20 Years of Value Partnerships
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About the Show
For the next few episodes, we’ll be bringing you conversations from the Mackinac Policy Conference. This year, the conference is focusing on “Bridging the Future Together”, which will invite dialogue among speakers and attendees on ways leaders will inspire radical collaboration across divides. With focus on the greatest issues and opportunities in Michigan, the concept of “Bridging the Future Together” will cover key themes critical to Michigan’s future including attracting businesses and jobs, improving education outcomes to ensure workforce readiness, strengthening infrastructure, and leading with innovation and equity. We thought it’d be a great opportunity to talk to attendees about how “Bridging the Future Together” will benefit the state of Michigan within their sectors. We hope you enjoy these bonus episodes.
On part 1 of this series, we’ll be focusing on value partnerships between BCBSM and provider partners.
Guests:
- Dan Loepp - President and CEO of Blue Cross Blue Shield of Michigan and Amy Loepp - Co-Founder, Impact100 Oakland County
- Bob Riney - President & CEO of Henry Ford Health
- Rob Casalou - President & CEO of Trinity Health
- David Miller - President of U-M Health
- Ruthanne Sudderth - Senior Vice President and Chief Strategy Officer of the Michigan Health and Hospital Association
Transcript
Chuck Gaidica:
Hi, everyone. Chuck Gaidica here for A Healthier Michigan Podcast. For the next few episodes, we'll be bringing you conversations from the Mackinac Policy Conference. This year, the conference is focusing on bridging the future together, which will invite dialogue among speakers and attendees on ways leaders will inspire radical collaboration across divides. With focus on the greatest issues and opportunities in Michigan, the concept of bridging the future together will cover key themes critical to Michigan's future, including attracting businesses and jobs, improving education outcomes to ensure workforce readiness, strengthening infrastructure and leading with innovation and equity.
We thought it would be a great opportunity to talk to attendees about how bridging the future together will benefit the state of Michigan within their sectors. We hope you enjoy these bonus episodes.
Hi, everyone. Chuck Gaidica here for A Healthier Michigan Podcast. For the next few episodes, we'll be bringing you conversations from the Mackinac Policy Conference. This year, the conference is focusing on bridging the future together, which will invite dialogue among speakers and attendees on ways leaders will inspire radical collaboration across divides. With focus on the greatest issues and opportunities in Michigan, the concept of bridging the future together will cover key themes critical to Michigan's future, including attracting businesses and jobs, improving education outcomes to ensure workforce readiness, strengthening infrastructure and leading with innovation and equity.
We thought it would be a great opportunity to talk to attendees about how bridging the future together will benefit the state of Michigan within their sectors. We hope you enjoy these bonus episodes.
On this episode, we'll be focusing on value partnerships between Blue Cross Blue Shield of Michigan and provider partners. We'll be talking with Blue Cross Blue Shield of Michigan President and CEO, Dan Loepp and Co-founder Impact100 Oakland County, Amy Loepp; Henry Ford Health President and CEO, Bob Riney; President and CEO of Trinity Health, Rob Casalou; President of U of M Health, David Miller; and Michigan Health and Hospital Association Senior Vice President and Chief Strategy Officer, Ruthie Sudderth.
First up is President and CEO of Blue Cross Blue Shield of Michigan, Dan Loepp, and Co-Founder Impact100 Oakland County, Amy Loepp.
Good to see both of you.
Amy Loepp:
Good to see you.
Dan Loepp:
Chuck, good to see you.
Chuck Gaidica:
Congratulations on a new life that's coming for you. This is exciting.
Dan Loepp:
It is, and it was a tremendous run, 18 or 19 years and being a CEO of a company the size of Blue Cross was interesting. So many good things. So many people I met, so many things that we've done. We're a different company today than when I started as CEO, much bigger, much more complex and diverse. There's lots of things coming, and the board did a great job in picking my successor and Trisha will do a tremendous job.
Chuck Gaidica:
This idea of retirement, and I want to get Amy's perspective too, because I've gone through this. So Susan will say, "You need to go find something to do now." But this idea, there's some freedom in it. Do you feel that?
Dan Loepp:
Not yet.
Chuck Gaidica:
Not yet, because your retirement goes through the end of the calendar year, right?
Dan Loepp:
Right, first of the year, but you can think about it. You know what I mean?
Chuck Gaidica:
Yeah. Yeah.
Dan Loepp:
Because you can see it, it's on the horizon. One of the things I think I learned, because there were a lot of my co-Blue Cross CEOs from around the country that have retired over the last two or three years, people that had 10, 15 years experience. So I would ask the question, "Okay, so what's the deal? What were you thinking? What are you going to do?" The best piece of advice I think I got, at least that hit me the most, is don't make any big decision for six months afterwards. Get your brain cleared. Figure it out. Obviously, talk to your wife and your family. Then maybe there's something, maybe there's nothing grandkids, which is great. We have four of them, so we'll see.
Chuck Gaidica:
It's a great season of life, the grandkids thing. Right?
Dan Loepp:
No doubt.
Chuck Gaidica:
Oh, my gosh. So in this idea of the 20 years or so, and you've seen changes, you talked about it maybe from the structure of Blue Cross, but you've seen changes in healthcare in general. So much has changed.
Dan Loepp:
Yeah, absolutely, and it is going to change exponentially over the next three to five years. When you look at just all the therapeutic drugs that are coming on the market, which are good things, but they're very expensive, and how does this all fit in an economic system where to get Wegovy or whatever-
Chuck Gaidica:
Sure.
Dan Loepp:
... it's $1,200 a month and how can the system take that, let alone all these gene cell therapies that they're getting very close to having a one shot cure for life, but they're 3 or 4 or $500,000 a piece. So how does that play, and who do you pick to get it? Who doesn't? All of that stuff, which is good obviously on one hand. But we have an economic issue that we as a nation and as a world, for that matter, need to figure out. It's not just the payers, it's everybody. It's the government, it's the physician, it's the hospital, all of that. It all affects all of us, and not one of us has the answer, and we're going to have to be collaborative enough to figure out how to fix it.
Chuck Gaidica:
We've been talking to a lot of healthcare leaders about Blue Cross Blue Shield of Michigan's Value Partnerships, and you see it from a different end of the funnel, I suspect. But they all talk about it, I wouldn't use the word glowing, but in some cases it has been. It's been a big success for many hospital systems.
Dan Loepp:
20 years ago when I was in waiting, we started Value Partnerships. I can remember going to a Beaumont doctor meeting with Dr. Simmer who was our medical director at the time and where we laid this out. This was only upside benefit for performance at the time. It's a lot more skin in the game today. If there were tomatoes in the place, they would have thrown them at me.
Chuck Gaidica:
Wow.
Dan Loepp:
But it's totally changed because what we're seeing is the patient cares better. We're paying docs more for their performance, so it's a win-win across the board. It's getting much more sophisticated in how we do it, especially in Medicare Advantage. Over 40% of the docs in our Medicare and MA programs have both up and downside risk, which means if you don't perform, you're going to pay in a bad way. If you do perform, it benefits you and your practice, and people are embracing it. That's a humongous change from 20 years ago.
Chuck Gaidica:
And benefiting patients are consumers.
Dan Loepp:
Totally, most importantly.
Chuck Gaidica:
Yeah. Yeah. Well, Amy Loepp is with us. You've been so patient sitting there. I remember personally, I'm going to just keep retiring until I get it right. But there's a whole piece of this, as Dan talked about, kids, grandkids, there's that whole personal part of this.
Amy Loepp:
So my goal is to keep him to his six months of not committing, which might be very challenging, and then myself unwinding with some of the things I'm doing.
Chuck Gaidica:
Yeah, and you're doing so much to help build stronger communities. Can you talk about that and your personal commitments as a couple and as an individual?
Amy Loepp:
Yeah, I think it's a two tier. So we have our family foundation that we're working on growing right now as opposed to spending-
Chuck Gaidica:
Okay.
Amy Loepp:
... so that we will be able to really focus on that more once during retirement and figuring out that focus that we want to do with our philanthropy. So I'm on three different boards, child abuse and Neglect, which is Children Trust Michigan, Prevention of Child Abuse and neglect, which is a statewide organization. We're the only organization that's solely focused on prevention. Then Eaton Academy, which has been near and dear to our heart for some time for children who learn differently. Then Impact100 Oakland County was the other baby that a friend of mine and I began in 2015. So we just reached our $2 million mark of giving grants.
Chuck Gaidica:
That's awesome. Impact100 touches people how?
Amy Loepp:
It's a giving circle, so we have a process that we're going through right now. So I would say any nonprofits that may be interested in receiving a grant, this is the time to look at our website.
Chuck Gaidica:
Yeah, okay.
Amy Loepp:
In essence, we do give away high-impact grants. So unlike some of the other amazing organizations that will give away smaller dollar amounts, we try to be more in the $100,000 increment.
Chuck Gaidica:
To an actual charitable organization.
Amy Loepp:
Yes. Yes, so-
Chuck Gaidica:
Beautiful.
Amy Loepp:
... 501(c)(3). So we have three grants we're giving away this year.
Chuck Gaidica:
Yeah, that's wonderful. I know that having grandchildren has changed life because, well, it's right here. This is my phone, but in here are credit cards. If one of the grandkids, not a kid, 'cause we didn't spoil our children, but now if a 3-year-old said, "I'd like a car," it'd be like, "You want a Buick, you can't even drive yet." Isn't it just the best season? Look at that. See, we're sharing pictures/
Amy Loepp:
Screen share.
Chuck Gaidica:
I didn't have a picture to share yet, but isn't it a fantastic season?
Amy Loepp:
Clearly.
Dan Loepp:
It really is, and it's-
Amy Loepp:
It's so fun.
Dan Loepp:
... so different. I always had people say, "Oh, you wouldn't believe it. It's terrific." You go, "Oh, yeah, okay, sure." But it's true, and our families are fairly close. Our third adult, large adult, Nathan, Amy's son is in San Francisco.
Amy Loepp:
You mean proximity close, is it?
Dan Loepp:
Proximity close.
Chuck Gaidica:
We're in close proximity.
Amy Loepp:
I'm just like, "What?"
Dan Loepp:
He's not quite to the grandchild stage, but I'm sure he will be. It's a blast. I love it.
Amy Loepp:
It's fun. We had him all over on Sunday and swimming and-
Dan Loepp:
We put a pool in exactly for that reason.
Chuck Gaidica:
I will share with you this personal story. We had downsized, so I retired from full-time-
Amy Loepp:
Did you?
Chuck Gaidica:
... from television. Yeah-
Amy Loepp:
You retired?
Chuck Gaidica:
... and we downsized to a condo. In the past two years, we went back to a home on a half-an-acre. I traded in my SUV for a minivan. We've got four car seats, and the first thing I bought was a used pool table precisely for what you just said. It's not for the kids, it's not for me.
Dan Loepp:
Right.
Chuck Gaidica:
We're doing everything now, and we have stuff that we had 40 years ago, and we're actually having a blast. We get tired-
Amy Loepp:
Yeah.
Dan Loepp:
Oh, yeah.
Chuck Gaidica:
... but it's just wonderful. Yeah.
Dan Loepp:
Totally.
Amy Loepp:
Love that you mentioned the minivan, because Dan meant, what was it, the hybrid-
Dan Loepp:
Pacifica. Yeah.
Amy Loepp:
Yeah.
Chuck Gaidica:
Yeah. Yeah.
