Healthy Rounds With Dr. Anthony Alessi

Dr. Alessi revisits his American Heart Month conversation with UConn Health cardiologist Dr. Peter Schulman, drilling down on advances in prevention, treatment, and management of heart disease, heart attack, and heart failure, how they've changed over the years, and further changes potentially on the horizon.
The Healthy Rounds Podcast at UConn Health:https://www.uconnhealth.org/healthyrounds
Submit questions for Healthy Rounds:HealthyRounds@uchc.edu
Dr. Peter Schulman:https://www.uconnhealth.org/providers/profiles/schulman-peter
Pat and Jim Calhoun Cardiology Center at UConn Health:https://health.uconn.edu/cardiology/
UConn Health:https://www.uconnhealth.org
Support from UConn Health Orthopedics and Sports Medicine:https://www.uconnhealth.org/orthopedics-sports-medicine
Grant support from Coverys:www.coverys.com
Transcript
Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. It is not designed to direct your personal health care, which should only be done by your personal physician.
I’m your host, Dr. Anthony Alessi, and it’s great to be with you on what has become known as our deep dive. And this particular episode of our deep dive is dedicated to a show we did with Dr. Peter Schulman last week. As you’ll recall, Dr. Schulman is a cardiologist and professor of medicine here at the University of Connecticut, where he has practiced for 44 years, and he has been a cardiologist for longer than that.
But before we get to Dr. Schulman, I want to go back to something that was discussed in a previous episode with Dr. Juthani, and that was the use of messenger RNA. We’re hearing a lot about that this week, because the Food and Drug Administration refused to review a flu vaccine that is based on messenger RNA, that’s put out by the Moderna company. And they really haven’t given good reason for why they have refused to review this.
Now, let’s take a step back, because we know that the current administration has stopped research to the degree of $500 million cut, just on the topic of messenger RNA. And that’s because there is misinformation out there -- I almost think it’s disinformation, but it’s misinformation -- that messenger RNA, somehow changes a cell structure, and that’s not the case at all. Dr. Juthani used a good example of it, but I’m going to go a step further.
Messenger RNA is just that. It’s a messenger. It brings a message to a cell. Think about it this way: If you were to order food from Uber Eats or DoorDash, right, that food is brought to your door by a messenger, he leaves the food and then leaves your premises.
Think of messenger RNA as just being that messenger. He doesn’t come in your house and start telling you how to rearrange your furniture. He just brings the message about what it is your body needs to be fighting, in this case, the flu.
Now, one of our problems is that we keep coming up a little bit off target when it comes to influenza, and Dr. Juthani explained that it’s because we have to decide in February. So right now in February, we’re deciding what flu we’re going to be fighting in the fall. We base that on information that we get from the southern hemisphere with the flu. That is the flu strain that is most prominent there. It takes a long time because you grow it in eggs and that’s how you produce the vaccine messenger RNA.
And thanks to Operation Warp Speed, we are now able to come up with a vaccine in a much shorter period of time. So let’s think about it. If we could do it in a shorter period of time, we will have a better idea of what our target is. For influenza that year. So now we’re talking about instead of February, possibly doing it in May or June when we have a better idea of the target and a better chance of hitting it. So again, I want to emphasize the fact that messenger RNA is purely a messenger and it’s not changing your cell structure in any way.
But let’s get to our discussion with Dr. Schulman, which we put out on the airwaves on February 9, and that is, we wanted to get him on because this is American Heart Month. That’s something that was started in 1964 by Lyndon Johnson, and they did it to coincide with Valentine’s Day and the heart. And I guess, many of you listeners are probably my age or thereabouts. And remember, the one thing about the heart I remember is, Dr. Christian Barnard, right? Dr. Barnard, on December 3, 1967, he performed the first human heart transplant into a fellow by the name of Louis Washkansky in South Africa. Now it only lasted 18 days and, and that was ostensibly because we didn’t really have immune-suppressant drugs that would avoid this rejection of the heart. But it suddenly really brought to light that great things were possible.
And indeed, great things have developed since 1964. In a recent study -- and this is because I like to know, are we getting our money’s worth out of something, right? So we’ve made changes in our lives, changes in our lifestyle that Dr. Schulman talks about, right? A better diet, stop smoking, exercise regularly, and, and taking newer medications, but has it made a difference? And it’s interesting because a recent study published looked at heart disease mortality, so everybody who died of any heart disease from 1970 to 2022, and those deaths are down by 66%, the biggest drop being in ischemic heart disease, the typical heart attack from a clogged artery. That dropped from 91% of the overall deaths to only 53%. But what we have also seen is an increase in heart failure, where the heart, as Dr. Schulman again explained very clearly, the pump of the heart begins to fail. And a lot of that is because we’re getting older. So there are newer medications to really work on that because heart failure was up 146% since 1970. So again, we really want to emphasize that we’re making great strides, but now we are redirecting our efforts to a large extent.
The other things we talked about that were really most striking, we had a question from Bob about taking aspirin -- and again, if you have questions for me or things you want to address on the show, you can go to healthyrounds@uchc.edu -- and this was a question about aspirin. At first everybody thought everybody should be taking a baby aspirin as you got older. But again, it’s something you need to discuss with your physician because there are certain risks to doing that.
But the other thing we talked about was cardiac arrest. We’ve gone through great efforts to have programs to teach people CPR and how to use these automatic external defibrillators, the AEDs, and these are very important devices if we’re going to save lives. But once again, I asked him, has it been worthwhile?
And what was interesting to me, that 90% of deaths from heart attack occur before getting to the hospital. But when we looked at CPR and AEDs, we looked at the survival being about 25 to 35%. So again, if you have. A cardiac arrest where your heart stops outside the hospital, you still only have a 30% chance of survival. But again, we do know that the quicker you have CPR or use an A ED, your chances of survival are better.
But when you address the issue of, am I having a heart attack? Everybody has come up against this, and we hear about this all the time: I’m not sure if it’s indigestion. I’m not sure if it’s a heart attack. Dr. Schulman made it very clear that cardiologists don’t mind a false alarm here because 90% of the deaths from heart attack -- so everybody who dies from a heart attack, 90% of those -- occur before getting to the hospital. So it’s important, I think if there’s one message to take away from this podcast, it’s that if you believe you are having symptoms of a heart attack, the typical ones crushing chest pain, pain radiating from your chest to your jaw, to your left arm, or both arms. Any of those signs, especially the crushing chest pain, shortness of breath, get to an emergency room, it will certainly in many cases, be lifesaving.
One of the best parts of all our shows I enjoy is when we ask our guests. What will we imagine in the future, 40 years from now? What is the treatment of heart disease going to look like? And it was so interesting hearing from Dr. Schulman, because he talked about rebuilding the heart. Because we talked about that heart failure number having gone up. How do we rebuild the heart? And that’s where he thinks the greatest strides are going to be made, either by using stem cells that can be used for growing new heart muscle, or devices that can be placed in the heart, even just through the groin, that would again help the heart to pump more efficiently.
Well, anyhow, I think that’s about it from my end here. I really enjoyed Dr. Schulman and all the information he was happy to share with us, and I hope you’re enjoying this deep dive as we do them, and the guests as we come up with them.
Next week, I’m excited because we taped an interview with my guest, who will be Commissioner Andrea Barton Reeves. She is the commissioner for the Connecticut Department of Social Services, and we had a lively discussion about Medicaid, the people who are on Medicaid, and a lot of, again, misinformation that’s out there about the Medicaid program and SNAP programs here in the state of Connecticut.
If you have any questions or ideas for future programs, as I always mention, reach out to me at healthyrounds@uchc.edu. Jennifer Walker is executive producer of the Healthy Rounds podcast. Chris DeFrancesco is the studio producer for our podcast, and Tessa Rickart is in charge of social media for the Healthy Rounds podcast.
Until next time, this is Dr. Anthony Alessi. Please stay healthy.

Heart disease and heart attack are much more treatable, manageable, and preventable today than they were 40 or 50 years ago. For American Heart Month, Dr. Alessi speaks with Dr. Peter Schulman, UConn Health cardiologist, about the evolution of care for and prevention of cardiovascular disease, from medications to procedures to lifestyle changes.
Still, some things haven’t changed, including the crucial difference early intervention, defibrillation, CPR, and getting to the hospital as soon as possible can make with a suspected heart attack.
They also discussed the evolving recommendations on baby aspirin, the current and future state of statins, the difference between the sexes when it comes to heart disease, and the continued trajectory of cardiology care in the future.
Submit questions for Healthy Rounds:HealthyRounds@uchc.edu
Dr. Peter Schulman:https://www.uconnhealth.org/providers/profiles/schulman-peter
Pat and Jim Calhoun Cardiology Center at UConn Health:https://health.uconn.edu/cardiology/
UConn Health:https://www.uconnhealth.org
Support from UConn Health Orthopedics and Sports Medicine:https://www.uconnhealth.org/orthopedics-sports-medicine
Grant support from Coverys:www.coverys.com
Transcript
Dr. Alessi: Welcome to the Healthy Rounds podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery and a grant from Coverys. It is not designed to direct your personal health care, which should only be done by your physician.
I’m your host, Dr. Anthony Alessi, and it gives me great pleasure to welcome my guest today, Dr. Peter Schulman. Dr. Schulman is a professor of medicine here at the University of Connecticut, where he is also a cardiologist and has worked in the Department of Cardiology for the past 44 years. Peter, welcome to the show.
Dr. Schulman: Thank you very much. I’m happy to be here.
Dr. Alessi: So, this is American Heart Month and it’s kind of interesting ’cause it’s one of those concepts that’s developed over time where we make people a little bit more aware of heart disease. But I’d like to take a step back a little bit, since you’ve been here 44 years and you and I are relatively of the same generation.
