Taking Healthcare by Storm: Industry Insights with Brian Frazee

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Brian Frazee, President and CEO of the Delaware Healthcare Association. 

Brian Frazee discusses his extensive background in healthcare advocacy, the unique challenges of Delaware's aging and growing population, the impact of the COVID-19 pandemic on healthcare, and DHA's strategic priorities including workforce development and health equity.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

Publication number QI-061325-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.

 Hello everyone, and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical Director of Quality Insights, and today I'm thrilled to have Brian Frazee, the president and CEO of the Delaware Healthcare Association DHA, joining me. Brian brings a wealth of experience to the role with a strong background and political advocacy, so very important in this  climate that we are in right now.

He also brings policy leadership, healthcare and healthcare association management. Before taking the helm at DHA, he served as vice president of government Affairs at the Maryland Hospital Association, where he led adv. Could see efforts for hospitals and health systems across the state. Again, something a skill that is so very important right now.

With his extensive experience working at the intersection of healthcare policy and politics, Brian is poised to guide the DHA into a new era of innovation, collaboration, and excellence. The Delaware Healthcare Association founded in 1967 plays a critical role in shaping the healthcare landscape in Delaware as the leading trade and membership services organizations for hospitals, health systems, and related healthcare entities.

DHA works tirelessly to improve the health of. All delawarean and I was very worried I was gonna stumble over that word.  By advocating for policy changes and providing essential leadership to support the state's healthcare providers, again, something that is so very important. Brian, thank you so very much for joining us today.

Jean, thank you so much for having me. I look forward to the opportunity to chat today. Yeah. So can you share a bit about your background and what led you to become the CEO of the Delaware Healthcare Association and what is it about the d a's mission that excites you the most? Sure. So I came to DHA, as you mentioned, with  sort of a unique blend of political policy, advocacy and association leadership experience, as well as a commitment to strong workplace culture.

And I really got my start in healthcare when I worked for what was my home state senator at the time in southern Maryland back in 2010. And he happened to be the chair of the Senate Finance Committee there which has jurisdiction over healthcare issues. And that was the same year that the Affordable Care Act passed at the federal level.

And Jean, as you probably know there were a lot of  things that the states had to do to really implement that law effectively. And so I was fortunate enough to get a front row seat to what Maryland did in that space, and I just found it to be really fascinating. And so I. I, uh, found my niche in healthcare through that experience.

I was always interested in politics and policy, which is why I had that job in the first place  with my state senator at the time. And so after  I got through the legislative session that year  it was an election year in Maryland and I was fortunate enough to be hired by that senator as his campaign coordinator.

And I managed the Southern Maryland Democratic coordinated campaign with all of the candidates from the local, all the way up to the federal level in southern Maryland. So, got some experience running campaigns and you know, managing a lot of different personalities, as you can imagine  through that experience.

And then I went to work for a private contract lobbying firm for a year, and that's when I really got introduced to advocacy. And then shortly after that, I got an opportunity to join. The Developmental Disability Provider Association in Maryland.  So we represented about a hundred agencies, support services to people with developmental disabilities, and that's how I got my experience in the association world.

So you kind of see where this is going.  I spent four years there. And then I had an opportunity to join the Maryland Hospital Association as their government affairs lead, and was there for eight years before I very unexpectedly ended up here in Delaware at the Delaware Healthcare Association. And I, I couldn't be happier here.

I love the role. I love our mission. You asked about what kind of excites me the most, and it's really the people the culture. And the opportunity here. And what I mean by that is there's such a great opportunity to do really big things in a short amount of time in our state because  we have a very collaborative state.

Everything is based on relationships.  You know, we like to say we're a state of neighbors here in Delaware. And I have found that to certainly be the case in my year and a half here so far. So I'm really excited about the work ahead. I mean, you really have the perfect background for the role. I mean, I'll say absolutely.

And I love that you say that Delaware is a state of neighbors. I mean, that's really wonderful to work within the community to make change.  It really important. Absolutely. Yeah. So, so you bring a wealth of experiences we were talking about in political advocacy, which is something I find so very interesting.

And healthcare leadership from your time with the Maryland Hospital Association. So how do you plan to leverage that experience to benefit Delaware's healthcare system? Okay, well first  I came to the state very humbled by the fact that IWI wasn't from here.  And that I had a lot to learn in terms of the people, the processes here the landscape.

 And so I spent a good portion of my time in the beginning of my tenure  really just listening and traveling around the state, meeting with my members, meeting with elected officials, meeting with community partners. I know I came into this role with some great experience that you mentioned, Jean.

