Transcription of Love Maine Radio #321: Jud Knox and Dr. Betsy Johnson

Speaker 1:                               You are listening to Love Maine Radio, hosted by Dr. Lisa Belisle and recorded at the studios of Maine Magazine in Portland. Dr. Lisa Belisle is a writer and physician who practices family medicine and acupuncture in Topsham. Show summaries are available at

Lisa Belisle:                             This is Dr. Lisa Belisle, and you are listening to Love Maine Radio show number 321, airing for the first time on Sunday, November 12, 2017. Today’s guests are Jud Knox, CEO of York Hospital and Dr. Betsy Johnson, president and CEO of the Maine Health Accountable Care organization. Thank you for joining us.

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Lisa Belisle:                             Jud Knox has served as the president and CEO of York Hospital since 1982. Thanks for coming in today.

Jud Knox:                                You’re welcome. It’s a pleasure to be here.

Lisa Belisle:                             I’m really very interested in York Hospital and part of this came from going down to visit last, I guess it was last fall now when the organization was doing a fundraiser and had started to do some more work in the area of elderly care. But I what I like about York Hospital is that you’ve been innovative for quite some time. How did you get involved in this innovative organization?

Jud Knox:                                I started at York Hospital in 1982 and at the time that I arrived that it was already a community hospital that was very patient focused and the staff concentrated very carefully on what’s right for patient’s families and the community. That was very good fortune for me. I was able to learn from the folks who were there, share some of my own values and hopes and aspirations with the folks who were there and the folks who are still there.

Lisa Belisle:                             I’m looking at your name tag, it has your first name and underneath the tag line is, love and kindness. It’s kind of unusual for a health care organization, is it not?

Jud Knox:                                It is a bit unusual. Love and kindness is a value set about nonjudgmental acceptance of people where they are and doing the best one can to enhance their lives and their wellbeing. It is probably a unusual phrase or value set to use in a hospital setting but I find it and others have found it very meaningful as a guideline, as a foundation for trying to take care of other people and trying to improve the lives of others.

Lisa Belisle:                             Your hospital is known for integrative care. You’ve been doing work in integrative medicine really a few decades now, probably longer but at least as long as I’ve been aware of it. You are one of the leaders within our state. How did that happen?

Jud Knox:                                The foundation blocks are something like being open to what individuals need and want. Perhaps providing care in a way that isn’t dictated from a set of perceptions but is more open to what people need. Whether it’s integrative care or greater family inclusion or just embracing people as who they are and what they need. That’s all part of what we try to do. We’re not perfect by any stretch of the imagination but that’s the value set that we try to bring to take care of people. It’s very similar to members of one’s family. Members of one’s family are all different. They have different expectations, different wants and different needs, they’re still members of the family, they’re still embraceable, they’re still engageable and so it is with everyone we try to take care of.

Lisa Belisle:                             At the same time you still are responsible for budgets and numbers and quality metrics and meeting the needs of insurers and the government and regulatory agencies so that’s an interesting thing to have to balance as the CEO.

Jud Knox:                                You’re so very right. It’s a very interesting and often challenging, the set of opposing forces in many ways. There’s a lot in healthcare, there’s a lot in medicine that’s structured, regulated, defined. There’s a lot of financial and regulatory restrictions that can very easily get one restricted or defined by all those forces. Because of that it takes some extra effort to take care of folks where they are in that context. It probably takes a little bit of rebelliousness to say, “Okay I know this is the form out there, this is the model, this is the template, if you will, but let’s bring ourselves back to center. Bring ourselves back to our overriding purposes. It’s more important than all of that.” That’s the person and the people, the folks that we’re trying to take care. It is a bit of a balance and I’m not going to tell you that by any stretch of the imagination that we always stay exactly on the rails or perhaps exactly in the bounds as others might define them.

Lisa Belisle:                             Having worked now over the course of 20 years of being a doctor both at the Maine Health System and also with Central Maine Healthcare and having done an article about Maine health and interviewed Bill Caron and worked with Peter Chalke before he retired at Central Maine Healthcare, one of the things that is very clear is that you’re dealing with the shifting sands of the landscape and it seems as though medicine has made some dramatic leaps but perhaps more challenging is that it’s making subtle movements even as you’re trying to deal with the dramatic leaps. Would you agree?

