The Health Management Academy
Untitled-design (12)

Episode 04

What it Means to Democratize Healthcare

Episode Description

In this episode, Jaewon Ryu, M.D., J.D., President & CEO, Geisinger, sits down with Renee at The Table. The conversation is centered on Dr. Ryu’s vision of making healthcare more accessible for all, and how that unifying theme has come to life in a variety of initiatives at Geisinger.

About Our Guest

Jaewon Ryu, M.D., J.D., President & CEO, Geisinger Health System

Dr. Jaewon Ryu is Geisinger’s president and chief executive officer. He came to Geisinger as the executive vice president and chief medical officer in 2016, and in that capacity, he has overseen all aspects of patient care at Geisinger, working to improve the quality, affordability and experience of care delivered across the enterprise. Read more


↓ scroll ↓

Renee DeSilva 0:06

Welcome back to The Academy Table. I’m Rene DeSilva, CEO of The Academy and your host. In each episode of The Table, I’ll bring you real conversations with healthcare’s best leaders and thinkers. We intend to broaden who is at the table while covering the issues that are critical for driving our industry forward. Recently, I welcomed Dr. Jaewon Ryu, CEO of Geisinger Health System. Dr. Ryu has had a fascinating career which has included stops in corporate law, a busy emergency department, and leading integrated care delivery efforts at Humana. He joined Geisinger in 2016 as Chief Medical Officer and he now serves as CEO. The unifying theme of his work at Geisinger has been around improving access to care. The vision of democratizing healthcare, as he calls it, is designed to make health easier by meeting people where they are and it comes to life in a number of programs and investments that they’ve made – 65 Forward, Geisinger at Home, the Abigail Scholars Program, and the list goes on. A couple of things to listen for as we get into the conversation. First, Dr. Ryu’s nonlinear career impacts his work today, starting from his early recognition of the role of upstream policy decisions on downstream health outcomes. Two, listen for how he talks about health equity in the context of an ageing rural community. I personally spend a lot of time talking to our members and thinking personally about health equity and he has a thoughtful frame about broadening the definition around where gaps in outcomes might exist. Finally, his personal journey is an interesting one. He represents a unique blend of intersection Gen X, Asian American from a multi generational household. Live in the discussion, it was interesting to hear how he processed those experiences in terms of the way in which he shows up to lead every day. So with that, join me at The Table.

Dr. Ryu, welcome to The Table. So happy to have you.

Jaewon Ryu 2:20
Happy to be here. Thanks for having me, Renee.

Renee DeSilva 2:22
Absolutely. So I’ve been looking forward to this time with you. You have such an interesting and diverse background in terms of how you arrived in your current role. But before we get into that, I’m just personally fascinated by the early forces that shape us as people and as leaders. So if you wouldn’t mind sharing a little bit about your own childhood. I did a little bit of research in advance of this conversation, so I know that you are from Chicago, immigrant family, your father was a neurologist and your mother had what I would consider to be one of the hardest jobs in terms of taking care of the family at home. Would you just maybe elaborate a bit on how these early forces shaped you?

Jaewon Ryu 3:02
Yeah. First of all, all of the above are true. And I would say my mom probably had the hardest job of them all. But I think really growing up in what was predominantly a suburban existence, I think it shaped me in many ways because I grew up kind of sheltered by many measures. I would say I was sort of sheltered. I went off to college and it was really the first experience, like many kids have, you know, outside the home, but also in a different environment altogether. And I think for me, it meant interacting with communities that didn’t have the same opportunities that I had always taken for granted. And I think as a result, I got very interested and active during college and actually immediately after college in youth enrichment programs, got interested in urban policy specifically around kids and education. After college, I took a year off actually and worked as a teacher through the AmeriCorps program. And it was sort of an education and enrichment program for kids in an inner city environment. And it was instrumental for me because it was eye opening, in many ways, that so many of the things that I had taken for granted growing up were things that I realized, wow, you know, it’s not a foregone conclusion that every kid gets to grow up with those things. And I think it was also a time when I realized that upstream policy decisions have significant downstream implications on how people live. I then went into medical school and I took these interests with me. So I think that’s really how some of these early forces shaped my thinking. Even in medical school, you know, on the south side of Chicago there was so much community need specifically with regard to public health and community health. I got very active in those areas and the same themes kept coming up, which is that upstream policies have significant downstream implications on the lives of people. And I think those were the things that then sparked an interest in pursuing a dual degree, joint-degree program. I went over to the law school, got more deeply steeped in policy specifically, but also implications of that. I went off and worked as a corporate healthcare attorney and saw sort of the business side of things, but really always had this interest in policy. So eventually, when I came back, finished up medical school and did residency, I think it was very natural for me to continue to, you know, itch that scratch, if you will, by pursuing a role in government. Did a stint there and really became interested in where payment and delivery intersect, because I saw that you could do so much more in terms of helping create better health for the communities. And since then, it’s kind of been one thing has led to another and it’s landed me here at Geisinger where I continue to have, you know, such an awesome, blessed experience being able to play in that space where payment and delivery intersect and trying to create better value, better health for the communities that we serve.