Can you talk a little bit about kind of the evolution of cardiology and the things you’ve found over the past 44 years?
Dr. Schulman: Well, that’s a very good question. I think I would almost call it a revolution, but evolution is pretty good. So, I was just thinking back on this, when I started cardiology practice more than 45 years ago at one other institution, if you had a heart attack and you survived the heart attack, you would probably have your second heart attack within 5 or 10 years, almost for sure. Because there was such a high risk of recurrent heart attacks, we didn’t have ways to prevent the second heart attack once you had one.
Actually, we didn’t even have ways to reduce your risk of your first heart attack. Now, 45 years later, in 2026, we not only have ways to dramatically reduce your risk of your first heart attack, but should you be unfortunate enough to have one, we can substantially reduce your risk of a second heart attack.
So, people who have a heart attack, that may be the end of it. They may have no further heart problems for the rest of their lives, and that’s what we’re striving for. Now, the same thing happened in heart failure. If you had severe heart failure back 50 years ago, if your heart was weak, well, sorry about that, but you probably would not live another 5 or 10 years. Your heart function, it’s like a motor of a car, would just lose horsepower over the years and decades and you’d be possibly gasping for breath in 5 or 7 years. Heart function would decline inexorably, just keep on going down.
Nowadays, we have ways to reduce the risk of heart failure, and we have ways to actually improve heart function if you already have a weakened heart. We have whole host of medications and many are very new within the last 5 years and we have devices that can strengthen the heart. So really, it’s major advances in heart disease prevention, heart disease treatment, and patient wellbeing that I’ve seen over the past 50 years. Those are just two examples.
Dr. Alessi: You know, that’s interesting because you talked about, you know, this revolution in medication as opposed to the more sexy things, right? The angioplasties, bypass surgery, so many of them, replacing valves through a catheter. I mean, those are the things you hear about and yet, I’m impressed that we’re hearing about the medical things, in terms of treating with drugs, as opposed to those. Have those things changed things a lot? I mean, it used to be an angioplasty was a big deal. And now it’s kind of routine, isn’t it?
Dr. Schulman: That’s correct. If you have a blocked artery, let’s say from, you have a heart attack and that’s usually due to a blocked artery, you can have an angioplasty. What that does is they put a little tube in the coronary artery. That’s the artery that supplies the heart with blood and oxygen, like the fuel line to our car. If that gets clogged, you can go in there with a little tiny balloon at the end of this long tube, open up the balloon, open up the blockage, and then put a stent in there, like the spring from a ballpoint pen.
It expands, it stays open, and it keeps the vessel open sometimes permanently. That’s all you’ll need. The stents never come out, they stay in the heart, and the heart tissue grows over the stent so that it almost becomes a new artery again with no blockage whatsoever. So yes, that’s a sexier way of treating heart disease.
But if we can prevent heart disease from the beginning, that would be a better way. Now, you brought up the sort of sexy way to treat heart disease. Now we’re realizing now that you can make lifestyle changes and a lot of them are very helpful, like getting more exercise, keeping an ideal weight, not smoking cigarettes, making sure your diabetes is controlled, keeping your weight controlled, diet, et cetera.
We realize now that that can be helpful. The lifestyle changes are important, but the newer medications really sort of outrun the lifestyle changes, so you should be doing both, in many cases.
Dr. Alessi: And that brings up, I had a listener question to bring in, and Bob had asked me this question, and the question was about a baby aspirin.
Now, you know, we’ve gone through these changes where, you know, when I was in training, we all knew that well, most doctors are taking a baby aspirin every day. We know it reduces heart attack and stroke. And then we start hearing that aspirin can also reduce colon cancer. And then all of a sudden more data says it’s not that useful.
Where are we on the use of a baby aspirin? ’Cause it, it seems like such a benign way of causing such a catastrophe.
Dr. Schulman: So, that’s very interesting, baby aspirin. It has gone both ways about 81 milligrams. Some countries actually use 75 milligrams, some use 100 milligrams. Well, it turns out that aspirin does reduce the risk of heart attack and stroke in just about everybody.
However, in many people, and if your risk is very low, that is taken into consideration. The other side of the coin with aspirin is that it slightly increases your risk of bleeding, so you can have a bleed into your brain. So, every recommendation is based on trying to balance the risk of taking aspirin, causing bleeding, versus the benefit of aspirin reducing the risk of a stroke or a heart attack.
So, in general, the long story short is that for people who’ve never had a heart problem and don’t have a ton of risk factors, we generally do not recommend aspirin because even though it does reduce the risk, your risk is already so low, and your risk of a bleed into the brain is not very big, but it’s a little bit higher with aspirin.
So balancing risk/benefit. Most people with no heart disease, no stroke in the past, we would not recommend aspirin.
Dr. Alessi: Okay. Alright. Thank you for that. Bob, you got your answer now. And in talking about American Heart Month, I wanted to talk a little bit about something probably less sexy than even medication, and that is, we’ve had this revolution of using CPR and defibrillators and making them more available.
How has that impacted cardiac disease and cardiac death in the field? I mean, are we wasting our time or has this been, do we have real data to support putting money behind that and training people?
Dr. Schulman: Well, we do have data to support that. It turns out that the quicker that if someone has a cardiac arrest, out of a hospital, in the hospital it’s different, but if someone has a cardiac arrest outside of the hospital, their recovery, their neurologic recovery, in other words, how well they can function, and their probability of survival depends on how quickly the CPR is given and how quickly the patient is defibrillated, if there is a portable defibrillator on site. It’s called an AED, “automatic external defibrillator”.
So, yes, there are data that shows that the quicker you get those treatments, the greater the survival. Unfortunately, the overall survival in out-of-hospital cardiac arrest is not great.
If you have a cardiac arrest, a true cardiac arrest, it’s probably in the neighborhood of 25, 30, 35%, something like that. So, there’s a pretty high chance you’re not going to make it. But, if someone, if a man has a heart attack and the wife knows CPR and can get EMS to the house, to the patient very quickly, then there’s a much greater chance of survival.
And one thing that brings up, if someone is having a heart attack, the chance of a cardiac arrest is higher. So, it’s important to realize that 90% of deaths from a heart attack occur before the patient reaches the hospital. So, the best thing to do if you’re having a heart attack or you think you even might have a heart attack, is get to the hospital very quickly.
If you end up in the emergency department, you have already jumped over 90% of the risk of dying from that heart attack. So, we cardiologists would rather see a few false alarms. You know, people have crushing chest pain and maybe it’s heartburn, but we don’t know at that time.
Better to get to the hospital, let the ED figure that out, because if you do have a heart attack, we could provide treatment immediately and it’s dramatic in improving the chance of your surviving and improving your long-term health.
Dr. Alessi: Wow, I didn’t realize it was that big a hurdle. That’s so important for us to know. What’s the most common thing you see in your practice? Over the years, has that changed? Is it mostly coronary artery disease? Is it valvular disease? What do you usually see?
Dr. Schulman: So, the most common, basically the most common disease is coronary artery disease, heart attack, and stroke to a lesser extent. But stroke is still important. So, heart attacks and coronary artery disease - that’s blocked arteries that supply the heart muscle with blood and oxygen - that’s still the most common.
But now that people are living longer and healthier, we’re seeing a lot of other conditions. We’re seeing heart failure, and that means that the heart, it’s not failing completely, but it’s failing to do its job properly. Heart failure comes in two different shades, one of which is a weak pumping heart, that’s called systolic heart failure.
And the other is a not-well-relaxing heart. It’s too stiff, and that’s diastolic heart failure. Both of those are becoming more important. And the other condition that’s very common, more in the senior population over the age of 70 and 80 is atrial fibrillation. And that’s a condition where the heart rhythm is, the upper chamber is beating very fast and irregular, and the main issue, the main risk of atrial fibrillation, is you know, is stroke.
Dr. Alessi: Yeah, it’s interesting that you say heart attack and stroke, because I guess the old saying is “if it’s happening in your heart, it’s happening in your brain at the same time” when it comes to cerebral vascular disease and cardiovascular disease.
Dr. Schulman: That’s exactly right.
And we tell patients that coronary artery disease means cholesterol buildup, atherosclerotic cholesterol buildup, sludge in the arteries. That can be arteries in any place in the body. It could be arteries in the heart that cause a heart attack, arteries in the brain cause a stroke, arteries in the leg that cause peripheral vascular disease, and many other places too.
Dr. Alessi: I’m going to shift gears a little bit since we’re moving into that topic a little bit, and something I didn’t anticipate us chatting about is the use of statins. In a neuromuscular practice I see people who try to shun the use of a statin, they’ve heard it makes you weak, things such as this.
Can you talk a little bit about the benefit of being on a statin medication?
Dr. Schulman: Yes, and we get that question every week in our clinic. Statin medication, what it does is it lowers the level of your bad cholesterol. And that is very helpful. Yes, every medicine we take can cause side effects.
Statin side effects that are significant are maybe 5%, and if you stop the statin, the side effects go away. So, it’s basically a very safe drug. Some people think there may be a teeny, very, very small incidence of diabetes that’s triggered by that, but that is infinitesimal. It’s so tiny.
But the benefit of risk reduction for heart attack is dramatic. You can reduce your chance of a heart attack by 25 or 30% or even more by taking a statin. So, patients ask me, “well, what are the side effects of statins?” So I tell ’em, “Yeah, a few percent of muscle aches, is very rare. You stop it, it goes away. What are the side effects from not taking the statin is a heart attack and a stroke. So take your pick.”
Dr. Alessi: Yeah, it’s a good way to put it. And I think about that because, I mean, when we started practice we didn’t have these drugs, really. Lipitor, Crestor, things like that, you know. It has made a big difference.
The other thing in American Heart Month, recently, we’ve emphasized heart disease in women. And is that because they’ve been kind of an ignored population? I think have they thought that in the past that women didn’t get heart attacks. What has happened there? Why the need for more awareness now?
