Fawn Lopez:
Hello and welcome to Healthcare Insider, a sponsored content podcast series from Modern Healthcare Custom Media. I'm Fawn Lopez, publisher of Modern Healthcare and vice-president of Crain Communications. I'm thrilled to again be joined by Randy Oostra, CEO of ProMedica, a health and well-being company based in Toledo, Ohio. A few months ago, Randy shared why he believes now is the time for a new model of care delivery. In this episode, we'll be continuing the conversation and talking in detail about what the industry can do specifically to transform our current delivery system, discussing how to increase access to healthcare, particularly primary care in rural areas and behavioral health services, as well as the important role of addressing social determinants of health.
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 well-being 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 and including addressing the social determinants or basic needs that all individuals have to live a full, purposeful, and healthy life. Randy, thank you so much for being here today. I'm looking forward to our conversation.
Randy Oostra:
Thanks, Fawn. Great to be with you again, and as always, appreciate the leadership of Modern Healthcare and all the great work that you do every day.
Fawn Lopez:
Randy, when we discussed this topic back in May, you highlighted the first and most important pillar of this new delivery model you envision is universal access to care. That's a bold goal. How can we feasibly achieve that? What really need to happen to accomplish that goal?
Randy Oostra:
Yeah, I think in our last discussion, we talked about the state of where healthcare is, and I think increasingly you talk to people who have concerns. I think when you think about voices from healthcare today, a lot of concern about where we're at relative to an industry and where we need to go and just the path to get there, so I think these conversations are critical, and I think a lot of these principles are what we agree on. There's a favorite term these days, "anosognosia," and the term really means it's a lack of ability to perceive your condition in life. It's actually, when you get a diagnosis, you don't believe it, or you don't recognize it. I think that's a bit true in healthcare today. I think we're in a condition, we're in a situation where everybody goes about their daily jobs, and we really don't recognize a lot of the issues that are important to us.
I think it starts with universal access. Again, we've made progress in our country, but really, when you look at the number of people, I read something that over 40% of people that are in the ages of 19 to 64 years old are not adequately insured, and then we still realize that we have almost 30 million people in our country that are uninsured, and then you begin to look at the underinsured and you really see that there's a massive problem, and the fact that you can't access healthcare in America should concern us all.
Then we know all these statistics, when one in four Americans say that healthcare is their biggest concern in life that as an industry should make us pause. When we say that one in three Americans couldn't receive care, couldn't access care because of costs, you think about that. So, I think what happens is we talk about all the great things in healthcare, and again, think we start with the great people in healthcare, and it's not a reflection on them, but you start looking at all that. Then there was a poll not so long ago where 13% of Americans said they personally knew somebody who died prematurely because they couldn't access care. You can't sit and talk about these issues without looking at the facts.
Then I think what we've seen over the last decade and longer, the outcomes in the United States, lower life expectancies and this idea that we've underinvested in things like access in public health, we've made progress in social determinants, a lot more work to do, and then the inequities in care, which add to this all, so clearly, we really need to look at some broad measures to improve access to care, and I think a lot of those are the things that we've already talked about, and there's some very specific things we could talk about today.
Fawn Lopez:
Great, let's go into those specifics. Primary care is essential, but many, particularly those living in rural communities, don't have convenient access, or many choices. What can the industry do to lower the barriers to assessing primary care, and specifically, what can we be doing from a policy perspective to address this issue?
Randy Oostra:
Yeah, this is not a new issue. It's one that we've known for a long time. Again, it's just a matter of, if you feel important about something, you address it. On some of these healthcare issues, we talk about them, we acknowledge them. 30% of physicians in the United States are in primary care. When you compare us to other countries that we compare ourselves to, 70% of physicians in their countries are in primary care, so clearly, we've got an imbalance there, and we know why that's happened over the last 50 years.
You look at primary care. We need in excess of another 50,000 primary care providers by 2025 and yet the incentives aren't aligned. The incentives, if you talk to young women, young men, when they're going down a path looking at medical school and where to practice, all the incentives are really around training specialists, and so much of what their work is about training specialists, they're in hospitals. Much of their training is involved with specialists every single day. Again, just all the incentives are not only to train to be a specialist, but to be a specialist when you think about finances. Clearly, when you think about it, urban areas have issues, rural areas have specific issues, and there are things that we could do today. We could increase the number of primary care swats we could increase primary care pay significantly. Yes, that would probably have to be involving reducing specialists, but again, I think what we do is we put money into the activities we want to reinforce.
We have done some things in telehealth. We can do a lot more in telehealth. When you think about the opportunities in rural areas, the way to incent people to go to rural areas, the way to provide it easy, and yet we run into all these barriers of state lines, and so telehealth would be a great example. We've already seen that. Then we just have a lot of boundaries that we put up, whether it's licensing, whether it's reimbursement, and if we really got serious about it, we try to remove those boundaries and making primary care are much more highly valued access point.
