Episode 297- How a System CEO Drives Access and Affordability with Optimism. With Jeff Flaks

Healthcare can feel stuck, but the ground is moving under our feet in the best possible way. We sit down with Hartford Healthcare’s CEO, Jeff Flaks, to unpack how a statewide system is using scale with purpose: pushing care into more convenient, lower-cost settings, investing in equity, and building digital experiences that actually save time for patients and clinicians. If you’re skeptical that big systems can deliver value, this conversation offers specifics instead of spin.

We start with the leadership behaviors that matter now: staying close to operations, listening to front-line teams, and measuring success by outcomes. From there we tackle the big critiques—costs, complexity, sponsorship optics—and dig into what it takes to move beyond the status quo. Jeff shares why headwinds like payer friction, tariff-driven supply chain costs, and Medicaid shifts are serious, yet not destiny. The difference comes from disciplined redesign: routing patients to the right site of care, building 24/7 primary care access, and wiring urgent care so radiology, histories, meds, and images are available in real time.

The most exciting thread is how AI and machine learning are finally making work easier instead of heavier. Think faster reads, smarter triage, and less administrative drag, all pointed at better quality and safety. We explore the compounding effect of improvement—how each layer of coordination accelerates the next—and why the pace of change in the next three to five years could outstrip the last decade. For patients, we offer practical advice on navigating benefits, choosing the right setting, and using digital tools to cut costs and waits.

If you care about access, affordability, and results, this episode gives you a clear view of what’s working and what’s next. Subscribe, share with a colleague, and leave a review with one change you want your health system to make next.

Transcript

Welcome And Mission

SPEAKER_00 0:00

Welcome to this episode of the Healthcare Bridge, where we explore the vital connections shaping our healthcare landscape. Hosted by Nathan Kaufman, Managing Director of Kaufman Strategic Advisors, the Healthcare Bridge is dedicated to improving healthcare delivery by strengthening the strategic and financial performance of healthcare providers. As part of the Common Bridge family, our focus is on fostering insightful, nonpartisan conversations that drive meaningful change in the healthcare industry. We invite you to join us as we build bridges toward a healthier future. The show is available on Substack, YouTube, and your favorite podcast platforms. Search for the Common Bridge and stay connected.

Origin Story And Early Career

SPEAKER_02 0:37

This is Nate Kaufman with the Healthcare Bridge, and today I'm excited to welcome a friend and colleague, Jeff Flax, who is the CEO of Hartford Healthcare. Jeffrey, welcome. Nate, thank you, my friend. It's nice to see you. To start out, what we try to do is provide an insider's perspective on healthcare. But first, let's talk about your origin story. Can you give us some of your background and something about Hartford Healthcare?

SPEAKER_01 1:05

First of all, I consider myself so blessed to work in this field. You know, I love this field. I love what we do in healthcare. I think it's the greatest place to work. We have such an opportunity to get up every day, make our community better, make the world better. So for me, I've been in healthcare since the beginning. I started, I was in high school. Both my mom and dad were public school teachers in southern Connecticut where I was raised. So we had a real sense of community, real sense uh in my family of giving back, being really deeply engaged. And I started working as a delivery boy at a local pharmacy and did it for about two years. And it just afforded me a chance to see healthcare, both in community centers, FQHCs, hospitals, nursing homes, doctors' offices. And it really gave me the chance to see so much about healthcare and to see so much about what it really means that I fell in love with it from that day forward. And uh, you know, I've been fortunate now for about 30 years to have been able to contribute to just trying to make healthcare better every day.

SPEAKER_02 2:09

In fact, I understand you were one of the modern healthcare up-and-comers. It's now called 40 under 40. So you should be congratulated. There aren't a lot of people who are actually nominated and selected for that.

Hartford Healthcare At A Glance

SPEAKER_01 2:22

As some may know, you were one of the truly original, original up-and-comers, because you predate me slightly. But for me, it was already some time ago, also. Uh, I was working in New York at the time. And look, I was very blessed, you know, fortunate to be in that position, to be recognized at that time for uh for contributing, you know, to our field and try to do it in any way that I possibly can.

SPEAKER_02 2:45

And can you tell us something about Hartford Healthcare? Just a little bit about the system and how many hospitals, that kind of stuff.

