My Opening Comment at National Academies of Medicine / Genomics & Health Disparities

On June 27, 2018, the National Academy of Medicine held a workshop on genomics & health disparities.  The webpage for the conference is here and in a few months there will be a circa 100 page conference summary online. 

I gave a three minute introduction the the panel I chaired, which was on the level of "health systems" and their role - as opposed to the level of the role of (patients & doctors) or the level of the role of (payers & policy). 

I post an informal transcript of my opening remarks below, which center on the article "Pitching to the  (Health System) C Suite) by Spellberg and colleagues (here).

Introduction by Panel Two Chair, Bruce Quinn MD / Los Angeles

Quinn:                               So one way of thinking about the organization of the panels this morning is that we're working in effect through different tiers of the health care system.

So we heard first a patient viewpoint. Always the most important place to start. Always very important to think that what we're achieving is patient centered health care. And we also heard through that some of the levels of problems that patients have. Virtually everyone can have problems with the health care system, but especially the patients we're focusing on today, who are more disadvantaged to start with.

Quinn:                               The next is going to be about health systems  --   after which we'll talk about the more the payer level, payer and higher policy level.

And so I'd like to just give a very brief introduction to frame where we are on this panel when we talk about health systems.

Patients and the doctor sitting in the room with the patient is very easy to visualize. We've all been patients. Many of us, may be healthcare providers.

The higher level of the healthcare system is also something we're familiar with. We have Medicare, we have Blue Cross, we have products approved by CLIA or the FDA. Now that’s the broad umbrella of federal or payer policy. Payers may be the people that don't pay for things, but we know what that is.

This level in between the health care systems is also very interesting but a little harder to get your head around. So I'd like to draw your attention to a publicly available article a year or two ago by Brad Spellberg at USC called How to Pitch the Hospital's C-Suite. It's a free article, and whether you're in health systems or a provider or even doing something like a health MBA, it's worth reading. How to Pitch to the Health System's C-suite.

Quinn:                               So his example is an antibiotic stewardship program. You know we overuse antibiotics. When you use them more wisely, it will improve outcomes. And Medicare and other groups are encouraging antibiotic stewardship programs. So you get this interest and you develop a four page pitch, you rewrite it three times, you've got some bar graphs, you go present it to the hospital CEO or CFO or we're gonna have an antibiotic stewardship program, it's gonna have these four outcomes. We're gonna reduce stays, reduce readmissions, save the hospital this much money. It takes one pharmacist, half of an infectious disease specialist, three-fourths of the nurse, half of an IT program or $400,000. It looks very good. And you walk out.

Quinn:                               Then someone walks into the same office and he's got a 20% of our patients have dementia, mild or more severe, we need a program for dealing with the population in the hospital that has dementia, mild or more severe.

Then someone comes in and talks about fall prevention.

Then someone comes in and talks about better triage to hospice, for which we need two social workers, half of the geriatrician etc. $400,000.

Then someone comes in and we need a new roof on the west wing, $400,000. The next time the phone rings and the emergency room is 30% understaffed for nurses, we need to raise nurse salaries by $400,000 or we spend $400,000 on locum tenens nurses for the emergency room.

And the MRI scanner that's served us well for ten years is finally given up the ghost, that's another $400,000.

And general counsel calls because some malpractice case is running over budget and it needs another $400,000.

So remember, you were the pitch for your $400,000 new program and all it's benefits and advantages, but by lunch time, you're twelve guys ago. So, this level of the hospital's C-suite is involved with coordinating different issues, coordinating different part of the systems, and rationing resources essentially.

Quinn:                               

Each of the speakers we have in this section, and I've had the chance to see most of the decks, are excellent and they are all talking about programs that involve coordinating at a higher level than the individual doctor. Either looking at it geographically nationally at the case of the VA and deciding what multiple systems and programs to implement, looking across a health care system in the case of University of Illinois, and so on. And all of them will eventually filter up to this level of a CFO, a CEO, a judgment, a hospital program. So with that I will close the introduction and I'm looking very much forward to hearing from Dr. Lawrence Meyer about genomics in the VA system.