Amy Loepp:
I was like, "Okay, but then you'll drive it."
Chuck Gaidica:
There is that whole part about being a young parent and then there's the part about having a grandpa mobile. I don't care. I'm way past...
Dan Loepp:
Yeah, no, absolutely.
Chuck Gaidica:
Yeah, I'm way past worrying about the image part of this whole thing. So you went past Eaton Academy, and I know that that's been a long time commitment. Just give us a little deeper dive on what that is.
Amy Loepp:
They are a independent school, private school that serves currently grade 1-12.
Chuck Gaidica:
Okay.
Amy Loepp:
We're looking at starting a kindergarten, but it is for children who learn differently. So it's a 10:1 ratio of the teacher to student.
Chuck Gaidica:
Okay.
Amy Loepp:
Each student has a unique profile that they work on then with that student, so it's very personalized, very important. In talking with people and the head of school, it's becoming more and more complicated. He's been in this role for 30 years, I think, of working with various students and just seeing the difference in the children. We just saw in the news what, one in nine, right?
Dan Loepp:
ADHD.
Amy Loepp:
Yeah, are diagnosed with ADHD now.
Chuck Gaidica:
Oh, yeah.
Amy Loepp:
So the complexity of whether it's now recognized more or whatever we want to say, but there's significant need out there, and-
Dan Loepp:
Generally what you'll find is the kids there at Eaton got lost in the system.
Amy Loepp:
Understandably.
Dan Loepp:
Right, absolutely.
Amy Loepp:
30 kids in a classroom, teachers can only-
Dan Loepp:
They generally disruptive or bummed out or-
Amy Loepp:
Or withdrawn.
Dan Loepp:
... had terrible self-esteem. They go into this environment, and it's game changing because you get smaller class sizes, but they really understand... It's kids with dyslexia and dysgraphia, all of those things, and it is a great place.
Chuck Gaidica:
Well, it's wonderful to have both of you here. Congratulations on the new season of life that's coming.
Dan Loepp:
Thank you.
Chuck Gaidica:
It's so wonderful to hear more about Impact100 and all that you're involved in, so much success. Thank you for your kindness to me over the years. So it's been a pleasure.
Amy Loepp:
Congratulations on your retirement too.
Chuck Gaidica:
Well, yeah. You can keep giving me-
Amy Loepp:
Retirement in air quotes, right?
Chuck Gaidica:
Yeah, yeah. You can keep giving me that congratulations. Thank you.
Dan Loepp:
I still like your blue couch, Chuck.
Chuck Gaidica:
Well, I keep telling you, it's not my blue couch. I know exactly where it's hidden in Farmington Hills, so-
Amy Loepp:
You might need to expand on that.
Chuck Gaidica:
... that's the couch. Because of doing our infomercial on Medicare Advantage, that's the sofa that frankly gets its own truck, and it's driven around as if it's Kevin Costner in a vehicle. That's the blue couch that we've taken out to the edge of a kayak drop in the middle of a ball field downtown Plymouth, Michigan. It's just been a joy to be part of that. But the couch is its own star.
Amy Loepp:
Does it get its own colored M&Ms and that kind of thing?
Chuck Gaidica:
I don't know. I haven't ever talked to makeup and wardrobe about how demanding the couch is, but it could be. But good to see both of you-
Dan Loepp:
Good to see you.
Chuck Gaidica:
... and much love and much success as you transition this year.
Dan Loepp:
Thanks, Chuck.
Amy Loepp:
Thank you. Appreciate it.
Chuck Gaidica:
Next up is president and CEO of Henry Ford Health, Bob Riney. Good to see you, Bob.
Bob Riney:
Great to be with you, Chuck.
Chuck Gaidica:
Yeah, Bob is President and CEO of Henry Ford Health and participated with Blue Cross Value Partnership program since the beginning, right?
Bob Riney:
We have, and we have always believed that value-based care is the right way to deliver care. It not only provides the right value from an economic standpoint, it's the right coordination of care for patients. I've been a part of myself a value-based network for 30 years, and I wouldn't get care any other way.
Chuck Gaidica:
Yeah, and when you use those words, what does that mean, value? Because we as consumers think of the value as well, that's the cost, but there's more to it.
Bob Riney:
Oh, there's a lot more to it. It really is about quality and making sure that the right care, right place, right time is all organized. If you think about medicine like a lot of things in life, it's a team-based sport. Value-based care really makes sure that a team is working on your behalf to do the right thing. If there's options for care treatment that you're being provided those options with the pros and cons of each option. You're a partner in this journey. Episodic care, which when people just shop around based on what they're feeling or worried about is not always the best care because you may be getting treated for one thing versus a holistic approach to how do we keep you healthy?
Chuck Gaidica:
That's interesting because we hear other phrases like functional medicine. So that implies that team approach, but it doesn't really talk about value and what you're getting as a customer.
Bob Riney:
Yeah, and value is getting quality. It's getting the safest care at the right location. If your care can be done in an outpatient basis and doesn't require an inpatient hospital stay, you're going to want that because you don't want to be compromised any more than you have to be. But it's having a team look and work with you on the right holistic approach. What value-based care really requires is that everyone have a primary care physician, someone that can be their quarterback or their coach that can help them determine whether they really need to see a specialist or not and if so, who?
Chuck Gaidica:
Yeah. When you talk about this, we're thinking of it, or at least I am in terms of being a consumer of that, but also this has to affect the staff across the hospital, across the system, right? Because when they see that working, that can add to their positive attitude. There's so many off ramps to that.
Bob Riney:
Absolutely. Team members want to do what's right for patients, and they want to eliminate waste or inefficiency as much as anybody, and even the advancement of our electronic medical records where your history is all in your phone.
Chuck Gaidica:
Right.
Bob Riney:
So if you see a doctor and they say, "Maybe we should think about this," and then they can go back and say, "You know what? It hasn't been that big of a change in the last three to four years. Let's continue to watch," versus, "Wow, this has taken a jump from your studies two or three years ago, we need to get more aggressive and assertive in the treatment," and that's what you want.
Chuck Gaidica:
I'm a data guy, so I'm wonky with my own numbers on my MyChart through Henry Ford. So I go on there, and I love seeing the... to me, it's like a video game, even though it's not. I've seen my numbers get better and better, and I've had my primary care doctor reflect back to me, "Just changing your lifestyle has..." In six months, you can literally see the numbers change in your favor. So for me, that's been a powerful thing to use my phone to go look at the numbers and say, "Oh, it's working."
Bob Riney:
It's funny you say that because the way Henry Ford uses MyChart, which is we put everything into it so the patient has complete access, it does make you feel like an owner of your care. I found that for myself personally, and you'd think, "Well, how can it do that?" But it's motivational, and it's a number, and numbers don't lie.
Chuck Gaidica:
Right. When you see a positive force, you're like, "Well, not only good for me, but it's good for my family. It's good for everything," right?
Bob Riney:
That's right.
Chuck Gaidica:
So lots of initiatives at Henry Ford Health, one of them is MI Mind. Tell us about that.
Bob Riney:
MI Mind is a way to really try and get at, I think, what's one of the saddest things that we're all dealing with, and that's just the incredible increase in suicides. We know that mental health issues have been rising, but we're seeing so many young people choose to take their own life. This is a way to really get coordinated and bring all of the care, again, through a primary care physician to really assess whether someone is at the beginning stages of depression or anxiety or feeling trapped in some way, shape or form and then connecting them to a network of behavioral health specialists that can really help.
I talk to families all the time, and I don't think there's a family that hasn't been touched by mental illness in some kind of a profound way. We need to pay attention because this rate of suicide is going in the wrong direction, and especially in young people. We can't wait for all the research. We have to start getting here and now with the care coordination that we have at our disposal. So this is an effort to partner and do just that.
Chuck Gaidica:
Some of those stats that we see over time that get repeated in various stories, the epidemic of loneliness across every age demographic. My mom and dad both passed in 2019, but mom had Alzheimer's. I would've had a preconceived notion, "Well, loneliness must be a thing for older folks in memory care." I get it. I understand it intellectually. But when you start to tell me 20 year olds are lonely and they've got 5,000 Facebook friends, it doesn't make sense. Yet, all the data suggests everybody is reflecting they're lonely.
Bob Riney:
I'm a big proponent of getting people as much as possible back into the office versus working virtually.
Chuck Gaidica:
Oh, yeah, yeah.
Bob Riney:
I think hybrids are fine, but I think that we're missing the obvious, and that's human connectivity-
Chuck Gaidica:
Sure.
Bob Riney:
... is a fuel for life. It really is. I think we've fooled ourselves to thinking that technology connections provide that. They don't. They provide busyness. They advance a lot of things in our life, but virtual friends aren't friends. Friends are people that you can be with, that you can hug, that you can go through good times and bad times. This social isolation, because we're now all addicted to technology that keeps us busy is very different than what we need as human beings, and I think we're discovering that.
Chuck Gaidica:
That. But you know that coming back together, we've come through this season where you couldn't hug, you couldn't kiss, there's a ritual that you and I employed when you walked up to the table. I shook your hand, I couldn't touch you. I couldn't be near you. So that whole idea of interacting with human beings in community has got to be at least a piece of the puzzle.
Bob Riney:
There's no question. I think that the pandemic, rightfully so, created a lot of fear and apprehension in us. But now that we've got through that and we're managing it well, like anything else in life, you have to overcome your fears. You have to overcome your apprehensions and get back to the positives that come from the interaction. I worry very much about our younger generations that have grown up with technology as being their sole source of communication or their predominant source because it's a learned skill, and we've got to help them. That's why I'm really big about getting people back into the offices, getting people back into stopping at a local watering hole and getting to know each other at the end of the day. That's what I think really helps in so many ways.
Chuck Gaidica:
Well, when you look forward now in a short period of time or long term with these Value Partnerships and the initiatives, what are you looking to make change with? You've just talked about one here with MI Mind, but what else are you focusing on?
Bob Riney:
I think we're going to really continue to evolve to recognize that if we want to create true health of populations that healthcare has its important role in helping people get better and do preventative work. But education health is important. Economic health is important. So we're leaning in and helping in all of those ways because ultimately health is multifaceted, as we all know. It's not just physical health. I think that Michigan is a collaborative enough environment that we can lead the nation in showing how this is done.
Chuck Gaidica:
Well, that's great to hear. Sometimes I feel like with people I know even within my family circle, that whole idea of financial health, spiritual health, when one part is off, it's like driving the car and you know it's pulling. You don't know exactly why, but you know, feel off. So trying to come up with this holistic approach is awesome.
Bob Riney:
I think when we get there, we're going to see major change in some of the public health numbers that we're not too proud of today.
Chuck Gaidica:
Well, that's great to hear. Well, Bob Riney, good to see you-
Bob Riney:
Great to see you.
Chuck Gaidica:
... President and CEO of Henry Ford Health. Take care-
Bob Riney:
Enjoy the island.
Chuck Gaidica:
Yeah, you too. Thanks.
Bob Riney:
Thanks.
Chuck Gaidica:
Now as president and CEO of Trinity Health, Rob Casalou. Good to see you.
Rob Casalou:
Good to be here.
Chuck Gaidica:
What a nice time on the island, huh?
Rob Casalou:
Oh, yeah. This is a place we've been coming so long, I can't even remember the first time.
Chuck Gaidica:
Yeah. Well, that's good, though, right?
Rob Casalou:
Yeah.
