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 Mar 29, 2022
Tuesday Mar 29, 2022
Tom Robertson, Executive Director of the Vizient Research Institute is joined by an old friend, Mike Dandorph, President and CEO of Tufts Medicine in Boston. Before assuming his current role, Mike was President, Rush University System for Health and Rush University Medical Center in Chicago, and prior to that he was the long-time chief strategist for the University of Pennsylvania Health System in Philadelphia. Mike shares his thoughts on leadership, comparing experiences in different models of AMCs. The conversation then turns to macroeconomic challenges facing the American health care system and Mike’s views relative to potential systemic changes.
Guest speaker:Michael J. Dandorph, MHAPresident and CEOTufts Medicine
Moderator:Tom RobertsonExecutive DirectorVizient Research Institute
Show Notes:
[00:50] Organizational structure is less important than staff alignment for a health system’s success
[3:47] Tufts Medicine aims to treat their patients as consumers and organizes for accountability, quality outcomes and invests with patient priorities
[4:10] Other key components are: physician alignment, incentives rewarding the right behavior and putting the right people in the right positions
[5:40] Culture plays a role in keeping the patient the center of attention as opposed to research
[07:34] Mergers and acquisitions: integration is really hard because it requires a lot of change, and humans don’t like to change
[8:56] In mergers, clinical teams need to come together to address programmatic integration, performance improvement, service rationalization and that takes trust. Leaders can help by creating an environment with honest conversations.
[11:10] U.S. health system higher costs aren’t translating into better access or better quality of care. It’s not just a provider issue, but a societal issue. Resources need to be deployed in a way that has a higher impact than it has now.
[14:08] Rate regulation won’t change the social determinant issues, but if health care organizations don’t control costs, the government may intervene
[17:44] Supply-induced demand is not the health’s industries big problem, it’s very sick people. Instead, where we take care of patients need to be considered to cut costs
[19:56] During the pandemic health care organizations came together in a broader ecosystem to provide the best care
[23:21] The current health system is so complex that it will have to be partially dismantled to be more rational. The insurers have gotten in the middle and that creates a huge administrative expense. 20% of costs is attributed to billing preapprovals and authorizations.
Links | Resources:
Michael J. Dandorph's biographical information
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Tuesday Feb 22, 2022
Tuesday Feb 22, 2022
Tom Robertson, Executive Director of the Vizient Research Institute rejoins Johnese Spisso, President of UCLA Health to discuss the economic shortcomings of managed care, and in particular the decades-long emphasis on reducing utilization. With over 25 years of experience in two west coast markets characterized by the long-standing influences of health maintenance organizations, Johnese brings an informed perspective when considering Tom’s proposition that the market’s failure suggests the need for another source of rational health care pricing. The conversation then shifts to the country’s need for more comprehensive mental health services and UCLA’s efforts in that area.
Guest speaker:Johnese Spisso, RN, MPAPresident, UCLA HealthCEO, UCLA Hospital System Moderator:Tom RobertsonExecutive DirectorVizient Research Institute
Show Notes:
[01:10] Why HMOs and primary care capitation concepts failed to cut health care spending
[5:56] Health care prices should have rational limits with rate structures that allow for capital investment and sustainability.
[10:39] Disparities of care would improve if we had a payment system that was payer agnostic
[11:00] UCLA Health is expanding its inpatient mental health with a $400 million investment to create a behavioral and mental health center of excellence. The new center will add 125 inpatient psychiatric beds.
[14:05] A rising number of America’s youth needs mental and behavioral health care
[15:14] UCLA has a “Depression Grand Challenge” app that monitors initial symptoms of depression and offers calming meditations resources
[16:45] Investing in research and innovation
[18:00] 14 cancer drugs were discovered at UCLA health over the past decade
[18:55] Need for developing better tools and technology to distribute resources efficiently
Links | Resources:
Johnese Spisso biographical information
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Tuesday Jan 25, 2022
Tuesday Jan 25, 2022
Tom Robertson, Executive Director of the Vizient Research Institute discusses the challenges of balancing research and patient care with Johnese Spisso, who before taking on her current role as President of UCLA Health, spent 22 years at UW Medicine in Seattle, another academic medical center in the top tier of research funding by the National Institutes of Health. Johnese describes UCLA’s innovation center, designed to bring new clinical discoveries to the bedside, and a purposeful focus of philanthropy on the translation of innovation into improved patient care, exemplified by UCLA’s recent ranking on the U.S. News and World Report’s honor roll.
