Hello, and welcome to Healthcare Insider, a sponsored podcast series from Modern Healthcare Custom Media. I'm Fawn Lopez, publisher of Modern Healthcare and vice president at Crain Communications. It is my pleasure to be speaking with Randy Oostra, president and CEO of ProMedica, a health and wellbeing company based in Toledo, Ohio.
Under his leadership, ProMedica has been on the forefront of transforming healthcare. In particular, it's pioneering work addressing the social determinants of health and healthy aging for individuals and communities. For his innovative leadership, Randy is among those recognized on Modern Healthcare's 100 Most Influential People in Healthcare list for 2021.
Today, Randy and I will be discussing how the pandemic exposed the flaws of the US healthcare system and why now is the time for a new model of care delivery. Before we dive in, I'd like to thank Randy and ProMedica for the sponsorship of this podcast series.
ProMedica is a mission-driven, not-for-profit organization focused on improving the health and wellbeing of people in hundreds of communities across the country. ProMedica has a bold vision to reimagine healthcare and how it is delivered by integrating care throughout a person's lifetime. Randy, thank you so much for being here with us today. I'm very much looking forward to our conversation.
Thank you, Fawn, and thanks to Modern Healthcare for your work in highlighting these important issues and really leading the discussion that really needs to take place in healthcare about the future of health and wellbeing in America.
Thank you, Randy. It's an honor to speak with you today. Let's start. You're of the opinion that the status quo of healthcare delivery can't remain. Explain for us how you reached that conclusion, and when? And more importantly, how has the COVID-19 pandemic influenced your perspective on that?
Yes. Let me start out by... I always like to put a caveat. This has nothing to do with the great people who work every day in American healthcare. I think we've seen that during COVID. And again it's been incredibly humbling for us all to see our caregivers. And really it has a lot more to do about the model that we put these people into and the model that they have to work in every day.
I think our opinion has been shaped by a number of things that have happened, really for well over a decade. And it started, we've talked about this before, kind of a decade-plus experience with the social determinants of health and how that really has such a major part of people's lives. And until recently was largely ignored by the American healthcare system.
Our early work with social determinants was really as hunger as a health issue, and just finding that hunger, which many times we make an issue relative to legislation and a lot of debate. And it's actually one of the major healthcare issues in our country. And then again, it's, like a lot of systems have done, work in communities and work in neighborhoods, and really it's really looking at the impact on people.
So, we can tell the story about the great things in healthcare, but what really is the impact on people in their daily lives? So, when you look at that, we have a slide that we use, a slide with all the health systems, children's hospitals in the state of Ohio, where were based, and then really the healthcare metrics for Ohio. And it doesn't add up. It doesn't make any sense. And so really what you look at is like, "Why do we have all these great systems, and why doesn't that translate into great health of our people?"
And we know the issues relative to healthcare being people's biggest concern, one-third of people unable to access care, people dying prematurely, or knowing somebody that died prematurely, because they couldn't afford care.
So you take that work and then the things that we know, that costs continue to rise. It's been doing that for decades, well over 70 years. 1950, it was four and a half percent of the GDP. Today it's 18%, projected to go to 20, so 4 trillion to 6 trillion. And then this idea that nothing's really changed. So when you begin to look at the path and how costs have increased, we see that really nothing's ever changed.
Again, it's just thinking about there's really no unified voice for healthcare to speak to these issues. We all have separate voices, hospitals, physicians, children's hospitals, academics, safety nets, the different physician groups, firemen, et cetera, et cetera. And a lot of it is really based on people just not wanting to change the system, because they're all looking at their pieces of the pie. And then this idea, "Well that's not my job. I only paid to do certain sort of things." And so really I think what we're seeing now is more and more CEOs saying, "Hey, something's got to change. This just cannot continue." And this idea that, "Hey, the American people built the American healthcare system, the largest payer of it all and why shouldn't we be thinking about changing?" And so what's the model 20 years from now? Because we can't just let it keep continuing or we know what's going to happen.
And then the final thing is really the whole thing with COVID, and the things that we've seen during COVID. Again, the great care that we took care of people, but the inequities of care. And one of the themes that we've really kind of come on in the last year or so is that facts often don't matter, but stories do. And we have lots and lots of facts about the impact on people and inequities and we really haven't done the things we should be doing in these areas. And it's really time, and I think these stories that are coming out of the last couple years are really going to drive us to change.
