KATELYNN COLE: Well, good evening, everyone. Thank you so much for being here tonight for our second Biannual Percy Allen Sloan Lecture in Urban Healthcare Leadership. My name's Katie Cole, for those who don't know me. I am a second year Sloan student and a member of the committee that helped put this together. And just to start off, I wanted to give some background information about this lecture series, which is named in honor of Percy Allen, a 1975 graduate of the Sloan program in health administration and was established by his Sloan classmates to honor his contributions to urban hospitals and health organizations and to provide students the opportunity to consider issues of access, excellence, community, and equality of care in urban settings.
A former National President of the National Association of Health Care Services Executives, Mr. Allen was inducted into the NAHCSE Hall of Fame in 2006 and also received the American College of Health Care Executives President Award. And in 2011, he was inducted into the Modern Health Care Hall of Fame. The Percy Allen Sloan Lecture in Urban Healthcare Leadership features an accomplished and high profile leader from the health care sector, working to address the health care needs of the under served and urban communities. We have a fabulous speaker here with us tonight.
But before I'll hand it over to Chris to introduce her, I want to recognize some individuals in our audience. If you wouldn't mind just standing up and giving a little wave. We have Percy Allen and his wife, Faye.
Clifford Barnes, the class of '74 and Andre Lee, class of '72.
We want to thank you so much for being here and making all of this happen. We really appreciate your generous gift so that we can bring such distinguished speakers to our campus.
I also want to take a moment to recognize Cynthia Taueg the Vice President of Community Based Health Services at St. John Providence.
And also just want to give a shout out to some of the prospective students that we have in the audience as part of the Sloan Visit Day. And I'm just going to hand it over to Percy real quick to give a couple of words.
PERCY ALLEN: Good evening. I just want to take this opportunity to thank Dr. Patricia Maryland for taking the time from her busy schedule to make the time to come here. It is an honor, a pleasure, and a blessing. Thank you, Pat.
CHRISTOPHER THAN: Hi, good evening, everyone. My name is Chris Than, Sloan class of 2017, and I have the distinct honor tonight of introducing Dr. Patricia Maryland.
Dr. Patricia Maryland is the President of Health Care Operations and Chief Operating Officer of Ascension Health. She previously served as a President and Chief Executive Officer of St. John Providence Health System in Warren, Michigan and as the Michigan Ministry Market Leader for Ascension Health, where she provided strategic and operational leadership, while promoting alignment among health ministries within the Michigan market.
Doctor Maryland has extensive experience in strategic planning, patient care operations, service line management, finance, clinical program development, and evaluation. She received a bachelor's degree in applied mathematics from Alabama State University Montgomery and a master's degree in biostatistics from the University of California Berkeley. She holds a doctorate of public health from the University of Pittsburgh, concentrating in health services administration and planning. With a few more words about Dr. Maryland, please welcome Cliff Barnes up to the stage.
CLIFF BARNES: OK, we're going to-- in sports sometimes they call it color commentary. So I'm going to provide a little for you. But first, let me just say this is a fitting time for this lecture series as an inauguration, so to speak, of this building as well as this hall. And as I understand it, this is the first lecture that the Sloan program has done in this building and so it's a fitting place for Dr. Maryland to be here.
Just to provide a little background and again, a little color, Ascension Health is not one of the shrinking violets in the health care system. Ascension Health is the largest not for profit system and the largest Catholic system in the United States. It employs 150,000 people, has 2,500 sites, 141 hospitals in 24 states. Their mission and focus is dedicated to the transformation through innovation across the care continuum, and Dr. Maryland is responsible to taking those words and making them action. It's not a small thing to do.
Dr. Maryland-- you know, how did this come about? She is the oldest sibling of a large family, and in that position, she many times had to take care of her younger brothers and sisters, while her mother, in many instances, had to go to the hospital because she had type 2 diabetes and Dr. Maryland actually got her introduction to the fragmentation and lack of coordination and health care in her personal experience with her mother. And I think that was one of the driving forces, the passion that created the history that she has gone through in the health care system.
We know a little bit about all the positions that she's had. For all of the first-year students, she started as a biostatistician. That's how she started in health care, all right? And so it's not necessarily where you start, it's where you progress to, and she's a wonderful example of progression.
She has many awards, as you would well imagine. She is a leader of innovation and she is a manager of change. When your philosophy is around transformation, that means a lot of people have to change. In other words, people have to then become enrolled in the process of change, and she's the chief enroller. So I'd like to welcome Dr. Maryland to the stage for a little survey about some of those things that she does.
DR. PATRICIA A MARYLAND: Since Cliff Barnes stole my word and my thunder here by sharing quite a bit about Ascension Health, I'll sort of reduce my presentation just a little bit, OK? But it's a pleasure. First of all, let me tell you how much it's truly a pleasure, an honor, to have been invited here to speak in a very important lecture series.
You know, when I think about where we are today, so on the precipice of wondering what's going to happen with the new president that'll be coming in effective January. What will happen to health care? And I think about all of the work that we have to be about when it comes to looking at ways to improve health for everyone. I'm so proud to say that I'm part of an organization like Ascension.
