A conversation about the future of healthcare in Utah
In lieu of an in-person event this year, Utah Business partnered with Kiln, Roseman University of Health Science, Intermountain Healthcare, Merit Medical, and Xevant to talk to some of our state’s top healthcare executives about Covid two years in and where we are going in the future. Hosted by Elle Griffin, editor-in-chief of Utah Business, today’s panelists are Jeremy Wells, chancellor at Roseman University; Brandon Newman, co-founder and CEO of Xevant; Katelin Roberts, executive director at BioHive; Lori Weston, CEO of Park City Hospital; and Nicole Priest, chief wellness officer at Merit Medical.
We’re more than a year into the pandemic, we have vaccinations and some people are returning back to work. What are some of the changes we’ve made in healthcare and then what are some of the changes we’ve made in business?
Jeremy Wells: One of the things I think we have learned is that the hybrid approach to healthcare,or higher education, or employment, not only works but can actually be better. By hybrid, I mean, a combination of online and ground. This is certainly true in higher education. What we’ve learned is that the student outcomes are just as good, if not, better in online education, and also, the faculty and certainly the students have enjoyed it and in some cases are demanding it.
Brandon Newman: The pandemic was an equalizer. For the first time, in what I would deem industry-wide, we saw providers, hospitals, and finally the payer, finally saying, we need to come up with something new, the old way of doing things isn’t really working. So we saw an onslaught of interest and said, “How do we work together, how do we collaborate, how do we align if we’re going to solve a massive issue, a pandemic that was worldwide that we had to start doing something together?” So the alignment was the first step.
Elle Griffin: We just wrote an article about how life sciences companies in Utah raised $1 billion in capital across 10 IPOs. That’s a huge amount and that’s really interesting. So how have life sciences evolved in this last year? How is that industry changing?
Nicole Priest: One thing that I am very excited about is the way that clinical medicine has changed. We now have telehealth visits and there are tons of patients and employees who are really enjoying that service.
Is hiring an issue in your respective industries? Because you see that all over the news right now. What’s going on there?
Jeremy Wells: It is an issue. When we try to recruit a dental faculty into the state, it’s tough because [Utah has] such a high cost of living now, and the home costs are so expensive. It’s tough to recruit out of state so we almost have to stay in state to recruit.
Lori Weston: We’ve seen the same thing at Intermountain Healthcare, so we’re looking within the organization to see how we train those caregivers that are on the front lines and how do we support them by tuition reimbursement and those types of things to incentivize the growth in healthcare.
Elle Griffin: How are you handling being short-staffed? Because it’s one thing to try to hire new people, but it’s another thing to be operating with a very tiny staff.
Lori Weston: Staffing is definitely a topic we talk about every single day. And sometimes it’s two or three times a day when we have to ask those within our healthcare system if they can send somebody our way to help with patient volumes for a few hours. There’s a constant look at staffing and volumes. Our nurses are [working all hands on deck]. They’re working in ICU, in surgery, they’re down at the front door, they’re running our vaccine clinics and testing. So everybody is in a different role every day. They are not doing what they were trained to do when they first went into healthcare. I don’t think any of us are, it’s been quite the experience.
Elle Griffin: Is there fear that it will lead to some burnout, and then we’ll be in an even worse hiring situation?
Lori Weston: I think we’ve already seen some of that. We’ve lost a lot of nurses, especially when you look at the baby boomers who only had a few more years until retirement and are choosing to retire now. We’re already starting to see caregivers who are burned out and leaving healthcare to do other things.
One of the issues we’ve been facing at a healthcare level is transparency in healthcare coverage and benefits. What exactly is the problem and is there a solution?
Brandon Newman: There is a solution. The thing is, we all know what the solution is and we have to be willing to align. It was part of the greater equalizer response of saying, “Hey, let’s hit the reset button, let’s all lock arms and admit to what we have.” We have a lot of dichotomies, and I don’t want to put it in two categories, because I know this represents a big contingent, but let’s put it in the providers, providing care, and those paying for care. I think we could all admit that those that want to pay for care want to limit as much as possible, and those who want to provide, want to provide as much as possible. So that over the last several decades has created lots of opportunity for non-transparency to say, “Hey, let’s create payment models that maybe not be in the best interest of everybody engaged.”
The faster we all look at care, in immediacy at the moment, the sooner we can actually get on the same page, we can get a line and say, “Hey, so and so needs care. They need the following treatment. How are we going to pay for that? Let’s create a pathway to do so,” but if we’re making that decision, 12 months after the fact, like most payers have been, well, we’re making a decision completely distant from the actual event of care. So I think that that moment of care, there’s a moment of empathy if we can create the data points to inform how we pay for the treatment, the care, the medication, the hospital visit, whatever it is then I think that we’d begin to break down those walls of non-transparency and start working together again.
Elle Griffin: What would that system look like from an end-user perspective?
