When Dr. Andy Mueller took the helm at MaineHealth nearly a year ago, COVID-19 vaccines were fueling optimism that the pandemic would soon be under control.

Instead, Mueller ended up leading the largest health care network and private employer in Maine through a resurgence of the pandemic that filled intensive care units and pushed hospitals to the limits of their capacity, and beyond.

“It was difficult psychologically,” Mueller said, recalling how the pandemic worsened, first because of the delta variant and more recently because of the omicron wave. “It was difficult getting a sense that we were coming through this (COVID-19 pandemic), but then, oh my gosh, the worst was yet to come.”

The crisis forced MaineHealth to respond and adapt in ways that could outlast the pandemic. But, he said, even when COVID-19 becomes less threatening to everyday life and hospitals return to more normal operations, the industry will face prolonged health effects and the continuing need for long-term changes.

Since last April, Mueller has been the chief executive of the $2 billion, 23,000-employee nonprofit health care network, which includes Maine Medical Center, eight other hospitals in Maine and New Hampshire, and a vast network of primary care, behavioral health and specialized health care.

Mueller, in a recent interview with the Press Herald, spoke about his desire to reform the health care system and about navigating MaineHealth through multiple urgent challenges, including the COVID-19 pandemic, the ongoing opioid epidemic and a growing mental health crisis.

Mueller, a former flight surgeon with the U.S. Air Force who has mostly lived in the South until last year, lives in Cumberland with his wife, Courtney, an attorney. They have three daughters, all currently attending college.

Mueller replaced former MaineHealth CEO Bill Caron, who retired last year.

Mueller’s previous job was president and CEO of Centra Health in Lynchburg, Virginia.  Mueller said he saw the leadership post at Maine’s largest health care network as a chance to advocate for substantial long-term reforms to the health care system, including how services are paid for.

“The two most important vital signs in America for mortality are your credit score and your ZIP code,” Mueller said. “We have to figure out how to change that.” Mueller was referring to the inequality of health care services based on where you live and financial means.

Mueller has many immediate issues on his plate beyond what is still a large number of  COVID-19 patients. Those include addressing the medical industry’s workforce shortage, investing more in behavioral health care and fighting the opioid crisis, which led to a record number of overdose deaths in Maine last year.

The workforce shortage is a monumental challenge, but MaineHealth is working on it by offering good pay and benefits, a positive workforce culture, and partnering more with local colleges and universities to make sure there’s enough new homegrown talent in the health care professions, Mueller said.

“COVID has created a day of reckoning,” Mueller said, causing health care systems to consider how they are delivering care.

Stresses on hospital capacity, reduced visitation for COVID-19 safety and curtailing the ability to see some patients in-person have forced hospitals to continually adjust. Some of the adaptations  – such as more telehealth when it makes sense to do so – will become permanent.

Mueller said the system learned how to become flexible and adapt, such as using more of the outlying hospitals, such as Pen Bay Medical Center, Mid Coast Hospital and Stephens Memorial Hospital, to help take care of COVID-19 patients, rather than relying mostly on Maine Med.

“One of the capabilities we honed is not only moving patients from rural hospitals to Portland (Maine Med), but also taking patients from Portland and sending them to rural hospitals,” Mueller said.

Mueller started a few months after a dispute over MaineHealth’s decision to give vaccine doses to out-of-state contractors when early vaccine supplies were constrained. Gov. Janet Mills rebuked the health care system in a statement on Feb. 9, 2021, calling it an “inexcusable act.”

Mueller said when he started, despite the vaccine dispute that happened before his arrival, he believed the partnership with the Mills administration was strong, and he said he has worked on making it stronger.

“As an organization, MaineHealth learned a great deal from that episode,” Mueller said. “Our focus is on working together with the Mills administration. We can’t do it alone, we need everyone’s help. The support they’ve given us has been essential to continue to build a great relationship.”

Going forward, Mueller said health care systems have been focused on “efficiency of operations” but need to be just as focused on “effectiveness” to deliver quality care.

One example is behavioral health, where people suffering from a mental health crisis are sometimes being warehoused in emergency departments instead of getting the need care in other settings, such as long-term care facilities.

The issue just surfaced last week, when the nurses’ union that represents Maine Med protested what they said were a lack of safe working conditions in the emergency department, caused in part by psychiatric patients assaulting nurses. Management and union representatives on Thursday were working toward a solution to prioritize worker safety.

“We’re all working really hard to get to the right place to ensure our care team members are safe,” Mueller said.

More broadly, Mueller said investments need to be made in behavioral health, including substance use disorder treatment.

Mueller said the mental health repercussions of isolation from the pandemic are only just beginning to be felt.

“In the wake of traumatic events, mental health symptoms may not manifest for one to two years out from the traumatic event,” Mueller said. He said health care systems need to integrate behavioral health with other parts of the system, such as primary care.

Mueller arrived at MaineHealth at a crucial time for labor relations, with nurses at Maine Medical Center forming a union last year, and currently negotiating the first contract with the hospital. Mueller said he wants to forge a strong partnership with the union.

Todd Ricker, lead labor representative for the Maine State Nurses Association, an arm of National Nurses United union, pointed to recent actions by nurses highlighting pandemic working conditions that could be improved, including by providing more staff support.

“The conditions in which nurses work are the same conditions in which patients receive care,” Ricker said.

Beyond workforce issues, Mueller said the long-standing financial model of how the U.S. pays for medical services does not incentivize proven ways to keep people healthy, such as preventive care and early detection. Much of the current fee-for-service business model for health care instead incentivizes people to wait until they are seriously ill to seek medical care, leading to more expensive care and procedures.

“We have to change the way the business model works,” said Mueller.

The 52-year-old CEO is being paid a $1.3 million base salary plus $600,000 to meet performance incentives, a compensation package that is in the 50th percentile for similar-sized health care networks nationwide, according to a consulting firm hired by MaineHealth.

By comparison,  Northern Light Health, the second-largest health care network in the state, paid its former president and CEO Michelle Hood $1.8 million, according to the most recent financial statement available. Caron, the MaineHealth CEO who recently retired, earned $1.7 million, according to the system’s most recent public financial statement.

Mueller said he’s not advocating yet for any one particular set of payment reforms, but new models should be “more like a subscription model.” Instead of paying for care on a per-service basis, patients would pay a flat fee every month. Mueller said he realizes significant payment reform is aspirational, and in order to do it, they would need to get everyone at the table, including government, insurance companies and health care networks.

Greg Dufour, chair of the MaineHealth board of trustees, said he’s optimistic that Mueller’s “personal, approachable and empathetic” leadership style will get results, including major payment reforms.

“He has a vision of what the future of health care looks like, and what an organization like MaineHealth has to do to adapt to that future,” Dufour said. “He’s a forward thinker, a future thinker, but also grounded in what we have now, and what we have to do to get there.”

However, Mitchell Stein, a Cumberland-based health policy analyst, said making substantial reforms to payment models is unlikely because of the byzantine way the United States structures its health care systems, and that governments, health care providers, employers and insurance companies often have competing interests. Stein said another complication is that two of the biggest entities that pay for services – Medicare and Medicaid – are federal programs.

“It’s like mom and apple pie, everyone’s for it and it makes sense,” Stein said of payment reform, but then well-meaning reformers run into the “quagmire” of the entrenched system. “To truly do population health you have to involve all the payers, but that’s not how the system is set up. It doesn’t make sense for an individual payer to buy in, without all the payers buying in.”

Mueller said regardless of financial models, to improve health care, MaineHealth will need to maintain a sharp focus on  keeping its population healthy.

“We are not really in the health care business. We’re in the people business,” Mueller said.