And I want to start with just giving you a little bit of an overview, a little bit more of an overview on Ascension, who we are, our organization, and then specifically to talk about the type of investments that we've made within our national ministry. And we call ourselves a ministry, and you'll hear that term used a lot because it's fundamental to who we are and the mission that we serve each and every day
I want to talk about what kind of investments we've made in order to be able to improve the overall health of the communities where we reside. And so let me start with we're, as you can see, 24 states and the District of Columbia, so very large footprint across the country. We are definitely the largest not for profit health care system, and I say that more from the perspective that we generate about a billion dollars of operating margin each year, but that money, quite a bit of that money is reinvested back into taking care-- yes, operating margin, OK? But that money is reinvested back into taking care of the populations that we serve in the communities where we reside.
We have 18 markets and I want to talk a little bit about how we've structured ourselves. We have structured ourselves into markets and with the ability to be able to-- we've put a stake in the ground to say that in each of our markets, we need to make sure that we have not only our hospitals, which is a big part of the care continuum, but we also are providing other services that will be able to really drive and improve the overall health of those communities that we serve.
So we've said we're going to create in each market, a regionally, clinically integrated system of care, and within that system of care, we not only have our hospitals but we also have components of the care continuum like our skilled nursing facilities, our home care, our rehab facilities, all coming together to really be well organized, to allow us to be able to coordinate the care in a much more effective way.
Cliff talked a little bit about my history as a child. My mother suffered and died from complications of type 2 diabetes. And when I think about her life, her short life-- she died at the age of 64-- I think about what could have been done differently throughout her lifespan to be able to keep her healthy and allow her to live to an older age. She did not have the best of care. It was very fragmented. It was very disjointed.
We didn't really understand how to use the health care system. And for those of you that are thinking about going into this area of community health, let me tell you, there's something so important to help. Number one, how, as an individual, do you take responsibility for your own health? How do you teach people and educate people about taking care of themselves? And then how to use the system more effectively.
And then as a provider, on the provider end, how do we organize providers in such a way that they're working together on behalf of that patient and they're coordinating their efforts? So if a patient coming in with type 2 diabetes, who also ends up with diabetic neuropathy, diabetic retinopathy, then making sure that those specialists that can help that person are convening together on behalf of the patient. That's what it's all about, and that's what community health, I think, long term is all about.
And that's where, when we think about the idea of a regionally clinically integrated system of care, it's looking at all the components of that health care system coming together working on behalf of the needs of each person that they see and providing that person-centered, personalized care to that individual each and every time they use your system.
By numbers, large, huge organization-- this past year, we provided about $150 million in care for persons living in poverty, and I'm going to focus on that. These are dollars that we take out from our own operations to invest in our communities, to take care of those that are living in poverty. We also provide about $1.8 billion a year in community benefit. These are big, staggering numbers, but we have the wherewithal to do that and make this investment back into the community.
What I want to share is that I'm proud as I said, of being part of an organization founded by religious sponsors, along with the Alexian brothers, and there are seven sponsors that support this organization. In 1999, they made a decision then when they came up with this mission. They really focused on being able to provide Catholic health care that's dedicated to spiritually-centered holistic care, which sustains-- look, listen to these words-- and improves the health of individuals and communities.
Even then, they were thinking about something broader than the individual, but it's taking care of the community, looking at community health as a big part, a centerpiece, of who we are, in terms of the mission that drives everything that we do as an organization.
We have a clear mandate. Our calling is that we want to be able to provide health care that works, health care that's safe, and health care that leaves no one behind and to be able to provide this throughout the lifespan of the individuals that we take care of. And it's fundamentally built on making sure that we have inspired people. So our providers, our associates that take care of these patients, need to be inspired, creating that culture that really fosters the fact that we want individuals who are working for us who have the same calling, who have the same commitment to being able to take care of individuals in a very different way.
We also know we can't do this work alone, and it's built on having those trust partnerships, being able to work with others to be able to do this work. And empowering knowledge-- innovation is a big part of who we are and what we do. And then making sure that we have the scale, the complexity, the ability to be able to-- with our vital presence, to be able to do this work.
I think this is an interesting slide here, because when you think about the Relationship between Triple Aim, from the Institute for Health Improvement and also the National Quality Strategy that this really tells us that these are sort of the drivers for the health care policy. The National Quality Strategies' three aims closely resemble IHI's Triple Aim, and it builds on the work that IHI has done by giving additional consideration to the health of their communities.
The National Quality Strategy speaks of healthy people and healthy communities, while the Triple Aim speaks to population health. None are new concepts, but they represent a renewed focus on the social determinants of health in improving health status. So Ascension Health has been involved in this quality work for some time, and I just will tell you that we made a decision that in around 1999, early 2000, that we were going to really focus on creating healing without harm. And that is that we're going to really lead with quality, first and foremost, in all the work that we do. And that one of the lines in the sand that we drew was, let's work on trying to prevent, through our own errors, that usually happen within health care systems, let's try to prevent mortality based on what we know are those conditions and exposures to, whether it's sepsis or ventilator-associated pneumonia or other kind of condition falls that may create other complications.
Let's do what we can to create as safe an environment as possible and really create a culture that we're going to heal without harm, and we're going to do our best by using evidence-based protocols. We're going to engage our whole workforce to be able to take with a huge amount of seriousness, to take within their daily work, within their own just sort of drive to do the best they can to be able to reduce the potential errors that happen on a day-to-day basis and really reduce morbidity, reduce mortality wherever possible. Creating that culture is really important and it's something that drives all of us I think within our national ministry.