Jud Knox:                                I would very definitely agree with you. There are leaps, there are big steps, there are tiptoes, there are stumbles and they’re all happening simultaneously. One of the most interesting things for us to be attentive to, those of us who are trying to provide healthcare and medical care is to be really cognoscente of what’s happening in the broader social context. We don’t in healthcare live on an island. We cannot pretend or be effective ignoring the rest of the social movements that are going on. It’s fascinating, I often talk to my leadership group about interestingly enough, what’s happening in retail. What are the lessons in retail that one can apply? They aren’t necessarily neatly analogous but what can be applied by what’s happening in retail? Because those same movements, those same changes are going to change people’s habits and conduct and going to very much reflect on what happens with people’s wants and needs in medical care.

Some of our greatest challenges are to me, not necessarily the steps that are going on within medicine and the changes that are going on within medicine. If anything, those changes may be more slowly occurring than the changes that are going on more broadly. That’s a little bit, I’m a very positive guy, but that’s a little bit of a danger signal for medicine and those of us providing healthcare.

Lisa Belisle:                             The dangerous signal being …

Jud Knox:                                Make sure we pay attention to what’s going on outside our realm as well as what we’re aware of and know about inside our service industry, if you will.

Lisa Belisle:                             Having known many doctors and having been a doctor, I’ve had a bit of sense that there’s an ivory tower thing that has happened for many years. Not unlike academia. It’s understandable that if somebody gets a lot of education they probably assume that they know a lot and they want to stay in that tower where things feel safe. It’s not always been my experience that every single person, every single doctor, every single healthcare provider wants to take a broader view. Some people would prefer to stay in that ivory tower. Not all. I have plenty of doctor friends who are very open minded and very aware of social considerations. How do you deal with people who would really prefer just to stay where they’re comfortable?

Jud Knox:                                It is a difficult thing because I respect the training, education, experience, skills that folks bring to take care of other people. Changing or impacting those folks’ attitude or approach to what they’re doing is really bit of a delicate piece. It’s not to force them to change because they’re wrong, it’s not to impose something on them because they’re going in the wrong direction, it’s really tried to try to suggest that they have enormous heart and head to offer but to be able to offer it effectively we all need to recognize that we may have to offer it differently than we have in the past. It doesn’t make the skillset wrong, it doesn’t make the delivery wrong, it doesn’t make the approach wrong, but it may mean that who we’re trying to help is in a different place than they were a number of years ago and to be effective in helping them we need to do some changing.

It’s a bit of a challenge to stay away from not that you suggested it, but it’s a bit of a challenge to stay away from the right and wrong piece. I often have discussions about whether walk in care is episodic so it’s not good and primary care is longitudinal so it is good. I really try to stay away from the good bad piece. If we’re trying to take care of people, what are the vehicles that are going to be effective in embracing them?

Lisa Belisle:                             That’s a very important point and that is that when we look at something like evidence based medicine we tend to be very algorithmic. There’s a good, there’s a bad. There’s a yes, there’s a no. That’s really a weird thing to try to impose upon the human organism which is multi variant. We have different genetic structures, we have been raised in different social cultures. It’s a funny thing, we want to offer the best care and most doctors I have met have want to offer the absolute best care. If they need to say something is right in order to offer that care, that’s where they’re coming from the very best place. But it’s not a black and white situation often.

Jud Knox:                                I agree with you. It is a very, very valuable point. The physicians, nurse practitioners, physician assistants that I know all want to do the right thing to help other people. There’s is no question about that. Not any. We have built a lot of templates. We’ve built a lot of protocols. We’ve built a lot of, through professional associations and regulatory approaches, the right ways to do things. We’ve in some ways constructed a bit of trap for ourselves even though we have to deal with that trap in the current. We have to develop the ability to live in the present but extend ourselves out to what might be in the possibilities in the future. Possibilities that we see and possibilities that the people that we are taking care of see. That’s a difficult thing.

