin Mahoney (05:10)
Someone like Dr. Drew Weissman, who for eight years did not get a grant, did not get a publication, but last year he won the Nobel Prize for medicine. Because during those eight years, when he had a novel idea, the health system was able to keep funding it so that those novel ideas can turn into life -changing ideas.

Ed (05:31)
I love it. Yeah, that's super, super inspirational. I think you sort of answered my next question about what might people not know about Penn Medicine. And I think you just shared with us a couple of really keen insights and like I said, super inspirational. What are one or two of the most critical strategic issues that the health system faces today?

Kevin Mahoney (05:53)
Yeah, I think the most critical issue facing Penn Medicine is the same as facing every hospital across the country, which is we got grayer and poorer during the pandemic. Sixty five percent of our patients are now paid for by the federal government, either through Medicare or Medicaid, through the exchange, Medicare Advantage. When I started here almost 30 years ago, it was 40 percent. So over 60 percent of our patients, again,

are paid for by the federal government. So as the federal budget goes, so goes healthcare. Our Medicare increased last year. In the upcoming year, it's about 2 .6%. Electricity costs a lot more than 2 .6%. Gas, food, employee salaries. So we need, as an industry, to become more efficient. And we talk about it a lot, but we haven't actually achieved it. Together we can.

Ed (06:39)
Yeah.

Kevin Mahoney (06:53)
So you asked what's something that people might not know about pay medicine. We have four sites of delivery. The hospital everybody knows about, outpatient clinic everybody knows about, home care they've heard about, digital. Where can we place that patient? Best for them and best for us. An example, more than 50 % of our

chemotherapy and home infusion, medical infusions are done at home. That's unheard of. But wouldn't you rather get your chemotherapy in your favorite chair, watching your TV, you know how the flipper works, your dog sitting beside you like that? That's not only humane, but it saves the healthcare system a lot of money. So we're gonna keep pushing those four sites of delivery. If we can deliver through the iPhone, monitor patients.

Ed (07:26)
Yeah.

Kevin Mahoney (07:50)
follow up with patients, stay on top of them, have them then communicate to us. That improved communication will reduce the cost of care dramatically, and it's less costly. So, number one issue facing me is I need to change everybody from there are no unprofitable patients, just unprofitable delivery systems. We can keep calling senators and congressmen saying raise with Medicare's plan.

There's no money in the till. You know, between Social Security, the military, education, all the things that we have to pay for as a country, the debt service. There's not some big hidden bolus of money. And none of us want to pay a lot more taxes. So we need to figure out how do we deliver care and what we're getting paid for from Medicare. Not we need more money. We do, but again, I think it's a leadership call.

Ed (08:49)
Yeah.

Kevin Mahoney (08:50)
for all of us to lean into it.

Ed (08:55)
I love that. That's great insight and great call to action. Before we jump into Penn Medicine a little bit deeper, and I know one of the things that you were very passionate about as well as becoming the most clinician friendly health system, I skipped over and it was funny because I didn't mean to. It's probably because there's a firewall song. I'm firewall. What was the name of our band? Not firewall, but.

Kevin Mahoney (09:21)
Firefall.

Ed (09:23)
Firefall. Thank goodness. But tell us a little bit more about yourself. So I'm super intrigued. So your parents are originally from Ireland. So did they immigrate to the United States?

Kevin Mahoney (09:25)
They didn't know what a firewall was back then.

So just let me clarify, my grandparents are from Ireland. So, but they came over late, they came over in the 1920s and 1930s. So they were after the Civil War. Several of them were very active participants in the Civil War. So they raised me to have pride in our heritage, but to deeply understand

Ed (09:42)
Yeah, it's got you. Yeah.

Kevin Mahoney (10:05)
our heritage and that shaped a lot of my thinking. A lot of how I come from a family, eight kids, two parents, you know, we mixed it up early on. Sadly, we also suffer from alcoholism and depression and I've lost my mom to alcoholism, my brother, my youngest brother committed suicide. it changed me.

Ed (10:35)
Yeah.

Kevin Mahoney (10:35)
and how I approach the world, but always great, great fun. I think I talk a lot about the summer of 1978, which put me where I am today. And I'll go through it very quickly. But in late, I did not do well in my first year in college at Millersville State College, 1 .98. And they told me that's not a sustainable grade point average.

Ed (10:54)
Please.

Kevin Mahoney (11:05)
I came home, my dad said, you better get your act together. I went out and started working for a landscaper. And three events were going to put me on the path to where I am today. The first event is I met a developer. His name was Bill Rouse. And he wanted me to cut this cornfield because he was going to put offices up out in the suburbs. And I said, Mr. Rouse, people sleep in the suburbs. They work in Center City.

