Even as it grapples with labor shortages, supply chain woes, an exhausted workforce, and more, there is much optimism and hope for the industry’s future.
Meet PowerCardiologistDFW’sCouple BIOTECHNORTHTHETEXASBOOM 2022 EDITION SystemHospitalCEORoundtable
its core, the practice of medicine is about people. At UT
#1 hospital in DFW for six years in a row. Putting patients first is our passion. And medicine at its best. Nationally ranked in: CardiologyCancer & Heart Surgery Diabetes & UrologyRehabilitationPulmonologyNeurologyGeriatricsGastroenterologyEndocrinology&GISurgery&Neurosurgery&LungSurgery
#1 hospital in DFW. Again.
about improving the health of people so everyone can achieve their full potential. You’ll see that supreme dedication to your good health throughout UT Southwestern, and
– named
everything we do – discovering, educating, healing –
It’s at Southwestern, is especially William P. Clements Jr. University Hospital the
at our
easy to be amazed by all the advancements in modern medicine. But
Hospital system leaders grapple with an industry that’s in flux while preparing for the future. 96 94 90 MEET FOUR PHARMAPRENEURSDFW From drug development to delivery of services, these innovators are disrupting the pharmaceutical market. BIOTECH BOOM With a business-friendly environment and a steady supply of talented graduates, the region’s biotech industry is starting to take off
CONTENTS
A disjointed healthcare industry is forging ahead because it has to. Here’s how it is facing the challenge.
BYMADDOX GOFFNATALIE BYBIOTECH; STUDIOSCREATIVECACTUS BYCOVER VOORHESTHE
HEALTHCARE ANNUAL 2022
083DCEOMAGAZINE.COM SEPTEMBER 2022 LETTER FROM THE EDITOR
Will Maddox Healthcare Editor
101
HEART TO HEART How married couple Dr. Shelley Hall and Dr. Rick Snyder became two of North Texas’ most powerful cardiologists.
we burn the calories we eat our heart takes blood in and pumps it out in equal measure. Nearly every aspect of our physical selves seeks balance; our bodies work best when we maintain equilibrium. I am learning this the hard way as I navigate the healthcare system to get my knee fi xed after I tore my ACL. I’m experiencing what happens when the body is imbalanced. The same could be said for our healthcare system. Like so many other industries, healthcare is jolted by forces outside its control. Labor shortages, supply chain issues, new COVID-19 variants, and a workforce that’s exhausted after battling a pandemic for nearly three years are creating challenges at every level of the system. Meanwhile, there is much optimism and hope for the future. Technology is allowing us to personalize medicine, and pharmaceutical companies are developing treatments for diseases faster than ever before.
When the Body Seeks Balance
TheNorthinfrastructureisinplaceforTexastodevelopintoanationwidebiotechpowerhouse.
D CEO’s 2022 Healthcare Annual looks at the triumphs and trials of the local health system. Inside this special edition, you’ll find a discussion with leaders of some of the largest health systems in the region who share their growth strategies and labor challenges (p. 101). You’ll also meet innovative pharmaceutical entrepreneurs who have made North Texas their home (p. 96) and get an insider’s look into the emerging biotech industry in North Texas (p. 94). In addition, we feature Drs. Shelley Hall and Rick Snyder, two of the most successful cardiologists in the state who also happen to be married to one another (p. 90). Ten years ago, we launched the only news site in the region that focuses on the business of healthcare to tell stories just like these. I hope you sign up for our daily e-newsletter and tell us what we’re missing by contacting me at will.maddox@dmagazine.com.
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Doctors on the medical sta practice independently and are not employees or agents of the hospital except for resident doctors in the hospital’s graduate medical education program. © 2022 Getting what you need when and where you need it is easy, so why shouldn’t health care be the same way? That’s exactly why Texas Health is expanding across North Texas. From new hospital additions to more urgent care locations in your neighborhood to greater access to virtual care, we’re making health care more convenient and accessible for all North Texans. And we’re just getting started. Learn what we're doing TexasHealth.org/BrightIdeasat: Growing with you is how we care more.
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How is compassion fatigue linked to burnout and moral injury? Compassion fatigue occurs when individuals become overwhelmed with constant exposure to the trauma of others. We saw this throughout the pandemic as physicians and nurses worked tirelessly to treat their patients. Compassion fa tigue quickly set in as they experienced trauma and grief daily. However, as we failed to listen to medical professionals, we forced them experi ence the lasting pain of moral injury. So now what? We must take lessons learned in the pandem ic and apply them in all workforce environ ments. If employers do not empower their team members, listen when they advocate for themselves, and act swiftly and purposefully, employees will experience moral injury. Lead ership should ensure compassion fatigue never becomes moral injury.
ASK THE EXPERTS
Workforce Burnout
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What is burnout and can it be prevented? If so, how? In the traditional sense, burnout is described as the emotional, mental, and physical reactions one experiences when under constant stress. Individuals experiencing burnout are at risk for increased anxiety, depression, and an in ability to implement effective decision-makin skills. Decreased productivity is also a symptom of continued stress in the workplace. Burnout has been seen as inescapable in careers like the stock market trade as well as in the helping profession. While working in a high-stakes en vironment is undoubtedly stressful, burnout is not inevitable. When we view burnout from the lens of an administrator’s responsibility to the employee, we have the power to ameliorate the victim-shaming nature of the term, empowering future generations to experience the workforce in a more meaningful way. How should we describe burnout?
Although we have begun recognizing the impor tance of mental health, we have not yet shifted our vocabulary when discussing some of its pre ventable deterioration. In some environments, “burnout” has become a weapon used to shame employees into believing that they are inca pable of managing their experiences. Replacing “burnout” with terms like “moral injury” and “compassion fatigue” should become the norm. Doing so requires those in power to act swiftly to repair relationships with their team and em powers employees to advocate for themselves rather than feel the shame of “burnout.”
