Delivery of Care

When convergence works, and silos get broken down

A frank conversation with Dr. Michael Wagner, president and CEO of Care New England, about the future of Rhode Island’s second largest health system

Photo by Richard Asinof

Dr. Michael Wagner, MD, the president and CEO of Care New England, provides an illuminating vision of the future of Rhode Island's second largest health system in an exclusive interview with ConvergenceRI.

By Richard Asinof
Posted 4/22/24
A frank discussion with Dr. Michael Wagner, the president and CEO of Care New England, offers an intriguing look into how the second largest health system in Rhode Island is intent on achieving financial stability and reinventing itself as a health system for the future.
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PROVIDENCE – ConvergenceRI had an epiphany while covering the Providence Business News native advertising event on Thursday morning, April 4, at the Marriott, which combined a “Health Care Summit” with the awarding of 16 “Health Care Heroes” to hard-working members of the health care workforce in Rhode Island.

The bulk of the morning was spent listening to Michael Mello, editor of the Providence Business News, ask insightful questions of a distinguished panel of “experts” drawn mainly from the advertising sponsors of the event – including Dr. Michael Wagner, president and CEO of Care New England, Dr. Kristin Russell, chief medical officer of Neighborhood Health Plan of Rhode Island, Joan Kwiatkowski, CEO of PACE Organization of Rhode Island, Dr. Raj Hazarika, Point32 Health Services, Inc., and state Sen. Pamela J. Lauria. [Many of the questions had been apparently shared in advance of the panel.]

From their leadership positions, the panel of experts shared their educated prescriptions of what should happen within the disrupted health care landscape. The captive audience [who had the honor of paying $85 to attend the summit] was mostly there to lend support for their colleagues – the health care heroes.

Perhaps the epiphany was obvious: It was the leaders who were doing the talking who needed to listen to what the health care heroes had to say about their experiences about what has been happening on the front lines of health care.

When ConvergenceRI sat down to interview Dr. Michael Wagner, the president and CEO of Care New England, the conversation began with that realization. And, for Dr. Wagner, the conversation with ConvergenceRI became a surprising learning experience for him.

Dr. Wagner had expected to talk about the financial transformation of Care New England, describing how he had helped to cut down a $58 million loss to a $14 million loss in a year’s time, expanding on his comments at the Providence Business News health summit. Instead, the conversation appeared to open new doors for listening and learning about potential future investments in the pioneering research underway at Care New England as a way of reinventing the health system. Call it an unexpected journey that you are welcome to join.

ConvergenceRI: Thank you for making time to talk with me.  

ConvergenceRI: I attended the Providence Business News “health summit,” and I had a distinct reaction. As much as you folks were talking, I had a sense that the people who were being honored should have been the ones that were talking, and you guys should have been the ones who were listening.  
WAGNER: [chuckling] Yes.

ConvergenceRI: I felt that it was indicative of the current nature of the health care system…  

ConvergenceRI: …Where it is still pretty much stuck in silos. and people tend to talk at each other, rather than with each other.  

ConvergenceRI: Did you feel like you got your message across at that gathering?  
WAGNER: Panels are always difficult, when you have five people. And, typically, they prep you with a couple of questions that they are going to ask. So, it’s semi-produced. Which is fine. Because it helps to get the message, or at least to prep people so they are not caught off guard.

Your comment, though, around the people who were being honored: Boy, wouldn’t it have been great if we actually heard some of their stories, because they have done really amazing work.

I don’t know all the people who were being honored. But, hearing their quick bios around what they have gotten accomplished, there were some folks who it would have been very helpful to hear what they had to say.

Especially around behavioral health, health equity, quality, and working in community locations. Wouldn’t it be interesting to actually have them talking? I think you’re right.

