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Becker’s Healthcare Podcast
Driving Collaboration and Quality Across Cardiovascular Care in Michigan with Dr. Vikram Kashyap
00:18:28
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- [00:02]
A
The most important healthcare decisions don't happen in isolation. They happen when leaders come together. Becker's 16th annual meeting brings together more than 3,500 hospital and health system executives this April in Chicago. With 800 speakers from Ascension, Cleveland Clinic, Common Spirit, and more, the conversations get real. Leaders will share how they're scenario planning for policy shifts, breaking through value based care barriers and building clinical teams that translate new ideas into real world care care. Join top decision makers in the room April 13th through the 16th. For the agenda and event details, visit BeckersHospitalReview.com and click on the Events tab in the upper right.
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B
This is Laura Deardo with the Becker's Healthcare Podcast. I'm thrilled today to be joined by Dr. Vic Kashyap, endowed Chair of the Frederick Meyer Heart and Vascular Institute and Vice President of Cardiovascular Health at Corewell Health. Dr. Kashyap, it's a pleasure to have you on the podcast today.
- [01:01]
C
Thank you so much, Laura, for including me in your series. Very happy to be here.
- [01:06]
B
Absolutely. Now I'm excited for our conversation because I know the cardiovascular care is such a dynamic space. There's so much happening and really interesting to think about how it's evolving. Most people in their lifetimes are either touched by this type of care or have loved ones who are. I'm excited to learn more about how you're thinking about things today and what you're seeing in the future. But before we dive in, can you tell us a little bit more about yourself and core well health?
- [01:32]
C
Yeah, happy to. So I'm a vascular surgeon by training. I spent the majority of my career in Cleveland, Ohio, was there for a couple of decades and then a few years ago got contacted about this opportunity which was to run a heart and vascular institute. And I'll say that Corbel Health and in this area has been evolving, changing very dramatically over the last few decades. So initially Butterworth Hospital was a community hospital, and then Spectrum Health, a system in west Michigan. And Spectrum Health, which I joined back in 2022, merged with Beaumont Health, which is on the east side of the state in metro Detroit, and we're now called corewell Health. So for those podcasts that you do on branding, we have a little branding confusion since we've had some name changes, but we're now a 21 hospital system across the state of Michigan, and our goal really is to provide comprehensive care for our patients and our communities.
- [02:37]
B
I love that. And it's simple, yet so complex when you think about everything that entails providing that type of Complex care and access to care for the broader communities and populations you're serving. So I'm curious, can you tell us a little bit more about the last year? So what was an important initiative that you led? What did you do and what were the results?
- [02:56]
C
Yeah, so we've. The Frederick Meyer Heart and Vascular Institute has been in place for over a decade now. And the Meyer Heart center is a eight story hospital devoted to heart and vascular care that's been in place for over 20 years. That being said, like many places, I think we were still fairly fragmented. Know silos in cardiology, in cardiac and thoracic surgery, in vascular surgery, in wound care, in multiple areas across the cardiovascular landscape. And I think perhaps not just last year, but in the last couple years, our biggest success has been really becoming much more collaborative, much more coordinated as a heart and vascular institute. So what does that mean? For instance, we have really focused on ensuring the highest quality for our patients. Now every physician, every group wants to do that. But what we've done is looked at it at a system level. So we look at every mortality that happens in the heart and vascular space. Each group is tasked to really do a very careful analysis and then bring back to us any lessons learned, any gaps in care and any other items that can really be socialized for our group as a whole to improve the care of patients. Well, what's happened over the last three to four years? We've dropped our raw mortality significantly. We have improved our observed to expected mortality ratio, which was at the one level that is on par or average down to 0.67. And I think that focus on improving individual patient care and then having the lessons learned in one area be socialized to all areas across the Heart and Vascular Institute have really been a great success for us.
- [05:10]
B
That's helpful to understand, you know, and I really appreciate you kind of talking through the systematic way that you approached trying to tackle some of these issues, because I think having heart issues and challenges are so such a big issue for patients, their families. And so being able to provide some of those best practices and really figure out what makes the most sense in terms of moving the needle for mortality is so helpful. Can you dig a little bit deeper in there? How did you really make a difference or what were some of the things that you did and changes that you made in order to serve the community better.