We understand that this work can be very difficult, but what we're most proud about is that in 2010, we were able to actually come up with less than-- we were able to reduce deaths by more than 5,000. 5,000 that would have been considered based on the kind of errors that happen within hospitals, would have happened, but we said, no, we're going to make this not happen and really prevent that.
And I say that because it's that culture that really says we're going to ask each associate that if there's something we're doing that's creating a problem, we want you to let us know. We want you to report it. We want you to call it out. We need you to be bold to be able to do that. That's the kind of culture that we've created within Ascension that I think I'm most proud of.
Now, this slide is, how do we invest in your community in such a way to be able to affect the overall health of a community? So I want to restate that part of our call is for health care that leaves no one behind, and in our mission, to give special attention to the poor and the vulnerable. Achievement of our goals in this area requires investment in our communities, and so in fiscal '16, our investment was, as I stated earlier, $1.8 billion. This evidence-based model outlined by the CDC is a nice infographic that summarizes the major guiding principles of our community work.
We start with understanding the social determinants of health and what they are. We understand the scope of these factors that affect our overall health status. And we target specific populations and/or communities. This varies from each of our states where we reside. We know that the needs within the different communities that we are in, whether it's Texas or Michigan or Wisconsin or Kansas, that those needs are very different in the communities where we exist.
And so we start with what is the overall needs of that community, and we understand those needs to be able to figure out how best can we support those communities. Our strategies, our goals, our outcomes relate to one or more of the buckets at the bottom of this infographic.
Ascension's approach to community health improvement is highlighted in the following video, just produced by our community health department. And I really think that you'll see in my presentation, a number of videos describing the work that we're doing within our national ministry.
- What happens when people leave our hospitals or clinics? They go home to their communities, where they live, where they learn, where they work, where they play, and where they pray, and chances are, we will not see them again until they come back through our doors for more care.
In this rapidly changing health care environment, keeping people and populations healthy, whether they are seeking medical care or not, will become increasingly imperative to achieving Ascension's quadruple aim, which commits us to delivering exceptional health outcomes, an exceptional experience for the people we serve, and an exceptional experience for providers at an affordable cost.
As we move toward being rewarded for value rather than volume, addressing the non-clinical barriers that can stand in the way of good health becomes the focus. Ascension continues to lead the change toward improved population health. Knowing that caring for the most poor and vulnerable communities we serve is at the heart of our mission. We know access to high quality, low cost clinical care is critical to the health of our communities. We also realize we can't look at individual health problems without looking at the larger context that created them.
Health care doesn't only happen in the doctor's office. It happens in communities, where social, economic, and environmental factors, as well as human behaviors, can shape a community's health landscape. We are committed to understanding the unique needs of the communities we serve and identifying the barriers and impediments to good health and facing them head on.
We know that a person's zip code may be more telling of health outcomes than their genetic code. Numerous studies correlate poor health outcomes with low income neighborhoods, where financial and emotional pressures due to low-wage work or housing, food insecurity, and neighborhood violence take a toll. All of these factors also contribute to high levels of stress, which often compound an already difficult situation.
Education and literacy, transportation, access to healthy food options, cultural norms, social traditions, and family characteristics are all social and environmental factors that shape health outcomes. To help reverse the potentially detrimental effects of these factors, we continue to engage with local community resources and continue to build partnerships to improve overall health in our communities.
Outside the walls of a hospital and clinic or doctor's office, we must collaborate with local leaders and policymakers to influence healthier standards and behaviors. As the idea of health care shifts from an emphasis on treating people when they are sick to implementing prevention and wellness programs that support people throughout their lives, our mission calls us to lead this transformation.
We know we can't accomplish this alone. It's only by engaging with our communities that we have the opportunity to vastly improve health, to impact outcomes, improve the quality of life for all, and truly live our mission.
PATRICIA MARYLAND: So I want to be able to talk a little bit about some of the specific initiatives that we have across the country, that we have in place across the country. This really shows four major areas, actually five, we pointed out here, of our community health ministries, where in each of these communities we've looked at-- and I'll use examples. In El Paso, for example, what are the needs of this community? Border violence is something that's plagued this region for a number of years. And so the work that we have going on and around community health really centers around how do we help with reducing the violence in this region? You may think that this is out of our core business, but we know that it's important because it does impact the overall health of this community.
And in the city of San Antonio, we know there's been increased awareness and programs around and need for early childhood development, and we then, have provided some services and programs and provide those services to these young children in this community.
In another community in New Orleans and Kansas City, gang-related youth violence is a major problem. Also getting access to healthy foods vegetables and fruits is something that's a huge need. And so we provide services to be able to address some of those within those communities around where our clinics are located.
We have five health clinics that are really key to us in these key markets. In addition to that, we have 90 community health centers, and some of them are federally qualified health centers, across the country, in which we provide services in other markets across the country.
But these are really special to us because our sponsors, so these communities, spike communities are really important to us, and we have been very intentional in partnership with the Daughters of Charity to put dollars into these communities to be able to drive and improve the overall health of these communities.