Thank you for your work on social determinants of health. And thank you for your effort in driving change in healthcare. To expand upon what you just talked about, about the delivery model, what does this new healthcare delivery model that you envision look like? And you talked a little bit about the structure. Can you elaborate more on that?
You know, if we all got a group together and we said, "Let's put together a bunch of information relative to the type of things that we think should happen to the American healthcare system." I think we'd start out by talking about universal access, that we need to make sure we have access, and not only do you have access to care, but you can afford it. And we'd talk a lot about copays and deductibles. So, "Just so I have access doesn't mean I can really get care because I can't afford even that." And then having affordable care. So we've talked a lot about, people don't like this topic, but capping expenditures. And then really forcing some discussion about incentivizing different types of models. We'd all say we need more primary care, we need more mental health services. We need to take care of our children and our seniors much better. So healthy aging would be a big topic.
We've always believed that social determinants should be required. Because again, we still see people saying, "It's not our job." But again, who better to look at these things. And again, looking at something very holistically. So we think that's got to be a piece of it. We know there's tremendous waste, there's burden with a lot of administrative things. We know there's opportunities with the costs to rethink about those, and really incentivizing different behavior. We know that we need to think about the workforce of the future and change some things there. That's more recent. And then how do we think about... We just read some things recently about all the number of rural hospitals that have closed and are in the position to close.
So we look at rural and frontier hospitals, and what kind of model do we want for them in the future? Let's not let them close. Maybe they don't necessarily going to see all that many inpatients, but maybe they do a lot of work with social determinants in public health. And then again, just thinking about that whole public health piece, and is there a role for these healthcare institutions to do more? We would say yes, a lot of people might say no.
And then again, the last theme is climate control and the impact that climate control, when you really look at the link between climate control in health inequities and the growing public health concern, we can't ignore that anymore.
So when we begin to think about a model, those come front and center, I think, and we have to think about how we're going to address those. And then begin to think about some of the things that we're doing today have to change. These are priorities, but priorities in our country for a long time. We just haven't done anything with it. So I think you start with that as kind of a framework for a model. And then you think about, "How can we get there? What things do we need to do in the next 50 to 20 years to kind of move toward a different model?"
There's a lot packed in that response. I could spend hours on each of those topics that you have mentioned. But let's talk about the new delivery model that you are envisioning. Who will need to be involved and what kind of changes will be needed, Randy?
Yeah. We had an opportunity to talk Senator Sherrod Brown, oh, probably five, six years ago. And we were showing this slide that shows Ohio's health and all the great care we have in the system. It's like, "What's wrong with this picture?" And we talked about the need for a new model. And so what we began to talk about is the need for a national commission, and a national commission that would have broad representation of everyone that would need to be there, but only there if they're focused on really wanting to change. And the idea that they would come to the table with the idea that we're going to create a new model. And the reason the model would have to be probably a decade or longer out is like, "Okay, we need to give time for people to change." We may have young women, young men entering careers that all of a sudden their economics might be changing. So they may want to rethink that.
So the idea would be this time-limited national commission. It would be a broad group of people looking at these sort of issues. And then begin to start to think about, "What kind of model could we put in place. How are we going to change the model? How are we going to incentivize the things we know we're missing?" We already talked about those. And then, "How would we create an ongoing path to be able to do that?"
So, we think that's something that is definitely doable. I think when we originally talked about it, Senator Brown was very, very supportive. We had spent a fair amount of time with Senator Cassidy as well. And a lot of interest. When we explain it to people, they go, "Yeah, that makes a lot of sense. We should do that." And then the other piece and part to it is, this is to the cynic, it's worth a shot, you know? If you sit there today and say, "What else is going to change?" This has an opportunity to get some dialogue about it changing the model. So we think that could be critically important.
Thank you for starting the dialogue and for your commitment to change. So what are some of the challenges that you've found or experienced when presenting your ideas about this new model or any new model?
Yeah. This has been really interesting. So we have talked for years, and again, most of this was pre-COVID, and we, of course, all had other things during COVID. What was interesting about it is when we would go talk to people, we would get kind of what I already talked about. It was kind of like, "Hey, we understand, we agree. This makes a lot of sense. This national commission makes a lot of sense." People would kind of strategize on who might be the right people to lead that discussion. But then right away it was like, "Well, we got some other things going on. Well, we're focused on transparency." Great. Transparency and bills that people can't afford. That that makes a lot of sense. And by the way, "Oh, we're impeaching somebody," or "We have this going on," or "We're focused on this."