He said, it's out of rule, the zoning, regular, I said, that's just the way it's always been. And he said to me, don't do things because of the way they've always been, do them the way you want them to be. For an 18 year old kid, it had a big impact on me.

Might've been a 15, 20, 30 minute conversation, but it really got me thinking about how I approach life. I then went to cut this cornfield as Mr. Ellis asked me to. I fell off the tractor, under the tractor and the farm tractor ran over me. I ended up in the hospital on a ventilator with the priest giving me last rites and everybody thinking I was not gonna make it. And what is amazing out of that experience though,

is I loved every day being in that hospital. The fact that everybody was taking care of me, everybody from top to bottom, all they wanted to do was to take this egocentric teenager and make them better. And I'm like, this is just, this is what I want to do with my life. We already established I'm a lousy student. So being a physician, being a nurse, those things were out of my reach. So I didn't know what I was getting in the hospital.

but I knew I wanted to be in that environment. And then later that fall, November 10th, I went back to Millersville State College to meet my friends. And I walked into a room and I saw my wife, my current wife, she wasn't then, but that was, we've been married 41 years together, 46 years. And Pam is the reason I am where I am today because I run hot, I run Irish. She is calm, cool and collected.

Ed (13:01)
Yeah.

Kevin Mahoney (13:15)
I come home, I can't believe the way the world is, and she says, well, let's change it. she's the yin to my yang.

Ed (13:23)
Yeah, that's a beautiful story. Thank you for sharing with us. And I can see how it shapes your leadership today. So back to Penn Medicine. And as I stated, one of your passions is to become the most clinician friendly health system. Tell me why that's important to you in the organization.

Kevin Mahoney (13:44)
So a couple reasons. One, I review physicians and I watch what they have to go through. Pre -authorization. ICD -9 codes, know, just malpractice attorneys after them. And we need doctors. it's a noblest profession. And instead of elevating them and letting them do what they're trained to do,

You know, we pull them down, we put more regulations on, we put more things on their back. And, you know, frankly, they're getting burnt out. The other thing is we are facing 100 ,000 physician shortage in the country by 2030. If we don't start making it easier to be a doctor, like why go into fintech? You know, Elon Musk today announced that, you know, we're going to fly to Mars within two years and like do that. Like don't.

don't come work and just click away on your computer. So I think we want to be the most clinician friendly for two reasons. our clinicians deserve it. And second, we won't be able to take care of the growing demographics of older people that need health care if we don't create a more efficient system.

We talk about clinicians, we also include in that respiratory therapist, nurses. I want to be the place where you can come practice your profession, practice your craft, and not just be a box checker for an insurance company or some other regulatory agency. We think technology...

can get us out of where we're in. Technology's kind of got us in the corner because the EMR, without the EMR, we couldn't have done, you know, ICD -11. So the EMR enables things that actually increase the burden, they don't improve the burden on the practice. So we're committed to making the difference.

Ed (15:34)
Yeah.

No, I love it. Can you share an example how you might leverage tech to be on the helpful side?

Kevin Mahoney (15:57)
Well, I mean, sure. And everybody, you know, is talking about ambient listening, AI and the like. But, you know, who has time to go through all the data? So we're trying to put in place. We call it tickle me epic after tickle me Elmo. Like, can we be going through the medical record every night? You know, they told Kevin Mahoney get a colonoscopy. He didn't get it.

So text them. Not the doctor has to go through the chart, tell the front desk, call this person, but truly go through and identify and using communication methods that we're used to right now, which is texting. I don't know what the future will be, but it's sure not call a landline. It's sure not the US mail. mean, texting is the, so how do we use?

again, AI technology to go through the medical record to identify patients that need us before they may know they need us. I mentioned my Irish grandparents with them came a tendency for colon cancer. My grandfather suffered, two of brothers and sisters have had to have surgery. So you call, you read the paper, you're told everybody, you know,

50 you got to get a colonoscopy and then we move it to 45, now we move to 40. But it's a very blunt instrument. How do we use technology to identify, all right, know, Kevin comes from a family that gets colon cancer. The CEA gene is present in that family. Let's get them in first and not first come first serve. And I think that technology will make us faster, quicker and better and more efficient.

The other thing that we're trying to eliminate using technology, pre -authorization again is a blunt instrument. In the building I'm sitting in, just in this building, we have 51 employees who do nothing but pre -authorize x -rays. And there's at least 51 people at the insurance company doing the same thing. Less than 1 % get turned down. So I'm spending five plus million, they're spending five plus million for what?

