>>We might be able to compare
it to national average of 29.9%. there are still plenty of room
for improvement when it comes to dealing with the adverse effects
of obesity in the state. turning over to current smokers.
when the data here, you’re classifyied being a current
smoker. there’s quite divide between
Detroit and the Tacoma regions here.
the trend in Detroit has been fairly flat across that time
period. in the Tacoma region, we see a
positive trend from 2013 to 2016 with a drop in smokeing prefer
lens down to about 16% in 2016. highlights another area of
potential improvement for the stateed as a a whole. from 2013 to 2016, we see this
trend down to about a state average of 8.7 in 2016.
notably below the national average in 2016 which was 11.9%.
positive health marker in terms of our community.
now with greater coverage, we might also anticipate that
people might have easier way to access care and have increase in
utilization. what we see here is the number
of individuals reporting that the they could not access their
healthcare services due to preventive costs.
that has been trending downward for the state here looking at
the Tacoma region. we see similar story from 2014
to 2016. we see similar trend for the
Detroit region from 2013 through 2015. we see a positive trend.
so 2013 through 2015 we’re move moving in the right direction. WE SEE A POSITIVE TREND HERE.
BACK IN 2013, WE — 2011 WE HAD 33%
POPULATION. THAT HAS FALLEN DOWN TO 26% IN
2016. A POSITIVE TREND GIVEN POTENTIAL
BENEFITS OF EARLY DETECTION OF POTENTIAL HEALTH ISSUES THAT
PEOPLE CAN HAVE WITH ROUTINE CHECK UPS. WE HAVE PERCENTAGE POPULATION
THAT THEY ONLY HAVE FAIR OR POOR HEALTH.
THAT’S BEEN FAIRLY STABLE. WHAT’S INTERESTING HERE,
CONSISTENTLY HIGHER IN THE DETROIT, MORE INDIVIDUALS RATE
ING THEMSELVES FAIR OR POOR THAN
THEY DO IN THE TACOMA REGIONS. WHAT’S INTERESTING GIVEN WHAT WE
SAW IN THE LUST COUPLE OF SLIDES WE HAVE INCREASEED COVERAGE, WE
HAVE INCREASE ACCESS IN UTILIZATION.
WE HAVE MORE ROUTINE VISITS. WE DON’T RATE OURSELVES HAVING
BETTER HEALTH. I WILL TURN IT BACK OVER TO
KEVIN.>>>>WE’LL CONTINUE TO LOOK AT
TRENDS IN UTILIZATION. SHIFTING OUR FOCUS TO THE
HOSPITAL SECTOR. THE NEXT SECTION FOCUSES ON USE
AND EXPENDITURES IN IN THE HOSPITAL
SECTOR. THIS DATA COMES FROM THE
AMERICAN HOSPITAL ASSOCIATION. THEY ARE COLLECTING DATA ON ALL
THEIR MEMBERS. WE ARE TAKING THIS DATA AND
SEGMENTING BILL LOCATIONS OR LOOKING AT GRAND RAPIDS.
THAT’S THE LIGHT BLUE LINE. WE’RE LOOKING AT DETROIT WHICH
IS THE GREEN LINE. THE U.S. AS A WHOLE NATIONAL
AVERAGE, THAT’S THE DARK BLUE LINE.
WE CALL THE BENCHMARK WHICH IS CAN THE RED LINE.
THE BENCHMARK IS MADE UP OF AN AVERAGE OF HOSPITAL OUTCOMES IN
BUFFALO, NEW YORK, ROCHESTER, NEW YORK, WISCONSIN AND KENTUCKY
KENTUCKY. IF YOU LOOK AT THINGS LIKE
POPULATION DEMOGRAPHICS INCLUDE INCLUDING AGE, THE PROPORTION OF
POPULATION OVER AGE 65, YOU LOOK AT INDUSTRY OF EMPLOYMENT.
THOSE ARE THE AREAS IN THE U.S. THAT MATCH PRETTY CLOSELY WITH
GRAND RAPIDS. SOME PEOPLE GET THE CARE THEY
COULD GET IN OTHER REGIONS. THIS TENDS TO BODE WELL FOR THE
COMMUNITY .
HAVING LOW RATE HOSPITAL AD ADMISSIONS IS A POSITIVE SIGN
FOR SPENDING HEALTHCARE IN THE REGION.
HOSPITAL EXPENSES FOR ADMISSION. THIS IS NOT THE COST YOU PAY.
THIS IS WHAT HOSPITALS SAY ON AVERAGE.
IT COST TO TREAT A PATIENT THAT COMES IN THE HOSPITAL.
THIS IS THE COST FROM THE HOSPITAL’S PERSPECTIVE.
ALL OF THESE AREAS, GRAND RAPIDS RAPIDS, DETROIT, NATIONAL
AVERAGE, THEY ARE GROUPED TOGETHER.
THESE COSTS ARE RISEING OVERTIME . IF YOU THINK ABOUT WHO IS NOT
GOING TO THE HOSPITAL ANYMORE, MAYBE IT’S THE HEALTHYIER PEOPLE
LEAVING SICKER PEOPLE TO THE HOSPITAL.
IT COULD BE THE DISEASE BURDEN THE POPULATION FOR HOSPITAL AD
ADMISSIONS IS INCREASEING. IT COULD BE INEFFICIENCYIES
INVOLVEED. IT’S NOT CLEAR WHAT THE REASON
IS. WE DO SEE SUBSTANTIAL GROWTH IN
HOSPITAL EXPENSES. THAT’S HAPPENING ALL THROUGHOUT
THE COUNTRY. IT DOESN’T NECESSARILY MEAN YOU
HAVE TO GO TO HOSPITAL TO GET CARE.
IT MEANS YOU RECEIVEED CARE THROUGH A PROVIDEER WHO IS PAID
UNDER THE OUTPATIENT PERSPECTIVE PAYMENT SYSTEM.
PROTESTANT ITHE PROVIDEER WAS AFFILIATEED WITH
THE HOSPITAL. IF YOU LOOK AT THE NATIONAL
AVERAGE, THIS IS THIS HAS RISEN SLIGHTLY BUT STEADY OVER THE
TIME SPAN. SOMETHING LIKE 2000 VISIT PER
THOUSAND POPULATION IN 2005. WHERE YOU SEE REAL GROWTH IS IN
MICHIGAN, IN DETROIT AND IN WEST MICHIGAN.
IN FACT, IN BOTH OF THOSE REGION REGIONS, USE OF OUTPATIENT
HOSPITAL SERVICES HAS DOUBLEED OVER THIS 11 OR 12-YEAR PERIOD.
DOES THAT MEAN PEOPLE ARE USEING MORE CARE, ARE WITH YOU DOUBLE
ING AMOUNT OF CARE?
PROBABLY NOT. WE CAN’T TELL EXACTLY FROM THE
DATA. PROBABLY THIS TREND REPRESENTS
AN INCREASE IN AFFILIATION WITH HOSPITAL SYSTEMS THROUGHOUT THE
STATE OF MICHIGAN, PROVIDEERS AFFILIATEING WITH HOSPITALS.
YOU MAYBE GOING TO GET CARE AT YOUR PHYSICIAN OFFICE.
IF THE PHYSICIAN IS AFFILIATEED WITH THE HOSPITAL SYSTEM, THAT’S
GOING TO COUNT AS AN OUTPATIENT HOSPITAL ADMISSION.
THAT’S PROBABLY PICKLED UP IN THE MICHIGAN DATA SINCE WE’RE
NOT SEEING THAT INCREASE IN THE BENCHMARKING COMMUNITY OR THE
NATIONAL AVERAGE. EMERGENCY DEPARTMENT VISITS, WE
TRACK VERY CLOSELY IN WEST MICHIGAN WITH THE NATIONAL
AVERAGE AND BENCHMARK COMMUNITIES.
DETROIT IS A CLEAR OUTLIER HERE.
THIS IS GOING TO SHOW UP THROUGHOUT THE EXPENDITURE
METRICS THAT WE’LL LOOK AT TOO. THE MORE EMERGENCY DEPARTMENT
CARE YOU USE, THAT TENDS TO COROLLATE WITH HIRE EXPENDITURES
EXPENDITURES. WE’LL SEE THAT SHOWING UP.
MEDICARE EXPENDITURES, THIS IS TRYING TO GET A SENSE OF WELL,
FOR THE POPULATION THAT IS OVER THE AGE OF 65, HOW MUCH ARE WE
SPENDING PER PERSON PER YEAR IN THIS POPULATION?
HOW MUCH IS THE FEDERAL GOVERNMENT PAYING FOR CARE FOR
SOMEONE IN THIS POPULATION. THIS IS THE PATTERN WE’RE SEEING
HERE HAVE BEEN PRIOR TO THE YEARS INCLUDEED IN THE SLIDE
HAVE BEEN INCREASEING EXPENDITURES.
THE AVERAGE PERSON IN IN MEDICARE,
THEIR EXPENDITURES WERE GROWING OVERTIME.
IN THE LAST FEW YEARS WE’VE SEEN THAT DECLINE.
THE INCREASEING AGEING OF THE POPULATION THAT A LOT OF PEOPLE
TURNING 65. THE BEAM ARE MEDICARE AND LOWER
END OF THE AGE DISTRIBUTION TEND TO BE LOWER COST MEDICARE PEOPLE
PEOPLE. THIS COULD BE DRIVEING SOME OF
THE COSTS. PEOPLE MIGHT ARGUE THAT IT’S
MEDICARE ADVANTAGE. THERE’S BEEN A BIG EXPANSION IN
MEDICARE ADVANTAGE, MEDICARE ADVANTAGE WHICH IS INCLUDEED IN
THIS DATA, EXPENDITURES FOR PEOPLE WITH MEDICARE ADVANTAGE
MAYBE BETTER AT MANAGEING CARE OR
REDUCEING EXPENDITURES. GRAND RAPIDS COMES IN LINE WITH
THE BENCHMARK HERE. WE’RE BELOW THE NATIONAL AVERAGE
AND FAR BELOW DETROIT. ON AVERAGE FOR MEDICARE PATIENT
IN THE GRAND RAPIDS REGION, IT’S ABOUT $9500 A YEAR THAT THE
AVERAGE PERSON IS USEING THE CARE
CARE. COMPAREED TO DETROIT WHICH IS
CLOSER TO $10,500.
I LIKE TO PUT IN SOME MEASURE OF QUALITY.
HERE’S A NICE MEASURE OF QUALITY QUALITY.
THIS IS AMBULATORY CARE. IT’S USEED AS OVERALL MARKER OF
EFFICIENCY OF CARE. HERE YOU WANT THE NUMBER TO BE
LOWER AS OPPOSEED TO HIGHER. THE FACT THAT GRAND RAPIDS IS
THE LOWEST OF THESE COMPARISON REGIONS, THAT’S A GOOD THING.
IN AMBULATORY CARE SENSEITIVE DIS
DISCHARGE YOU WERE DISCHARGEED FROM THE HOSPITAL THAT COULD
HAVE BEEN TREATED IN OUTPATIENT SETTING.
MEASUREING THE EFFICIENCY OF CARE
CARE. WE HAVE IN GRAND RAPIDS, COMPARE
COMPARED TO OTHER COMMUNITIES, FEWER AMBULATORY CARE.
NOW SHIFTING FOCUS AGAIN. WE’RE GOING TO LOOK AT MAJOR
MEDICAL CONDITION. THIS IS FOCUSING ON PEOPLE WITH
CHRONIC CONDITIONS. THIS IS USEING DATA FROM
BLUECROSS BLUESHIELD OF MICHIGAN MICHIGAN, BLUE CARE NETWORK AND
PRIORITY HEALTH. THE POPULATION TO KEEP IN MIND,
THE POPULATION THAT WE’RE LOOKING AT HERE, THESE ARE
PEOPLE BETWEEN THE AGES OF 18 AND 65 FOR THE MOST PART.
PEOPLE THAT ARE DIAGNOSEED WITH ONE OF SIX CHRONIC CONDITION.
