Arizona State University professor Dr. Denis Cortese attacks a big problem in a book he co-authored: “Rescuing Healthcare: A Leadership Prescription to Make Healthcare What We All Want it to Be.” In his book, Cortese says the only way out of the current health care quandary is leadership reform, with medical practitioners empowered and given the leeway to create meaningful change in their fields. Cortese will discuss his new book.
TED SIMONS: EMERITUS PRESIDENT AND CEO OF THE MAYO CLINIC DR. DENIS CORTESE ATTACKS A BIG PROBLEM IN A BOOK HE CO-AUTHORED. THE BOOK IS TITLED "RESCUING HEALTHCARE: A LEADERSHIP PRESCRIPTION TO MAKE HEALTHCARE WHAT WE ALL WANT IT TO BE." DR. CORTESE IS NOW THE DIRECTOR OF ASU'S HEALTHCARE DELIVERY AND POLICY PROGRAM AND HE JOINS US NOW.GOOD TO SEE YOU AGAIN.
DENIS CORTESE: GOOD TO SEE YOU TED, THANK YOU
TED SIMONS: RESCUING HEALTHCARE. WHY DOES HEALTHCARE NEED RESCUING?
DENIS CORTESE: WOULD YOU LIKE TO BE ADMITTED TO HOSPITAL TOMORROW?
TED SIMONS: NOT NECESSARILY.
DENIS CORTESE: HOW WOULD YOU LIKE TO BE SICK TOMORROW?
TED SIMONS: NOT AT ALL.
DENIS CORTESE: HOW ABOUT BEING A PATIENT TOMORROW. SOMEONE THAT LONG SUFFERERS OR ENDURES?
TED SIMONS: YOU KNOW THAT ANSWER.
DENIS CORTESE: WE HAVE TALKED A LITTLE BIT ABOUT THAT BEFORE BUT THAT IS THE STRATEGIC PLAN FOR HEALTHCARE THIS CENTURY. IT'S JUST THAT SIMPLE. AND THAT IS HOW DO WE CREATE THE ANSWERS YOU JUST GAVE. NO, TRY TO AVOID THE HOSPITAL IF I CAN. TWO, I PREFER NOT TO BE SICK IF POSSIBLE. THREE, I PREFER NOT TO BE A PATIENT. I MYSELF HAVE FIVE CHRONIC MEDICAL CONDITIONS AND I WANT TO BE ACTIVE AND FUNCTIONING WELL. THEY CAN'T CURE ANY OF THEM BUT WANT TO BE ABLE TO NOT SUFFER LONG TO MAKE THAT WORK. SO, HOW ARE WE GOING TO GET THERE FROM HERE? THAT'S A STRATEGIC DIRECTION. LEADERSHIP COMES IN TO MAKE THAT HAPPEN. THE KEY IN HELPING TO CORRECT THE DELIVERY OF HEALTHCARE, I'M NOT TAKING ABOUT SOLVING AN INSURANCE PROBLEM. POLITICIANS ARE STILL STRUGGLING TO DO ANYTHING JUST ABOUT INSURANCE. WE HAVE A LOT OF PEOPLE WITH INSURANCE THAT ARE NOT GETTING THE BEST CARE, THE BEST COORDINATION, THE BEST OUTCOMES. INSURANCE ALL BY ITSELF DOESN'T SOLVE THE PROBLEM. THAT'S ONE PIECE. POLITICIANS AS YOU ELUDED TO JUST BEFORE, THEY SORT OF ACCOMPLISH THE POSSIBLE. LEADERS HAVE TO ACCOMPLISH WHAT SEEMS TO BE IMPOSSIBLE. THERE'S A DIFFERENCE BETWEEN A LEADER AND A POLITICIAN. LEADERS HAVE TO LOOK AT HERE'S THE FUTURE, AND HERE'S WHERE WE ARE, HOW DO WE GET THERE FROM HERE? THE FIRST ROLE, PARTICUARLY FOR HEALTHCARE IS IF WE CAN GET THE KEY LEADERS, NOT JUST ONE GROUP, THERE ARE MANY MANY PEOPLE HAVE TO HAVE A SHARED VISION OF JUST WHAT YOU SAID. WE ARE WE TRYING TO AIM FOR. ONCE YOU CAN CREATE THAT SHARED VISION, THE NEXT LEVEL OF LEADERSHIP -- ROLE FOR LEADERSHIP IS TO GET PEOPLE TO UNDERSTAND, IF THIS IS WHERE WE WANT TO BE, HERE'S WHERE WE ARE. THERE'S A GAP. HOW DO WE CLOSE THE GAP?
