This Week In Richmond: Michael V. Gentry and Sean T. Connaughton
This. Week in Richmond, is made possible in, part by the. Virginia. Education Association. An. Investment. In teachers today will, pay dividends, tomorrow. Dignity. Memorial the. Dignity, network provides, professional, and compassionate funeral. Memorial. Cremation. And cemetery, services, throughout, the Commonwealth, of Virginia, Virginia. Tourism corporation, promoting. Why Virginia, is for lovers lovers. Of wine and craft beers, the outdoors, beaches, history, music and more fall, in love with Virginia, at Virginia, org. Additional. Support provided by, these sponsors. And by. The members, of Virginia's. Public television, stations. Thank, you. Welcome. To this week in Richmond we have a very special opportunity today to talk about healthcare, something. That everyone, is interested, in and has, a great deal of conversation. Going on both. In the Commonwealth, and throughout the nation now. Sean Connaughton you're no stranger, to to our audience, and the people in the Commonwealth from, your. Work both in state government, and transportation. Issues some. Time ago and that was a Virginia Hospital Health Care Association they. May not know throughout, the Commonwealth. Michael, Gentry from. Centerra. CEO. Santaro, health system but, they will know after this show and we want you all to, help. Our viewers know what one of the key things that they need to really be thinking. About with, healthcare, I mean sometimes health. Care become so personal. Lives yeah but, take it beyond just the individual, person what are some of the key topics, the key issues, in healthcare, as. We move into. 2018. Long. Ago first first. We're going to become very close friends because, I appreciate the promotion I'm the chief operating officer okay, executive. Office okay, so. I should clarify that, soon that my drive back to Norfolk, will be a pleasant one but. You. Asked a great question because health care is a very, individual. Topic. And if. You think about the, Affordable, Care Act what's, worked well about it and what hasn't worked well about it you. Step back it's really a financing. Mechanism for, how we can care for, more individuals, in America and, that, challenge, is is that some of us have extraordinary, needs, and some of us have almost, no, needs and. So, how. Do we finance, it and how do we motivate the folks that are young and healthy and really, don't see any health, care needs in their future for, even a decade or longer and, how, do we engage them on the topic and of course we tried to do that from a financing, standpoint, of saying you, know listen you know join, and join in the game or else we'll give you a tax and. So. Far that hasn't worked to the degree we thought it might, and so, then. The cost what's. Happening, today is the cost of health care is. Moving, to the folks that need it the most and. So that's where we see this disproportionate. Issue. Across. The country and so that's why it's, such an interesting topic, because dependent. Upon who we're talking to and their, personal, situation. Their. Observations. Of what can be done or should be done very quite, a bit. And. That I'm sorry about I could have served senior, vice president, on you but I was. You. Know it's interesting. We. Talked about health care it's, obviously a lot of things being driven by politics, there's parts.
Of It being driven by by media, interest in it but. There's been a quiet revolution. Being. Led by health systems, in in. Improving, quality and this. Is something that people I don't think really have focused, on is that, beyond the things happening, in Washington, or in Richmond, and things happening with our insurance policies, and people being, concerned about premiums. And, deductibles and, things is that the. Members of the Hospital. Association have. Been working, extremely, hard to, improve their, quality measures. And being. Led by systems, like Sentara which have some of the best rated hospitals, now in the country, we've, now seen for the first time Virginia, is now moved into the top ten for, quality in. A couple of ratings one by the federal government one by a company, called leapfrog. Actually. Looking at things like readmissions. Hospital, acquired conditions. And. A whole bunch of other metrics, which, says a lot about what's happening, in Virginia, that people, are, are. Seeing. That the health care providers, are providing to. Them much. Better services, making sure that when they come in for any. Sort of medical treatment, and that, they are actually. Coming. Out healthy, and staying. Healthy and. Making. Sure that these. That the provision, of health care is something that is. The highest quality, really. In the country Mike maybe you can talk to you a little bit about some things they're doing, sure I'll comment on that a little bit the. Topic, of quality, is broad and it's a little hard, to follow sometimes because, if you step back we, have CMS. The Centers for Medicare, and Medicaid and they. Have a number of criteria that, they're asking hospitals, to follow and some of those are about the patient's, experience, some. Are about clinical processes. And some are about clinical outcomes, and then, in addition there are a number of other organizations Shawn. Mentioned leapfrog, which, was initially employer-sponsored. And. Then there's truven, which has now been bought by IBM. Watson. Another. One is the u.s. news top, 50, list or their variety of those there's another, top, 100, list which, has a different set of metrics and so. When. You're running a health system you're thinking well what should my clinical, dash. Card. Look like you know what should I have on it because, all of these metrics are not the same and so. The payers like, anthem. For instance or perhaps optimal, health they, may have clinical, metrics for themselves for. Their. Members. That they want you to achieve and so, really, running a health system requires, you to look to the market, and say what, is of interest to the organizations. That are paying us for services, and then, what do we know as well that needs to be improved whether, or not it's measured, and so, I'll speak just for Sentara about. Four years ago we built a new process, called CPI, or clinical, process, improvement, where, we wanted to improve clinical, outcomes across. The organization. So an easy one would be to say how, long does it take us to, when. Someone has a diagnostic. Mammogram. And, there's. Some suspicious finding. To do a follow-up, test and get to result, in a plan of care and dependent, upon which location. You went to incent error that varied quite a bit and so, we made a very, intentional, effort to shrink that amount of time from the matter of weeks to, a matter of days because think about the individual, they have uncertain.
