Archive for May 2021

Marna Borgstrom, CEO Yale New Haven Health (Part 2)

Tom Robertson, Executive Director of the Vizient Research Institute, sits down with Yale New Haven Health’s CEO, Marna Borgstrom, for a second time. Tom and Marna shift gears to discuss macroeconomic issues affecting the affordability of health care for middle class households. 

 

Guest speaker:

Marna Borgstrom, MPH

CEO

Yale New Haven Health System

 

Moderator:

Tom Robertson

Executive Director

Vizient Research Institute

 

Show Notes:

[00:56] Marna has been in academic health care for 42 years, loves it and believes in it for all it does in health care delivery, however she believes health care providers have gotten very insular in the way they look at and provide care.

[01:50] Historically, there’s been an attitude that if health care built systems that suit them, including how they bring people in, that the people or patients would be grateful that the providers are making time to see them.

[3:00]  Health care organizations exist for one reason, our patients – whether it’s in education, whether it’s in research or whether it’s in the delivery of care, we exist to provide better health care and a better health care experience to our patients

[5:36] It’s concerning how health care has a negative financial impact people’s lives – some to the point of bankruptcy.

[6:27] The majority of patients care what health care costs. We’re pricing ourselves out of the market because patients don’t know how to assess the value of care.   

[7:18] To the average person, value is what you pay because they aren’t able to discern the right diagnosis. It’s a challenge for health care to get the value equation right, because the only thing people can really evaluate is their experience and how we made them feel.  

[7:50] Health care may be heading for an all-payer rate-regulated public utility model where providers compete on service rather than on price. 

[9:17] At YNHH 65% of patient care is paid by the state or federal government; on Medicare, which is the largest piece, they lose 11 cents per dollar of cost – not price, but cost. 

[9:50] With Medicaid, YNHH loses 53 cents on the dollar of cost and not covering their variable costs in most cases.

[13:30] Physicians largely practice in a payer-agnostic way.

[16:06] YNHH spends a lot of time and investment developing talent across the health system.

[16:30] People are rewarded for what they do. We promote people for their potential, and potential is not based on what you’ve done in the past, it’s a cumulative on how you’ve developed and how you do what you do.  

[17:00] Important for leadership: 1. lead with humility (no one leads by themselves); 2. be self-aware – you have to be courageous, take thoughtful risks and learn from your mistakes; 3. drive alignment and collaboration with diversity, equity and inclusion; and 4. strive for improvements and innovation.

 

Links | Resources:

Marna Borgstrom’s biographical information Click here

 

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Marna Borgstrom, CEO Yale New Haven Health (Part 1)

Tom Robertson, Executive Director of the Vizient Research Institute sits down with Marna Borgstrom, CEO of Yale New Haven Health, to discuss everything from a purposeful restart following the COVID-19 crisis to creative approaches to dealing with the manifestations of social determinants of health...in the meantime offering insights into what American medicine does particularly well and where we could do better.

 

Guest speaker:

Marna Borgstrom, MPH

CEO

Yale New Haven Health System

 

Moderator:

Tom Robertson

Executive Director

Vizient Research Institute

 

Show Notes:

[01:00] What health care gets right: It’s a great “sick care system”

[01:48] Where we fall short: We are not a health care system, we’re a sick care system

[02:15] Marna likes the book The Paradox of America’s Health Care by Betsy Bradley and Lauren Taylor. Marna says it says if you combine social infrastructure spending and health care spending per capita the United States doesn’t  spend more than other developed countries.  

[3:00] The authors say since many illnesses are a function of socioeconomic issues; countries that invest in social infrastructure treat fewer catastrophic health care events.

[4:44] Health care organizations have a unique role to be both investor and conveners of other businesses and government.

[5:22] In Connecticut there are no safety city/county hospitals to act as safety net hospitals, so Yale New Haven Health academic medical centers must support Bridgeport and New Haven communities – two of the 50 poorest  midsize cities in the United States.

[6:18] Yale New Haven has a joint venture with federally qualified community health centers to create integrated, primary ambulatory care and access to specialty care for medically indigent patients.

[6:38] Yale New Haven has a “Promise” program which guarantees a 4-year college experience for high school students who have a B average, low absenteeism, and family support. Over the past 10-years, that program has dramatically increased the graduation rate. It not only educates but gives students skills. 

[7:40] They also cooperate with Habitat for Humanity and other corporate community partners to improve social infrastructure.

[8:55] Beyond financial investments, Yale New Haven brings organizational skills and people who can drive the community’s socioeconomic initiatives

[11:11] Have about 40 rapid-cycle performance improvement initiatives going

[12:37] Electronic Health Record prompts pathways to diagnostics for diagnosis

[13:26] Signature care when anyone you care about can come into the health system, and you don’t feel compelled to make a call for a work-around to give them good care. Instead, the system works well for each patient. Making progress to achieve that.   

[16:50] Volume-based procedures are driven by local physician requests  and local competition

[18:00] “Academically-based health system” where you can make your physicians part of an integrated network that moves around the physicians to different health system facilities a few days a week to provide specialty care.  In aggregate you’re getting more volume, expertise delivered to local markets without having it all come from those markets.