We're also investing in our children and youth, and as example of that, I want to talk about a program at St. John Providence-- Cynthia Taueg was introduced earlier-- where we have actually gone out and partnered with 18 school-based programs that we've set up in 18 different schools. We've placed in these schools a nurse practitioner, RNs, medical assistants, and mental health therapist. We actually provide and pay for certain services to be provided on a routine basis, not only medical services but dental services and I said, mental health services.
In addition to that, we've got camps, asthma camps, diabetes educational programs, give them access to healthy foods, and most importantly, I think and one of the programs that I love the most is the Open Arms grief counseling. A number of our children have lost-- have been unfortunately, families where there's been homicides. And really the need for grief counseling is something that's really important in the Detroit community area.
We have seen impact. We track on a routine basis and have looked at the reduction of absenteeism and ED visits for certain conditions. What's interesting about school-based programs-- this is sort of a safe environment. Kids come to school and they feel like they can trust, and they're willing to utilize our mental health services and/or get in for a regular physical or a follow-up on a health problem that they might have. Even some of the family members, beyond the children, utilize our school-based clinics. And I think this is an excellent way of being able to bridge, build trusting relationships with your community and provide a much needed service to the young youth in the community.
And I'm going to share just a video from this program.
KRIS KUCHTA: The goal of the school based health care initiative is to bring health care, mental health and physical health, to the students.
JAQUAN WHITE: About a week ago, we had a 5K run and I had a physical paper I had to get done. And I was running all over Detroit trying to get it done, and they were the first one to say, hey, you can come in here and get your physical.
DR. JONNIE HAMILTON: We have our two basic events that are for all of our schools is our asthma the camp and our Kids Now, which is a nutrition program, nutrition and exercise program.
TONYA WOODS-BROWN: We want to empower and teach these kids that although you have a chronic disease, you can still live a healthy life if you know how to take care of yourself.
DR. JONNIE HAMILTON: One of our tobacco prevention program is called Kick Butts. It's an essay contest or a poster contest. So the kids get posters and they do their essays. And they're graded and they get prizes for the first, second, and third place winners.
KRIS KUCHTA: Our students have a lot of needs-- social, emotional, physical. They can self-refer as long as they're 14 years or older. They come in for counseling. Whether they're grieving or they're going through something at home or being bullied, they have access to this, and they don't need to go through a primary care provider. They don't have to have parents fill out a lot of paperwork. They can just come in and get help.
DR. JONNIE HAMILTON: I think the school-based health initiative is a fantastic program and most of us think that we wish we had it when we were in school because it gives the kids an opportunity to learn about health and to learn about prevention and learn about some of the things that they need to do in order to stay healthy. Because we always say, a healthy mind and healthy body makes a healthy learner.
PATRICIA MARYLAND: So we've learned that it's important to have welcoming, accessible services for these students and many need the services of a therapist and will not likely go and get access to these in a different kind of environment. A school-based program is really something that we have found to be extremely effective.
Further, because it is located in a school, there's no stigma associated with being part of a school clinic. I'm going to also share with you this special program called Open Arms, grief.
NARRATOR: Open Arms is a prevention program whose program goals are to provide long-term support to children and their families.
KAREN GRAY-SHEFFIELD: Many of these clients that we see are innocent victims. Some have been victims of a drive-by shooting or have been assaulted by gangs in the community. And we actually go into the hospitals. We go bedside, provide counseling and support, offer them resources and information that will help them to deal with the trauma that they have experienced.
MICHELLE FOLLEBOUT: We go into the schools. You go and work with families that are struggling with traumatic situations.
FELICIA BERRY: We engage with the stages of grief and we normalize, validate, and confirm those feelings that are associated with loss.
NARRATOR: Open Arms helps family members of all ages to embrace life again.
PATRICIA MARYLAND: So we are investing in the health of our senior citizens also. According to the Pew Foundation, about 10,000 people turn 65 every day until 2020. Epidemic of diabetes, as I described with my mother's situation, is a precursor to so many other chronic diseases, including heart disease, and kidney failure. In addition to our skilled nursing facilities, our PACE program, our assisted living facilities, home care and other acute care facilities, we also include prevention strategies to address the needs of the elderly.
This evidence-based intervention is targeted to adults, age 55 and above. It involves two locations for both exercise and education. And what I want to say is, this is an example of where we repurposed-- in East Detroit, it was clear that we did not need as many inpatient beds as we had, and it was important to look at repurposing those beds to something that's going to better serve the needs of the community. And what we did was to take some of these older-- we closed two hospitals. Between the two hospitals, about 650 beds closed. And we repurposed those facilities to better serve the needs of the elderly and of the community.
And we created what we called a community hub, providing services on these campuses, on these hospital campuses that could better meet their needs. One of our campuses, we worked in partnership with the police department and said, we need a secure environment for individuals, who are older, who want to come on the campus and want to exercise. They want to be able to come and see their primary care physician. They need a place where they can learn how to cook more healthily. So we need nutrition classes. And we built partnerships with the Agency on Aging, with the police department, with others coming together to be able to create something for this community that they could appreciate and really use to improve their overall quality of life.