Yes You know and so all of us worry about what do you do with this uncertain, news and so, that's a that's a an example that it's easy to understand, and follow but, that was on no, payor scorecard. That wasn't on any external, metric, that's where we looked inside the organization, and say what can we do better. For, our members and our patients, but, all health systems in Virginia, were all motivated, to. Vastly, improve our game and I would I would, say thanks to Sean and his leadership in the Hospital Association that, I think. A few years ago we were sort of middle of the pack and, we really. Wanted to move to, the top tier, in terms, of outcomes, for all states in the country. And. David, you know it's interesting and. One. Of the things that, do the leadership, of Mike and the other members of our board every. Time our board of directors gets, together it starts with a safety moment, things that have happened at a hospital will do sort of show. Employees. And people who have stepped up and done the right thing and then. Also we focus, on best of practice, we have one of the members actually who is the best of practice in a certain area come up and present to the board about, how they got there and how their journey started, and, why that's important, is obviously it, is about the peers talking, to each other that you know you don't compete on quality and. You. Know we really would encourage people, our. Board and our organization, and all the members are so transparent that if you go on to our website, which. Is bhh, a.com, you. Can actually look up and see a quarterly. Metrics. On quality. For every one of the hospitals, in the state our. Board has decided, that they want to make public. Every. One of those metrics, so, that people can see how they're doing and also. How, they are comparing. Against, other, hospitals, in the state and this, is a way that we can work together and, help identify areas, that are there are challenges and then, that makes us better, hospitals, and health systems and that, is a better outcome for the people of a Commonwealth of Virginia you, know think about I was thinking about the quality of care when. Looking, forward to getting a chance to talk with the two of you you know some national, show. Not. Another Virginia one Frank was hearing how, hospitals. Have. Been addressing, the the issues of. The. Germs or infections, that take place and, and. Well. I'm sure have been addressed. Forever. They've been addressed, but it was talking about some new, protocols. That were put in place that. Really were, focusing. On that with with the doctors with the nurses with the stuff all the staff that helped. Helped. People when they were there for whatever needs. They had particular surgical, needs right, to might be picking, up something other infection. That could be causing trouble and I thought it, was a really good positive report. About, what was happening in, health care throughout the country on. The infection, front it's. It's low tech but unbelievably. Obvious is just the need to wash our hands, and, so I'm sure that was mentioned in the report. It. Was in the process, of making sure that you. Know not.
Picking On doctors, and others, so to make sure that that, they, followed. That right, and even to the point that we're saying that other. Staff, were encouraged, even though you don't speak up to a doctor, but but we encourage if they had any questions to say did, you wash your hands well let me comment on that that's a great point because when you said that your tone of voice changed, because we want we're, naturally wired, to be deferential those, physicians have gone through extraordinary. Sacrifices, amenda, straining, and so, there's a level of respect that should be there there's no question and so, the culture, change has really been while we want the respect to remain, intact we, also want, to have an environment, a culture, that says you, know dr. Jones dr. Smith. You. Know has, a team we need to wash our hands did you miss that and, I would say what's also interesting beyond. The basic hand-washing on this topic of infections, is the use of copper in healthcare. It's. In terrorism probably, the first health system in the country, that, infused, acquired. Bed. Linens that are infused with hopper, and so if you come to a sanitary facility, heard about our sheets are brown they're, not white they're brown because. They are infused with copper, and so. For individuals that have some sort of infection, or to prevent infection. From coming to other individuals, that don't the. Copper, within, the sheets, limits. The ability for. That to occur and then we've gone beyond, that and worked with another organization that, has infused copper, in the countertops, and so. You think about you know how to germs, pass along and, so what are the surfaces. That we touch and obviously, you know the bed linens and then, the bed rails the. Countertops, and so that's, new, technology. Just in the last two years and we, did an in-depth, clinical. Trial and did the hospitals, that we're using it we're not using it and statistically. Found a difference in terms of lower infection, rates so, that's something we adopted, across the organization, and it's, this type of practice, you, know Shawn talked about the Hospital, Association when, we get together saying, hey guys what's working, we. Do not compete, when it comes to doing better, for our patients we share those