SYDNEY REECE, LPC , REGIONAL DIRECTOR OF INTEGRATION, CONNECTIONS WELLNESS GROUP
What is moral injury? Moral injury is “disruption in an individual’s confidnce and expectations about one’s own or other’s motivation or capacity to behave in a just and ethical manner.” (Drescher, et.al, 2011)
The symptoms of moral injury are like burnout–increased anxiety and depression, guilt, and de creased decision-making skills. Although it has been applied to treating veterans, we can use this terminology to describe what is also hap pening in some sectors of the workforce. A lack of supportive and ethical leadership has been emphasized as one of the main factors causing moral injury. It is the responsibility of admin istrators to ensure their team is not required to achieve an outcome that might necessitate violating their moral compass. Leaders should, instead, be removing barriers impeding progress and encouraging team members to advocate for themselves, their teams, and their clients.
SYDNEY REECE is a licensed professional counselor who serves as the regional director of integration for Connections Wellness Group. She earned her master’s degree in counseling from the University of North Texas. She has worked in a variety of healthcare settings, including acute inpatient facilities, private practice, and outpatient facilities. She now uses her skills to ensure patients are treated without the typical barriers that clinicians are burdened with navigating in more traditional healthcare settings. By eliminating these barriers, Reece believes healthcare, specifially mental health care, will become more accessible to everyone.
DR. DANIEL SUCATO: Most can be treated without surgery. Physical therapy can improve range of motion, strength, and flexibilit. Other treat ments include bracing, casting, and anti-infla matory medications.
Pediatric Orthopedics
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DANIEL J. SUCATO, M.D., M.S., AND PHILIP L. WILSON, M.D.
DR. DANIEL SUCATO: Pediatric orthopedics in volves anything related to children’s muscles, joints or bones, so that would be conditions like clubfoot, scoliosis, developmental hip dysplasia, and even traumatic or sports injuries. We also have subspecialties in spine, upper and lower extremities, foot and ankle, sports injuries, and fractures.
How early will a child show signs of having an orthopedic issue that may need medical attention?
DR. DANIEL SUCATO: At the initial visit, the family and patient will first meet with the povider to discuss the concerns and note any family histo ry regarding the issue. A physical and orthope dic examination will evaluate the areas of con cern. If necessary, appropriate imaging studies, such as ultrasound, plain radiograph, CT or MRI scan, will follow. Let your child know the imag ing studies, if necessary, will not hurt.
DR. PHILIP WILSON: We also make sure the child is directly involved in the discussion. As kids get older, the perception and magnitude may be dif ferent for parents than it is for the child. Prior to the visit, parents can help by letting them know we are just going to check their muscles–no shots. What are common issues in children that fall under the category of “pediatric orthopedics?”
DANIEL J. SUCATO, M.D., M.S., is chief of staff, the director of the Center for Excellence in Spine and a pediatric orthopedic surgeon at Scottish Rite for Children. He is a professor in the Department of Orthopedic Surgery at UT Southwestern Medical Center at Dallas.
SCOTTISH RITE FOR CHILDREN ASK THE EXPERTS
PHILIP L. WILSON, M.D., is an assistant chief of staff, director of the Center for Excellence in Sports Medicine and a pediatric orthopedic surgeon at Scottish Rite for Children. Wilson also serves as the medical director of North Campus. He is a professor at UT Southwestern Medical Center and provides orthopedic trauma and pediatric sports medicine coverage at Children’s Medical Center of Dallas.
DR. PHILIP WILSON: Within pediatric sports medicine, conditions involving the cartilage or instability of the joint or injuries affecting th tissues around the joint are common reasons for treatment. Do all orthopedic issues require surgery? What are other forms of treatment?
DR. PHILIP WILSON: We always reserve surgery for use when other options are not available. In addition to what Dr. Sucato mentioned, some times simple reassurance to the family that the orthopedic condition is normal or will improve with age may be all that is required.
DR. DANIEL SUCATO: Orthopedic issues can pres ent as congenital abnormalities of the bones, meaning the bones were not completely or normally formed in utero. This can occur in the spine or the upper and lower extremities. Often these patients do not require treatment early, or sometimes ever, but they should be evaluated to see if treatment is necessary.
DR. PHILIP WILSON: As a pediatric cartilage and ligament surgeon, we often see children with congenital meniscus or cartilage conditions within the knee. Sometimes these can present as early as toddler age, but more often young school-age with a loss of full extension or oc casional limp. What should I expect at our fist visit to a pediatric orthopedic specialist?
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090 Heart to Heart 2022 HEALTHCARE ANNUAL
How married couple Dr. Shelley Hall and Dr. Rick Snyder became two of the most powerful cardiologists.
A story by WILL MADDOX portrait by JILL BROUSSARD AFTER BLOOD TRAVELS through the body, delivering nutrients and oxygen, the low oxygen blood flows into the right atrium, which pumps the blood into the right ventricle, sending the blood into the lungs, filling them with oxygen. Next, the left atrium receives oxygen ated blood and sends it into the left ventricle, which pumps it into the body to start the process over again. The left and right sides of the heart work together in equal measure—and are literally what keep us alive. Like the two chambers of the heart, Dr. Shelley Hall and Dr. Rick Snyder are potent forces in the cardiology world, balancing complex cases with statewide and national physician leadership, all while being married to one another and raising a family. Although physician mar riages aren’t all that uncommon (medical school and residency provide prime opportunities to meet one’s match), it is rare for a couple to climb the healthcare ladder as high as Snyder and Hall have done. So, how do they make it work? The expertise, energy, and discipline required to live the lives of this heart couple would sap most of us aver age humans, but Hall and Snyder seem to thrive when fully engaged, even if it means they are focused on giving each other a hard time.
Hall wasn’t interested in riding the coattails of Snyder’s medical ca reer. The reverse was also true. “It was immediately obvious that she was going to go places from a cognitive standpoint in clinical medicine because she was upstaging my interns and senior medical students,” Snyder says. “We call them gunners.”