ConvergenceRI: To be fully transparent, I used to work at The Providence Business News. The story of how I started ConvergenceRI was related to my experiences putting together one of those health summits [in 2013], where I essentially wrote the entire script and all the questions. And, the editor at the time couldn’t even deem it important enough to give me a public thank you.  
WAGNER: [laughing]

ConvergenceRI: I did a quick calculation of how much money they brought in at the door. I said to myself, “They are making this amount of money off my work. I can do this myself. And that is literally the genesis of ConvergenceRI.

From my point of view, we don’t often have an opportunity to have a good discussion about what’s happening in health care [in Rhode Island]. People get stuck in their own silos. I have been trying to sit down and talk with people and get their perspective, particularly talking with some of the important leaders, like yourself.

One of the phrases that you used at the PBN Health Summit was that you called the entire health care system “fragile.” What did you mean by that?  
WAGNER: Let me start back at “the health care system, big picture.” We spend 4.5 trillion dollars on health care.

ConvergenceRI: Something like 17 percent of the…  
WAGNER: …17.5 percent of the gross domestic product. We spend a huge amount of money, twice [as much] as any other developed country on a per capita basis. So, for us, it works about to $13,000 per person in health care. In any other developed country, it’s about $6,000 to $7,000.

We spend a tremendous amount on health care. Yet, our outcomes and our experiences, our equity, are far below the levels of other developed countries. In life expectancy, maternal mortality rates, infant mortality rates, measures on quality of care, we don’t do as well. We’re spending all this money, but we’re not achieving outcomes that are commensurate with the dollars being spent.

I’m going to start with that and expand on the big picture. The other is that being a practicing physician, I have lived in the world of disconnected, fractionated and frustrating care.

ConvergenceRI: What was your specialty?  
WAGNER: I was in Internal Medicine, and I did Primary Care; I focused on inpatient care, taking care of patients in the hospital.

I spent a lot of time working with patients who’d come in with an undifferentiated problem – a cough, shortness of breath, whatever. Then I had to work with them through the health care system.

I lived first-hand the frustration of what it is like to be a primary care doctor and to work with patients who are trying to navigate their way through the health care system. Our system is very difficult to access, to navigate, and it’s very frustrating for people.

My son’s trying to get hooked up with a provider, and he can’t get on the portal. And I’m like...

ConvergenceRI: How old is he?  
WAGNER: He’s 27.

ConvergenceRI: Is he living in Rhode Island? Massachusetts?      
WAGNER: He’s living in Rhode Island. He’s living with us here in Rhode Island. He’s trying just to get access to the portal, so that he can then get connected into the system. [Hopefully], he’s going to get a phone call today to get him into the system. But it’s very frustrating.

And, I think, most people who interact with the health care system would say, “When I worked with the doctors, when I worked with the nurses, when I worked the people who are delivering care, they do amazing work. And that’s true here in Rhode Island. I think we do a great job when people are actually connected in care. But, it is all of the difficulty of getting access, of having a disconnected experience.

At a macro level, our health care system doesn’t work very well. And then, on top of that, we actually have a fair amount of waste in the health care system. Some people will say that about a quarter of the expenditures in health care are “waste.”

We pay too much for services; there are redundant services like extra lab tests, if you just had known that the person had [the same test] done at the hospital next door, and saw that, you wouldn’t have repeated it.

There is a lot of administrative waste. There’s a lot of waste in the system. Even if you if took just a fraction of that 25 percent, that is a huge amount of dollars on an annual basis.

The big picture: Health care leaders need to be part of the solution of trying to fix health care.

ConvergenceRI: So, when you say, “fragile,” I assume that, given the way you described the big picture, a lot of it is that the finances are not sustainable, which makes the system fragile. Is that correct?  
WAGNER: Yes. That was the context before the pandemic – 2020. We walk into the pandemic, and the pandemic, as I said at the PBN event, the pandemic exposed all of the fragility of the system – a fragile workforce that was already getting burned out, shortages of nursing, and an increasingly more complex environment

(There are) therapies now that are very amazing in terms of what they can do for patients who have certain diseases, but they cost a lot of money. They are complex, and so the system of care is getting more complex, and we didn’t have the resiliency; we didn’t have the infrastructure to manage all of that. 