Dr. Schulman: Yes, many of the things you mentioned are correct. So, women were felt initially to have a lower risk of heart attack. Partly in the past, because there were fewer women who were smokers. The women were less likely to have more of the risk factors, hypertension, et cetera. Now we see that men and women are more alike from a physiologic standpoint.
Women are more commonly in the workforce. The instance of smoking is closer to the same, the instance of diabetes. So, all the risk factors for developing heart disease are the same. And then on top of, so women for initially underrepresented or non-represented in major clinical trials. For example, the first major trial of heart disease was the Framingham study that was started in the late 1940s.
And there were no women included. There were about 4, 5,000 men from Framingham, Massachusetts who were studied to see who would develop heart disease and what risk factors they had. So now we recognize that more frequently women are getting heart disease. But, the other side of the coin is their symptoms can be atypical.
So, women in heart disease, it’s in part an effort to assure that physicians and cardiologists and primary care providers are recognizing that A) women can have heart disease just like men, and B) the way that their symptoms could be somewhat atypical. So instead of, for example, a heart attack, instead of chest pain, like an elephant on the chest or a squeezing in the chest, women may have just shortness of breath, or weakness, or fatigue.
So, we have to remember that those could be symptoms of heart problems, and we need to take those seriously.
Dr. Alessi: If we were to have this conversation, I don’t know, 40 years from now, what do you think is developing in the field? What’s the future in terms of heart disease and treating heart disease?
Is it in mechanics? Is it in medication? Is it genetics? What do you think we’re going to be? Or are we going to be dealing with routine heart replacements? What do you think?
Dr. Schulman: That’s a difficult question. You know, I see patients coming into the office every day and I’m just trying to treat them for heart failure or atrial fibrillation.
I think, number one, we will have major strategies to prevent heart attacks. For example, right now, if you don’t get your cholesterol lower enough to prevent a heart attack with a statin, there are now injectable drugs. There are a class of drugs called long name PCSK9 inhibitors. They inject under the skin.
They substantially reduce the cholesterol levels to less than 40, let’s say.
Dr. Alessi: Really?
Dr. Schulman: And these drugs will be available in pill form in the next 2 to 5 years. So, we’ll start to get fewer heart attacks down the road. Heart failure will be treated with even more medication. Now we can, in most people, stabilize the weakened function of the heart. Few people, we can make it stronger. But, down the road we’ll have more medications that will clearly get the heart stronger.
We may be able to infuse cells, stem cells that are targeted for the heart. They implant themselves in the heart muscle and they regenerate normal heart muscle so any weakened heart will be strengthened again.
Dr. Alessi: Wow.
Dr. Schulman: We’ll have devices. There probably won’t be heart transplants, there’ll be little battery powered, AA-powered mechanical hearts that we could just slip in maybe through the leg instead of by open heart surgery. I’m just speculating, I don’t know, but I see things going in that general direction.
Dr. Alessi: Wow. Well, Peter, I want to thank you for your time today. But more importantly, I understand you’re going to be retiring this year, so I really want to thank you for everything you’ve done for our patients over the years and the care you’ve given them. So many patients speak so highly of you and the personalized care they’ve gotten from you, and I want to thank you for that publicly.
Dr. Schulman: Thank you very much.
Dr. Alessi: Many thanks to our guest today, Dr. Peter Schulman. If you have any questions or ideas for future programs, you can reach out to me at healthyrounds@uchc.edu.
Jennifer Walker is Executive Producer of the Healthy Rounds podcast.
Chris DeFrancesco is the Studio Producer for the Healthy Rounds podcast.
Until next time, this is Dr. Anthony Alessi. Please stay healthy.
 

Dr. Alessi dives further into the discussion he recently discussed with Connecticut Public Health Commissioner Manisha Juthani. Topics include how Connecticut stacks up against other states in terms of citizens' health, confusion over health recommendations and waning confidence in the federal government, the continued importance of vaccines, and potential lost ground on research as a result of a culture trending toward an attack on science.
Submit questions for Healthy Rounds:HealthyRounds@uchc.edu
DPH Commissioner Manisha Juthani:https://portal.ct.gov/DPH/About-the-Commissioner 
UConn Health:https://www.uconnhealth.org
Support from UConn Health Orthopedics and Sports Medicine:https://www.uconnhealth.org/orthopedics-sports-medicine
Grant support from Coverys:www.coverys.com
Transcript
Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. The podcast is not designed to direct your personal health care, which should only be done by your physician.
I’m your host, Dr. Anthony Alessi, and it’s great to be with you for what we’ve come to be known as “the Deep Dive” in terms of looking back at a recent podcast we did. In this case, one we did last week with Dr. Manisha Juthani. Dr. Juthani is the Commissioner of the Connecticut Department of Public Health. She’s a medical doctor and a specialist in infectious diseases, and my conversation with her was very educational and brought out so many things that I didn’t know about the Department of Public Health and the vast job that she faces.
We started off the interview by asking her how she ended up getting this job and it’s interesting because she related the situation where she was working at Yale and COVID was developing, and basically it was a situation where Governor Lamont felt that he had a confidence in her and really it was the fact that he saw something in her in terms of her ability to lead, that he brought her into his cabinet and into this executive role. And it relates back to my conversation with Dr. Agwunobi, who again talked about his father as an inspiration for him. And it brings to me in my own life that there are so many people who professionally inspired me to move ahead in the medical field. And, it’s something that I’ve always felt is as adults, we have somewhat of a responsibility to encourage young people to inspire them when they may not have that confidence in themselves to achieve great things, things that they want to do, whether it be medicine, whether it be business. If we recognize some attribute in that child or in that young person, it’s worth mentioning like, you know, “you really have a future”. And really those words from an adult can really change someone’s life, as it does for so many people. I think many professionals, many successful people, whether they be actors or sports stars again, have gone through that.
Probably the single most important question I asked Dr. Juthani was, “are we safer living here in Connecticut as opposed to other states in this country?”
And the reason I ask that is because we have seen such a dramatic change in leadership with respect to health here in the United States. People have lost confidence in the Centers for Disease Control. Just think about that. The Centers for Disease Control have been really the hallmark of research in many areas, and it’s been the hallmark for people throughout the world. And yet we here in the United States have lost confidence in them. That loss of confidence primarily comes from their positions now on childhood vaccination, and as she explained it, the difference is basically at this point surrounding three vaccinations.
Here in Connecticut, we require 14 vaccinations that are administered at different points in a child’s development. The CDC has made three of those now optional, specifically measles, meningitis, and hepatitis. So, here in Connecticut, those are still required if a child is going to attend public school and be around other children.
So, here in Connecticut, when it comes to these vaccinations, from that standpoint, we are somewhat safer because they’re still required. But the CDC has raised doubt. It’s raised doubt in parents’ minds that these vaccines may cause autism, for which there is no scientific proof, and we’ll get into some of that a little bit later.
But, the point here is that you need to really discuss this with your physician, and I think everyone believes that. It’s also a thing that she mentioned that, so childhood vaccinations are administered to prevent disease. That’s the idea. To prevent polio, to prevent smallpox, or measles, any of these contagious diseases that could lead to death in some cases, or be crippling in the case of polio.
Whereas as adults, when we get vaccines like the flu and shingles, as much as they may prevent disease, that’s not the overall objective. The objective is to prevent hospitalization. To prevent days lost from work, from enjoying your life, and put you at risk for other illnesses. So, you may still get a flu, you may still get shingles, but it would be such a mild form that you would not require a hospitalization, and that’s a very important distinction.
So, we have a situation where there’s distrust. The other problem we’re having and that she brought out is when I asked her what keeps her up at night, what worries her the most, and her answer was very interesting from the standpoint that it wasn’t so much the future, when I asked what the future may hold.
Her biggest concern is making up for lost ground. Are we going to be able to make up for the research that’s been halted and stopped because of federal funding? And specifically centering around messenger RNA. So, I thought it would be worthwhile to talk a little bit about that. It’s not just messenger RNA, but HIV research has also been set back. But, I did want to talk a little bit about messenger RNA because I think there’s so much misinformation about it. Messenger RNA is just what it says, a messenger. It is a messenger that brings information to cells that produce a protein. It’s a RNA is basically the recipe. Messenger RNA is something that’s just that, it’s a messenger.
It’s only there for hours, maybe a day, and then it’s gone. When we design vaccines, the messenger RNA is basically the chassis. It is like when you go to buy a car, you buy a General Motors car, you’ll get a chassis. That chassis may be on a Suburban, it may be on a Cadillac Escalade, it may be on a GMC. It’s the same chassis, but they changed the body.
And that’s the story, the same story we have with messenger RNA. It is the chassis for which you change the body based on what you are fighting.
The big problem is, and messenger RNA provided it saved millions of lives just based on COVID. But now we are embarking on a situation where messenger RNA can treat a variety of cancers by creating personalized vaccines against someone’s own cancer, or generalized vaccines to target the cancer proteins and alter them, these destructive proteins.
A recent study looked at people with lung cancer. And they looked at people with lung cancer who got the COVID vaccine, and those who did not get the COVID vaccine using messenger RNA. And what they found was that those who got the COVID vaccine with messenger RNA lived longer, across the board, lived longer than the people who did not.
So again, we believed that the messenger RNA serves to prime our immune system, our own natural cells to fight this cancer. And it’s amazing that we are on the cusp of this, and yet all research has stopped pertaining to messenger RNA, based on the edict from the federal government. And as I mentioned, they stopped HIV.
Another one, I mean, let’s talk about it. Acetaminophen, right? We are hearing about acetaminophen and the fact that acetaminophen can cause autism. That’s the latest thing we’ve been trying, that has been told to us, and that we have been fed, directly from the mouth of the president of the United States.