Hall thought she would go into pediatrics, as many women did at the time. But she didn’t like her pediatrics rotation and preferred to speak with patients rather than their families. Snyder supported Hall’s pursuits, but when she decided to pursue cardiology, he wasn’t so sure
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MAKING THE ROUNDS
As Hall was getting back into her studies after taking a year offfrom medical school, she wanted to get some time with patients before she hopped back into academics. As a third-year student, she would spend the year in rotations at the hospital. She asked her school’s dean for help, and he called Snyder and asked if the returning medical student could shadow him for a couple of weeks. He obliged. Hall stood out during that period. Other students in the group had been grinding through their training without a break and were eager to get home after doing the minimum. Hall had taken a year offand wanted to get back into the swing of things, and she volunteered for extra tasks. The two didn’t start dating right away, mainly because Snyder was already in a relationship. But the reconnection was enough to start a friendship, and over the next several months, saying hello in hospital hallways turned into her reaching out from time to time to discuss med icine. Eventually, something more serious took shape, and the two be gan dating about a year later.
One particularly proud moment was working with Dallas Coun ty when he was president of the county’s medical society during the West Nile outbreak in Dallas. After making a passionate speech about the benefits and risks of spraying Dallas County to kill the infected mosquitos, Judge Clay Jenkins called a press conference later that day to announce the spraying. Snyder was thrust forward to explain the move to the various city councils in Dallas County and on radio and television shows. “As a physician, we treat one patient at a time, but as an advocate, we can impact the whole country all at once,” he says.
But their frustration on the matter, like so many things they may disagree on, is quickly swept under the rug with their ability to let things go and separate the professional from the personal. The two could not let the small stuffget in the way of what they held most dear; they both wanted to pursue their highest potential as physicians, and they both wanted to have a robust and full home life. Those dual goals would not be achieved easily, but they were up for the challenge. “Shelley has more energy than anybody else on the planet and is involved in a lot of things,” Snyder says. “She definitely wanted a career and a home life.”
Both Snyder and Hall are cardiologists and physician representatives, and their house is no stranger to political fundraisers. They have spent ample time in Washington D.C., and Austin speaking with legislators about laws impacting physicians. Snyder has long been focused on impacting legislation and says that they can impact more patients in legislator chambers than in operating rooms. “I was very satisfied,” he told D Magazine at the time. “I was feeling good about the city. I was feeling good about my family, that were being protected.”
092 SEPTEMBER 2022 DCEOMAGAZINE. COM he wanted to be in a relationship with someone who worked in the same subspecialty. She said she would focus on heart transplants rath er than interventional cardiology, which would have minimal overlap.
Hall is the chief of transplant cardiology at Baylor Scott & White Health, one of the country’s largest programs. She is also the president of the Texas chapter of the American College of Cardiology and is on the national board of the organization, too. Snyder is president of the cardiology group HeartPlace and is also president-elect of the Texas Medical Association, a role that will have him leading the country’s largest medical association, which includes more than 56,000 physicians. He has also been president of the Dallas County Medical Society and president of the medical staffat Medi cal City Dallas hospital. Additionally, Snyder has been involved with the Medical City heart transplant program, a competitor of the Baylor program, the couple says. He likens their ability to balance profession al competitiveness and their relationship to liberal political consultant James Carville and his wife Mary Matalin, a consultant for the Repub lican Party. “We like to say we work for the enemy,” Snyder jokes. Together, they sit on the board of the corporate organization that vice CEO, and the sales rep said, “This is Dr. Hall, the chief of transplant cardiology for Baylor Scott & White Health.” The CEO, making a pa triarchal assumption he shouldn’t have, began approaching Dr. Snyder. Snyder attempted to back away and behind his wife, but the CEO kept coming toward him. Finally, Hall stuck out her hand and introduced herself. “It was like watching a car wreck in slow motion,” she says. Although sexist assumptions plague many female professionals, Snyder says he often finds himself being shown up by his wife. At Medical City, a man the age of 50 was getting surgery, and his heart arrested during the operation. For 45 minutes, the team worked to resuscitate him with chest compressions; if someone survives after being in that condition for that long, they often become brain dead. Nonetheless, Snyder took on the patient, finding out that he had 99 percent blockage in his heart. The team put in four stents and a pump and got his heart working again. When they extubated him, to every one’s surprise, he was alert and asked questions about his heart only someone in the industry would know. As they talked, Snyder learned the patient was a cardiac drug rep in town with a degree in cardi ac physiology who worked with UT Southwestern physicians. Snyder mentioned that he had trained some of the physicians at UTSW and how his wife was director of heart failure and transplants at Baylor. The patient said, “Oh, you are married to Shelley Hall! I love her.”
2022 HEALTHCARE ANNUAL
DR. SHELLEY HALL runs HeartPlace, which often proves entertaining for the rest of the members sitting around the table. “I’m happy to support him when I agree with him, but I’m not afraid to disagree with him,” Hall says. “Our group always loves it when we have different views, and they can sit back and eat popcorn and watch the show.”
Busy doctors who are also working to raise a family require a great deal of discipline and energy, but Hall and Snyder are no regular phy sicians.
Being married and in the same field is not without awkward mo ments. The couple once booked individual trips to the same hotel for the same conference without knowing it until just days before they left. At another conference, the couple was introduced to a major medical de
Hall’s approach has been different. She isn’t a huge fan of politics or the political process and has focused more on the scientific and re search side of medicine, but she is starting to lean into her leadership roles and see her ability to have an outsized impact. On a recent trip to D.C. with Snyder, the two were making the rounds to legislators. Hall felt intimidated, and Snyder reminded her others were likely more in timidated by her than vice versa.
Despite leading the team that saved the man’s life, Snyder found himself playing second fiddle. “I found out two things about this guy: No. 1, he was neurologically intact, and No. 2, I took a guy who was 99 percent dead, and now he is essentially Lazarus and still alive. And my wife still shows me up.”
PLAYING AT THE HIGHEST LEVEL
When Snyder later decided to get certified in heart failure transplant, she was miffed (and Snyder never fails to remind Hall that he got a higher score on his heart failure and transplant board exam).
THE POLITICS OF THE PROFESSION
“I’m happy to support him when I agree with him, but I’m not afraid to disagree with him.”
HALL: “Critical care, me. Preventative health, him.” When did you know wantedyouto marry the other?
In the first meeting, Snyder did the talking. In the next one, he in troduced his wife to give her perspective. By the third conversation, she interrupted him and jumped in to help advocate for her fellow car diologists. The two are focused on changing the law to increase organ donation by making Texans opt-out of being on the organ donation registry at the DMV rather than opt-in. “I don’t like politics, but I un derstand the importance of them,” Hall says.