TED SIMONS: GIVE ME EXAMPLES OF LEADERSHIP AND HOW MUCH OF THE VISION RIGHT NOW IS SHARED?
FROM A NATIONAL PERSPECTIVE I WOULD SAY THE VISION IS NOT SHARED VERY WELL AT ALL. HOWEVER, WHEN YOU LOOK AT REGIONS OF OUR COUNTRY, PARTICULARLY SOME STATES, YOU WILL FIND LEADERS WHO 30 YEARS AGO DECIDED THAT TO IMPROVE THE HEALTH OF THE PEOPLE IN THEIR COMMUNITY AND I DO MEAN HEALTH. THEY FOCUSED ON BEHAVIORS. THEY FOCUSED ON KEEPING PEOPLE IN SCHOOL. THEY FOCUSED ON TRYING TO IMPROVE SOCIAL CIRCUMSTANCES. THEY ALSO DID IT WITH THE MINDSET THAT OUR GOAL IS TO TRY TO HELP PEOPLE STAY HEALTHY. IF WE CAN'T KEEP THEM HEALTHY, WE ARE GOING TO CURE CONDITIONS WHEN WE CAN. CAN'T CURE EVERYTHING. CAN'T CURE DIABETES, CAN'T CURE ASTHMA. FOR THOSE THINGS WE CAN'T CURE, WE ARE GOING TO KEEP THEM WELL. AND TO KEEP THEM WELL YOU MIGHT NEED VERY AGGRESSIVE NEW MODELS OF CARE WHERE WE ARE USING THE ACTIVE INGREDIENTS WE ALREADY HAVE, AND WE ARE USING THEM ON THESE PATIENTS IN A ONGOING WAY. HERE'S WHAT HAPPENS IN THOSE COMMUNITIES. COMMUNITY LEADERS FREQUENTLY THEY ARE PHYSICIANS. THEY ARE HOSPITAL ADMINISTRATORS. THEY MAY EVEN BE INSURANCE PEOPLE. THERE ARE COMMUNITY WORKERS. THEY HAVE COME TOGETHER TO SAT WE ARE GOING TO CHANGE THE CARE IN THIS COMMUNITY AND THEY BAN TOGETHER. THEY DON'T OWN EACH OTHER THEY JUST WORK TOGETHER WITH A COMMON ELECTRONIC RECORD. FREQUENTLY, THEY START THEIR OWN INSURANCE COMPANY. WHEN THEY DO THAT, THEN WHEN PATIENTS SIGN UP FOR THAT INSURANCE COMPANY, I'M THINKING OF GRAND JUNCTION, COLORADO FOR INSTANCE. THE WHOLE COMMUNITY BANNED TOGETHER IN 1993 AND CREATED AN INSURANCE COMPANY. THERE WERE THREE HOSPITAL SYSTEMS AND THERE STILL ARE AND ALL THE DOCTORS WERE INDEPENDENT. THEY WENT TO A SINGLE ELECTRONIC RECORD. WHEN THAT HAPPENED THEY CAN FOCUS ON THEIR SICKEST PATIENTS AND PRACTICE ANYWAY THEY WANT.
TED SIMONS: BACK TO THE ART OF THE POSSIBLE. IS IT POSSIBLE FOR THAT VISION THAT WORKS APPARENTLY WELL IN GRAND JUNCTION, COLORADO TO WORK ACROSS THE ENTIRETY OF THE UNITED STATES?