On another campus, we turned that into a place where-- in the city of Detroit, they did not have access to many well-respected and skilled nursing facilities and/or independent living, assisted living facilities. And we said we needed to take, convert this one hospital to a place, where we could now set up on this campus, a place that's safe, that's attractive, that's within the city of Detroit so that individuals who needed to go to a facility like this and reside in a facility like this could still have access to their friends who lived in their communities.
And so we were able to do that through these programs. And you can see some of the work, the impact of the data is clearly here, that we're definitely making a difference, in terms of the overall health of these communities that we're serving on these two campuses.
This evidence-based intervention is targeted to these patients and we know that continuing to work in partnership with others to provide services to these communities is so important. I wanted to share with you in this next video, a little bit specifically about the programs.
LOUISE RYDZEWSKI: We have a body, mind, spirit approach. What we try to do here is we're trying to meet seniors where they are and we want to improve their quality of life physically, mentally, emotionally, socially. This is an area that is rich with seniors. There's a lot of senior apartments here.
So it has become really a kind of a family for them. They enjoy the classes, enjoy each other, and they keep an eye on each other. There are a number of people who were on diabetic medication, no longer are. They've lost weight. They've lost inches. Blood pressures have gone down. Some people have dropped their blood pressure medication. They tell me they sleep better. Stress levels are down. I have doctors in the building, and actually, doctors that are not in the building, that recommend their patients to come here.
We have all kinds of classes. We have exercise classes, and then we also have educational lectures. We have a dietician come in and give all kinds of cooking classes and tips. We also have stress management, diabetes self-management, chronic disease self-management. We do have a lot of fun here. The instructors are great. People laugh a lot and really seem to enjoy it.
I love my job. It's a lot of fun. Coming to work, I almost feel guilty sometimes because I am really enjoying myself. If I do come to work in a little bit of a down mood, it doesn't last because they're so positive.
PATRICIA MARYLAND: Now, think about the importance of taking two hospitals that we closed, that we could have just left in those communities with no life and how we converted those facilities into something that's addressing the needs of these communities. We also have plans underway to expand this effort further by providing these same services in other recreation centers around the area as a partnership with the local government. This not only increases access but also helps our physicians across the service area to make referrals to locations that are more accessible to their patients. And we don't charge anything for the services that we're providing. That's all part of our charitable support.
I want to talk a little about now-- switching gears a little bit-- about another innovative that we've made that's really innovative because it really does-- I think, it truly is a powerful demonstration of the principle of collaboration. Manufacturers, pharmaceutical manufacturers sometimes make more medications than they can sell. And so the surplus inventory traditionally is sent to the incinerator, just thrown away. Hospitals and clinics always fully cover the cost to dispense medication. Hence, they are never sold or purchased. So work to turn surplus into health is the work that we're doing with a program called Dispensary of Hope.
Ascension is the lead funder for this program, but we also said, we don't want to limit this just to our health system. We need to make this available to any health system. So you know, this project is owned by a number of members. We are providing about, let's see, comparing the Dispensary of HOPE patients with two other cohorts, the savings from health outcome improvements was between $1.9 million-- 1.9-- what's that number? Is that million? OK, per 1,000 families. That's a huge number. I mean, it really is. And you can see some of the results here, that-- and I'm going to show you a video, but I think what's important here is we collect and distribute about $13 million annually to low income and uninsured populations. Again, we can never-- we're not purchasing it from the pharmaceutical company, but we're asking them not to throw it away, not to incinerate it but instead, let's use it to make a difference for individuals who can't afford to go out and get their own medications.
And the problem is called Dispensary of Hope and I'm going to share a little quick video about the program.
REPORTER: Upcoming year, look out for higher prices.
NARRATOR: It's a simple story.
REPORTER: Just wants to raise these--
NARRATOR: If you don't have access to medicine when you are sick--
REPORTER: More money for prescription drugs than you were, say a year ago. More than average annual wage--
NARRATOR: It's much harder to get healthy. 30 million Americans are without access to medicine, but nothing speaks as loud as the people themselves.
AARON: Gary was one of the first patients I saw here at the clinic his big issues were COPD.
So if Gary wasn't stable on his breathing medications, he would suffocate.
MARCIE: I have high blood pressure, diabetes, high cholesterol, asthma, and I have arthritis real bad.
TERRY: I had a hole in my heart, and then I was diagnosed with congestive heart failure. So I went ahead and left work in 2009 and with that, my insurance went.
ALESHIA: I need the meds, you know, because of my bipolarness, and I can't sleep. I had a son to get killed and he was 14. I was already taking medicine, but they had to increase it because of what I was going through. So you can imagine, once it stopped, when I couldn't get it anymore, what type of person I was and how it made me feel.
AARON: For our patient load who can't really afford anything, even the $4 list at Kroger and Walmart is too expensive.
TERRY: What I was worried about was going to the emergency room because I didn't have the money to pay for it. That would stop a lot of people from going and getting the help they need and wind up either getting worse or passing away or whatever.
NARRATOR: The Dispensary of Hope network can help ensure that no one goes without medicine due to money or insurance issues.
CHIP DAVIS: As great and as powerful as a medicine might be, it is of absolutely no use to a patient who can't access it.
JIM LUCE: They are very diligent in their effort that it's getting to the people that deserve it when they need it and in line with what their doctors say they need at those clinics.