Lisa Belisle:                             At one point in my career I was very, I went from being an idealistic medical student and very excited about the possibilities of my career to being very disappointed because the reality of caring for people is very sobering. People are very complicated and their social situations are very complicated. I so wanted to do things well that I was just destroyed when I realized I couldn’t be perfect for them. I’ve come to the other side now and I really feel very optimistic about what we have to offer people within our system. Part of the reason I feel optimistic is that we are heading towards a time where we more appreciate teamwork. Where we more appreciate working in a structure where everybody has something to offer. We don’t, as a doctor, I don’t have to be perfect because I have other people that I work with who can do other things probably better than I can. We’re starting to educate our medical students this way now too. Have you noticed things like this playing out within your system?

Jud Knox:                                As tumultuous as medical care and healthcare delivery is today that we’re making positive progress. Some of the confusion, if you will, contradiction and even dissatisfaction is helping us formulate a different set of expectations and deliverables than we have in the past. That’s making us or allowing us to be more flexible and more individual oriented than perhaps the approach that we’ve built in the past. I do believe that, the team approach is freeing. The idea that none of us are perfect and none of us have all the answers even the answers that we have aren’t necessarily the right answers for everyone we’re taking care of and being okay with that. We are evolving as caregivers, as carers, we are evolving in that way. It’s improving.

Lisa Belisle:                             The other thing that I feel optimistic about is something that I heard somebody else who studies medical education speak about in a talk he gave to the first year Maine Track students that work with Tufts and also Maine Medical Center and he said, “You are in great time because we have high tech. We’ve made these advances in medicine that have helped a lot of people and we are understanding how important relationships are again. This next generation of students and practitioners can use both sides of their skillsets. They can be able to have high tech and high touch. They can use integrative care like massage or acupuncture and they can use robotic medicine.” That’s probably the most exciting thing that I have heard somebody talk about in medicine recently. York Hospital is really attempting to do that.

Jud Knox:                                the most important thing any of us have are relationships. The most important things we can have. Relationships are a connection of compassion and love and whether it’s in medical care or any other part of our life. Anything we do in a really meaningful way, in my opinion, has to be based on relationships and relationships are one to one, constantly dynamic and always work. Not necessarily bad work but always work. If we’re going to help people, if we’re going to deliver care, the foundation is the relationship. Recognizing that is probably one of the most important things we can do moving forward.

Lisa Belisle:                             As far as relationships are concerned one of things that I noticed when I was at the fundraiser, I don’t even think it was just a fundraiser, it was also an announcement of a grant that was being given by a family to advance care for older people, but I was impressed with the community. I was impressed with the people who had shown up to celebrate this work. I was impressed with, and I have been consistently impressed with the people who’ve remain committed to York Hospital, who want to see it furthered. You have had some beautiful new structures put in place, your physical plant is obviously evolving and lovely but more importantly the community support is so strong. That’s something that as we’ve evolved into health systems doesn’t always maintain its importance.

Jud Knox:                                I’m a very strong believer in the connection with community which is to me about relationships. For York Hospital to be valuable, no less sustainable. The organization then, the folks in the organization have to work on those relationships all the time. Communities aren’t stagnant they change. Their characters change. How do we change as an organization to keep that relationship in a valuable place for the community? Again, I’m not professing perfection or awesome achievement but it is the piece that I feel is extremely important for community medicine. The development of systems and expansions of major, major providers of care, we’re in a very interesting market in York, Portsmouth Hospital is owned by Hospital Corporation of America which is 180 hospitals around the country. Another hospital on the seacoast has now been purchased by Mass General. Happens to be one of the larger providers in New England. And here’s York Hospital is a 55 bed independent hospital sitting in a number of relatively small communities.

I’m not boasting about that position, I’m merely saying that the relationship piece our work on relationships with the communities is why we still have good relationships with those folks. I don’t know longer term the answer to your question and it’s a wonderful question. A bit perplexing. How are those relationships maintained as organizations cover states and regions? Not community or groups of communities. I’m not sure.

Lisa Belisle:                             Can you give me an example of a change that you have seen in the time that you’ve been in York Hospital starting in 1982 that has surprised you? Whether it’s a change of attitude, whether it’s a change of circumstance. Maybe it’s a person’s change of mind.