Chuck Gaidica:
Just that whole movie title somewhere in time, it just brings you down.
Rob Casalou:
Exactly.
Chuck Gaidica:
It slows you down, I guess a better way to say it.
Rob Casalou:
Yeah, absolutely.
Chuck Gaidica:
So hospitals and physician organizations within Trinity Health System have been long time participants with Blue Cross Value Partnerships program. What is that? What does that mean, a Values Partnership program?
Rob Casalou:
Well, you got to talk about the word value and who's receiving it. I think the value is to the ultimate payer and recipient of care, so those who pay the bills through Blue Cross and to providers and then the experience of our patients. So the partnership that we've enjoyed with Blue Cross is trying to create that value in those relationships that we both value.
Chuck Gaidica:
Along with value is still the word quality. It's still attached in there to make sure that the bar is high.
Rob Casalou:
Oh, absolutely. Actually, if you look at the partnership that we've been involved in, it started with quality. It wasn't about the money and what I call the financial part. Now it is about both. It's quality, but now we look at the total cost of care, and we partner together with Blue Cross in order to try to lower that total cost of care.
Chuck Gaidica:
So when you look at other initiatives like collaborative care, does that expand beyond the notion of doctors collaborating? It's a collaboration that goes farther than that.
Rob Casalou:
It's a multi-professional. So when you talk about our medical group, we have one called IHA that's part of Trinity and Southeast Michigan and now in West Michigan, and we have primary care offices. It used to be a primary care office was the primary care doctor, the MA, in and out, order a bunch of tests, sometimes end up in the hospital. Now when you go into our offices, we have registered dieticians. We have pharmacists. We have behavioral specialists. It's a team IT collaborative care in that office to try to maintain everyone in the lowest intensity that they have to have in healthcare and meet their needs.
Chuck Gaidica:
Well, it used to be when I was growing up, I remember I had an uncle who had some health issues, and there used to be this idea you had to go to a big clinic, one of the big names in America to find this notion of collaborative care, although I don't think they had that name for it then. This seems to be something that's growing everywhere, and it's to our benefit as potential patients, right, as customers?
Rob Casalou:
Oh, absolutely. When you look at it in healthcare, we sell a product nobody wants to buy, right?
Chuck Gaidica:
Yeah.
Rob Casalou:
We are the product that people need, though, and when they need it, they want it to be the best. They also want to have the lowest intensity experience, both from a healthcare standpoint, but also from a cost standpoint because people pay a lot of their own bills now. So our job is, the way we used to make money in the old days was the more you utilize the hospitals, the more you utilize things, the more money that the hospitals made and health systems made. That has turned 180 degrees. That's what the Value Partnership is all about. It's about us making a living as a health system, but making it a different way. The only way we do that now is by keeping people within what we call a home, in their primary care home. We have to provide all those resources in that home or otherwise they're going to filter out and start burning up the cost of care.
Chuck Gaidica:
I think that's what I've seen too in my own experience within my family's system, thinking back to mom and dad was, I'm going to pick and choose these. "I've got migraines, well, I'll go to a different expert," and, "I've got a back thing, I'll go to this expert." They're trying to make decisions themselves that don't seem like all the pieces of the puzzle get connected.
Rob Casalou:
Oh, yeah.
Chuck Gaidica:
Yeah.
Rob Casalou:
We talk a lot about the mental health crisis and the mental health... That's why embedding mental health resources in our primary care office has been key, 'cause a lot of folks come in and they may have a physical ailment. It's being driven by something on the mental health side of their life, and we can identify it right there. We can actually connect them with a psychiatrist while they're in the office.
Chuck Gaidica:
Come on.
Rob Casalou:
Oh, yeah.
Chuck Gaidica:
Wow.
Rob Casalou:
If we have to. We have virtual connections with the psychiatrist. We have embedded social workers and others in the offices that try to deal with those social issues.
Chuck Gaidica:
Well, and how critical is that because when you're in this intimate setting with a primary care physician or one of the team, that is likely going to be a place where you would share some of this information that maybe you wouldn't share. They already know, they've already just seen you in a paper gown.
Rob Casalou:
Oh, yeah.
Chuck Gaidica:
I'm just saying.
Rob Casalou:
Well, particularly with a new patient, when they come in, we start with a social screening. A lot of folks walk in, they don't have access to food, they don't have transportation. They may not even be literate and not able to read, so we identify the social determinants right when they come in. Then if there's an identified issue, that's being dealt with at the time that they're in the office.
Chuck Gaidica:
I see.
Rob Casalou:
So when you get that kind of stuff out of the way, now they may come in with a legitimate physical issue that we have to deal with, or it's just an annual physical, but whatever that case may be, these other resources help us take care of everything we can at that time.
Chuck Gaidica:
So it sounds like there's a lot of streamlining and great stuff happening within primary care, this team approach. But what are still some of the challenges as you look forward in time, even a short period of time, what are you working on?
Rob Casalou:
The one you've heard about from everybody you're going to talk to and that's shortages of doctors and other providers. We have 350 primary care physicians and advanced practitioners in the state of Michigan alone, Trinity does, and yet we could use more. So we're going to continue to have to use ancillary staff, advanced practice practitioners, PAs and nurse practitioners as well as, like I mentioned, the dieticians and other folks to help create space and capacity to take care of more people.
Chuck Gaidica:
But in a way, that those particular specialties you're talking about, that may be the precise person I needed help from anyway. Not that my primary shouldn't have a hand in it, it's just maybe I did want to have a lifestyle change, what we used to call a diet-
Rob Casalou:
Oh, yeah.
Chuck Gaidica:
... so if there's a dietician, right?
Rob Casalou:
We just opened our first of two now lifestyle medicine primary care practices. So we're adding the pillars of lifestyle medicine. The three that we really focus on are stress, exercise and food, so we add that dimension to those offices. So our goal with IHA is to continue to expand that in addition to all those other resources. Then we just opened two senior primary care offices dedicated to all the issues of seniors. We have one in Livonia and one in Ann Arbor right now. Again, we pilot these and then we spread them. IHA has been an advanced medical group, I think a good partner to Blue Cross for a long time. So they've been a good experimental ground for a lot of advanced thinking.
Chuck Gaidica:
Well, when you use the word seniors, it's not what it used to be because there are not only more of us. I resemble that remark now.
Rob Casalou:
So do I.
Chuck Gaidica:
So there are more of us, and if you're doing your job well, everything you're saying is you're extending not only lifespan for me, but I want my health span to go along... If I'm going to make it to 90 or 100 now, I'd like to be healthy right up to the end. Right?
Rob Casalou:
Well, you're singing my tune right now. I'm saying 65. Yeah, 65 is no longer considered old.
Chuck Gaidica:
Right.
Rob Casalou:
Yeah.
Chuck Gaidica:
Right.
Rob Casalou:
Yeah.
Chuck Gaidica:
Well, Rob, it's good to see you.
Rob Casalou:
Good seeing you too.
Chuck Gaidica:
Enjoy the conference, and thanks for all the insights.
Rob Casalou:
Great being here. Thanks.
Chuck Gaidica:
Yeah. Rob Casalou, president and CEO of Trinity Health. Next is President of U of M Health, David Miller. Good to see you.
David Miller:
Thank you very much. That's for the opportunity.
Chuck Gaidica:
Having a good time? You said it's your first Policy Conference?
David Miller:
First time, it's been wonderful, very energizing, great ideas, great focus on the talent in the state of Michigan and can't ask for better weather.
Chuck Gaidica:
Well, that is nice because it's like being one of the bears. It's not too cold, not too hot, it's just right, especially when you have to hoof it yourself, not let the horses do their thing, right?
David Miller:
That's exactly right.
Chuck Gaidica:
Well, it's so great that you're here because the Michigan Medicine really has a lot of connections to Blue Cross and Value Partnerships program, right?
David Miller:
Correct.
Chuck Gaidica:
That goes back a ways.
David Miller:
It does. Now, the Value Partnerships program and then all of the initiatives that represent the collaborative quality improvement initiatives have more than a 20-year history of strong partnerships between University of Michigan, Blue Cross Blue Shield of Michigan, and physicians and clinicians across the state of Michigan, really an example for the nation.
Chuck Gaidica:
I've heard that word collaborative a lot when it comes to medicine in relation to the Value Partnerships in particular. But that's something that's ongoing, this notion that this is really a team effort.
David Miller:
Without a doubt. I think what's really unique about the programs is the recognition that identification and solving some of the biggest challenges in healthcare is best done by those individuals who are delivering that care every day. So when you see the spirit of these CQI initiatives where instead of just describing differences and outcomes, there starts to be an effort to understand those, to solicit the best ideas. Then to bring those back to the different practices where patients receive care across state, it's really transformative and sets a model for the nation.
Chuck Gaidica:
That collaborative care model is we think of our primary care physicians, but it really starts to fan out from there, dieticians, depending on your context, what's going on in your life.
David Miller:
Oh, absolutely. I think when you look at the breadth of the different programs, they cover key aspects of primary care. They cover key aspects of specialty care, and as you mentioned by definition, recognize and support the multidisciplinary nature of clinical care. Physicians, nurses, dieticians, respiratory therapists, all sorts of different specialists are contributing to the great solutions we're seeing around the state of Michigan.
Chuck Gaidica:
But as a consumer walking in as a patient, I think you're going to be blown away to understand that you have a team, whether you recognize it right away or not that it isn't just one person. Not to diminish the importance of that person, but that collaborative effort really benefits us in so many ways.
David Miller:
Absolutely. As you know, there's a famous statement at University of Michigan from Bo Schembechler, "The Team, The Team, The Team," but that really applies in healthcare. On behalf of patients, it is that expertise across multiple areas to meet the needs of the patients in our communities that, I think, leads to the very best outcomes.
Chuck Gaidica:
Well, I'll let you know that I'm part of the team, at least I know when we have a grandchild at U of M that the last time we had one, I walked up and they said, "Oh, you're in the system," so I could get my badge right away with my picture. I thought, "I'm part of the team. This is awesome, 'cause that's where everybody keeps on going," which is awesome.
David Miller:
Absolutely, our families are absolutely part of the team, a key part of the team. Congratulations, we're glad that went so well.
Chuck Gaidica:
Yeah, thanks, multiple times-
David Miller:
Fantastic.
Chuck Gaidica:
... which is really nice. So when you look at what's happening in the world of medicine now, what are you seeing that gives you great hope for the future? Is it refining the programs that are in place, or do you see something new on the horizon?
David Miller:
Yeah, that's a great question. I think there are probably two parts. First is, how do we take the care that we're providing already and make it better?
Chuck Gaidica:
Okay.
David Miller:
That's where these CQI programs that have been supported with Blue Cross Blue Shield of Michigan with strong partnership with University of Michigan and other systems in state. They ask the question, "Okay, we know that treatment A works very well, but all the patients who could potentially receive it or not, what are the barriers? Are they issues related to access? Are they issues related to education?" So I think that improvement in the currently-available therapies offers a lot of promise.
On the other side, though, there's the new discovery and new innovations, and it's amazing. I recently went to our specialty pharmacy program, a really exemplary program at University of Michigan. I looked on the shelf at all the new medication that are now available to treat complex conditions, inflammatory conditions, neurologic conditions. These were fundamentally different than when I was in medical school 25 years ago. It is that continuous innovation in therapies, in imaging, in treatments that I think is going to really start to further impact health, particularly in areas like cancer, cardiovascular disease and neurosciences, and that's an exciting time. Then we can take those new therapies and learn how to best deliver them just as we're doing now with the ones that are already available.