WE’LL LOOK AT THE EXPENDITURES AND USE FOR THE CHRONIC
CONDITIONS. WE’RE GOING TO COMPARE GRAND
RAPIDS AND DETROIT. ALL OF THESE MEASURES ARE
LOOKING AT PER MEMBER PER YEAR USE. HERE ARE THE CONDITIONS WE TRACK
TRACK. WE LOOK AT ASTHMA, DEPRESSION,
DIABETES, LOW BACK PAIN AND WE HAVE COMPARISONS WHAT ARE CALLED
HEALTHY MEMBERS WHICH ARE PEOPLE WHO DO NOT HAVE A DIAGNOSIS OF
THESE CONDITIONS BETWEEN AGES 30 AND 39.
THERE’S LOT OF THINGS SHOWING UP HERE.
IF YOU JUST LOOK AT THE TRENDS OVER TIME, YOU’LL NOTICE A
PATTERN. EXPENDITURES FOR PEOPLE WITH
THESE CONDITION HAVE INCREASEED OVERTIME.
LAST COUPLE OF YEARS WE HAD REALLY LARGE INCREASES IN
EXPENDITURES FOR CORONARY ARTERY DISEASE.
LAST YEAR USEING THE DATA FROM 2016, CORONARY ARTERY DISEASE
EXPENDITURE IN WEST MICHIGAN WERE APPROACHING $30,000 PER
PERSON WHO WAS DIAGNOSEED WITH THAT CONDITION.
WHAT YOU SEE THIS YEAR FOR CORONARY ARTERY DISEASE IS
DECLINE IN EXPENDITURES. THAT’S REALLY THE FIRST TIME
THAT WE’VE SEEN THAT HAPPENING SINCE WE’VE BEEN TRACKING THIS
DATA THAT EXPENDITURES FOR THE CHRONICALLY ILL POPULATION HAS
DECLINEED FROM ONE YEAR TO THE NEXT.
FOR CORONARY ARTERY DISEASE. NOT SOMETHING WE’RE USEED TO SEE
SEEING. UNFORTUNATELY THE DATA WE GET
DON’T ALLOWS TO UNDERSTAND WHAT IS CAUSEING THIS DECLINE.
YOU CAN SPECULATE THERE ARE FEW THINGS THAT MIGHT BE DRIVEING
THIS. THERE MAYBE PRICEING CHANGE OR
UTILIZATION CHANGE OR MAYBE THIS IS A HEALTHYIER GROUP OF PEOPLE
WHO WE’RE LOOKING AT NOW THIS ARE SHIRRED SHIR INSUREED BY
PRIORITY HEALTH. IT’S A GOOD SIGN TO SEE
EXPENDITURES FALL. IN THIS FIGURE, WE’RE AGAIN
TAKING THE SAME EXPENDITURES THAT I SHOWED YOU BEFORE NOW
WE’RE LOOKING AT THE COMPONENT THAT IS DUE TO PRESCRIPTION
MEDICATIONS. WE’RE ALL CONCERNED WITH PRICES
IN EXPENDITURES IN PRESCRIPTION MEDICATION.
IF YOU TAKE THE AVERAGE PERSON WHO HAS ANY ONE OF THESE
CONDITION BEES U TAKE — CONDITIONS YOU LOOK AT WHAT
SHARE OF THE EXPENDITURES ARE DRIVEN BY PRESCRIPTION PLED CASE
CASE. — MEDICATION.
THAT’S THE RED BOX HERE. THE OTHER COSTS ARE SHOWN IN
BLUE. DIABETES IS THE CONDITION THAT
HAS LARGEST RELIANCE ON PRESCRIPTION DRUG AND HAS HIGH
HIGHEST SHARE OF EXPENDITURES. IT’S ABOUT A QUARTER .
THIS IS SOMETHING NEW WE ADDED LAST YEAR. THIS IS GOING TO GET MUCH MORE
INTERESTING WHEN WE HAVE FEW MORE YEARS OF DATA TO TRACK THIS
THIS. DO YOU WE COMPARE WITH THE
DETROIT REGION? TAKING KENT, OTTAWA, AND COMPARE
COMPARING THEM TO THE DETROIT METRO AREA.
YOU CAN SEE THAT EXPENDITURES TEND TO BE LOWER AND HAVING ONE
OF THESE CHRONIC CONDITIONS. EXPENDITURE TEND TO BE LOWER ON
THE WEST SIDE THAN THE EAST SIDE OF THE STATE.
THIS HAS BEEN THE TREND THAT’S PREVAILED WHEN WE LOOKED AT THIS
IN THE PAST ALTHOUGH FOR CERTAIN CONDITIONS IT TEND TO FLUCTUATE. THE PART THAT I THINK IS MOST
INTERESTING WHEN YOU TAKE THESE EXPENDITURES AND UTILIZATION
MEASURES AND YOU BREAK THEM DOWN TO SHARE WHAT THE GEOGRAPHIC
VARIATION AND MEASURES LOOKS LIKE.
WE TAKE — IN THIS CASE WE’RE LOOKING AT CORONARY ARTERY
DISEASE. WE LOOK AT HOW THAT VARYIES
DIFFERENT ZIP CODES THROUGHOUT THE STATE.
WE CONTROL FOR SOME THINGS HERE. THIS ISN’T JUST RAW EXPENDITURE.
WE TAKE THE ZIP CODE EDUCATION LEVEL, THE AVERAGE AGE IN THE
ZIP CODE. WE CAN — WE CONTROL SOME OF
THESE THINGS ZIP CODE TO ZIP CODE.
YOU CAN THINK OF THESE EXPENDITURES AS AVERAGE
EXPENDITURES, CONDITIONAL ON AGE AGE, EDUCATION AND INSURANCE
STATUS IN A ZIP CODE.
RED, THAT’S GOING TO REPRESENT HIGHER EXPENDITURES, GREEN WILL
REPRESENT LOWER EXPENDITURES. FOR SOMETHING LIKE CAD SPENDSING
YOU SEE A REALLY WIDE VARIATION IN SPENDING BY ZIP CODE.
IF YOU’RE IN THESE DARKEST GREEN ZIP CODE, ON AVERAGE WE’RE SPEND
SPENDING BETWEEN 15 AND $23,000 A YEAR IF YOU HAVE CORONARY
ARTERY DISEASE. COMPAREED TOOTH RED TO THE RED
ZIP CODE. SOME OF THE VARIATIONS IS HAPPEN
HAPPENING ACROSS PRETTY SMALL GEOGRAPHIC UNITS UP.
GO FROM ONE ZIP CODE TO THE NEXT AND YOU MAY DOUBLE SPENDING ON
AVERAGE IN SOME CASES. THOSE WHO ARE MORE FAMILIAR WITH
THE AREA MAY SEE PALLET EARN PATTERNS HERE I
DON’T SEE. AS WE LOOK THROUGH THIS, THE
EAST SIDE SUPPORT STATE TEND TO HAVE HIGHER EXPENDITURE AND HIGH
HIGHER UTILIZATION THAN THE WEST SIDE.
ZIP CODES TO THE NORTHEAST AND SOUTHWEST OF GRAND RAPIDS TEND
TO HAVE HIGHER EXPENDITURES AND HIGHER UTILIZATION.
HERE IS DIABETES AND SAME OUTCOME.
WE SEE KIND OF A LOT OF THAT REGIONAL VARIATION.
YOU SEE MORE GREEN ON THE WEST SIDE OF THE STATE THAN ON THE
EAST SIDE OF THE STATE. HERE IN YOU’RE IN IN THE LOWEST
SPENDING GROUP, YOU’RE SPENDING AROUND 15 OR $16,000 PER YEAR.
COMPAREED TO UP TO $20,000 FOR SOMEONE WHO IS LIVEING IN ONE OF
THOSE RED ZIP CODES. PRESCRIPTION ISINGEDING IS
ACCOUNTED FOR THIRD OVERALL SPENDING. THIS IS
NOT JUST DIABETES PRESCRIPTION EXPENDITURES.
THIS IS PRESCRIPTION EXPENDITURE EXPENDITURES OVERALL FOR SOMEONE
DIAGNOSEED WITH THIS CONDITION. BUT ON AVERAGE, THIS IS LOOKING
AT THE NUMBER OF FILLS PER YEAR. YOU’RE HAVING 55 TO 65 FILLS IN
THE LOW REGION COMPAREED TO 70 TO
8 FEATURE FILLS IN THE HIGH REGION.
THAT REPRESENTS ONE MORE ADDITIONAL PRESCRIPTION PER YEAR
THAT’S FILLED 12 TIME IT IS YOU LEVELING IN ONE OF THOSE RED ZIP
CODES. THIS IS REALLY INTERESTING
DISPARITY BETWEEN EAST AND WEST SIDE HERE IN UTILIZATION RATES
FOR PRESCRIPTION MEDICATIONS. LASTLY, SOMETHING WE WERE ABLE
TO ADD THIS YEAR, THIS THE FIRST TIME WE’VE HAD DATA.
THIS LOOKING AT TELEHEALTH VISIT VISITS.
ANNUAL VISITS FOR A PERSON WHO HAS A DIABETES DIAGNOSIS.
THE TAKE AWAY HERE IS THAT OVER OVERALL, TELEHEALTH IS STILL, AT
LEAST FOR SOMEONE WHO HAS A DIABETES DIAGNOSIS IS STILL NOT
WIDELY USEED. THERE’S A MUCH GREATER RELIANCE
ON TELEHETH ON THE WEST SIDE THAN THE EAST SIDE.
THIS MAY CORRESPOND TO RURAL VERSUS URBAN, DIFFERENCES YOU
SEE MORE RURAL ZIP CODES HAVING HIGHER USE OF TELEMEDICINES.
THIS IS ONE THOSE OUTCOMES THAT WILL BE INTERESTING TO SEE HOW
THIS DEVELOPS OVER TIME. AND WHAT THIS USEAGE LIKES LIKE
OVERTIME. FIRST YEAR WE HAD ABILITY TO
LOOK AT THIS. ALREADY STARTING TO SEE
INTERESTING THINGS HERE. IT WILL BE HELPFUL TO SEE HOW
THIS GROWS OVERTIME. I THINK I’M OUT OF TIME.
WE WILL END THE PRESENTATION THERE.
HAPPY TO TAKE SOME QUESTIONS IF ANYONE HAS IT. FIRST QUESTION HERE THAT’S A
REALLY GOOD QUESTION, IT’S SOMETHING WE DISCUSSED PUTTING
THIS REPORT TOGETHER. MENTAL HEALTH.
MENTAL HEALTH IS NOT PART OF THE REPORT.
THE IMPACT IT HAS ON ALL ASPECTS OF HEALTH CHECK.
CAN WE TALK LITTLE BIT ABOUT MENTAL?
I AGREE COMPLETE WELL THIS. THIS IS SOMETHING THAT NEEDS TO
BE INCLUDEED IN THE REPORT. WE NEED TO HAVE SOME MEASURE OF
USE AND EXPENDITURES FOR MENTAL HEALTH, HOW MENTAL MENTAL HEALTH
MAY IMPACT.
WE DO INCLUDE DEPRESSION IN THERE.
THAT’S A ROUGH MEASURE OF MENTAL HEALTH.
WE CAN DO MORE TO TEASE OUT SOME OF THE ADDITIONAL CONCERNS THAT
COME ALONG WITH THAT. THERE ARE SOME THINGS IN THE
BOOK THAT I DIDN’T INCLUDE IN THE PRESENTATION THAT LOOK A
LITTLE MORE INTO HOW COMORBIDITY COMORBIDITIES INTERACT AND HOW
THAT DRIVE SPENDING. IF YOU HAVE DEPRESSION AND OTHER
CONDITION, HOW DOES THE COMBINATION OF THOSE THINGS
CHANGE EXPENDITURES. SOME OF THAT IS IN THE BOOK.
I COMPLETELY AGREE THAT WE CAN DO MORE TO LOOK AT MENTAL HEALTH
ISSUE.>>WE GOT A CLARIFICATION
QUESTION ABOUT WHETHER OR NOT DETROIT DATA IS FOR THE REGION
OR JUST FOR THE CITY? IN TERMS OF THE HEALTHCARE OVER
OVERVIEW, THAT’S FOR THE DETROIT REGION CONSISTING OF THE COUNTY
COUNTIES OF MACOMB, OAKLAND AND WAYNE COUNTYIES.
