‘We needed to think of our­selves a lit­tle bit dif­fer­ently’

Modern Healthcare - - Q&A -

“We know the na­ture of med­i­cal care is chang­ing from be­ing pre­dom­i­nantly in­pa­tient to far more out­pa­tient, and so we’re al­lo­cat­ing more of our re­sources to am­bu­la­tory care.”

In Chicago’s uber-com­pet­i­tive health­care land­scape, aca­demic med­i­cal cen­ters have been forg­ing new al­liances at a stag­ger­ing rate, es­pe­cially as they eye growth in the sur­round­ing sub­urbs. In March, Rush Univer­sity Med­i­cal Cen­ter, si­t­u­ated in Chicago’s pre­dom­i­nately low-in­come near West Side, and sub­ur­ban Rush-Co­p­ley Med­i­cal Cen­ter for­mal­ized a 30-year af­fil­i­a­tion by join­ing to­gether un­der a new ban­ner: Rush. Michael Dan­dorph, pres­i­dent of Rush Univer­sity Med­i­cal Cen­ter, will take the helm as pres­i­dent of the newly formed sys­tem. He re­cently spoke with Mod­ern Health­care re­porter Maria Castel­lucci about Rush’s ex­pan­sion plans, ef­forts to im­prove care co­or­di­na­tion and its role in ad­dress­ing pop­u­la­tion health is­sues. The fol­low­ing is an edited tran­script.

Mod­ern Health­care: What was the strat­egy be­hind de­vel­op­ing this fully in­te­grated sys­tem and how is it dif­fer­ent from what you were do­ing?

Michael Dan­dorph: One of our goals is to be the lead­ing aca­demic health sys­tem in Chicago. To do that, we’re go­ing to have to think about more than just what Rush looks like on the cam­pus with our flag­ship hos­pi­tal. We started to think about how we gov­erned the or­ga­ni­za­tion and how we make strate­gic in­vest­ments and re­source al­lo­ca­tion and plan our growth re­gion­ally. We needed to think of our­selves a lit­tle bit dif­fer­ently.

Through the cre­ation of the par­ent board, we wanted to po­si­tion our­selves to think not only about this as an in­te­gra­tion with Co­p­ley, but with re­gard to how we grow a sys­tem if we de­cided to in­te­grate with other providers or physi­cian groups or al­ter­na­tive care providers or in­sur­ance com­pa­nies for that mat­ter.

As we think about it from a strate­gic per­spec­tive, it al­lows us to do plan­ning in a dif­fer­ent way. We’re think­ing about ca­pac­ity op­ti­miza­tion and how we pro­vide bet­ter ac­cess to pa­tients.

MH: It sounds like you have ex­pan­sion plans and that’s where this came from.

Dan­dorph: We think about that in a cou­ple ways. There’s or­ganic growth and how you in­crease mar­ket share, how you grow as a sys­tem. We’re mak­ing in­vest­ments in am­bu­la­tory sites in other mar­kets off of our cam­pus. A lot of it is about how we in­vest in am­bu­la­tory-care ca­pa­bil­i­ties be­cause we know the na­ture of med­i­cal care is chang­ing from be­ing pre­dom­i­nantly in­pa­tient to far more out­pa­tient, and so we’re al­lo­cat­ing more of our re­sources to am­bu­la­tory care.

We’re also think­ing about part­ner­ships in a very dif­fer­ent way, which is why we con­structed that par­ent board the way that we did. We want to be­come nim­bler in the way that we’re viewed by po­ten­tial part­ners to make sure that we’re think­ing about their suc­cess as well as what the part­ner­ship does for our over­all abil­ity to man­age pop­u­la­tions and to cre­ate greater value.

MH: How is this strate­gic idea dif­fer­ent from your coun­ter­parts in the Chicagoland area or even other aca­demic med­i­cal cen­ters?