Making it work required a strong sense of each other’s strengths and weaknesses, implicit trust, and an ability to communicate and prioritize efficiently and consistently. Spending their days taking care of hearts and saving lives and their offtime raising children and rep resenting colleagues in the highest halls of government would seem to be a heavy burden. Still, Hall and Snyder seem to take on everything with a balance of focus and humor.
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It has only been over the last 10 years that Hall and Snyder have re discovered their social life, taking trips to Cancun, where Snyder and Hall soak up the ambiance. “We had very little room for anything else,” Hall says. “It was work and kids, work and kids, for 20 years nonstop.”
What was your firt impression of your SNYDER:spouse?
HALL: “When I had to choose between moving back to New England for fellowship or staying in Dallas.” What have you learned SNYDER:yourmedicineaboutfromspouse? “I have learned much from her about the support.”chanicalphysiologyheartogypathophysiol-ofadvancedfailureandofme-circulatory HALL: “How not to put a central line in! (It’s an inside joke.)” Who would play spouseyouron a TV medical SNYDER:drama? “A young Dana Delany” HALL: Clooney”“George What do you most SNYDER:aboutadmiretheother?
HALL: “His passion and dedication for something he believes in. Like a dog with a bone, he will work for it and defend it.” What would the other describe as an ideal SNYDER:date? “A musical in New York or the Broadway Dallas, followed by dinner at a fun restaurant.” HALL: “Hanging out in our media room, watching shows together.” If not a heart doctor, what would SNYDER:spouseyourbe?“An FBI agent or a CSItype detective.” HALL: “Tough one. Either a businessman or the President’s Chief of Staff.”
TWO HEARTS IN SYNC
“Shelley is the most caring and giving person. She always volunteers to lend a hand in an emergency. I have seen it if we come upon an auto accident or whenever a pilot asks if a doctor is on havetionaboutfearsrelatecanProfessionally,board.sheempathizeandtoapatient’sandconcernstheircondi-likenooneIseen.”
On top of their high-profile physician and leadership roles, the two have raised five children, now ages 38, 35, 27, 26, and 24. As the kids were growing up, it wasn’t easy, and sacrifices had to be made. But the two sharp minds kept things organized with shared Apple calendars and a dry-erase board where each kid had their own color. That way, the couple could divvy things up to ensure that kids would get to recit als and sports activities. “Both of us can go at Mach speed in the world of texting,” Snyder says. They would trade offtaking the kids to school, as their work of ten began early. They had a nanny for support but avoided live-in help, as they were afraid they would depend on it too much and risk becoming too uninvolved in their kids’ lives. They also had to make sure only one parent was on call each weekend. Still, it was rare for the family to have dinner together between all the activities and working schedules, but, when each child turned 10 and every birth day after, a special weekend with just mom and dad anywhere in the continental United States headlined the year’s activities. Even with fi ve children, a cardiology practice, and advocacy work, they made time to manage hockey and soccer teams, lead Scouts and In dian Guide groups, and participate in other activities. “I look back on it and think, ‘How did we ever do it?’” Hall says. “We took a di vide-and-conquer mentality.”
Dr. Rick Snyder and Dr. Shelley Hall have taken similar career pathways and achieved great heights in their profession, all while raising fie children. Couples don’t do that successfully without knowing each other well. We decided to put them to the test by asking them identical questions in separate interviews.
It might be easy for a couple as busy as Hall and Snyder to wonder if they spent enough time with their kids. Lingering ques tions about work-life balance haunt many parents. But the children put those fears to rest when Hall brought up the subject after they were grown. “I asked, ‘Do you regret that I wasn’t the room mom or the carpool mom or things like that?’ To be honest, they said no. They said I was a role model as a strong working mother.”
SNYDER: “During one of our getaway weekends. It was just the two of us at my family’s lake house in Cedar Creek during the summer of 1992.”
When they both sat for an interview, I spoke with Snyder for a few minutes before Hall joined us, and I joked that it would be good to have her fact-check what he had told me so far. Her first words to me were said with a wink: “He lies.”
FULL HEARTS, CAN’T LOSE
“That she was a attractive.”wereic,attitude,twoparedpageswerepenmanshipwrittenphysicalsHeracademicandthe-topneouslywhomedicalintroverted,quiet,nerdystudentwassimulta-wayover-confidentanoutspoken‘gunner.’historyandwerealsoinperfectandsevento10long(com-tothetypicalorthree).Herworketh-andenthusiasmrefreshingand
SHUTTERSTOCK
HALL: “Uh oh; he is a player!” Who is the better heart SNYDER:doctor?“Dangerous question. For advanced heart failure, transplant, and cardiology,anderal,Shelley.port,circulatorymechanicalsupnoquestion,Forgenpreventative,interventionalme.”
094 SEPTEMBER 2022 DCEOMAGAZINE. COM With a steady supply of talented graduates and a business-friendly environment, the region’s biotech industry is starting to take off story by WILL MADDOX 2022 HEALTHCARE ANNUAL BOOM BIOTECH DFW’S
But players in the space say it isn’t wise for the region to rest on its laurels. It will take continuing focus, in vestment, and recruiting to help the region move from an emerging biotech hub to a national powerhouse.
095 BUSINESS AND POLITICAL LEaders gathered on a windy day in March for the ribbon cutting of BioLabs’ Dallas location at the Biotech + Hub at Pegasus Park in the Design District. Philanthropist Lyda Hill, Mayor Eric Johnson, and U.S. Representative Eddie Bernice Johnson were all in attendance. It isn’t every day that a local business gets that kind of attention, but BioLabs’ arrival in Dallas was about more than just adding some lab space to a trendy new development. It was a sign of what the region is becoming.
The gravitational pull of BioLabs is luring other or ganizations to Pegasus Park, too. UT Southwestern, McKesson, Health Wildcatters, and several nonprofits have secured space, creating synergy for startups and convenience for VC funding. “In the past, investors may have nailed down one or two reasons for coming to Dallas,” says Dr. Hubert Zajicek, co-founder and CEO of Health Wildcatters. “Now, they are trying to find other purpose-driven entities or organizations to visit, and this makes things easier because of the spotlight.”