Guest speaker:Johnese Spisso, RN, MPAPresident, UCLA HealthCEO, UCLA Hospital System Moderator:Tom RobertsonExecutive DirectorVizient Research Institute
Show Notes:
[0:55] UCLA Health System’s high rankings with the U.S. News & World Report
[2:30] UCLA focuses on delivering patient safety and performance improvement plan, not rankings
[3:55] MOVERS dashboard: Mortality, Outcomes, Value-based care, Experience of the patient and family and quality measure for Readmissions. It is reviewed monthly by department chairs.
[4:53] UCLA relies on Vizient to lead them through the quality, safety and service rankings; the ability to benchmark against similar academic medical centers and to be able to share ideas and lessons learned with peers has been invaluable
[6:56] All academic medical centers need to do more work on health equity
[7:37] Balancing priorities between research and patient care
[9:38] UCLA started an innovation center to develop new therapies, new technologies that are coming forward from bench to bedside. It also created a bio design program to take clinical ideas from thought to commercialization.
[10:55] UCLA has patient and family advisory councils for innovations
[11:15] COVID has allowed the public to see the value of the investment in research because UCLA was able to bring COVID tests and participate in clinical trials faster than before.
[12:40] Philanthropy is investing in innovation to advance health care forward.
[14:00] Hospital systems struggle to consolidate clinical programs to reduce variation and cost
Links | Resources:
Johnese Spisso biographical information
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Tuesday Dec 14, 2021
Tuesday Dec 14, 2021
In a slight departure from the usual format, Tom Robertson, Executive Director of the Vizient Research Institute sits down with Tim Babineau, MD, President and CEO of Lifespan, Rhode Island’s largest health system, to discuss a single issue facing every medical provider in the country. Tom and Tim reflect on some of the contributing factors behind the national health care labor shortage, the implications for service and eventually patient safety, and the heart-wrenching toll on the current workforce. Dr. Babineau examines the situation with an extraordinary blend of compassion and concern. You’ll find the conversation riveting.
Guest speaker:
Timothy J. Babineau, MD, MBA, FACS
President and CEO
Lifespan
Moderator:
Tom Robertson
Executive Director
Vizient Research Institute
Show Notes:
[01:27] Health care staffing shortage at a “crisis” level
[2:07] Health care professionals frustrated because they cannot meet the patient demand
[5:51] Staff vacancies at Lifespan have tripled within the last 12 months
[7:30] Work environment has become incredibly stressful, and burnout rate has “gone through the roof.” Dedicated health care professionals with decades of experience are quitting.
[9:30] Society monetarily undervalues health care workers
[10:50] 21 months of constant stress is a huge mental health burden on health care workers and their families
[12:21] Tim’s advice: take care of yourself and stay healthy so you don’t need to go to the hospital. If you do go to the hospital, please be kind to the caregivers there.
[13:36] It’s going to take a national conversation to find a solution, market specific strategies are not working
[14:53] Need to make the health care profession more attractive with innovative models of care where people can work at the top of their license
[15:52] Need to rethink health care as a common good
[19:48] Pandemic has exposed inadequacies and vulnerabilities in a market-based approach in health care
[22:13] Disparities of care
Links | Resources:
Timothy J. Babineau biographical information
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Tuesday Nov 02, 2021
Tuesday Nov 02, 2021
Tom Robertson, Executive Director of the Vizient Research Institute and Mark Wietecha, CEO of the Children’s Hospital Association, return to consider macroeconomic topics centered around the concept of health care in a “culture of capitalism” as Mark describes it. The discussion considers opportunities to change the financing model to enable providers to take a more holistic approach to treating children within the context of their family situations. Mark describes the longitudinal health care impacts of adverse childhood experiences, and the importance of early intervention to mitigate their effects.