Renee DeSilva 6:05
Yeah, I want to unpack that. But before we go there, I am curious. Careers are not linear. I love the flow, your career arc flow in terms of medical school, law school, you dabbled in a law career, went back to medical school. So I think that’s an interesting, interesting weaving. When you were at the law firm or pursuing a law career, were you always intending to go back to medical school? Or did you feel pulled back to that? I’m just curious how at that point of intersection in your career, you came back into the healthcare space?

Jaewon Ryu 6:37
Yeah, Renee, you’re hitting on something that, you know, sometimes surprises people and it certainly surprised me. But I have found, at least in my experience, things are not linear. Things never go the way that you plan. And I would have loved to say that I had, you know, some master plan on all of this. I didn’t. I think the reality was I followed my interest, followed my passion. And you’re absolutely right. You know, I actually enjoyed the practice of law and found myself learning quite a bit, which is probably why I enjoyed it. But at the end of the day, it felt one step, maybe even two steps removed from where the rubber hits the road. And as far as healthcare is concerned, I think that rubber hitting the road is in the actual provision and delivery of care. And I really enjoyed, you know, clinical and sciencey aspects of, you know, being a physician. And so it made sense for me to go back at that point and get closer to that rubber hitting the road. I think it’s also why I chose emergency medicine as a specialty because I would still argue and, of course, I’m biased that nowhere in healthcare does the rubber hit the road more squarely than in emergency medicine. In the ER, you’re seeing all the roads come together, whether it’s inpatient and outpatient, primary care and specialty care, primary care, like literally prevention, primary services, with folks coming in where life hangs in the balance. I mean, you really see it all – cradle to the grave, pediatrics, elderly, and I just absolutely love the variety, love the unpredictable nature of it. But also, to me, it represented, you know, so much of what goes on in the healthcare industry. You have insured/uninsured, you have different payers playing out and their members landing in the same emergency room. Sort of a neat environment where, you know, all the crossroads of healthcare come together.

Renee DeSilva 8:30
Absolutely. The other piece of that, which you well know too, is it’s also maybe that nexus point around all the social determinants of health, right, that come to play in terms of on the behavioral side, how do you think about when you’re discharging patients? Are they even able to get their needs taken care of when they leave that moment? So I definitely can see your connection point to in terms of how that then drives several different avenues of follow up for that patient? It is. It’s very striking.

Jaewon Ryu 8:57
Well, on that point, I think it’s interesting. One of my ER faculty folks from medical school used to say this and I’ve found that it’s absolutely true, an ER physician and ER staff more broadly, you’re probably a hefty dose, maybe it’s even as much as a half, is essentially you’re social worker. And I think it’s exactly right. It’s the right way to think about this specialty because you can do so much good and you can make such an impact in people’s lives. But a lot of times the problems that you’re solving for, of course, they’re clinical, but they’re also social. Does this person have the support systems at home to be able to survive and thrive or do you have to admit them simply because those things aren’t in place? Are they in an environment where you can rely on them taking their medications? Or, you know, do you have to provide for that through other means? I think all of those questions become very real and shockingly more common than I think most people would think.

Renee DeSilva 9:55
I think that’s a great insight. So you went on to have about a three year run at Humana which then brought you to Geisinger. I think Geisinger has a wonderful national reputation. I think most folks understand the integrated nature of the model, but it’s always interesting to hear how the CEO explains the health system. So would you just give us a top line on who Geisinger is today?