But I also knew that I really needed to, to listen and be humble in that regard.  You know, coming from the outside, so to speak. And what I learned very quickly was  kind of what I said earlier around just the very special culture of state, of neighbors we have here in Delaware, but also how many challenges we have in our healthcare system.

So, you know, we're the sixth oldest population in the country. We're the eighth. Fastest growing in the country. So we have a uniquely aging and growing population here. And that's putting a lot of strain on our healthcare resources.  We also don't have the best healthcare outcomes in Delaware. We have a lot of work to do, especially as it relates to obesity and diabetes.

And so I really saw an opportunity to use the experience from the Maryland Hospital Association and frankly from the other roles I had too, of really being  the convener and being a leader, bringing people together and figuring out what can we do to help address these challenges together. In fact, we just announced last week, the first ever joint advocacy agenda with several of our healthcare partners in the state. Uh, It was the first time we've ever done something like that here in Delaware, where, my organization was standing with the medical society, with the nurses association, the home care, the nursing home folks.

To really say, what can we do together to address these challenges because they affect all of us. So I really learned, especially from the state senator that I mentioned, the leadership skill of, and the power of bringing people together and being a convener and really driving outcomes in our work.

And so I really hope to continue doing that here in Delaware in collaboration with everyone else. It really makes sense. I think a lot of people think about healthcare organizations operating in silos. So it does, it makes sense to address things together. You can get much further together. DHA. Yeah.

DHA represents hospitals, health systems and healthcare related organizations in Delaware. Many people  might not realize that. So what do you see as the key challenges facing healthcare providers in the state today, and how is DHA addressing them? Sure. So I'll kind of build on, what I said a minute ago, Gian around  just our population.

And before I get there, I'll say that, our hospitals have been ranked number two in quality in the Nation by US and World Report last year. And so we've made a lot of  progress despite the challenges that I outlined. we're the sixth oldest population in the country. Eighth fastest growing population in the nation that impacts both service, demand and workforce.

We rank ninth highest in the nation for diabetes prevalence.  We're the eighth highest in the nation for adult obesity. I. So we have just a lot of challenges in terms of both our population but also our health outcomes. And hospitals certainly play a key role in helping to address that. You know, our ultimate goal is to keep people healthy on the front end so that they don't end up needing hospital care.

So we have a lot of work to do to continue driving toward better outcomes. Delaware hospitals also are the largest private sector employer in the state. We support more than 28,000 direct jobs. And so strong hospital systems, we like to say support healthcare communities. And what can we do together to make  what we like to say the first state first in health.

That's kind of our new motto that we've been living by lately. And so our advocacy agenda at the association.  aims to strengthen Delaware's healthcare workforce, ensure healthcare access, quality and affordability, and also advance health equity. So those are kind of our three strategic aims under which all of the legislation, policies, regulation work that we do as an organization really drives toward,  those three aims and really helping to address together the challenges that we have  as a state.

Being the first state, you have like the best nickname, the best motto. Yes. Say first. Yep. I know, I, well, I told my team, I said, you know, we're the first state. There's gotta be some type of motto we can have that really drives our goal to be the first. And somebody came up with the first aid first in hell.

So we kind of uh, took it and ran with it. Yeah, so the Covid Pandemic had a profound impact on healthcare systems across the country. What are some of the lasting effects you've seen on Delaware's healthcare landscape you know, particularly in, in areas like workforce and patient care, I. Yep. So it goes without saying that the pandemic changed everything.

I mean, it changed the way we look at issues. It changed the way we operate in a lot of ways, even to this day. And as you said, especially as it relates to workforce and patient care, the first thing that comes to mind, Jean, is telehealth. I mean, you know, I like to say that  before the pandemic telehealth was in a lot of folks  you know, long-term plans that ultimately had to be implemented essentially overnight in March of 2020.

And so we've come a long way just from a technology standpoint in terms of access and telehealth and flexibility both on the workforce front, but also for our patients and the people that we serve. And also how do we. Uniquely support our workforce. So our members are doing a lot of innovative things around, building childcare centers as part of the hospital to help their workforce with childcare needs, which have consistently been brought up as a barrier to people being employed.

 So how do we support our workforce and our frontline providers in that?  Also, elder care is another barrier that's mentioned a lot. We have elder care programs that our members support. Scheduling flexibility. So how do we even, operationalize different provider schedules in a way that makes more sense  in this post pandemic world.

So all that is to say it really gave us an opportunity to, you know, once we got through the crisis part of COVID-19, really look back and figure out, okay. How do we adjust and really, look toward the future in terms of what both our workforce and our patients and communities need. The other thing I'll say is that health equity has certainly come to the forefront  because of the pandemic.

