Episode 4: Visionary Voices with Andy Crowder

Larry Kaiser:
Hello and welcome to this episode of Visionary Voices, Optimum Healthcare IT’s conversational thought leadership podcast that hosts digital and technology healthcare leaders to discuss IT innovation and transformation. I’m your host, Larry Kaiser, Chief Marketing Officer here at Optimum Healthcare IT.

In this episode, we’re joined by Andy Crowder, SVP and Chief Digital Officer at Advocate Health, one of the nation’s largest not-for-profit health systems. With a career spanning top roles at organizations like Scripps Health, Atrium Health, and now Advocate, Andy brings a wealth of experience in digital transformation and enterprise strategy.

Joining him for today’s conversation is one of Optimum Healthcare IT’s Executive Vice Presidents of Enterprise Application Services, Amirah Centinario, who will lead this conversation on two critical but timely topics: navigating the complexities of mergers and acquisitions in healthcare IT, and the digital and operational readiness needed for hurricane preparedness.

Welcome to the show, the both of you. Great to have you here today.

Andy Crowder:
Awesome. Glad to be here.

Larry Kaiser:
So, you know, this is season one of our podcast, and every episode we’ve dove into our first segment, which we refer to as a Bandwidth Banter. It’s kind of a fun take on icebreakers, and helps our listeners get to know our guests a little better, gets everybody a little comfortable in front of the microphone, and adds a little color and some fun to these conversations sometimes.

Andy, I know that you enjoy spending a lot of time on your boat relaxing, and when people own a boat, as my family used to do, you name the boat, and there’s always a backstory to that. So I would love to know what the name of your boat is, and what’s the backstory to the name.

Andy Crowder:
Yeah. The name of the boat is “It’s Real”—REEL. And it’s a play off of my wife, Rachel, and I have been married for a little over 15 years, and either every 5 years or every 10, and I think we’ve done both, so we’re up on our 15th now, we redo our vows. And we try to go back to the same place, and inside the ring it says “It’s real.” Now, it says “REAL,” not “REEL.” But we spend enough time on the water with a fishing rod in our hand that it’s both real and reel. And so that’s the name of the boat, and that’s the connection.

Larry Kaiser:
I always love the creativity that people put into their boats. You know, my family had a boat years ago, and honestly, I forget what we used to call it. But my dad and I probably spent two weeks coming up with a name for it at the time. And again I completely forget what it is now because it’s been so long, but we put a lot of thought and effort into that. So, that’s an interesting story. And congratulations on 15 years.

Andy Crowder:
Yeah, thank you.

Larry Kaiser:
Sure.

So, Amirah, a little different for you. You know, I’m not sure if you’re a boater or not, but I’d love to know the last song you listened to and maybe the last concert you attended.

Amirah Centinario:
Sure. So I have a 7- and a 9-year-old, so I will say at drop-off this morning, the last song I listened to was “Chicken Banana.” So those of you that have children might know it, and there’s a dance to it. And I’ll refrain from having you guys have to see what the dance is, but you can look it up. And then the last concert I went to, I think it was Phish in Madison, actually. That was really fun. It was an outdoor facility. And yeah, I think that was the last one. It’s been a minute. I need to go to more.

Larry Kaiser:
Yeah, I had a friend in high school whose brother decided to take a year off in between graduating high school and going to college and followed Phish around for an entire tour. And of course this was before we had all the digitization of things that we have, so he had a wall of cassettes, and he recorded every single one that he went to.

Amirah Centinario:
Wow!

Larry Kaiser:
I’m a Pearl Jam fan myself. You can probably tell from the posters behind me on the wall, and I’m excited if I can go see two concerts a year. But I’ve known people that have backed up and traveled with them as well, and I’m always fascinated by that. And I’ve never seen Phish myself, but I like a couple of their songs.

Amirah Centinario:
That’s a good concert.

Larry Kaiser:
You should go to more concerts, though.