- [05:49]
C
Yeah. So I will, I'll have to make sure to credit all of our amazing teams, our physicians, our surgeons, our other providers, including nurse practitioners and PAs that are part of the Team nurses. They have worked diligently and collaboratively to really provide great care for a long period of time. However, we did see improvements in heart surgery, in cardiology, in vascular surgery, in terms of 30 day mortality. I think this was both a refinement of practice and very careful selection of patients. We also saw an improve in our ODE ratio, probably because of documentation. That is, we had very sick patients here in West Michigan, just like many other urban and semi urban areas. But maybe we weren't displaying how ill they were until we did a better job of looking at risk factors and documenting them appropriately in the record. So I think those two things, one absolute or raw mortality decreasing, but then also the expected mortality for a cohort of patients increasing because of the risk of that population being appropriately delineated has been the success here.
- [07:12]
B
That makes a lot of sense. And you know, it's helpful to understand all the different kind of adjustments that you were making to move the needle. Now, looking ahead for 2026, what are some of the big priorities and headwinds that you're most focused on?
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C
Yeah, one of the big challenges we had last year is a complete change in our anesthesia workforce. And this is not dissimilar to some of the other systems and hospitals around the country. We've moved from a private practice, contracted model to an employed model. And that was a big change for the system, for the hospital, and quite frankly, for each individual physician, especially the surgeons that rely on great anesthetic care for taking care of their patients. So we're in the midst of this transition, going to an employed model that has meant a lot of recruiting of great anesthesiologists. And oh, by the way, let me put a plug if somebody wants to come join us in Corwell Health in Grand Rapids. We are open to, we have open arms, but that has been, as you can imagine, a lot of change management. Different people in the operating room, different processes. Perhaps in some areas, people coming from different cultures, coming to this culture, this medical culture here. So all that change, I think, has been very disruptive and getting to a point where we're almost complete or maximally employed in that department of anesthesia is going to be a hallmark for us. We hope to accomplish that in 2026. I think that really stabilizes our surgical and procedural areas to a great degree.
- [09:03]
B
That makes a lot of sense. You know, that is such a huge change, especially with anesthesia. I know today, across the board is something that is top of mind for so many clinical teams and trying to figure out the right model that makes sense in each community is no easy task. And so when you're going through some big changes like this, especially when it's oper operational things happening in the operating room. But then two, you know, wanting to make sure that clinicians have faith and really trust their colleagues to deliver the best care possible. How do you go about this change management and making sure that, you know, everybody across the board is comfortable with how you're moving forward and, you know, ready to do whatever it takes in order to keep that great quality care going?
- [09:45]
C
Yeah, well, I think the first element is communication and maybe communicate, communicate, communicate over communication. And we do this in, in a multimodal way. We have town halls where we have all the members of the Hart and Bashka Institute, which are now over a thousand people, dial in for a virtual town hall. We have in person grand rounds once a month where we hit some of these topics. We have a monthly newsletter and I meet periodically with different teams in different spaces, whether it be the vascular surgeons or the thoracic surgeons or the electrophysiologists or other proceduralists that get affected by this change. So one is to communicate what's happening. Two is to be really brilliant at the tactical changes that are occurring on a daily basis, whether it be schedules, whether it's using a certain number of locums providers to fill in the gap till we get to a fully employed model and other things. And then I think the other, the other part about this, Laura, is also to really have focus, have people focus on the long term. What is going to be the long term effect of this? Well, it's going to be that we're going to have a department of anesthesia that is as aligned with the different strategies that we have for the Heart and Vascular Institute, including quality, including research, education, strategic growth, et cetera. And that's going to be a very positive state for us once we were able to achieve this.
- [11:26]
B
I love that. I think being able to have that type of communication, clarity and relationship with the team, that they understand exactly what's going to happen and why things are happening and then really get on board to make that change makes a big difference. What do you think the hardest thing that you'll have to do in the coming year will be?