Jud Knox:                                The change that’s been the greatest in my years at York Hospital is the movement of physicians from private practice to employment. Decades ago as a hospital executive I worked with physicians in relationships where they were in private practice and worked at the hospital and there was an interesting and for the most part, pretty comfortable set of relationships, mutually respective relationships developed. Today we have probably 160 providers employed at York Hospital. Employment when we talk about physicians is not necessarily a positive word. But most importantly it’s a totally new relationship with providers. I’m not sure anybody’s really comfortable with it yet and there are organization who have been in these structures, employment structures long before we were. Long, long before we were. Perhaps those with that experience are but it’s still an awkward relationship. That’s interesting for me to stay after talking so much about the importance of relationships and positive relationships. That’s the biggest change.

Is it a good change? One might ask and it can be and is transitioning us to a good set of positive relationships but I’ll just speak for ourselves. We’re not there yet. We’re still trying to figure out what that new relationship is. It’s as if we formed it, the relationship, the employment relationship without sitting down and going okay, doctor, what would you like this relationship to be for you? And hospital, what are your expectations out of this relationship? Interestingly enough, at least in my experience, we never had those discussions. We had the, I’d like to be employed. Here’s our contract. That’s not a great way to develop relationships. Are we learning? Yes we’re learning and we’ve moved some significant distance but we’ve still got a ways to go.

Lisa Belisle:                             What is your hope for the future?

Jud Knox:                                My hope for the future is that there are no barriers to great medical care. I’m a universalist from that perspective. I’m a open access, everybody deserves the best medical care that we can bring about to folks that we can bring to folks. That’s what I hope. We’re really lucky in our corner of the world, we provide care to everybody comes to our doors regardless of their ability to pay and I’m very proud of that. We’re a little microcosm compared to the broader picture and that open access would, that would be my dream.

Lisa Belisle:                             Well I hope that you see your dream.

Jud Knox:                                Thank you very much.

Lisa Belisle:                             I’ve been speaking with Jud Knox who has served the president and CEO of York Hospital since 1982. I really appreciate your having the time to come in talk with me today and I appreciate the work you’re doing.

Jud Knox:                                Thank you, my pleasure. Very happy to be here.

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Lisa Belisle:                             Dr. Betsy Johnson is the president and CEO of Maine Health Accountable Care Organization at Maine Health just up the street. Nice to see you today.

Betsy Johnson:                     Nice to be here.

Lisa Belisle:                             I’m interested in the type of work that you do because I know that you and I both have a background in primary care medicine really but also in public health and you’ve gone into an increasingly important area of medicine and it’s the administrative, more of the administrative aspect of healthcare. I want to talk about that but first, why make that decision?

Betsy Johnson:                     My journey in healthcare, I can’t say that I ever knew where it would take me when I went into primary care 20 odd years ago. But certainly what puts me where I am today is where I started back then. Practicing, I’m an internist, got out of residency and jumped into a primary care practice, Boston, which I loved, in fact I worked for a HMO, managed care organization and which was then called Harvard Community Health Plan. They provided excellent superlative care. Everything under one roof. That was my first experience in practicing medicine. I learned how to manage a population of patients, we had capitated care and in the 90s as I was practicing there, healthcare blew up. Truly, you probably experienced that too, Lisa. That the HMOs for all some good reasons really blew up under pressure we moved into, I experienced moving into a fee for service world of medicine.

It went backwards for me. I started in one place and then moved into this world of fee for service and volume and more is better and let’s do everything. As I continued on this journey, I also got involved in the business side of medicine and had opportunities to seek some business education and learned more about as I watched this unraveling of one type of care to another and was truly concerned and bothered by it. I thought, I need to do something about this. I need to, I wanted to get involved so ultimately my path to where I am now in an accountable care organization is an opportunity for me to take all those years of experience and watch, as we’re all watching how medicine is unfolding and the problems persist. I feel that in Maine, in this accountable care organization, is a place where I can hopefully make a difference.

Lisa Belisle:                             Let’s define a couple of words for people who are listening. One is capitation. What did it mean to be practicing under a capitated system?