SPEAKER_01 2:53

Yeah, Nate, you know, Hartford Healthcare serves really the entire state of Connecticut. So we're in all eight counties. We have more than 500 locations here in Connecticut, several into western Massachusetts and to Rhode Island, but principally serving Connecticut. We have about 47,000 people who work within our health system. We're just approaching$8 billion this year in terms of our annual operating budget. And we have about 10 hospital campuses across Connecticut. So we're a comprehensive system. We have very significant programs in home care, significant programs pre-hospital care, very significant ambulatory network. And we've been extremely focused on driving more access, creating more affordable options for care, improving significantly the issues around health equity, and working to make healthcare better, higher quality.

What Makes A Great Health CEO

SPEAKER_02 3:43

So I remember in the 90s, Hartford Healthcare basically had two hospitals, and I think you contributed to the growth. What's the difference between a great CEO and a not so great CEO of a healthcare system? What do you think really makes a CEO stand out in today's environment?

SPEAKER_01 4:02

To me, it's staying really close to the organization, close to the operations, close to the community, staying really close to the purpose of the organization. At the end of the day, this is about delivering better healthcare, right? Making it higher quality, more convenient, lower cost, you know, more equitable. But that needs to be done from deep within the organization. So I think a leader has to listen, has to be closely engaged, has to understand the real issues that our colleagues who work here are working through to try to do their jobs to the best of their ability, has to really understand the issues that our customers, right, our patients, our residents are experiencing, you know, within our organization. So, you know, to me, it's really staying really obsessed both with improvement, continuous improvement, and at the same time staying very close to the purpose and legitimacy and realness of the organization.

Answering System Criticism

SPEAKER_02 4:56

That makes a lot of sense to me. For sure. Health systems today are getting criticized a lot. You hear, oh, you know, they're bloated, they're they're not focused on cost, they're sponsoring sports teams as opposed to providing care to people. What do you say to folks that are critical?

Disrupting The Status Quo

SPEAKER_01 5:16

Look, I think we have to listen, right, first and foremost, always. But to me, it's really about the core of the organization. You know, we need to be accountable and we need to demonstrate the value that we're creating. In our organization, I talk all the time that you know we can't protect the status quo. We have to change it. And we need to disrupt it because healthcare isn't accessible. It has not been affordable, right? We cannot continue to drive up rates and see these above inflationary adjustments. We've got to figure out ways to deliver care at lower cost settings, more you know, that are more preventive-related care and to move to being outcomes-based as opposed to productivity-based as we go forward. We need to recognize that healthcare needs to be better. So, from my point of view, when you're leading, now there's times I've seen it in our own health system in the early days when we're building Hartford Healthcare, you know, where there would have been criticism because we were starting to bring together the different components of the health system. But we had a vision and we had a purpose and we had a destination in mind. And people who were trying to protect the status quo to say, stay the way you are, those original individual, independent hospitals that became Hartford Healthcare never had the capacity to do what we do today. So when you look at what we're building today, using artificial intelligence, using machine-based learning, the capacity to manage and coordinate care differently, you know, the ability to diversify so that we can move care to more convenient, more cost-effective settings. That never would have been possible if we didn't change. So at one level, you know, I think you have to listen and have to understand, you know, the uh concerns that are being expressed. But at the same time, you have to be purposeful and principled and having a clear vision and destination. And sometimes you have to just move forward, right? And and let let the outcomes ultimately speak for themselves. And I think in a lot of ways, that's what's happening right now.

Headwinds And Financial Pressures

SPEAKER_02 7:07

Yeah, and you're very energetic about healthcare as opposed to me. I mean, I hate giving my speech because when I talk about healthcare and the new beautiful bill and you know, 340B, which is a regulation, a loophole is being challenged, and site neutral, another loophole is being challenged. And these are all necessary for us to compensate for the underfunding of care. I mean, how do you maintain your optimism in the face of all of these potential headwinds?