And then, the pandemic comes, and we exposed all those weaknesses. And, when I use the word, “fragile,” I am specifically talking about the period from 2022 to today.

In 2022, we had the massive loss of a lot of staff, through the “great resignation,” with many people burned out, deciding to go into different fields – to leave nursing, to leave being a physician, or other health care jobs.

So, we had a drop in the number of people who were available to work; costs went up tremendously. Financially, hospitals that had had pretty thin margins to begin with, now went tremendously negative, [because of the impact of COVID].

My old system, Tufts up in Massachusetts, this is all in the public record, lost $400 million on a $2.2 billion organization. That’s a tremendous loss. Now, there were other factors. But it was an indication of the fragility of the health care system. All of that then puts more stress on the remaining people at the organization. And the system is fragile. That’s what I mean by that.

ConvergenceRI: Thanks. That is a really comprehensive answer. As you have probably been following in ConvergenceRI, I have been trying to explore the report that the Rhode Island Foundation put out, that Manatt did, and do a comprehensive analysis of that report. Because, in my own opinion, I found the report lacking.

If you read my story, I went back and forth with Zach Nieder, the senior strategic initiative officer from the Rhode Island Foundation, asking him how they could do this entire report and not talk about the impact of COVID on all of the things related to hospitals and health systems? [See link below to ConvergenceRI story, “Show me the data – and the money!”] 

To me, unless you are going to address the impact of COVID on the entire health care system, the study of hospital costs doesn’t make sense. That’s my personal opinion.    
WAGNER: We were one of the organizations that helped to underwrite the study. It was Care New England, Lifespan, Blue Cross and Blue Shield of Rhode Island, and South County Health.

So, I had a chance to see some early drafts of the report. One of the things that we wanted to achieve was some degree of objective data. Because there was a lot of stuff being thrown around, such as: “We get paid less than Massachusetts” and “We get paid less than Connecticut, so, we have to increase commercial rates.”

There was a dialogue occurring, but there was no data around the dialogue. We were all pushing for [an opportunity to go] beyond positional statements. Let’s start to get some data. I think the study accomplished a beginning in that process, but it was not the be-all and end-all.

One of the comments I made in one of the local papers was around the issue of  “It’s a start, but it is not by any means definitive in terms of outlining the issues.” I think one of the flaws in the analysis is the financial analysis comparisons, looking at prior years and then 2022.

ConvergenceRI: Why 2022?  
WAGNER: 2022 was – and I said this at the PBN event – 2022 was a devastating year for health care organizations, and it was a negative anomaly in health care finance, because of no more or very little federal support. The staffing costs went up; the volumes went down. And, if you look at the health organizations across the country, everybody was hugely negatively affected.

So, the problem with the study is that the last year that they have any economic data on is 2022, which is a really bad year.

So, I think it portrays an image of a devastating economic consequence for hospitals. Is it true? Yes, it’s true. But it is also somewhat of an anomaly. If you look at the national data, from 2022 into 2023, margins for hospitals started to rebound. And, in fact, a year ago, when you look at the data nationally, most hospitals were now achieving positive margins.

In other words, they were rebounding from the negative 2022 experience, now moving into 2023. And that exactly mirrors what happened at Care New England. We started to become profitable in March of last year. And now, we are moving to having a consistent level of profitability over the past year.

So, my point is, you picked a year that is really bad. So, what can we learn from that? I think the answer is, I think the question is, we all did badly in 2022. How well did we have resilience? How well did we come out of that negative trough? And, how do we as an industry, and one of the report cards that the state should be asking of our leaders of the health care systems is: “How are you managing your organizations back to being sustainable and profitable?” And, I would like to say that Care New England met that challenge.

[Editor’s Note: Wagner offered a critique of the study for focusing on the year 2022, the year when the impact from the COVID pandemic was paramount for hospitals and health systems, seeming to agree with ConvergenceRI’s criticism of the study and its lack of analysis looking at the impact of COVID.]

