25 episodes

Crosswinds is a series of casual conversations with national thought leaders hosted by Tom Robertson, executive director of the Vizient Research Institute. New episodes released every month feature the brightest people in health care considering questions that others haven’t thought to ask – always remarkable, never exactly what you’d expect, and having fun along the way. Crosswinds: Two old friends sitting in comfortable chairs… talking.

Crosswinds Tom Robertson and the Vizient Research Institute

    • Health & Fitness
    • 3.8 • 5 Ratings

Crosswinds is a series of casual conversations with national thought leaders hosted by Tom Robertson, executive director of the Vizient Research Institute. New episodes released every month feature the brightest people in health care considering questions that others haven’t thought to ask – always remarkable, never exactly what you’d expect, and having fun along the way. Crosswinds: Two old friends sitting in comfortable chairs… talking.

    Malcolm Isley Executive Vice President & Chief Strategy Officer Prisma Health

    Malcolm Isley Executive Vice President & Chief Strategy Officer Prisma Health

    Tom Robertson, Executive Director of the Vizient Research Institute is joined by Malcolm Isley, Executive Vice President and Chief Strategy Officer for Prisma Health, headquartered in Greenville, South Carolina. Malcolm describes the unique challenges of delivering health care to rural populations and of striking a balance between local access and the need to consolidate higher acuity services, before he and Tom discuss the transition from large community system to newly-developed academic partnerships.

     

    Guest speaker:
    Malcolm Isley, MHA
    EVP & Chief Strategy Officer
    Prisma Health

     

    Moderator:
    Tom Robertson
    Executive Director
    Vizient Research Institute

     

    Show Notes:

    [01:09] A third of South Carolina’s 5.2 million population lives in rural areas and making health care accessible and affordable is a challenge, given the disparities in social determinants of health. 

    [03:32] Prisma Health covers half of the state’s population. Prisma also partners with Federally Qualified Health Centers (FQHCs) for clinically integrated networks and other activities.

    [06:05] Accountable Communities Programs

    [07:25] Virtual care

    [09:58] Prisma Health has developed local systems of care, with each region aligning services to provide the highest value to the patients.

    [11:05] Prisma has intentionally been moving more care from the tertiary and quaternary hospital to the community hospital, with the goal to keep care close to an individual’s home and make care more affordable.

    [12:40] In the community hospital setting, Prisma is working on ambulatory care.

    [12:54] “Center of excellence” doesn’t have to be at a physical location. It’s a commitment to certain cost, quality, patient engagement and outcomes, not a location.

    [18:20] Prisma is not owned by a university, but they have a lot of very productive university partnerships to improve community health.

    [19:05] 8,000 students filter through Prisma every year, supporting workforce development activities in medical, nursing, pharmacy, social work and technical education.

    [21:14] Prisma Health receives 200 – 300 requests a day for mental health services.

    [25:13] Examples of non-traditional partnerships.

     

    Links | Resources:

    Malcolm Isley's biographical information

     

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    • 34 min
    Eric W. Dickson, MD, MHCM, FACEP President & CEO UMass Memorial Health

    Eric W. Dickson, MD, MHCM, FACEP President & CEO UMass Memorial Health

    Tom Robertson, Executive Director of the Vizient Research Institute is joined by Dr. Eric Dickson, Chief Executive Officer of UMass Memorial Health in Worcester, Massachusetts. An Emergency Medicine specialist, Eric provides a unique perspective on the impacts of both the pandemic and the labor shortage on front line clinicians. The conversation turns to overcoming organizational inertia before Eric and Tom share thoughts around the value of mergers and acquisitions.

     

    Guest speaker:
    Eric W. Dickson, MD, MHCM, FACEP
    President & CEO
    UMass Memorial Health 

    Moderator:
    Tom Robertson
    Executive Director
    Vizient Research Institute

     

    Show Notes:

    [00:53] Labor shortage:  U.S. health care has lost 15% of its workforce since the pandemic  

    [03:05] Health disparities and unequal accessibility

    [04:48] Care at home

    [05:56] Integrated payment system

    [06:55] UMass’ Hospital-at-home program may close after COVID waivers end due to current payment system

    [08:04] When health care systems are big enough

    [10:34] Regional systems of care

    [14:52] How to overcome organizational inertia

    [17:27] Realigning the staff with the mission to put the patient’s interest first will help the workforce overcome burnout and be more engaged