And what was kind of interesting about it was, people logically would say, "That makes sense," but yet it didn't seem to be a priority. What you kind of hope happens out of this is, you think COVID underscores the need more than ever to change the whole model here. And again, I think when you look at... Especially now with inequities and all the other things that add to this, more than ever, and again, think about the challenges we have today, this seems very unsustainable. You talk to healthcare people all the time, Fawn. It feels that way. And so if there was ever a time to do it, it's now.
But really what we got is, "Interesting, it's just not the right time." And the question we ask, "Well, when is the right time?" So that's really what we've heard. On the healthcare front, we have increasing voices of people go like, "Yes, I agree. How do I become part of this?" And then we have others who say, "I don't get it," and "That's not my job," "I'm just running my X, Y, Z." We've got a little bit of everything. So that's really kind of been the response so far that we've gotten.
How do we move the needle on change? How do we overcome the pushback?
Yeah, I think it starts with communication. I was at a meeting with several people last week where we talked about how we're going to push forward. We have a number of individuals, leadership folks that you would know that say, "You know, I could see myself being part of this discussion." We continue to see that build. And I think a lot of it, I think, starts with a couple different things. I think it's building voices, this idea that stories matter. Again, I go back to stories matter facts don't. Because we have a lot of facts that show we're not really doing the right things, and yet we seem to ignore those and keep telling the great story, which we have a lot of great stories. And I think it's about getting involved. I think it's about getting information. We have a lot of resources at ProMedica and we can give you a link to get some information.
I think it's a matter of speaking up. And I think it's just a matter of a lot of national dialogue. So what we would encourage people, and I think the idea here is, to begin to think about the idea, think about the things that we talked about today and other things that we could add as well. And really it's just taking that first step. And we have some, I think, some opportunities coming up for people to participate in more dialogue. And if people are interested, if people want to be part of that, we'd encourage them to raise their hand and then we'll link them into a broader discussion.
Thank you. Your response reminded me of an old proverb. "If you want to go fast, go alone. If you want to go far, go together." That's essentially what you're saying. So you essentially written the playbook in this space, and you're recognized as a leader who isn't willing to allow the status quo to continue, which is very grateful for. And you mentioned a little bit about how other people can be involved. What suggestions do you have for other healthcare leaders? How do they begin to engage in this kind of work and this kind of movement?
Yeah, I think a lot of it is... We click through a whole variety of issues. And when you kind of just, again, think about it from your own perspective, there's one perspective and you've heard it along the way, "That's not my job. You're trying to boil the ocean. My job is to run X, Y, Z. What happens outside of our walls. It's not my responsibility, it's the government's responsibility." And I think the thought here is, I think we need to think more broadly about how all these issues evolved in our country, a little bit about who we are. We talk a lot about Good to Great and the Social Sectors, Jim Collins' book, the sequel. And he says, "What's important in life is the impact you can make relative to your resources."
And I think the point for everyone running these large organizations, or any organization, they are many times mission-based nonprofits, not always, but they're the pillars of their community. The people they work with, the people they represent. And I think it's a question for each one of us to think about, "What's my leadership role? I have resources that I'm fortunate to have been a part of in my organization. What can I now do to lend a voice to a movement that's going to change things for people?" And that's where this whole thing starts. It's the impact on people.
We do a lot of great things in healthcare. We do some miraculous things clinically. But it doesn't necessarily translate to people living in neighborhoods and how they deal with health and wellbeing. So I think our encouragement here is for people to have an open mind, to participate in these dialogues, to do the type of things we all know need to be changed in our healthcare and what we do, and then to participate and think collectively together how we can change, and then how we can do it responsibly, and how we can do it over a period of time.
And so that would be our thought, I think, for people to think about. And the good news is, again, I think we hear it from more and more individuals that you know and everyone on this podcast listening would know, of course saying like, "Yeah, we agree. So let's work together."
That's encouraging. Randy, thank you so much for this discussion and thank you for your leadership and commitment driving change. It has been both inspiring and thought provoking. So thank you very much.
Yeah. Thank you, Fawn. Again, always thank you for your support and the great leadership of Modern Healthcare.
Thank you so much. To our audience, thank you for tuning in today. This conversation with Randy Oostra is the first in a series of three episodes. In future episodes, Randy and I will be diving in more deeply into how to transform the healthcare delivery model, touching on topics including social determinants of health, the climate crisis, and racial inequities. Please stay tuned to the Healthcare Insider podcast page in the upcoming months.