Betsy Johnson:                     We talk a lot about we want to move to a fully capitated model in healthcare or we want to a partially capitated model. What does that mean? That means that a physician or provider group or a hospital by the insurance companies which can either be commercial companies or it can be our government medicare, will pay the system upfront. The global capitation is when we figure out how many patients Lisa you have in your panel, you have 2,000 patients and we’re going to pay you certain amount per patient per month to take care of that patient and you get it upfront and you manage under that budget. It’s no different really than having a household budgets. It’s how I like to compare it sometimes.

We know how much money we have and we have to live within it. It’s a similar concept for the health system of total capitation. There’s lots of intricacies involved in that. We have targets we have to hit and there’s lots of ways we calculate how much money you would get per member per month and then sometimes we try to calculate, we don’t do a full capitation but we capitate only to primary care doctors. That’s a little bit what capitation. It’s different than the system that we live under now so we pay providers and we pay for hospital care and we pay for nursing home care. Basically we bill out by how many services we rendered. It’s a volume based world.

Lisa Belisle:                             When you say fee for service, essentially somebody comes in, we do something with them and then we ask the insurance company or the government to pay for that one particular encounter versus getting paid whether a person comes in or not, into the practice because they’ve been, quote capitated.

Betsy Johnson:                     Right. There are pros and cons of both systems and having lived under both of them in a capitated model you have funds to take care of the patient whether they’re there in front of you or not. In a fee for service world you’re thinking about the patient only when they’re in front of you in your office. There’s lots of other things you need to help the patient think about for their health and wellness that not only in that one moment when they’re in your office for 15 minutes. Having funds for your practice to have a nurse, a population health nurse who might outreach and tell them it’s time for their flu shot or it’s time for them to check for how they are doing on their diabetic diet or their exercise. All those other things and health that we don’t necessarily pay for up front.

Lisa Belisle:                             Since we’ve made this really dramatic shift, and we’re still shifting.

Betsy Johnson:                     Absolutely.

Lisa Belisle:                             I don’t think we’ve gone completely from one to the other. What were some of the pluses and minuses of capitation when we were actually in a system where we had the ability to have a certain amount of money for each person. And really focus on wellness?

Betsy Johnson:                     That was the issue. In HMO days in capitated models the danger is that if you don’t constantly check for quality or patient experience there can be first incentives to have a pot of money and not perhaps do everything that you should do. If you do less services you’re going to have more money. That’s what, that could happen. Not all health systems did that or would do that. There’s ethics involved here. The incentives can get mixed sometimes. In accountable care which people ask me a lot, how is accountable care different from capitated HMO days?

There’s such an emphasis today on having quality metrics in place. The checks and balances of if we’re going to provide these services or we’re going to be given this money to take care of these funds, these precious funds to take care of a community, then we need to make sure that we are living up to what we said we would do for quality and that we would do what we said to live up to the patient’s experience of that. Those are in place now. That’s what we’re doing. Now we’re in a world of there’s a lot of emphasis on quality. Lisa, you tell me, it can be really frustrating for providers, all this emphasis on metrics and comparing ourselves to each other. How well do I manage my diabetic patient versus someone else? It’s continuing to evolve and what the right way to incent the quality without putting the people and providers who are trying to take care of patients under more duress?

Lisa Belisle:                             Having now been working with Central Maine Healthcare for four years and previously in my own private practice, I can see good and bad things about all the things that you’re talking about. I do love the idea that we want to take care of our patients. We want to give them the best possible care so if you have somebody who has diabetes, you want to make sure that their blood sugars are down and you want to make sure that they’ve had their eyes examined and we want to make sure that the nerves in their feet are still working and that we’ve checked their cholesterol and all of these things that are being measured ’cause this is important for somebody that has diabetes. On the other hand, these are still people. It’s not like somebody’s bringing …

Betsy Johnson:                     They’re not a metric.

Lisa Belisle:                             They’re not. And it’s not like somebody’s bringing their cocker spaniel to the veterinarian and you say to the owner of the cocker spaniel, “Okay, you need to do this to your dog.” These are people who can make decisions and sometimes they don’t want to do the things that we’re asking them to do. Even if they completely understand why we think they should.