>>WE HAVE ANOTHER QUESTION ON READMISSION.
HAVE YOU STUDYIED HOSPITAL READ READMISSIONS?
IN THIS REPORT NO, IN MY OWN RESEARCH YES.
IT’S A REAL QUESTION. BECAUSE MEDICARE EFFORTS TO
REDUCE READMISSIONS. THERE HAVE BEEN SEVERAL OF US
DOING RESEARCH IN THAT AREA AND LOT OF THAT RESEARCH JUST
POTENTIALLY GOT UP ENDED BY A NEW PAPER THAT CAME OUT OF ABOUT
A WEEK AGO SAYING WE’VE ALL BEEN MEASUREING READMISSIONS IN
INCORRECTLY. THAT WAS A BIT SURPRISEING BUT
APPARENTLY THERE WAS ANOTHER CODEING CHANGE THAT HAPPENED.
YOU ACCOUNT FOR THE CODEING CHANGE THAT TENDS TO WIPE OUT
THE IMPROVEMENTS WE’VE SEEN IN READMISSIONS THAT MOST OF US
WERE ATTRIBUTEING TO THE HHRP. IT’S AN AREA KIND OF THAT
PARTICULAR INTEREST IN. WE HAVE NOT LOOKED AT THAT
SPECIFICALLY FOR WEST MICHIGAN OR DETROIT.
I THOUGHT THIS MIGHT COME UP. SOMEBODY ASKED ABOUT THE VAPEING
. WE SHOW SMOKEING RATES BUT NO
INFORMATION ON VAPEING. VAPEING IS ANOTHER AREA THAT I
HAVE INTEREST IN TOO. I STUDYIED SOME EFFECTSFUL
CIGARETTE TAX. VAPEING IS LITTLE MORE
COMPLICATE COMPLICATED.
IF YOU LOOK AMONGST TRADITIONAL
TOBACCO USE AMONG TEENS IT’S FEW FEWER OF 8% OF TEENS SMOKEING
TRADITIONAL CIGARETTES. VAPEING IS ESCALATEING.
THERE’S CONCERN WHAT ARE THE LONG TERM EFFECTS OF THIS.
WE DON’T KNOW. HOW DO WE TRY AND REDUCE TEEN
USE OF THIS. IT’S A PARTICULARLY CHALLENGEING
ISSUE BECAUSE ON THE ONE HAND, VAPEING CAN BE A TOOL FOR PEOPLE
WHO HAVE BEEN SMOKEING FOR A LONG
PERIODS OF TIME TO STOP SMOKEING TRADITIONAL CIGARETTES WHICH ARE
MORE HARMFUL THAN VAPEING. YOU WANT TO BE CAREFUL NOT TO
INITIATE TEEN USE. I THINK SOME OF THE THINGS FDA
IS DOING TO LIMIT THE FLAVORS I THINK THAT WILL HELP.
WOULD LIKE TO BE ABLE TO — IT INTERESTING TO SEE WHAT THE
TREND LOOKS LIKE IN MICHIGAN. THE DATA THAT I KNOW WHERE YOU
GET INFORMATION ON VAPEING LIKE THE NATIONAL TOBACCO SURVEY YOU
CAN’T GET THE DATA YOU NEED TO SAY WHAT’S HAPPENING IN GRAND
RAPIDS. WE CAN TRACK THAT FOR THE STATE
AND MAYBE THAT’S SOMETHING WE’LL ADD TO THE PUBLICATION NEXT YEAR
YEAR. IT MAKES SENSE STRATEGICALLY TO
PARTNER WITH PROVIDEERS. FINANCIALLY IT MAKES SENSE
BECAUSE YOU CAN INCREASE AND CHARGE A FACILITY FEE AND
INCREASE REIMBURSEMENTS. IF YOU THINK ABOUT CMS TRYING TO
MOVE TOWARDS A WORLD WHERE WE’RE PAYING FOR QUALITY CARE AS
OPPOSEED TO PAYING FOR FEE FOR SERVICE.
IT DOES MAKE SENSE TO PARTNER WITH PROVIDEERS WHO YOU CAN HAVE
MORE CONTROL HOW THE CARE IS DELIVERED AND COORDINATE THAT
CARE BETTER. ONE OF THE INTERESTING POLICY
PROPOSALS HERE AROUND THIS, AROUND THE FINANCIAL ASPECTS OF
THIS COORDINATION IS THE TRUMP ADMINISTRATION HAS PROPOSEED
THIS MUTUAL PAYMENT POLICY THAT MAY
TAKE EFFECT. THERE’S A LAWSUIT NOW THAT MERCY
HEALTH IS TO STOP THIS POLICY. IF THAT GOES THROUGH, MOST OFF
SITES WOULD NO LONGER GET THIS ADDITIONAL PAYMENT.
THEN WE’LL KNOW — THAT WILL GIVE US GOOD SENSE WHETHER THE
PAYMENT POLICY IS DRIVEING CONSOLIDATION OR WHETHER IT’S
CONCERN OVER COORDINATION OF CARE AND BETTER MANAGEMENT
THAT’S DRIVEING COORDINATION. I THINK THAT’S SOMETHING TO LOOK
TO KEEP AN EYE ON. WHAT HAPPENS WITH THIS SITE
NEUTRAL PAYMENT POLICY AND HOW THAT IMPACTS ADDITIONAL
COORDINATION. IS THERE SIMILAR DATA FOR
PEDIATRIC. WE DOESN’T HAVE PEDIATRIC DATA
THERE. THAT’S REALLY IMPORTANT SUBSET
TO CONSIDER FOR FUTURE WORK. HAVE YOU BEEN STUDYING THE
IMPACT OF INCREASE DEDUCTIBLE AND COPAYS?
UTILIZATION? NOT AS PART OF THIS YEAR OWES
REPORT. THERE’S LOT OF WORK BEING DONE
IN THIS AREA. NOTHING THAT WE HAVEN’T INCLUDE
ED THIS YEAR.
>>SOMEONE ASKED TO CLARIFY THE TERMS COST AND EXPENDITURES.
THIS IS REALLY IMPORTANT. WHEN WE LOOK AT THE MEASURE OF
HOSPITAL COSTS FOR EXAMPLE, THAT IS NOT PRICES.
THAT’S NOT THE LIST PRICE OR THE PRICE THAT — IT’S NOT EVEN THE
NEGOTIATEED PRICE THAT INSURANCE IS PAYING.
IT’S WHAT THE HOSPITAL SAYS THE COST OF EMISSION.
IF YOU ASK THE HOSPITAL, ON AVERAGE WHEN YOU ADMIT SOMEONE,
HOW MUCH DOES THAT COST YOU IN TERMS OF RESOURCE AND STAFF.
THAT’S THE COST MEASURE FOR THAT THAT.
FOR THE EXPENDITURE MEASURE FOR THE MAJOR MEDICAL CONDITION
SECTION, THAT IS THE SUM OF WHAT THE INSURANCE COMPANY IS PAYING
TO PROVIDEERS THROUGHOUT THE YEAR
YEAR. WE ADD THAT UP FOR WESTERN THAT
CONDITION. WE DIVIDE BY THE NUMBER OF MONTH
MONTHS AND THAT GIVE US AVERAGE ANNUAL EXPENDITURES.
SOMEONE ASKED ABOUT OUT OF POCKET COSTS.
WE UNFORTUNATELY DON’T HAVE THAT IN THE DATA THAT WE’RE ABLE TO
TRACK WHAT THE CHANGES AND OUT OF POCKET EXPENDITURE.
WE’VE DONE SOME VARY WORK IN THE PAST ASKING PEOPLE AND ASKING
FIRMS WHAT’S YOUR AVERAGE DEDUCTIBLE, WHAT’S YOUR AVERAGE
COPAY AND COINSURANCE RATE. WE WEREN’T ABLATED THAT THIS —
ABLE TO DO THAT THIS YEAR FOR VARIOUS
REASONS. IT’S SOMETHING WE LIKE TO DO IN
THE FUTURE. WE’VE SEEN SOME INTERESTING
RESULTS. I THINK IT’S SOMETHING WORTH
PURSUEING. ANOTHER ONE THAT CAME UP LAST
YEAR, THIS IS SOMETHING THAT WE HAVE TO ADD AND WE DIDN’T THIS
YEAR. WE SHOULD, OPIOIDS.
WHAT’S HAPPENING WITH OPIOID USE USE.
THE QUESTION ASKED, CAN YOU DISCUSS SUICIDE, DRUG USE AND
OPIOID AND OTHER ILLEGAL SUBSTANCES?
IT WAS A YEAR OR TWO NOW, VERY FAMOUSLY THERE WAS THIS
REVELATION IF YOU LOOK AT DEATH RATES FOR WHITES BETWEEN THE AGE
AGES OF 18 AND 49, ESPECIALLY MALES, COMPARE U.S. TO OTHER
COUNTRYIES YOU SEE MORTALITY RATE
RATES RISEING IN U.S. THAT HAS BEEN ATTRIBUTEED TO
OPIOID CRISES. TRACKING OPIOID USE, THE DATA IS
AVAILABLE TO DO THAT. IT’S SOMETHING WE SHOULD ADD AND
WE WILL NEXT YEAR. HOW OPIOID USE IS CHANGEING
MICHIGAN. THING TO KEEP IN MIND LOOKING AT
OPIOID USE DATA, I THINK PEOPLE OFTEN FAIL TO SEE THIS WHEN I
TALK ABOUT THIS SUBJECT IS THAT, OPIOID PRESCRIPTIONS ARE FALLING
OVER THE LAST FOUR OR FIVE YEARS YEARS.
THERE’S FAR FEWER PEOPLE PRE PRESCRIBEED TO OPIOIDS. I DO THINK IT’S A GOOD IDEA TO
GET THE DATA ON OPIOIDS THAT WE CAN GET AND WE CAN SHOW YOU THAT
DATA. THAT’S ONLY ONE PART OF THE
STORY. COMBINEING THAT DATA WITH THINGS
LIKE OVERDOSE DEATHS IT’S IMPORTANT TO THE PUBLICATION.
>>WE HAVE QUESTION REGARD TO PATENTS.
CAN YOU PROVIDE INFORMATION ON DECLINE IN NUMBER OF PATENTS.
IF YOU LOOK AT THE GRAPH, YOU’LL SEE HUGE DECLINE IN THE NUMBER
OF PATENTINGS ISSUEED SINCE 2014 IN THE REGION.
WHILE WE DON’T HAVE GOOD ANSWER FOR WHY WE’VE SEEN THIS DECLINE
BECAUSE IT IS SEEFER AS SEVERE AS IT IS.
NUMBER OF PATTERNS FALLEN AND INSTITUTIONS ISSUEING THESE
PATENTS HAVE DECLINEED DRAMATIC DRAMATICALLY.
THIS IS ON THE FACT THAT WE MIGHT WANT TO MORE R&D RESOURCES
TOWARD THIS AREA IF YOU WANT TO HAVE FUTURE GROWTH NOT ONLY IN
INNOVATION BUT THE ECONOMIC BENEFITS THAT MIGHT COME FROM
THE R&D INVESTMENTS.>>SOMEONE ASKED ABOUT THE
REASON FOR THE DECLINE IN EXPENDITURES.
IS POSSIBLE AVERAGE EXPECT DECLINE DUE TO INSURANCE COMPANY
COMPANIES PAYING HOSPITALS LESS? IT’S POSSIBLE.
WE CAN’T STAY WHAT’S REALLY DRIVEING THIS. WHAT ENTAILS EXPENDITURES, IT’S
PRICE, QUANTITY AND UNDERLINEING CONDITION OF THE PEOPLE WHO ARE
DIAGNOSEED WITH THESE CONDITIONS .
ANY ONE OF THOSE THINGS COULD EXPLAIN THIS.
IT COULD BE THAT THE PRICE IS CHANGEING. WHERE WE ABLE TO HOLD GROUP OF
PEOPLE CONSTANT YEAR TO YEAR. THAT WILL EXPLAIN THE DECLINE IN
EXPENDITURES FOR CORONARY ARTERY DISEASE.
THERE MAYBE OTHER EXPLANATIONS THAT ARE INVOLVEED WITH THAT TOO
. THANK YOU VERY MUCH.
