HIStalk Interviews Dennis Dowling, CEO, Formativ Health

Dennis Dowling is CEO of Formativ Health of New York, NY.

Tell me about yourself and the company.

I’ve been working in healthcare most of my life and my entire career. I have spent probably 42 of 45 years working in an organization now known as Northwell, which is a healthcare system in metropolitan New York. I held a a variety of responsibilities. I was executive director of two of their flagship hospitals, North Shore University Hospital and Long Island Jewish Medical Center. I was more recently responsible for the strategy and the management of their ambulatory care network, which now comprises over 3,000 physicians and multiple joint ventures in dialysis, imaging, urgent care, ambulatory surgery, and so forth. 

In January 2017, I became as chief executive officer of a commercial, for-profit joint venture known as Formativ Health.

How hard it was to turn Northwell’s management services into an investor-backed joint venture company?

There are clearly differences between a not-for-profit, community-based organization and its culture and that of a for-profit, commercial enterprise. The difficulty is in having both of these organizations understand the culture of the other and figure out how to adapt their cultures, missions, and objectives together.

It’s not the business so much as the personality and character of the organizations that have to be understood. If you have a community-based organization, no matter how large or complicated — a not-for-profit, mission-driven organization like most of healthcare — to understand how to function and operate in a for-profit, commercial world is a challenge. Similarly, these commercial, for-profit organizations don’t get it when they’re dealing with a community-based organization like most of healthcare.

In what areas are physician practices least prepared to meet current and future expectations?

I would start with consumerism, the advent of transparency, convenience, and the expectations that most of the population has of other industries. Whether it’s banking, retail, or airlines, when you interact with any of those industries as a consumer, you have certain expectations about service and convenience. Healthcare is way behind in having that transparency, convenience, access, and service as part of its DNA.

Hospitals, physician groups, and practices need to adapt quickly. As you can see recently with Amazon, Google, and CVS, a myriad of industries and organizations are moving into the healthcare space. If the current healthcare providers don’t understand and adapt quickly, they’re going to get overrun and pushed aside.

How will practices and hospitals that are accustomed to staying busy and profitable just by opening their doors market their services and improve the patient experience?

Just as you asked the question, that’s the challenge facing healthcare today. Some are going to be able to understand the challenge, recognize it,and adapt to meet it. Others will be swept aside.

The new patients of today and tomorrow will accept nothing less than transparency, ease of access, convenience, and good service. They will no longer accept sitting in a waiting room with a 300-page novel that they can read while they’re waiting for their physician. They won’t accept that any longer, nor should they. That’s the new expectation.

Technology is going to have a lot to do with it, just like it does in other industries. This is another challenge for healthcare — to quickly develop and adapt the technology that the consumers of today are going to expect and demand. Technology that allows them to interact with their provider without going through a phone tree and filling out dozens and dozens of forms in a waiting room multiple times. This is an antiquated system.

There are good, understandable explanations as to why healthcare has been slower than other industries to react. A lot of it is regulatory. A lot of it is privacy concerns. Nevertheless, for whatever reason, it is what it is. It’s going to have to change and change very quickly.

Hospitals have been acquiring physician practices and are now merging with each other to form what could be just a few dozen national health systems. That gives them scale to improve communication, engagement, and patient satisfaction, but with the risk of being seen as a faceless corporation that doesn’t value people as individuals. Will patients see the situation getting better or worse?

What is transpiring now in healthcare has been experienced by many other industries throughout this nation. It could be the airline industry, banking, or accounting. There used to be the Big 8, now I think there are three accounting firms left. There used to be airlines like TWA, Pan American, and Eastern. They’re all gone. They were all swept aside. Either for some of the reasons we’ve already mentioned – adaptation, meeting some of the challenges that they faced, and they weren’t able to have that flexibility to adapt — or they were swept aside through this consolidation. 

Healthcare is going through that as we speak. There are no longer these little community-based hospitals that were the local equivalent of the YMCA and a Main Street mom and pop store. They’re now all being brought together into these massive health systems. At the end of the day, there will be some number.  We can guess the number of jellybeans in the jar, but there will be very fewer healthcare organizations. Not only are they consolidating as hospitals to each other, their physicians are consolidating into large medical groups and then again into hospitals to create these health systems.

There’s also now the trend where insurance companies are acquiring providers and providers are creating insurance companies. I think the latest trend is going to be the commercial market, like the CVSs and the Amazons, getting into healthcare. You’re having the retail meets the healthcare providers and vice versa. I don’t know who’s going to be left standing at the end of the day, but the landscape is going to be dramatically different than it was yesterday.

What’s that going to mean for the patient? I’m going to be optimistic. I think what they will have is a much more open, transparent, and accessible healthcare system than they had yesterday, notwithstanding the Marcus Welby image of the kind, gentle healthcare provider — whether it was a hospital or a physician — of the past.

People need ease of access. They need high levels of service. Competition for access and service is a good thing. Healthcare needed a prod to become more convenient and more focused on the patient, satisfying their needs for both service and access. This will ultimately be a good thing. It will be disruptive to the providers, but I think it will ultimately be very positive for the patients.

What service and technology improvements do you recommend to practices?

That’s the focus and objective of Formativ. We’re looking to fill this gap — I consider it a gap — between connecting the patient with the physician. Right now, it’s a very frustrating experience for both physicians and patients. Walk into virtually any physician’s practice and it’s like walking into a three-ring circus. There are all kinds of activities. You’ve got phones ringing. You’ve got people standing and waiting to make a new appointment. You’ve got these poor people behind the desk trying to juggle and balance handing out paper and moving patients back into the exam area. The organizational skills these poor receptionists need to balance and manage are incredible.

We go in and say, there’s no need for all of this. Like in other industries and other experiences, you can take that noise out of the waiting room and out of that day, moving it to the day before. Get it done in a more relaxed and more manageable setting. You can pre-register. You can get all the patient demographic and insurance information before you walk into the waiting room. You can do it electronically. When the patient walks into that waiting room to see their physician, it becomes a clinical experience, not an administrative nightmare.

When they’re leaving and need care coordination, follow-up care, or prescription refills, you can all do this electronically or over the phone by someone who is dedicated to help that patient navigate the system rather than trying to cram it all in to the same time you are there to have a clinical experience. You can do this through technology and dedicated service.

We refer to that as our patient access service. Individuals who are sitting anywhere are interacting with the patient, have the ability to see into the electronic health record of that patient, can communicate with the clinical providers through the electronic health record, can answer patient questions, can get schedules and appointments made, can answer insurance questions, and can help coordinate that whole experience for that patient.

Do you have any final thoughts?

It’s an exciting opportunity for those that recognize the challenge and the need that the population is demanding from their healthcare providers. For those who are willing to step up and to meet that challenge, it can be a very exciting and rewarding opportunity.

I’ve been doing this for well over 40 years. It’s been a pleasure and an honor to try and meet the needs of the community of patients — who, more often than not, experience some hardship or problem with healthcare – and try to relieve them of some of the frustration and the anxiety. Through technology and  personalized service, there’s this incredible window where those that are willing can step through. I believe the receptivity of patients is going to be extraordinary.

I’m just blessed to be able to have the opportunity to see the transformation and be part of it. It is coming, make no mistake about it. Don’t think it’s not. There is a wave of consumerism that will engulf healthcare. I hope and expect that most of the healthcare providers will be able to step up to meet the challenge.