Amirah Centinario:
I’ve been looking them up for this year, and there’s a few on my list that I want to go to that are coming into Minneapolis. But I actually like talking about my first concert, and my first concert I ever went to was Backstreet Boys, and I like to talk about that because that was my generation, and their opener was a female that was brand new that they found named Pink, and it was one of her first concerts, and it was really cool. So I’ll remember that.

Larry Kaiser:
Cool.

Amirah Centinario:
Yeah.

Larry Kaiser:
Whenever I tell someone the first concert I ever saw, I get a nice little laugh out of it because it wasn’t supposed to be me. My parents were supposed to go to a concert for their anniversary, and my dad fell and slipped a disc in his back. So I went with my mother to see Dirty Dancing in Concert as my first concert.

Amirah Centinario:
So.

Larry Kaiser:
Okay.

All right. Well, hey, I appreciate playing along with this and sharing some personal details here. But obviously we’re here for a really interesting conversation. Let’s get to the meat of that. Amirah, the mic is yours. Take it away, and have a great conversation, everybody.

Amirah Centinario:
Thank you, Larry. So, Andy, I know you’ve been through a lot of M&As. I think when we were speaking earlier, you have done five mergers and acquisitions since 2019. So when I talk about M&A with clients, I typically look at it in multiple workstreams. Governance and change management being one of those key areas, of course, EHR and third-party applications, technical infrastructure, and then what do you do with your data? Do you happen to look at it the same with parallel workstreams, or how do you look at M&A?

Andy Crowder:
Yeah, I mean, I think all of those workstreams are critically important as you start to work through the details of the M&A activity. But I think that there’s a foundational one that comes well before that, which is what I would call cultural alignment. And you know, fortunately for us, the ones that we have started, our CEO, Gene Woods, and Carol Lovin in the Integration Management Office, do a phenomenal job upfront about assessing those opportunities for cultural alignment and cultural fit.

And we’ve probably said no to more of them than we’ve said yes to, because it wasn’t a cultural fit with our organization. And so I think the most recent one that we’ve done with Advocate Aurora and Atrium is a casebook example of how leading with culture ensures success in all of the elements. And you know, it’s not a walk in the park. You have to get up every day and bring the best version of yourself and assume positive intent for everything that’s happening. But if you start with culture out of the gate and make sure that all of those boxes check, it lays a foundation of trust and relationship that allows you to go do hard things faster at scale.

And so that’s the most important one. And again, we have said no to more than we’ve said yes to, and we’re able to deliver some things that aren’t normally accustomed when you see these large integrations. Most of them, you know, they don’t lower cost. They don’t deliver some of the value. You’ve got significant turnover. You’ve got staff separations.

We’ve been able to exceed all of our synergy targets. We’ve lowered cost of care. We’ve lowered mortality rate. We’ve improved teammate and physician engagement scores when you’re doing a large M&A. And our balance sheet and our financial performance is in better standing than it was when we started it. And that’s not the norm in the industry.

So I think being really, really selective is important. I also think that a foundational component that organizations have to have is they have to be in a position to do an M&A. You have to make the right investments in your platform solutions and in your IT technologies and capabilities. Because if you don’t, it will be your rate-limiting component of doing the M&A the right way.

Amirah Centinario:
Sort of restate that—essentially ensuring that the core that you have today is in a good place, so that when you do the M&A, you know you’re bringing it onto a foundation that is stable in its best situation.

Andy Crowder:
Correct.

Amirah Centinario:
What are the kinds of things for cultural alignment that you look for? I’m curious.

Andy Crowder:
Well, I mean, I think at first it starts with significant respect and honor for teammates and inclusivity. For all, our mission has been cornerstone to everything that we’ve done.
You know, you have to be absolutely committed to improving the lives, the healthcare, the quality outcomes of all of your patient populations in all of your markets. We have a significant commitment to serve some of the underserved communities and rural communities and not walk away from those places. You see a lot of rural hospitals closing today, and that has not been our position. We have found a way to take our core base with virtual and other technologies and ensure that we’ve got the same level of care in rural Georgia and Alabama that we’ve got in our core tertiary markets.
And so we’re really trying to make—we’re trying to democratize the same great quality of care at the lowest cost possible in all of our care venues. And if you don’t make the right investments in your teammates and your culture, and you’re not focused on that, you could focus on a lot of other things. And I think that purpose-based approach really does help bring the best out of all of us.