DENIS CORTESE: ABSOLUTELY. THERE ARE CURRENTLY NOW 110 INTEGRATED DELIVERY SYSTEMS LIKE MEMORIAL HERMAN, LIKE BANNER, LIKE KAISER, LIKE INTEGRATED MOUNTAIN CLINIC, THERE'S 110 OF THEM, WHO OWN THEIR OWN INSURANCE COMPANIES. THEY HAVE MEDICARE ADVANTAGE PLAN MEDICAID ADVANTAGE PLAN OR COMMERCIAL PLANS FOR PEOPLE UNDER AGE 65. YOU WONDER HOW IMPORTANT IS THAT? IS THAT IF REGULAR INSURANCE WON'T PARTICIPATE IN PAYING US IN A WAY WE GET TO BE VIABLE BY KEEPING PEOPLE HEALTHY, RIGHT NOW, IN A FEE FOR SERVICE MODEL, WE ONLY MAKE MONEY WHEN PEOPLE ARE SICK. IF YOU WANT TO CHANGE THAT NEW FUTURE, WE HAVE TO CHANGE DELIVERY MODELS AND PAYMENT MODELS. SOME PROVIDERS HAVE SAID NOBODY WILL PARTICIPATE WITH US SO WE'LL DO IT OURSELVES. OTHER PLACES ARE SEEING PARTNERSHIPS COME UP. HOWEVER, LET ME JUST GIVE YOU A COUPLE OF EXAMPLES OF WHAT CAN HAPPEN WHEN A PATIENT FINDS THEMSELVES IN AN INSURANCE COMPANY OWNED BY A PROVIDER SYSTEM. WHEN THEY'RE SICK THEY MAY VERY WELL GET HOSPITAL CARE I AT HOME. THEY COME INTO THE HOME. WHERE? ALBUQUERQUE, NEW MEXICO, PRESBYTERIAN HOSPITAL WITH THEIR MEDICARE ADVANTAGE PLAN. THEY HAVE BEEN DOING THAT FOR ALMOST 13-14 YEARS. THAT'S JUST ONE EXAMPLE. THERE ARE OTHER EXAMPLES WHERE THEY GET INDEPENDENCE AT HOME PROGRAMS WHERE THE PROVIDERS, MOST OF THE CASES, THEY WILL BE COMMUNITY WORKERS, THEY MAY BE NURSES, OCCASIONALLY DOCTORS WHO WILL COME TO YOUR HOME AND MAKE SURE ON A REGULAR BASIS THAT YOU ARE FOLLOWING THE MEDICATIONS, IF YOU HAVE ASTHMA THAT YOUR HOUSE IS CLEAN, OCCASIONALLY THEY WILL EVEN HIRE A CLEANING SERVICE TO CLEAN YOUR HOME TO AVOID YOU KETTING A FLARE OF ASTHMA AND ENDING UP IN AN EMERGENCY ROOM OR A HOSPITAL.
TED SIMONS: RIGHT
DENIS CORTESE: WE HAVE EXAMPLES ALL OVER THE COUNTRY LIKE THAT. IF WE WOULD FOCUS ON LEARNING FROM THE EXAMPLES AND GETTING OUR LEADERS TO SAY, HERE'S A VISION. NOW, INSTEAD OF THE LEADERS SAYING HERE'S HOW YOU DO IT, DON'T DO THAT. YOU LOOK AROUND THE COUNTRY AND SAY WHO'S DOING IT? WHO'S ALREADY THERE AND LET'S LEARN FROM THEM AND REPLICATE THOSE EXAMPLES. I'M TOTALLY CONFIDENT WE CAN DO IT AND IT'S BEEN COMING OVER THE LAST TEN YEARS. WE SEE IT MORE AND MORE.
TED SIMONS: WE HAVE ABOUT A MINUTE LEFT HERE. WE ARE TALKING ABOUT HEALTHCARE THROUGH THOSE WHO DELIVER HEALTHCARE. YOU SAY THERE IS A BUT OF A SHARED VISION OUT THERE. YOU SAY THAT IT CAN BE DONE. IT'S BEING DONE IN LITTLE POCKETS. GIVE ME A TIMELINE. WHEN COULD THIS HAPPEN WITH REAL SUBSTANTIVE CHANGE?
DENIS CORTESE: IF THE FEDERAL GOVERNMENT WOULD BEGIN TO PAY IN A WAY THAT PROVIDERS WHO PROVIDE THE BEST OUTCOMES, BEST SAFETY, BEST SERVICE AND LOWEST COSTS AND YOU PAY THEM IN A WAY THAT THEY CAN STAY IN BUSINESS, WE WOULD CHANGE THIS IN A YEAR.
TED SIMONS: ACCESS WOULD BE AS STRONG IF NOT STRONGER FOR EVERYONE, EVEN THE POOR?
DENIS CORTESE: YES. IF WE CAN SAVE ONE THIRD AND MOST ESTIMATES ARE THERE IS 30% WASTE IN HEALTHCARE DELIVERY. THAT'S A TRILLION DOLLARS.
TED SIMONS: "RESCUING HEALTHCARE: A LEADERSHIP PRESCRIPTION" THIS IS REALLY INTERESTING STUFF. IT'S SOMETHING TO THINK ABOUT. GOOD TO HAVE YOU ON THE SHOW AGAIN. GOOD TO SEE YOU AGAIN.
DENIS CORTESE: THANK YOU VERY MUCH AND YOU'RE WELCOME. THANKS FOR ASKING ME.
TED SIMONS: YOU BET.
Denis Cortese: Emeritus President, CEO of Mayo Clinic, Director of ASU's Healthcare Delivery Program. M.D. Author:"Rescuing Healthcare"