I think  and you know this gene, it goes without saying that. Disparities were really ripped open wide during the pandemic, and we saw the impact that  it had particularly on underserved communities. And so there was a lot of  target of resources and other things to make sure that we were getting to those communities.

But we also continue to see significant disparities in our health outcomes. So we have really made it our priority to advance health equity, which is why that's one of our strategic aim and our advocacy agenda.  I know my members have done the same thing. I. In fact, one of the first things I did when I got here was ask the board to establish a health equity council as part of the Delaware Healthcare Association, so that we had a dedicated group really driving that work forward on a statewide basis, while also supporting.

The individual hospital efforts that were happening.  So that certainly is something that we continue to focus on.  And also emergency preparedness. We were not prepared. No one was prepared for Covid to 19.   it had been a hundred years since we had dealt with something like that.

And so. We have also spent a lot of time in the emergency preparedness space to figure out how do we make sure that we're prepared for something like that in a better way next time. Hopefully that day never comes, obviously, but just making sure we're prepared for any type of scenario, whether it's a public health crisis  god forbid, a mass casualty event, or any of those types of things, a natural disaster.

Things where a lot of people would need hospital care at one time. We wanna make sure that we're here and ready for whatever might come at us in the future. I agree with all those points. And you know, we're recording this the end of March, and I'm sure you're aware that telehealth was kind of on the, maybe on the cliff that the waivers put into place during Covid for telehealth were not gonna be extended, but then they were.

Which is wonderful and I think it's lifesaving for a lot of  individuals. Most definitely. Absolutely. So Delaware has a growing. Aging population, which you said, which is very unique. I feel like,  so you have, the population is growing and you have a lot of  individuals also who are aging.

Obviously that presents challenges and opportunities. How is DHA positioning itself to meet the needs of Delaware's changing demographic, especially with regards to healthcare access and. Most importantly, affordability. Yep. So this is our top priority honestly, Jean.  Just making sure that we're one, educating people about this.

'cause you're right, it is very unique to be a growing and an aging population. bank rate actually ranked Delaware as the number one place to retire last year. , We have a lot of people retiring For a number of reasons, but we also have a lot of young families moving here in the post pandemic

era.  We just talked about COVI, you know, a lot of people moved during that time and a lot of people moved to Delaware and continue to move to Delaware because it's a great place to be. And so  we do a lot of education first and foremost, especially with our elected officials to say. Delaware's an attractive place to live.

 Raise a family, retire. We need to keep it that way and we need to keep pace. Our healthcare system needs to keep pace with those needs. And so what we're doing in addition to the education is advocating for policies that will allow our members to continue doing that.  we're working hard to recruit and retain frontline providers, so everyone from doctors, nurses, allied health professionals to meet the current and future access needs of our state.

Our members have invested in residency programs to bring more physicians to our state because we have a physician shortage in Delaware. But even so we have to work together to increase the healthcare workforce pipeline. That's been a big topic of conversation in recent years here in Delaware.

There's been talk about everything from a medical school to  kind of a medical school light, if you will.  Something to, you know, continue incentivizing people to get into the healthcare workforce. We have a loan repayment program. We're advocating for a scholarship program for those positions.

Recently did a partnership with one of our community colleges here in Delaware to get more nurses into the pipeline. So again, how do we like incentivize people, recruit and retain people who really want to be here for the long haul? And Delaware, a key piece with our growing needs.

Primary care is another big priority for us. Our members actually lose about $70 million annually in supporting ambulatory primary care estate because it's such a big challenge and  there's such a big need. So we, again, recruiting and employing primary care providers through that is a priority.

But then some challenges that have arisen through this are really twofold, I would say. One is the rising, cost of medical liability insurance prior authorization  health insurance denials and delays, and also HB three 50. So HB three 50 was a very draconian. The past here in Delaware last year that no other state in the country has done  that essentially allows a politically appointed board to completely take over a nonprofit hospital if they don't believe that you're  meeting the healthcare spending benchmark here.

So   we have very grave concerns about that approach. We're hoping to make some changes to make it make sense for our population here in Delaware. But those are just the challenges in addition to some of the things that we're pushing proactively in that space. You hit on all the big ones and now I'm gonna hit on a few more big ones, but everybody is kind of worried about, and I'm sure you are as well, potential cuts to Medicaid and Medicare.

Yeah, everybody is concerned. Although  we were told  that nothing would happen to Medicare and Medicaid, maybe that won't be the case. So can you tell us more about DHAs advocacy priorities and the steps you're taking to protect these essential healthcare programs in Delaware? I. Yeah, so this is another top priority gene.

