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Becker’s Healthcare Podcast
Advancing Population Health at Rady Children's Health with Dr. Michael Weiss
00:16:29
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- [00:02]
A
This is where healthcare leadership comes together. Becker's 16th annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April 13th through the 16th. This year's event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former President George W. Bush. For the agenda and event details, visit Beckershospitalreview.com and click on the events tab in the upper right, click. We're looking forward to hosting you in Chicago.
- [00:32]
B
Welcome to the Beckers Healthcare Podcast. My name is Paige Twenter. I'm a reporter and assistant editor with Becker's Healthcare. I am so excited to be joined today by Dr. Michael Weiss. Without further introduction, I would just love Dr. Weiss if you could tell us about yourself and a bit about your organization.
- [00:50]
C
Sure. Well, Paige, thank you, and thank you very much for having me today. I'm really excited to share some of the work that we're doing. Mike Weiss, I'm a general pediatrician, just a country doc. I practiced in the community for about 22 years here in Southern California in a private practice with a number of other physicians in general peds. And I always was kind of excited about the system of healthcare and how things could certainly be better than they are. I have a background with having lost a brother and sister in childhood to congenital disease. And I grew up as a family member kind of observing this not only as a clinician, but more as a family member. And it just always was something that I wanted to do above and beyond seeing the patient in front of me. So I, over the course of time, sought a little bit more education on the business side of medicine. And I was fortunate enough about 11 years ago to be sought out by Children's Hospital of Orange county to start a population health division here. Lo and behold, here we are 11 years later, and we've built something that I think is very exciting in terms of our organization. It's been a very exciting year. Children's Hospital of Orange county, which is where I was hired onto, actually merged with Rady Children's Hospital in San Diego to become Rady Children's Health. And that's now been one year since that merger. So we are represented by three hospitals. We have San Diego, Orange, and then we have a hospital in a hospital in Mission Viejo. And we have in both regions, we have subspecialty clinicians, tertiary quaternary services, and primary care networks. So it's actually a beautiful incubator to be working in this field.
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B
You've buried the lead. Dr. Weisser didn't even mention the lead of you're the first ever endowed chair for wellness at Rady Children's. That was a recent appointment.
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C
Yeah, well, it's always hard to blow your own horn, but I very, very honored that the Clavis foundation, which is a local foundation, had the forethought to really look at wellness and prevention. And I also give Rady Children's Health and chalk a lot of credit for really having the bot to think outside the four walls of the hospital and really consider that paradigm change of health care moving more into prevention and wellness. You know, we as clinicians and hospitals are very, very good at being reactive to situations. You know, patient, sick, make an appointment, come see me, I'll take care of you. But the reality is, when you look at the geography of, you know, these urban or suburban hospitals that we all work at, only 5 to 7% of the population ever really experiences the hospital, which is great. You know, we, we love that. But where are the other 93 to 95%? These are kids that are at school, they're at the park, they're at faith based organizations. They're at, you know, all these various community based organizations. And for us as a healthcare system, if we're not going out and proactively addressing the causes of illness and working with those communities, I don't feel like we're doing our job. So I applaud Rady Children's Health, the Clavis foundation, and I'm honored to be that first chair working toward that goal.
- [04:31]
B
On that note of prevention and meeting that 93% of patients who aren't going to the hospital, what are like two to three priorities you're setting for yourself in the next 12 months?
- [04:46]
C
Yeah, it's definitely going to be a bell shaped curve. There's going to be somewhat of an uphill battle because it's really a culture change. As a pediatrician, I was trained to fix, I was trained, bring me a problem and I will fix it. I was not trained to prevent the problem from happening. And so I think priority number one is really going to be education and awareness. It's really working across the organization, primary care, specialty care, ancillaries, the community leadership to get people to really understand the importance of prevention and proactivity. You know, we've all seen some degree of the beautiful slide that shows that 80% of what makes us healthy has nothing to do with what doctors and hospitals do. It's your genetics, it's your environment, it's the exposures you have. It's all those things. And if we're not addressing those, we're not addressing the major reasons why illness occurs, the social drivers of health, et cetera. So I think that's priority number one. I think priority number two is that I want to be sure as we enter into this arena that we do it in an evidence based fashion. So certainly things like integrative medicine are something that the public really wants. And I can tell you that the clinical side is very skeptical. And so bringing those two areas together, studying it in an appropriate manner and assuring that it's evidence based is another huge priority that I have. I always look back to, you know, people are probably aware, if they're of my generation, of the Framingham Study, which is a study that was done in Massachusetts that's ongoing, that has looked now for 50 or 60 years at a cohort of people that were born and they followed numerous markers on those patients, looking all the way from blood work to social drivers to genetics to their employment, et cetera, et cetera, to determine what it is that really drives health. Well, I would love to really do something like that on the pediatric side to really look at what are the interventions that we can consider that may ultimately lead to better longevity, better outcomes in children. You know, for instance, a family who has a baby and the family has a strong history of cancer or diabetes or rheumatologic condition, are there interventions that we can undertake before those things manifest that can perhaps prevent them or prolong the onset of those, those conditions? So that's another paradigm change that I think would be important. And again, doing it in an evidence based way so that we can study it and publish those studies and try to drive change in terms of how we practice medicine.
- [07:50]
B
With the 50 year Framingham study, are you imagining or wanting to kind of start like a decades long research project then?