But, again, a scientific study looking at 43 studies on acetaminophen during pregnancy concluded that there is no evidence that this painkiller increased the risk of autism or other neurodevelopmental disorders. And this was just published in The Lancet. But the point here was also that this looked at sibling studies.
So, where twins both got acetaminophen, mom got acetaminophen during pregnancy, twins were born, one became autistic, the other did not. Had nothing to do with acetaminophen. That’s just common sense. But again, we’re being fed information that is false, and it’s part of the attack on science that we’re living with, and she made that very clear.
But most importantly, I think again, it’s important to discuss these things with your physician. What that’s led to now are physicians being inundated with questions, and there are so few physicians. It was another part of our conversation was how do we encourage more people to go into primary care?
Because it’s the primary care physician who you’re going to approach with these questions, and it takes time to answer them. So again, it puts our health care system kind of in a hole and somewhat behind.
I came away from the interview with Dr. Juthani hopeful. Hopeful in the sense that we know that there are people in charge in our state who understand science and who understand how to keep us safe. But by the same token, it increased my frustration over the fact that we have ignored science, and we are moving in the wrong direction right now.
With that, I thank you for your time today and really I urge you to listen to Dr. Juthani’s interview, as well as this Deep Dive, and reach out to me. If you have questions, if you have ideas for future programs, or questions I can go back to Dr. Juthani with, just reach out to me at healthyrounds@uchc.edu.
As always, Jennifer Walker is the Executive Producer for the Healthy Rounds podcast. Chris DeFrancesco is our Studio Producer who’s taken time to put this all together as a Deep Dive. Be sure to listen next week as we kick off American Heart Healthy Month, and we talk about the importance of screening for heart disease and treating heart disease.
My guest is going to be Dr. Peter Schulman, who’s a Professor of Medicine and a cardiologist here at UConn Health. Thanks again for listening, and until next time, this is Dr. Anthony Alessi. Please stay healthy.

Despite what’s coming out of Washington, Connecticut’s public health commissioner says the state has not changed its recommended vaccine schedule. Dr. Manisha Juthani joins Dr. Alessi to discuss the state of public health, beyond the confusion over current government recommendations. Topics include Connecticut’s standing among the most vaccinated states, the challenges of public health policy, access to health care, how the flu shot formula is determined, some of the Department of Public Health’s lesser-known functions, and how she came to be DPH commissioner.
Submit questions for Healthy Rounds:HealthyRounds@uchc.edu
DPH Commissioner Manisha Juthani:https://portal.ct.gov/DPH/About-the-Commissioner 
UConn Health:https://www.uconnhealth.org
Support from UConn Health Orthopedics and Sports Medicine:https://www.uconnhealth.org/orthopedics-sports-medicine
Grant support from Coverys:www.coverys.com
Watch a video of this interview:https://youtu.be/BA1Tg6CXA9A
Transcript
Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we bring you up to date and timely medical information provided by national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery, in addition to a grant from Coveris.
This podcast is not designed to modify or in any way influence your medical care. That should only be done with the cooperation of your physician. I’m your host, Dr. Anthony Alessi, and it’s great to have with me today my guest, Dr. Manisha Juthani. Dr. Juthani is a medical doctor and she also serves as the Commissioner of the Connecticut Department of Public Health.
Dr. Juthani: Thank you so much for having me.
Dr. Alessi: Manisha, let’s start with a little bit about your background. How’d you end up with this job?
Dr. Juthani: It’s a really interesting story, actually. I was an Infectious Disease Physician in practice at Yale School of Medicine, was there for about 20 years, ran the fellowship program, saw patients, did research, and then the COVID-19 pandemic hit, and we as a hospital had to figure out a way to care for a hospital full of COVID-19 patients, had to expand our fellowship services from 3 services to 10 over three different hospitals. And as the pandemic wore on, the first wave was our biggest hit. And in the second wave, if you think back, it was December of 2020, and indoor dining had reopened in the state of Connecticut. And, we were seeing patients coming in who never left their home, but whose son went to a restaurant or a bar and came home and infected their immunocompromised mother. Or somebody who had just had a transplant who, again, never left their home, but whose relative went to a restaurant and brought the virus back home. Again, remember back to December, 2020, this was pre vaccines.
Dr. Alessi: Sure.
Dr. Juthani: And at that time, a friend of mine said, let’s write a letter to the governor complaining, and would you sign on asking him to shut down indoor dining again? And I said, yeah, I can sign on to that.
And I’m seeing these patients myself. So I signed on. And the governor, to his credit, said, there are a bunch of these physicians complaining, and I think we should meet with them. So, he met with us and I told him the stories of the patients that I was seeing, and he said, you know, “Manisha, I think the people of Connecticut need to hear what you have to say, will you come onto one of my press conferences?”
So I said, sure. And the next week I was on one of his press conferences. And even though I had a feeling the policy of the administration was not gonna change because I know the governor really felt like businesses had struggled, and if people were gonna gather, they were either gonna gather at home or gather in restaurants, so might as well let the restaurants stay open.
And I thought that may be the case, but I still advised people what he asked me to do, and that really built a connection for us and a foundation for public health principles, maybe you could say. And six months later they asked me to take this job, which was a complete diversion from what I had done for 20 years of my life.
And here we are, four years in running that I have stuck with it.
Dr. Alessi: Do you like it?
Dr. Juthani: I do really like it. And maybe part of that is in infectious diseases you are tasked with dealing with emergent problems and challenges, and I was brought into one, which was the COVID pandemic and public health, as you already mentioned, is the backbone of so much in our society.
And so, I really started to enjoy more than just addressing the pandemic in the job. And now we’re in a phase where we are losing guidance from the federal government on certain things, and so now I feel a responsibility to the state to try to lead us during a time when we do not have the same guidance that we’ve been used to at a federal level.
Dr. Alessi: I’m glad you brought that up because it’s something I planned on discussing with you. So, I mean, we’re at a stage now where people don’t trust the CDC. They have opted for ideology over science. In fact, Peter Hotez just wrote a book, right, Science Under Siege.
So, we sit here in Connecticut and we hear about South Carolina, New Mexico, all these measles outbreaks. We hear about this rising flu. Are we safer here in Connecticut?
Dr. Juthani: I do believe we are safer for several reasons. First of all, although we have vaccine hesitancy, at the moment, we are the most vaccinated state as it relates to measles in the country when you look at kindergarten vaccination rates at 98.7%. So, we lasted two years without a case of measles.
I thought for the last two years we would have one. We had our first in December of 2025. But that one case did not lead to any other cases so far. We’ve made it through one incubation period. We’re waiting for a second, so there is still a small chance, but that says a lot about the herd immunity we have in the state.
So, I think that reflects on our population at large. I would also say as it relates to the flu, we have vaccination rates this year that are finally higher than they were at this same time last year. That means that people know we’re in the middle of a flu surge and they’re getting vaccinated. Now, do we have more people that we could vaccinate? For sure.
And that’s why we continually try to message that it’s still not too late to get a flu vaccine. But I do think that we are safer. We do have a very highly immunized population. We do have lots of people that have questions, and it’s our job in medicine to answer those questions. But in many ways, as it relates to vaccine preventable diseases, I do think we are safer.
Dr. Alessi: You brought up the flu, right? And a lot of people we now know we’re dealing with an H3N2 or the Clade K, or whatever nomenclature it has, but it’s not something we were ready for, in terms of the guesswork. Can you talk a little bit about the guesswork that’s involved? Because I think a lot of people don’t understand that it takes so much guesswork to figure out which strain is gonna affect everyone.
And can you also mention the importance of still getting the vaccine, even if it’s not a bullseye?
Dr. Juthani: Every year the flu goes with the weather. So, seasonally, what we look for and plan around is what were the strains circulating in the Southern Hemisphere during their winter that then usually predicts what strains are going to impact the Northern Hemisphere in our winter, and the cycle goes on and on, year over year.
So, for this year’s flu vaccine, we looked at what the Southern Hemisphere had, the vaccine components were put forward, and you’re right, it’s not a hundred percent match, however, it is still doing pretty well.
And we have data from Europe and we’re looking at data from here in the United States. Different estimates based on children or older adults, anywhere from 30 to 60% protection from hospitalization and death. And that’s still pretty good as it relates to a flu vaccine. So, the key difference that I think people need to understand is that the childhood vaccine schedule that we talk about is really meant to prevent disease.
When we talk about measles, 97% of people will not get measles, if you’ve gotten both shots. With the flu shot, it’s not necessarily preventing disease altogether, but it is preventing you from severe disease and it’s preventing you from prolonged disease, it’s preventing you from going into the hospital and it’s preventing you from dying. That is considered a success, as it relates to the flu shot. And let me tell you, when you think about days lost from work, from school, potentially being in the hospital, that is still really, really important. And we are seeing that play out even now with the current flu shot.
It’s not a total miss.
Dr. Alessi: Good. I wanna get to, you mentioned the standard vaccine schedule, and in the past week we’ve seen our illustrious CDC decide that it’s time to change that. Yet, again, not based on any science that I’m aware of, and so how do we get around that here in Connecticut?
Because it’s almost ludicrous, right? That we have to think of how to keep people safe here when our federal authorities are telling us something different. So, what’s your plan to get the word out that we still need to do that?
Dr. Juthani: The few things that we’ve been doing ever since this announcement came out are, number one, make clear that in Connecticut, the recommended vaccine schedule to prevent 17 diseases as opposed to just 11, which is what the new guidance recommends, has not changed in Connecticut. We’re still recommending the same schedule.
The second thing is that out of that schedule, there is a subset that are required for in-person school attendance. Again, that schedule is not changing.
Dr. Alessi: See, and that’s what I always thought. I always thought school attendance was where the rubber meets the road. So, now what?
