Issue link: https://beckershealthcare.uberflip.com/i/417381
49 we are located, and at the same time, we are a regional and national referral center taking care of people from across the country. Managing the process of serving our local areas with the highest quality care while also ensuring access to the same for patients who come to us from out of state can be a unique situation. We are fortunate, however, to have so many peo- ple who count on us and significant demand for our services — as well as playing an important role in our communities. DW: Something we've been dealing with for 15 years is the poor payer mix. Texas, for years, has led the country in the amount of uninsured indi- viduals. Houston is about 34 percent uninsured. The uninsured problem is compounded by the state of Texas' decision not to expand Medicaid and the PPACA prohibition of selling insurance to undocumented individuals. Houston is esti- mated to have 16 to 18 percent of its population as uninsured, undocumented individuals. Even if the state of Texas expanded Medicaid, and the PPACA worked wonderfully well, we would still have to deal with 16 to 18 percent of the pa- tient population having no ability to pay. This demographic creates a unique challenge for our system's vision of population health; specifically, how do we keep all these people healthy and well when they have no access to healthcare? We don't see this challenge going away. It's something we grapple with every day. Q: When was the last time you found yourself really, genuinely excited about something? Why was this moment par- ticularly thrilling? SA: Diseases caused by genetic abnormalities are very common in pediatrics and impact a large portion of our patients. Over the last 15 to 20 years, we've been working on gene therapy tech- nology that uses viral vector to replace a defec- tive gene in a certain part of the body and restore function. One particularly exciting area of this work has focused on a congenital form of blind- ness. You use an attenuated virus and basically en- gineer this virus to carry the corrective gene. You place the vector with the corrective gene in the retina and restore the patient's sight. That's pretty exciting in its own right. SS: Montefiore is a special place, and I've been lucky enough to spend my professional career here. Every day brings something new and excit- ing. I'm particularly looking forward to the up- coming opening of our new ambulatory center, the Hutch Metro Center. This "hospital without beds" is certain to be a model for the future de- livery of care. "The Hutch" will have a beautiful, patient-centered space featuring multidisci- plinary approaches to primary, specialty and sub- specialty care. WT: I was genuinely excited just last week at Ochsner's Power of One Employee Experience meeting. The Power of One is Ochsner's com- munications platform and our Employee Experi- ences bring together hundreds of employees from across our system together in one place. In one day, I got to spend time with 2,000 fantastic em- ployees, educating them on developments in the healthcare industry and also energizing them for the future. It's so exciting to see how committed they are to our patients. It is really uplifting and exhilarating to have the opportunity to lead such a great team. It gives me great energy. DW: The last excitement was probably just a month ago when we concluded our fiscal year, and it wasn't that we hit an all-time record finan- cial performance, but that six of our hospitals went a whole year without a serious safety event. We set out in 2006 to become the country's first high reliability [healthcare] organization. We wanted to emulate other industries where we caused no harm to our customers. We studied other industries that are highly reliable, like com- mercial aviation and nuclear energy. Instead of trying to reinvent what we do, we adopted many practices from those industries and applied them to healthcare. When you look at our performance on hospital-acquired conditions, serious safety events — whatever you want to pick — we're clearly in the top 5 percent, if not 1 percent, across the board. We want to be the first health system to achieve zeroes across the board on all hospital acquired conditions and serious safety events. Q: What should we in healthcare spend more time solving, discussing or investi- gating? What is most in need of innova- tion? SA: If you look at where healthcare is going, ev- eryone talks about value-based healthcare: the notion of high-quality care at an appropriate cost. But when you really take a close look at it, I think the industry has been focused solely on cost, with quality really being an afterthought. The big move among insurance companies now is the creation of narrow networks, which is in effect saying, "We'll offer you a less expensive insurance product if you sign up for a much narrower scope of providers." This issue is criti- cal to pediatric healthcare. You may have heard that in Seattle, there were a number of health insurance exchange products offered in the state — and all excluded Seattle Children's Hos- pital. Seattle Children's is now suing the state health commissioner. Are we really moving toward value-based health- care, or are we just moving to a system that will have cost as its only criterion and will try to ex- clude providers of care and providers of very spe- cialized care that are important in communities? You can imagine that when you have high-tech children's hospitals, the cost of care will be higher. But for certain types of care, those high-tech hos- pitals are where you'll have the best outcomes. A value-based system has to take into consideration both the cost and the quality of the care provided. If it is only focused on cost, then you are not de- veloping a true value-based system. SS: Leaders across disciplines need to focus on chronic disease, socioeconomic determinants of health and workforce development. It might sound like these issues aren't related, but they are intricately tied to the future success of our coun- try. We are tackling these issues head on because we see them day in and day out in our commu- nity. We have community outreach and popula- tion health resources dedicated to moving the needle on chronic disease through wellness initia- tives, antismoking campaigns, and screening and treatment events. We provide access to healthcare to those who need it through a network of more than 170 locations across the region, including the largest school health program in the nation and a home health program. We understand the relationship of poverty and health and work to ameliorate the challenges of housing, homelessness and transportation that our patients experience. As the largest employer in the Bronx, we take meaningful responsibility to support education and job training programs that will fuel the future healthcare workforce. Our ef- forts cannot stand alone and need to be magnified on a broader scale. We work with our partners in academia, private, nonprofit and government sec- tors to create a space for this to happen, but more work is needed in these areas. WT: We need to focus on reinforcing people's personal commitments to leading healthy life- styles and giving them the information and assis- tance needed to keep them engaged. We need to make sure delivery systems and payment mecha- nisms are modified to provide the right payment and incentives to ensure providers are working with their patients to help them live healthier life- styles. Currently, many payment mechanisms are not structured to provide innovation in the way we take care of patients to help them stay healthy. We will continue to have challenges in healthcare until we have a broader portion of the population actively leading a healthy lifestyle. DW: I do not see any real progress in truly reform- ing the healthcare system in this country. The PPACA goes after health insurance reform. That was a necessary step, but we are not reforming the delivery of healthcare and changing the incentives in the system so we can bring costs down and make it more affordable to all people, including patients, governments and employers. What we need to focus on is changing our delivery system and how we finance it so we are more incentivized to keep people healthy and treat chronic disease more aggressively instead of waiting until they get acutely ill. As a country, we have to bring our costs per cap- ita down to where the rest of the industrialized countries are; not spend double what every other country spends. There are pockets of success on an experimental basis, but as a country we seem to have no appetite for significantly reforming the financing and delivery of healthcare. n