Crosswinds
Crosswinds is a series of casual conversations with national thought leaders hosted by Tom Robertson, executive director of the Vizient Research Institute. New episodes released every month feature the brightest people in health care considering questions that others haven’t thought to ask – always remarkable, never exactly what you’d expect, and having fun along the way. Crosswinds: Two old friends sitting in comfortable chairs… talking.
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Episodes
Tuesday Feb 28, 2023
Tuesday Feb 28, 2023
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, MBAPresident and CEOBJC HealthCare Moderator:Tom RobertsonExecutive DirectorVizient 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.
Links | Resources:
Richard J. Liekweg's biographical information
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Tuesday Jan 31, 2023
Tuesday Jan 31, 2023
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, MDHospital Group President and Co-Chief of Clinical OperationsEmory Healthcare Moderator:Tom RobertsonExecutive DirectorVizient 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
Links | Resources:
Dr. Bryce Gartland's biographical information
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Tuesday Dec 13, 2022
Tuesday Dec 13, 2022
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, FACHEChief Operating Officer & Executive Vice PresidentStrong Memorial Hospital, University of Rochester Medical Center
Moderator:Tom RobertsonExecutive DirectorVizient 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
Links | Resources:
Dr. Kathy Parrinello's biographical information
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Tuesday Nov 15, 2022
Tuesday Nov 15, 2022
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, BSNPresidentUniversity of Maryland Medical Center Midtown Campus
Moderator:Tom RobertsonExecutive DirectorVizient 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
Links | Resources:
Alison G. Brown's biographical information
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Tuesday Oct 18, 2022
Tuesday Oct 18, 2022
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, MHAChief of Business Development and CommunicationsVCU Stravitz-Sanyal Institute for Liver Disease and Metabolic Health
Moderator:Tom RobertsonExecutive DirectorVizient 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
Links | Resources:
Marcos Irigaray's Biographical Information
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Tuesday Sep 20, 2022
Tuesday Sep 20, 2022
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, MBAChief Strategy Officer, UAB MedicineCEO Cooper Green Mercy Health Services Authority Moderator:Tom RobertsonExecutive DirectorVizient 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
Links | Resources:
David Randall's biographical information
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Tuesday Jul 26, 2022
Tuesday Jul 26, 2022
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, MHAEVP & Chief Strategy OfficerPrisma Health
Moderator:Tom RobertsonExecutive DirectorVizient 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.
Links | Resources:
Malcolm Isley's biographical information
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Tuesday Jun 28, 2022
Tuesday Jun 28, 2022
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, FACEPPresident & CEOUMass Memorial Health Moderator:Tom RobertsonExecutive DirectorVizient 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
Links | Resources:
Eric W. Dickson's biographical information
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Tuesday May 24, 2022
Tuesday May 24, 2022
Tom Robertson, Executive Director of the Vizient Research Institute is joined by Dr. Russell Howerton, a surgeon and long-time Chief Medical Officer at Wake Forest North Carolina Baptist, now Atrium Wake Forest Baptist Health. Russ and Tom discuss everything from shared experiences with bygone general practitioner physicians to the effects of modern era mergers and acquisitions. Along the way, they tackle issues ranging from the balance between autonomy and systematic reliability to the economics that influence the delivery of care.
Guest speaker:Russell M. Howerton, MD, FACSSenior Physician Executive Atrium Wake Forest Baptist Health Moderator:Tom RobertsonExecutive DirectorVizient Research Institute
Show Notes:
[00:50] Advice to give a young Russ Howerton
[01:40] Father exemplified individual accountability, autonomy model of medicine
[02:25] Trained under Lucian Leape, author of “To Err is Human”
[06:27] There’s variation of service with any sized system, and scaling it up with a merger won’t change that
[11:15] There’s some debate that a highly skilled, low-volume surgeon will be better than a low-skilled, high-volume surgeon, but probably little debate that an institution has systems and processes in place better when doing high volume.
[12:30] The financing and provisions of the infrastructure to deliver health care is complex – it’s like a Jenga puzzle to manage it
[15:00] Society doesn’t want to see market failure in health care where people can’t get service when they need it at a micro level
[22:00] Thoughts on price parity for patients
[22:50] Price parity would free us from “segregating" patients by their payer status
[23:54] Payer parity is different than global budgeting. It puts pressure on the current pricing model and wouldn’t survive indefinitely in society because many valued services would be hard to support.
[26:50] Atrium Wake Forest Baptist wants to be a regional leader in converting to a value-based care model, but still can’t keep the lights on without focus on the volume-based model.
Links | Resources:
Dr. Russell Howerton's biographical information
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Tuesday Apr 26, 2022
Tuesday Apr 26, 2022
Tom Robertson, Executive Director of the Vizient Research Institute is joined by Mark Laret, retired CEO of UCSF Health in San Francisco. Prior to his distinguished tenure at UCSF, Mark was CEO of UC Irvine Medical Center. He began his career at his alma mater, UCLA. Mark reflects on his career, which began in the early days of managed care. He describes the emotions involved in retiring, and the two long-time friends share their thoughts on what the future might hold.
Guest speaker:Mark LaretRetired President and CEOUCSF Health Moderator:Tom RobertsonExecutive DirectorVizient Research Institute
Show Notes:
[01:11] Rationale for consolidation in health care
[2:27] Merging health organizations may have very different cultures and it will take effort to align those differences
[5:55] A lot of decisions are made to back programs that support patient care, but it’s a struggle
[7:10] Biggest surprise is that health care is not fully capitated
[10:40] Proudest moments
[15:13] Site of service differential payments makes no sense to anyone outside of health care, but it was a mechanism for solving a problem that hospitals had serving the underserved, and not being reimbursed for them
[17:32] Need to maintain the best parts of the market-based system, but reprioritize access and eliminate health disparities
[18:28] Decisions not proud of almost always come back to whether or not we did enough to service patients
[10:19] Our goals need to be how to improve the health of the communities that we serve, and how we make payroll and cover the cost of new drugs and supplies
Links | Resources:
Mark Laret's biographical information
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