Dr. Juthani: The way it works in Connecticut is the Department of Public Health establishes a standard that should be met for schools to maintain safe communal education. The point of school standards is that when you have highly communicable diseases that can be prevented and you have certain children that may not even be able to get those vaccines, we wanna try to protect the community at large. And so, that schedule was last updated in 2011.
It’s been a long time since that schedule was updated. And, it’s actually in our regulations as a state what that schedule is. As you mentioned, there’s been no new science put forward to suggest that we should not be vaccinating school aged children against meningitis, hepatitis A, hepatitis B.
These are three vaccines for which the recommendations changed by the federal government, and that are on our required list of school vaccines. So, given that, we have no new changes in recommendations. Those are standing as they have been. The other thing to make clear is that these vaccines are available even though the recommendation changed from recommend to shared clinical decision making on these vaccines. They’re still available. They’re still covered by insurance, and there’s no evidence that has changed. So, what message we’ve been trying to get out is that although you are hearing a change from the federal government, for people in Connecticut, status quo is what we are hoping for.
That’s the best way to protect our kids.
Dr. Alessi: Manisha, I’m gonna switch gears a little bit because we’ve been spending a lot of time talking about infectious disease, but as the Commissioner of Public Health, you have a lot more responsibility than just outbreaks, right? I mean, we still have food safety, water safety. How do you go about doing all of that? I mean, I don’t think people understand that. And you also oversee practitioner licensure, right? Not just physicians, but dentists and everything else. How do you get your arms around that, and what’s the biggest problem that keeps you up at night?
Dr. Juthani: So you’re absolutely right. I learn something new every day because we do do so much. We have regulatory functions, which means that we need to keep certain industries accountable to make sure that our hospitals are safe, our nursing homes are safe, our providers are doing what they’re supposed to do, and that our water is safe for people to drink. These are regulatory functions that the Department of Public Health does. We have functions as it relates to communicable diseases, as you mentioned. A whole host of infectious diseases that we try to prevent, whether they be vaccine preventable, or whether they be things that are endemic in society, things like tuberculosis, HIV. There are many things that we monitor at the level of the state: Lyme disease, obesiosis, all different types of infectious diseases. And then we have a bunch of diseases that are more chronic diseases that we also do interventions on: cancer prevention, diabetes prevention, hypertension prevention, a whole host of diseases.
And then we prepare for the scenarios what we don’t know is coming. If we get a power outage and a nursing home loses power, what are we going to do for the safety of those nursing home residents? Some of that responsibility comes back to the Department of Public Health.
So, you’re absolutely right. There’s something new I have to think about every single day. There are things that I don’t even know what to plan for sometimes and new things that come up because new diseases come up, new problems come up, new scenarios come up, and we try to plan for all of those as we go forward.
Dr. Alessi: So, what’s the biggest problem? What’s the biggest thing that’s always on your mind?
Dr. Juthani: Right now the thing that’s really on my mind is the fact that people don’t know where to turn and there is an inherent lack of trust that developed during the COVID-19 pandemic, which has been morphed into a different type of distrust now. And the messaging that we are hearing from the federal government only creates more confusion.
So, what gives me most concern is that people don’t know where to turn, don’t know who to trust, and we can tell people to talk to their doctor, to talk to their provider, to listen to that person. But you know, the reality is that when providers have 15 minute slots to go over highly complex issues, it is very difficult for a provider to answer all the questions that somebody might be coming up with in addition to the specific health questions that that individual has.
So, I really have been spending a lot of this year, this past year, 2025, coming now into 2026, trying to figure out how to get ahead of this, and yet what I get challenged with is not knowing what new hit is going to come that’s gonna throw us off course, that’s gonna lead us down a different rabbit hole where people now have additional questions and concerns that they might not have had yesterday.
Dr. Alessi: Something you mentioned, and I think is important, and I think it’s access to health care and physicians. So, I mean, you oversee physicians and regulation. And, I mean, how do we attract more physicians to come to Connecticut? I have to tell you, Connecticut to some degree is a hostile environment from a medical-legal standpoint.
I mean, we’ve all heard this and we know that. But how do we get especially primary care physicians, ‘cause we train so many physicians here and at Yale and at Quinnipiac, and they leave. What are your thoughts on that?
Dr. Juthani: So the first thing I’d say is that we do have people who leave, but we also have a very robust training environment in Connecticut. So, we have outstanding residency programs and fellowship programs, and so by the very nature of that, there is going to be some attrition. There’s going to be people who come here, train here, and go elsewhere. Your other point though, on being able to recruit primary care into this state is a real challenge.
We know that there’s been an expansion of the primary care workforce, whether it be PAs, NPs, who are also helping to fill some of the primary care needs in the state. But part of that also is because we do have a hard time recruiting and retaining people who do wanna practice primary care. I do think that there are things that have happened in the legislative sessions in these last couple years, you know, potentially increasing rates of reimbursement for some providers.
These are small things, but you know, the reality is we have a long way to go as it relates to that, and I do think that when we train Connecticut natives, they often do wanna stay in Connecticut or come back to Connecticut. So, we’ve had a physician’s working group that the legislature has asked and tasked with trying to come up with strategies.
For the last two years, they’ve been meeting to come up with strategies to help retain physicians in the state of Connecticut. We’ve talked about loan forgiveness. That is one strategy. But you know, the reality is when we look at some of these medical schools around the country that have gone to free tuition, they are not necessarily training up more primary care physicians.
They are ending up recruiting some of the most talented physicians because they’ve now become the most competitive places to go because it’s tuition free. And many of them are going on to be very highly specialized. So, I think it’s been a very challenging nut to crack throughout this country, actually.
And I do think that we’ve tried to do certain things to help facilitate retaining primary care providers, but there’s definitely more to do.
Dr. Alessi: Are there any discussions statutorily, to protect physicians, like they do in other states against frivolous malpractice suits, and things such as that? ‘cause when you go, you know many physicians are in private practice, when you go to pay that med mal bill, it’s a big deal. Is there ever any discussion about that?
Dr. Juthani: That is a topic that comes up all the time and it is not something under the purview of the Department of Public Health, so we don’t have any controls over it, but particularly this physician working group that I mentioned that comes up every single year. And I think when we talk about tort reform and potentially having physicians be in a situation where they could be more protected from that type of situation, I know that it is something that many physicians bring up every year.
Dr. Alessi: I’m gonna shift gears on you again. Injury prevention, right? The CDC has an injury prevention center that has now closed due to funding, and when we think of injury prevention we don’t think of public health. But, certainly now we’re seeing, you know, the promotion of bicycle helmets, God forbid, a motorcycle helmet but, in addition to that, you know, seat belts and things such as that, those are public health moves. Do we have our own injury prevention commission or a center that work on these issues?
Dr. Juthani: That is another part of DPH. So, in fact, we have a large group that works on injury prevention. As you mentioned, there are things like helmets and seat belts. Seat belts are one of the most profound public health interventions that we’ve had in this country.
Dr. Alessi: It’s right there with cigarette smoking, right? The surge in generals...
 Dr. Juthani: Yeah, Absolutely. Absolutely.
And so, you know, when I tell people that, as you know, think about seat belts.
If you look at the 1960s to the number of people who died in car crashes to today, seat belts are one of the most impressive public health interventions that are out there. And most people don’t think of that as a public health intervention, but it is. And helmets are the same thing.
Suicide prevention, that is also in our injury prevention work. Gun safety, we have a lot of funding that we get from the state that we have funded 18 different groups to date to work on gun buyback initiatives, locks and safes. A whole bunch of other interventions that work with children from a young age to try to prevent them from engaging in gun violence down the road, primary prevention of gun violence in the first place.
You think about opioid overuse and unfortunately deaths that occur from that. That is a core data function that we do at the Department of Public Health. Figuring out when people die from opioid overdoses, which drugs they might be dying from. We have a lab that tests for those types of things, and we generate a report regularly where we partner with other sister agencies and towns throughout our state so they know what’s actually happening in their jurisdictions.
That’s just a smattering of the types of injury prevention work that happens at DPH.
Dr. Alessi: Any discussion about, since you brought it up, in terms of injury prevention in drug overdose, safe sites. They have them in some cities. They naturally have them in Europe. Has that ever been under discussion here in Connecticut, safe places for people to go and use narcotics?
Dr. Juthani: It’s been under vigorous debate for the last three years, I believe. And, you know, I’ve heard people from New York that have talked about it and in other places, and I know that one of the challenges in Connecticut and right now in particular is that because we know that there have been certain federal laws in place that make it challenging to open these facilities, it has posed a challenge here in Connecticut.
So, it has remained under discussion and under debate, and every single legislative session it has come up.
Dr. Alessi: In closing, I wanna ask you what’s the next innovation we’re gonna hear about in public health?
Dr. Juthani: You know, I have often thought of what new vaccine might be out there? What scientific inquiry might be out there that might help us get to the next level as it relates to public health? I hate to say that I’m in a position right now where I’m just trying to preserve the status quo. And I say that because we’re in a situation right now where mRNA vaccine research has been completely cut.
If you think about the COVID vaccines that came to market so quickly and people had a lot of concerns over, how could that happen so quickly. That’s because money was put into research and technology and innovation in a way that we were on the precipice of cancer cures from mRNA technology and all of that has been stopped in its tracks.
Dr. Alessi: And the money was put in by the same people who took it away.
Dr. Juthani: It was, that’s correct. I mean, that was an accomplishment of the first Trump administration, and so to think about what we could have been doing today, tomorrow, or the next day, what cure was just over the horizon that we now won’t have. When we think about HIV vaccine research that was just eliminated.
You know, we’ve made strides in that arena for a very long time. Having said that, look, we want to work with this administration where we can find common ground. And in government, it is our job to try to find a path forward. We recently had new dietary guidelines that came out.
Dr. Alessi: Sure.