 We actually, as an organization just released our first ever federal advocacy agenda. Frankly, we were planning on doing that anyway, but it became even more important with these Medicaid cuts that you mentioned. I mean, look, the reality is that it's going to happen one way or the other.  The latest budget resolution that passed directed the Energy and Commerce Committee and the house.

Representatives to find $880 billion from the Medicaid program to cut. So we are deeply concerned about that for a number of reasons. I mean, as you know, the Medicaid program provides essential health benefits for low income families, seniors, disabled people and serves as a lifeline for one in four Delawarean.

We have more than 250,000 people on Medicaid here in Delaware. But it's really not about the numbers, it's about the people and put simply. Cuts to Medicaid will mean less healthcare for Delawareans, which is the exact opposite direction that we want to go in as a state and as a country frankly. And so we believe that a healthy Delaware, healthy America cannot exist without a strong Medicaid program.

Now a lot of people say, well, what's the real impact and the real impact? Is that cuts to Medicaid would mean less people with insurance coverage. And we know that uninsured individuals are more likely to delay or avoid needed care. And so what happens is they end up in the hospital emergency departments because they don't seek the care that they need.

And again, that goes against our mission of keeping people healthy and giving them access to care when they need it. Medicaid cuts could also mean lower. Reimbursement for our healthcare providers, training critical resources going back to our workforce, so it could have a negative impact there as well.

And so, hospitals will continue being the backstop on this issue. Our hospitals continue to care for every person that enters our doors. 24 7, 365. Regardless of their ability to pay. And we're just really happy that our congressional delegation is providing strong leadership and advocating for maintaining critical healthcare programs  that will help the patients and the communities that we serve.

It'll be really interesting, I think to see what happens. Yep. Workforce issues, we touched on a little bit their major concern in healthcare.  I read a statistic that  99% of long-term care facilities are facing. Workforce shortages  many states are grappling with the shortages.

What strategies is DHA pursuing to address workforce shortages in Delaware? I think you touched on a few. And how can innovation help in this area? I. Yeah, so there's a lot of innovation going on as we discussed earlier. And, also, this is a multi-pronged approach, right? You know, there's not a silver that will solve our workforce challenges, but a couple of them that we're pursuing specifically are creating a healthcare workforce shortage scholarship program.

 So right now we already have, and we helped create a state healthcare provider loan repayment program. Really to attract more primary care providers to Delaware more than anything else. But there's more work that we need to do to help doctors, nurses, and allied health professionals access the education and training they need to join our, healthcare workforce here in Delaware.

And what we've consistently heard is scholarships are a great way to do this because you help people more on the front end versus the back end with loan repayment. So that's, of course, not to say that loan repayment is not a good policy. But  providing scholarship opportunities can be even more incentivizing to a lot of people.

 As we target even middle and high school students, very early to encourage them  to get into the healthcare workforce. We're also looking at creative new, excuse me, creating new incentives for clinical preceptors. So these are people who help educate and train the next generation of our healthcare workforce, and we just don't have enough of them.

So how do we cultivate our existing workforce and really help them lead and mentor the next generation of leaders? And many states have enacted tax credits or provided grants to help incentivize more nurses, in particular to service preceptors. So we're looking at doing something similar here in Delaware.

We're also advocating for adequate reimbursement for primary care, behavioral health care other preventative care that improves community health and reduces utilization. So I'll tell you that we have   all of our hospitals are members of the association, but we also have the four.  Behavioral health hospitals in Delaware as members of DHA, as well as the post-acute care hospitals here.

So  also we have a long-term acute care hospital as well. That's part of the membership. So our approach is really comprehensive, not just on the acute and children's hospitals, but also on the other ones as well. On the federal level, CMS payment rates don't keep pace with the cost of care for physicians or hospital providers.

In fact, physicians actually experienced almost a 3% payment cut for Medicare. That took effect January, 2025. So we're working to try to reverse that with our physician  colleagues and also supporting additional Medicare  GME spots, that's graduate medical education and supporting the children's hospital's graduate medical education programs as well.

All of our health systems have brought new physicians to Delaware through the residency programs. We had about 200 join us in 2024 alone.  So allowing for additional slots will help those programs continue to grow. And also advocating for reducing the administrative burden on healthcare providers by supporting legislation to reform.

The prior authors process and really addressing some of the behaviors we see from the health insurers in terms of denying and delaying care. So that's a lot. I know.  Those are just a few of, the things that we're advocating for, but again, we  expect this is gonna be a, multi-pronged approach  for the long term as we try to address this issue because it's, major.

