Tom Robertson, Executive Director of the Vizient Research Institute, is joined by Rich Liekweg, President and Chief Executive Officer of BJC Healthcare in St. Louis. Rich describes the similarities and differences between three models of academic medical center health systems in which he has worked - Duke, UCSD, and BJC - they then turn their attention to some of the macroeconomic drivers affecting medical spending across the country. They discuss the role of the traditional payment system in creating economic pressure on providers to establish and maintain low-volume surgical programs and they share an aspiration for new approaches to tackle the medical manifestations of social determinants of health.

Guest speaker: Richard J. Liekweg, MHA, MBA President and CEO BJC HealthCare Moderator: Tom Robertson Executive Director Vizient Research Institute

Show Notes:

[00:55] Richard Liekweg discusses the similarities of the three hospitals he worked in during his career.

[04:11] Declaring a health organization a system is not enough to achieve the level of standardization and integration to bring real value to patients and healthcare.

[07:15] Sometimes variation of services is a function of innovation. Health organizations need to make sure it’s true innovation and not just preferences driving the variation.

[08:11] Recent cost pressures encourage health systems to move some inpatient care out of the larger hospitals to the smaller community hospitals.

[11:35] Healthcare’s current payment structure is problematic. It doesn’t align incentives across those who pay for care, those who provide care and those who are receiving care.

[14:55] Regional health systems have an opportunity to pursue true clinical integration by placing low-volume, high-risk surgical programs in one or two locations.

[20:36] It will take investing in social programs rather than looking to healthcare providers to fix social determinants of health.

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Richard J. Liekweg's biographical information

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Tom Robertson, Executive Director of the Vizient Research Institute, is joined by Dr. Bryce Gartland, Hospital Group President and Co-Chief of Clinical Operations for Emory Healthcare. The conversation opens with an examination of the challenges health systems face when trying to standardize clinical practices across multiple institutions and cultures. Bryce and Tom then discuss the role of the traditional payment system in creating economic pressure on providers to establish and maintain low-volume surgical programs and share an aspiration for a new reimbursement system – a more sustainable model that would enable providers to be more innovative in attacking the medical manifestations of social determinants of health. They close with a shared view of the potential for healthy seniors to contribute to a new approach to elder care.

Guest speaker: Bryce Gartland, MD Hospital Group President and Co-Chief of Clinical Operations Emory Healthcare Moderator: Tom Robertson Executive Director Vizient Research Institute

Show Notes:

[00:34] How to standardize intra-system variation of resource consumption

[03:08] Workforce burden – how do we work smarter, not harder

[03:48] Mergers and acquisitions come with commitments to services and practices within the facility or community

[04:23] Emory’s successes in standardization for care

[07:59] Reimbursement payment systems for care and surgical procedures

[13:09] Price disparities and health disparities

[13:47] Covid pandemic was a great accelerator that exposed care vulnerabilities and reimbursement system flaws

[17:57] Social determinants of health

[20:25] ‘Elder Corps’ concept

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Dr. Bryce Gartland's biographical information

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Tom Robertson, Executive Director of the Vizient Research Institute, is joined by Kathy Parrinello, Chief Operating Officer and Executive Vice President of the University of Rochester’s Strong Memorial Hospital. The conversation centers around what Kathy describes as a feeling of moral distress among health care professionals when systemic barriers prevent them from providing everything needed by their patients. Brought into clearer focus by the pandemic, but not caused by it, were health care disparities – both access and experiential – that have been building for decades. The discussion explores the role of the traditional financing system in fostering such disparities and closes with Kathy's thoughts related to the challenges posed by the labor shortage.

Guest speaker: Kathy Parrinello, RN, PhD, FACHE Chief Operating Officer & Executive Vice President Strong Memorial Hospital, University of Rochester Medical Center

Moderator: Tom Robertson Executive Director Vizient Research Institute

Show Notes:

[00:32] Clinician felt moral distress during the pandemic because of health disparities, community mistrust, staffing shortages, inadequate insurance coverage, etc.