Chuck Gaidica:
I know there's also been this focus on post-surgery and medications, right? Can you talk about that a little bit?
David Miller:
Yeah, absolutely. Well, I think a great example of that has been one of the collaboratives focused on prescribing opioid medications, right?
Chuck Gaidica:
Oh, yeah.
David Miller:
I think we've all heard and have recognized the impact of opioid use disorder in our communities. There was a tremendous idea that in the state of Michigan actually partnerships between surgeons and anesthesiologists, again, University of Michigan faculty members saying, "How much pain medications are patients actually taking after an operation?" We know it's needed, but if you look at it from an opioid perspective, how many of the ones we prescribe are patients actually taking?" Because there's a risk that those initial prescriptions could be what's often referred to as a gateway to longer term opioid use disorder. In fact, what was found through this collaborative model was patients are taking far fewer than we prescribed so we can modify our practice patterns together safely, and patients are very open to the use of non-opioid alternatives. So putting those two things together across the state of Michigan and actually leading a trend nationally has been really substantial work to reduce the number of opioid medications prescribed postoperatively in a really scientific evidence-driven fashion that has had a big impact across the state and now is actually being seen nationally.
Chuck Gaidica:
When you say cut back on the number, it's likely, I'm just making an assumption, it's not just the prescription, it's actually the number of whatever you're getting. Why do I need 12 when I'm only going to go through three and then I'm fine?
David Miller:
That's exactly it. What was seen was there were a lot of historical practice patterns of, say, prescribing perhaps 15 pills after an operation. In fact, the patients were only taking about three. So it is exactly as you said, reducing the number, and in so doing, reducing the risk of longer term complications of opioid-related medications.
Chuck Gaidica:
Again, that's to our benefit in the end. It's great that a lot of smart people are thinking about this from a different perspective, but for us as the patient, it makes a lot of sense. I don't want to get hooked on something, and if I don't need it, why is it still in my cabinet?
David Miller:
That's exactly it. We have to acknowledge that we have to control pain well after surgery, right?
Chuck Gaidica:
Yeah. Yeah.
David Miller:
But these medications can be habit-forming, so we want to reduce the number. We don't want them around, like you said, afterwards in households where there could be at risk for children, for other patients, et cetera.
Chuck Gaidica:
Or our waterways-
David Miller:
Exactly-
Chuck Gaidica:
... or whatever it is.
David Miller:
... so ultimately a big win-win.
Chuck Gaidica:
Sure. What is the M OPEN Network? What is that?
David Miller:
Yeah, I described that a little bit. It started as what was called the Michigan Opioid Provider Engagement Network.
Chuck Gaidica:
Okay. That's what it is. Okay.
David Miller:
Right. Then now it's really started to focus not just on the number of pills that are prescribed, but actually looking out more broadly into the community and thinking about how to address opioid use disorder. Again, coming back to your concept of a broader team-based effort that isn't just the postoperative care is an important part of it, but there are also needs for rescue medications for patients who are experienced opioid use disorder and treatments for that. So it's become now have a broader focus of not just that postoperative setting, which is incredibly important and incredibly multidisciplinary in its structure.
Chuck Gaidica:
So when you look at how U of M is leading the way with so many initiatives that connect directly or indirectly to the Value Partnership platform, you've got to feel real good about that because a sense being a leader is a good thing. You're an influencer then.
David Miller:
Absolutely. Well, I have to reference our motto of leaders and best at University of Michigan, so thank you for that. Absolutely. Again, coming back to it, the power of this to have the individuals delivering the care see the opportunities and challenges, use data to develop the best available evidence and then translate that back out into communities across the state, that's a model that resonates in the state of Michigan and nationally. I think for the last 25 years, what we've seen is lower mortality, better outcomes after treatment, better clinical decision making, higher patient satisfaction. It is really a way that gets back to the patients, families and communities in a meaningful fashion.
Chuck Gaidica:
As you look in the near term two to five years, what are you seeing that gives you such hope about what's happening, and I don't want to call it streamlining, but this notion of refinement with everything we've talked about?
David Miller:
Yeah, I think as innovation comes into healthcare, whether it's a new type of surgery or whether it's a new medication, that refinement means that we're getting the highest value for those treatments as quickly as we can. The structure that's been set up in Michigan, this collaboration based on data with subsequent dissemination of the best available techniques and treatments really gets us to that place faster than anywhere else in many ways.
Chuck Gaidica:
I think often a lot of us, I'll just say for me, I sometimes think innovation is going to be the most costly option when indeed it turns out to be the opposite. Innovating leads to this contraction and you save money in the end, which is great.
David Miller:
I think an innovation comes in many different ways, right? Sometimes it's the new medication or new surgery, sometimes it's looking at how we do things already and changing our behaviors. That has been elusive, but the collaborative model in the state of Michigan has really unlocked that type of innovation.
Chuck Gaidica:
Very cool. Well, David Miller, good to see you.
David Miller:
Good to see you. Thank you so much.
Chuck Gaidica:
Yeah. David is president of U of M Health.
David Miller:
Thank you so much, Chuck. It's a pleasure to be here. I appreciate the opportunity.
Chuck Gaidica:
Oh, you're very welcome.
David Miller:
Have a great day, and Go Blue.
Chuck Gaidica:
Finally, Senior Vice President and Chief Strategy Officer of the Michigan Health and Hospital Association, Ruthie Sudderth. So good to see you again.
Ruthanne Sudderth:
It's great to be back.
Chuck Gaidica:
Isn't it pretty?
Ruthanne Sudderth:
What a beautiful day on Mackinac Island. I love it. The sun is shining, and I couldn't ask for anything better.
Chuck Gaidica:
Well, we're all feeling better, right?
Ruthanne Sudderth:
We are.
Chuck Gaidica:
We're all are sitting here and enjoying soaking it in, calming our lives down. I know that Blue Cross Blue Shield of Michigan and Michigan Health and Hospital Association have really worked together for a long time over the years. Statewide healthcare and safety and quality improvements seem to be top of the list. We're hearing that from hospital systems. I'm sure we'll hear more about it from you, and this idea that it's affecting us right down to the level of consumer-
Ruthanne Sudderth:
Absolutely.
Chuck Gaidica:
... as a potential patient is helpful.
Ruthanne Sudderth:
Absolutely. Yeah. There's a long history of working together on some really important issues that affect families every day in Michigan, and we're so grateful for the support that the Blues have offered over the year to our Keystone Center for Patient Safety and Quality to do work ranging from maternal health improvement to working with care for seniors, all the way to infection prevention and everything in between. So it's been a great partnership.
Chuck Gaidica:
So tell us more about Keystone Center.
Ruthanne Sudderth:
So the MHA Keystone Center for Patient Safety and Quality was formed back in 2003, so we have our-
Chuck Gaidica:
Wow.
Ruthanne Sudderth:
... 21 anniversary this year. During that time, it's really our Patient Safety and Quality arm of our association, but they really work on member-led programs that are evidence-based that work to prevent harm and to improve the care that patients receive every day at the bedside and in the community. So we bring hospitals together, and they set aside any differences they might have outside the quality arm, and they really work together on patient care improvement. It's really tremendous the amount of lives they've been able to save and dollars they've been able to prevent going into the system by preventing harm and making care safer.
Chuck Gaidica:
So with that kind of innovation spanning two decades, is there any stopping it? As you start to look to the future, where else can innovation happen? Is it just refining what's been done, or are there these new off ramps to make change?
Ruthanne Sudderth:
Absolutely. That's a great question. Really having started at the bedside, we've learned over the last couple of decades that the outcomes that a patient has are really driven a lot more by the experiences that they have at home and outside the hospital. That's where health happens. So we have made health equity and health improvement a pillar of ours at the Trade Association and at the Keystone Center. So what that means is that we are refocusing and putting more resources into healthcare improvement and safety and quality. Right now, we're focused tremendously on some health equity work that involves not just hospitals, but partners in the community, because we do have to work outside the four walls of the hospital to keep people from coming in, to make sure that when they go home, they can keep their medication cold or have access to healthy food. So we're really doubling down on the commitment to working with partners on healthcare improvement and equity.
Chuck Gaidica:
That team approach is important at the hospital level with the association, but also the idea of the ownership for us as individuals, right? In the case of my senior mom and dad in the day, it was a team of us-
Ruthanne Sudderth:
Absolutely.
Chuck Gaidica:
... of the kids helping to make sure meds were there, they're being distributed properly.
Ruthanne Sudderth:
Absolutely.
Chuck Gaidica:
All that becomes so important.
Ruthanne Sudderth:
Absolutely. Having patient advocates and family members who you can rely on for support is so critical. We actually worked with partners recently on creating a caregiver navigator toolkit. So what that does is it provides healthcare providers with a whole suite of resources and tools to give to those care caregivers in the home that are going to be helping patients when they leave the hospital, and what an important step that is so that they don't have to come back?
Chuck Gaidica:
Well, and that takes a lot of stress off the caregiver because they may know what they need, they just know where to go to get it.
Ruthanne Sudderth:
Absolutely. Yeah. I've been in that situation personally taking care of family, and it's been done for me. It's a lot to remember, and it's a lot to navigate, and it can be a scary time. So we need to give families the resources that they need to be champions and be advocates for their family member and to keep them safe and well cared for at home.
Chuck Gaidica:
So when you get these hospital systems, the cats and dogs together, and they're all getting along, you must hear of their challenges, the threads that run through that are similar.
Ruthanne Sudderth:
Absolutely.
Chuck Gaidica:
How will you see moving forward MHA playing a role in this idea of addressing these key challenges for the hospital systems?
Ruthanne Sudderth:
Absolutely. Our Keystone Center has a lot of new efforts going on right now, bringing hospitals and health systems across the state together, again, on some really key issues that will help us advance safety and quality. One of those things is focusing on better data. We can't improve what we're not measuring. So we have a lot of efforts going on right now, especially in the health equity space, to gather better race and ethnicity data and outcome data so that we can measure how we're improving in those really important spaces. We also have a task force of our membership that has been working for two years on a health equity toolkit and recommendations for best practices for hospitals across the state to adopt together.
So that's going to be going out to our members in the year ahead. We're also not forgetting that health equity includes seniors, it includes people in rural communities. It's not just a race and ethnicity issue. So a lot of work is going in, again, with partners from across the state and with the health department and with Blue Cross Blue Shield of Michigan and others to adopt new standards of practice to make sure that we are getting to patients where they're at in their journey of health and preventing them from having to come to the hospital. But once they're there, making sure that care is really safe and high quality.
Chuck Gaidica:
All those things are so great. I think that what we're seeing even in the interviews we've had so far today is this idea that everyone is really aiming for me to have not only a long lifespan, but an increasingly important health span-
Ruthanne Sudderth:
Yes.
Chuck Gaidica:
... where those numbers come together, which means if I am going to be around for a long while, I'm going to be a consumer of health-related care in some way for maybe longer than it used to be the case.
Ruthanne Sudderth:
Absolutely.
Chuck Gaidica:
Right?
Ruthanne Sudderth:
Absolutely. That's what we're here talking about this week at the conference, of course, is bringing more people to Michigan. We have an aging state right now, and that means people need more care for more years and it's more expensive care. So how do we work together to make sure that people are getting the care that they need and that it remains affordable for our shared constituencies? So that's why I think our partnership has been so critical over the last two decades.