Dr. Juthani: Now do I agree with everything that’s in there? Not everything.
You know, I would say take saturated fats in moderation, and that means butter and red meat, et cetera. But, if we can have Americans think about eating real food and actually operationalizing that, where they minimize sugar, minimize alcohol, eat real food, eat real fruits and vegetables, and there are people who aren’t doing that, who start doing that because this messaging resonates with them, that would be a win.
That is what we all should be doing. That is what the old guidelines also said, but it’s packaged in a different way. And maybe there are more people that it will reach. So, I think that I really, really worry about scientific inquiry in this country. The United States of America was the beacon of research in our academic centers, at the NIH, in private industry.
That does not mean that new things still won’t happen. In public health, the interventions are often very, very simple. And we’ve done great strides with that, right? Like, if you think about water safety, going back to the origin of water safety, they realized that, this was in London, there was an area where cholera was happening and everybody was getting cholera.
And they realized that if you just kept water different, you know, sewage separate from drinking, and you just purify the drinking water, people all of a sudden stopped getting diseases. If you think about our restaurants, you do simple food safety things, people can go to a restaurant and eat the food safely. But if you don’t, then you’re gonna get sick.
Dr. Alessi: Absolutely.
Dr. Juthani: These are the types of interventions we’ve done in public health. Seat belts, as I mentioned, helmets. These are the vast things that we’ve done. But again, in public health, our successes are when things don’t happen. So when things don’t happen, people think things don’t work right. And so right now, unfortunately, I think we’re in a phase where there’s a little bit of pullback from public health.
Fortunately in Connecticut, maybe less so, but we need to keep on reminding people when we do have the successes so that we can give the opportunity for new and other innovative public health interventions to actually come forward, which are often simple interventions, but can make a huge difference.
Dr. Alessi: Thank you. Thank you for your time today, and thank you for keeping us safe.
Dr. Juthani: Thank you for having me, and it’s been my pleasure to be here.
Dr. Alessi: Many thanks to our guest today, Dr. Manisha Juthani, who is the Commissioner for the Connecticut Department of Public Health. If you have questions or ideas for future programs, you can reach out to me at healthyrounds@uchc.edu.
Jennifer Walker is Executive Producer of the Healthy Rounds Podcast. Chris DeFrancesco is our Studio Producer here at the Healthy Rounds Podcast. Until next time, this is Dr. Anthony Alessi. Please stay healthy.

In our first “bonus episode,” Dr. Alessi further explores some of the relevant topics from his conversation with Dr. Andrew Agwunobi, UConn Health CEO and executive VP for health affairs, such as patient safety, the per-capita cost of health care in the U.S. compared to other parts of the world, how aligned incentives might address that, and electronic medical records.
Watch for periodic “deep dives” released as bonus episodes as Dr. Alessi brings in more guests throughout the year.
Submit questions for Healthy Rounds With Dr. Anthony Alessi:HealthyRounds@uchc.edu
Dr. Andrew Agwunobi:https://www.uconnhealth.org/about-us/leadership
UConn Health:https://www.uconnhealth.org
Support from UConn Health Orthopedics and Sports Medicine:https://www.uconnhealth.org/orthopedics-sports-medicine
Grant support from Coverys:www.coverys.com
Transcript
Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery and a grant from Coverys. Our podcasts here are not designed to direct your personal healthcare, which should only be done by your physician.
I’m your host, Dr. Anthony Alessi, and today we’re going to do something a little bit different. Our first episode last week was with Dr. Andrew Agwunobi, the Chief Executive Officer for UConn Health and the Executive VP for Health Affairs.
And, in our discussion with him, he brought up several topics and you know, we only have 20 minutes or so to have the conversation, but he brought up many topics and I think this is going to be happening as we do more and more of these interviews because they provide topics for us to really take what we’re going to be calling the “deep dive”.
And that being these topics that we discussed really provoke further thought and the need for further explanation. So, I thought we’d have some fun with that by looking at some of the topics he brought up and maybe looking at them a little more carefully.
Among the things he talked about were research, education, things that UConn can be doing to improve the stature of the university and you know, I guess we expect research and education to be part of it. But he also talked about patient safety, patient satisfaction, improving the patient experience. You know, when I first heard the term patient safety, I thought it was an odd term because you think right away, “well, I’m in a hospital, I should be safe.”
But years ago, and I would say about 20, 30 years ago, we started looking at the entire hospital system and how we deliver care from the standpoint of industrial engineering. For those of you familiar with industrial engineering, it’s a way of looking at a process and finding a way to make it more efficient.
So, you look for the weak points in that process and make corrections. So, in the case of healthcare, we looked at a lot of different things and I guess probably the most relevant change came in the operating room where we now have a timeout that’s mandatory. So, before surgery begins, when everyone who’s involved is in the room, they take a timeout to make sure we’ve identified the right patient by their armband, make sure we’ve identified what side or what procedure we’re going to be doing and where it’s going to be done. We also make sure we have all the proper equipment in the room.
 So basically, you have a checklist. And that brings me to a book called The Checklist Manifesto by Atul Gawande. Dr. Gawande is a surgeon and a famous author, but he looked at the use of checklists in medicine. Much like a pilot, right, before a pilot takes off, they go through a whole checklist to make sure various things are working, we know who’s available, what they should do, but they go through a checklist of all their buttons and dials before they even initiate taking off.
So, medicine took that same, those same practices and applied it to really every procedure we do. If I’m giving an injection, say a nerve block, right, part of what I have to do is make sure that I’ve identified the procedure I’m doing, what side I’m doing, how have I marked my landmarks, and what I’m using. So again, a checklist to do a procedure. And that is to really help patient safety, and that’s just one example.
We’re going to get Dr. Scott Allen on the show. Dr. Allen is an internist who is really the guru here in the state of Connecticut when it comes to patient safety and quality, and he won a great award last year from the Connecticut Hospital Association, so, I look forward to having him on as a guest as well and talk a little bit about that.
One of the other things Dr. Agwunobi brought up was the per capita cost of care in the United States versus Europe. We spend twice as much as everyone else in delivering healthcare.
The cost in the United States per capita is $14,000 per year, as opposed to Europe where that same cost is only $7,000 per year. That’s a big difference. Now, you might say, well, it’s worth paying more if you’re getting a better result. But the interesting part is when you look at us compared to Europe, they live longer. They’re living longer and getting better care.
So we talked about how the fact that the United States is second to no one in developing new technology, but it’s finding out how to deliver that technology that’s been a real obstacle. And one of the solutions we discussed was that of aligned incentives, meaning that all the constituents to the process of delivering healthcare have to have an aligned incentive, the same incentive.
In our discussion I actually brought up the example of the Veterans Administration and I thought it would be worthwhile to really talk a little bit more about The Veterans Administration and how it all started. The Veterans Administration and the Department of Veterans Affairs as we know it today actually started 150 years ago.
It was back on March 3rd in 1865, it was called the “National Asylum for Disabled Volunteer Soldiers”, and the first branch of it was established in 1866 in Augusta, Maine, and the idea was established by President Lincoln to go out and find a way to care for volunteer soldiers, union soldiers who fought in the Civil War.
In 1917, it started branching into other things like life insurance, disability compensation, and now instead of being called the “Veterans Administration”, it’s the “Department of Veterans Affairs” because it’s so all-encompassing. But our discussion was based on the fact that in a VA system of medical care, all the incentives are aligned.
And basically, the incentive is to deliver the best care. There are no financial incentives, right? A doctor isn’t getting paid more or less based on the number of procedures or the complexity of the procedures. Pharmacies are not making more money because there’s a fixed rate for medication. So, there is a formulary that is the federal formulary, the federal list of drugs that are made available for free to veterans or at nominal cost. So again, pharmacies are aligned. And the hospitals themselves, there’s no incentive for upcharging, right, to find new ways of charging money because it’s all paid by the federal government and it’s paid in the same system.
What’s also interesting about the VA system is that many of the hospitals became aligned with universities. For example, here in Connecticut, the West Haven VA is really an arm of Yale University. Where I worked in Ann Arbor, Michigan the Ann Arbor VA was part of an arm of the University of Michigan, and you’ll see that throughout the country.
But one specific example I brought up and discussed with Dr. Agwunobi was the electronic health record. So, the goal of an electronic health record was so that someone’s chart, someone’s medical information, would be easily accessible. The VA was the first to really design that and put it into practice.
Where a veteran who may have had an x-ray here in Connecticut and spends his or her winter in Florida, when they went to a VA there to get follow-up care, their x-ray, the reports, their medications were instantly available. It wasn’t a paper record that needed to be mailed down there or tracked down.
And we were able to do that because it was a national system. So, with that, part of the Affordable Care Act was to push electronic health records further, and it was a great plan. The problem was that there were so many electronic health records, they didn’t all talk to each other. Now we’re starting to get away from that and there’s a lot more communication, with Epic and Cerner and other companies, but, we had so many different companies, so many different electronic health records that didn’t speak to each other. It really was an obstacle. And the VA, some 30 or more years ago, got around that. Unfortunately, the VA really hasn’t been able to keep up with it, their own designed record, and I’m sure they’re now using a commercial system.
A couple of the other topics that we discussed with Dr. Agwunobi included primary care incentives. Really, primary care physicians are probably the least paid of physician specialists, and how to get them more, how to encourage more people to go into primary care and especially rural care. We also talked a little bit about home care and shifting the focus of care from institutions like skilled nursing facilities or hospitals to the home.
And there’s been a big push for that, and I think we all agree that we need to do that more.
 So with that, I hope you enjoyed this deep dive and have given you some food for thought. If you’d like to get back in touch with me about any of these topics or if you have ideas for future shows, reach out to me at healthyrounds@uchc.edu.
