Modern Healthcare - - THE WEEK IN HEALTHCARE -

Beth Kutscher: Tell me a lit­tle bit about what led you to set up the fel­low­ship pro­gram with the Nashville Health Care Coun­cil. What in­ter­ested you about the project? Bill Frist:

Af­ter 20 years in medicine and then 12 years in the pol­icy arena in the Se­nate, it was ap­par­ent to me that Nashville has all of the fun­da­men­tal build­ing blocks of be­ing a pre­mier health­care—not just ser­vice, but to­tal health—cap­i­tal. The ex­per­tise that is in Nashville ex­ists nowhere else in the United States of Amer­ica. I say that af­ter trav­el­ing to most all of the states, 44 coun­tries, and be­ing im­mersed at the high­est level in writ­ing pol­icy in health­care and then de­liv­er­ing health­care one on one as a doc­tor.

This is where the gap is: to fill that void in hav­ing a for­mal pro­gram that would en­gage lead­ers in mean­ing­ful con­ver­sa­tions and ed­u­cate health­care lead­ers of to­day and to­mor­row on chal­lenges and so­lu­tions, to fos­ter lead­er­ship and pre­pare lead­er­ship for solv­ing the prob­lems that ex­ist to­day, but for which we don’t have so­lu­tions. Kutscher:

What are some of the chal­lenges you see that are fac­ing health­care ex­ec­u­tives? Frist:

I think the world of 2013 is a world of health trans­for­ma­tion cre­ated fun­da­men­tally by the cost of health­care, which has sky­rock­eted in re­cent years to the point on a macro sense it’s 18% of our GDP, and on a mi­cro sense, the cost of health­care is out­strip­ping the typ­i­cal per­son’s abil­ity to pay for it. So the big­gest chal­lenge is ad­dress­ing cost. To do that ef­fec­tively, health­care com­pa­nies, or the in­dus­try, have to fo­cus on the value equa­tion, which has cost as its de­nom­i­na­tor, but re­sults in the nu­mer­a­tor. The big­gest chal­lenge to health­care com­pa­nies to­day is—in this en­vi­ron­ment of rapid change, of the call for trans­for­ma­tion, of leg­is­la­tion like the Af­ford­able Care Act or Oba­macare be­ing im­ple­mented—the goal is to max­i­mize value in a way that pa­tients and in­di­vid­u­als ben­e­fit at the same time.

The sec­ond big chal­lenge is, health­care com­pa­nies of the fu­ture are go­ing to be … part of a more in­te­grated de­liv­ery sys­tem, which de­mands col­lab­o­ra­tion and co­op­er­a­tion. In the past, we have re­lied on si­los in health­care de­liv­ery and si­los in terms of health­care com­pa­nies, and the com­pa­nies of to­mor­row are go­ing to have to fo­cus more on seam­less in­te­gra­tion with other com­pa­nies to achieve the goals sur­round­ing qual­ity and out­comes.

The third big chal­lenge is the role of the con­sumer will be greatly mag­ni­fied in the fu­ture. The role of the pa­tient, the con­sumer, the in­di­vid­ual who will be bet­ter ed­u­cated and mak­ing de­mands, new de­mands on the sys­tem and in­sist­ing on trans­parency and accountability. Kutscher:

There’s also an im­mer­sion com­po­nent that asks ex­ec­u­tives to pull back the cur­tain and share with their com­peti­tors what goes on be­hind the scenes, maybe even pro­pri­etary in­for­ma­tion. Is that part of the goal of the fel­low­ship, to have that sort of col­lab­o­ra­tion? Frist:

The im­mer­sion com­po­nent, which is about a third of the course, will be deep and un­prece­dented. The ... very in­ti­mate in­ter­ac­tion [will be both] with CEOs who will be shar­ing their tough­est chal­lenges to their own com­pa­nies and to their own ca­reers.

The sec­ond com­po­nent of the im­mer­sion is to open up and break down bar­ri­ers to en­cour­age col­lab­o­ra­tion, and that might be with doc­tors and hos­pi­tals, it might be doc­tor in­pa­tient with out­pa­tient group, it might be home health­care with hos­pi­tals, it might be aca­demic health cen­ters and com­mu­nity hos­pi­tals. But to break down bar­ri­ers and the si­los to en­sure col­lab­o­ra­tion.

The third com­po­nent of the im­mer­sion will be to en­gage the par­tic­i­pants in ac­tiv­i­ties that will be ac­tive and in­ter­ac­tive. For ex­am­ple, look­ing at the new and im­por­tant role in the fu­ture of per­son­al­ized medicine, we will likely walk each par­tic­i­pant through a im­mer­sion process of dis­cussing the

im­pli­ca­tions of pri­vacy is­sues sur­round­ing ex­change of ge­netic in­for­ma­tion, go­ing so far as even to take their own blood and sub­mit it for DNA anal­y­sis to make it real and tan­gi­ble, the sort of im­pli­ca­tions of hav­ing that in­for­ma­tion that may pre­dict you’re go­ing to have heart disease 10 years later or Alzheimer’s 20 years later— the tough is­sues that in­tro­duces into the health­care sys­tem.

They’ll go through ap­pro­pri­ate ge­netic coun­sel­ing, as part of this im­mer­sion course, to open up this world of how tech­nol­ogy and ge­nomics and the In­ter­net and so­cial me­dia is so rad­i­cally trans­form­ing health­care to­day and how it will be very dif­fer­ent to­mor­row. Kutscher:

Do you ex­pect to see more of that sort of col­lab­o­ra­tion among the for-prof­its work­ing to­gether go­ing for­ward? Frist:

I think so. The world is go­ing to de­mand it, and in this world of in­creased con­sol­i­da­tion, which is be­ing caused by the call for more seam­less care and more ef­fi­cient care and less waste, it will de­mand for­profit in­sti­tu­tions both shar­ing in­for­ma­tion—whether it’s health records or claims data—but also for-prof­its work­ing with aca­demic places. So one of the goals clearly will be much in­creased col­lab­o­ra­tion, greater trans­parency and more accountability as a part of do­ing busi­ness. Kutscher:

What are some of the other health­care pri­or­i­ties that need to be ad­dressed? Frist:

First and fore­most will be the cost is­sue and how to max­i­mize value, which means mea­sur­ing out­comes and re­sults. No. 2, the big­gest shift go­ing on, and thus chal­lenge to be ad­dressed, is the shift of risk from government, from pay­ers, and from busi­ness, over to con­sumers and to providers—the doc­tors and the hos­pi­tals.

That shift is a huge chal­lenge, be­cause providers—doc­tors es­pe­cially, but doc­tors and hos­pi­tals—are not ac­cus­tomed to man­ag­ing risk. And the con­sumers are go­ing to be greatly em­pow­ered with in­for­ma­tion, and that will in­crease all sorts of is­sues, like pri­vacy is­sues and the like.

The third, which is a prod­uct of the Af­ford­able Care Act, will be the ac­cess is­sues sur­round­ing the newly in­sured, both in Med­i­caid, as well as through the state ex­changes. Do we have enough pri­mary-care physi­cians? If we have enough of pri­ma­rycare physi­cians, will they be able to find a spe­cial­ist? Is the work­force of nurses and physi­cian as­sis­tants suf­fi­cient?

Frist is a co-di­rec­tor of a new health­care fel­low­ship pro­gram with the Nashville Health Care Coun­cil.

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