Chuck Gaidica:
Well, it's great to see you again. Thanks for bringing us up to date. What are you looking forward to here for yourself with the conference then?
Ruthanne Sudderth:
We're really focused, back to the issue of making sure we're prepared to care for the population of Michigan in the years ahead, and so this week we're really focused on workforce. This morning we announced some new data about the hiring needs of our hospitals and what it's going to take care of Michiganders in the years ahead. In the last year, more than 61,000 jobs have been filled at Michigan hospitals. We still have-
Chuck Gaidica:
Wow.
Ruthanne Sudderth:
... 19,000 open positions, though. That's how many people we're still looking to hire. A lot of those are nurses, of course, but we also need technicians. We need people in administration. We need people in IT and cybersecurity. So we're really focusing on building the healthcare talent pipeline so that we are ready to take care of older Michiganders, but also hopefully a lot more new and young families coming into our state.
Chuck Gaidica:
Well, Ruthanne Sudderth, good to see you.
Ruthanne Sudderth:
Great to see you too.
Chuck Gaidica:
Good to have an update on all of the above. I feel healthier already.
Ruthanne Sudderth:
You know what? I have that effect on people, Chuck, I really do. I love being here with you guys. Thanks for having me back.
Chuck Gaidica:
You're very welcome. Thanks for listening to A Healthier Michigan Podcast, brought to you by Blue Cross Blue Shield of Michigan. If you like our show and you want to know more, check us out at ahealthiermichigan.org/podcast, or leave us a review or rating on Apple Podcast or Spotify. To get all the new episodes on your smartphone or tablet, be sure to subscribe to us on Apple Podcasts, Spotify or your favorite podcast app.
Amy Loepp:
Good to see you.
Dan Loepp:
Chuck, good to see you.
Chuck Gaidica:
Congratulations on a new life that's coming for you. This is exciting.
Dan Loepp:
It is, and it was a tremendous run, 18 or 19 years and being a CEO of a company the size of Blue Cross was interesting. So many good things. So many people I met, so many things that we've done. We're a different company today than when I started as CEO, much bigger, much more complex and diverse. There's lots of things coming, and the board did a great job in picking my successor and Trisha will do a tremendous job.
Chuck Gaidica:
This idea of retirement, and I want to get Amy's perspective too, because I've gone through this. So Susan will say, "You need to go find something to do now." But this idea, there's some freedom in it. Do you feel that?
Dan Loepp:
Not yet.
Chuck Gaidica:
Not yet, because your retirement goes through the end of the calendar year, right?
Dan Loepp:
Right, first of the year, but you can think about it. You know what I mean?
Chuck Gaidica:
Yeah. Yeah.
Dan Loepp:
Because you can see it, it's on the horizon. One of the things I think I learned, because there were a lot of my co-Blue Cross CEOs from around the country that have retired over the last two or three years, people that had 10, 15 years experience. So I would ask the question, "Okay, so what's the deal? What were you thinking? What are you going to do?" The best piece of advice I think I got, at least that hit me the most, is don't make any big decision for six months afterwards. Get your brain cleared. Figure it out. Obviously, talk to your wife and your family. Then maybe there's something, maybe there's nothing grandkids, which is great. We have four of them, so we'll see.
Chuck Gaidica:
It's a great season of life, the grandkids thing. Right?
Dan Loepp:
No doubt.
Chuck Gaidica:
Oh, my gosh. So in this idea of the 20 years or so, and you've seen changes, you talked about it maybe from the structure of Blue Cross, but you've seen changes in healthcare in general. So much has changed.
Dan Loepp:
Yeah, absolutely, and it is going to change exponentially over the next three to five years. When you look at just all the therapeutic drugs that are coming on the market, which are good things, but they're very expensive, and how does this all fit in an economic system where to get Wegovy or whatever-
Chuck Gaidica:
Sure.
Dan Loepp:
... it's $1,200 a month and how can the system take that, let alone all these gene cell therapies that they're getting very close to having a one shot cure for life, but they're 3 or 4 or $500,000 a piece. So how does that play, and who do you pick to get it? Who doesn't? All of that stuff, which is good obviously on one hand. But we have an economic issue that we as a nation and as a world, for that matter, need to figure out. It's not just the payers, it's everybody. It's the government, it's the physician, it's the hospital, all of that. It all affects all of us, and not one of us has the answer, and we're going to have to be collaborative enough to figure out how to fix it.
Chuck Gaidica:
We've been talking to a lot of healthcare leaders about Blue Cross Blue Shield of Michigan's Value Partnerships, and you see it from a different end of the funnel, I suspect. But they all talk about it, I wouldn't use the word glowing, but in some cases it has been. It's been a big success for many hospital systems.
Dan Loepp:
20 years ago when I was in waiting, we started Value Partnerships. I can remember going to a Beaumont doctor meeting with Dr. Simmer who was our medical director at the time and where we laid this out. This was only upside benefit for performance at the time. It's a lot more skin in the game today. If there were tomatoes in the place, they would have thrown them at me.
Chuck Gaidica:
Wow.
Dan Loepp:
But it's totally changed because what we're seeing is the patient cares better. We're paying docs more for their performance, so it's a win-win across the board. It's getting much more sophisticated in how we do it, especially in Medicare Advantage. Over 40% of the docs in our Medicare and MA programs have both up and downside risk, which means if you don't perform, you're going to pay in a bad way. If you do perform, it benefits you and your practice, and people are embracing it. That's a humongous change from 20 years ago.
Chuck Gaidica:
And benefiting patients are consumers.
Dan Loepp:
Totally, most importantly.
Chuck Gaidica:
Yeah. Yeah. Well, Amy Loepp is with us. You've been so patient sitting there. I remember personally, I'm going to just keep retiring until I get it right. But there's a whole piece of this, as Dan talked about, kids, grandkids, there's that whole personal part of this.
Amy Loepp:
So my goal is to keep him to his six months of not committing, which might be very challenging, and then myself unwinding with some of the things I'm doing.
Chuck Gaidica:
Yeah, and you're doing so much to help build stronger communities. Can you talk about that and your personal commitments as a couple and as an individual?
Amy Loepp:
Yeah, I think it's a two tier. So we have our family foundation that we're working on growing right now as opposed to spending-
Chuck Gaidica:
Okay.
Amy Loepp:
... so that we will be able to really focus on that more once during retirement and figuring out that focus that we want to do with our philanthropy. So I'm on three different boards, child abuse and Neglect, which is Children Trust Michigan, Prevention of Child Abuse and neglect, which is a statewide organization. We're the only organization that's solely focused on prevention. Then Eaton Academy, which has been near and dear to our heart for some time for children who learn differently. Then Impact100 Oakland County was the other baby that a friend of mine and I began in 2015. So we just reached our $2 million mark of giving grants.
Chuck Gaidica:
That's awesome. Impact100 touches people how?
Amy Loepp:
It's a giving circle, so we have a process that we're going through right now. So I would say any nonprofits that may be interested in receiving a grant, this is the time to look at our website.
Chuck Gaidica:
Yeah, okay.
Amy Loepp:
In essence, we do give away high-impact grants. So unlike some of the other amazing organizations that will give away smaller dollar amounts, we try to be more in the $100,000 increment.
Chuck Gaidica:
To an actual charitable organization.
Amy Loepp:
Yes. Yes, so-
Chuck Gaidica:
Beautiful.
Amy Loepp:
... 501(c)(3). So we have three grants we're giving away this year.
Chuck Gaidica:
Yeah, that's wonderful. I know that having grandchildren has changed life because, well, it's right here. This is my phone, but in here are credit cards. If one of the grandkids, not a kid, 'cause we didn't spoil our children, but now if a 3-year-old said, "I'd like a car," it'd be like, "You want a Buick, you can't even drive yet." Isn't it just the best season? Look at that. See, we're sharing pictures/
Amy Loepp:
Screen share.
Chuck Gaidica:
I didn't have a picture to share yet, but isn't it a fantastic season?
Amy Loepp:
Clearly.
Dan Loepp:
It really is, and it's-
Amy Loepp:
It's so fun.
Dan Loepp:
... so different. I always had people say, "Oh, you wouldn't believe it. It's terrific." You go, "Oh, yeah, okay, sure." But it's true, and our families are fairly close. Our third adult, large adult, Nathan, Amy's son is in San Francisco.
Amy Loepp:
You mean proximity close, is it?
Dan Loepp:
Proximity close.
Chuck Gaidica:
We're in close proximity.
Amy Loepp:
I'm just like, "What?"
Dan Loepp:
He's not quite to the grandchild stage, but I'm sure he will be. It's a blast. I love it.
Amy Loepp:
It's fun. We had him all over on Sunday and swimming and-
Dan Loepp:
We put a pool in exactly for that reason.
Chuck Gaidica:
I will share with you this personal story. We had downsized, so I retired from full-time-
Amy Loepp:
Did you?
Chuck Gaidica:
... from television. Yeah-
Amy Loepp:
You retired?
Chuck Gaidica:
... and we downsized to a condo. In the past two years, we went back to a home on a half-an-acre. I traded in my SUV for a minivan. We've got four car seats, and the first thing I bought was a used pool table precisely for what you just said. It's not for the kids, it's not for me.
Dan Loepp:
Right.
Chuck Gaidica:
We're doing everything now, and we have stuff that we had 40 years ago, and we're actually having a blast. We get tired-
Amy Loepp:
Yeah.
Dan Loepp:
Oh, yeah.
Chuck Gaidica:
... but it's just wonderful. Yeah.
Dan Loepp:
Totally.
Amy Loepp:
Love that you mentioned the minivan, because Dan meant, what was it, the hybrid-
Dan Loepp:
Pacifica. Yeah.
Amy Loepp:
Yeah.
Chuck Gaidica:
Yeah. Yeah.
Amy Loepp:
I was like, "Okay, but then you'll drive it."
Chuck Gaidica:
There is that whole part about being a young parent and then there's the part about having a grandpa mobile. I don't care. I'm way past...
Dan Loepp:
Yeah, no, absolutely.
Chuck Gaidica:
Yeah, I'm way past worrying about the image part of this whole thing. So you went past Eaton Academy, and I know that that's been a long time commitment. Just give us a little deeper dive on what that is.
Amy Loepp:
They are a independent school, private school that serves currently grade 1-12.
Chuck Gaidica:
Okay.
Amy Loepp:
We're looking at starting a kindergarten, but it is for children who learn differently. So it's a 10:1 ratio of the teacher to student.
Chuck Gaidica:
Okay.
Amy Loepp:
Each student has a unique profile that they work on then with that student, so it's very personalized, very important. In talking with people and the head of school, it's becoming more and more complicated. He's been in this role for 30 years, I think, of working with various students and just seeing the difference in the children. We just saw in the news what, one in nine, right?
Dan Loepp:
ADHD.
Amy Loepp:
Yeah, are diagnosed with ADHD now.
Chuck Gaidica:
Oh, yeah.
Amy Loepp:
So the complexity of whether it's now recognized more or whatever we want to say, but there's significant need out there, and-
Dan Loepp:
Generally what you'll find is the kids there at Eaton got lost in the system.
Amy Loepp:
Understandably.
Dan Loepp:
Right, absolutely.
Amy Loepp:
30 kids in a classroom, teachers can only-
Dan Loepp:
They generally disruptive or bummed out or-
Amy Loepp:
Or withdrawn.