Dan­dorph: Prob­a­bly the big­gest dif­fer­en­ti­a­tion is hav­ing an in­te­grated aca­demic med­i­cal cen­ter that has a ded­i­cated health science univer­sity. That’s a ma­jor strate­gic op­por­tu­nity for us. Our cur­ricu­lum can bring var­i­ous as­pects of health­care to­gether—a med­i­cal school, an in­te­grated nurs­ing pro­gram, al­lied health pro­grams, a busi­ness health ad­min­is­tra­tion pro­gram—to de­velop the fu­ture skills that a health­care work­force is go­ing to need to suc­ceed.

We’re re­ally think­ing about how we im­prove care co­or­di­na­tion in a way that al­lows us to move the ex­per­tise closer to the com­mu­nity set­ting, closer to peo­ple where they live.

There are a few ex­am­ples where we’ve be­gun to in­te­grate with our care pro­cesses. One is an app called Seam­lessMD, which al­lows sur­gi­cal pa­tients to

bet­ter man­age their own care be­fore and af­ter surgery.

MH: What are you do­ing in the pop­u­la­tion health realm?

Dan­dorph: We are look­ing at how we use com­mu­nity health work­ers to keep peo­ple out of the hos­pi­tal and avoid read­mis­sions or pre­vent ad­mis­sions that don’t need to come to the ED. One of the more in­ter­est­ing part­ner­ships that we struck is with an in­no­va­tion group called Avia.

Through them, we de­vel­oped a part­ner­ship with a com­pany called Pro­teus Dig­i­tal Health. They have a smart pill with a biodegrad­able chip that’s the size of a grain of sand that gets em­bed­ded into a pill. We’re fo­cused right now on hy­per­ten­sion. If some­one is tak­ing med­i­ca­tion pre­scribed by a physi­cian, that chip, through an app, will pro­vide in­for­ma­tion back to the physi­cian let­ting them know if the pa­tient is tak­ing the drug at the right time, if there are meta­bolic is­sues around ab­sorp­tion of the drug and what’s go­ing on with their heart rhythm in a mean­ing­ful way. We’re in the process of launch­ing it.

MH: What are some chal­lenges you face to­day as an aca­demic med­i­cal cen­ter? How do you bal­ance the re­search mis­sion with a lot of pa­tients com­ing to Rush for in­tense spe­cialty care?

Dan­dorph: Ob­vi­ously, changes be­ing de­bated with re­peal and re­place of the Af­ford­able Care Act and dif­fer­ent evo­lu­tions of what health­care re­form is go­ing to look like and the ex­pan­sion of Med­i­caid are big. Be­ing on the West Side of Chicago, we have a lot of is­sues around dis­par­i­ties in care, an un­der­served pop­u­la­tion.

We’ve launched two ma­jor ini­tia­tives. One: We should be the largest em­ployer on the West Side of Chicago. We have a mis­sion to be an an­chor in the com­mu­nity in a way that brings peo­ple to­gether in a dif­fer­ent way to im­prove the health of the com­mu­nity. Work­ing with other providers in the Illi­nois Med­i­cal District we are bring­ing gov­ern­ment, church lead­ers, the busi­ness com­mu­nity to­gether in a way to cre­ate op­por­tu­ni­ties for em­ploy­ment, ed­u­ca­tion and ca­reer de­vel­op­ment.

We’re also call­ing for an ap­proach to a to­tal health col­lab­o­ra­tive in which we’re not only think­ing about health­care and what Rush can do, but how can we be a cat­a­lyst on the West Side to bring part­ners to­gether in a dif­fer­ent way to deal with those un­der­ly­ing is­sues.

MH: What does that look like in terms of part­ners?

Dan­dorph: We’re work­ing closely with one of the city col­leges, Mal­colm X Col­lege on the West Side, that’s been very fo­cused on de­vel­op­ing pipe­line pro­grams for health­care and col­lab­o­rat­ing with them. We’ve de­vel­oped a pro­gram where we can train com­mu­nity health work­ers be­cause we know that drives some of those pop­u­la­tion health is­sues.

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