So we worked with Independence Blue Cross, our local Blue Cross provider, to gold card physicians. If you've proven through your ordering pattern that you don't abuse your ordering, you get a gold card. You don't have to do it anymore. But that requires going through the technology, going through the EMR, and finding out the ordering pattern. can't just be, I went to Penn, therefore I get a gold card. No, you need to prove it over time.

Ed (18:29)
Yeah.

Kevin Mahoney (18:50)
I think there's so much we can do. We have issues like a lot of hospitals in America, of the emergency room being overcrowded, overburdened. And I talked to the doctors, like, why don't you discharge the patient home and have them get their test next week? And I'm afraid they're not going to. They have transportation issues. They don't have a nuclear family, so I'm afraid.

They're not going to get the tests they need, so I'm going to admit them to make sure they get the test. That's something we should be able to fix with technology. Remote patient monitoring, following patients at home, following through the cable box, following through the iPhone, as opposed to you have to go sit in a bed upstairs so we can follow you.

Ed (19:38)
Kevin, I love your insights and would love to hear from you concerning how tech leaders like CIOs or Chief Digital Officers, those type of people, should best work with CEO. So I know you're very fortunate. I know you're CIO and you're Chief Information Security Officer, both of them pretty well. They're great leaders. So you're really blessed in that sense. But what would you say, half our audience are sort of tech digital leaders.

What would you say to them the best way to work with a CEO?

Kevin Mahoney (20:09)
Yeah. So Mike, Mike Rastusia, who's our CIO, we've been together for almost 30 years working and Michael has learned to talk my language, not necessarily talk his language. And, you know, the cloud, the edge of the cloud bandwidth, like these are all words that get thrown around, but I'm trying to solve problems. I'm not trying to get educated in technology. So when you're working with your CEO,

What is it we're trying to solve? How can we do it as opposed to a lot of jargon and tech speak or we want to be the first in the cloud. I don't want to be the first in the cloud. I want to be the first health system that solves the problem, know, lower cost. so what might get you on the cover of CIO magazine is not necessarily what motivates me as a leader. So again, back to start with the why.

Why are we here? What are we trying to solve? I think also we need to do a better job of articulating. You frankly, are we spending enough in technology right now? So I'm proud at Penn. We spend, you know, four and a half, five percent of our patient revenue on IT, benchmark performance across the country. I'm not sure it shouldn't be double.

Now, where am I going to get the money to put into that as far as the challenge? But if we're going to live in a digital world, we need to make sure that we're making the right investments. And I think the last thing is empathy. And we're not all tech wizards. I'm certainly not.

Ed (21:57)
Yes.

Kevin Mahoney (22:01)
You know, just building something and assuming people can use it as opposed to more human factor design, education. And, you know, then the last thing that I think is critical again from an academic medical center is that the doctors and nurses work with our CIO if we have a good idea to share it with everybody.

Like don't hold on to it. If we figured out a solution, let's help everybody out. Penn has a solution or WashU has a solution, but the world has that solution.

Ed (22:47)
Yeah, love it. Let's pivot to leadership in our last couple of minutes. I would love to better understand, although I think we have a pretty good sense of it already just in our dialogue thus far, but your approach to leadership, how do you look at leadership?

Kevin Mahoney (23:05)
It's an old, but I try to be authentic. You know, I want people to trust me, to believe in me, but they're not going to do that if they think you're a shyster or you talk, you know, out of both sides of your mouth. So I try to make sure, you know, that old saying from Mark Twain, you know, don't tell a lie or whatever it was, but if you tell the truth,

You never have to worry about what you said to the person before because you're going to be saying the same thing. So authenticity, I think, is critical. And then again, understanding Stephen Covey's seven habits of highly effective people. Empathy is the only one that I think is important. Understanding where people are coming from, understanding why they're not taking their medication, understanding, you know, that they...

They maybe have trouble coming to work because they're taking care of three generations of their family. that empathy has been really important to me. That also means you have to listen. So during the early days of the pandemic, I was giving all kinds of pep talk to our employees, wear your mask, stay six feet apart and everything will be fine. And I was walking across the bridge of the hospital and one of the employees stopped me and he said, can I be honest with you? I said, sure.

He said, you sound stupid. And I said, why? And he says, I have five kids living in one bedroom. Staying six feet apart may be a privilege that you have, but it's not what I have. So when I hear you talking, stay six feet apart and we'll all be fine, what I hear you saying is my family's gonna die from COVID. So again, understanding where people are coming from, I think is just so important to be a leader.

It requires you to dig underneath and to really live it, not just say it.