MEDICINEONCONANO
2022 HEALTHCARE ANNUAL B
The area’s logistics infrastructure supports the in dustry, too. DFW Airport is only the second in the country that has been named a Center of Excellence for Independent Validators by the International Air Trans port Association, which means it meets the standards for safe handling of pharmaceutical and life science products. “When you’re flying a vial with maybe four or five ounces across the world from Mumbai to DFW, you need to know has it hasn’t been shaken too much,” Varela says. “It could be worth $250,000.”
“Past success is significant and important, but it isn’t enough to be evidence of an unstoppable tidal wave,” Zajicek says. “If you learn anything from ecosystems, it’s about the redeployment of capital. People make money or entrepreneurs have an exit, and then they re invest the earnings.”
Dallas recently ranked No. 6 nationally in a report on
The morecompanyIrving-basedhasraisedthan$1billion in the past several years to support its precision medicine initiatives and focus on cancer
PHARMALANTERN This byandItdevelopmentoncompanyclinical-stageDallas-basedbiotechfocusesthecancerdrugprocess.wentpublicin2020raised$69milliontheendof2021.
BioLabs is an international, membership-based net work of shared lab and office space that help launch biotech companies. The Dallas location is BioLabs’ first in the U.S. that isn’t on the East or West Coast, where this type of innovation usually originates. The compa ny is part of what is the beginning of a biotech district that includes the medical center and UT Southwestern Medical School. “Pegasus Park has created a central hub or a landing place for the life sciences to come and con gregate within that one building,” says Jorge Varela, vice president of innovation at the Dallas Regional Chamber. BioLabs is a 37,000-square-foot facility with several private labs and dozens of benches with enough room for 30 to 35 startups. The company’s site director at Pegasus Park, Gabby Everett, says BioLabs expected to be about 15 percent full in the first year. But in just two months, the space was already 30 percent occupied, a level that usually takes three to four years. It isn’t just the name and reputation bringing members into the space. The opportunities for collaboration, discussion, and social ization are ample, with a café on site, ping pong tables, and a brewery across the street. “It has that Silicon Val ley feel to it with a comfortable vibe,” Everett says.
emerging biotech markets produced by real estate gi ant CBRE. Individuals involved in life science research as a career grew by 79 percent between 2001 and 2020, compared to 8 percent for all industries. The number of U.S. graduates in biological and biomedical sciences is twice what it was 15 years ago. These occupations have the second-lowest unemployment rate of any industry, meaning the battle for talent is fierce.
DFW’s success has been built on the backs of local biotech success stories.
CARIS SCIENCESLIFE
Dallas-Fort Worth is well positioned to meet the chal lenge. In addition to the region’s relatively low cost of living, business-friendly environment, and blistering growth, its educational institutions are supplying the tal ent companies are looking for. Last year, area universities produced 1,935 bachelor’s degrees, 378 master’s degrees, and 108 doctorate degrees in biological and medical sci ences, according to the Dallas Regional Chamber.
ALCON Founded in Fort Worth in 1947, Alcon is the global leader in eye care, offering surgical and eyecare products that have impacted 260 million people in 140 countries. It has a market cap of $38.06 billion.
This andbiomarkerproductsassuccesshasdiagnosticSouthlake-basedstartupseensignificantinfundraisingitworkstocreatethatuseapHtodiagnosetreatcancer.
ON OFSHOULDERSTHEGIANTS
STUDIOCREATIVECACTUS
DCEOMAGAZINE.COM SEPTEMBER 2022
Through infrastructure investments and a push for growth, Fort Worth has developed its own biotech scene, with accelerator TechFW leading the charge and partnering with UNT’s Health Science Center in Fort Worth and Texas A&M’s growing research and inno vation presence in the city. Fort Worth’s labor supply is boosted by HSC and TCU’s School of Medicine, and it has a growing funding presence with venture capital firm Cowtown Angels, which has supported the start up biotech industry in the city.
097 From drug development to clinical trial infrastructure and delivery of services, these innovators are disrupting the region’s pharmaceutical market.storybyWILL MADDOX photograpby by DAN SAELINGER SEPTEMBER 2022
Bhattacharya knows the power of medicine, as she lost both her parents to Covid-19. She is fueled by much more than just making a profit and is hopeful that their treatments will hit the market in the next two to three years. “We have seen the impact in the patients, so I’m optimistic,” Bhattacharya says. “It will bring so many patients relief in their life.”
Standard treatment can include oxygen therapy and sending infants home with complicated breath ing equipment. However, the medications can cause side effects and merely treat the symptoms rather than the cause of BPD. “It’s tough on the families because they’re transforming the home into some sort of an ICU,” says Dr. David Riley, a neonatologist at Cook Children’s and also the chief medical officer at AyuVis.
The Bedford-based clinical-stage company has nu merous gene therapies in the works at various points in the developmental process, and investors are be ginning to take notice. The company has raised more than $25 million through various private funding and non-dilutive funding efforts. It has also received orphan drug designation from the FDA for a treat ment that will allow it to continue to develop medi cines that a ffect fewer people.
AYUVIS When premature babies are born more than two months early, they often injure their fragile lungs and develop bronchopulmonary dysplasia, a breathing disorder where the lungs don’t develop properly. The disease can be mild or severe but can cause breathing difficulty into the teen years, and the children spend a lot of time in the hospital and need extensive care. Fort Worth-based AyuVis aims to change the way these babies are treated.
The company is designing immunotherapy drugs that control inflammation and infection and can attack the root cause of BPD and potentially other conditions. Other immunotherapy drugs suppress the body’s immune response, but research has shown that AyuVis’ respiratory treatments do not reduce the immune response.