[06:00] Healthcare has changed since COVID, but it isn’t all due to the disease but rather a factor of post-traumatic stress and supporting clinicians leaving healthcare

[09:27] Healthcare systems rely on surgeries for their financial health. The pandemic’s cancellation of “elective” surgeries exposed the vulnerabilities of that system, and a reevaluation of the term “elective” vs. “scheduled” surgeries.

[13:42] Experiential disparities

[18:40] Labor shortages

[22:42] Using community partners to help with patients with social determinants of health

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Dr. Kathy Parrinello's biographical information

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Tom Robertson, Executive Director of the Vizient Research Institute is joined by Alison Brown, President of the University of Maryland Medical Center Midtown Campus in Baltimore. Alison describes a number of hospital initiatives that evolved in response to atypical provider incentives arising from Maryland’s unique payment system, most recently including global spending budgets. From interdisciplinary rounds and transitional care teams to coordinated post-discharge care for chronically ill and socioeconomically vulnerable populations, Alison shares experiences viewing patient needs through both an “inside-out” and an “outside-in” lens. The conversation turns to an innovative Maryland program involving “peer recovery coaches” to assist emergency patients battling substance abuse. Tom extends that concept by describing a conceptual patient navigation volunteer program that he calls the “Elder Corps”.

Guest speaker: Alison G. Brown, MPH, BSN President University of Maryland Medical Center Midtown Campus

Moderator: Tom Robertson Executive Director Vizient Research Institute

Show Notes:

[01:21] In 2014, CMMI issued a waiver that capped what any individual hospital could charge on an annual basis. Each hospital had to rethink how they manage their operating margins.

[03:17] Development of “Transitional Care Teams” that help patients with a safe and timely hospital discharge.

[09:35] Workforce challenges for serving traditionally underserved or marginalized patients

[12:27] Peer recovery coaches

[13:09] Elder Corps

[16:00] Redeploying staff to support the team that provides care

[19:31] Addressing the “experiential disparities” for patients who can’t afford a concierge experience

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Alison G. Brown's biographical information

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Tom Robertson, Executive Director of the Vizient Research Institute is joined by Marcos Irigaray, long-time chief marketing and strategy officer at VCU Health, who now leads strategy and business development for the VCU Stravitz-Sanyal Institute for Liver Disease and Metabolic Health. Marcos discusses VCU's role as an academic research institution that also serves as the principal care delivery system for the region's socioeconomically vulnerable population. The conversation moves from managing the medical manifestations of social determinants of health to VCU's success in launching innovative care programs focusing on the complex needs of the chronically ill.

Guest speaker: Marcos Irigaray, MHA Chief of Business Development and Communications VCU Stravitz-Sanyal Institute for Liver Disease and Metabolic Health

Moderator: Tom Robertson Executive Director Vizient Research Institute

Show Notes:

[00:45] VCU’s mission to be a safety net for the Commonwealth’s disenfranchised or indigent population

[03:38] Chronic disease medical home program for patients with challenging social determinants of health uses a team that includes a primary care physician, social worker, pharmacist and dietician.

[07:13] Performing house calls for complex care populations

[10:26] Children with chronic conditions as well as elder patients benefit from wraparound care

[12:21] Marcos’ new role as Chief of Business Development and Communications at VCU’s Stravitz-Sanyal Institute for Liver Disease and Metabolic Health

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Marcos Irigaray's Biographical Information

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Tom Robertson, Executive Director of the Vizient Research Institute, and David Randall, Chief Strategy Officer, UAB Medicine, discuss the vulnerability of the traditional health system business model, driven by a payment system that creates unintended consequences. The conversation then turns to how things could change, and David describes a unique experiment underway involving a completely different funding method for indigent care.