Amirah Centinario:
So it sounds like you’ve got it down pat, to say the least. I’m impressed. You know, a lot of mergers and acquisitions can be a lot more painful than the way that you’re describing it, because that upfront due diligence isn’t necessarily done—not only with aligning culture, but, you know, doing assessments and things like that before getting into it all.
Is there anything, though, that you wish you would have done sooner or done differently? Let’s focus maybe on the most recent one, because I know you’ve done a lot of them and have probably improved along the way.

Andy Crowder:
Yeah, you know, I don’t know. I don’t know that we would. If I go back over the past two years, this last one was the fifth one. So, I mean, we’re getting really, really good and effective at what we’re doing. I can’t think about anything that I would have done differently about this last one. I think early on, maybe we weren’t as diligent on the pre-technical assessment as we could have been.
It kind of came at the very end of maybe some of the cultural validation activities. Now we start—because we’re in a different landscape today—one of the first things we start with now is the technology assessment, and specifically the cyber assessment. The cyber assessment is the foundational one out of the gate. They’re the first in. Think of them as the Navy SEAL team that goes in, and we’ve got a third party that does that.
One of the other things too is we wanted our own engineers a lot of times maybe to do a bulk of this work. And so we put that on our own backs. And now, based on the scale, we’ve got partners that we elect to do that with. I won’t mention them here, but selecting the right partners that have the competency and skills to do these assessments and to help your team keep focused on running the joint and optimization and enhancements and those types of things—bringing value for your core base and not diverting your attention—really helps you keep speed and agility in the front.
So those are a couple of things that we learned early on that we’ve got to put in the front side of this. Select the right partners, get your network foundations and your cyber assessments done upfront.

Our CISO likes to say, “See, it starts with me.” I get to be center stage on this. So Todd Green and the team—they do a great job, and I’m glad to have them doing that work for us.

Amirah Centinario:
Yeah, any M&A puts a higher cyber risk, right? So that’s a key piece for our listeners, I think.
Also, how about—you know, it sounds like by bringing in partners, you’re able to still continue with some of your initiatives for your core business. Are you still having to balance and pause some initiatives for these acquisitions? Or have you gotten to, you know, a place where bringing partners in has gotten you to be able to keep moving?

Andy Crowder:
I think, for the—the short answer is we’ve been able to bring partners in and not derail our system initiatives. I mean, the honest truth is innovation, automation, our AI strategies—can’t slow down while we’re doing an M&A. And if we build the right platform capabilities, what used to take us 12 to 18 months ought to be able to be shortened significantly by leveraging different technology approaches and standards.
And so short answer is we’ve been able to maintain those. I will tell you that sometimes we may look at it and go, “You know what? We were gonna go do this enterprise deployment of this new capability,” and the integration component wouldn’t have been done till now. What can I do to accelerate that to where I can give them that same value as part of the core and bring them in closer?

It’s interesting. We had roadmaps for our digital acceleration strategy at Atrium Health, and it was aggressive. And yet we did M&As. We actually incorporated them into that strategy and accelerated the deployment as opposed to slowing it down.
The great part about an M&A activity is, it is a point in time to actually have a laser focus and drive change and outcome. And in a normal organization, you may have slowed the pace of that. But when you have this M&A opportunity, you want them to have those same capabilities that the rest of your enterprise has so you can act as a system.
And so many times the M&A activity didn’t slow it down. It sped it up, and we had to find ways to do that. And you do that by having a top-notch team and great partners, because you don’t want to slow down. Healthcare can’t slow down.

Amirah Centinario:
Never does. I agree. It’s very impressive.
So, as far as the market goes—you know, M&A has become an extremely prominent part of it. Where do you see the market trending with M&A? And where do you see the market trending in general?