[APPLAUSE]>>WE ARE GOING TO ASK OUR
PRESENTERS TO COME UP HERE AND DIANE WILL PUT THEIR CARDS DOWN.
WE WILL GO ALPHABETICALLY SO WE CAN DO IT IN THAT ORDER.
I HAVE THE DISTINCT PLEASURE OF INTRODUCEING TODAY’S EXPERT
PANEL PANELIST.
WE ARE FORTUNATE TO HAVE THIS ESTEEMED GROUP.
EACH PANEL MEMBER HAS OUTSTANDING ACCOMPLISHMENTS,
MULTIPLE AWARDS AND AN SENTENCE EVERY RESUME.
I CAN GO ON FOREVER. I’M NOT GOING TO.
TO MAXIMIZE MY TIME OUR TIME, I’M GOING TO GO OVER THE BASIC
PIECES ABOUT THEM. YOU’LL SEE FROM THEIR
PRESENTATIONS HOW MUCH EXPERT THEY ARE.
LY GO OUR FIRST PANELIST IS ROB CASALO
CASALOU. COMBINEED TRINITY HEALTH,
MICHIGAN HAS TEN OUTPATIENT HEALTH CENTERS, 12 EMERGENCY
DEPARTMENTS, 17 URGENT CARE FACILITY AND EMPLOYS MORE THAN
20,000 INDIVIDUALS INCLUDEING APPROXIMATELY 3600 PHYSICIANS.
ROB JOINED ST. JOSEPH IN 2008 AS PRESIDENT AND CEO OF BOTH ST.
JOE’S MERCY ANN ARBOR HOSPITALS. WHICH MADE THE TOP 100 TOP
HOSPITAL LIST SEVEN TIMES UNDER HIS LEADERSHIP.
IN 2015 HE WAS NAMEED REGIONAL PRESIDENT AND CEO OF ST. JOES.
ROB IS RECOGNIZEED AS NATIONAL LEADER IN HIS QUALITY IN
COMPASSIONATE CARE. HE EARNED BACHELOR OF ARTS IN
ECONOMICS A MASTERS IN BUSINESS ADMINISTRATION AND A MASTERS OF
HEALTH SERVICE ADMINISTRATION FROM THE UNIVERSITY OF MICHIGAN.
OUR SECOND PRESENTER WILL BE TINA FREESE DECKER WHO IS
PRESIDENT AND CEO OF SPECTRUM HEALTH SYSTEM.
$6.5 BILLION NATIONALLY RECOGNIZEED HEALTH SYSTEM THAT
INCLUDES A MEDICAL GROUP, HEALTH INSURANCE COMPANY AND MULTIPLE
HOSPITALS. TINA IS FOCUSED ON GROWTH,
INNOVATION AND STRENGTHENING COMMUNITY PARTNERSHIPS TO BEST
ADDRESS IMPROVEMENT GOALS ACROSS MICHIGAN.
DURING HER 16 YEARS SERVEING SPECTRUM HEALTH, TINA HAS
DEVELOPED A STRONG REPUTATION OF HER FORWARD THINKING AND STRONG
BUSINESS PRACTICE. TODAY, TINA IS THE PROUD
RECIPIENT OF THE MODERN HEALTHCARE TOP 25 CEO IN 2018.
SHE EARNED BACHELOR OF SCIENCE FROM IOWA STATE UNIVERSITY AND
GRADUATEED WITH A MASTERS OF HEALTH ADMINISTRATION AND
INDUSTRIAL ENGINEERING FROM UNIVERSITY OF IOWA.
OUR FINAL SPEAKER WILL BE DR. RA DR. RAKES H PAI.
AWARD-WINNING LEADER IN COMMUNITY HEALTHCARE.
METRO SERVES 250,000 PATIENTS ACROSS WEST MICHIGAN AND BEYOND.
DR. PAI IS A CARDIOLOGIST WITH CERTIFICATION IN — HE PRACTICEED
IN IDAHO, NEVADA AND OREGON WHERE HE SERVEED AS EXECUTIVE
MEDICAL DIRECTOR FOR BLUE CROSS BLUECROSS
BLUESHIELD. HE IS A FELLA WITH THE AMERICAN
COLLEGE OF CARDIOLOGY.
HIS MEDICAL DEGREE IS FROM THE NEW MEXICO SCHOOL OF MEDICINE.
HE COMPLETEED MASTERS IN BUSINESS
ADMINISTRATION AT THE UNIVERSITY OF TENNESSEE HAS HASLEM COLLEGE OF
BUSINESS. PLEASE WELCOME ROB TO THE POLAND PODIUM
PODIUM.>> GOOD MORNING.
IT IS A PLEASURE FOR ME TO BE HERE AND PARTICULARLY WITH MY
COLLEAGUES DR. PAI AND TINA. ONE NOTE ON TRINITY HEALTH.
TRINITY HEALTH IS ONLY NATIONAL HEALTH CENTER HEADQUARTERED IN
THE STATE OF MICHIGAN. IT’S ONE OF OUR LARGER REGIONS
AND LAVONIA IS OUR NATIONAL HOME
HOME. IT’S BEEN GREAT TO JOIN THIS
FAMILY AND I’M NOT GOING TO SPEND MUCH TIME TALKING ABOUT
COMMERCIAL AROUND OUR SYSTEM OR ABOUT WHAT WE’RE HERE FOR TODAY.
THAT’S A FORECAST. COUPLE OF DISCLOSURES LIKE TO
START WITH. I SAID THIS IN OTHER AUDIENCES.
WHEN YOU’RE IN CAREER PATH IN HEALTH AND HOSPITAL
ADMINISTRATION, YOU HOPE THAT YOU’LL READ THINGS BETTER WHEN
YOU START IT. I WOULD SAY IN TERMS OF OUR
ORGANIZATION AS A BUSINESS AND THE HEALTH SYSTEMS THAT WE RUN,
THERE’S BEEN LOT OF SUCCESS. REALLY, I WOULD DECLARE THAT I’M
LITTLE FRUSTRATEED AND EMBARRASS EMBARRASSED THAT IN THE 25 YEARS
THAT I’VE BEEN LEADING ORGANIZATION THE COMMUNITIES WE
SERVE. YOU SAW THE STATISTICS EARLIER,
THEY ARE NOT AS HEALTHY AS WHEN WE STARTED.
THAT’S NOT ANYTHING ANY OF US WANT TO PUT IN OUR RESUME. WE WANT TO ENJOY THOSE THINGS
THEY LOOK FORWARD TO. THAT’S WHAT I HOPE WE’RE IN THE
BUSINESS TO DO. I DO ALIGN WITH TRINITY’S
MISSION TO BE A TRANSFORMING AND HUMAN PRESENCE IN THE
COMMUNITIES WE SERVE. IT INCLUDES PERSONAL HEALTH BUT
ALSO INCLUDES THE LOCAL ECONOMY ECONOMIES THAT WE RESIDE IN.
A FEW ASSERTIONS THAT I ALSO MAKE BEFORE I GET TO THE
FORECAST, THE LANDSCAPE IS CHANGE.
THIS IS AN OBVIOUS STATEMENT HERE.
THE LANDSCAPE IS CHANGEING. ALL OF US WHO HAVE A THEORY WILL
LINE UP AGAINST SOMEONE ELSE WHO HAS A DIFFERENT THEORY.
IT’S REALLY BEEN VERY HARD TO KEEP UP WITH WHETHER IT’S ON
POLICY SIDE IN WASHINGTON OR JUST THE CONSUMER SIDE, I THINK
THE LAWS OF ECONOMICS HAVE FINALLY ARRIVEED IN OUR INDUSTRY
BECAUSE IF YOU LOOK AT OUR INDUSTRY, DATEING BACK, WE
DESIGN DESIGNED THE U.S. HEALTH SYSTEM
AROUND LEGISLATION FOR 70 YEARS. THAT LEGISLATION WAS BASICALLY
DICTATEING HOW WE GOT PAID. WE DESIGN OUR SYSTEMS TO DO
GREAT JOB GETTING PAID VERY WELL WELL.
PARTICULARLY ON SICK CARE. WHEN WE LOOK AT WHAT’S THE
PRODUCT PEOPLE WANTED TO BUY, NOT SURE WE DELIVERED ON THAT.
I’M NOT SURE PEOPLE WANT TO BUY HOSPITAL CARE AND HEALTHCARE AND
SICK CARE. WE’VE DONE REALLY GOOD JOB.
SOME OF THE NUMBERS WE SHOWN IN TERMS OF OUR EXPENSES AS A
COUNTRY AND YOU CAN SEE ON THE LAST BULLET POINT, WE GOT AWAY
WITH THINGS UNTIL WE STARTED CONSUMEING TOO MUCH OF THE
COUNTRY’S GROSS DOMESTIC PRODUCT PRODUCT.
WHEN YOU START HITTING 20% OF A NATION’S GDP, YOU’RE BECOMEING A
BURDEN TO BUSINESS, YOU’RE BECOMEING A BURDEN TO CONSUMERS.
THE AC SARKS ALWAYS A — AC SARKS ALWAYS CA IS ALWAYS A
HOT TOPIC. IT WAS NOT A CATALYST CHANGE.
IT WAS A LAW CREATEED IN RESPONSE
TO UNDENYIABLE ECONOMIC ISSUES IN
OUR COUNTRY. FEW QUESTIONS THAT I PONDER.
IS OUR NEW FAVORITE TERM POPULATION HEALTH, IT’S ABOUT
THE ECONOMICS OF HEALTHCARE OR ABOUT TRULY IMPROVEING THE
HEALTH OF THE POPULATION.
ANOTHER WAY, ARE WE DEVELOPING STRATEGYIES FOR OUR HOSPITALS
AND HEALTH SYSTEMS.
THOSE OF US WHO APPEAR AND OTHER OTHERS IN THE ROOM AND COUNTRY,
HOW TO SURVIVE THE TRANSITION AND MAKE A AMERICAN MARGIN
AROUND POPULATION.
I THINK THAT’S A QUESTION WE ALL HAVE TO LOOK IN THE MIRROR AND
ANSWER. ARE WE TRYING TO SURVIVE THE
TRANSITION, OR WE MAKING A DIFFERENCE IN POPULATION.
THERE’S AN ECONOMIC DEFINITION FOR ALL THE ECONOMYIST HERE.
IF YOU’RE A PRODUCT THAT NOBODY WANTS TO BUY BUT YOU’RE A
PRODUCT THAT PEOPLE NEED, YOU’RE OIL.
YOU’RE A COMMODITY. HEALTH SYSTEM HAVE A HARD TIME
ACCEPTING THAT, SOME WAYS PRODUCT NOBODY WANTS TO BUY BUT
WERE NEEDED. IT’S HARD TO LOOK IN MIRROR AND
SAY, WE MIGHT BE COMMODITIZE IN A FUTURE HEALTH DELIVERY SYSTEM.
THESE ARE PROVOCATIVE QUESTIONS I CAN LIKE TO ASK THAT THESE
SETTINGS. HOW RER WEARE WE DOING WITH THE
POPULATION HEALTH? YOU SAW SOME STATISTICS.
HAD WE DEVELOPED CULTURE OF HEALTH IN OUR LOCAL COMMUNITIES?
SEE SOME DISPARITYIES BETWEEN EAST AND WEST MICHIGAN.
I WOULD HAVE LOVE THE SLIDE THAT OVERLAID THE ISSUES AND SOCIAL HEALTH.
WHEN YOU LOOK AT OTHER COUNTRY IES
THAT HAVE DECIDEED TO — I’M NOT HERE TO PROEM MED CARRY FOR ALL,
I’M NOT DOING THAT. SOME COUNTRYIES DECIDEED TO
NATIONALIZE THEIR HEALTH SYSTEMS SYSTEMS.
IF YOU LOOK AT THE COST, VERY LOW IN LOT OF THOSE COUNTRYIES.
THEY INVEST HEAVYILY IN SOCIAL DETERMINE DETERMINANTS.
IF THE UNITED STATES IS THE MOST EXPENSEIVE COUNTRY IN THE WORLD
FOR HEALTHCARE, ARE WE NUMBER ONE IN HEALTH?