ConvergenceRI: This is a great conversation. My sense is that hospitals have to reinvent themselves.  

ConvergenceRI: They need to do it in a way that they take their strengths and really invest in them. For me, one of the more remarkable things that is going on now at Care New England is that your head of Pediatrics, Dr. Jill Maron, has developed a whole series of techniques around analyzing saliva swabs of infants, with the potential to grow not only a state industry, but a national industry and a world industry. [See links below to ConvergenceRI stories, “On the cusp of a revolution in the care of newborns” and “The promise of saliva assays knows few boundaries.”]

And, if I were in your position, I would take whatever money I could and invest in her in developing that industry through her work, and make Rhode Island the base. Does that make sense to you? Is it something you could do? There is no question about ownership. You don’t have to pay royalties. She has all the clinical data.    

ConvergenceRI: You have the ability, given the leadership of Women and Infants Hospital, to do that. Is that the type of enterprise that Care New England could build out as a way of differentiating itself?    
WAGNER: Yes, yes. There are two parts.

One is that you are hitting on something that is very important. Which is this concept, “What is different about Care New England?”

And Women and Infants, if you look at us, the [enterprise] is comprised of very distinct kinds of health care organizations. We have a behavioral health hospital, Butler, which does 52 percent of all the inpatient discharges in behavioral health, and has a large ambulatory day program. And, it is seen as the premier behavioral health expertise in the state.

Obviously, Bradley Hospital, with Pediatrics, has its niche as well. At Women and Infants, 8,500 babies are delivered [a year], 81 percent of the deliveries [in Rhode Island] on an annual basis; it has an 80-bed NICU. Our NICU is twice the size of the largest NICU in Boston.

And people (in Rhode Island) don’t quite recognize that, at Women and Infants, there is nothing comparable to it in Boston, and in fact, I think you have to go as far as New York to find something at the level of Women and Infants.

Why is that important? Because we are able to recruit doctors like Jill Maron, who I know from Tufts, because she was up there when I was up there, and Dr. Methodius Tuuli, chair of OB-GYN, and other leaders at Women and Infants, because it is such a world renowned organization. We are able to attract and keep incredible talent, like the Jill Marons of the world.

And then the other is Kent Hospital, which sits in a very unique part of the state. And then we have several other parts of the organization. When you pull all that together, we have incredible strengths in the performance that we have from an academic perspective in Family Medicine, in Psychiatry, and OB-GYN is really, I think, some of the premier academic programs that are affiliated with Brown.

A big part of our work is supporting our academic leaders in the discoveries and the work that they are doing. And so, continuing to support Jill’s work, and figuring out ways to commercialize it, and working with her to figure that out is an important part of our work.

ConvergenceRI: Have you sat down and talked with her about how to do that? Because I had a conversation with her with some folks at Brown and some folks at RI Bio about trying to have an opportunity to present her data as a way of jumpstarting a conversation.  Unfortunately, I think, and this is my opinion, the RI Life Science Hub may be heading in the wrong direction.  

ConvergenceRI: They are focusing on commercial wet labs. And there is a glut of wet labs in commercial space in Boston and we are not going to attract companies or keep companies and have that type of competition. What you have with Dr. Jill Maron’s work, which I find to be extraordinary, is an opportunity to build out that enterprise here where you own it.    

ConvergenceRI: And, you can support her work, and if you sit down and talk with her, she can tell you exactly what she needs to do. So, why not create a program where she can present her data [from her clinical trials] and you have the space that she grow that whole enterprise?  
WAGNER: It’s a great idea. Have I talked with her specifically about her specific research? No. Because I have other… [pause]

ConvergenceRI: Other responsibilities?  
WAGNER: But let me get to one of the other points you made. Which is that the hospital of today is not the hospital of tomorrow.