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In addition to the biology and chemistry aspects of development, there is an entire industry to support the infrastructure needed to get these life-changing advancements to market. Over the past couple of decades, North Texas has become a leader in the life sciences and drug development industry, attracting the types of companies that create a pharmaceutical powerhouse and the talent to fuel ongoing growth. North Texas is home to McKesson, one of the larg est pharmaceutical distribution companies in the world. In addition, it has recently attracted the first non-coastal location of BioLabs, an international net work of shared lab and office space. There are many other companies in the space that operate under the radar, quietly making a difference for patients and a name for the region as one that supports and develops life-changing medicines. Here are four of them.
debilitating diseases that can lead to blindness that a ffect millions of people around the world. These diseases are especially painful because the patients know exactly what they are missing. “They’re not born blind. They have seen the world and are gradually losing their vision,” Bhattacharya says. “They’re losing their world. So, when they go through this journey, it’s a very traumatic journey for the pa tient as well as their family.”
SUCHISMITAACHARYA AyuVis
BHATTACHARYASULAGNA TherapeuticsNanoscope
STAGE 1: IN THE LAB NANOSCOPE THERAPEUTICS Co-founded in 2009 by Sulagna Bhattacharya and Samarendra Mohanty, Nanoscope Therapeutics has developed several biomedical innovations that in clude diagnostic and therapeutic treatments. Most of the company’s innovations have centered around bringing sight to the blind. Bhattacharya grew up with a family connection to degenerative retinal dis ease and was inspired to pursue the science behind inherited retinal degeneration, a group of visually
BY THE TIME MOST PEOPLE HEAR ABOUT a pharmaceutical advancement, chances are that the scientists have been waging war against a specific dis ease or condition for years, if not decades. According to industry group PhRMA, it takes 10 to 15 years on average to develop a new medicine from the moment of discovery through the regulatory process. The pro cess is expensive, too. Estimates range from just un der $1 billion dollars to $2.6 billion to get a drug out of the lab and into the pharmacy.
COURMED
Starling launched the Southlake-based business in 2020 after several years with McKesson and is cur rently in a pre-seed round of raising money. As of this spring, the company onboarded 12 customers, with eight more on the way. As a Black entrepreneur, he knows that decentralizing and digitizing the process will allow for a more diverse trial population.
“Customers don’t want to leave and want to get all those services at home. They don’t want to leave and go to the dentist or the doctor,” Miles says. “With the abil ity to get all the services, they get their time back.”
The venture’s name comes from a combination of Ayurveda, traditional Indian medicine that means life science and knowledge and Vision, represent ing the founder Suchismita Acharya’s ability to plan ahead. Eight years in and with $6.6 million raised, the company is looking forward to its first clinical tri al and bringing some solace to families dealing with a premature child struggling to breathe. “It took quite a bit of time, but it’s a very interesting journey,” Acha rya says. “We have a goal to help these pre-term ba bies to grow with healthy lungs so that they can have their quality of life.” CLINICAL TRIALS
099DCEOMAGAZINE.COM SEPTEMBER 2022 2022 HEALTHCARE ANNUAL DERRICKMILES CourMed STARLINGR’KES Reveles
REVELES
Once a drug is ready to be tested on humans, clinical trials must occur to ensure the medicine is safe and effective. Trials can be costly, inconvenient for po tential subjects, and time-consuming for all parties involved. Often, a clinical trial is the last ray of hope for a patient su ffering from a debilitating or fatal ill ness, so providing greater access to these medicines is even more essential.
STAGE 2:
R’Kes Starling’s company, Reveles, looks to change all of that by allowing patients to undergo a clini cal trial in their own homes. Using telehealth, elec tronic consent, in-home nursing support, and home health, Reveles manages trials so that patients can go through the entire process without worrying about transportation and other barriers that keep patients from participating. Reveles is ahead of the curve; EY predicts that by 2024, 50 percent of all clinical trials will be hybrid or remote.
CourMed launched before the pandemic as a health care delivery service, crowd-sourcing drivers to offer next-day delivery of pharmaceutical and healthcare products. Partnering with pharmacies to cover the cost of delivery, the business quickly grew, as consum ers prioritized convenience and the gig economy grew.
During the pandemic, CourMed shifted into the vac cine distribution market. The company organized health care providers and helped connect them to patients need ing a Covid-19 vaccine, and CourMed connected patients with a pharmacy that may have gained a new customer. Partnerships with McKesson, Microsoft, and Goo gle helped CourMed grow quickly, and the business ha s continued to evolve. Today, it focuses on deliv ering healthcare services to patients in their homes rather than products. The company helps source everything from optometrists to dentists willing to make house calls.
Location isn’t the only advantage Reveles provides to patients and trial sponsors. Having trial partici pants interact with a nurse in their home rather than a clinical investigator has proved helpful. “Patients will be more open to the provider as opposed to the in vestigator; it’s a common phenomenon,” Starling says. “Our role is to capture all that information and get it back to the principal investigator and the sponsor.”
Founder Derrick Miles has even been a beneficiary of the services. After working out one day, he found that his ear was clogged, and there was nothing he could do about it. He avoided a hectic trip to the emergency room when a provider came to the house to unclog his ear. Not only was it more convenient, but it was also cheaper than a visit to the ER, he says.
STAGE 3: DELIVERY & SERVICES
At its heart, McKinney’s CourMed is a technology platform built to connect customers with services. Miles has expanded the business to connect concierge physicians to patients, leveraging the CourMed cus tomer base to raise the concierge physician’s practice.
In addition, the Covid-19 pandemic has put a damper on clinical trial participation, and local re searchers are reporting difficulties in recruiting pa tients for research and trial purposes. Finally, clinical tr ials have not reflected the diversity of the popula tion that will eventually benefit from them. A U.S. Food and Drug Administration report on drug trials between 2015 and 2019 showed that trial partici pants were 7 percent Black and 13 percent Hispanic. According to the census, the U.S. is 13 percent Black and 18 percent Hispanic. That lack of representation could have medical impacts, as a diverse population may react differently to the medicine being tested.