Ed (25:06)
Yeah, that's a powerful moment for sure. So you've been at Penn Medicine, as you mentioned, what'd you say, 30 years now?

Kevin Mahoney (25:17)
27. I was rounding up.

Ed (25:18)
Yeah, getting close. So obviously there's something that has kept you there so long. And we did talk about the mission and vision and just how powerful that is. Anything else that has kept you there?

Kevin Mahoney (25:33)
Yeah, I tell everybody they come into my office, give me career advice. The one bit of career advice I give people is pick your organization first and your job second. You have to believe in your organization. And I, you know, this is only my fourth job since I got into healthcare. And

I tend to stay in a place a long time because I work hard at picking that organization. So could I have moved and become a CEO sooner? Probably. I don't think I'd be any better off than I am today because again, I live our mission every day. I communicate our vision. I communicate what it means to be at Penn. It is a magical place.

Ed (26:27)
I know it sounds like it. I'm ready to go.

Kevin Mahoney (26:29)
But when we're hitting on all cylinders, again, COVID knocked us back just like everybody. But we're back in the game. We opened a clinical trial the other day. It was in Australia. But it'll revolutionize cell therapy, which we had the first cell therapy approved. I have a dozen doctors trying to make it better. it motivates me. It gets me up in the morning.

It's not just on Nobel Prize. It's also Dr. Srinivas, Dr. Hirschberg inventing HeartSafe Motherhood, which is an app for postpartum eclampsia, which has reduced maternal morbidity and mortality in black females dramatically. it was a lot of blood, sweat and tears, but the total investment is probably less than 100 ,000. But people are alive because of it.

just like the multi -million dollars of investment in Lake and Life Sciences. So it's both ends of the spectrum, but the people at Penn motivate me. The history of Penn, we talk about walking on the shoulders of giants. Dr. Rush, back in 1765, started to publish on mental health way before anybody else. And that history motivates me.

Ed (27:56)
Yeah. No, I didn't mean to interrupt earlier, but I was just, I'm so excited myself for Fed Medicine, just listening to you and your leadership and the great things that your organization has been doing for, earlier than anyone else. So it's super exciting. So obviously CEO, lot of responsibility, been doing it long time.

How do you decompress? What do you do to sort of, it sounds like your wife is awesome in helping you with that as well, but what do you do?

Kevin Mahoney (28:28)
Yeah, so walking. I I love to be outside, whether it's cutting the grass, working in the yard, hiking through Valley Forge Park, hiking on the rail trails. I mean, that's what I like to do. We get back to Cape Cod, you know, every summer and that centers me because that's where I went as a kid. But I would say decompression happens through nature. For me.

Ed (28:55)
Yeah, that's that's.

Kevin Mahoney (28:57)
But I think it's important if we're going to be healthy, whether it's reading, if you like to read books, read books. You like to ride your bike, right? But you have to have something that resets your brain.

Ed (29:10)
So Kevin, this has been a great conversation. Learn a lot about you. I sense this great passion for what you do, which is great. And as a CEO of a great organization, so it's not surprising that the two are together.

We talked a lot about sort of your formative years and how you got into healthcare. And then we talked about some of the first that are being done at Penn Medicine and just the way that you look at digital and the different care settings and moving people to the appropriate care setting that's best for them and best operationally. 

Kevin, the other thing that you taught us was the best way for a CIO or tech leader to interact with the C -suite and the CEO, and that's to speak the language of the business, the language of the clinicians, not to be super techie. And of course, empathy is kind of the key to all of that. We talked about your approach to leadership and authenticity. And then I love what you had to say about picking an organization first. When I asked you about why you stayed so long, you picked the organization first and the job second. I love that. And that's just the importance of

decompressing. So we covered a lot. Is there anything I missed or anything you want to double down on? I'll give you the last word.

Kevin Mahoney (31:53)
Yeah, so I'm a capitalist at heart. I love competition. think it makes it better. I do worry that the American health care system has taken competition versus collaboration and cooperation a little too far. you see, we dropped out of the US News World Report rankings, know, depends nine or eight or one like it. What are we doing to make our patients better? And there are.

In Philadelphia, there aren't Jefferson patients and Penn patients and Temple patients. They're just patients. So trying to find things that we could cooperate on more, health equity, behavioral health, food insecurity, and knock back some of that natural competition that we have, that would be an important legacy for me.

Ed (32:45)
Yeah, that's very, very, very well stated. A great way to end our program. Kevin, thanks again for being part of Digital Voices and sharing yourself with us.

Kevin Mahoney (32:57)
Thanks very much, I enjoyed it.

Ed (32:59)
Hey, that wraps up another edition of Digital Voices.