Guest speaker: David Randall, MBA Chief Strategy Officer, UAB Medicine CEO Cooper Green Mercy Health Services Authority Moderator: Tom Robertson Executive Director Vizient Research Institute

Show Notes:

[01:00] Provider operating margins affected by increasing Medicare population

[03:45] Diversifying revenue

[04:50] Global spending budget allows provider organizations to be more innovative and think about capacity differently

[07:18] Current payor system based on sickness and volume does not incentivize preventive wellness care

[09:36] If price wasn’t an issue, it may help payors and providers to focus more on care processes

[10:47] Example of shifting from unit price to episodic cost – cancer care

[11:36] Would be good to have a national discussion between the payers and providers focused on optimizing episodes of care

[12:48] UAB’s fund-flow model is relatively payer agnostic.

[14:55] Have to figure out how to get paid for services outside the four walls of the hospital, such as community outreach programs for mental health

[16:47] Even if we are paid more money, there’s still a capacity issue

[18:44] Global payments example: Jefferson County Indigent Clinic

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David Randall's biographical information

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Tom Robertson, Executive Director of the Vizient Research Institute is joined by Malcolm Isley, Executive Vice President and Chief Strategy Officer for Prisma Health, headquartered in Greenville, South Carolina. Malcolm describes the unique challenges of delivering health care to rural populations and of striking a balance between local access and the need to consolidate higher acuity services, before he and Tom discuss the transition from large community system to newly-developed academic partnerships.

Guest speaker: Malcolm Isley, MHA EVP & Chief Strategy Officer Prisma Health

Moderator: Tom Robertson Executive Director Vizient Research Institute

Show Notes:

[01:09] A third of South Carolina’s 5.2 million population lives in rural areas and making health care accessible and affordable is a challenge, given the disparities in social determinants of health.

[03:32] Prisma Health covers half of the state’s population. Prisma also partners with Federally Qualified Health Centers (FQHCs) for clinically integrated networks and other activities.

[06:05] Accountable Communities Programs

[07:25] Virtual care

[09:58] Prisma Health has developed local systems of care, with each region aligning services to provide the highest value to the patients.

[11:05] Prisma has intentionally been moving more care from the tertiary and quaternary hospital to the community hospital, with the goal to keep care close to an individual’s home and make care more affordable.

[12:40] In the community hospital setting, Prisma is working on ambulatory care.

[12:54] “Center of excellence” doesn’t have to be at a physical location. It’s a commitment to certain cost, quality, patient engagement and outcomes, not a location.

[18:20] Prisma is not owned by a university, but they have a lot of very productive university partnerships to improve community health.

[19:05] 8,000 students filter through Prisma every year, supporting workforce development activities in medical, nursing, pharmacy, social work and technical education.

[21:14] Prisma Health receives 200 – 300 requests a day for mental health services.

[25:13] Examples of non-traditional partnerships.

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Malcolm Isley's biographical information

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Tom Robertson, Executive Director of the Vizient Research Institute is joined by Dr. Eric Dickson, Chief Executive Officer of UMass Memorial Health in Worcester, Massachusetts. An Emergency Medicine specialist, Eric provides a unique perspective on the impacts of both the pandemic and the labor shortage on front line clinicians. The conversation turns to overcoming organizational inertia before Eric and Tom share thoughts around the value of mergers and acquisitions.

Guest speaker: Eric W. Dickson, MD, MHCM, FACEP President & CEO UMass Memorial Health Moderator: Tom Robertson Executive Director Vizient Research Institute

Show Notes:

[00:53] Labor shortage: U.S. health care has lost 15% of its workforce since the pandemic

[03:05] Health disparities and unequal accessibility

[04:48] Care at home

[05:56] Integrated payment system

[06:55] UMass’ Hospital-at-home program may close after COVID waivers end due to current payment system

[08:04] When health care systems are big enough

[10:34] Regional systems of care

[14:52] How to overcome organizational inertia

[17:27] Realigning the staff with the mission to put the patient’s interest first will help the workforce overcome burnout and be more engaged

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Eric W. Dickson's biographical information

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