Jaewon Ryu 10:16
Yeah, so Geisinger has been around for over 100 years, 106 years to be exact. We’re situated in central and northeastern Pennsylvania. We cross a fairly significant geographic area, many areas of which are rural or small town and then some are sort of smaller, more urban environments, whether it’s Wilkes Barre, Scranton, Williamsport, or some others. And I think we’ve been around a long time, but more importantly, anchored around our communities. It was a system that was born out of the community needs. I think that’s still sort of woven into our DNA today. And I think the other calling card feature for us has been, you know, we’ve been in this value-based game probably longer than most. We started our own health insurance company back in 1985. So we’ve been at this for about 35 years around the notions of prevention, getting upstream, building clinical programs to try to drive value and affordability. At the same time, you know, we’re not a fully contained or integrated system because we also take care of members of other health plans and also have some members of our health plans outside our own delivery area. And so, a lot of folks kind of think of us as a 50/50 hybrid, if you will, where half of what we do is firmly and squarely in that prepaid, risk-based environment and then the other half of what we do is still working in partnership with other providers or other payers as the case may be. And as a result, I think we’ve been able to build an awful lot of neat programs, neat capabilities, hire great people, and bring them to our communities. I think the quick thing that I’ll mention, you know, if the first 100 years or so of our existence was about building things and expecting people to come, so think of it as the Field of Dreams analogy. You build it and they come. And we’ve been very fortunate. Our communities have come in abundance and gotten their care and services here. But I think for this next chapter of Geisinger, really going back a couple years since I took this role, it’s all about trying to build programs and meet people in communities where they are. Take them out to the people, closer to the home, closer to the communities, closer to clinics, and by doing so we think that, you know, we make health a lot easier versus, you know, sometimes coming on to big tertiary care campuses can be clunky, especially when you’re dealing with vulnerable populations, whether they’re elderly, socioeconomically vulnerable. We think that we’re solving for a lot more things when we make that a lot easier by bringing more services to them.

Renee DeSilva 12:57
I love that. I’ve heard you maybe frame that broader strategy, which I’d love to unpack a bit, as democratizing healthcare. Maybe just elaborate on that a bit, this notion of meeting people where they are also really comes to life for me. So how do you frame or explain this notion of democratizing healthcare?

Jaewon Ryu 13:14
Yeah. And we have said, and I think it’s because of where we are. If anybody’s been to central and northeastern Pennsylvania, we have a lot of areas that, frankly, have just seen better days socioeconomically. And I think the pandemic, if anything, it made that dynamic even more compelling. And so as a result of that, we’ve tried to build programs and figure out financing mechanisms and business models to actually bring like high end services directly to these folks where, you know, in any other area of the country you would say that defies logic. And so, you know, we have folks here that think of those kinds populations that, you know, whether they’re really going paycheck to paycheck and struggling to make ends meet or they may be unemployed or recently unemployed or struggling with all the other challenges that life has thrown their way or even, you know, maybe well to do but have many, many chronic diseases and that’s a significant challenge on what they try to achieve in their lives. At every single step of that we think that when we’re able to build programs and when we have them in an environment where the care collides and intersects with the delivery and the financing, we know that we can bring these tremendous programs to bear. So for example, we have our 65 Forward senior focused primary care, essentially concierge primary care, patient panels a fifth of the size of what you would see in primary care practices across the country. If you were in a big city and you wanted to afford concierge care you would say, well, you know, a lot of these models charge a subscription fee that’s exorbitant just to participate in the model. And here, it’s free. And the only, quote/unquote, “requirement” is that someone is on our own Medicare Advantage plan. So that’s a great example of where when we combine the financing of the care with the delivery of the care, we can really focus on the health and wellness of the patient and not have to worry about – is this or that reimbursable, is this sort of that, you know, an adequate payer mix to maintain these kinds of services. And I think that allows us to “democratize,” quote/unquote, you know, these high end programs that otherwise you would have to be a means to afford. Another great example is our Genomics Program. Just by virtue of being a patient at Geisinger you have the ability to get your full genome or exome, I should say, sequenced. We search for 77 or 80, at least, conditions that result from mutations where you can actually have an actionable impact on your care plan. And if you have one of those mutations, if they’re found, we return the results through the clinical enterprise and we change your care plan accordingly. Something like that we would have to typically pay out of pocket in today’s day and world and here at Geisinger that’s open and available to anybody just by being a patient here. And so these are just some examples of what we’re able to do when we free up from the confines of, you know, what is reimbursable, what is not. The Fresh Food Pharmacy is another great example. And I’ve joked around but it’s absolutely true. There’s no CPT code for a banana or offering someone insights on how to cook with olive oil. You know, there’s no code for that to reimburse. But when we’re able to have that come under our umbrella and, you know, part of it we bear the risk on the population. For the rest of the population, you know, they get to draft off of these efforts if you want to think of it that way. That really brings high end programs and education and services to the masses. That’s the best way we can deliver value to our communities.