Why Optimism Is Justified

AI And Getting Better Faster

SPEAKER_01 7:45

I have to tell you, you know, and I understand what you're saying, because you know, I go to different meetings with my peers and you know, you listen to thought leaders like yourself and others. And there's many people who are focused on the headwinds we're up against today. And the headwinds are real. You know, the issues around Medicaid restructuring at the federal level, tariffs are having a huge negative impact on health systems in many ways because so much of our supply chains are global. Uh, you know, issues around eligibility and different aspects of payer reform and payer relations. You know, there's many different things that are on the horizon that have the potential to, you know, to create vulnerabilities for health systems. Now, that being said, there have, you know, there are always the issues in front of us, sometimes more significant than others. We will work through these types of things and get to the other side. My premise, Nate, there's never been a better time in healthcare. And the reason I believe this is the best time we've ever had in healthcare, because we've never been able to get better faster than we can right now. Historically, Nate, and I know you know this better than anyone, in healthcare, you'd add new technology and it would make doctors and nurses' lives more difficult, and it would make them slower, less efficient, more administrative, pull them away from the bedside or the patient, add technology in healthcare, make healthcare more expensive. And that was true for a long time. Today, what we're seeing now is the improvements we're making in healthcare are making people's jobs easier and better and allowing them to recenter their purpose back to why they're here and their love and using their expertise to help people and make people and help get better. So I'm such a proponent right now that now and into the future, we have an opportunity to really address things that were historically intractable, just problems that you know have been here since really the beginning of time, and we're now able to address them. And we're able to really get better faster. So I am very optimistic and I'm encouraged. Nate, think about the iPhone. You know, the first iPhone comes out and uh, you know, it got panned. I have a copy of it in my office, and people were talking about, you know, well, they were criticizing it because it didn't have a keyboard. And Nate, I know you were a huge back in the day, Blackberry guy, right? And you mean you had two of them and you were quick as could be in the you know, the texting they say, well, how could you have this without you know that? Why does it have a camera? And version one of the iPhone had challenges, there were change management issues, it had bugs within the software. But look at what it is today. And I look at where we are in healthcare in many ways. The improvements today, they really are great. I mean, we're seeing some incredible differences being made using AI and using machine-based learning and seeing improvements. But this is the beginning of the beginning of the beginning. Imagine what it's going to look like in three and five years, right? And we just have to keep projecting forward, staying the course, and about working to be the best at getting better, right? Get better tomorrow than we are today, be better next year than we are this year. Right. And that's the goal. Just keep getting better.

iPhone Analogy For Healthcare Change

SPEAKER_02 10:39

And it's amazing from my perspective, knowing you, that you're able to like tolerate all this without medication. Uh I couldn't do that. I have my shrink twice a month. What do you know? At three o'clock on Mondays. I know never to call Monday afternoons. I understand West Coast time. So just in close, um, advice for patients. What is your advice for patients with respect to the healthcare system right now? It's hard to negotiate or navigate. It is expensive, and I would blame some of that on the payers who have changed plan design to make uh higher deductibles and co-payments. I mean, what what is your advice to patients?