I want to rewind 20 years. I want to take us back 20 years and imagine that we are sitting in a room of hospital executives, and back then, a lot of more independence and a lot less system development. And, we are sitting in a room of 30 or so people who run a variation of different kinds of community and large hospitals.

And if I went and said to them, in 20 years, how many of you currently have pediatrics units in your hospitals? And all their hands would go up. They all would have pediatric units. How many of you have OB [obstetrics] units? Every hand would go up. How many of you rely on your orthopedic surgery for driving [profit] margins for your organization? They would all raise their hands.

I am coming from the future. Twenty years from now, most of you will not have a pediatric inpatient unit; probably half of you will no longer be doing OB-GYN; and, your orthopedic surgery will have left the building, because almost all of the orthopedic work, including total hip and total knee elective surgeries will be done in day surgery environments.

If I did that 20 years ago, they would have laughed me out of the room. And they would say, “There’s no way!”

The point I am making is that the hospital of 20 years ago is not the hospital that we have today. And, to your point that you were making around [the fact that] hospitals have to figure out where they are going, and that’s a fundamental question. What innovations are we doing today that are going to change the hospital five, 10 years from now?

The answer: “Hospital at home.” Now, 4 percent of the discharges from Kent Hospital are people who are actually admitted, inpatient, but in their home. And so, now, instead of going up to the floor, we evaluate the patient. If they meet inpatient criteria, we get them back home, if they also agree to it, they have to meet certain criteria in terms of a safe house.

ConverenceRI: [interrupting] Essentially a geriatrics unit.     WAGNER: It is mostly geriatrics but it doesn’t have to be. It can actually be younger individuals. A doctor goes and sees the patient every day.  Nursing is out there twice a day. And we have other services that we wrap around.

We have admitted and discharged over 500 patients through that program since it started a couple of yeas ago. The satisfaction rates are through the roof, because people are in their homes. The outcomes are better than if they had been admitted to the hospital.

We also have a unit at Kent called the “ACE” unit, which is the “Acute Care for the Elderly.” And that program is specifically aimed toward the elderly population. It is an age-friendly environment.

That unit, [with its] lower readmission rates, lower length of stay, where patients are less likely to be sent out to a nursing facility, has better long-term outcomes. If the hospital of the future is going to be age-friendly, it’s going to have a very short period of time when people are in the hospital, because it’s a risky environment. It’s going to be procedural for things that cannot be done in an ambulatory environment.

And, the hospital of the future will not be predominantly inpatient; it will have a mixture of inpatient, procedural, ICU, and ambulatory services in a single campus. And, that’s what the future of the hospital campus will need to look like.

ConvergenceRI: I agree with you.  And I have questions about what that future campus will look like. But let me continue with questions about future investments in innovation. In addition to the research that Dr. Maron is doing, there is a wonderful segue with the research that Dr. Audrey Tyrka is doing around stress, and her work with COBRE, the STAR COBRE, and the fact that it connects really well with the work that Dr. Jill Maron is doing.

And, you have the same opportunity to grow the enterprise around the research of stress from a neurological point of view, in terms of how stress changes the development of the brain and how you then change your treatment accordingly. And, the possibility of changing the entire way that behavioral health is addressed. [See links below to the ConvergenceRI story, “The potential for collaboration.”].  

ConvergenceRI: And, once again, Dr. Tyrka is someone whom I have interviewed. If you can diagnose infants [by running a non-invasive saliva swab and then doing a rapid genomic sequencing] and then know what is happening with them, and you can measure the stress levels in terms of what’s the best way to support a child’s growing brain with the goal of limiting the amount of toxic stress that is happening, and having a coordinated program.

Once again, it seems to fit into everything that you are talking about the reinvention of the hospital, and being proactive rather than reactive in the way that would change the nature of health care and the way it is delivered.  
WAGNER: You are adding an important dimension to the conversation, which is around the issue of how do advances such as Jill’s or Audrey’s work that they are doing, and others, including Dr. Tuuli,

And when you take the work that they are doing, and you’re making the connection, which I think is fundamentally an interesting one, and one that I had not made myself, around Audrey’s work, and the work that Jill is doing, so I am learning something, which is great.