NO. WE’RE WAY DOWN THE LIST.
WE’RE NOT GETTING WHAT WE’RE PAY PAYING FOR.
WHY AM I ASKING YOU THESE QUESTIONS THAT YOU HAVE ANSWER
TO. I THINK IT’S BECAUSE WE KNOW
WHAT’S HAPPENING, AND WE EITHER DON’T KNOW WHAT TO DO, WE DON’T
CARE — I DON’T THINK THAT’S THE CASE — WE FIGURE WE KEEP TREAT
TREATING ILLNESS AND MAKE A GOOD LIVE DOG IT OR WE KEEP FAILING
TO CHANGE THE DETERIORATEING HEALTH IN THE POPULATION.
I’M AGAIN TO BLOW THIS ONE. WE TALK ED ABOUT OBESITY.
WHEN YOU SEE BIG HIKE IN OBESITY BACK IN THE ’70s, INFORMATION
ENEMY THEN 1976 MacDONALD
1976 McDONALD’S INTRODUCEED SUPER SIZE.
OUR WRAP SHEET ISN’T LOOKING GOOD. I THINK RIGHT NOW WE KNOW HEALTH
IS COSTLY. PARTICULARLY POORLY HEALTH.
YOU CAN SEEM OF THE NUMBERS HERE EVEN AS A PERSON WHO DOESN’T
EXERCISE, HIGHER COST. DIABETES ALONE, 33% OF ADULTS
WITHOUT HIGH SCHOOL DEGREE ARE OBESE.
WE GO BACK TO SOCIAL DETERMINANT DETERMINANTS.
EDUCATION AND POVERTY. 33% OF ADULTS EARN LESS THAN 15K
PER YEAR ARE OBESE COMPAREED TO 25% EARN LEAST $50,000.
THERE’S RACE DISPARITYIES AS WELL
WELL. MY LAST SLIDE ON THE FORECAST.
I THINK RIGHT NOW I’M STILL SEE SEEING MEDICAL ARMS RACE AMONGST
ALL THE HEALTH SYSTEM WHO COMPETE.
PART OF THAT IS STILL INVESTING IN THE ACUTE SIDE OF CARE AND
PUTTING OUR BILLBOARDS UP ON THE LATEST TECHNOLOGYIES WE HAVE.
I THINK I STILL SEE THAT. I SEE IT SHIFTING LITTLE BIT.
OUR BALANCE SHEETS WHICH LOT OF US WERE LARGELY FULL OF BRICKS
AND MAR MARTYR MORTAR HOSPITALS.
ONE COMMENT ON PHYSICIAN COMMENT — I LIKE THE ANSWER.
MICHIGAN IS PARTICULARLY STRESS STRESSED IN GETTING PEOPLE TO
LIVE HERE AND ALSO INCOMES ARE HARD TO MAINTAIN IN MICHIGAN
COMPAREED TO OTHER STATES. THEY COME TO MAINTAIN
COMPETITIVENESS. HAVING SAID THAT, LIKE IN
TRINITY, MICHIGAN WE’RE GOING TO OPEN 17 NEW AMBULATORYIES.
PAYERS AND PROVIDEERS. WE HAVE BLUE CROSS AND PRIORITY
IN THE RAM TODAY. PAYERS AND PROVIDEERS ARE TRYING
TO FEEL CLOSURE OUT HERE WHAT THE FUTURE WILL LOOK LIKE.
WHO THE PRIMARY RELATIONSHIP WITH THE PATIENT?
IS IT THE INSURER OR THE PROVIDE PROVIDER?
THAT ANSWER VARYIES DEPENDING AND
IT’S ANSWERED BY ALL OF US INDIVIDUALLY BUT BUSINESS MODELS
TRYING TO VIE FOR THEIR POSITION IN THIS NEW ERA.
INDUSTRY CONSOLIDATION MEANING HEALTH WILL CONTINUE.
WE’VE SEEN LOT OF IT HERE IN WEST MICHIGAN.
LOT OF INDEPENDENT HOSPITALS JOINING OTHER HOSPITALS,
SPECTRUM, AND OTHERS, EAST MICHIGAN, SAME THING.
I THINK THAT WILL CONTINUE AS STAND ALONE HOSPITALS AND STAND
PLAN PRACTICES HAVE HARD TIME SURVIVING ON THEIR OWN.
WE DIDN’T TALK ABOUT THE NEW ENTRANCE.
THEY HAVEN’T BEEN ABLE TO MEASURE THEIR IMPACT YET.
WAIT UNTIL AMAZON AND GOOGLE GET GOING.
THEY WILL FOCUS ON COST AND FOCUS ON SERVICE I THINK THEY’RE
GOING TO PUT HEALTH SYSTEMS IN BULL’S EYE APPROPRIATELY SO BY
THE WAY. I THINK THEY ARE GOING TO BRING
A NEW VALUE. WE HAVE TO FIGURE OUT HOW TO
WORK WITH THOSE DISRUPTTORS THAT ARE COMEING IN.
EMPLOYERS, SOME OF YOU — I THINK EMPLOYERS, BEYOND LOSS
PATIENCE WITH THE COST OF CARE. NOW THEY’RE LOOKING AT
EVERYTHING THEY CAN DO TO LOWER HEALTHCARE COST.
SHIFTING BURDEN TO THEIR EMPLOYEES NOW DIRECT CONTRACTING
IS BECOMEING MUCH MORE PREVALENT .
CUTTING OUT THE MIDDLE MAN GOING STRAIGHT TO A PROVIDEER AND
PROVIDE LIMITED CHOICE. I WILL MOVE ALL THE RISK TO THE
PROVIDEERS. THIS GOING TO PROBABLY BE THE
ONE THING YOU SEE FOR STANDING HERE YEAR FROM NOW, THERE’S BEEN
LOT OF TRACTION. WITH THAT, I’LL STOP AND TURN TO
OVER TO TINA. [APPLAUSE]>>GOOD MORNING.
I’M PLEASEED TO BE HERE TODAY WITH YOU.
I’M TINA FREESE DECKER AND PRESIDENT AND CEO OF SPECK
SPECTRUM. I’M EXTREMELY PROUD OF ALL OUR
PHYSICIANS AND CAREGIVERS AND TEAM MEMBERS AND HOSPITALS AND
INSURANCE PLANS. WE ARE MORE THAN JUST THE
HOSPITAL AND HEALTH. WE ARE TRANSFORMING AND CHANGE
THE WAY CARE IS DELIVERED. WE WANT TO MAKE SURE IT’S
PERSONALIZED AND SIMPLE, AFFORD AFFORDABLE AND EXCEPTIONAL TO
MEET ALL THE TRENDS THAT ROB JUST TALKED ABOUT.
WE SEE THOSE FORCES COMEING FORWARD.
WE NEED MAKE SURE THAT WE CAN DO WHAT WE NEED TO DO TO IMPROVE
THE HEALTH OF OUR COMMUNITYIES THAT WE SERVE HERE.
IT’S VERY IMPORTANT THAT WE ARE TRANSFORMING FROM NOT JUST
TRADITIONAL HOSPITAL TO HEALTH SYSTEM, IT’S REALLY FOCUSED ON A
HEALTHYIER YOU. TO DO THAT, WE ARE REALLY FOCUS
FOCUSED ON HOW WE GET OUR 30,000 PEOPLE TOGETHER IN A UNIFYING
APPROACH AND PURPOSE. WE’RE SPENDING LOT OF TIME ON
CULTURE. I BELIEVE THAT TO PROVIDE THE
BEST CARE AND THE BEST COVERAGE, WE MUST HAVE THE BEST CULTURE
AND THE BEST ENVIRONMENT TO DO SO.
OUR FOCUS IS ON CREATEING THAT CULTURE.
KEY ELEMENT OF THE CULTURE THAT WE’RE FOCUSING ON IS
COLLABORATION. AS I STARTED THIS ROLE FOR THE
PAST FOUR MONTHS, I FOCUSED ONLY OUR CULTURE, TRUST IN
TRANSPARENCY AND CULTIVATEING THE
FINEST TALENT. THE COMMON ELEMENT IS HOW WE
WORK TOGETHER, SHOWING THAT VULNERABILITY AND WORKING
TOGETHER AND CREATEING THAT COLLABORATION.
TRUST AND TRANSPARENCY WILL EMPOWER THE COLLABORATION HAVING
PEOPLE REALLY WORKING TOGETHER ON A COMMON GOAL WILL CONTINUE
TO EMBRACE AND FUEL MORE COLLABORATIONS AS WE GO FORWARD.
WE WANT TO ENSURE THAT WE HAVE COLLABORATION THAT’S BOTH
INTERNAL AND EXTERNAL BECAUSE THAT WILL HELP US MOVE MUCH FAST
FASTER IN ADDRESS THE HEALTH NEEDS OF OUR COMMUNITY.
TODAY I WANTED TO HIGHLIGHT FEW AREAS OF COLLABORATION.
I THINK ARE A SUCCESSFUL BUT WE NEED TO CONTINUE TO MOVE FORWARD
WITH THOSE. THE FIRST ONE IS OUR
COLLABORATION, OUR COMMUNITY COLLABORATIVE ON INFANT MORE IT
WILLTY IT WILL
MORTALITY. THIS IS STRONG COMBINATION
PROGRAM. IT’S ONE WE’VE COME TOGETHER TO
WORK WITH MOTHERS AND FATHERS AND THEIR BABYIES TO REDUCE THE
INFANT MORTALITY RATE. WE HAVE BEEN SUCCESSFUL IN THIS.
YOU CAN SEE ON THE CHART THAT IT GOES DOWN 1.93 TO 1.2.
THAT ENEMYIES WE HAVE LIMITED DISPARITY AFRICAN-AMERICAN
INFANT MORTALITY AND CAUCASIAN WOMEN.
THAT’S SUBSTANTIAL TO DO THAT IN THE LAST 10 YEARS.
PART OF THIS IS BECAUSE WE’VE WORKED TOGETHER TO PUT PEER
SUPPORT GROUP AND ENGAGE WITH BEST PRACTICES.
THIS NUMBER SHSOMETHING WE SHOULD CONTINUE TO PUSH TO DRIVE
DOWN. WE NEED TO DRIVE DOWN THE TOTAL
INFANT MORTALITY.
ONLY 46% OF THE PEOPLE ARE IN THIS PROGRAM.
WE NEED TO ENGAGE MORE THEME THAT PROGRAM.
THIS IS AN AREA WHERE COLLABORATION HAS REALLY HELPED
US BECAUSE WE’VE JOINED TOGETHER ACROSS OUR HEALTH SYSTEMS TO
MAKE SURE WE’RE MAKING AN IMPACT CONNECTING ON THE HEALTH.
THE OTHER AREA THAT’S REALLY KEY IN OUR COMMUNITY IS OPIOIDS.
WE MENTIONED IT TODAY IN THE DISCUSSION.
WE’RE FOCUSING ON HOW TO DO WE ADDRESS THAT NATIONWIDE CRISES
HERE. WE RECOGNIZEED THAT THIS IS A
BIG ISSUE.
I RECOGNIZE SPECTRUM CANNOT DO THAT ALONE.
IT TAKES ALL OUR PARTNERS. MANY US AT THE TABLE HERE HAVE
WORKED TOGETHER TO PUT TOGETHER BEST PRACTICES, EDUCATION AND
TOOL KITS TO ADDRESS THE ISSUES. WE ARE COMEING OUT WITH INTERNAL
SCORE CARDS. WE BETTER UNDERSTAND THE
PRESCRIPTION PATTERNS OF OUR PROVIDEERS AND GIVE THEM
EDUCATION HOW TO IMPROVE. WE HAVE COLLABORATEED ON HOW WE
USE OUR RESPECTIVE MEDICAL RECORD SYSTEMS TO MAKE SURE WE
DON’T PRESCRIBE MEDICATIONS FOR LONGER THAN SEVEN DAYS.
WE’RE IMPLEMENTING ACROSS THE EMERGENCY DEPARTMENTS THE
ALTERNATIVE TO OPIOIDS PROCESS SO WE LIMIT THE OPIOIDS.