Many thanks to Jennifer Walker, who’s the Executive Producer for the Healthy Rounds Podcast, as well as Chris DeFrancesco, our Studio Producer, who is kind enough to put all this together. I hope you’re enjoying the podcast, and next week we’re going to be chatting with Dr. Manisha Juthani, who is the Commissioner for the Department of Public Health here in Connecticut, and I know you’re going to enjoy that conversation.
Until next time, this is Dr. Anthony Alessi. Please stay healthy.

In our debut podcast, Dr. Alessi starts at the top, with “Dr. Andy” — Dr. Andrew Agwunobi, UConn Health CEO and executive VP for health affairs. Dr. Andy shares his thoughts on the state of health care delivery, what he learned from his experience in the private sector, and the big things on the verge of happening with the upcoming partnership between UConn Health and Waterbury HEALTH.
Submit questions for Healthy Rounds With Dr. Anthony Alessi:HealthyRounds@uchc.edu
Dr. Andrew Agwunobi:https://www.uconnhealth.org/about-us/leadership
UConn Health:https://www.uconnhealth.org
Support from UConn Health Orthopedics and Sports Medicine:https://www.uconnhealth.org/orthopedics-sports-medicine
Grant support from Coverys:www.coverys.com
Watch this interview on YouTube:https://youtu.be/bdH6geAXAAY
Transcript
Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery and a grant from Coverys. It is not designed to direct your personal health care, and that should only be done by your physician.
I’m your host, Dr. Anthony Alessi, and it gives me great pleasure to welcome my guest today, Dr. Andy Agwunobi. Dr. Agwunobi is the CEO of UConn Health, as many of us know. He’s also the executive VP for Health Affairs here at the University of Connecticut. Andy, welcome to the show.
Dr. Andy: Thank you, Tony. Great to be here.
Dr. Alessi: Well, first of all, let me thank you for this opportunity. I mean, this opportunity would not happen without you and other people and the opportunity to produce a podcast and bring together a community of people from our community who want better health care, and we appreciate that. And especially this is our first episode
Dr. Andy: Right.
Dr. Alessi: So it’s great to have you as our first guest.
Dr. Andy: Well, it’s a pleasure.
Dr. Alessi: But let’s get started. As far as your career goes, what made you want to make kind of the switch from clinical medicine to really, to health care administration?
Dr. Andy: Well, I think the short version is it probably started with my father, who was a general surgeon, British trained, but he also was a businessman at varying levels of success.
I mean, he had at one time he had a pharmaceutical import export business, and at one time he was doing selling I think he had clothes that he was doing import, export, so a trucking business. So I grew up believing that you could do both, you could do sort of business and health care together and that was a normal thing.
But I think maybe even more important to me was I just, I just like people and I like solving problems. And I always felt like if I could bring my, sort of, my, my, my love of interacting with teams, but use that to help solve problems in health care that would be perfect for me.
Dr. Alessi: You know, several years ago you left us, and I like to think you went behind enemy lines, okay. you went and found out the secrets that they’d been hiding from us over in managed care. how had that experience helped you and what was that like?
Dr. Andy: It was great. Just, for people, that are listening, I started as the CEO in UConn Health in 2015. And in 2022 I decided to join Humana which is a national managed care organization, to run their home solutions service, which basically is everything that happens outside of hospitals, so home health care, nursing homes, et cetera.
And I did it for a couple of reasons. One is, I wanted to really understand that, that business, because I feel like a lot of care is going to go into the homes where meet people where they need the care. But I also wanted to see what it was like to run a national health care organization.
And so I learned a lot, I enjoyed it, but it did teach me that we don’t put enough resources into making sure that the services that, I’m talking about in general, hospital industry,
Dr. Alessi: Sure.
Dr. Andy: but the services that we provide to patients are paid for fairly.
Dr. Alessi: Very interesting, and, and since you bring up the national picture, I’d like to know, I mean, let’s face it, in the United States, we’re great at innovation, we’re great at research.
But we’ve kind of failed when it comes to delivery of health care, and you’re a national leader, you understand the national perspective. How do we fix this?
Dr. Andy: Well, I think you’re right. I mean, one thing I do want to underscore is how great we are in innovation. If you think about the NIH, NIH is the world’s largest funder of biomedical innovation, something like 37 billion a year. And then you think about venture capital, you think about private equity, you think about startups, entrepreneurial culture, we are sort of a center for innovation and, and entrepreneurial. And not just within our country. People come from all over, from Israel,
Dr. Alessi: Absolutely.
Dr. Andy: from everywhere to do that. So, that’s one piece of it. But the other piece of it is when that innovation comes into health care, number one, it comes typically at a very high cost or very high price. And it’s partly because of the way we’re set up and I think delivery of care, I mean I could talk about sort of tactically, we don’t have the right primary care, we don’t have full primary care coverage, we don’t have full insurance coverage, we have gaps in access.
But I think one piece I want to highlight is when those innovations come into what is a broken care delivery system, they’re not coming, they’re coming at a very expensive cost. And I’ll just give you an example, just hypothetically.
Dr. Alessi: Sure.
Dr. Andy: when startups pitch to hospitals and they pitch to clinical groups, they’re typically pitching a high price, no risk, per click, fee for service for an innovation,
Dr. Alessi: Sure.
Dr. Andy: and that can drive up the cost of health care instead of being a solution. Hopefully AI will be different.
Dr. Alessi: When we think about it, and you brought it up in terms of health care delivery, what are the biggest touch points?
Is it pharmacy benefits? Is it physician fees? Is it hospital costs? If you were to attack this, people like to just pick one target, and I understand there are a lot of targets here,
Dr. Andy: Right.
Dr. Alessi: But where do you think our biggest failing is?
Dr. Andy: So, you’re right. I mean, costs are, there’s so many pieces to our system.
So for example, hospitals are 30% of costs. Pharmaceuticals are, although they’re only sort of 10% of costs, they’re growing at a rate faster than all of the other cost categories, particularly hospitals, et cetera. And if you look at our pharmaceutical prices compared to other developed countries, we are double what their cost are, right?
Dr. Alessi: Sure. Yeah.
Dr. Andy: So we could look at all of those. And even when you look at physician prices their costs are like 20% of the total long-term care is like 25%. So there’s a, there’s a lot of categories.
One of which, by the way, is administrative burden, when you, when you take both payers and providers, and you put the administrative costs, and we’re talking about things like billing costs, revenue cycle management costs, HR, prior authorization, you take all of those, denials management.
Dr. Alessi: Sure.
Dr. Andy: You take all on both sides. You take all of that, that’s 15% of the costs, right.
Dr. Alessi: Wow.
Dr. Andy: So, and by the way, they believe it’s, it’s studies have shown that of the total, which is about 950 billion, about 260 billion of that is wasted, right. So, so there’s a lot of categories, but, but getting to your question, if I had to choose one, I would choose misaligned incentives. Because if you think about it, there’s a lot of money in health care. But the insurance companies are maximizing their margins, the hospitals are maximizing their margins in order to deliver care, doctors who are not employed by hospitals are doing the same.
And so if, if we all got together and if, if there was trust and we came together and said, okay, wait a minute. How can we best spend this money so that we’re not 17.9% of the, the economy of the United States and growing.
How can we get it down where, where we’re not wasting anything that we don’t need to waste and we’re delivering it? I think we could, we could make big headway. So I would say misaligned incentives are the biggest piece.
Dr. Alessi: I think that’s a, it’s a great point. It, what it brings to mind is the VA.
Dr. Andy: Mm-hmm.
Right. I’ve worked in a VA system for a while when I was at the University of Michigan at the
Dr. Andy: Right.
Dr. Alessi: And if we look at that as a socialized system, for example, they had really the first efficient medical records, right?
Dr. Andy: Yes. Yes.
Dr. Alessi: In the 1990s, a vet could go anywhere in the country.
Dr. Andy: With great medical record.
Dr. Alessi: And their records were there.
Dr. Andy: Yeah, perfect.
Dr. Alessi: But they couldn’t afford to keep it up.
Dr. Andy: Right, right, right.
Dr. Alessi: would that be the kind of system we should strive for? I hate to use socialized or universal, but in at the VA, right, everybody is kind of aligned, I mean, from that standpoint. Is that a kind of system we should be thinking of or?
Dr. Andy: Yeah I, I do think directionally that’s the system in the sense that studies have shown that when you have, that in countries that have universal health care, their access to care, their equity across different socioeconomic groups, their costs are less per capita than the United States, so I do believe that.
But having said that, the, the problem is our foundational system, again, going back to misaligned incentives is so, I don’t wanna be doom and gloom, but it’s so broken.
Dr. Alessi: Yeah.
Dr. Andy: That just laying on universal health care on top of that would not work.
Dr. Alessi: Sure.
Dr. Andy: So there has to be fundamental design changes. And also you want to avoid, we need to learn from others, and one thing we, one thing we can learn is to not have the wait times that they necessarily have in the UK or maybe even have in Canada for certain types of care.
Dr. Alessi: Absolutely.
Dr. Andy: By the way, I wanna say this. Even though in terms of the other countries, we have higher costs per capita costs is about 14,000 per person versus 7,000 average for those countries, we do have the clinical quality and the clinical capacity to do something really special because what we’ve seen is that the care processes we’re number two when it comes to care. So that’s like safety. Safety and like prescribing.
Dr. Alessi: Sure.
Dr. Andy: We’re number two. We’re not at the bottom like we are in
Dr. Alessi: Absolutely.
Dr. Andy: In sort of life expectancy and things like that.
Dr. Alessi: And that’s the point, right? I mean the life expectancy issue is surprising, right? That we spend so much money and we’re not living as long as people, for example, in the UK.
Dr. Andy: Right. Exactly. But, but I think ’cause there’s always this sort of a dissonance where people are like, well, but yeah, but people come to the United States for care and I think that’s because we do have quality.
Dr. Alessi: Yeah.