- [11:44]
C
Well, that may be the hardest thing, but let me tell you about a couple of other things that I think that are happening that are big changes. So we've been a Heart and vascular institute, but recently we also incorporated the pulmonary division into our area. So now actually we're in the midst of a name change again, but it's not for the overall organization. It's for our department as we go to the heart, lung and vascular department. And that's important for many reasons. This was an organizational change that we did not ask for. This happened because of some changes in the overall structure of the organization. We really welcome this as a great opportunity for the pulmonologists, who already collaborate, by the way, with many of our thoracic surgeons and others, to really even enhance that relationship, especially for lung cancer treatment, for lung transplant and other areas. We've had a lot of folks in overlapping areas related to both pulmonary and cardiac issues, let's say, in the areas of syncope, in the areas of shortness of breath, et cetera. Now, these groups that often are evaluating similar types of patients are all under one roof and they can hopefully elevate the care that they're giving, elevate their algorithms to an even greater level. And I think the last thing that this is really going to be impactful is our whole research infrastructure where we have tremendous number of folks that are interested in research. We've started about over 60 trials now, I'm sorry, over 70 trials in the last five years, clinical trials. And this allows groups that previously had been separate to collaborate to really be at the forefront of early stage treatments for heart and lung problems. So we're really looking forward to that as both a challenge and an opportunity for us.
- [13:54]
B
That makes a lot of sense. And, you know, it is really interesting to see how those dynamics have been shifting. And I know it's, you know, no small task to have those types of clinical trials and research and more becoming a bigger part of what you're doing there. And I'm curious when you think of that balance between trying new things and the research and the development and accelerating therapies, and you know, also knowing that you have to care for a growing patient base, how do you keep the both innovation as well as clinical quality and safety in mind and, you know, looking ahead as well as thinking about what needs to be done right in front of you?
- [14:35]
C
We have a beautiful strategic roadmap and we actually have changed it into a visual that, that looks like four pillars holding up a temple. You've seen that visual before for strategies with the foundation, four pillars and then the, the capstone on top. And the capstone has our vision, which is that we want to be nationally ranked, recognized for what we do, and being a destination for compassionate and collaborative and innovative heart and vascular care. Now, heart, lung, and vascular care. And the strategic pillars have to do with exceptional quality, being brilliant at our operational capabilities, focusing and elevating research and education, and lastly, strategic growth. And whenever we have a group meeting, a strategy meeting, or an operational meeting that's more related to tactics, we show the same slide and have people really coalesce around. These are our four pillars. This is what we'll work on, what we'll focus on. And below we have the number of metrics and tactics that are related to those pillars. So getting the team members aligned in a way that they can see that their work affects either one or multiple strategic pillars that we have and then allows us to move forward because of their work, I think is very impactful, keeps people engaged, keeps people and the team aligned to what our future is going to be.
- [16:08]
B
That's helpful for understanding. Thank you so much for digging a little bit deeper there. Now, before we wrap up, I wanted to ask you about growth too. Where do you see some of the best opportunities for organizations, organizational growth in the next year or two?
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C
Yeah, I think the, the biggest potential, quite frankly, Laura, is the, the possibility that we've been talking about for some time of really, really having a collaborative Pan Michigan approach to heart and vascular care. And what do I mean by that? Well, Big System on west in West Michigan, that Spectrum Help, that was the organization that I joined, based out of Grand Rapids. Big System on the east part of the state, Legacy Beaumont, based out of Metro Detroit. Now we're Coral Health west and Corewell Health East. Well, if we can collaborate and really align on different protocols, algorithms for patient care, I think we could have a huge impact on not just our local communities, but, but really the whole Michigan population. Whether we talk about heart failure, eligibility for heart transplant, we talk about shock and emerging strategies to deal with patients in cardiogenic shock, including advanced mechanical circulatory support. We talk about peripheral arterial disease and how we treat patients with claudication all the way to limb threatening ischemia. We talk about wound care, we talk about coronary disease. All these different entities that we see in our so many hospitals across Michigan. If we can coordinate that care in a way that's more meaningful, that can have a really big impact, I think for many of the folks that we take care of.
- [18:00]
B
Absolutely. That makes a lot of sense. And you really paint a great picture of what's ahead and the possibilities for you at corewell. Thank you so much for joining us on the podcast today. Dr. Kashap, it's been a pleasure speaking with you. I'VE learned a lot, and I look forward to seeing you as well at our annual meeting in April. I know you'll be speaking on a panel and really digging deeper into some of these themes we've been talking about. So I'm excited to have you as part of it.
- [18:22]
C
Well, thank you. It's been my pleasure, Laura. I really appreciate it.