- [08:01]
C
I would love to. You know, I've spoken with our research department here and we have some NIH grant recipient researchers. Here are one, our two grants, which are the big NIH grants, and they seem very excited about what I've described. So I think if we can outline something like that and perhaps draw out a multi decade approach to this, it would be very, very exciting.
- [08:29]
B
I'd also love to know more about, I mean, I asked for your priorities and you gave me priorities. I'd love to know more about kind of like your personal investment in this. You mentioned earlier your family background and losing your brother and sister really fueled your interest in, you know, working for, I believe you said, 22 years in healthcare. Can you share more about that?
- [08:55]
C
Yeah, I mean, you know, I'm 40 years in now of being a pediatrician and 22 in private practice. And then I did a stint kind of learning the business side actually on the adult side, in the insurance side. But I think medicine is a very interesting thing. It's probably the only business that runs the way it runs and is still in business because of the way that we approach it. And we all talk about value based payment and we talk about universal healthcare, all of this. And again, I've been doing this for 40 years and I think 30 years ago I started first hearing value based payments coming. It's coming, it's coming. You know, and here we are 30 years later and there are pockets of it. You know, we in Southern California and we're, I know we're a unicorn, but you know, I, I oversee a group of 140,000 Medicaid children who are under global capitation and have been so for almost 30 years. And we've made that work for 30 years. Our doctors are happy, the patients are getting great care and the system works. But I understand that the vast majority of the country is still in a fee for service paradigm and it's very challenging to achieve some of these things. In a fee for service paradigm, there's no payment, reimbursement, reward for preventative care, for counseling, for team based care. There are pockets of demonstration projects. You know, CMMI has done a number of things and you know, I give them credit, but we're still in this do one, get paid, do two get paid twice world. And until we change that paradigm, it's going to be a big challenge for us to move into this preventative proactive care model.
- [10:51]
B
You mentioned paradigm shifts with, or an uphill battle with culture changes related to integrative medicine. And then of course, paradigm shift or really a true adoption and rollout of vbc, whereas right now it's just in pockets and will likely just be in pockets for many more years. I'm curious on actionable tips like for our listeners, if they're interested in having their own unicorn of 140,000 children. VBC model, what first steps would you recommend?
- [11:29]
C
Well, I think you have to start with leadership. Buy in. You know, as much as I hate to admit it, in my 40 years I've come full circle and I am semi tainted. Health care is a business and it is all about the money. And as much as we as physicians want it to be all about the quality of care, you know, certainly that's there and we're doing our very, very best. But the reality is it really comes down to making it work financially. And I get it. You know, I, I have spent my career trying to understand the business side and the clinical side and marrying the two so that they don't kill each other and we can get things done. But I think that the number one thing is it's got to be a leadership, cultural belief. You have to have the C suite believing and understanding that value based care can work clinically and financially. And there's plenty of, again, pockets of unicorns that are doing this. There's great work in Massachusetts, there's great work in, in Pennsylvania, there's great work in Seattle, Washington, in California. But again, this starts at the very top. The second piece of it is you have to have a payer that believes in it. And the payers, you know, are in a very difficult position because their number one goal is they have to sell product. And they sell product based upon the attractiveness of their outcomes and their, and their programs. And I think that there are enough studies demonstrating the outcomes and the attractiveness. I'm holding my hands up in air quotes for those listening of these programs to make it attractive enough to invest in that. A great example is there is a health plan, I won't name it on the podcast, who invests in a special needs program. They actually pay various medical groups. We are one of them. A proactive fee to care manage their highest risk patients. And what has been shown in that program is that by putting a care team around these highest risk patients, including case management, social services, navigation systems, et cetera, you can reduce the ED visits, you can reduce the readmissions, and thus reduce the cost of care while maintaining or improving the quality of care. So it works. It's just a matter of getting the C suite and the health plans together to understand that it works.
- [13:57]
B
Unfortunately, we only have a few more minutes. I could talk forever with you, but we unfortunately have a few minutes left of our podcast today. And last question for you, Dr. Weiss, is where do you see the biggest opportunities for growth in the next year?
- [14:13]
C
Yeah, you know, I really think that the movement for what's called advanced primary care is, is very important. You know, primary care right now. And I can say this because I did it for 22 years, feels like a hamster wheel, particularly in pediatrics, you know, we have what are called the bright futures recommendations from the American Academy of Pediatrics. And you know, all the current issues aside with vaccine refusal and you know, all those Types of things. You know, we are given 10 to 15 minutes to see a child, and there are 15 or 20 things that we need to do in that visit, including anticipatory guidance, including immunizations, including the physical exam, including preventative care, you know, et cetera, et cetera. I think advanced primary care really is the future where we are able to more effectively embed mental health, social services, community health workers, a number of different roles, health coaches, into a primary care where the physician or app is able to do their job and have these wraparound services that are reimbursed to provide all those other services that we know make up 80% of what health is. So I think valuing advanced primary care, paying for advanced primary care is extremely important. The other positive out of that is that the major issue with subspecialties these days is they're overwhelmed. And I get it. It's very challenging. And a significant percentage of what's referred to subspecialty care is not appropriate for subspecialty care could be cared for in a primary care office. And a lot of times it's not able to be done because of time, simply time. And so I think we can make both sides of that equation work by really looking toward funding and supporting an advanced primary care model.
- [16:13]
B
Well, thank you so much, Dr. Weiss, and I'm excited to hear updates on advanced primary care models. Yeah, thank you. I really, really appreciate your time today, Dr. Weiss.
- [16:23]
C
My pleasure, Paige. Thank you very much for having me.