practices, very intentionally. And that's, something that's I won't, say it's, relatively. New but probably in the past few years we've made that an area of focus because when we set the goal about. Four years ago to be a top-tier. State, in the country for. The delivery of healthcare and to have a healthy population in, Virginia, then, by definition we, knew we had to work we had to work together there's no one single system, that would have all the answers and. It's interesting one of the, areas. That we're working, on is we've been sponsoring a program. Essentially a team training, cross team training, program, with. The Virginia, Department of Health ourselves. The Virginia nurses association, and Medical. Society of Virginia so you got, essentially. We, bring contrary, zin of doctors, and administrators. And nurses, as. Well as people from the state, to. Work together in. A. Multi, week training. Program. To. Cut down or lower, some of these barriers, so that what they can learn, to be much more teamwork still. Having that deferential. You, know the deference that you may have, between, the, different. You. Know experiences, and backgrounds, and licensure. But. To, break also those down to make sure that they're talking to each other and can bring that sort of team. Training, back to the hospitals, where they're working and dealing with patients. So. The first. Time in the Commonwealth, to have a governor, elect who's a physician. And. First. One in a long time I think there was one way, back when but. But. There's a, new. House, of Delegates with. 19. New, members and we're having the conversation before. All the recounts, have taken place so what we can safely say 19, new members is that for, certain yes. Healthcare, issues have got to be top. On the list, of issues for the upcoming session. Exit. Polls in Virginia, showed that it was the top issue, right, topping, 40 percent of people who said my primary, issue that I'm concerned about health care and whether it was national. Or state. But it but it was hella care. So. What. What. What do you you, see on the horizon or, what, would you hope. To see on the horizon with, regards, to health.
Care Being addressed, in the, 2018. General. Assembly. Well. You. Know four years ago that, governor. Governor. Like McAuliffe, came in and said we really want to go after Medicaid, expansion, and so. The. Legislature. And the governor just were not in sync on that topic and what's. Impressed me and, while I appreciate those efforts what's impressed me with governor-elect Northam, is that he said listen let's. Work together for the benefit of everyone so he hasn't come in and pushed very hard on a specific approach. But. He has talked, about how. Can we make sure that if you live in Virginia you have access to health care how, do we do that Republicans. Democrats you, know we care about everybody that lives in the Commonwealth, so what's a pragmatic. Approach to this and so. I think that, the, intentions. Of four years ago were very noble. Probably. The approach, that we're taking today, in the administration, is taking today, it leads, me to be a little more optimistic that. We can take that topic on and not divide, ourselves in the process and so, I would say for, myself for, the Association, were pretty optimistic that. We, can have some significant, accomplishments. And. Of course governor-elect Northam, having. The background, in medicine that he does he, has real-world, experience. On the challenge, of the topic, and. He certainly talked. To us recently and, and. Talked. To us specifically, about you know what do we do to continue to elevate clinical. Outcomes, how do we do that in a way that's affordable, for everyone and then, how do we take care of folks that are probably. May. Not have the access, that they would like to have today and so sort of that three pronged approach I don't want to speak for him but but, that's what I got out of the conversation. I thought it was very constructive and, and. As Mike said it's, very exciting to have a, governor, who comes, from the. Background a comes from he. He talks our language, he. Obviously has, incredible. Background in providing healthcare. Both. In the, military and then down to Norfolk, and in the pediatric side, and particularly at the. Providing. Care and practicing, at one. Of our members, the Children's. Hospital Kings daughters which. By far most. Of the patients or Medicaid patients, so he sees and understands, directly. How some, of these government, programs help. People, who can afford health, care and I, ended up with very positive, outcomes, and so we're very hopeful, as we, look. Forward and seeing now having a governor. With. The kind of type of knowledge and background in health care that he does to. Be able to work with him on dealing, with issues like access. To care issues. On quality, how, do we deal with population health, and then also how do we pay for it I think one of the things that. As we look, out. We, have the politics, involved, with, with. The programs coming out of Washington, the Affordable Care Act I think, sometimes it gets lost that. As. Mike said this is really about financing. And how do you end up making sure the people have. The resources to go and get health care if. You look at the average Hospital in the state it's, 60%. Of, the. Payers are. Medicaid. And Medicare, 60. / 60 % and then about 7 percent on average. Are. Inch and care completely, free so it's.