     

    Links | Resources:

    Eric W. Dickson's biographical information

     

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    • 21 min
    Russell M. Howerton, Senior Physician Executive, Atrium Wake Forest Baptist Health

    Russell M. Howerton, Senior Physician Executive, Atrium Wake Forest Baptist Health

    Tom Robertson, Executive Director of the Vizient Research Institute is joined by Dr. Russell Howerton, a surgeon and long-time Chief Medical Officer at Wake Forest North Carolina Baptist, now Atrium Wake Forest Baptist Health. Russ and Tom discuss everything from shared experiences with bygone general practitioner physicians to the effects of modern era mergers and acquisitions. Along the way, they tackle issues ranging from the balance between autonomy and systematic reliability to the economics that influence the delivery of care.

     

    Guest speaker:
    Russell M. Howerton, MD, FACS
    Senior Physician Executive 
    Atrium Wake Forest Baptist Health
     
    Moderator:
    Tom Robertson
    Executive Director
    Vizient Research Institute

     

    Show Notes:

    [00:50] Advice to give a young Russ Howerton

    [01:40] Father exemplified individual accountability, autonomy model of medicine

    [02:25] Trained under Lucian Leape, author of “To Err is Human”

    [06:27] There’s variation of service with any sized system, and scaling it up with a merger won’t change that

    [11:15] There’s some debate that a highly skilled, low-volume surgeon will be better than a low-skilled, high-volume surgeon, but probably little debate that an institution has systems and processes in place better when doing high volume.   

    [12:30] The financing and provisions of the infrastructure to deliver health care is complex – it’s like a Jenga puzzle to manage it

    [15:00] Society doesn’t want to see market failure in health care where people can’t get service when they need it at a micro level

    [22:00] Thoughts on price parity for patients

    [22:50] Price parity would free us from “segregating" patients by their payer status

    [23:54] Payer parity is different than global budgeting. It puts pressure on the current pricing model and wouldn’t survive indefinitely in society because many valued services would be hard to support.

    [26:50] Atrium Wake Forest Baptist wants to be a regional leader in converting to a value-based care model, but still can’t keep the lights on without focus on the volume-based model.

     

    Links | Resources:

    Dr. Russell Howerton's biographical information

     

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    • 33 min
    Mark Laret Retired President & CEO, UCSF Health

    Mark Laret Retired President & CEO, UCSF Health

    Tom Robertson, Executive Director of the Vizient Research Institute is joined by Mark Laret, retired CEO of UCSF Health in San Francisco. Prior to his distinguished tenure at UCSF, Mark was CEO of UC Irvine Medical Center. He began his career at his alma mater, UCLA. Mark reflects on his career, which began in the early days of managed care. He describes the emotions involved in retiring, and the two long-time friends share their thoughts on what the future might hold.

     

    Guest speaker:
    Mark Laret
    Retired President and CEO
    UCSF Health
     
    Moderator:
    Tom Robertson
    Executive Director
    Vizient Research Institute

     

    Show Notes:

    [01:11] Rationale for consolidation in health care

    [2:27] Merging health organizations may have very different cultures and it will take effort to align those differences

    [5:55] A lot of decisions are made to back programs that support patient care, but it’s a struggle

    [7:10] Biggest surprise is that health care is not fully capitated

    [10:40] Proudest moments  

    [15:13] Site of service differential payments makes no sense to anyone outside of health care, but it was a mechanism for solving a problem that hospitals had serving the underserved, and not being reimbursed for them

    [17:32] Need to maintain the best parts of the market-based system, but reprioritize access and eliminate health disparities

    [18:28] Decisions not proud of almost always come back to whether or not we did enough to service patients

    [10:19] Our goals need to be how to improve the health of the communities that we serve, and how we make payroll and cover the cost of new drugs and supplies

     

    Links | Resources:

    Mark Laret's biographical information

     

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    • 25 min
    Michael J. Dandorph President & CEO, Tufts Medicine

    Michael J. Dandorph President & CEO, Tufts Medicine

    Tom Robertson, Executive Director of the Vizient Research Institute is joined by an old friend, Mike Dandorph, President and CEO of Tufts Medicine in Boston. Before assuming his current role, Mike was President, Rush University System for Health and Rush University Medical Center in Chicago, and prior to that he was the long-time chief strategist for the University of Pennsylvania Health System in Philadelphia. Mike shares his thoughts on leadership, comparing experiences in different models of AMCs. The conversation then turns to macroeconomic challenges facing the American health care system and Mike’s views relative to potential systemic changes.