Andy Crowder:
Yeah, well, I think that all healthcare systems are focused on creating enterprise competencies and scale and best practice and spreading that best practice across their ecosystem. And, you know, some organizations find themselves in a position that they may not have the wherewithal to do that on their own accord. Either their financials don’t afford it or they haven’t made the right platform decisions. And those organizations that are forward-thinking are seeking partners. Thankfully for us, we’re able to answer that call in many cases.

Gene Woods likes to say we’re open for business for the right partners, and that’s really true. So I think you’re going to continue to see it. I think that you’re gonna see big consolidation in some of the inventory surgery opportunities, and some of the other places as part of a growth strategy. I think we’re starting to see different relationship models for our independent providers. Some may choose to become directly employed. Some may be part of our Connect strategy. Some may be part of our MSO opportunity. And we’ve got a lot of different models that we can deploy for them. But I think you’re going to see it continue. I don’t think it’s going to slow down anytime soon. You’re starting to see more regional players come in where there’s not necessarily direct competition, and they’re able to strengthen their base as a result of those relationships. So I think you’re going to continue to see it.

And hopefully, it’s going to continue to drive the type of value that Advocate Health’s been able to drive, because the health industry needs it.

Amirah Centinario:
Yeah, and I think you’re at the forefront—if I could almost call it the bleeding edge—of the approach.

M&A is becoming more rapid as well. We’re not only seeing M&A increasing; we’re seeing the desire for the timelines to continue to shorten. And I think some of the callouts that you’ve had today are key—make sure that your base is where it needs to be, and then extending past that can be quicker. It can be cleaner, if you will. But one of the questions I have is:

No matter how much diligence you do upfront and cultural alignment you have, how do you approach integrating the new sites when you have your system standards, and then the new sites will have areas where they don’t align? Do you usually take the approach that the system is the foundation? Or do you have a different approach?

Andy Crowder:
Yeah. So I would say that for our enterprise platforms—Epic, Workday, Microsoft, Philips, some of our core solutions—we’ve made our big bets with those vendors and have very deep relationships and partnership. And we are going to spread those systems to the new environment.

There are some ancillary systems that—maybe it’s a specific niche radiology or cardiology solution. Or maybe it’s a different nurse call system at that facility. Or if it’s a building automation system where that solution is still working and it’s interoperable with our enterprise platforms—we may wind that down to contract termination.

We also know that there are times when you’ve got a bolus of contracts that are coming up for renewal. When you can time that with your enterprise renewal, you can dramatically reduce the portfolio, rationalize it. You can usually get a much better cost and a much better feature. And when you get on those enterprise solutions and rationalize it, your cyber risk goes down, your infrastructure costs go down, and your ability to spread scale and best practice goes up—so that speed to value.

But you don’t just come in and rip and replace everything day one, that’s for sure. You focus on your core enterprise solutions—the EHR, the ERP, maybe your time and attendance and scheduling solutions—all become foundational to what we’re doing. That’s not really a choice in most of our environments.

Amirah Centinario:
That makes sense. How about when you get one step lower—so let’s take EHR as an example. When you get into a typical EHR implementation, you have your design phase, then you get into build, testing, etc. How do you approach the acquiring sites? Is it typically that your enterprise solution is considered the foundation, or are you considering some of the customizations they may request on your rapid timelines?

Andy Crowder:
We do start with a foundation—kind of a gold standard for the EHR. We try to align that, and I hate to use the word “foundation,” but as close as we can to foundation. We do two quarterly upgrades a year. We are Epic-hosted; it’s not in our data center. We have a very cloud-forward strategy which gives us some agility. We just did our last update in this environment, and I think the total downtime for the upgrade was like 18 minutes. So we’ve gotten really, really good at how we do these things in partnership with Epic and others.

But we start with the foundation. But regardless of how good you think that foundation is, you still have to understand nuances. Sometimes there are regulatory differences, payer differences, contractual language that’s in place—and you have to understand all of those things. So the due diligence is: you have to start as if it’s a brand new install almost every time.