Guest speaker:
Mark Wietecha, MS, MBA
CEO
Children’s Hospital Association
Moderator:
Tom Robertson
Executive Director
Vizient Research Institute
Show Notes:
[01:40] Health care affordability is impacted by the costs associated with investments in technological advancements that were made over the last 50 years.
[04:41] Healthcare costs can’t be carried at the social level which causes non-affordability at the individual level.
[07:15] The same exact medical service, when provided by several different sources, will yield an extremely wide variation of cost to the patient. Markets create health disparities.
[10:01] A core challenge of health care is that it was created in a culture of capitalism, which creates a competitive system.
[13:26] Under a rate-regulated model, the mindset of the provider community could shift to worrying about total cost of care.
[14:21] Large children’s hospitals in downtown areas tend to receive kids who can’t get care anywhere else
[16:04] Models need to take into account social and relational acuity, which may be far more important for children, and some adults, than medical acuity.
[17:01] In a rate-regulated world, providers will naturally go where cost is lowest in their portfolio.
[30:16] One thing we could learn from pediatric medicine is that intervention and early investment are part of a road map to thriving in life.
[35:52] In order to get closer to an accessible and affordable system, we must look at the whole person and whole community.
Links | Resources:
Mark Wietecha biographical information
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Tuesday Oct 26, 2021
Tuesday Oct 26, 2021
Tom Robertson, Executive Director of the Vizient Research Institute sits down with Mark Wietecha, CEO of the Children’s Hospital Association to discuss the similarities and differences between adult medicine and pediatrics, with particular attention to settings involving tertiary care, research and education. Mark describes epidemiological differences between adult and pediatric populations and discusses the implications for health system design. The session closes with a conversation around social determinants of health and the poignant topic of end-of-life care.
Guest speaker:
Mark Wietecha, MS, MBA
CEO
Children’s Hospital Association
Moderator:
Tom Robertson
Executive Director
Vizient Research Institute
Show Notes:
[01:40] Health care affordability is impacted by the costs associated with investments in technological advancements that were made over the last 50 years.
[04:41] Healthcare costs can’t be carried at the social level which causes non-affordability at the individual level.
[07:15] The same exact medical service, when provided by several different sources, will yield an extremely wide variation of cost to the patient. Markets create health disparities.
[10:01] A core challenge of health care is that it was created in a culture of capitalism, which creates a competitive system.
[13:26] Under a rate-regulated model, the mindset of the provider community could shift to worrying about total cost of care.
[14:21] Large children’s hospitals in downtown areas tend to receive kids who can’t get care anywhere else
[16:04] Models need to take into account social and relational acuity, which may be far more important for children, and some adults, than medical acuity.
[17:01] In a rate-regulated world, providers will naturally go where cost is lowest in their portfolio.
[30:16] One thing we could learn from pediatric medicine is that intervention and early investment are part of a road map to thriving in life.
[35:52] In order to get closer to an accessible and affordable system, we must look at the whole person and whole community.
Links | Resources:
Mark Wietecha biographical information
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Tuesday Sep 28, 2021
Tuesday Sep 28, 2021
Tom Robertson, Executive Director of the Vizient Research Institute and Dr. Marc Boom, President and CEO of Houston Methodist, return to compare the U.S. health care system to other countries, contemplate challenges rooted in the fragmented financing system, and discuss the importance of addressing health disparities and traditionally under-funded areas such as mental health.
Guest speaker:
Marc L. Boom, MD, MBA, FACP, FACHE
President and CEO
Houston Methodist
Moderator:
Tom Robertson
Executive Director
Vizient Research Institute
Show Notes:
[04:14] Health care is closer to being a right versus a privilege.
[5:10] We have a health care structure where health care in the United States fills in an inadequate social safety net but isn’t designed for that, so we pay for it from a societal standpoint.
[05:23] When we look at health care from a societal standpoint, we don’t have the results other countries have, but Dr. Boom firmly believes that if you are really sick, there’s nowhere better to be than the United States.
[05:50] The U.S. should pilot health care rate regulation to see what works.
[09:40] No one would design the payment system we have in the U.S. today. It’s grossly inefficient, unfair and it drives decision-making to situations that doesn’t make sense.