Betsy Johnson:                     We are all only human. That’s the field, the profession that we’re in for taking care of people it’s our job to inform, to help, to connect, to listen, to give them the best services but you’re right, even every human being is in a different part of their life and sometimes they’re going to connect into that and be able to listen and do what’s best for health and other times they’re not. And there’s many reasons and one of the things we can also talk about is this emerging theme of understanding the social determinants of health. That has been neglected in the healthcare world. What are the social determinants of health? That’s everything else that affects someone’s life other than their medical issues. Their financial situation, their transportation opportunities, their education, all of those things impact how well, as you said earlier, someone’s going to be able to take care of themselves. We haven’t, I don’t think we’ve paid enough attention to that in the healthcare arena.

Lisa Belisle:                             You’re absolutely right. One of things that I’ve noticed with patients is that sometimes we don’t even try to figure out what it is that could be socially impacting their situation because we don’t know that we have anything we can offer them and we like to solve problems as doctors.

Betsy Johnson:                     And science, use science.

Lisa Belisle:                             Exactly. If have somebody who has diabetes and they also don’t have access maybe they aren’t able to drive themselves to the supermarket and get healthy fruits and vegetables and they’re relying on the food pantry and as hard as the food pantry tries, they give them a lot of starches and things that are going to shoot their blood sugars up. It’s this really complex system that as a doctor or nurse practitioner or physician assistant, it’s not so easy to get in there and say, “Okay, so do I, how do I get this person a ride more frequently to get fresh fruit and vegetables?” And then it becomes, one of the things that really bothers me is that it becomes almost like there’s a conflict that comes up between the provider and the patient. Because the provider wants one thing and the patient, even if they’d like to do that, they can’t.

Betsy Johnson:                     They can’t.

Lisa Belisle:                             That’s tough because that really impacts the relationship between two people which is supposed to be a healing one.

Betsy Johnson:                     Right, absolutely. Then when it becomes not a healing relationship then you could lose the patient. Then you don’t know where they are or how you can help them. That’s the risk we take. Another area that I think a lot about in this context has been therefore the health system can’t do it all by itself. As a community. I think about that in Maine, as a community, how do we come together differently than we have already? Maine is a wonderful innovation, collaborative community and there’s many good people trying to think about this. We still live in some silos of trying to help the same person and how do we continue to integrate that and come together as a community differently than we are now? That’s one of things I think a lot about.

Lisa Belisle:                             What are you seeing that is positive in that area? What types of innovations or what types or organizations are working on this problem?

Betsy Johnson:                     In fact, one of the things that an accountable care organization does, the place I work, which brings together groups of providers and hospitals to take care of for certain population of patients, one of the areas that we focus on is called care coordination. In that we have a staff of people who are working directly with the practices and the providers who are in our network and we work with them to be able to coordinate and there’s some real success stories of coordinating that transition of care from the hospital to the skilled nursing facility to home.

There’s been an increasing emphasis on how well home health can help a patient. Our care coordination department is working to tie those service together. Our care coordination and our care managers also have at their fingertips the information about transportation or about access to medication programs and so there’s a centralized place where we can be a repository of that information and give it out. We have providers in our accountable care network that are both employed by the Maine Health System but also small independent private practices like there used to be in. We try to provide those services across the spectrum across all the different type of practices. There’s some real success stories in there.

Lisa Belisle:                             I would agree. I’ve seen this first hand when somebody else other than just a doctor, nurse practitioner, physician assistant is there at the one time visit every two months. It’s really a team of people that are there to support people that need the most support. That it’s nice to have someone who can be calling the patient on a regular basis and just saying, “How are you feeling? And how is your blood pressure today? How are your blood sugars looking?” Because that regular checking in, not only does it help us to know how they are clinically, but emotionally, socially, even the loneliness factor that comes into health can be mitigated by this type of interaction. I’ve seen really nice relationships build and people’s health improve because of it.