NARRATOR: $10 billion worth of surplus medicine is destroyed every year. The Dispensary of HOPE partners with pharmaceutical manufacturers to make sure some of that surplus reaches people in need. A rigorous process of accountability then guides the donated medicine to qualified pharmacies and clinics across the country, who in turn dispense the needed medicine to qualified patients.
CHIP DAVIS: We can avoid so many other unnecessary costs in the system, like subsequent hospital stays or surgical interventions, if we can ensure that a patient has access to the medicine their provider believes will drive them to the best positive health outcome.
JIM LUCE: They have less hospital stays, shorter hospital says, less clinic visits, and those are very burdensome on the cost of health care. The preventative is every bit as important to overall health care fiscal responsibility, let alone getting it to the patients that need it.
AARON: When the manufacturers got involved and were able to get us those medicines, their quality of life, being able to stay stable on their medications, goes up. Instead of seeing him every other day, like I was when I first started seeing him, it was more like every three months because he was stable on his medication.
TERRY: If I was able to talk to the manufacturers of medicine, then I would tell them thank you for the quality of life that I've been able to have because of them and the Dispensary of HOPE.
ALESHIA: Once I started back on my medicine, I was able to hold a job down. I've been there now for four years. Just to be taking the medicine and just being a person, it makes me feel. I don't know how long that's going to last or whatever, but maybe when it's time for it to stop or whatever, I'll be able to, at least, purchase it my own self.
CHIP DAVIS: Trusted third parties, like Dispensary of HOPE, that have a proven track record of being committed to both patient safety and in establishing the highest standards of product integrity, is exactly the type of partner that our companies are looking for and want to continue to work with.
JIM LUCE: Having a company like Dispensary of HOPE makes it a very efficient and effective way to get these medicines to the people that need it.
MARCIE: If it hadn't been for them, I don't-- I guess I'd have done without it. Probably wouldn't be here now. I have 21 grandkids, one more on the way, five great-grandkids and three more great-grandkids on the way. It really helped me out and it keeps me going to enjoy all my grandkids.
NARRATOR: The Dispensary of Hope, connecting abundance with need.
PATRICIA MARYLAND: I think what's key about this program, that's so important to share with you, is this was an idea from one associate, who said as he was going around physician offices and collecting medications provided by the pharmaceutical companies to help those patients who couldn't afford to pay for their own medication, he said, I'm going to think maybe if I take this and go and ask the pharmaceutical companies directly. And that seed of an idea, that courage that he showed in being able to go out and to take and push this idea further.
Now, we just, about a month ago, tripled the size of the warehouse where we're storing this product and providing this all across the country, and we've made this accessible to any health system that would like to utilize these products for their patients that are in need. It's all about collaboration
I want to now talk about a program that Dr. Cynthia Taueg has been very, very involved with, a relatively new program called Bridges to Helping Others Prosper Through Empowerment. It's sort of a collaboration between Ascension, St. Vincent dePaul and Catholic Charities.
And we said, we want to be able to, in the city of Detroit again, we know that poverty is a real problem and it's something that we've got to get our arms around in order to be able to create quality of life and really impact overall health. So this pilot program was held in one zip code in Detroit over a one year period of time. It was very successful during this year. Through some of the evaluation, you can see some of the impact on the screen here of the effort.
Right now-- we had an initial cohort of 50 people. Now, there are about 60 other individuals that want to participate. And it continues today with the goal of expanding to other communities and adding other partners. We see this as one step in helping others learn what they really don't know about-- how to really stop what we consider generational poverty. We know it's very different than situational poverty that might result because somebody's lost their job and they no longer have access to resources. But just the generational-- generation after generation experiencing the same, how do we get them out of that? And to really reinforce that they can believe in themselves, that there are other options, if you will, to be able to have a better life.
It's providing the coaching, the mentoring, that needs to happen and really showing up and getting them connected to resources that are available within their communities. And really connecting them to those resources to be able to help their situation and help their families. So I'm going to share a little bit of video about the program.
CASSANDRA JACKSON: Bridges to HOPE is a program that is based on bridges out of poverty. Bridges to HOPE, which HOPE is an acronym for Helping Others Prosper through Empowerment. The conversations started, the planning started about two years ago. It started with our leadership from St. John Providence, Catholic Charities in southeast Michigan, and St. Vincent dePaul with a discussion about what and where it would take place in the city of Detroit and basically, the population that we would serve.
I would hope that people not only want to participate but also donate, get involved to help someone get ahead. It's not as easy as some people may think. It takes a support system. It takes resources, and it takes encouragement. We can leverage our resources to give individuals more support, and that's what we do.
PATRICIA MARYLAND: So we recognize that this is not a silver bullet and no one leaves generational poverty with one class. Because we only have the one class, but we are going to continue to make this effort with other cohorts. Leaving poverty is a process, not an event. It's a long series of steps. We have several key partners in this work, including not only the St. Vincent dePaul and Catholic Charities but other local job training programs. And just the feedback we continue to hear is extremely positive.
So it's not reasonable to expect that people will change their behavior easily because there's so many other forces that are social, cultural, physical that may conspire against their ability be able to get out of that generational poverty. But we do know that we can help make a difference.