Renee DeSilva 13:50
So going back to the 65 Forward concierge service for seniors. When you implement that, smaller panel size, docs are allowed to spend more time with patients really helping them get to some of the things that are impacting their health, not all of which will maybe even be medical things, it could be loneliness or isolation, a whole host of things. How have you seen that then drive positive outcomes on the other side? Are you looking at things like reduction in ER visits, hospital admissions, any way that you’ve been able to connect the outcomes to that investment?

Jaewon Ryu 17:39
Yeah, and you nailed the key ones right there. We have seen that, first of all, patient engagement and satisfaction is unparalleled. It was disappointing when we dropped to the 98th percentile at a couple of these clinics. Otherwise, they’re literally at the cream of the crop, 99th percentile. And then from a quality standpoint, every one of the preventive measures, the uptake and percentage at which we’re hitting that is significantly higher even than the rest of our primary care which is higher than most others in the industry. And so that’s been a big winner. And then you nailed the ones around ER utilization rate or inpatient admission rates. They typically have been anywhere between 25 and 40% lower on each of those. And I think it’s because we’re addressing issues, identifying disease and addressing them upstream so that those downstream needs become less common. And I think, at the same time, it’s establishing the relationship with these patients. Because at the same time that we’re delivering the clinical care, in each of these sites we have wellness programming. Every day of the week there’s something going on whether it’s, you know, domino club, book club, fitness and yoga. Now, albeit during COVID we’ve had to adapt and some of this is, you know, not what you would typically see. But those activities really make it more like a social club or a community club that folks want to belong to. And then at the same time that we have them there for their wellness activities, I think there’s a muscle memory that they’re coming into the clinics, interacting with our staff and when they have a medical need, they’re that much more likely to let us take care of it.

Renee DeSilva 19:20
Absolutely. So if you reflect on the broader industry, do you see this moment that we’ve gone through as a country and COVID as an accelerator for value-based care models like similar to what you’ve been talking about here? Or do you think we’ll stay business as usual? What’s your prediction as to how this overall pandemic will shape some of these more innovative models for care delivery?

Jaewon Ryu 19:45
I think it will accelerate and I think everybody points to the example of telemedicine as a good illustration. I think people saw the value of having that as a patient engagement and treatment vehicle and traditional reimbursement there has been a little bit clunky, to say the least. And I think that’s just one illustration where there’s been an aha moment for a lot of folks across the industry that, you know, wow, when you’re freed up from worrying about, “Is there a CPT code for the banana?,” when you can get freed up from that, a lot more becomes possible. I don’t know that everybody’s going to come in one fell swoop into value-based arrangements right away, but I think there’s a greater receptivity which probably did accelerate under the COVID pandemic in a way that without it, I think it still would have happened, I think those winds of change were well underway even from before, but maybe those winds behind the sails got a little bit stronger with COVID.

Renee DeSilva 20:47
Yeah, it’ll be interesting to watch. Also, going back to your earlier statement around early policy drives outcomes. It’ll be interesting to watch how the new administration pushes on this to, you know, both from CMMI perspective under Liz Fowler’s leadership. It sounds like there’ll be more demonstration projects. But I’m hopeful, although you sort of still see that it can be really challenging to have a foot in both boats in terms of fee for service and making strides around more risk based. So optimistic, but it’ll be interesting to see how the industry unfolds.

Jaewon Ryu 21:20
Yeah, I think you hit on a key point, which is, and people have said, wow, I’ve got a foot in each canoe and that’s difficult. It is tricky to do that because you don’t want to create differential care models just based on, you know, the kind of world that a patient happens to be in on the financing side. But at the same time, we know that the financing side can power a lot of clinical programs that can’t be sustainable in a traditional fee-for-service environment. So there is clunkiness, there is a tension. But I think the more we can move the industry in that direction, I think people will see greater value. I also think that we have necessity working on our side in some ways, specifically with the government programs, whether it’s Medicaid, Medicare. I think those are places where, you know, in particular, there’s probably greater impetus towards moving towards value-based payments because in a traditional fee-for-service model, you know, those payment rates tend to be lower, obviously, than the commercial rates. And so there’s greater value, I would argue, in terms of improving people’s health and managing the potential upside in terms of the savings on the total cost of care versus just trying to get paid per unit of activity, especially in those two lines of business.