The Exact opposite, of what the population is. With. What in what type of health care coverage they have about 2/3 of the people in the state have, commercial, insurance you. Had about 2/3 of the people who use our care when it makes sense you think about it Medicare, particularly. Older. People and then a lot of the Medicaid or people who have, severe. Disabilities, in Virginia the only really three main, groups that get Medicaid or the. Severely, disabled. The elderly and then single, children. The, issue is that 7% a lot of the government. Programs at Virginia has not taken, advantage of, our. Programs. That go after that 7 percent who. We. End up having to provide care to them for free and, obviously. That. Has a drag, on the. Ability, of hospitals. To continue, to reinvest, and provide. Care in the long term to the rest of the population and. It states that have drawn down that federal money we've, seen the. Injured, in Carefree care. Lower. Itself at least by half and, so. These you know you think about that that this is billions. Of dollars, that. Are available every, year to the people. Of the Commonwealth of Virginia and, we can take advantage of if we can find a way to move and walk forward to go forward well. The Senate Finance Committee here in Virginia had their retreat recently, but he seemed. Obviously. Openly, we're wrestling, with some way of, Medicaid. Redesign or. Reshaping. Or and and it. It. Seemed, like there was some some movement, there to look that whatever is happening, are not happening, on the federal level but some, way of trying to address. Providing. Health care for more, Virginians, yes and, more adequately, reimbursing. Those who are providing. Yeah. It's easy to step back and really see the perspective, of, individuals. On this topic you know as a country we, have a challenge, figuring out how will we in fun how will we fund the, entitlement, programs that we have today how will we do that it's a very fair question and so, for the folks that are reticent, to move forward on this topic they're, really looking at it at a national, perspective for, the folks that would like to move forward they're saying we, are by definition. Disadvantaging. Ourself against. All the other states that have accessed the funds that are available and while, the first question, is legitimate, and true we. Should not disadvantage. Ourself in the interim while that topic, is being solved and. Then you can make a strong case that. Putting. The investing, those dollars into. Individuals, that don't have healthy. Lifestyle, practices if we elevate. The health of those individuals. Then. We may actually save, the Commonwealth, money through that investment, and so it's a. Topic. That has a lot of dialogue a lot of perspectives, and. If you step, back and take a look at the the types of money that's, available I, mean, it can make a significant. Impact on health care throughout, the entire Commonwealth. And, this. Is a conversation. Now that's starting to happen in other parts, of the country that have not taken advantage of those dollars and it's. Something that we are very obviously. Supportive. Of having, the conversation, with the governor with, a new General Assembly, many. Of the newly, elected in, the House of Delegates have, all ran, on taking, advantage of that money obviously. The. The final, numbers on the General Assembly, are. Still being worked out as you mentioned with the recounts, but, we think this is a great time to work together to. Come up with a mechanism that's, the Virginia way we love to talk about the Virginia way solving, complex problems together and we. Think this is a might, be a year that we can end up doing that you, know in our closing minute, time flies we haven't talked at all about. Healthcare. Being or the major employers. In the Commonwealth. I'm. Sure you've got like, you. Would have you and Sean both would have numbers, all around your head about what part of the economy, and the number of people who are employed in. Hospitals. And in healthcare in general I think. Our viewers need to hear it sure well I'll speak to centerra and let Sean tackle, the topic for Virginia but for Sentara that, means 28,000. Individuals, are working in health care for, our organization. Throughout, the Commonwealth, and if you look at all. The hospitals. 125,000. Directly. Employed in the hospital's another. 300,000. Employees. In. In, healthcare, related jobs like labs, and, outpatient, clinics in whichever and so. You're looking at one out of every 11 jobs in the Commonwealth are, actually tied to healthcare and as. The population continues, to grow as it continues get older those, numbers are going, to increase and so these. Are great paying jobs these, and, in most communities the, largest employer is, the hospital, in the health system especially, their rural communities, right, and this is in, fact we've seen a couple of hospitals back just one recently, and rural area, unfortunately.
Went Bankrupt, and. That community right now is doing everything it can to get it back and this is one of the things that we love our health system with a lot of our health care workers we got to make sure that we nurture them and help them grow and, do everything we can that's why look for the general great way to end the show yes, thank. You both very much thank you thank you. This. Week in Richmond, is made possible in, part by, the. Virginia, Education Association. An. Investment. In teachers today will, pay dividends, tomorrow. Dignity. Memorial the. Dignity, network provides, professional, and compassionate funeral. Memorial, cremation. And cemetery, services, throughout, the Commonwealth, of Virginia. Virginia. Tourism corporation, promoting. Why Virginia, is for lovers lovers. Of wine and craft beers, the outdoors, beaches, history, music and more fall, in love with Virginia, at Virginia, org. Additional. Support provided by, these sponsors. I. And by. The members, of Virginia's. Public television stations. Thank, you. You.
2018-01-07 22:45