I mean, how do you expect an individual who's worried about, number one, making sure they can feed their families, have housing, good housing, available for their children and their families. You know, they're not going to think about health first when they've got all these other issues to deal with and to address. So our goal is really to help connect them to those resources so that they can have access and the potential of a better life.
So I wanted to just talk a little bit about some of what we're seeing, in terms of the changing in health care environment and this shift from fee for service to fee for value. There's no question that, as we think about how we're getting paid and the incentives that are being provided to provide high quality care to reduce those never events, to get-- and if you're not doing the work that you need to around quality, how we are penalized because of it. We're getting penalized because of readmissions to the hospital within a 30-day period of time for certain conditions, or the patient's experience may not be at the level that is considered to be acceptable.
So we know that, although we are hesitant about making this shift, if you will, to value-based care, to population health management, we are being forced through the way we're getting paid and reimbursed for that care. Ascension is participating in a number of models, in terms of Medicare shared savings programs, bundle payments. So we've got experiments going on and pilot initiatives going on across the country in all of our-- in our different markets. And we're testing our ability to be able to do well under the new value-based environment.
We're finding it to be tough because we're living-- it's almost like living in this schizophrenic world of having your feet in both camps. Because today, most of our reimbursement is coming still on the fee for service side. And you know, so we're tentative about making that move fully in and embracing fully the value-based care, but we know that it's something that we have to do.
Ascension made the decision to support CMS, when they've basically said they'd like to see the majority of your reimbursement coming from value-based reimbursement. So we've decided that by 2020, that at least 75% to 80% of our reimbursement would come from value-based care. So we're moving in this direction.
In order to position ourselves for it, we decided that it was really important to reorganize ourselves. And so we've moved from a holding company to creating an operating model, really trying to place all of our health ministries across the country on the same platform, really standardizing the way we take care of patients, the way we organize our work.
We also are trying to create economies of scale as we all think about how we manage the supply side, for example. How we organize our clinical services, because it's really important to drive down costs. If you remember the Triple Aim, we've added the quadruple aim because it's about not only-- we start with quality. We work on experience, both from a patient's perspective and also from a provider perspective, which then should create affordable care. We should be able to drive down the overall cost of care. It's really an important piece for us.
So when we think about this, how do we do this in a way that makes sense? We've also made a decision that as part of our cultural change, is that we are going to really focus on being able to provide what we call person-centered care. And what do we mean by that? It's that any person coming into any of our facilities, no matter where they enter into our system, we want to be able to create an environment that's conducive to really being able to gain their trust.
So we have created what we call across this continuum, what we call person-centered care, focusing on making sure that when they come into our system, we welcome them in a way that's consistent across the board. We respect them. We also include them in the care process along with their family members. We protect them from harm, that we don't do more harm to them when they enter into our system. We engage them in their care process, and we comfort them when needed. And what we're trying now to do is develop protocols that can ensure consistency each and every time they enter into our system for this care.
So in conclusion, health is a state of physical, mental, and social well-being and not just the absence of disease or infirmity. And at the end of the day, it's all about health. So even though most people see-- when you think about Ascension, you think of us as a health care system, really focusing on the high-end quaternary, tertiary services that are provided. But we, instead, see ourselves as wanting to really make a difference in improving the overall health of communities, and that's why it's been really important for us.
And I'll say this because it's probably the funniest thing that I heard when I first joined Catholic health care and it came from one of our nuns, no margin, no mission. So you first must generate a margin, and then you take those dollars and you reinvest in taking care of those who can't take care of themselves and to be able to push and take care of the communities. So that's what Ascension is all about.
So, I'm going to stop now. And if we have a few minutes, I'd like to invite Cynthia Taueg up and maybe to take any questions, another 10, 15 minutes of questions.
SPEAKER 1: Well, I'll start it off. So, I'm curious-- I know you say you partner with a lot of different organizations. So are you finding that you find these organizations and you're supporting them financially, or do you see sometimes on the flip side, they're coming to you because you're a large organization with a lot of resource and they want you to kind of take over their work?
PATRICIA MARYLAND: I think it's a combination and I'll say first and foremost, there's no question when you go into any community that there are lots of services already being provided to-- I probably should use the microphone. There are lots of services being provided by other organizations. The key is really being able to connect the dots. And I see Ascension as a convener, if you will, being able to go out and say, you know what, when you think about the needs of this community and I'll use one-- I'll go back to east Detroit because I think it's one of our favorite because we spend a lot of time in Detroit, especially during the worst of economic times.
I'm not sure if people realize that during 2007 through at least 2011, '12, within the city of Detroit proper, there wasn't a grocery store. So most people that live in the city of Detroit, if you didn't have transportation, ended up going and buying their foods from fast food restaurants and/or convenience stores on a corner in the neighborhood and couldn't get access to fresh fruit and vegetables.
And one of the programs that I want to share with-- Cynthia started through a grant, seed grant that came out of Ascension Health was Enterprising Health. Why don't you tell them a little bit about Enterprising Health.
CYNTHIA TAUEG: Sure. One of the things that we did to foster innovation and then realizing that the needs of our communities was so great was to say, what if we supplied some seed dollars to innovative people in our community and have them to do something to improve health? So we had that experiment going for a number of years, and we had some successes. One of them was a program called Healthy Dollar. I don't know about this state of New York, but in Detroit we have a lot of dollar stores. And people will go to these dollar stores and buy food.