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SEPTEMBER 2022 101 Hospital system leaders grapple with an industry that’s in flux while preparing for the future. THEWEATHERINGSTORM story by WILL MADDOX DANYLCHENKOYAROSLAV 2022 HEALTHCARE ROUNDTABLE
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on survival—on equipment, PPE, and keeping our people safe—that we got away from some of our core tenets of culture. That’s something we’ve been reinvesting in with programs that focus on making sure everyone remembers why they work in the facilities they do, why they love to serve the community, and why their roles are so important. When we started to look at why people were leaving the workforce entirely or leaving us, wages were a part of it. But there was more to it. Often, it was due to their direct supervisors. All the turnover that had happened in our workforce meant that people were now supervisors who had never been trained to be leaders. Our culture program started at the bottom, but we’ve now expanded all the way up to the level of the chief nursing officer to ask ‘What do you know about being
“We’ve gotten smart about how we invest in accountable care through data and analytics.” “We’ve been able to weather that storm because we’re in affiltion with 50 different colleges and universities, so we have talent coming into the pipeline through internships, externships, clinical rotations, and the like. We also got in front of the storm cloud by implementing raise programs to retain people, particularly in the clinical space. For example, in our most portable workforce—the ladies and gentlemen who work in housekeeping, food services, or plant throughChildren’s,100nursingourtheythesethatallowmechanicsprogramimplementedoperations—wealivingwagesixyearsago.Thewereinplacetoustoimmediatelyscaleupsothatwecanretainvaluableindividuals,asareanimportantpartofpatientcareteam.Ontheside,wehavenursesindifferentdepatmentsatand60ofthemwentretrainingandoffered
WHAT ARE THE CURRENT ECONOMICS OF THE LABOR MARKET IN YOUR HEALTH SYSTEM, AND HOW ARE YOU ATTRACTING AND RETAINING TALENT? CHRIS DUROVICH:
DR. SANJAY SHETTY, Steward Healthcare System
was the number of available medical professionals to train and treat patients. We were at the point with Omicron where we began to see lines forming outside the emergency department. At some point, you can’t treat people because you do not have the capacity to treat them. We have 50,000 employees statewide in our DR. SANJAY SHETTY: “All of us saw through the pandemic that the rising contract labor prices changed the dynamic of the entire workforce. Suddenly, the stickiness to an institution changes when nurses can travel across the country and make enough to pay off a motgage in six months. During the pandemic, we were so focused a leader? What do you know about employee engagement and retention? How can we make you better at that part of your job?’ It is paying dividends with respect to retention. From a recruitment standpoint, we’ve expanded our international recruiting, and we’re thinking about new pipelines we can open. We’re opening two
more than 1,500 shifts. That’s a lot of person power to put back into the system with a very incremental expense.”
IN THE PAST COUPLE OF YEARS, North Texas healthcare executives have faced multiple generational challenges, dealing with everything from COVID-19 to physician and nurse shortages that have led to a fierce war for talent D CEO’s healthcare news site recently brought together three of the region's most influential leaders to disuss the changing nature of healthcare and how it impacts hospital systems. Participating were Chris Durovich, president and CEO of Children’s Health; Peter McCanna, CEO of Baylor Scott & White Health; and Dr. Sanjay Shetty, president of Steward Health Care System. The conversation touched on the future of the pandemic, how providers can embrace value-based care, and what a hospital system may look like in the future. Here’s a recap of the discussion.
PETER MCCANNA: “Labor is a very serious public health problem. A lot of industries are facing workforce shortages. But during the surges of the pandemic, particularly the last Omicron surge, it wasn’t the number of physical beds that was restricting assets; it system. We have more than 12,000 nurses, and this workforce shortage affets all allied health professionals. So, it’s a severe problem. It’s acute, and we believe it’s a long-term problem. We are addressing it in a disciplined fashion. Our program is the four Rs: recruit, retrain, retain, and reduce agency (using staffing encies to fill positions). Bfore the pandemic, we had essentially zero contract agency nurses. At the peak of the January Omicron surge, we had 1,500, at rates of $150 to $200 an hour. These are massive investments. It is the most significant near-term and long term problem facing hospital systems, but it’s something that we can fix. e need to attract young people to the profession because it’s a profession of purpose, it’s going through a lot of change, and it is an exciting place to work.”
RANKED IN 10 CHILDREN’HOSPITSPECIALTIESALSS BEST 2022- 23 CARE.PEDIATRICTHELEADINGWAYIN At Children’s Health,SM we specialize in caring for families across North Texas and beyond. Our leaders are committed to driving innovative medical research and advanced treatment options to make life better for children. childrens.com
MCCANNA: “Healthcare healthcare–you can’t access us. If you were in retail, that would be a cardinal sin. So, we want to be accessible through multiple channels and give you care when, where, and how you want it. And it will be personalized to you. We can take information about you, maybe we even have your DNA profile, and we will hit that up against 300 million records and find a cohot that looks a lot like you and use pattern recognition to give you a diagnosis and to issue a treatment plan that we believe will work. Physicians will still have a big role, but it will be augmented by AI. It’s a very exciting future because the tools are uniquely different than thy were just five or 10 years ao to achieve this.”
PETER MCCANNA, Baylor Scott & White Health
The country is a very diverse place, and what works in Massachusetts and Florida is probably several years ahead of where we are right now in Texas, which is a market that is much more fee-for-service based. We expect to see that continue to evolve as we engage with payers.” how to do, which is going to be prevalent in the use of the genome. That, in turn, engenders a whole lot of machine learning and a whole bunch of artificial intellience. Notwithstanding examples in the past five years of Ebola, COVID, and monkeypox, I also think we’re going to see a resurgence of infectious disease, and that’s going to force us to rethink the lines between healthcare and public health. Each of us in our respective organizations is living with this every day. Finally, I think we’re going to see the home continue to play a more important part in care, and this is also going to impact our staffing.oday, we think about clinical care teams of nurses and respiratory therapists and patient care techs and the like. I envision a time in the future when those job descriptions will change.”
TAKE A TRIP 10 OR 15 YEARS INTO THE FUTURE. HOW WILL HEALTHCARE SYSTEMS BE DIFFERENT FROM WHAT WE EXPERIENCE TODAY?