AS I SAID EARLIER, THAT’S JUST ONE ASPECT OF OUR STRATEGY TO
ADDRESS THE OPIOID CRISES. IT’S ONE THAT WE CAN WORK
TOGETHER ON AND COLLABORATE. YOU CAN SEE IN THE CHART HERE,
IT SHOWS PRIORITY HEALTH MEMBERS UTILIZEING OPIOIDS FOR THE LAST
NINE MONTHS. THE TREND GOING DOWN.
I DON’T HAVE THE DEATH INFORMATION FOR THIS, WE TALKED
ABOUT IT EARLIER, I THINK THIS IS A KEY MEASURE TO SHOW THE
LEADING TRENDS IN HOPEFULLY THE LAGGING TRENDS WITH SHOW THE
DEATH RATES AND MORTALITY WILL FOLLOW THE SAME TREND.
WE NEEDED TO DO THIS COLLABORATIVELY WITH ALL OUR
PARTNERS HERE. WE HAVE TO BE FOCUSED ON THE
SAME THING TO ADDRESS THE HEALTH ISSUES OF OUR COMMUNITY.
THIS IS ONE AREA THAT WE’RE FOCUSING ON AS WELL AS
BEHAVIORAL HEALTH. BECAUSE IT TAKES ALL OF US TO DO
THAT. I WANT TO FOCUS ON COSTS.
IF YOU TALK TO ANYBODY IN HEALTHCARE, ROB’S PRESENCE HIT
IT RIGHT, THE COST OF HEALTHCARE IS UNSUSTAINABLE.
IT’S COMPLETELY UNAFFORDABLE FOR PEOPLE TO ADDRESS COSTS.
THIS WILL TAKE THE BEST MINDS COMEING TOGETHER TO REALLY THINK
ABOUT HOW TO DO WE REDUCE THE COST OF CARE.
AN EXAMPLE THAT I WANT TO SHOW YOU SPECTRUM HOME-BASEED CARE.
WE’VE WORKED IN A COLLABORATIVE MANNER IN OUR COMMUNITY, THAT
HAVE REALLY FOCUSED ON HOW TO APPLY BEST PRACTICES TO REDUCE
THE COST OF CARE. THIS IS SPECIFICALLY FOR
POPULATION THAT IS THE HIGHEST COST POPULATION, THE FRAIL,
ELDERLY, THOSE WHO HAVE CHRONIC DISEASES.
WHAT HAPPENS THEY GO INTO THE EMERGENCY DEPARTMENT, THEY
DIDN’T GET ADMITTED AND THAT FOLLOWS EVERY FEW WEEKS.
OUR FOCUS IS LET’S GET IN EARLY, LET’S GET ENGAGEED WITH THIS
POPULATION SO WE CAN MAKE SURE THAT WE CAN DO THINGS
APPROPRIATELY. NOW THEY HAVE ACCESS TO EVERY
WEEK, SOMEONE VISITS THEM IN THEIR HOME AND IF THEY DO HAVE
AN ISSUE HEALTH ISSUE THEY CALL 24
HEALTH ACCESS. AS YOU CAN SEE FROM THE RESULTS
WE HAVE DECREASEED UTILIZATION AND INCREASEED SATISFACTION AND
INCREASEED OUTCOMES AND DECREASE ED
THE COST. THIS PROGRAM AS WELL AS OTHER
PROGRAMS WE HAVE FOR HOME-BASEED CARE OR TRYING TO REDUCE COST,
WE’RE SHAREING THE BEST PRACTICE S
BECAUSE WE ALL NEED TO LEARN TOGETHER TO MAKE A DIFFERENCE
AND GET TOTAL COST OF CARE FOR OUR COMMUNITY.
THIS IS ONE EXAMPLE OF LOW TECH, HIGH-TECH THAT IS REDUCEING COST
. IN EXAMPLE OF HIGH-TECH IS OUR
CARDIOVASCULAR SIMULATION LAB. IT’S WHERE OUR RESIDENTS AND
FELLOWS CAN COME TOGETHER TO LEARN THAT BEST TECHNIQUES AND
PRACTICE ON CUSTOMIZES MANNEQUIN MANNEQUINS TO DO THEIR CRAFT
WELL. WE LEARNED WHAT ROLES PEOPLE
NEEDED TO PLAY, WE LEARN HAD EQUIPMENT WE SHOULD USE OR NOT
USE AND THEN THE FOLLOWING DAY, WHEN WE WENT INTO THE OR, WE
WERE SO MUCH MORE CONFIDENT BECAUSE WE ALREADY PERFORMED THE
PROCEDURE ON THE PATIENT’S ANATOMY.
WE WERE ABLE TO DO IT LESS TIME AND LESS EQUIPMENT TO REDUCE THE
COST OF CARE. THAT’S EXAMPLE USEING INNOVATION
AND MAKING SURE WE’RE DOING IT RIGHT AND REDUCE THE COST OF
CARE. I THINK THIS INNOVATION, THIS
WORK ON SOCIAL DETERMINANTSFUL HEALTH, WORK ON ENGAGEING OUR
PEOPLE WHAT WE’RE DOING IS IMPER IMPERATIVE AS WE GO FORWARD.
THERE’S SO MANY TRENDS COMINGING AT
US. OUR FOCUS IS TO MAKE SURE WE
IMPROVE HEALTH TO INSPIRE HEALTH AND SAVE LIVES.
WE BELIEVE TO DO THAT, WE HAVE TO PROVIDE MORE PERSONALIZED
HEALTH APPROACH. ONE THAT IS SIMPLE, ONE THAT IS
AFFORDABLE. REALLY LOOKING AT COST OF
HEALTHCARE. ONE THAT’S EXCEPTION EXCEPTION
EXCEPTIONAL. WE DEMAND TO MAKE SURE WE HAVE
THE HIGHEST OUTCOME POSSIBLE. THIS GOING TO BE VERY HARD TO DO
DO, IT’S GOING TO TAKE LOT OF TIME, EFFORT, PERSEVERANCE AND
COLLABORATION, I BELIEVE WE HAVE THE RIGHT TOOLS, TECHNOLOGY AND
PEOPLE HERE BECAUSE WE ARE UNIQUE IN OUR COMMUNITY WHERE WE
WANT TO COLLABORATE WITH OTHERS TO DRIVE THIS FORWARD AND MAKE
IT HAPPEN. I THINK THAT COLLABORATION IS
THE KEY ELEMENT OF THIS. HOW WE’RE GOING TO MAKE A
DIFFERENCE AND HOW THIS COMMUNITY CAN MOVES FORWARD TO
BE SUCCESSFUL. I USUALLY QUOTE SOMEBODY, I WILL
QUOTE MOTHER THERESA. I BELIEVE YOU CAN DO WHAT YOU
CANNOT DO I CAN DO WHAT YOU CANNOT DO.
BUT TOGETHER WE CAN DO GREAT THINGS.
THAT’S THE POWER OF COLLABORATION.
THANK YOU. [APPLAUSE]>>GOOD MORNING EVERYONE.
I’M NEW TO THE WEST MICHIGAN AREA.
I STARTED MY POSITION AROUND THE TIME THAT TINA WAS APPOINTED CEO
CEO. WHAT A GREAT TURN OUT TODAY.
IT’S EXCITEING TO BE HERE. I’M GOING TO BE TALKING ABOUT
THE CALCULATEING VALUE IN HEALTHCARE.
THE IMPORTANCE OF THE CONSUMER EXPERIENCE.
IT’S GOING TO BE MAYBE LITTLE BIT DIFFERENT COMPAREED TO MY
PREDECESSOR. THIS IS THE HEALTHCARE BUZZ.
I TELL AUDIENCES WHEN 9/11 FRONT OF LARGE 9/11 — I’M IN
FRONT OF LARGE GROUPS LIKE THIS. THERE’S NO BETTER TIME TO BE
BORN IN THE UNITED STATES THAN TODAY. I THINK OF POPULATION HEALTH AS
EMERGENCY THIS FULL OF DIABETICS HOW WE MAKE SURE EVERYONE GET
THE RIGHT CARE AT THE RIGHT TIME AND DOESN’T FALL THROUGH THE
CRACKS. DIABETES IS A VERY CHRONIC
CONDITION IF IT’S LEFT UNTREATED FOR YEARS, YOU CAN END UP RENAL
DISEASE. THAT IS ONE OF THE MOST EXPENSE
EXPENSIVE DISEASES. MAKING SURE EVERYONE GETS THE
RIGHT CARE IS REALLY IMPORTANT. I THINK THE OTHER TWO BULLET
POINTS HERE ARE VERY IMPORTANT. SUPER EXCITEING.
ONE WILL BE THE GENOMEIC
REVOLUTIONER. WE CAN TAKE THE PATIENT’S
GENETIC MATERIAL, KNOW WHAT MUTATIONS THEY HAVE AND OFFER
THEM TREATMENT BASEED ON THEIR GENETIC MUTATION.
THAT’S VERY EXCITEING FOR HEALTHCARE.
THIS ISN’T GOING TO JUST BE KIND OF DOWN THE ROAD A NUMBER OF
YEARS FROM NOW. THESE CONCEPTS ARE COMEING TODAY
. WHAT ARE SOME OF THE TRENDS IN
HEALTHCARE? I THINK A — HEALTHCARE IS THE
LARGEST SECTOR IN OUR ECONOMY, OVER $3.5 TRILLION IS SPENT ON
HEALTHCARE CONSUMEING TO 20% ALMOST OF GDP.
IT GETS LOT OF PRESS. I THINK SOME THINGS ON THE LEFT
ARE SUPER EXCITEING. WE’LL TALK ABOUT THIS “NEW YORK
TIMES” ARTICLE IN MORE DETAIL ABOUT WHY THE U.S. SPENDS SO
MUCH MORE ON HEALTHCARE COMPARE ED
TO OTHER NATIONS. THE BLUES AND PRIORITY AND OTHER
PAIRS IN OUR MARKET HAVE DONE NICE JOB MARKETING THIS.
REGIONALLY, OPIOIDS IS A HUGE ISSUE.
IT’S THE FIRST TIME AMERICAN LIFE EXPECTANCY HAS NOT GONE UP.
IT’S DUE TO SUICIDE AND OPIOID OVERDOSE.
IT’S VERY UNFORTUNATE. IT IS A HEALTH CRISES.
INTERESTINGLY, THE ARTICLE THERE IN THE MIDDLE, MOST OPIOIDS GO
TO PEOPLE WITH BEHAVIORAL HEALTH CONDITIONS WHICH MAY NOT BE THE
RIGHT GROUP OF PEOPLE TO BE RECEIVEING HEROIN IN A PILL.
WHICH IS WHAT OPIOIDS ARE. IT’S NOT A BIG CITY ISSUE.
IT’S NOT JUST DETROIT PROBLEM, IT’S A PROBLEM HERE IN GRAND
RAPIDS AND WEST MICHIGAN AND ALL DELIVERY SYSTEMS AND PAYERS HAVE
TO BE AT THE TABLE TO REDUCE THAT.
THERE HAVE BEEN GOOD RESULTS. I DO THINK TECHNOLOGY IS GOING
TO BE VERY INTERESTING IN DISRUPTING THE HEALTHCARE
INDUSTRY. WE’LL TALK ABOUT THAT MORE
DETAIL. I THINK PATIENT GENERATEED DATA
FROM YOUR APPLE WATCH, WHO HAS AN APPLE WATCH ON?
I THINK THAT’S REALLY IMPORTANT APPLE WATCH HAS THE ABILITY TO
NOW RECORD A HEART TRACEING. YOU CAN KNOW WHAT RHYTHM YOU’RE
IN. THAT’S SUPER EXCITEING.
AS PROVIDEERS WE HAVE TO DO BETTER JOB INCORPORATEING THAT
DATA. HOW MANY STEPS YOU ARE TAKING
AND HOW ACTIVE YOU ARE AND WHAT ARE YOUR EKG TRACEING.
WE CAN GET THAT DATA IN REALTIME REALTIME.
THAT’S SUPER EXCITEING. THE WE HAD OUR FIRST GENE
THERAPY IN FALL OF 2017. THAT DRUG COST DOLLARS FOR
TREATMENT. THERE’S ONE EQUATION.
IT’S AN EASY ONE. THIS IS IT.