Yeah, it is major. And I'll say I, that's very exciting about establishing some residency spots. I don't think people realize how. Challenging It is. I was a program director for a time of a residency, and it is, it's challenging  to get the spots to train the physicians  and  but it's important.

I mean, if you want to provide good care, you want to have, provide preventative services you need those primary care spot. So  that's commendable. Yep, absolutely. And, and no one, knows that better than Eugene, obviously in your role, you know, way more about that than I do  but absolutely.

So  you were talking about workforce. You are building your own DHA team. You've recently welcomed new staff members to help advance healthcare access. You talked about equity and quality in Delaware. So can you tell us about some of the initiatives that these new hires are gonna be focusing on in the coming years?

Yeah, so I am very excited about this gene. So  I'm very proud of the fact that we have actually doubled the size of our team since I got here a year and a half ago. So we're still a relatively small but mighty team, but we've doubled in size. So we have four new positions that really focus on communications, policy planning, advocacy strategy, political strategy, operations.

 And so it's really given us more bandwidth to do more and,  I'm really proud  of that and this team that we've built because I was very lucky to both inherit and now also build what I know is the best team in Delaware. And I mean that very sincerely because they've been fantastic. And I was just meeting with them yesterday and I said, I feel like I.

We have been together for years because  all of them just hit the ground running in, in our work. And so I'm really excited what the future holds there.  We've done a lot of great work in the last year and a half. I mean, when I got here, we negotiated a major provider tax agreement with now Congresswoman Sarah McBride, who was a state senator at the time.

So that will result in the largest ongoing investment in our Medicaid program since the Affordable Care Act. So we negotiated that. We navigated the HB three 50 issue that I mentioned earlier, that we're still working on. We've doubled the size of our team. I had a seat on our new governor's transition team.

The team has been engaged all over the place, both federally with our new federal advocacy agenda at the state level, with the state advocacy agenda, the joint advocacy agenda that I mentioned earlier. And so we just finished our governance review of the association to make sure that we're supporting our members in the best way possible.

We're gonna be doing strategic planning later this year to really figure out how all of this fits together. So all that is to say I'm just really excited about what the future holds because there's so much opportunity to continue doing great work and building on what we've done already. And now that we have more people on our team  and I expect we'll continue to grow, we'll just have more bandwidth to engage in more and more across the state and also at the federal level.

Talking about the future. Last question  and I think probably now more people, more of us  are kind of unsure about what the future holds, but looking towards the future, what role do you see DHA playing in shaping the healthcare policy landscape in Delaware and. The federal level because what we're all in this country together.

And what are your biggest hopes for the healthcare system in the state moving forward? If you had your wishlist, that was gonna be granted. Yep. I would say just from a kind of overarching standpoint, gene, you know, my vision is that DHA will be the leading healthcare advocacy organization in the state.

 And at the federal level, on behalf of Delaware and that we will be the go-to resource for healthcare policy in the state and really viewed as a leader in this space as a convener. As a collaborator, as an organization who really steps up and wants to do big things and think boldly about, what should healthcare look like in our state.

You know, you mentioned like, where do we want to go in five to 10 years given our unique population, we want to have better outcomes than we do now. So, we're at a really big inflection point right now because we have a new governor.  We have a new general assembly, we have a new federal administration, obviously.

And so how can we work together to advance all of these priorities, especially around workforce healthcare access, quality and affordability and health equity in a really big way.  And I really want our organization to be leading those efforts and really viewed as a credible, reputable, strong organization that.

Just, it values heavy engagement on these things because there's a lot of challenges, there's a lot of opportunities, and it's gonna take a lot of hard work sustained over a long period of time, strategically to really move the ball on this stuff. And I'm really confident that we can do that together.

And I'm just really excited about, especially with the team that we've built and our new leaders that are in place here in Delaware I think we have a lot, to look forward to in, in terms of what we'll achieve together in the next five to 10 years. Big, bold moves are definitely what are needed right now.

Absolutely. Yes, absolutely. So if people wanna learn more about the Delaware Healthcare Association, how can they do that? So feel free to visit our website, which is actually under construction. We're in the process of getting, a new website. I'm hoping that we'll launch later this spring, but if you go to www.deha.org I.

Also follow our social media channels. In fact, you'll probably get a lot more information, especially right now while our website's under construction. We're on LinkedIn, Facebook, Instagram, Twitter and we really have a lot of heavy engagement there. Please follow us and follow the latest work on what we're doing to make the first state first in health.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.