Then things to incent people to go into primary care, whether it's environments, whether it's limiting student debt, whether we try to encourage more the primary care factors and the prestige or primary care and make it more of a pivotal part than it is today. I know in our own system, we've talked about centers of excellence, and the primary care doctors always say, "Well, what about us? You like to talk about cardiology and orthopedics and cancer. We are a center of excellence and yet we don't always get the prestige that we're due."
So, I think that there's a lot of issues. I don't think any of them are particularly new, but I think we really need to think about priorities, and the priority has to be improving access. We can do it and we can do it if we start to look at some different measures. I think the frustration is we just haven't done that.
Fawn Lopez:
Agreed. I just wanted to share something. One of my nieces is in medical school and her choice is to become a primary care physician, so I'm so proud of her, and so excited that our healthcare industry is going to get an additional person who is very passionate about caring for patients.
Randy Oostra:
If she wants to come to the Midwest, we know a system that would employ her, so we'll exchange emails. That'd be great. We'd love to have her.
Fawn Lopez:
I will be reaching out to you. Thank you. Another major challenge right now is access to mental health services. It is estimated that 37% of the population live in an area where there's a shortage of mental healthcare professionals. What can we be doing to change the status quo?
Randy Oostra:
Yeah, a lot of the same discussion that we've had with primary care, I saw a statistic the other day, and some work that we've been doing. We do a lot of work with light purpose and we work a lot with different polling companies and looking at issues and saw some statistics at 18 to 24-year-olds, 70% were moderate to severe depression, so you began to think about that as a parent with children in college, leaving high school, also the effects of COVID, and what that did to people. Then also just as we think about people entering the workforce and just the type of efforts that we see there, and so we're short. We're short, I think the last numbers I saw between six and 7,000 mental health providers today, and we see huge needs in rural areas, horror stories about mental health patients being boarded in ERs because there's just no place to go.
Again, you got to go back to, what's our priorities? What are we talking about? What are we investing in? I get frustrated when we talk about surprise billing in those sort of issues and price transparency, not that they're not important, but the idea is like we've had some really significant, important access issues. You may be worried about telling people what their bill is. Let's worry about getting them care first, then we'll talk about those other issues as well, so I think it's the same sort of issues, increasing slots for mental health providers, increasing pay significantly, investing and rewarding telehealth opportunities, especially as we think about getting it into rural communities, student debt.
I think there's a lot of stigma. There's been historically a lot of stigma about mental health and even going into mental health within the industry, and so you get up about your niece, a young woman going into specialty, or what she's going to pick and choose, and when other physicians say, "Oh, you don't want to do that. You don't want to go to mental health. You don't want to go into primary care," I think that's partly on the industry. I think we started to see lower rates of treatment being sought, and so I think we need to think again about how we get out to people and provide treatment options both from the early end to the later end.
I think we also have a lot of issues relative to practice and how we practice. I think we're going to look back a decade from now and look in horror about electronic medical records and what we put people through. You hear young physicians over and over again, older physicians going home at night and spending hours catching up on their electronic medical record, which was supposed to help them.
Also, I think just new models of care. I think when we think about telepsychiatry, some of the more integrated models that we see talked about, I think those are all the things that we need to look at more strongly. Then I think we just think about that integration, about courting with PCPs. The next funding of clinics, I think there's a round of funding we could think about, and then also just community mental health grants, looking at those as well, so I think those are all the things.
Then I think rural health is a special area that we need to look at, and I think again, we need to rethink rural health in America, and rather than let rural health hospitals close thinking about those as primary care access points, mental health care access points, places for centers of social determinants, and being a socially-based model where we provide comprehensive, integrated care, and then also public health. Why wouldn't we begin to repurpose these hospitals that are vital to communities, but repurpose them in a little different way to do the type of things know we need relative to an access point and where we have gaps, and why wouldn't we make that financially viable for those communities? I think if we start looking at those things, we can start to bend the curve both on PCPs, primary care, as well as mental health providers.
Fawn Lopez:
You touched on telemedicine and addressing primary care needs as well as mental health services. If you can talk to the important role that technology plays in the future in addressing these issues?
Randy Oostra:
Well, I think we saw it in COVID. People stood up responses to COVID literally in hours and days and we innovated crisply cleanly use technology in new ways, and then very quickly we'll go back to our old ways, so I think a big push in technology, a lot of the technology pieces, one of the frustrations that I think providers have is we get pitched on technology all the time, but they're always a one-off here, a one-off there, all these different companies.
I think we really need to rethink how we provide care, the levels of care, how we use technology, how we can incentivize people to use technology, how we can incentivize physicians to use technology, and really, almost think about a call to use technology in new different ways because a lot of the answer when you think about some of these shortages that we have you think about kind of the digital movement, we think about consumer demands, the answer there is technology. The individuals who are innovating are those that are typically backed by private equity. They get a lot of money. They may innovate in a part of a care path. But really, I think what we need is to let the industry really think about a broad mandate to adopt technology, to integrate technology, and you need to do that not only with support for technology, and we did that when we funded people's electronic health records.