But you’re anchored in: I’ve already got 70,000 users live on this platform. So you’re not really starting from scratch. But you do have to do your due diligence, because otherwise you could take something that worked great in a particular enterprise market or community, bring it to a critical access hospital or a community hospital, and break workflows because people are licensed differently. What functions they perform. So you have to go through and do that workflow validation.

And I would just say that, you know, anytime that you don’t have the caregivers and the frontline physicians and clinicians engaged in this assessment very early on and through every step of the way, you’re destined for failure. So, you know, keeping those clinicians and those informatics resources center stage in this work is really critically important.

Amirah Centinario:
Agreed. Is there anything else for our listeners that you would want them to know about M&A before we shift into disaster response?

Andy Crowder:
Yeah, I think the one thing that I would say is that sometimes, when you’re the larger entity… We drink our own Kool-Aid so much that we believe the thing that we’ve created is absolutely the best practice and the most efficient way to do it.

And if I reflect back on one of my mother’s comments, which is, you know, necessity is the mother of invention. Sometimes those who have had to figure it out and maybe don’t have all those resources actually created something that’s better than what the big house thought up. And you have to go into this with virtuous intent and positivity, realizing that you haven’t figured out everything perfectly, and we’re all here still to learn and practice a little bit of humility when you’re going into these situations.

Amirah Centinario:
Agreed. Yeah, I think it’s that whole new set of eyes mentality as well. I know that’s not exactly what you’re saying. You know, sometimes when you’ve done something over and over and over, and you have somebody who’s never done it before take a look at it, sometimes the innovative opportunities are uncovered by those new sets of eyes. And I think that’s very, very good for our listeners to hear. Thank you.

Are you okay with us shifting gears a little bit to disaster recovery? So I know, if you know, we’re coming into hurricane season. So this is very, very timely. And I read your white paper. It was very impressive on the disaster response that Advocate Health had. It was exceptional during Hurricane Helen, and I know that you were able to utilize your mobile capabilities to help impacted communities in the surrounding towns.

Can you explain what you’re most proud of in that moment, and how the culture kind of helped shape your response to support the communities?

Andy Crowder:
You know, I think it’s interesting. I’ll go back to actually before the hurricane. You know, not only did we excel incredibly well with disaster response to those in need. We did so in the pandemic as well. We did the largest mass vaccination sites in the world. We used a stadium and the Charlotte Motor Speedway to do it.

And so I think we already had core competencies with our air ambulance teams and our mobile solutions that we built up over time. So we were poised and had the platform and the infrastructure to go do that again. I mean, making bets in your platform capabilities and your infrastructure are really key, because otherwise you can’t deploy.

This one that hit was… You know, we have personal family and loved ones in that area. You know, the devastation that happened there was not only… And they’re still struggling with it. It’s not all the way back to normal in Asheville and some of those areas. Total communities just gone. You know, 1,000-year flood mark exceeded, or 100-year flood mark exceeded.

And one of the largest saline facilities in the world was in that area. And so it put ripples across the end. We went into not only supporting that community, but disaster response mode for our own teams. Because if you wouldn’t have done that, you would have had to call off cases. I mean, it was significant.

It did challenge us in some of our approaches to… You know, most of the time you go, “Let me get to a single source and get the best price.” But when you get to a single source and their primary facility is in the hills of North Carolina and it gets totally taken out, you are really at a loss. So I think we had to think about diversity of vendor for crisis very differently.

I mean, we even went back when that happened and looked at, okay, the CrowdStrike issue and some of the other items—and CrowdStrike’s a wonderful vendor, they’re still very core to what we do—but how much are we gonna put all of our eggs in one basket? There needs to be some diversity in the solutions, whether that’s hosting or cloud providers or those types of things.

So I think we were able to rally because we had core competencies and capacity. And they were close to us, and we had a lot of family members and loved ones who had loved ones in those communities who were already mobilizing their teams to go do anything. And so it was a great place for us to support our community and lift one another up.