Brandon Newman: If someone goes to the hospital, for example, and finds out that they have cancer, well, there’s somebody three months down the road that gets this claim in a system, usually up to three months, that they find out, “Hey, someone’s got cancer.” Well, let’s start providing care to them at that point. Well, they just missed a number of prior points of opportunity to help that person. So if we could create that care at that moment and get the payer involved at that point of care, the point of diagnosis, then I think that we start breaking down those elements of non-transparency, and really lack of productivity and we are seeing that today. That exists in a number of environments today but it requires access to data and real-time data analysis.
Elle Griffin: Any other perspectives on this maybe from the healthcare side of things?
Lori Weston: I think we’re all looking at those different models. It’s definitely a mind shift for providers, healthcare systems, and insurance, right? It’s paying for value and we’re not set up to do that right now. I think as you said, it does exist today, part of Intermountain’s business is at risk and what that means is we pay for episodic care. So I think we’re all looking at how do we make that model work, where you’re paying for a population versus just individual fee for service charges. It’s something that is definitely being looked at and hopefully, we can get to eventually.
Elle Griffin: Yeah, that’s interesting. I once hosted a panel that featured city planners on how you could tweak a city’s design to change different outcomes, and one of the things that the city planner of Salt Lake told me was that you can literally make a change, like Amsterdam, I’m going to make 30 percent of road spaces into bike spaces, and increase life expectancy by three years because people become more active and you can just see those tiny little tweaks made at the community level, and how it affects the overall population’s health, which is fascinating and brings me to my next question because we wanted to talk a little bit about social determinants of health. In fact, one of you, I believe it was Jeremy, you told me that a person’s zip code is a better-protected predictor of their health than their genetics. So how are we addressing some of those socioeconomic differences?
Jeremy Wells: I think what we first need to do is recognize that social determinants of health are real, and by social determinants of health, I mean, all of those social, economic, even political processes are factors that determine health outcomes. Some of the primary social determinants of health are food insecurity or housing instability, utility concerns, lack of transportation, lack of education, low-income levels, to name just a few. So at Roseman University, what we’re doing is we’re incorporating social determinants of health into our curriculum, so that the next wave of healthcare providers understand what they are and that they’re able to recognize them. In addition, our College of Medicine has developed a very practical approach to this with a program called Genesis.
This program is a home-centered healthcare model, where we send an interprofessional team into the home. The household is really the smallest unit of care in the United States. So, we send that interprofessional team in, doctor, nurse, physician assistant, nurse practitioner, whatever it may be, together with a social worker. What they do is they go into a home and yes, they treat the problem, but then they’re also assessing for social determinants of health. Then that social worker can help with those.
Brandon Newman: So if you layered the approach of providing care based upon social determinants, along with all the data points that you already have, you know what zip code they’re on, you know what age they are, you know what their socioeconomic situation is. If you layer that data in there ahead of time, then take an examples of who created this Covid module that basically would predict whether or not you’re going to get Covid, based upon where you’re located, based upon where the proliferation of Covid was at, how old you were, what drugs you were on, when was the last time you picked your medication up and we would pinpoint exactly where to get it. So instead of a shotgun approach, you say, let’s get everybody who has a particular social-economic or social determinants, let’s use data in a smart, automated, using AI way to be able to identify exactly who to provide care to.
This last couple of years has been so strange so what that is leading to now? There’s bound to be some fallout from all of this in terms of a rise in obesity, diabetes, and mental health crises. What does that mean? What needs to be done? How can we protect our wellbeing in the aftermath of the pandemic?
Nicole Priest: I think that’s the million-dollar question. We know that higher rates of obesity are going to lead to other chronic diseases: higher rates of diabetes, higher rates of cancer, higher rates of high blood pressure, and heart disease and all of these conditions that we know are so costly for healthcare. I was reading, about six months ago, that the average weight gain in the US through the pandemic was 27 pounds. It’s going to be higher now if we re-survey people and ask those questions again.
So in 2022 at Merit, we’re forming walking groups and we’re going to have challenges where teams can compete against each other, different buildings and manufacturing line one can compete with another manufacturing line, so kind of develop that camaraderie at work. We’re going to start some lifestyle classes where we can help people that are pre-diabetic or at risk for diabetes and we can talk about how to eat better, how to increase your exercise, and have those groups at work where people are working together for a common goal.
Elle Griffin: Looking forward, what are you most excited about seeing in the future as far as healthcare is concerned?
Jeremy Wells: I’m excited about our newfound commitment to some of these technology platforms that we weren’t addressing before.
Brandon Newman: For me, and this was a surreal opportunity for me to be a part of other healthcare sectors, locking arms and saying, “Let’s go at it and go fix it.” I think that we’re all saying, “Let’s go do that. Let’s lock arms, let’s embrace each one of those areas, instead of trying to compete against one another for the same patient over the same whatever it is, dollar.” I see the only way forward is for us to find ways to work together in harmony, focused on the specific end goal of improving health, reducing cost, and growing our communities.
Katelin Roberts: I second Brandon’s point. I think it was really just the tip of the iceberg in terms of collaboration for what we can do for the future and there was a lot of tragedy through that period, but I think that it taught us that we are resilient and that when we work together, we are so much stronger than just working in silos, and I think that that’s the best way that we can be even stronger moving forward to the future.