 

Links | Resources:

Marna Borgstrom’s biographical information Click here

 

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Tom Robertson, Executive Director of the Vizient Research Institute, sits down with Johns Hopkins’ president, Kevin Sowers, for a second time. Tom and Kevin talk about the redesign of primary care, telemedicine and mental health reimbursement.

 

Guest speaker:

Kevin Sowers, MSN, RN, FAAN

Executive Vice President, Johns Hopkins Medicine

President

Johns Hopkins Health System

 

Moderator:

Tom Robertson

Executive Director

Vizient Research Institute

 

Show Notes:

[00:28] Recap of global budgeted revenue (GBR)

[01:35] Global budgeted revenue allows each hospital to decide how they will spend their money to care for people, while achieving expected quality and satisfaction metrics

[02:26] Shift in care to begin building primary care practices that are chronic illness focused; can make huge impacts on utilization patterns

[04:58] Redesigning your primary care practice to effectively team manage for high-risk patients to avoid hospitalization

[06:29] Redesigning primary care: Create contact moments through telemedicine and technology to deliver better care for the chronically ill

[07:35] Be flexible in seeing chronically ill patients when they need to be seen

[08:31] Partner with primary care practices to design new models to innovate and transform the way we see very complex patients and to drive utilization

[09:49] The GBR allows better incentives to take lower acuity services and put them into a lower cost setting

[10:30] Acting as an integrated delivery system, under GBR, moving services to outpatient setting allowed hospitals to keep 50% of total cost for that population and allows you to do the right thing

[11:04] How the GBR payment system in Maryland addresses mental health better than with other payment models

[12:19] Reimbursement of mental health care costs in all-payer model plus transformational grant from HSCRC to begin addressing the gaps in behavioral health system

[13:18] Expanding behavioral health crisis services to include care traffic control system--a high tech, crisis hotline and referral system to allow patients with same day access

[14:07] Single managed service organization to oversee the work of getting patients into the care models they need, in the communities in which they live but not requiring them to visit the hospital

[15:01] Virtual care benefits from pandemic, highlights the advantages of a rate-regulated financing system despite revenue loss on cancelled surgeries and procedures

[16:29] Protection mechanism to keep Maryland hospitals viable during unprecedented times when the rest of country did not have a revenue stream that continually supports them

[17:15] Challenges with Academic Medical Centers and how they fit into this all-payer model, as well as how you pay for innovation. All-payer still has more positives. There will always be mechanical issues of policy.

[19:03] Kevin’s most admirable characteristic of his management style is compassion. Brought nursing experience into the executive suite that has translated into inspirational behavior modeling

[19:48] Two lessons learned

[21:20] Rise above the moment of chaos, listen to the people who are feeling the emotions, but respond to the moment with facts.

 

Links | Resources:

Kevin Sowers’ biographical information Click here

 

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Tom Robertson, Executive Director of the Vizient Research Institute sits down with John Hopkins’ president, Kevin Sowers to discuss possible future directions for health care finance. They consider the unintended consequences of payment rate disparity between public and private insurance and how Maryland’s unique all-payer rate-setting model empowers providers to make investments in patient well-being that would be more difficult under the traditional payment system. Kevin shares his insights on programmatic investment to deal with the manifestations of social determinants of health and partnering with others to create healthier communities.

 

Guest speaker:

Kevin Sowers, MSN, RN, FAAN

Executive Vice President, Johns Hopkins Medicine

President

Johns Hopkins Health System

 

Moderator:

Tom Robertson

Executive Director

Vizient Research Institute

 

Show Notes:

[01:01] Payment rate disparity between public and private insurance

[01:48] Maryland model payer system vs. other systems

[02:55] Advantages of Maryland model: Helps decrease ED utilization and hospital days

[04:15] Model forces you to consider community strategies to better manage high utilizers – Example of dental care patients

[05:24] Global Budget Revenue (GBR) total cost of care advantage – allows you to think how to integrate into the community to focus on the10% of patients who drive up 90% of your costs

[07:00] With GBR hospital gets paid the same amount whether it has 10 patients or 1,000 patients.

[07:52] GBR only for hospitals; unregulated and professional fees need to still be negotiated

[08:30] Example: Utilization patterns of the ED and hospital care to the homeless. Partnering with others to fund housing services for the homeless resulting in decreases in ED utilization and overall health care costs

[11:00] Use of grants to invest in social determinants of health, resulting in decreased health care utilization

[11:43] Developing systems of care with others in community to assist with socioeconomic factors and social determinants

[12:30] Example: Jobs program created to recruit, train and hire individuals previously excluded from workforce were hired to be community health workers

[13:00] Transforming lives to make a difference – “Living with options”

[13:56] Total cost of care model (GBR) enables you to do the right thing, and that’s rewarding

[14:47] Hospital at Home program to create healthier communities

[16:42] Background on Kevin and how he became a nurse

 

Links | Resources:

Kevin Sowers’ biographical information Click here

 

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