I appreciate that. So, if you think about that, about how we incorporate advances, because the hospital of the future will be affected greatly by advances, whether it is in the advances of surgical technique like we’ve had with hips and knees surgery, or the advances in pharmacology, which is going to have a huge impact, both in terms of cost but also outcomes, in terms of how patients are doing. I like where you are going with this.

ConvergenceRI: The next part of that is, and I did a story in the most recent edition of ConvergenceRI, about the work Dr. Beata Nelken is doing with her Jenks Park Pediatrics practice in Central Falls. [See link below to ConvergenceRI story, “Changing the lives of women and children in real time.”]

She is setting up a residence, the Jenks Park Residence, that is actually going to provide housing for women and children in Central Falls who are at risk of homelessness. With the backing of the mayor and Rhode Island Housing and the Pappito Opportunity Connection. Everyone talks about how housing is health care and health care is housing, but this is the first time in Rhode Island that I am aware of that this is actually being done.  

So, I look at a hospital facility like Kent where you already moving, in terms of focusing on an elderly population, and I’m thinking, why not create housing that does a similar thing to what Dr. Nelken is doing in Central Falls by creating a housing complex that basically meets people where they are in the community.

And, particularly in Warwick, because I have a feeling that Warwick and Cranston, we don’t necessarily see it, but those are the communities that are really stressed, because there is a growing dividing line, a gap, between the very wealthy and the very poor. And, your hospital gets caught in terms of how you pay for things, in terms of where the money comes in from. Being creative and innovative, you are doing that in terms of the elderly but I was wondering if there was a way of combining investments in housing for women and children at risk of homelessness.  
WAGNER: At the Providence Center, we actually do rent some residential facilities, which are mostly for individuals who are coming out of substance use disorders. So we do some housing and some recovery. It is an area that requires real expertise to do it, and do it well.

There is an important concept that you are getting at which is about the interplay between health care and social care. Going back to my earlier statistics about the amount of money that we spend on medical care being twice what other countries spend, the other countries spend twice as much on social care than we do. So, when you look at the total spend, it’s about the same. But our spend is mostly in health care, not in social care.

What’s the difference? In those countries, the ability for them to have wrap-around such as housing, social net, transportation, food security, has had an impact. I think part of the reason why they have had better outcomes is that they actually are spending more money on social care programs, which gets to your housing. It’s all connected together.

ConvergenceRI: For me, from the outside looking in, it seems that you have an opportunity to reshape Care New England in a fundamental way that’s different, that looks at what it means to be a health system in the future.  

ConvergenceRI: The next question that I had is that the biggest threat right now, as I see it, is private equity coming in and snapping up hospitals. And every hospital is vulnerable. How can you protect yourself from the threat of someone coming in and wanting to buy out Care New England? How do you preserve Care New England?  
WAGNER: First is, there is lot there to that question.

Let me get to the private equity first. Full disclosure. I have worked for startup companies; I worked for a publicly traded company in health care. I have a great respect for investment in startup companies, because they can actually help to change the trajectory of an industry. And, a large portion of the health care system is actually for-profit.

Much of it is privately held, or like all physician practices, or publicly traded. And, I am not going to say one is better than the other, because there are not-for-profit systems that don’t do a great job in running their business, either.

The point is, the ethics and the culture of the company matter a lot, and what their motives are.

Private equity, especially that which is based on deconstructing an organization as we have read in the papers, you know…

ConvergenceRI: You mean Steward Health Care.  
WAGNER: Yes. And other organizations like that, that have deconstructed the assets and then monetized them, I think is very corrosive and destructive – and not in the best interests from a public health perspective.

For Care New England specifically, when I came on board, we were losing between $3 million and $5 million a month. In 2022, we lost $58 million, and that was the bad year, right? That was the year that was bad for everyone. Proportionately, Care New England did not fare as badly as some other organizations.