Practical Advice For Patients

Quality, Safety, And Lower-Cost Sites

Risks, Innovation, And Resilience

SPEAKER_01 11:22

I'll tell you, Nate, if you look in this moment or even back just a you know a short period of time, you could see incredible improvements. So if you were to go to one of our urgent care centers today, you know, you could go online, on the app, make your appointment, tell them why you're coming. It tells you which one to go to, and you can make an appointment, or you could show up, obviously, without an appointment. But if you make the appointment, it tells you what room to go to. When you get there, the portable extra equipment is there. The radiologist is is in the ceiling on the speakerphone, interpreting real time the results for you. Your electronic health record is up on a 42-inch screen. They have all of your past images in front of them. They have all of your medications and allergies. They know who your other providers are and what your past experiences were if there's anything of relevance or concern. That didn't exist five years ago. And today it's become standard. Today, you can go on an app and download HHC 247 at the Apple store, and you can get in a queue to get a primary care visit this minute, and that queue will probably be in seven minutes, or you can make an appointment for two o'clock this morning or Sunday afternoon or wherever whatever time is most convenient for you. And you can pick your provider and you could set up the parameters of which you have that primary care experience 24-7, and they prescribe labs and imaging or whatever type of ancillary services you need. That didn't exist six months ago. And today we're seeing hundreds of people every day in that process. So to me, the the advice is for patients, we've got to engage. And we've got to recognize that we're moving every day to getting better, more coordinated care, more well-navigated care, enable to drive care to more affordable, more convenient settings, and working towards getting to more prevention and more uh outcome-based services as opposed to traditional food for service. So sometimes you have to step back, kind of look from above. The improvements have been massive. But now the benefits, the improvements on top of these compound on the ones that have already been made. So I believe that we are on the precipice of making healthcare so, so much better. And Nate, from a quality standpoint, the things that we call never events, they still happen, but they happen less now than they ever did before. If you look back at the Institute of Medicine study, right, from the early 2000s, the improvements have been extraordinary between then and now, you know, over basically two decades over a generation of time. The improvements are incredible, but they're not where they need to be, right? Because we still have things happening in institutions that should never happen, but they happen less than ever before. So quality is better, safety is better, the amount of surgery centers in the community that don't charge hospital rates, the level one, level two visits from emergency departments that now happen within the community, you know, the ability to manage imaging in communities and so forth, so that we can drive care where people want to be, where they live or work or in hours of the day or night that they prefer. It's better than it's ever been. And yet, Nate, I guarantee you, it's going to be so much better next year than it is now. And again, that rate of improvement, the rapidity of improvement, this is like we've never seen because the technologies and the enabling type of support systems are so good. So I am an optimist. I believe that we're on the precipice of just continued and even more substantial improvements, but we're not without headwinds. The headwinds are significant, they're disruptive. They could set us back, depending on what they are. They could stymie innovation, they could delay some of the advancements we're making if we don't have the investment capital or the operating margins to support these types of investments. So we are fraught with risks and challenges. And at the same time, there's great opportunities around us. So, you know, there is a dynamic tension, and it's not a panacea. But if you can kind of see around that tension, there's great opportunity.

SPEAKER_02 15:12

And that's what I think a good CEO has to do is you can't get hung up on the headwinds. You've got to keep moving forward. And uh we should cover that we didn't cover in our little brief visit, Jeffrey?

Appreciation And Closing

SPEAKER_01 15:26

No, Nate, first of all, let me say that. Well, you're a great thought leader, and I always consider you, you know, people talk like in sports terms, they say, you know, who the GOAT is. They talk about the debates about who's the greatest of all time. You know, you've had such a distinguished career, and in the course of my entire career, yeah, I've attended your speeches countless times, you know, at national meetings. I've read your commentary so many different times. Um, you know, you have continued to be such a positive influence of causing everyone, challenging the conventional, forcing people, you know, to kind of see certain realities, to think differently. You've counseled, you know, I couldn't even tell you how many boards of directors across America. Over the course of decades, you've helped make healthcare better. And you've certainly, you know, caused everyone sometimes to step back and rethink what they're doing. You you don't go with uh, you know, with the norm always. You you'll you'll challenge that conventional thinking. So we're grateful for everything you've done. You've helped Hartford Healthcare, you know, with full disclosure from a transparency standpoint as a tremendous advisor. And I've also always respected that while you've had this major focus on thought leadership, you continue to work with physician clients across the country. And you're a huge advocate for the practice of medicine and physicians in particular and advanced practitioners. So I'm appreciative. You've been a mentor to me in many ways. I've learned a lot from you. And I'd like to think that you've learned some from organizations like mine, you know, working as closely with us as you have.

SPEAKER_02 16:51

Every day I learned something new, Jeffrey. But most significantly, I can tell you with all that, I could never do your job. Uh the ability to have patience, optimism, and focus is not a trait that uh, and patience is not a trait that I possess. But anyhow, this was kind of fun. It was uh a brief talk with Jeff Flax, who is the CEO of Hartford Healthcare and really the driving force behind healthcare in Connecticut. And uh, Jeffrey, I appreciate your time. Grateful to you, Nate. Thank you, my friend.

SPEAKER_00 17:24

Thank you for joining us on this episode of the Healthcare Bridge. We hope you gained valuable insights into how strategic and financial analysis can transform healthcare delivery. Remember, building stronger connections in our healthcare system is a collective effort, and we're honored to be part of that journey with you. Be sure to subscribe and stay tuned for more conversations that aim to bridge gaps and create a healthier future for all. You can find all your healthcare bridge episodes at the Common Bridge on Substack, YouTube, and your favorite podcast platform.