     

    Guest speaker:
    Michael J. Dandorph, MHA
    President and CEO
    Tufts Medicine


    Moderator:
    Tom Robertson
    Executive Director
    Vizient Research Institute

     

    Show Notes:

    [00:50] Organizational structure is less important than staff alignment for a health system’s success

    [3:47] Tufts Medicine aims to treat their patients as consumers and organizes for accountability, quality outcomes and invests with patient priorities

    [4:10] Other key components are: physician alignment, incentives rewarding the right behavior and putting the right people in the right positions   

    [5:40] Culture plays a role in keeping the patient the center of attention as opposed to research  

    [07:34] Mergers and acquisitions: integration is really hard because it requires a lot of change, and humans don’t like to change

    [8:56] In mergers, clinical teams need to come together to address programmatic integration, performance improvement, service rationalization and that takes trust. Leaders can help by creating an environment with honest conversations.

    [11:10] U.S. health system higher costs aren’t translating into better access or better quality of care. It’s not just a provider issue, but a societal issue. Resources need to be deployed in a way that has a higher impact than it has now. 

    [14:08] Rate regulation won’t change the social determinant issues, but if health care organizations don’t control costs, the government may intervene  

    [17:44] Supply-induced demand is not the health’s industries big problem, it’s very sick people. Instead, where we take care of patients need to be considered to cut costs  

    [19:56] During the pandemic health care organizations came together in a broader ecosystem to provide the best care

    [23:21] The current health system is so complex that it will have to be partially dismantled to be more rational.  The insurers have gotten in the middle and that creates a huge administrative expense.  20% of costs is attributed to billing preapprovals and authorizations.

     

    Links | Resources:

    Michael J. Dandorph's biographical information

     

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    • 27 min
    Johnese Spisso President, UCLA Health (Part 2)

    Johnese Spisso President, UCLA Health (Part 2)

    Tom Robertson, Executive Director of the Vizient Research Institute rejoins Johnese Spisso, President of UCLA Health to discuss the economic shortcomings of managed care, and in particular the decades-long emphasis on reducing utilization. With over 25 years of experience in two west coast markets characterized by the long-standing influences of health maintenance organizations, Johnese brings an informed perspective when considering Tom’s proposition that the market’s failure suggests the need for another source of rational health care pricing. The conversation then shifts to the country’s need for more comprehensive mental health services and UCLA’s efforts in that area.

     

    Guest speaker:
    Johnese Spisso, RN, MPA
    President, UCLA Health
    CEO, UCLA Hospital System 
     
    Moderator:
    Tom Robertson
    Executive Director
    Vizient Research Institute

     

    Show Notes:

    [01:10] Why HMOs and primary care capitation concepts failed to cut health care spending

    [5:56] Health care prices should have rational limits with rate structures that allow for capital investment and sustainability.

    [10:39] Disparities of care would improve if we had a payment system that was payer agnostic

    [11:00] UCLA Health is expanding its inpatient mental health with a $400 million investment to create a behavioral and mental health center of excellence. The new center will add 125 inpatient psychiatric beds.

    [14:05] A rising number of America’s youth needs mental and behavioral health care

    [15:14] UCLA has a “Depression Grand Challenge” app that monitors initial symptoms of depression and offers calming meditations resources

    [16:45] Investing in research and innovation

    [18:00] 14 cancer drugs were discovered at UCLA health over the past decade

    [18:55]  Need for developing better tools and technology to distribute resources efficiently

     

    Links | Resources:

    Johnese Spisso biographical information

     

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    • 24 min

Customer Reviews

3.8 out of 5
5 Ratings

5 Ratings

Disgusted in RI ,

Lifespan is a terrible organization

Timothy Babineau is a bad leader. He’s greedy and unfit to run an equitable organization. Lifespan executive leadership vaccinated themselves before frontline staff and gave upper management big bonuses. Did frontline staff get hazard pay? No.

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