THE HEALTHCARE VALUE EQUATION. I THINK THIS HELPS ARTICULATE
THE QUADRUPLE AIM. RIGHT CARE WITH THE RIGHT
CONSUMER EXPERIENCE. THIS EQUATION IS EXTREMELY IMPORTANT. YOU CAN HAVE A POSITIVE CONSUMER
EXPERIENCE OR YOU CAN HAVE A NEGATIVE CONSUMER EXPERIENCE.
IN THE NEXT SLIDE I WILL GO THROUGH SOME OF THESE THINGS AS
IT RELATES TO METRO HEALTH. ON THE QUALITY FRONT, WE’RE
REALLY TRYING TO IMPROVE THE HEALTH OF OUR COMMUNITIES.
ROB AND TINA DID NICE JOB HIGHLIGHTING ALL THE THINGS THEY
ARE DOING. WE’RE AT THE TABLE AS WELL.
DEPRESSION SCREENING. IF YOU HAVE A MENTAL HEALTH
CONDITION AND A CHRONIC DISEASE, YOUR UTILIZATION PATTERNS GO UP.
YOU USE THE ER MORE, YOU’RE IN THE HOSPITAL MORE, YOU HAVE POOR
OUTCOMES WITH YOUR DISEASE BECAUSE OF THAT MENTAL HEALTH
CONDITION. WE HAVE DRAMATICALLY DRAMATIC
ALLY INCREASE DEPRESSION SCREENING TO REACH
MORE AND MORE PATIENTS. THE LAST FOUR BULLET POINTS HAVE
TO DEAL WITH MAKING SURE PATIENT PATIENTS WITH HEART DISEASE THAT
COME TO OUR HOSPITAL GET CARE QUICKLY AS POSSIBLE.
TIME IS MUSCLE. IF WE’RE ABLE TO GET THEM TO THE
LAB QUICKLY WE CAN DECREASE THEIR MORTALITY RATES.
WE HAVE TO GET THEM THAT EKG. IT’S VERY IMPORTANT.
WE DRAMATICALLY IMPROVE THIS OVER THE LAST FIVE YEARS.
IT’S STILL SOME OF THE METRICS AREN’T EXACTLY 100%.
COMPREHENSIVE STROKE PROGRAM, WHICH DR. HAHN HIGHLIGHTED LAST
YEAR, THAT PROGRAM HAS GROWN SIGNIFICANTLY.
WE’RE ABLE TO GET OUR PATIENTS THAT HAVE A STROKE INTO THE LAB
WITHIN 30 MINUTES IN THAT — AND THAT DRAMATICALLY IMPROVES THEIR
OUTCOME. NEXT ON COST, METRO HEALTH HAS
DONE PRETTY GOOD JOB WITH COST OVERTIME.
WE WANT TO BE LOW COST LEADER. WE’RE NOT LOW COST IN EVERYTHING
EVERYTHING. THERE’S A RECENT ARTICLE THAT
CAME OUT WENT LAST FEW DAYS THAT HIGHLIGHTED SOME OF OUR COST
WITH RESPECT TO TO TO TO EWE MOAN PNEUMONIA. ININ THE UNITED STATES WE DO NOT
DO WELL WITH COSTS. IN WEST MICHIGAN THAT NUMBER IS
LITTLE BIT LOWER AROUND 9500. WHY IS HEALTHCARE MORE EXPENSE
IVE IN THE U.S.?
THIS ARTICLE CAME OUT IN JANUARY OF 2018 “NEW YORK TIMES” ARTICLE
ARTICLE, AARON CAROL IS PEDIATRICIAN AND ECONOMYIST, THE
REASON IS COST IT’S PRICES. IT’S NOT THAT WE USE MORE
HEALTHCARE SERVICES COMPAREED TO GERMANY OR SWITZERLAND OR UNITED
KINGDOM IT’S THE PRICES WE CHARGE CONSUMERS IN THIS COUNTRY
COUNTRY. WHY ARE THE PRICES HIGH?
I THINK THE PRICES ARE HIGH BECAUSE IT’S A VERY COMPLEX
HEALTHCARE ECOSYSTEM. IF YOU LOOK AT THE TOP, THOSE
ARE ALL THE THINGS, ALL THE DIFFERENT STAKEHOLDERS THAT
CONSUME HEALTHCARE RESOURCES. PHARMACEUTICAL INDUSTRY AND
KEVIN TALKED ABOUT THAT AND PATIENTS.
YOU CAN SEE AT BOTTOM, THOSE ARE THE PAYING ENTITYIES, COMMERCIAL
PAYERS, EMPLOYERS WHICH ARE SELF-FUNDED AND MEDICARE AND
MEDICAID. PUTTING PRESSURE ON ALL THIS ECO
ECOSYSTEM IS ALL THIS INNOVATION INNOVATION.
HOW DO WE PAY FOR TREATMENT FOR SICKLE CELL DISEASE.
THAT’S SOME OF THE PRESSURES THAT WE HAVE TODAY.
I THINK ONE THING THAT’S REALLY IMPORTANT TO FOCUS ON IS THE
LAST PART OF THAT EQUATION. THE EXPERIENCE.
AS WE ALL KNOW AS CONSUMERS, HOW WE CONSUME THINGS CHANGEED
DRAMATICALLY. HOW WE CHECK IN FOR A FLIGHT,
HOW WE ORDER SOMETHING ONLINE AND IT’S DELIVERED TO YOUR DOOR,
EXTREMELY EXCITEING. I BROKEN DOWN HEALTHCARE JOURNEY
INTO THE PRECARE EPISODE, THE ACTUAL CARE DELIVERY EPISODE.
IT’S NOT NECESSARILY THE EASY FOR THE RIGHT PATIENT TO FIND
THE RIGHT TYPE OF PHYSICIAN OR
HOSPITAL DELIVERY SYSTEM FOR THEM. MOST PATIENTS FIND THAT PROVIDE
ER THEY HAVE CONFIDENCE IN.
THEY GET WHAT THEY NEED AND GET THE OUTCOMES THEY SUPPOSEED TO
GET. WHERE WE REALLY LACK IS THE POST
CARE EXPERIENCE. THE CONSUMER EXPERIENCE IS
FRAGMENTED AND IT’S CONFUSEING. WHAT’S WRONG WITH THE POST CARE
EXPERIENCE? THIS IS WHAT’S WRONG WITH IT.
THE POST CARE EXPERIENCE IS VERY NEGATIVE BECAUSE WE CAUSE
FINANCIAL THUNDERSTORM PATIENTS. THIS IS PATIENT — HARM TO
PATIENTS. PEOPLE ARE RAISEING $650 MILLION
ON GO FUND ME FOR RYEING HEALTHCARE COST.
CLARITY IS NOT THE SOLUTION. YOU GET LOT OF BILLS AFTER YOU
GET OUT OF THE HOSPITAL AND YOU GET THEM FROM DIFFERENT PLACES.
SOME OF THEM SAY THEY ARE NOT BILLS AND THEY ARE.
IT’S VERY CONFUSEING. IT CAN KEEP GOING MONTHS AFTER
YOU HAD WHATEVER IT IS YOU HAD. IT’S VERY CONFUSEING TO PEOPLE
GO FUND ME IS A RESOURCE FOR THEM.
WE’RE IN THIS AWKWARD DANCE WITH WE HAVE CARE DELIVERY.
HOW DO WE DELIVER CARE TO PATIENTS AND PAYMENT REFORM.
WE’VE BEEN DOING THIS DANCE FOR A NUMBER OF YEARS.
THE CARE DELIVERY MODEL HAS EVOLVEED ITSELF WITH THE CARE
TEAM APPROACH. PHYSICIANS RECOGNIZEING, I’M NOT
THE BEST DIABETES EDUCATOR. I’M NOT A SOCIAL WORKER OR A
PHARMACIST. WE’RE SORT OF PARSEING SOME OF
THAT OUT TO THOSE DIFFERENT MEMBERS OF THE CARE TEAM TO TAKE
BETTER CARE OF PATIENTS. I DO THINK THAT PAYMENT REFORM
MODEL STRUGGLEED TO SOME DEGREE . THIS IS MY FORECAST PIECE.
THIS IS WHAT I THINK WILL HAPPEN IN HEALTHCARE.
IT’S HAPPENED IN OTHER INDUSTRY INDUSTRIES.
I SEE NO REASON WHY IT WOULDN’T HERE.
YOU LOOK AT GROWTH OVER TIME, HEALTHCARE HAD THIS SLOW
INCREMENTAL TORTOISE LIKE EVOLUTION OF CHANGE.
IF YOU LOOK AT HARE OR RABBIT, INNOVATION IS REALLY EXPONENTIAL
AT THIS POINT. THINK ABOUT SOCIAL MEDIA, WAS
THAT SOMETHING THAT EXISTED FEW YEARS AGO, YOUR iPHONE CAME
INTO PLAY IN 2007. THE GAP BETWEEN THE HARE AND THE
TURTLE IS REALLY THIS INNOVATION PIECE.
I THINK IT’S REALLY DRIVEN BY CONSUMER OBSESSION AND COMPANY
IES LIKE ALL THESE PLAYERS ON THIS
SLIDE ARE DOING VERY INNOVATIVE THINGS THAT THE HEALTHCARE SPACE
SPACE. JUST TO HIGHLIGHT THE PICTURE
HERE. THIS IS SEATTLE, WASHINGTON ON
THE RIGHT PANEL, YOU CAN SEE THE SPACE NEEDLE DOWNTOWN.
THESE TWO LARGE BUILDINGS LOOKING DOWN, THAT’S AMAZON.
JEFF BEZOS SITS IN THAT BUILDING IN FRONT OF THIS.
HE SITS A THE TOP OF THAT. THAT BUILDING IS CALLED DAY ONE.
DAY ONE IS HIS ORIENTATION THAT THEY ARE LOOKING VERY FAR DOWN
THE FUTURE. THEY ARE LOOKING AT LARGE
ADDRESSABLE MARKETS AND HEALTHCARE IS GOT TO BE IN THEIR
SIGHT. I’M OUT OF TIME.
I WANTED TO HIGHLIGHT. LOT OF THESE COMPANYIES ON THIS
SLIDE ARE DOING INNOVATIVE THINGS.
THE LAST MESSAGE I WANT TO LEAVE IS, WE AS HEALTHCARE LEADERS
NEED TO REALLY DISRUPT OURSELVES OR WE WILL BE DISRUPTIBLE.
THANK YOU. [APPLAUSE]>>THOSE WERE ALL EXCEPTIONAL
PRESENTATIONS. NOW WE’LL START THE Q&A.
ANY OF YOU CAN ANSWER THESE QUESTIONS.
FIRST ONE GIVE EXAMPLES HOW AMAZON WILL DISRUPT HEALTHCARE?>>THEY HAVE AN DELIVERY DELIVERY THAT’S
UNPARALLEL. WE CAN GET SOMETHING TOMORROW
AND SOMETIMES TODAY. WILL LEARNING PROVIDE SERVICES AROUND
PHARMACEUTICAL AROUND OTHER THING THAT WE SELL IN THIS
INDUSTRY AND KIND OF MASTER THE DELIVERY PROCESS OF THAT.
>>THEY HAVE THE PLATFORM TO DELIVER, THEY HAVE SIGNIFICANCE
OF SUPPLY CHAIN PLATFORM THAT EXPAND ANYWHERE YOU ARE.
I THINK THAT THEY HAVE REALLY FOCUSED ON THE CONSUMER
EXPERIENCE. IT IS SO EASY TO CLICK AND BUY
IT. IF YOU THINK ABOUT OUR BILL
PAYMENT PROCESS, IT IS ANYTHING BUT EASY.
I THINK THAT THEY ARE AHEAD OF HOW WE CONNECT WITH CONSUMER.
WE SEE THEM IN TRAINING TO EVERY LITTLE BUSINESS THAT CAN GET
INTO HEALTHCARE. I EXPECT WELLS GOOGLE AND APPLE
WILL BE MAJOR PLAYERS IN HEALTHCARE.
>>I WOULD SAY, I SEE THEM WITH PRIME BENEFITS KIND OF EVOLVEING
THAT. THERE CAN BE DIFFERENT TIERS ON
TOP OF THAT. THERE WILL BE HEALTHCARE TIER.