Renee DeSilva 22:39
I think that’s right. Obviously, underscoring all of that is a sound primary care strategy. And I was struck by the Scholars Program that you’ve built which, as I understand it, is tuition-free medical school for a cohort of students each year that are committing to primary care and that would plan to give Geisinger a two-year commitment. So, curious about any thoughts that you’d share on that program. And I think it’s really powerful in terms of reducing the debt burden that maybe frees up folks to follow that path. But what’s been your experience to date?

Jaewon Ryu 23:12
Yeah, we are at an all time high in terms of number of applicants in our medical school. It’s not a coincidence that it comes as we’ve launched that program. It’s called the Abigail Scholars Program or Abigail Geisinger Scholars Program. Up to 40% of each class, as you mentioned, will go tuition free even with a living stipend during medical school. But it’s targeted around primary care and behavioral health, i.e. psychiatry. And it also has a year of service requirement for every year of support that Geisinger gives them. And so if they’re fully supported for all four years, there’s an expectation of a four year commitment back to Geisginer at the end of their training. Very similar to how the military health services programs are run. And we, in fact, have several alums of that program which was critically informative as we thought about how to design this. A lot of it, believe it or not, stems from the needs of our community and what we think as we look at the next decade, two decades, three decades to come – aging demographics, sicker populations. We know that primary care and behavioral health are going to be tremendous needs. They are already and that need and the gap to address those needs will only widen. And so we think this is a key ingredient to what we’re trying to do in terms of addressing the health needs of our community. It starts with primary care. And if you can get upstream, so to speak, and make sure that people have access to really top notch primary care services, time and time again we have seen that that reduces the need on all the downstream elements of healthcare. And, you know, my specialty emergency medicine I would argue is a downstream, you know, net net. It’s a downstream specialty. And if we’re able to build things more upstream, I think that benefits our communities. It’s part and parcel of what I said earlier in terms of building programs and meeting people and communities where they’re at. And I think primary care is a good illustration of that.

Renee DeSilva 25:21
Yeah. You are really grounded in the community. I wanted to get your thoughts on if we can just look at all of this from the equity lens. And it’s certainly a topic that I think if you’ve been in healthcare for quite some time, you know that there are gaps in outcomes by patient population. You know that oftentimes the zip code is sort of the best predictor of health for many people. And I think COVID has shined a spotlight on it. I wonder though, if you think about the community that you serve, you’ve got this rural mix, as you mentioned, and some urban communities. How do you just think about articulating or, I guess, maybe orchestrating your equity strategy given the needs of the community that you serve? Talk a little bit more about that.