Dan Loepp:
... had terrible self-esteem. They go into this environment, and it's game changing because you get smaller class sizes, but they really understand... It's kids with dyslexia and dysgraphia, all of those things, and it is a great place.
Chuck Gaidica:
Well, it's wonderful to have both of you here. Congratulations on the new season of life that's coming.
Dan Loepp:
Thank you.
Chuck Gaidica:
It's so wonderful to hear more about Impact100 and all that you're involved in, so much success. Thank you for your kindness to me over the years. So it's been a pleasure.
Amy Loepp:
Congratulations on your retirement too.
Chuck Gaidica:
Well, yeah. You can keep giving me-
Amy Loepp:
Retirement in air quotes, right?
Chuck Gaidica:
Yeah, yeah. You can keep giving me that congratulations. Thank you.
Dan Loepp:
I still like your blue couch, Chuck.
Chuck Gaidica:
Well, I keep telling you, it's not my blue couch. I know exactly where it's hidden in Farmington Hills, so-
Amy Loepp:
You might need to expand on that.
Chuck Gaidica:
... that's the couch. Because of doing our infomercial on Medicare Advantage, that's the sofa that frankly gets its own truck, and it's driven around as if it's Kevin Costner in a vehicle. That's the blue couch that we've taken out to the edge of a kayak drop in the middle of a ball field downtown Plymouth, Michigan. It's just been a joy to be part of that. But the couch is its own star.
Amy Loepp:
Does it get its own colored M&Ms and that kind of thing?
Chuck Gaidica:
I don't know. I haven't ever talked to makeup and wardrobe about how demanding the couch is, but it could be. But good to see both of you-
Dan Loepp:
Good to see you.
Chuck Gaidica:
... and much love and much success as you transition this year.
Dan Loepp:
Thanks, Chuck.
Amy Loepp:
Thank you. Appreciate it.
Chuck Gaidica:
Next up is president and CEO of Henry Ford Health, Bob Riney. Good to see you, Bob.
Bob Riney:
Great to be with you, Chuck.
Chuck Gaidica:
Yeah, Bob is President and CEO of Henry Ford Health and participated with Blue Cross Value Partnership program since the beginning, right?
Bob Riney:
We have, and we have always believed that value-based care is the right way to deliver care. It not only provides the right value from an economic standpoint, it's the right coordination of care for patients. I've been a part of myself a value-based network for 30 years, and I wouldn't get care any other way.
Chuck Gaidica:
Yeah, and when you use those words, what does that mean, value? Because we as consumers think of the value as well, that's the cost, but there's more to it.
Bob Riney:
Oh, there's a lot more to it. It really is about quality and making sure that the right care, right place, right time is all organized. If you think about medicine like a lot of things in life, it's a team-based sport. Value-based care really makes sure that a team is working on your behalf to do the right thing. If there's options for care treatment that you're being provided those options with the pros and cons of each option. You're a partner in this journey. Episodic care, which when people just shop around based on what they're feeling or worried about is not always the best care because you may be getting treated for one thing versus a holistic approach to how do we keep you healthy?
Chuck Gaidica:
That's interesting because we hear other phrases like functional medicine. So that implies that team approach, but it doesn't really talk about value and what you're getting as a customer.
Bob Riney:
Yeah, and value is getting quality. It's getting the safest care at the right location. If your care can be done in an outpatient basis and doesn't require an inpatient hospital stay, you're going to want that because you don't want to be compromised any more than you have to be. But it's having a team look and work with you on the right holistic approach. What value-based care really requires is that everyone have a primary care physician, someone that can be their quarterback or their coach that can help them determine whether they really need to see a specialist or not and if so, who?
Chuck Gaidica:
Yeah. When you talk about this, we're thinking of it, or at least I am in terms of being a consumer of that, but also this has to affect the staff across the hospital, across the system, right? Because when they see that working, that can add to their positive attitude. There's so many off ramps to that.
Bob Riney:
Absolutely. Team members want to do what's right for patients, and they want to eliminate waste or inefficiency as much as anybody, and even the advancement of our electronic medical records where your history is all in your phone.
Chuck Gaidica:
Right.
Bob Riney:
So if you see a doctor and they say, "Maybe we should think about this," and then they can go back and say, "You know what? It hasn't been that big of a change in the last three to four years. Let's continue to watch," versus, "Wow, this has taken a jump from your studies two or three years ago, we need to get more aggressive and assertive in the treatment," and that's what you want.
Chuck Gaidica:
I'm a data guy, so I'm wonky with my own numbers on my MyChart through Henry Ford. So I go on there, and I love seeing the... to me, it's like a video game, even though it's not. I've seen my numbers get better and better, and I've had my primary care doctor reflect back to me, "Just changing your lifestyle has..." In six months, you can literally see the numbers change in your favor. So for me, that's been a powerful thing to use my phone to go look at the numbers and say, "Oh, it's working."
Bob Riney:
It's funny you say that because the way Henry Ford uses MyChart, which is we put everything into it so the patient has complete access, it does make you feel like an owner of your care. I found that for myself personally, and you'd think, "Well, how can it do that?" But it's motivational, and it's a number, and numbers don't lie.
Chuck Gaidica:
Right. When you see a positive force, you're like, "Well, not only good for me, but it's good for my family. It's good for everything," right?
Bob Riney:
That's right.
Chuck Gaidica:
So lots of initiatives at Henry Ford Health, one of them is MI Mind. Tell us about that.
Bob Riney:
MI Mind is a way to really try and get at, I think, what's one of the saddest things that we're all dealing with, and that's just the incredible increase in suicides. We know that mental health issues have been rising, but we're seeing so many young people choose to take their own life. This is a way to really get coordinated and bring all of the care, again, through a primary care physician to really assess whether someone is at the beginning stages of depression or anxiety or feeling trapped in some way, shape or form and then connecting them to a network of behavioral health specialists that can really help.
I talk to families all the time, and I don't think there's a family that hasn't been touched by mental illness in some kind of a profound way. We need to pay attention because this rate of suicide is going in the wrong direction, and especially in young people. We can't wait for all the research. We have to start getting here and now with the care coordination that we have at our disposal. So this is an effort to partner and do just that.
Chuck Gaidica:
Some of those stats that we see over time that get repeated in various stories, the epidemic of loneliness across every age demographic. My mom and dad both passed in 2019, but mom had Alzheimer's. I would've had a preconceived notion, "Well, loneliness must be a thing for older folks in memory care." I get it. I understand it intellectually. But when you start to tell me 20 year olds are lonely and they've got 5,000 Facebook friends, it doesn't make sense. Yet, all the data suggests everybody is reflecting they're lonely.
Bob Riney:
I'm a big proponent of getting people as much as possible back into the office versus working virtually.
Chuck Gaidica:
Oh, yeah, yeah.
Bob Riney:
I think hybrids are fine, but I think that we're missing the obvious, and that's human connectivity-
Chuck Gaidica:
Sure.
Bob Riney:
... is a fuel for life. It really is. I think we've fooled ourselves to thinking that technology connections provide that. They don't. They provide busyness. They advance a lot of things in our life, but virtual friends aren't friends. Friends are people that you can be with, that you can hug, that you can go through good times and bad times. This social isolation, because we're now all addicted to technology that keeps us busy is very different than what we need as human beings, and I think we're discovering that.
Chuck Gaidica:
That. But you know that coming back together, we've come through this season where you couldn't hug, you couldn't kiss, there's a ritual that you and I employed when you walked up to the table. I shook your hand, I couldn't touch you. I couldn't be near you. So that whole idea of interacting with human beings in community has got to be at least a piece of the puzzle.
Bob Riney:
There's no question. I think that the pandemic, rightfully so, created a lot of fear and apprehension in us. But now that we've got through that and we're managing it well, like anything else in life, you have to overcome your fears. You have to overcome your apprehensions and get back to the positives that come from the interaction. I worry very much about our younger generations that have grown up with technology as being their sole source of communication or their predominant source because it's a learned skill, and we've got to help them. That's why I'm really big about getting people back into the offices, getting people back into stopping at a local watering hole and getting to know each other at the end of the day. That's what I think really helps in so many ways.
Chuck Gaidica:
Well, when you look forward now in a short period of time or long term with these Value Partnerships and the initiatives, what are you looking to make change with? You've just talked about one here with MI Mind, but what else are you focusing on?
Bob Riney:
I think we're going to really continue to evolve to recognize that if we want to create true health of populations that healthcare has its important role in helping people get better and do preventative work. But education health is important. Economic health is important. So we're leaning in and helping in all of those ways because ultimately health is multifaceted, as we all know. It's not just physical health. I think that Michigan is a collaborative enough environment that we can lead the nation in showing how this is done.
Chuck Gaidica:
Well, that's great to hear. Sometimes I feel like with people I know even within my family circle, that whole idea of financial health, spiritual health, when one part is off, it's like driving the car and you know it's pulling. You don't know exactly why, but you know, feel off. So trying to come up with this holistic approach is awesome.
Bob Riney:
I think when we get there, we're going to see major change in some of the public health numbers that we're not too proud of today.
Chuck Gaidica:
Well, that's great to hear. Well, Bob Riney, good to see you-
Bob Riney:
Great to see you.
Chuck Gaidica:
... President and CEO of Henry Ford Health. Take care-
Bob Riney:
Enjoy the island.
Chuck Gaidica:
Yeah, you too. Thanks.
Bob Riney:
Thanks.
Chuck Gaidica:
Now as president and CEO of Trinity Health, Rob Casalou. Good to see you.
Rob Casalou:
Good to be here.
Chuck Gaidica:
What a nice time on the island, huh?
Rob Casalou:
Oh, yeah. This is a place we've been coming so long, I can't even remember the first time.
Chuck Gaidica:
Yeah. Well, that's good, though, right?
Rob Casalou:
Yeah.
Chuck Gaidica:
Just that whole movie title somewhere in time, it just brings you down.
Rob Casalou:
Exactly.
Chuck Gaidica:
It slows you down, I guess a better way to say it.
Rob Casalou:
Yeah, absolutely.
Chuck Gaidica:
So hospitals and physician organizations within Trinity Health System have been long time participants with Blue Cross Value Partnerships program. What is that? What does that mean, a Values Partnership program?
Rob Casalou:
Well, you got to talk about the word value and who's receiving it. I think the value is to the ultimate payer and recipient of care, so those who pay the bills through Blue Cross and to providers and then the experience of our patients. So the partnership that we've enjoyed with Blue Cross is trying to create that value in those relationships that we both value.
Chuck Gaidica:
Along with value is still the word quality. It's still attached in there to make sure that the bar is high.
Rob Casalou:
Oh, absolutely. Actually, if you look at the partnership that we've been involved in, it started with quality. It wasn't about the money and what I call the financial part. Now it is about both. It's quality, but now we look at the total cost of care, and we partner together with Blue Cross in order to try to lower that total cost of care.
Chuck Gaidica:
So when you look at other initiatives like collaborative care, does that expand beyond the notion of doctors collaborating? It's a collaboration that goes farther than that.
Rob Casalou:
It's a multi-professional. So when you talk about our medical group, we have one called IHA that's part of Trinity and Southeast Michigan and now in West Michigan, and we have primary care offices. It used to be a primary care office was the primary care doctor, the MA, in and out, order a bunch of tests, sometimes end up in the hospital. Now when you go into our offices, we have registered dieticians. We have pharmacists. We have behavioral specialists. It's a team IT collaborative care in that office to try to maintain everyone in the lowest intensity that they have to have in healthcare and meet their needs.