Betsy Johnson:                     I absolutely and again, that gets back to that community. Isolation, loneliness greatly impacts health. Just knowing that someone’s out there who’s going to check in with you and then also help you to feel accountable. That accountability role that accountable to your health that you followed up, that you went and picked up your medication. It’s easy not to do that. It’s easy to get mixed up on whether you took your medicine this morning or not. Having people. The other really when you asked about advances, that successes that is just happening faster than we can keep up with in healthcare is the technology aspect. Using other modalities other than just the nurse care manager that might visit the home but using things like our iPhones and telehealth and other ways to connect with patients. That’s an exploding emerging field and healthcare is trying to wrap its arms around it but we have a lot we can do in that area to help improve health.

Lisa Belisle:                             It’s important that we really be exploring this more and we’ve been very reticent as a field to even engage in the most basic thing as like electronic medical records.

Betsy Johnson:                     Right. I know.

Lisa Belisle:                             Just the idea that we need to put something in place so that more people have access even to their own health information that was really something that we were dragging our feet on as only 20 years ago.

Betsy Johnson:                     Right.

Lisa Belisle:                             And we’re still really working on this.

Betsy Johnson:                     We’ve a lot of catch up to do.

Lisa Belisle:                             We do. And simultaneously our patients still need to be cared for and we still need to take care of the social issues in our community. It is exciting to see but it’s sometimes it can be a little frustrating to be a provider within the system.

Betsy Johnson:                     Yes. Talk about the providers whether they’re physicians, nurse practitioners, PAs, nurses, medical assistants who are caring, it’s easy to get burned out and overwhelmed in trying to keep up with not only just as you know, taking care, even in our healthcare world 50 years ago, taking care of people as they traveled through life and making sure they have health and wellness is a challenge but with all of the change in having someone just understand an electronic health record which is complex at best and then all of the other things they need to keep up with. The messages from the insurance companies, the messages from the accountable care organization, you need to do this, you need to do that. It’s overwhelming. How can we simplify it and cut through some of the clutter and utilize our tools in a way that is both efficient and effective for the care team? And then ultimately the patient.

Lisa Belisle:                             I’ve been speaking about nurse practitioner and PA and doctor because I think of them as almost most of the time the endpoint in a medical visit. You just raised a really important point and that is that there’s not really an endpoint. That you do have, it starts with a patient service representatives at the front desk and then the medical assistants and then the nurses. I know that the people that I work with in my practice, they make our practice run and every doctor I’ve ever spoken to who is happy in their practice or as happy as one can be, it’s because they have a really great team working with them.

Betsy Johnson:                     It’s all about the team.

Lisa Belisle:                             At the same time you’re right. We talk about provider burnout. We talk about doctors getting frustrated. A lot of people who are they’re medical assistants or they’re nurses, they look around at other potential jobs that they could make just as much money for and they say …

Betsy Johnson:                     It’s not always in healthcare, right.

Lisa Belisle:                             Exactly. That’s the thing. There are other ways that they could live their lives and be happier and as dedicated as they are to being in the medical field sometimes they just say, “Listen, I don’t have to put up with this anymore.” How do we also keep other members of the team healthy and well?

Betsy Johnson:                     That’s another passion of mine is thinking about in any organization, I’m sure that’s true here for yours, thinking about the health and wellness of your employees. It’s hard because it’s not always about the money. Certainly everybody wants to get paid for what they’re trained and licensed and educated to do and paid fairly and well but beyond that there’s all those other factors of what makes a healthy work environment, what makes you want to wake up in the morning. In healthcare we’ve already attracted the do gooders. We’ve attracted the people to this profession who want to care and heal others. How do we then support and care and heal them too in a work environment? What do you do?

Making sure leadership is attentive to what’s going on to their employees. Making sure you have programs in place, whether it’s employee engagement events, going offsite for a field trip of some sort or just in the office having coffee and place to decompress in the middle of the day. All those things, being attentive to again, the health and wellness of the employee. If you have a happy work staff it makes for a very rewarding work environment and therefore if you feel good about where you’re working, you’re passing that on to the patient who you’re seeing. That’s been supported in lots of studies that happy healthcare team is going to have a more rewarding and happy patient engagement experience too.

Lisa Belisle:                             When you were making the decision to go into medicine, what was it about being a doctor that sent you in that direction?