Jaewon Ryu 26:02
Yeah. So I mentioned earlier a couple of our programs around social determinants. And I think you raised a very important point, which is diversity and equity is, yes, it’s about race, yes, ethnicity, yes, gender, all of those things. And in our case, it’s also rural, you know, rural folks. And I think the CMS data proves this out that, you know, they travel longer distances to get to their care. Access is not as easy. You know, we have up to 20% of our areas that still don’t even have broadband coverage and so even when you’re talking about telemedicine, you can’t pull that off if someone doesn’t have broadband. And so there are a lot of these other challenges. And I would chalk all of those up to social determinants of health that we’re seeking to address. And a lot of them are in the programs that I mentioned, whether it’s, you know, 65 Forward, Geisinger at Home, our primary care redesign programs, even our Life Geisinger, which is sort of a frail and elderly population, you know, day program. All of these programs, mail order pharmacy, building things, moving them into the home, I think are all intended to make care easier and make care easier across populations that otherwise would have challenges getting to the care. And so I think that’s one aspect of how we view this world of equity. I think the other is in continuing to train and educate a diverse population which can become the workforce of the future. And so whether it’s at our medical school or at our nursing programs or otherwise, we have tried to remove as many of the financial barriers of that education. And so our medical school is a good illustration. And don’t quote me on the statistic because I don’t remember it, but I know that it places us at a significantly higher percentage of our medical students who are the first in their families to graduate college. Another good example of where I think by doing that we make sure that everybody, you know, across different socioeconomic classes, which also happens to hit different races and ethnicities and perhaps even gender, we know that we’re able to remove some of those barriers to make sure that that future workforce is looking a lot more diverse. So I think that’s another way we look at it. The other way that I would throw in there, it gets to payer mix. I think when you’re in a value-based world, you’re freed up to really reinvent the care model in a way that doesn’t inadvertently create disproportionate services. Let me talk about that a little bit. You know, in the traditional health system lens, folks who have Medicaid or Medicare or, you know, any of the traditional government payers, I think a lot of certainly hospital finance people have traditionally viewed them as being well, that’s not a great payer mix. And so sometimes, and I’m proud to say we have not done that here and it’s partly as a result of our value-based orientation. But a lot of places may choose to design their programs or choose to locate where their programs may be based on those considerations of payer mix. If you’re in a value-based world, you don’t worry about the payer mix of what unit reimbursement looks like. You’re just focused on any improvement you can make to the care. That’s how value gets created. And so in a weird way, I think the value-based payment world actually promotes work around equity more so than the fee-for-service world. And so I think that’s what frees us up to focus on all of the programs that I mentioned, whether it’s social determinants or just getting care to the people, meeting them where they’re at. It knows no bounds because we’re able to just focus on improving health, at least for that value base component of what we do. And I think that permeates and has a halo effect across the totality of what we do.

Renee DeSilva 30:11
Yeah, that’s interesting. We spend some time at The Academy on Health Equity Alliance. And I want to take that back, this notion of how does value-based care actually help you get to a more equitable delivery of care? I think that’s an insight, Jaewon, that doesn’t come out a ton. But I think the way that you frame that is really smart. And I want to spend a bit more time on that at the firm because I think you’re right. I think the workforce demographics have a big role to play in it. I think just the willingness to think about this strategically. I hear many organizations beginning to stand up equity committees at the board, just like you have a quality or an executive compensation committee. And I think how the payment model either detracts or accelerates on equity and outcomes is a really powerful takeaway, so thank you for that sentiment. I do want to shift to leadership more broadly and have just a few things I’d like to explore with you on that front. So you talked about this a moment ago and there’s data that would support it that, you know, that if your workforce reflects your community that can be really helpful way in closing outcomes. You bring diversity of background to your role, I think, in a number of directions. You know, both your law school time spent, your age – Gen X as many CEOs are Boomers, your ethnicity. So talk about that. I’ve been, so let me just preface this, for myself, I have been on a journey around just being more comfortable speaking from the lens and often being the only woman or certainly the only black woman in many settings. And for a lot of my career, I just really ignored it. And I would say the last 12 or 15 months or so I have started to feel maybe more of a sense of need or feeling compelled to just be much more deliberate about how I think about maybe my unique voice or contribution to the conversation. So, you know, with that lens, I just would love maybe your own reflections on that for yourself.

Jaewon Ryu 32:12
Yeah. And to be honest, I think I’m still on a journey here. And it’s sort of reassuring and refreshing to hear you talk about your journey because I think, in many ways, you know, we each have our own personal journey, especially those of us who come from, you know, minority populations, so to speak. And, I think in my role, in many ways, similar to what you said, I think, historically I just have not thought of it that much. You know, and maybe not thought of it deliberately at least. I do think and I would agree with you over this last year, I’ve probably thought about it more in the last year and certainly since last summer I would say than I have in all the years prior to it. And I think partly it’s because of the events, you know, going back to last summer and just very disappointing, obviously, deeply troubling events. And it does remind us all and certainly reminds me that there’s still a lot of work to be done. But as far as, you know, what I bring to work every day with me, I think sometimes, especially being an Asian American leader, it’s, you know, I’m reminded of this by other colleagues, especially in recent times with what we’re seeing with Asian American populations across the country. You know, if you look at healthcare as an industry, a significant portion of providers, at least, are of Asian American heritage. And I think there’s a feeling like, you know, there aren’t as many Asian American leaders out there and perhaps that’s something that is indicative of something deeper going on. Tough to say, to be honest. But I think, at the same time, if we all do the hard work of ensuring that our leadership and the broader representation of how we show up in the communities are more reflective of the diversity of the communities around us, I think that will position all organizations in the industry much better. And that certainly, you know, is a focus here. I mean, people think rural America and they automatically think, you know, it’s totally Caucasian. That’s not the case and it is increasingly becoming less the case. And at the same time, we’re in areas that aren’t so rural and, frankly, kind of urban as well. And so trying to make sure that whether it’s our clinical staff, whether it’s our administrative staff, our leadership, and whether it’s language or race or ethnicity or gender, it really is important to us to make sure that we have that broad representation at all levels of our organization if for no other reason then it simply helps us understand our communities better. And I think that’s where our focus has been. We’re nowhere near where we want to be, but at the same time, I think we’ve made some great strides. You know, we have more than a quarter of our board and leadership being women. Half of our chief administrative officers that lead our hospital campuses are women. You know, I think it’s about a third of our providers are of Asian American descent. We know that Latino populations and Spanish speaking populations are rapidly growing in our communities as well and so we’ve been trying to be more deliberate around adding Spanish speaking staff across all of our areas as well. And so all of these efforts, there’s so much to tackle. Because I think we as an industry, we as a society are frankly behind and we’re playing catch up. And I know that’s something we’re deeply committed to. In fact, recruiting a Chief Diversity, Equity and Inclusion officer here. Just getting launched with that search. So a lot of efforts afoot, but, you know, somewhat disappointingly, I can’t say we’re at the place we need or want to be yet and hopefully that’s something we’ll get closer to, you know, in the years to come.