MCCANNA: “The pandemic forced us into a different managerial operating style. We moved from mission control to what we call mission command, meaning we are clear about what the goal is but allow the commanders in the field to innoate and achieve those goals. There are fabulous things that are going to pay dividends down the road as we go through the modernization of healthcare. We have learned how rapidly we’re able to apply virtual care in our environment. We’ve just scratched the surface of virtualization in healthcare. We’re in the firt inning but have an optimistic future where everything that is done short of a procedure will be done through a virtual channel and, on top of that, a home channel.”
SHETTY: “We started in 2010 from a set of six community hospitals, then owned by the Boston Archdiocese, so we embraced accountable care because it was a survival mechanism. We’ve taken on value-based contracts in the commercial space, and we’ve aligned ourselves with a large network of physicians who
DUROVICH: “We now have mapped the human genome, which is only going to accelerate what we understand, what we know causes what, and ultimately, how we work through how best to diagnose and treat within that dimension of using the genome. We’re going to continue to have the conversation about what we know how to do, but also the ethics of what we know accounts for $1 for every $5 spent in our economy. I think we’re going to see an evolution in healthcare that will look and feel a lot like what you expect from service providers in the other areas of your life—an ecosystem that gives you an array of choices, ease of navigation, and is accessible. What service business issues 50 percent back orders on any given day? That’s what we do in to experiment with before. Telehealth is a great example of that. We went from 2 percent usage to as high as 70 percent. It’s back down now, but not to where it was. People are more used to doing things virtually, and hospitals are going to provide a smaller and smaller sliver of care. In thinking about our hospitals in the future, they are going to have more and more ICUs, with more care
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“Physicians will still have a big role, but it will be augmented by AI.”
WHAT CAN YOU SHARE ABOUT WHAT YOUR SYSTEM HAS LEARNED IN THE PAST TWO YEARS?
WHY HAS THEENCOUNTEREDCHALLENGESBASEDEMBRACEDSTEWARDVALUE-CARE,ANDWHATHASITALONGWAY?
SHETTY: “One positive of the pandemic is that it forced agility, innovation, and a willingness to experiment with things that no one was willing nursing schools—one in Florida and one in Arizona.’”
believe in the model and are also incentivized to believe in the model. We’ve gotten smart about how we invest in accountable care through data and analytics, making sure that every dollar we’re putting toward the program is going to reduce total medical expense and yield a better quality score.
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SHETTY: “We’ve been on this growth journey for a number of years, and going forward, it will probably look similar to what we’ve done in the past, which is looking for communities that have a set of hospitals with a paired set of physicians and an affilte network that matches our model. We also divested a portion of our Medicare ACO business. It was described as a divestiture, but it’s probably closer to a partnership with CareMax. We could do this ourselves, but we could partner with someone who’s already good at it and has that access to capital to accelerate our journey. What we’re going to the future is going, and we want to accelerate our journey to pathways where we’re being incentivized to deliver highquality, lower-cost care.”
106 SEPTEMBER 2022 DCEOMAGAZINE. COM moving out of the clinic and into the home. As mentioned, it’s already starting. For those embracing accountable care models, they are thinking about a more efficient y to do this. For things that we would never have thought could be possible, the pandemic has forced us to say, ‘Wait, maybe we should give it a try.’ If you aren’t going to let me do inpatient surgery, can we try it as an outpatient? That is going to be huge. So what do we do with these big assets of hospitals? We’ve got to think about how we redesign and deploy them for other purposes and serve a narrow niche. I think the future also involves more directly engaging with the consumer. We have engagement with employers, with school districts, and with municipalities because they’re recognizing the value of having a local partner. We need to recognize the power of serving their needs in a much more direct and meaningful way.” HOW HAS THE PANDEMIC IMPACTED VACCINATIONS?PEDIATRIC
CHRIS DUROVICH, Children’s Health
MCCANNA: “We believe in building out the ecosystem both up and downstream from the hospital to give you what you need. We can’t do that all by ourselves. We’ve got to develop partnerships. We have a long history with United Surgical Partners International and its ambulatory surgery centers, so we’re used to doing this as a health system. We’ve also announced a hospital-at-home partnership with Contessa Health, which is considered by generation, have much less loyalty than you might think. We believe if we are providing them with what they want, where they want it, when they want it, we can increase loyalty. And when we increase loyalty, revenue will grow.”
CAN YOU GIVE US A LOOK INTO WHAT THE GROWTH STRATEGY LOOKS LIKE FOR YOUR SYSTEMS?
2022 HEALTHCARE ROUNDTABLE
DUROVICH: “Rough estimates say that there will be 150,000 more children in North Texas five years from now than there are today. What we have endeavored to do is to provide multiple points of interaction. We have our flagship, we have our hospital in Plano, we are part of the Redbird mall development, and we are in the process of opening another facility in Prosper. Through partnerships with two providers, Haven Healthcare and Perimeter Healthcare, we’ve gone from 12 psychiatric beds to 55 beds available. We’ve also moved into the technology space as an independent provider. We have a tele-school relationship with 250 school nurses and tele-mental health
DUROVICH: “There are roughly 20 million kids in the United States under the age of 5. Getting them vaccinated is the most fail-safe way we can continue to protect people. The Kaiser Family Foundation found that fewer than 20 percent of parents of children younger than 5 are indicating they will get their children vaccinated. That’s not a good statistic. Other vaccination rates are down more than 3 percent, so we have an infectious disease issue that may creep back into our lives. If you combine that with increases in measles, chickenpox, and hepatitis, it underscores the importance of timely vaccinations.”
“Rough estimates say that there will be 150,000 more children in North Texas five years from now.”
the national leader in hospitalat-home, to provide that option to patients who need it. We’d like to think no one ever requests medical records for our patients because they stay in our system, but when I looked at a competitor’s system, it was about 50/50. Patients in healthcare today, particularly if you break it down see is some hospital growth but especially continued growth on the accountable care side. The Medicare model of a sole focus on seniors is something that’s going to be replicated with Medicaid and eventually the commercial and employer space, where each of those populations can have specific needs. We believe that’s where relationship with almost 300 school nurses. We’ve been able to train our team to deliver care virtually, and we have used apps to continue to engage on a extraordinarilytheirchildrenusebasis.business-to-consumerOuropportunityistoallofthoseoutletstoreachand,moreimportant,parents.Thefutureisexciting.”