Amirah Centinario:
And was most of your—I know a lot of it was—you mentioned a few things that you had to figure out on the fly, like the shortages, the saline facility. Did you have a pretty robust emergency response program built ahead of time then, and so you were able to pull on that and then adjust very quickly with the rest of it?

Andy Crowder:
Yes, and we’re actually making pretty significant investments in that now as well.

For natural disasters and for cyber-type threats. And we’ve got organizations helping us with that assessment. We understand where the highest risks are from a risk registry point of view. And our privacy teams and our risk teams are looking at that. And we’re doing everything we can to lower that risk for these big threats. Because the great part about scale is you’ve got competencies and capacities. But when you rely on those enterprise platforms and they become damaged…

The impact to an outage or an incident is now much larger.

Amirah Centinario:
Yeah, that makes sense. So I think I have one last question, Larry. I know that you probably thought I was done there, but it makes me think of one more.

What is the key way that you’re able to instill this culture at your organization? Because I think I’m hearing that your culture is that foundation that’s allowing all of these other things that we’ve talked about. And what are some key ways to instill that?

Andy Crowder:
Yeah. So I think, come back to this thing. This is—you know, I believe it starts with leadership. And so if you look at our senior executive leaders, you know, they walk the walk and they talk the talk. So it starts at the top.

And they set a tone and a culture and a set of attributes that are pervasive in everything that we do. And I think that there’s no replacement for strong, balanced leadership in an organization.

And we’re fortunate enough to have some of the best in the industry. And when you have the best in the industry, you attract and retain the best in the industry.

And I think that that core team, the boards that we have, the community partners that we have, the relationship from an administrative point of view are so strong. It takes all of us working really, really hard to have these types of outcomes.

And I think that, you know, one incident or one moment can cause those things to be derailed. But strong leadership is foundational to everything that we do.

Amirah Centinario:
Thank you for that.

Larry Kaiser:
Well.

I don’t know about our listeners, but from that conversation I learned several things. One, Advocate has a playbook. They’ve built it. It’s effective. It’s able to be repeatable. And it sounds like they’re—you know, bring on any natural disaster. You guys got it covered. It sounds like your playbook is great. That white paper was fantastic. We’ll be posting that white paper with the podcast as well. So our listeners will be able to check that out.

You know, from an M&A perspective, it just sounds like, you know, you guys have built a playbook for yourself, and it works well, and you know exactly what you’re looking for and exactly what to do. And it’s a repeatable, successful process. So, you know, kudos to the organization there, because that sounds fantastic. So I do appreciate all the insights on that. Any last thoughts from either one of you on the topics we discussed today?

Amirah Centinario:
I just want to call out how impressed I am. Not one, by the—you know, it’s talking the talk and walking the walk culturally, top down. That’s impressive and not an easy feat. And it really has to be day in and day out. So I just, you know, want to express appreciation for that, as well as calling out for our listeners how important it is for your enterprise to be in a good place, in the best place it can be when—if you want to take on some of these rapid rollouts. Because the better your enterprise landscape is, if you will, the easier it is to extend and rationalize with your partners. So wanted to call those two things out in summary. Andy, would you agree that those are kind of the two big callouts there?

Andy Crowder:
Yeah, those are two really, really big callouts. And I do think that the very first statement I made around cultural alignment—you know, there’s some things that just don’t go together well. And no matter how hard you try, no matter what you do from a system point of view and some of those other foundational items, if the culture is not aligned up front, it’s not going to go well. And so start with culture and your core beliefs and your leadership team, and the rest of it can work itself out.

Amirah Centinario:
Agreed.

Larry Kaiser:
Fantastic. Well, thank you to both of you for joining us today. I appreciate the insight, Andy.

Good luck on future M&A, as well. To our listeners, thanks for tuning in to this episode of Visionary Voices, powered by Optimum Healthcare IT. And remember that the future of healthcare IT starts with your vision. We’ll catch you next time on Visionary Voices.