Renee DeSilva 36:05
Absolutely. I’m optimistic. You know, I spend a lot of my time talking to your peers across the country. And the level of candor and just willingness to just engage on what can be hard conversations, I think, is at an all time high. And I think it starts there. So I’m feeling optimistic that as an industry there’s greater awareness and commitment, CEO attention, all the things that, you know, are important in terms of really trying to move performance and the conversation forward. So one final question for you. The name of this podcast is The Academy Table. A big part of that is around, when I think about a table, I miss being around a table full of friends and colleagues. But it is often one of the more joyful moments for all of us. And for me, it’s also about just amplifying voices, some of which are known, like yours, and some that will be new to the group. So I’ve been asking my guests this question, which is, if you could invite one or two people for a conversation at your table, they can be people who are alive or no longer alive. How do you think about the perfectly curated table that you’d personally like to put together?

Jaewon Ryu 37:06
Yeah, you know, this is always an interesting question. And I think lately, in particular, and I think my wife would also agree with me on this, it’s interesting when you’re parents, you know, because you see these kids grow up. They start out as little babies, you don’t know what they’re going to turn into. Then as they go through childhood, adolescence, and so forth, you see these personalities start to develop. And our kids are 11 and soon to be 13. And they’re at that age where you can see their personalities, you can see their interests. If I could formulate and wave the magic wand of what I would wish to be at the table, I’d love and I’d be very curious to be at a table with our two girls when they are age 70 or 60.

Renee DeSilva 37:53
That’s amazing.

Jaewon Ryu 37:54
And just by life expectancy, there’s a good chance I won’t be around when they’re, you know, in their 60’s and 70’s. But I’m very curious. And I think my wife and I are both very curious, what kind of lives will they lead? And, you know, what will be their decisions as they go through life when they are parents? And how will their personalities impact what they choose to do as a career or who they choose to be with or not? And you know, how they choose to parent or not? I think those are all questions that, I got to tell you, I’m dying of curiosity and I don’t think I’ll ever be able to truly know. So maybe I’ll take advantage of this question and say, I wish that I could know by having them at that table.

Renee DeSilva 38:37
Yeah, that’s amazing. You know, to that point, I live now in a multi-generational household, maybe you do as well. Do I have that right?

Jaewon Ryu 38:44
I do. I do.

Renee DeSilva 38:46
And so I even think about that, just the blessing it is. My mom is 74, she lives with us. Just to have her at whatever version our dinner table takes, some nights it’s standing around running to basketball practice, but it is a gift to have that time. So I love that response, Jaewon, thank you so much for sharing that.

Jaewon Ryu 39:03
No, thank you. Thank you.

Renee DeSilva 39:06
Thanks again for joining me at The Table. The Table is a podcast produced by the Health Management Academy. Make sure you catch future episodes by visiting our website or by subscribing on the podcast platform of your choice. And if you have suggestions for topics or guests, I’d love to hear from you. Please drop me a note at I look forward to talking with you soon.