[10:13] Need to address access issues and coverage. Data shows with Obamacare more people are covered, but not in every state because societally or politically we cannot answer how to get there. That’s fundamentally what we must do as a society so changes can be made.
[11:47] Need to think about our communities as a population, and not make decisions based on where people are with insurance.
[14:15] Need to redesign how we think about health care societally and hold accountability for broad-based health of a population.
[14:45] Need to address the fundamental underpinning issues of poverty and how it affects access to health care.
[15:43] Care needs to be a multidisciplinary team with social workers, case managers, mental health workers especially around complex care.
[16:14] Cost of pharmaceuticals and devices impacts the cost of care.
[16:24] Example: TAVR is a minimally invasive way to replace an aortic valve. The cost for the hospital system plummeted when it was introduced. People should be saving tons of money because there’s less time in the hospital, but instead the manufacturers priced the devices to fill in the entire price gap.
[17:03] Example: Hepatitis C therapy
[21:16] We’re in the business to deliver unparalleled safety, quality, service and innovation.
Links | Resources:
Marc L. Boom biographical information Click here
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Tuesday Sep 21, 2021
Tuesday Sep 21, 2021
Tom Robertson, Executive Director of the Vizient Research Institute sits down with Marc Boom, MD, President and CEO of Houston Methodist, to discuss Dr. Boom’s unique perspectives developed through his experiences managing the health care needs of a major population center during devastating hurricanes. Dr. Boom compares the stresses posed by natural disasters to the duress encountered during the COVID pandemic and focuses on the importance of communication, culture, and trust to support staff resiliency.
Guest speaker:
Marc L. Boom, MD, MBA, FACP, FACHE
President and CEO
Houston Methodist
Moderator:
Tom Robertson
Executive Director
Vizient Research Institute
Show Notes:
[01:28] Houston Methodist has experienced many natural disasters: Tropical storm Allison flooded the main hospital and it took years to recover, fallout from Katrina by caring for evacuees, Hurricane Rita where evacuating the city was worse than the actual event and Hurricane Harvey dumped 51 inches on the city.
[03:04] For the health system, the biggest vulnerability in a disaster is the people and staffing. Then it is supply chain which was obvious in the COVID pandemic. There’s planning for this, but when the infrastructure of power or water goes down that causes problems.
[04:36] The less sophisticated, less disaster hardened facilities such as dialysis centers in the city won’t be able to function without power and water and will shut down in disasters. Houston Methodist then goes into triage mode to handle their dialysis patients.
[05:30] Texas legislature recently made sure the dialysis centers got on the power grid, so hopefully in the future they will be able to handle their own patients during disasters.
[07:29] Competition is healthy, but it needs to be thoughtful. We can’t create a pricing structure that disadvantages the institutions that are the safety nets that keeps things going when disasters strike. But you can’t price out of existence the smaller entities.
[10:24] Staff resiliency is important, and you must give them a chance to recover
[11:52] COVID is a totally different type of disaster because of its longevity.
[11:52] When you have the right culture in place, the right things happen. When you have the baseline culture, people will step up when the going gets tough.
[12:45] Communication is key because that comes with trust which is earned by leadership, the institution and the culture over many years. If you don’t have the culture and trust to begin with, you’ll have trouble during the tough times.
[15:03] At the beginning of COVID, Houston Methodist had a strong balance sheet, so they committed to no layoffs, pay cuts or furloughs.
[15:27] Throughout the pandemic, they implemented a lot of soft practices: spiritual care, bonuses, a day off for all employees, Astros tickets, etc. Every single week there was something fun. Those things matter, and it helped recharge the staff.
Links | Resources:
Marc L. Boom biographical information Click here
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Tuesday Aug 24, 2021
Tuesday Aug 24, 2021
Tom Robertson, Executive Director of the Vizient Research Institute and Mark Keroack, MD, CEO of Baystate Health, pick up on a theme introduced in episode one and consider the frequency with which traditional financing is misaligned with the best interests of the patient. They then discuss the interpersonal dynamics involved in leading a complex health care organization. Mark describes the importance of respect, particularly when viewpoints differ. The session closes with an inspiring bit of history that you won’t want to miss.