We should do the same thing again and really direct those dollars and resources toward it and access program. Think about what we did to inset electronic health record, let's do the same thing with access and let's think about technology aspects and really, really think about that differently. It's so main to people's lives. If I could access, yeah, we talked about these statistics, when we started fun about the lack of access, let's incentivize the behavior that we want, the use of technology, and the expansion of primary care and mental health. Again, I think if we put a program together like we did with EHR, we could make some huge improvements, and I think it's going to take some thinking around that for us to be able to do it.
Fawn Lopez:
Thank you for that. Finally, you touch upon social determinants of health in your last couple of remarks. Let's discuss that area of healthcare. It is an area that ProMedica has been a leader in for many years and most healthcare leaders have acknowledged that they should do more to addressing the social determinants of health. What potential do you see or do we still need to realize in this area and how do you see the work on social determinants of health evolving?
Randy Oostra:
Yeah, I think the good news is we made progress. 10 years ago. If you talked the social determinants, say, idea, you got this glazed-over look and people are like, "What the heck are you talking about?" So, there's a lot more acceptance today, and people have done a variety of things. Some organizations have really done some great things. I do get a little concerned sometimes that for some organizations, it's a little bit of lip service. I was at a group meeting recently, a bunch of CEOs had a chance to present some socially-determinant work and a CEO of a very large system said, "Yeah, I'll buy it." Didn't say it that way, but basically, "I'll buy it. It's not our core competency. We shouldn't be doing it," and yet there organizations out promoting their social determinate work. That's the concern that you have and the individual saying, "Hey, this isn't our core competency. We take care of people."
I think it's this question about when the day is over, what kind of healthcare system do you want to access as an individual, one that only looks at you clinically, or one that takes into account your lives, where you live, those environments that affect your life day to day? I think we know the impact it has each and every day. We've always believed that social determinate sort of increasingly be encouraged and then required and then paid for because it's so fundamental to care in something that we should be looking at.
I also think that healthcare should be really focused on applying social determinants, not only to patients, but to their employees. We're a huge employer in this country. We can make quite a statement. We can be the poster child for how to take care of employees. We started screening for social determinants of health a couple years ago, along with white purpose. Again, it's the same sort of response that you'd see in patients depending on income levels, where people live. Sometimes surprisingly people with even good incomes have significant social issues. We had one case where we had some individuals identified for social needs and turned out it was a couple that had to adopt their grandchildren and were in some financial difficulty, so you don't always know. I think we've done a lot of work with a company in screening for white purpose and these social determinants, so I really think we need to think about that and taking a leadership role.
The other thing I think that healthcare needs to think about and come to conclusion on is what kind of business are we in? What kind of work do we do? Really, I think more and more, we should think of ourselves as driving social impact in this country. Who better than to drive social impact on healthcare? Most times, mission-based nonprofits, tremendous resources, tremendous people who've dedicated their lives to take care of people, mainstays in their communities, mainstay institutions. Why wouldn't we ask them to do something different and why wouldn't we ask them to change their model, especially since America built the American healthcare system, if you think about how we've reimbursed it? So, I think we really need to change to this social impact focus so it's not only clinical, it's the social determinants of health. It's a much better focus on health inequities. I think it has a lot more to do looking at a new holistic model and really thinking about how we deliver care.
Again, it's using the strength of the American healthcare system to really do things in a very different way, be a backbone, if you will, to social change. This would be a major social innovation project. Rather than start from scratch, let's use an institution, one of the most respected institutions, our community that is well-resourced, well-run, yes, they have challenges. Why wouldn't we ask them to take a larger role in addressing a lot of our social issues, social problems in our country, and begin to think about a plan to do that? A lot of people would disagree with that, "We don't get paid for that. That's not our job." I think it's time for us to rethink what healthcare's job is from a health and well-being standpoint, and I really think is a country, we really need to think about asking healthcare to take the primary lead in the interventions and screening of the social determinants and do that over the next few years. I think we'd see a radical change in this country.
Fawn Lopez:
Couldn't agree more. I have to say, thank you so much for the work that you and ProMedica do to addressing social determinants of health in your community. Thank you for this conversation, Randy.
Randy Oostra:
Great. Thanks, Fawn.
Fawn Lopez:
And to our audience, thank you for tuning in today. This conversation with Randy Oostra is the second in a series of three. In our next episode, Randy will continue to share how to transform the healthcare delivery model, addressing the climate crisis, ESG and other crucial topics. I'm your host, Fawn Lopez. Look for more episodes of Healthcare Insider at modernhealthcare.com/podcast, or subscribe at Apple Podcasts or your preferred podcatcher. Thanks for listening.