Dr. Andy: We just don’t have coverage for everybody. We we don’t, we have a fragmented insurance system and we don’t have the primary care that we need. We don’t have enough pri-, we don’t have enough general practitioners.
Dr. Alessi: Absolutely.
Dr. Andy: And by the way, I’ll put a plug in to say, people say, well, what’s the solution for general practitioners?
I think the solution for general practitioners is to pay them more.
Dr. Alessi: Absolutely.
Dr. Andy: Right?
Dr. Alessi: I mean, that’s what they do in Canada.
Dr. Andy: Right, if you pay them more, people will go into that profession. People don’t realize that a medical student can choose anything he or she wants to choose. And when you have such a difference between a specialist hard work
Dr. Alessi: Sure.
Dr. Andy: I mean, really hard work in primary care relatively low pay, you’re not gonna get people going into it. And loan forgiveness on its own is not going to work. So, so anyway, I, I don’t wanna go on a tangent.
Dr. Alessi: No, I think it’s a good point and, and I think one of the issues in primary care is the paperwork. My gosh. They get dumped on more than anybody with forms and things like that, that people need. But, but I wanna move on a little bit.
Dr. Andy: Right.
Dr. Alessi: UConn itself, let’s drill down on UConn. Academically, how do we get ourselves into more of a national conversation?
Dr. Andy: Mm-hmm.
Dr. Alessi: Right? I hate to use the example of US News and World Report ’cause I think that’s really a PR move than anything…
Dr. Andy: Mm-mm.
Dr. Alessi: …but how do we get to that level? Or, or are we there
Dr. Andy: Right.
Dr. Alessi: and I’m just missing it. We are there in, in, I think pockets, but
Dr. Andy: Right.
Dr. Alessi: Not as an overall institution. Is it funding? Is it the fact that we’re not a private institution like Mayo Clinic or someplace like that?
Dr. Andy: Right.
Dr. Alessi: How do we get there?
Dr. Andy: Yeah, I mean it’s a good, good question. I wish we had our, our Dean here as well,
Dr. Alessi: Sure.
He’s Bruce Liang and Dr. Lepowsky. But I do think part of it is, well, first of all, our schools, Schools of Medicine, Schools of Dental Medicine are extremely strong, right?
Dr. Alessi: Absolutely.
Dr. Andy: Which is the basis, right? I mean. They had something like 5,600 applicants for 112 slots in the, in the medical school, and 1,600 for 50 slots in the dental school. So we’re very competitive. Great academicians, great researchers and scientists. But I think maybe some of it is focus and really trying to carve our own niche for what are we best known for.
 one of the areas that myself and Bruce have been working on is translational research, particularly since our clinical enterprise is so strong right now, growing faster than any other health care system in Connecticut. Leveraging that for translational research, clinical trials.
And the other piece that I think we can really sort of supercharge a little bit is our commercialization of research. So I think we just we do a lot really, really well and we can talk about things that we are nationally known for, but I think we can, there are some areas that we can definitely strengthen and Dr. Liang is, is helping lead that.
Dr. Alessi: I’m gonna put a plug in for my department over in Orthopedics. But I mean I came here from private practice.
Dr. Andy: Right.
Dr. Alessi: And I’ve worked with a lot of institutions over the years,
Dr. Andy: Right.
Dr. Alessi: … and our sports medicine people, I mean, as evidenced by our success in sports,
Dr. Andy: Yes.
Dr. Alessi: it doesn’t just happen. And Bob Arciero,
Dr. Andy: Yes.
Dr. Alessi: And, and the whole crew over there have done such a phenomenal job, but, I, it’s an honor to work with them.
Dr. Andy: Well, I wanna thank you for your leadership and them, because there’s so many areas that we stand out in. If you think about things like Geriatrics
Dr. Alessi: Sure.
Dr. Andy: You think about Orthopedics, Sports Medicine. Think about Neurosurgery. I mean, I could go down the list.
Dr. Alessi: I know, absolutely.
Dr. Andy: but it’s, it really makes me proud. It’s one of the reasons I came back. I came back because I was sort of like, this is such an amazing academic medical center and the sky’s the limit in terms of the future.
Dr. Alessi: Well, let’s talk a little bit about the future.
You know, we’re going through this, I don’t know, purchase or alignment with other hospitals,
Dr. Andy: Right.
Dr. Alessi: Is that crucial to us moving forward?
Dr. Andy: Yeah.
Dr. Alessi: And is it because bigger is better? It gives us a better, I mean, now that you’ve been on the other side of Humana, does it give us more power? I, and I’m assuming that’s it, I don’t know?
Dr. Andy: So yes, I think that this is a key part of our strategy. Now, it doesn’t mean that it’s only expansion outside. We also are doing what people call organic, which is inside expansion of all our different departments. But the reality is that we’re small. We’re one of the smallest academic medical centers in a consolidating market.
So you have Yale New Haven Health System, you have Northwell, you have Hartford Health care, you have Trinity, all of which are huge, right? And then you have UConn Health and a few independent hospitals.
Dr. Alessi: Sure.
Dr. Andy: And so it’s important that we expand and expand why? Because of economies of scale, right? Where we can
Dr. Alessi: Absolutely.
Dr. Andy: We, we have the top line growth, we have revenue growth, we have patients.
Dr. Alessi: Right.
Dr. Andy: We’ve tripled our patient revenue in the last 10 years, but we’re out of space. So our surgeons don’t have space to operate. You know, they have space but they don’t have…
Dr. Alessi: I understand.
Dr. Andy: … extra space to operate, right, and so on and so forth, so continuing to grow that top line revenue, but doing it in an efficient way, right? Not as a state organization, but as a public private partnership.
So those hospitals we’re talking about, Waterbury being the first.
Dr. Alessi: Sure.
Dr. Andy: These are going to be private.
They’ll be a community network, private community network that we have influence on and can make sure that we’re proud of, the quality of care, the safety of care, and make sure that patients come back to those hospitals. But one of the other things that’s really important is what we’re doing for the state.
We’re a public health system. We’re the state’s only acute care academic medical center, and the state wants to make sure that hospitals don’t close
Dr. Alessi: Sure.
Dr. Andy: because then that decreases access to care, but also that the economies of those communities remain. And so they’ve looked to us and said, you guys are doing such a great job, help us, the state, to do this. And it’s a huge responsibility and one we’re proud of.
Dr. Alessi: When, and, and I think you, you actually brought up the topic already and that is when you merge or kind of work with these other hospitals, there’s always a problem of merging the culture.
Dr. Andy: Mm-hmm.
Dr. Alessi: It sounds like you want to keep the culture there ’cause obviously there’s a different culture in Waterbury than there is at Day Kimball Hospital,
Dr. Andy: Mm-hmm.
Dr. Alessi: or Bristol Hospital. So it sounds like you don’t want to bring, kind of destroy the local culture,
Dr. Andy: Right. Yeah. Yeah.
Dr. Alessi: Is that, is that the idea?
Dr. Andy: Well I, it’s a tricky balance.
Dr. Alessi: Yeah.
Dr. Andy: Because we wanna do a couple of things.
One, respect the local culture, but two, bring a level of specialist care to those hospitals that elevates their quality and their safety and everything that’s necessary in their patient experience. And we also want to treat them the way we believe they should be treated in a partnership. So there’s going to be some sharing and blending of cultures, but without losing either our culture or losing their culture.
So it takes, it takes a little bit of it’s gonna be tricky, but again, I think leadership is all about working within ambiguity as opposed to clear, clear guidelines.
Dr. Alessi: Andy, in closing, if we were to do this podcast 10 years from now, what does UConn look like?
Dr. Andy: So, 10 years from now, UConn Health will be much bigger.
It will be a model for the nation in terms of how you do public-private partnerships with state academic medical centers in the right way, where it benefits everyone, it benefits the state, and it benefits those private organizations in community networks.
We will be independent on the clinical side, independent of state support. And by the way, last year that was $60 million was coming to us on the clinical side. This year, we’re down to about 10 to $15 million, but we would be independent of the state, so in other words, the state funds the schools…
Dr. Alessi: Absolutely.
Dr. Andy: … which it should do, schools and the research. But clinically we’re able to fund that through patient revenues, et cetera, and diversification of revenues.
But I think most important to me as a physician is that we’re providing that we’re the best in the state, and I hate to be competitive, but we’re the best in the state in terms of quality, patient experience, and safety because ultimately that is the business of clinical health systems is patient care.
And then you touched on it on the academic side, we continue to be a fantastic, high ranked, even higher ranked in terms of our schools, but have a national stature in terms of research, particularly related to clinical trials and translational. I think if that, if we did that alone, that would be, that would be enough.
Dr. Alessi: Andy, listen, thank you. I want to thank you for your time today, but more importantly, as a physician practicing here, I want to thank you for your leadership. It’s great to have you back. I’m glad we got you back from Humana, and I look forward to the future with you.
Dr. Andy: Well, I look forward to the future with you, and I wanna thank you and your colleagues for your leadership too.
And thanks for doing this podcast.
Dr. Alessi: Many thanks to my guest today, Dr. Andy Agwunobi. If you have questions or ideas for future podcasts, you can reach out to me at healthyrounds@uchc.edu.
Jennifer Walker is the executive producer of the Healthy Rounds podcast. Chris DeFrancesco is our studio producer for the Healthy Rounds podcast.
Until next time, this is Dr. Anthony Alessi. Please stay healthy.

Coming January 2026
Healthy Rounds covers a range of topics, including new medical technologies and treatments, research, disease prevention. Its host, Dr. Anthony Alessi, also shares insights on current developments in health care policy, emphasizing the importance of being an informed patient, understanding preventive measures, and taking control of your health through proactive choices and awareness of new medical guidelines.
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This podcast includes conversations between the participants and does not necessarily represent the position of UConn Health.