Chuck Gaidica:
Well, it used to be when I was growing up, I remember I had an uncle who had some health issues, and there used to be this idea you had to go to a big clinic, one of the big names in America to find this notion of collaborative care, although I don't think they had that name for it then. This seems to be something that's growing everywhere, and it's to our benefit as potential patients, right, as customers?
Rob Casalou:
Oh, absolutely. When you look at it in healthcare, we sell a product nobody wants to buy, right?
Chuck Gaidica:
Yeah.
Rob Casalou:
We are the product that people need, though, and when they need it, they want it to be the best. They also want to have the lowest intensity experience, both from a healthcare standpoint, but also from a cost standpoint because people pay a lot of their own bills now. So our job is, the way we used to make money in the old days was the more you utilize the hospitals, the more you utilize things, the more money that the hospitals made and health systems made. That has turned 180 degrees. That's what the Value Partnership is all about. It's about us making a living as a health system, but making it a different way. The only way we do that now is by keeping people within what we call a home, in their primary care home. We have to provide all those resources in that home or otherwise they're going to filter out and start burning up the cost of care.
Chuck Gaidica:
I think that's what I've seen too in my own experience within my family's system, thinking back to mom and dad was, I'm going to pick and choose these. "I've got migraines, well, I'll go to a different expert," and, "I've got a back thing, I'll go to this expert." They're trying to make decisions themselves that don't seem like all the pieces of the puzzle get connected.
Rob Casalou:
Oh, yeah.
Chuck Gaidica:
Yeah.
Rob Casalou:
We talk a lot about the mental health crisis and the mental health... That's why embedding mental health resources in our primary care office has been key, 'cause a lot of folks come in and they may have a physical ailment. It's being driven by something on the mental health side of their life, and we can identify it right there. We can actually connect them with a psychiatrist while they're in the office.
Chuck Gaidica:
Come on.
Rob Casalou:
Oh, yeah.
Chuck Gaidica:
Wow.
Rob Casalou:
If we have to. We have virtual connections with the psychiatrist. We have embedded social workers and others in the offices that try to deal with those social issues.
Chuck Gaidica:
Well, and how critical is that because when you're in this intimate setting with a primary care physician or one of the team, that is likely going to be a place where you would share some of this information that maybe you wouldn't share. They already know, they've already just seen you in a paper gown.
Rob Casalou:
Oh, yeah.
Chuck Gaidica:
I'm just saying.
Rob Casalou:
Well, particularly with a new patient, when they come in, we start with a social screening. A lot of folks walk in, they don't have access to food, they don't have transportation. They may not even be literate and not able to read, so we identify the social determinants right when they come in. Then if there's an identified issue, that's being dealt with at the time that they're in the office.
Chuck Gaidica:
I see.
Rob Casalou:
So when you get that kind of stuff out of the way, now they may come in with a legitimate physical issue that we have to deal with, or it's just an annual physical, but whatever that case may be, these other resources help us take care of everything we can at that time.
Chuck Gaidica:
So it sounds like there's a lot of streamlining and great stuff happening within primary care, this team approach. But what are still some of the challenges as you look forward in time, even a short period of time, what are you working on?
Rob Casalou:
The one you've heard about from everybody you're going to talk to and that's shortages of doctors and other providers. We have 350 primary care physicians and advanced practitioners in the state of Michigan alone, Trinity does, and yet we could use more. So we're going to continue to have to use ancillary staff, advanced practice practitioners, PAs and nurse practitioners as well as, like I mentioned, the dieticians and other folks to help create space and capacity to take care of more people.
Chuck Gaidica:
But in a way, that those particular specialties you're talking about, that may be the precise person I needed help from anyway. Not that my primary shouldn't have a hand in it, it's just maybe I did want to have a lifestyle change, what we used to call a diet-
Rob Casalou:
Oh, yeah.
Chuck Gaidica:
... so if there's a dietician, right?
Rob Casalou:
We just opened our first of two now lifestyle medicine primary care practices. So we're adding the pillars of lifestyle medicine. The three that we really focus on are stress, exercise and food, so we add that dimension to those offices. So our goal with IHA is to continue to expand that in addition to all those other resources. Then we just opened two senior primary care offices dedicated to all the issues of seniors. We have one in Livonia and one in Ann Arbor right now. Again, we pilot these and then we spread them. IHA has been an advanced medical group, I think a good partner to Blue Cross for a long time. So they've been a good experimental ground for a lot of advanced thinking.
Chuck Gaidica:
Well, when you use the word seniors, it's not what it used to be because there are not only more of us. I resemble that remark now.
Rob Casalou:
So do I.
Chuck Gaidica:
So there are more of us, and if you're doing your job well, everything you're saying is you're extending not only lifespan for me, but I want my health span to go along... If I'm going to make it to 90 or 100 now, I'd like to be healthy right up to the end. Right?
Rob Casalou:
Well, you're singing my tune right now. I'm saying 65. Yeah, 65 is no longer considered old.
Chuck Gaidica:
Right.
Rob Casalou:
Yeah.
Chuck Gaidica:
Right.
Rob Casalou:
Yeah.
Chuck Gaidica:
Well, Rob, it's good to see you.
Rob Casalou:
Good seeing you too.
Chuck Gaidica:
Enjoy the conference, and thanks for all the insights.
Rob Casalou:
Great being here. Thanks.
Chuck Gaidica:
Yeah. Rob Casalou, president and CEO of Trinity Health. Next is President of U of M Health, David Miller. Good to see you.
David Miller:
Thank you very much. That's for the opportunity.
Chuck Gaidica:
Having a good time? You said it's your first Policy Conference?
David Miller:
First time, it's been wonderful, very energizing, great ideas, great focus on the talent in the state of Michigan and can't ask for better weather.
Chuck Gaidica:
Well, that is nice because it's like being one of the bears. It's not too cold, not too hot, it's just right, especially when you have to hoof it yourself, not let the horses do their thing, right?
David Miller:
That's exactly right.
Chuck Gaidica:
Well, it's so great that you're here because the Michigan Medicine really has a lot of connections to Blue Cross and Value Partnerships program, right?
David Miller:
Correct.
Chuck Gaidica:
That goes back a ways.
David Miller:
It does. Now, the Value Partnerships program and then all of the initiatives that represent the collaborative quality improvement initiatives have more than a 20-year history of strong partnerships between University of Michigan, Blue Cross Blue Shield of Michigan, and physicians and clinicians across the state of Michigan, really an example for the nation.
Chuck Gaidica:
I've heard that word collaborative a lot when it comes to medicine in relation to the Value Partnerships in particular. But that's something that's ongoing, this notion that this is really a team effort.
David Miller:
Without a doubt. I think what's really unique about the programs is the recognition that identification and solving some of the biggest challenges in healthcare is best done by those individuals who are delivering that care every day. So when you see the spirit of these CQI initiatives where instead of just describing differences and outcomes, there starts to be an effort to understand those, to solicit the best ideas. Then to bring those back to the different practices where patients receive care across state, it's really transformative and sets a model for the nation.
Chuck Gaidica:
That collaborative care model is we think of our primary care physicians, but it really starts to fan out from there, dieticians, depending on your context, what's going on in your life.
David Miller:
Oh, absolutely. I think when you look at the breadth of the different programs, they cover key aspects of primary care. They cover key aspects of specialty care, and as you mentioned by definition, recognize and support the multidisciplinary nature of clinical care. Physicians, nurses, dieticians, respiratory therapists, all sorts of different specialists are contributing to the great solutions we're seeing around the state of Michigan.
Chuck Gaidica:
But as a consumer walking in as a patient, I think you're going to be blown away to understand that you have a team, whether you recognize it right away or not that it isn't just one person. Not to diminish the importance of that person, but that collaborative effort really benefits us in so many ways.
David Miller:
Absolutely. As you know, there's a famous statement at University of Michigan from Bo Schembechler, "The Team, The Team, The Team," but that really applies in healthcare. On behalf of patients, it is that expertise across multiple areas to meet the needs of the patients in our communities that, I think, leads to the very best outcomes.
Chuck Gaidica:
Well, I'll let you know that I'm part of the team, at least I know when we have a grandchild at U of M that the last time we had one, I walked up and they said, "Oh, you're in the system," so I could get my badge right away with my picture. I thought, "I'm part of the team. This is awesome, 'cause that's where everybody keeps on going," which is awesome.
David Miller:
Absolutely, our families are absolutely part of the team, a key part of the team. Congratulations, we're glad that went so well.
Chuck Gaidica:
Yeah, thanks, multiple times-
David Miller:
Fantastic.
Chuck Gaidica:
... which is really nice. So when you look at what's happening in the world of medicine now, what are you seeing that gives you great hope for the future? Is it refining the programs that are in place, or do you see something new on the horizon?
David Miller:
Yeah, that's a great question. I think there are probably two parts. First is, how do we take the care that we're providing already and make it better?
Chuck Gaidica:
Okay.
David Miller:
That's where these CQI programs that have been supported with Blue Cross Blue Shield of Michigan with strong partnership with University of Michigan and other systems in state. They ask the question, "Okay, we know that treatment A works very well, but all the patients who could potentially receive it or not, what are the barriers? Are they issues related to access? Are they issues related to education?" So I think that improvement in the currently-available therapies offers a lot of promise.
On the other side, though, there's the new discovery and new innovations, and it's amazing. I recently went to our specialty pharmacy program, a really exemplary program at University of Michigan. I looked on the shelf at all the new medication that are now available to treat complex conditions, inflammatory conditions, neurologic conditions. These were fundamentally different than when I was in medical school 25 years ago. It is that continuous innovation in therapies, in imaging, in treatments that I think is going to really start to further impact health, particularly in areas like cancer, cardiovascular disease and neurosciences, and that's an exciting time. Then we can take those new therapies and learn how to best deliver them just as we're doing now with the ones that are already available.
Chuck Gaidica:
I know there's also been this focus on post-surgery and medications, right? Can you talk about that a little bit?
David Miller:
Yeah, absolutely. Well, I think a great example of that has been one of the collaboratives focused on prescribing opioid medications, right?
Chuck Gaidica:
Oh, yeah.
David Miller:
I think we've all heard and have recognized the impact of opioid use disorder in our communities. There was a tremendous idea that in the state of Michigan actually partnerships between surgeons and anesthesiologists, again, University of Michigan faculty members saying, "How much pain medications are patients actually taking after an operation?" We know it's needed, but if you look at it from an opioid perspective, how many of the ones we prescribe are patients actually taking?" Because there's a risk that those initial prescriptions could be what's often referred to as a gateway to longer term opioid use disorder. In fact, what was found through this collaborative model was patients are taking far fewer than we prescribed so we can modify our practice patterns together safely, and patients are very open to the use of non-opioid alternatives. So putting those two things together across the state of Michigan and actually leading a trend nationally has been really substantial work to reduce the number of opioid medications prescribed postoperatively in a really scientific evidence-driven fashion that has had a big impact across the state and now is actually being seen nationally.
Chuck Gaidica:
When you say cut back on the number, it's likely, I'm just making an assumption, it's not just the prescription, it's actually the number of whatever you're getting. Why do I need 12 when I'm only going to go through three and then I'm fine?
David Miller:
That's exactly it. What was seen was there were a lot of historical practice patterns of, say, prescribing perhaps 15 pills after an operation. In fact, the patients were only taking about three. So it is exactly as you said, reducing the number, and in so doing, reducing the risk of longer term complications of opioid-related medications.