But still, losing $58 million was not sustainable. When I came on in December of 2022, which was my first month, which was the start of FY 2023, because our fiscal period starts in October, we were already losing about $13 million in the first three months.

And, by the time February came around, we were $20 million in the hole. So, we had to immediately do a turn-around. And, literally, I’m on board for like two months, and we had to immediately – my CFO, Todd Conklin  had just started. He walked in the door and I said: We have to do a turn-around, and we have to do it fast.

So, we identified, mostly overhead, that could be taken out of the organization. We had very few employees that were affected. But there was a lot of stuff that we were doing that was unnecessary. And so, we tightened the belt. We really focused with each of the operating units – Butler, Kent, Women and Infants, the VNA – and we worked with them relentlessly around how do we help you manage expenses, how do we help you in looking for opportunities for growth. And, we were able to turn the tide around by April of 2023, a year ago, we were starting to make a very slight margin.

We had turned a negative $3 million to $5 million loss per month into a very small margin. We were able to finish the year, reverse about from a negative $20 million, to a negative $14 million. So, we actually made up $6 million in the latter six months of the year.

And, we ended the year at a negative $14 million loss. Which is what the budget was that the team had set out. That’s a $44 million improvement. Which is pretty dramatic.

We now have set out a goal of a $12 million operating margin for this year, and we are already well ahead of our budget, and we were profitable by $2.5 million as we go through the year.

We will likely exceed our $12 million margin target and we will be profitable. And we are profitable now.

How do you stave off private equity? The first thing you have to do is you have to stabilize the organization. You have to get to a point where your head is above water, and you are starting to give people space to think about where we are going. We’ve done that.

ConvergenceRI: What comes next?  
WAGNER: The next phase is that you have to hard wire performance. And this is the piece where people think not a lot is happening. But what is happening is that we have to hard wire performance in things like revenue cycle, and talent acquisition – all of the basic building blocks.  Remember, we have been in 10 years plus of merging discussions, and four years of the pandemic.

The teams got distracted. And when there were mergers, the executive team is like wondering if they are going to have a job. They’re wondering who is going end up on top. They’re wondering a whole bunch of things, and you can’t necessarily hire talent in that environment, either.

So, we’ve come out of that. We’ve now hired a complete executive team. We’ve hired everybody at all the major positions. We’re making money. And we’re now hard wiring performance. And we’re seeing results that are now going to have a sustaining ongoing and cumulative effect.

The third phase is acceleration. And that is about growth; that’s about focusing on how do we actually take this incredible organization of Care New England, that really is at the foundational aspects of health care delivery.  Behavioral health, primary care, geriatrics, maternity care, newborn care. These are all the fundamental aspects of health care delivery.

To me, as a primary care doc, that’s really exciting. And most health care occurs at that foundational level. That’s the position that Care New England is in.

From my perspective, financial stabilization, and an exciting strategic story, is the most important thing to keep us from ever considering private equity in taking over our organization.

ConvergenceRI: That’s a good answer. But it is also about listening. I would also say: call a meeting. Get Drs. Jill Maron and Audrey Tyrka in the same room together with you, and ask them: Where would they like to go? And how do they see themselves fitting in.    
WAGNER: It’s a great question.

ConvergenceRI: It would allow you to shape your own identity based on innovative research moving forward.

Moving forward  
The interview continued for another 20 minutes, focused on the changing world of orthopedics. Dr. Wagner learned from ConvergenceRI about the sale of OrthoRI to a private equity firm, Aspire Orthopedic Partners, and the growing success of IlluminOss that was revolutionizing the treatment of bone fracture repair. The session concluded with Dr. Wagner saying that he would have to become a more regular reader of ConvergenceRI.

The conversation with Dr. Wagner perhaps marked a change in the way that Care New England’s president and CEO will approach his decision-making – with more of an inclusive kind of conversation, one where he is listening attentively to his top doctors. Stay tuned.

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