Guest speaker:
Mark A. Keroack, MD, MPH
President and CEO
Baystate Health
Moderator:
Tom Robertson
Executive Director
Vizient Research Institute
Show Notes:
[02:24] Guaranteeing some kind of basic set of health care delivery, I think, would have a lot of promise.
[04:37] Baystate Health is the tertiary care provider for a million people.
[06:53] We ran the S-curve analysis at Baystate in the third month I was here, and people’s jaws dropped
[07:22] If 90% of your margin comes from 15% of your patients, you want to accept transfers of referral-based surgeries and very sick people in ICUs.
[08:15] For the Medicaid patients, you want to take risks on them to keep them out of the hospital because you’re going to lose money on every case. They need to be healthy and at home.
[11:00] Health care is an irrational system where your instincts about doing the best for patients will often cause you to lose money, and your instincts of containing care in order to make a margin, may actually cause you to do things that might not be in the best interests of the patients.
[11:30] Baystate Health has a physician leadership academy to teach physician leaders the business of health care: budgets, working in teams, strategy and how to do a business plan. They are really committed leaders who care about the institution.
[12:32] To work in a large, complex academic medical center, you need to be willing to try to understand where other people are coming from and put yourselves in their shoes.
[12:32] Book recommendation: “Heroic Leadership” by Chris Lowney. It is a history of the Jesuit order and a biography of St. Ignatius of Loyola.
[13:40] St. Ignatius of Loyola had four key cornerstones to his culture: 1. A sense of self-awareness; 2. He highly prized ingenious, ingenuity and creativity; 3. Heroic ambitions and 4. “You need to see “God’s love in every living thing”
[14:45] When someone is diametrically opposed to your point of view, rather than write them off as clueless, try to understand why this smart person might think differently. Even if you end up disagreeing with them, they will end up feeling respected.
Links | Resources:
Mark A. Keroack biographical information Click here
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Tuesday Aug 17, 2021
Tuesday Aug 17, 2021
Tom Robertson, Executive Director of the Vizient Research Institute sits down with Mark Keroack, MD, CEO of Baystate Health in Springfield, Massachusetts to discuss a number of possible long-term changes arising from the COVID pandemic including workforce issues and patient preferences for virtual care. Mark offers his perspectives on the impact that health care spending has on the rest of the economy and shares a hope that the pandemic may leave in its wake a greater spirit of togetherness in the industry.
Guest speaker:
Mark A. Keroack, MD, MPH
President and CEO
Baystate Health
Moderator:
Tom Robertson
Executive Director
Vizient Research Institute
Show Notes:
[01:24] Big changes happen in pandemics
[02:22] All of a sudden, workplace safety, workplace wellness, diversity and inclusion have become a top priority for the CEO. Health care will be demographically challenged in the next generation of workers. So they are focusing on the team so the team can focus on the patient.
[03:26] Virtual visits are here to stay. It will be interesting to see how it is integrated and how it extends the work. Managers are determining who will work remotely full time.
[04:18] Payers and the government will look to health care to recoup some of the savings from remote working because of the amount of spend in the country. There may be an incremental increase in the level of government involvement in health care.
[04:45] We may come out of the pandemic with a greater sense of community and a greater sense of social connectedness.
[06:50] You can get work done as a team on a Zoom call. I think that the use of face-to-face meeting time will have to be different if we ask people to take the trouble to commute in.
[10:32] In America, the states are running a lot of health care policy. Different states try different things, and we can learn from each other and will copy what works for other states.
[11:19] Things that work in health care are quality improvement and patient safety.
[12:02] It’s easy to make money doing the “wrong thing” and hard to make money doing the “right thing.”
[12:16] What health care gets wrong: Other countries run on a fee-for-service backbone, but they don’t have that variability by diagnosis or the variability by payer class that we do in America, and it causes us to over-invest in some kinds of care and under-invest in others.
[13:40] High quality can coexist with moderate prices.
[16:28] I’m proud of Baystate’s strategy for population health.
Links | Resources:
Mark A. Keroack biographical information Click here
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