Betsy Johnson:                     I was very, I am very influenced by my upbringing and my family life. I didn’t have any doctors in my family. My dad was an episcopal priest. I grew up with a mother and a father whose life was committed to a congregation, so community. We basically lived in two places. We’re from the south but we lived in New Jersey for a while in a small community and moved back to Nashville Tennessee. Watching my parents as they … Our life as kids, I have three siblings. We went about our lives but our lives were we lived right next door to the church. There could be phone calls in the middle of the night, everything from happy and sad. Often the middle of the night calls were the hard ones, something bad happening. Grew up to weddings and funerals, people knocking on your door asking for money for gas. I just grew up in an environment of taking care of others.

As I began to sort myself out and think what I wanted to do with my life, I knew in college and I figured that my love sciences and humanities and taking care of people that being a physician would be the right path for me. I love being a doctor. I love the profession and again, that’s part of why I do what I do now because I feel very passionate about trying to continue to make it a field, a profession that is sustainable.

Lisa Belisle:                             What type of family culture are you yourself providing now?

Betsy Johnson:                     For my own family?

Lisa Belisle:                             Yeah.

Betsy Johnson:                     My husband is a cardiologist so we have two sons who are 15 and 11. Family first. In my life it’s always been family first. It’s part of why we moved to Maine. My husband and I had both gone to college in Maine and we went back and forth and when we decided where we wanted to raise a family we knew Maine was the place to do that. In our lives, even in our professional lives, we have made decisions for the next job or the next activity, we always weigh it against how will that fit into our family life. As you know, childhood for our kids it goes fast. Having a teenager son and a preteen you realize how fleeting it is. Attending to them first and foremost is certainly our approach now. Does work and life and everything get in the way? Yes, but we all juggle those things, I’m sure you do too.

Lisa Belisle:                             Yes, absolutely there’s always a juggling that goes on. I also think about my own kids when it comes to being my dad was a doctor, I’m a doctor, we have lots of doctors in my brothers and sisters and sisters-in-law and brothers-in-law. If the worst thing that they hear about sitting around the dinner table is our struggles with helping other human beings, that’s not so bad.

Betsy Johnson:                     Right.

Lisa Belisle:                             Even if we are as frustrated as we possibly can be because we don’t have the answers or we’re bumping up against some huge social issue at least there’s the effort. At least there’s some sense that we’re in the struggle. We’re working on it. That there’s hope because people are still doing this.

Betsy Johnson:                     Yes. Sitting around the dinner table is one of the most important things you can do in a family.

Lisa Belisle:                             That’s a very good point, yes. I am really, it’s taken awhile with your busy schedule to get you in here but I feel great about the conversation and I appreciate your taking the time to do this. I’ve been speaking with Dr. Betsy Johnson who is the president and CEO of the Main Health Accountable Care Organization here in Portland. Keep up the good work and thanks for coming in.

Betsy Johnson:                     Thank you so much.

Lisa Belisle:                             You’ve been listening to Love Maine Radio, show number 321. Our guests have included Jud Knox and Dr. Betsy Johnson. For more information on our guests and extended interviews, visit Love Maine Radio is downloadable for free on iTunes. For a preview of each week’s show, sign up for our e-newsletter and like our Love Maine Radio Facebook page. Follow me on Twitter as @drlisa and see our Love Maine Radio photos on Instagram. We love to hear from you so please let us know what you think of Love Maine Radio. We welcome your suggestions for future shows. Also, let our sponsors know that you have heard about them here. We are privileged that they enable us to bring Love Maine Radio to you each week.

This is Dr. Lisa Belisle. I hope you have enjoyed our show. Thank you for sharing this part of your day with me. May you have a bountiful life.

Speaker 1:                               Love Maine Radio is brought to you by Maine Magazine, Aristelle, Portland Art Gallery, and Art Collector Maine. Audio production and original music are by Spencer Albee. Our editorial producers are Paul Koenig and Brittany Cost. Our assistant producer is Shelbi Wassick. Our community development manager is Casey Lovejoy. And our executive producers are Kevin Thomas, Rebecca Falzano, and Dr. Lisa Belisle. For more information on our production team, Maine Magazine, or any of the guests featured here today, please visit us at

Here’s a track from Spencer Albee’s new album Relentlessly Yours, in stores and online now at

Speaker 5:                               (singing)