YOU CAN HAVE TELEHEALTH VISIT, YOU CAN HAVE — THEY CAN BE
LARGE PURCHASEER AND LARGE PHARMACEUTICALS IF YOU HAVE
HUNDRED MILLIONS OF SUBSCRIBERS THAT’S POWERFUL IN THE
PHARMACEUTICAL INDUSTRY. JUST TODAY JOHNSON AND JOHNSON
RAISEED PRICE ON DRUGS, 70%. LOT OF THEM HAVE BEEN DOCK THAT.
AMAZON WILL PUT A PRICEING PRESSURE ON THAT COMPONENT.
>>WHAT DO YOU MAKE OF THE TELE TELEHEALTH DATA AND WHAT’S THE
FUTURE FOR TELEHEALTH FOR EACH OF YOUR ORGANIZATIONS?
>>WE STARTED TELEHEALTH FOR FOUR OR FIVE YEARS NOW. IT INCREASES BY UP TO 50%.
LAST YEAR IF YOU LOOK AT JANUARY JANUARY, WE INCREASEED BY 300%,
WE TARGETED THE FLU POPULATION SO THEY WOULD STAY OUT OF THE
EMERGENCY ROOMS AND WE CAN TALK TO THEM VIA TELEPHONEICALLY.
I EXPECT TELEHEALTH TO GROW. WE’LL BE DOING MORE THINGS HOW
TO WE CONNECT MORE WITH PEOPLE IN THEIR HOME USEING THEIR HOME
DEVICES WHETHER IT’S THEIR CURRENT TVs OR CURRENT
TECHNOLOGY. I THINK THIS WILL CONTINUE TO
GROW. EVENTUALLY, TELEMEDICINE IS LIKE
ANYTHING ELSE. IT WILL BE HEALTH.
WE HAVE TO THINK DIFFERENTLY, WE HAVE TO MAKE SURE WE’RE THINKING
DIGITALLY FIRST.>>I AGREE TINA.
IT’S GOTTEN MANY VENUES WHERE IT GETS TO USE NOW AND WILL IN THE
FUTURE. CONNECTING RURAL AREAS, BEING
ABLE TO BRING SPECIALTY CARE. WE’RE HUBBED FOR THE MICHIGAN
STROKE NETWORK. WE’RE AND TO BRING THAT
EXPERTISE OUT ON THE FIELD. I DO BELIEVE THE VIRTUAL VISIT
THING, IT WAS SLOW IN SOME MARKETS.
NOW BECAUSE WE’RE TAKING RISK FOR AN EPISODE OF CARE AND WE’RE
TRYING TO DO EVERYTHING WE CAN TO LOWER THAT, NOW SUDDENLY THE
VIRTUAL VISITS ARE GROWING EXPONENTIALLY.
IT’S A WAY TO MANAGE CARE OUTSIDE OF THE OFFICE AND
OUTSIDE THE HOSPITAL.>>I AGREE IT’S A PERVASIVE
TREND. IT WILL BE THE WAY CARE WILL BE
DELIVERED. WE WON’T MAKE THAT DISTINCTION
THAT TINA JUST CALLED OUT. WE’RE LITTLE BIT BEHIND METRO
AND UNIVERSITY OF MICHIGAN HEALTH.
I DO THINK THAT TELEHEALTH CONSUMER IS REALLY GOING TO BE
IMPORTANT. I THINK THAT TELEMEDICINE
COMPONENT CARE TEAMS TALKING TO CARE TEAMS VIA VIDEO WILL BE
REALLY IMPORTANT.>>DR. PAI, WHAT DO YOU SEE AS
THE ROLE OF EMPLOYER ON PATIENT COVERAGE DECISIONS AND DO YOU
SEE ANY TRENDS REGARDING EMPLOYERS DIRECTLY INVOLVEED
WITH THOSE COVERAGE DECISIONS DUE TO
HIGH COST?>>I’VE SEEN EXAMPLES OF
EMPLOYERS TRYING TO INTERJECT IN DECISIONS LIKE THAT.
WE ABSOLUTELY GET THAT. IT’S VAR HARD TO — VERY HARD TO
BUDGET FOR $1 MILLION TREATMENT WHEN YOUR PLAN IS $10 MILLION A
SPEND WE TOTALLY GET THAT’S A
CHALLENGE. I WOULD REALLY BE HESITANT TO
GET INVOLVEED WITH THOSE KINDS OF
DECISIONS. I TEND TO STAY OUT THAT.
YOU COULD ADDRESS IT THROUGH OTHER MECHANISMS LIKE RE
REINSURANCE TYPE PRODUCT.>>I REALLY THINK THAT THIS IS
THE LONG TERM PLAY. WE HAVE TO MAKE SURE WE
UNDERSTAND HOW IT ALL COMES TOGETHER IN THE ONE YEAR THAT WE
DO THIS. I THINK THAT’S A BIG THING WE
NEED TO FOCUS ON OVER THE NEXT FEW YEARS.
SOME SOMETHING WE’RE SELF-FUNDED EMPLOYER.
THE FOCUS IS ON BENEFIT DESIGN AND ON THE SITE OF CARE.
I THINK THAT’S WHERE I SEE THE EMPLOYERS GETTING FLEXING THEIR
MUSCLES NOW. WHERE ARE THE INCENTIVES FOR
PREVENTIVE CARE. TRYING TO MOVE EMPLOYERS TOWARDS
LOWER END OF CARE BY PROVIDING THE BEST INCENTIVES OR HEALTHY
LIFESTYLES. OR WORKING WITH THE PAYERS,
LIMITING CLOYS AND TRYING TO LOWER COSTS.
THAT’S WHERE I SEE MORE OF THE EMPHASIS MORE THAN THIS IS WHAT
WE’RE GOING COVER .
>>>>>> I’LL SIR CALL BECOME TO SOCIAL
DETERMINANTS. SOME PEOPLE WHO HEALTHY FACE
SOMBER YEARS YEAR — BARRIERS. ONE OF OUR GROUPS INEST MICHIGAN
MICHIGAN, GROUP CALLED IHA. WE SCREENED 55,000 PATIENTS IN
THE LAST FEW MONTHS AND FOUND THAT SOCIAL ISOLATION WAS THE
NUMBER ONE SOCIAL DETERMINANT. THAT CAN HIT A HEALTHY PERSON
QUICKLY AND START TO EVOLVE IN OTHER ISSUES.
AS A COMMUNITY, WE NEED TO GET OUR ARMS AROUND THAT ISSUE. I WANT HEALTHCARE TO TRANSITION
AWAY FROM HEALTHCARE TO KEEP PEOPLE HEALTHY.
THE PAYMENT REFORM MODEL HAVE TO PIVOT MORE.
I WOULD LOVE TO BUILD MORE FROM METRO.
IF WE RECEIVEED A PER MEMBER PER MEMBER MONTH FEE TO WORK A
CERTAIN POPULATION THAT DIDN’T HAVE KNOWN CHRONIC DISEASE.
THE FOCUS WILL BE ON FEATURE OH KEEPING THEM HEALTHY.
WHAT KINDS OF THINGS CAN WE CREATE.
HOW MANY STEPS ARE YOU TAKING. IS THERE SOMETHING GOING ON IN
YOUR LIFE THAT YOU HAVEN’T INTER INTERACTED WITH US.
IT WOULDN’T HAVE BEEN TO BE HIGH COST.
IT’S INTERACTING AND KEEPING PEOPLE ENGAGEED IN THEIR HEALTH
AND MAKING ALL THOSE MONEYS MONEY HUNDREDS OF
DECISIONS THAT YOU HAVE TO MAKE TO KEEP YOURSELF HEALTHY AND
AVOID OBESITY OR BEING OVER OVERWEIGHT.
LOT ALL THESE CHRONIC DISEASES ARE BEHAVIORAL DRIVEN.
IS A PROVIDEER AND NURSEING SHORTAGE?
IS IT AFFECTING OUTCOME AND WHAT ARE THE SOLUTIONS?
I’LL START THIS AND YOU GUYS CAN JUMP IN.
WE GOT MILLION PHYSICIANS IN THE UNITED STATES.
IT USEED TO BE CHARACTERIZEED IN FOUR DIFFERENT AGE GROUPS.
JO WE ALL KNOW WHAT HAPPENS AT
SECRETARY. THERE’S GOING TO BE — 60.
THERE’S GOING TO BE A DRAMATIC. THEY’RE GOING TO RETIRE.
[LAUGHTER] WE HAVE AN AGEING OF OUR
PHYSICIAN POPULATION. THAT’S GOING TO HAVE A BIG
IMPACT. I THINK THERE’S BEEN MOVEMENTS
TOWARDS DOCTORS AND NURSE PRACTITIONING AND P.A.s AND
OTHER APPs Ps FILLING IN. THERE WILL BE MORE OF THAT IN
THE FUTURE. IMPACT ON OUTCOMES, I’M NOT SURE
THAT’S BEEN A REAL SIGNIFICANT ISSUE YET.
IT COULD BE DOWN THE ROAD. SKILL SET OF PHYSICIANS IS
IMPORTANT. WE NEED THEIR EXPERTISE.
NOT ONLY TO CONNECT WITH THE PATIENTS AND HELP GUIDE US TO
REDUCE VARIATION TO REALLY MAKE SURE WE’RE DOING THE RIGHT
THINGS IN OUR PRACTICES. IT CAN’T SIT ON THEIR BACKS TO
DO SO. WE NEED TO HAVE HEALTH COACHES
AND MORE COMMUNITY HEALTH WORKERS. IT’S TRUE PARTNERSHIP AND
COLLABORATIONS WITH CAREGIVERS. WILL EVOLVE OVERTIME.
ONE THING WE’RE IN THE MIDST OF GREAT NURSEING PROGRAM HERE AT
GRAND VALLEY AND OTHERS AROUND THE STATE.
WE TALK ABOUT THE NURSEING SHORTAGE.
SOME OF THE CONVERSATION WE HAVE WITH THE SCHOOLS IS WE CAN’T
PLACE OUR NEW GRADS. WHAT’S THE PROBLEM?
THE PROBLEM IS IF YOU LOOK AT WHERE THE SHORTAGES R THEY’RE
PRIMARYILY IN AREAS LIKE ER, ICU OR OR WHERE YOU DON’T START A NEW GRAD.
THEN, ALL OF SUDDEN, SCHOOLS COME BACK AND SAID WE THOUGHT
THERE WAS A SHORTAGE AND WE CAN’T PLACE SOME OF THESE NEW
GRADS. THE SOLUTION HAS BEEN REALLY,
WE’VE HAD TO CHANGE OUR TRAINING AND CHANGE OUR THINKING IN THE
HOSPITALS TO ALLOW NEW GRADS TO MOVE INTO THOSE AREAS SOONER AND
BE BUDDYIED AND BE TRAINED REALTIME IN THOSE MORE INTENSE
AREA WHERE IS SHORTAGES EXIST. THAT’S ONE ISSUE.
PROVIDEER SIDE, JUST SAY, YEAH, THERE’S A SHORTAGE, TELEHEALTH
IS A WAY TO BE ABLE TO SPREAD SOMEBODY’S EXPERT EXPERTISE MORE
BROAD BROADER WAY.
TRYING TO REDUCE DEMAND IS A WAY TO DEAL WITH THE PROVIDEER
SHORTAGE. WE CAN MOVE CARE AWAY FROM
SPECIALTIES. THAT WOULD HELP THAT AS WELL. WHAT IS THE NEXT COLLABORATIVE
EFFORT OUR COMMUNITY NEEDS TO DO IN HEALTH?
WE NEED FOCUS ON BEHAVIORAL HEALTH.
IT’S A HUGE ISSUE. WE’VE BEEN SEPARATEING IT FROM
THE PHYSICAL HEALTH FOR FAR TOO LONG.
THERE ARE MANY PEOPLE WORKING ON THIS AREA. THANK YOU FOR PROVIDEING THIS.
??? THANK YOU. ??? THANK YOU ??? OUR NEXT HEALTH FORUM IS
ORGAN TRANSPLANT DONATION AND IT’S NEXT FRIDAY IN FEBRUARY.