Chuck Gaidica:
Again, that's to our benefit in the end. It's great that a lot of smart people are thinking about this from a different perspective, but for us as the patient, it makes a lot of sense. I don't want to get hooked on something, and if I don't need it, why is it still in my cabinet?
David Miller:
That's exactly it. We have to acknowledge that we have to control pain well after surgery, right?
Chuck Gaidica:
Yeah. Yeah.
David Miller:
But these medications can be habit-forming, so we want to reduce the number. We don't want them around, like you said, afterwards in households where there could be at risk for children, for other patients, et cetera.
Chuck Gaidica:
Or our waterways-
David Miller:
Exactly-
Chuck Gaidica:
... or whatever it is.
David Miller:
... so ultimately a big win-win.
Chuck Gaidica:
Sure. What is the M OPEN Network? What is that?
David Miller:
Yeah, I described that a little bit. It started as what was called the Michigan Opioid Provider Engagement Network.
Chuck Gaidica:
Okay. That's what it is. Okay.
David Miller:
Right. Then now it's really started to focus not just on the number of pills that are prescribed, but actually looking out more broadly into the community and thinking about how to address opioid use disorder. Again, coming back to your concept of a broader team-based effort that isn't just the postoperative care is an important part of it, but there are also needs for rescue medications for patients who are experienced opioid use disorder and treatments for that. So it's become now have a broader focus of not just that postoperative setting, which is incredibly important and incredibly multidisciplinary in its structure.
Chuck Gaidica:
So when you look at how U of M is leading the way with so many initiatives that connect directly or indirectly to the Value Partnership platform, you've got to feel real good about that because a sense being a leader is a good thing. You're an influencer then.
David Miller:
Absolutely. Well, I have to reference our motto of leaders and best at University of Michigan, so thank you for that. Absolutely. Again, coming back to it, the power of this to have the individuals delivering the care see the opportunities and challenges, use data to develop the best available evidence and then translate that back out into communities across the state, that's a model that resonates in the state of Michigan and nationally. I think for the last 25 years, what we've seen is lower mortality, better outcomes after treatment, better clinical decision making, higher patient satisfaction. It is really a way that gets back to the patients, families and communities in a meaningful fashion.
Chuck Gaidica:
As you look in the near term two to five years, what are you seeing that gives you such hope about what's happening, and I don't want to call it streamlining, but this notion of refinement with everything we've talked about?
David Miller:
Yeah, I think as innovation comes into healthcare, whether it's a new type of surgery or whether it's a new medication, that refinement means that we're getting the highest value for those treatments as quickly as we can. The structure that's been set up in Michigan, this collaboration based on data with subsequent dissemination of the best available techniques and treatments really gets us to that place faster than anywhere else in many ways.
Chuck Gaidica:
I think often a lot of us, I'll just say for me, I sometimes think innovation is going to be the most costly option when indeed it turns out to be the opposite. Innovating leads to this contraction and you save money in the end, which is great.
David Miller:
I think an innovation comes in many different ways, right? Sometimes it's the new medication or new surgery, sometimes it's looking at how we do things already and changing our behaviors. That has been elusive, but the collaborative model in the state of Michigan has really unlocked that type of innovation.
Chuck Gaidica:
Very cool. Well, David Miller, good to see you.
David Miller:
Good to see you. Thank you so much.
Chuck Gaidica:
Yeah. David is president of U of M Health.
David Miller:
Thank you so much, Chuck. It's a pleasure to be here. I appreciate the opportunity.
Chuck Gaidica:
Oh, you're very welcome.
David Miller:
Have a great day, and Go Blue.
Chuck Gaidica:
Finally, Senior Vice President and Chief Strategy Officer of the Michigan Health and Hospital Association, Ruthie Sudderth. So good to see you again.
Ruthanne Sudderth:
It's great to be back.
Chuck Gaidica:
Isn't it pretty?
Ruthanne Sudderth:
What a beautiful day on Mackinac Island. I love it. The sun is shining, and I couldn't ask for anything better.
Chuck Gaidica:
Well, we're all feeling better, right?
Ruthanne Sudderth:
We are.
Chuck Gaidica:
We're all are sitting here and enjoying soaking it in, calming our lives down. I know that Blue Cross Blue Shield of Michigan and Michigan Health and Hospital Association have really worked together for a long time over the years. Statewide healthcare and safety and quality improvements seem to be top of the list. We're hearing that from hospital systems. I'm sure we'll hear more about it from you, and this idea that it's affecting us right down to the level of consumer-
Ruthanne Sudderth:
Absolutely.
Chuck Gaidica:
... as a potential patient is helpful.
Ruthanne Sudderth:
Absolutely. Yeah. There's a long history of working together on some really important issues that affect families every day in Michigan, and we're so grateful for the support that the Blues have offered over the year to our Keystone Center for Patient Safety and Quality to do work ranging from maternal health improvement to working with care for seniors, all the way to infection prevention and everything in between. So it's been a great partnership.
Chuck Gaidica:
So tell us more about Keystone Center.
Ruthanne Sudderth:
So the MHA Keystone Center for Patient Safety and Quality was formed back in 2003, so we have our-
Chuck Gaidica:
Wow.
Ruthanne Sudderth:
... 21 anniversary this year. During that time, it's really our Patient Safety and Quality arm of our association, but they really work on member-led programs that are evidence-based that work to prevent harm and to improve the care that patients receive every day at the bedside and in the community. So we bring hospitals together, and they set aside any differences they might have outside the quality arm, and they really work together on patient care improvement. It's really tremendous the amount of lives they've been able to save and dollars they've been able to prevent going into the system by preventing harm and making care safer.
Chuck Gaidica:
So with that kind of innovation spanning two decades, is there any stopping it? As you start to look to the future, where else can innovation happen? Is it just refining what's been done, or are there these new off ramps to make change?
Ruthanne Sudderth:
Absolutely. That's a great question. Really having started at the bedside, we've learned over the last couple of decades that the outcomes that a patient has are really driven a lot more by the experiences that they have at home and outside the hospital. That's where health happens. So we have made health equity and health improvement a pillar of ours at the Trade Association and at the Keystone Center. So what that means is that we are refocusing and putting more resources into healthcare improvement and safety and quality. Right now, we're focused tremendously on some health equity work that involves not just hospitals, but partners in the community, because we do have to work outside the four walls of the hospital to keep people from coming in, to make sure that when they go home, they can keep their medication cold or have access to healthy food. So we're really doubling down on the commitment to working with partners on healthcare improvement and equity.
Chuck Gaidica:
That team approach is important at the hospital level with the association, but also the idea of the ownership for us as individuals, right? In the case of my senior mom and dad in the day, it was a team of us-
Ruthanne Sudderth:
Absolutely.
Chuck Gaidica:
... of the kids helping to make sure meds were there, they're being distributed properly.
Ruthanne Sudderth:
Absolutely.
Chuck Gaidica:
All that becomes so important.
Ruthanne Sudderth:
Absolutely. Having patient advocates and family members who you can rely on for support is so critical. We actually worked with partners recently on creating a caregiver navigator toolkit. So what that does is it provides healthcare providers with a whole suite of resources and tools to give to those care caregivers in the home that are going to be helping patients when they leave the hospital, and what an important step that is so that they don't have to come back?
Chuck Gaidica:
Well, and that takes a lot of stress off the caregiver because they may know what they need, they just know where to go to get it.
Ruthanne Sudderth:
Absolutely. Yeah. I've been in that situation personally taking care of family, and it's been done for me. It's a lot to remember, and it's a lot to navigate, and it can be a scary time. So we need to give families the resources that they need to be champions and be advocates for their family member and to keep them safe and well cared for at home.
Chuck Gaidica:
So when you get these hospital systems, the cats and dogs together, and they're all getting along, you must hear of their challenges, the threads that run through that are similar.
Ruthanne Sudderth:
Absolutely.
Chuck Gaidica:
How will you see moving forward MHA playing a role in this idea of addressing these key challenges for the hospital systems?
Ruthanne Sudderth:
Absolutely. Our Keystone Center has a lot of new efforts going on right now, bringing hospitals and health systems across the state together, again, on some really key issues that will help us advance safety and quality. One of those things is focusing on better data. We can't improve what we're not measuring. So we have a lot of efforts going on right now, especially in the health equity space, to gather better race and ethnicity data and outcome data so that we can measure how we're improving in those really important spaces. We also have a task force of our membership that has been working for two years on a health equity toolkit and recommendations for best practices for hospitals across the state to adopt together.
So that's going to be going out to our members in the year ahead. We're also not forgetting that health equity includes seniors, it includes people in rural communities. It's not just a race and ethnicity issue. So a lot of work is going in, again, with partners from across the state and with the health department and with Blue Cross Blue Shield of Michigan and others to adopt new standards of practice to make sure that we are getting to patients where they're at in their journey of health and preventing them from having to come to the hospital. But once they're there, making sure that care is really safe and high quality.
Chuck Gaidica:
All those things are so great. I think that what we're seeing even in the interviews we've had so far today is this idea that everyone is really aiming for me to have not only a long lifespan, but an increasingly important health span-
Ruthanne Sudderth:
Yes.
Chuck Gaidica:
... where those numbers come together, which means if I am going to be around for a long while, I'm going to be a consumer of health-related care in some way for maybe longer than it used to be the case.
Ruthanne Sudderth:
Absolutely.
Chuck Gaidica:
Right?
Ruthanne Sudderth:
Absolutely. That's what we're here talking about this week at the conference, of course, is bringing more people to Michigan. We have an aging state right now, and that means people need more care for more years and it's more expensive care. So how do we work together to make sure that people are getting the care that they need and that it remains affordable for our shared constituencies? So that's why I think our partnership has been so critical over the last two decades.
Chuck Gaidica:
Well, it's great to see you again. Thanks for bringing us up to date. What are you looking forward to here for yourself with the conference then?
Ruthanne Sudderth:
We're really focused, back to the issue of making sure we're prepared to care for the population of Michigan in the years ahead, and so this week we're really focused on workforce. This morning we announced some new data about the hiring needs of our hospitals and what it's going to take care of Michiganders in the years ahead. In the last year, more than 61,000 jobs have been filled at Michigan hospitals. We still have-
Chuck Gaidica:
Wow.
Ruthanne Sudderth:
... 19,000 open positions, though. That's how many people we're still looking to hire. A lot of those are nurses, of course, but we also need technicians. We need people in administration. We need people in IT and cybersecurity. So we're really focusing on building the healthcare talent pipeline so that we are ready to take care of older Michiganders, but also hopefully a lot more new and young families coming into our state.
Chuck Gaidica:
Well, Ruthanne Sudderth, good to see you.
Ruthanne Sudderth:
Great to see you too.
Chuck Gaidica:
Good to have an update on all of the above. I feel healthier already.
Ruthanne Sudderth:
You know what? I have that effect on people, Chuck, I really do. I love being here with you guys. Thanks for having me back.
Chuck Gaidica:
You're very welcome. Thanks for listening to A Healthier Michigan Podcast, brought to you by Blue Cross Blue Shield of Michigan. If you like our show and you want to know more, check us out at ahealthiermichigan.org/podcast, or leave us a review or rating on Apple Podcast or Spotify. To get all the new episodes on your smartphone or tablet, be sure to subscribe to us on Apple Podcasts, Spotify or your favorite podcast app.