So this young lady named Cathy, she said, I want to start a healthy dollar. So she had fresh fruits and vegetables, smoothies, other things there that people could come in and purchase at a low cost. So that was one of our successes. Some of the others didn't turn out quite as well, but it really did inspire people to think about their health and think about what they could do in an entrepreneurial fashion to be able to help people be more healthy. But Healthy Dollar and her slogan was "healthy dollar, holler."
SPEAKER 2: I was intrigued with the pharmacy benefit because it never even dawned to me that they would have leftover drugs given their high prices. So my question, from what you said, in New York state there's a delivery system reform program going on, which you may be-- since I see you have a few facilities in New York state might be part of. Is it possible that the Millennium Collaborative in Buffalo, for example, would be able to tap into the drug program, the pharmacy program?
PATRICIA MARYLAND: Absolutely, as I said, it's open to any health system. And that's one of the reasons why I wanted to present today and share this Dispensary of HOPE program because we want to spread the word. But this program is available across the country with any provider that might be interested.
SPEAKER 3: How do you think that the new administration, the new presidential administration--
PATRICIA MARYLAND: I knew that question was going to come up.
SPEAKER 3: Is going to impact Ascension's ability to access people in need, if at all? And what steps are you all taking to make sure that whatever that impact is it doesn't leave people behind?
PATRICIA MARYLAND: Well, first of all, before the election, we had been working with both-- as we were going through the primaries, we had been working with both candidates very closely just to understand their thoughts about health care and the Affordable Care Act, in particular, and their perspective of what they would do if they were elected. So we were able to have the view from both camps, if you will, from Hillary's and President-elect Trump.
There's no question that there are going to be changes, and some needed changes to the Affordable Care Act. I just will say that because I mean, it's become too costly. What I'm concerned about is I don't think we should throw the baby out with the bathwater. I think it's further refinement, and we even heard President-elect talk about two particular components that he would probably consider keeping, and that would be individual students like yourselves, up to the age of 26, staying on your parent's plan. And then, if you have a preexisting condition and not allowing insurance companies just to throw you off the plan because of a preexisting or not give you access to health insurance because you have a preexisting condition. Those are two components that he felt were worthy for further consideration to be sort of kept in whatever future plan or changes will be made.
I guess what I'm concerned about would be if we decide for Medicaid-- some of our states that did accept the expansion, Medicaid expansion within their states, were doing much better and were able to take care of more individuals. Although we're getting paid less, we've increased the number of individuals that we're able to take care of in a way that allows us to remain viable in those communities and those markets.
I am concerned if we move back to a potential state grant, where a block grant is given to a state, so much money, and then, the potential of those states being able to use those monies for other things besides health care. I would be concerned about that. But we're going to be working with President-elect Trump and help to, at least, provide data, provide information, and maybe help shape some of what he's thinking about from a policy perspective. So it's just we're all hanging on for a wild ride.
You know, health care continues to increase in cost and the impact, in terms of the GDP is such that it's non-sustainable long term. We know that. We've got to continue to look at ways to drive down the overall costs of health care, and we all have to do our part, not only the provider industry but also the device industry and the pharmaceutical industry. We all have to do our part because we're all contributing to the escalation of costs.
SPEAKER 4: Naturally, they'd give the question to me-- the closer question, Dr. Maryland, but it's good to see both you and Dr. Taueg on the national stage at Cornell. As you know, I had worked with both of you in Detroit. My question is a little different because most of the audience here is students, graduate students in the master's program. And I just ask you if maybe as a reflection, what are the kinds of things that the students should be thinking about, in terms of their studies, in terms of their skill sets, that they should really be preparing themselves for, as they will be the ones that kind of lead us into the brave new world?
PATRICIA MARYLAND: I think it's an excellent question, and I can tell you that clearly, when I think about the transformation of health care and how we're moving more towards value-based care and managing risk in terms of populations. Some of the skills that were not required of us when I was-- 20 years ago, 30 years ago-- through school, the data, big data. Predictive analytics is a big area of focus. And attention actuarial capability size, being able to look at populations, measuring the risk associated with those populations. That's huge. These are like nontraditional areas that were not part of the curriculum when I was in the program.
And I would say, now, yes, maybe in my biostatistics days, yes. But in terms of the traditional master's program, that's not something that was required. And now I'd say to you, understanding data, being able to have either someone who has expertise in predictive analytics, being able to look out and forecast trends, those are areas that I think are just truly needed as we think about the future.
I also think just fundamental leadership skills and being able to know how to work with people, how to engage with your workforce, and create the kind of culture that you-- because we spend a lot of time-- we talk within Ascension about-- [INAUDIBLE] since you worked with the Center for a number of years-- virtuous servant leadership. And what are some of those attributes?
We need leaders who can listen well, have strong emotional intelligence, a good self-awareness about how they're being perceived with others, collaborative skills, being able to work in partnership. Because I think the future-- we talked a lot about the examples of these programs that we shared earlier through the videos. Most of those are in partnership with other organizations. So being able to work with other players, other partners, being comfortable with collaboration, those are all, I think, some basic skills of leadership that are going to be really important going forward in the future. Other things? Other thoughts that you might have?
CYNTHIA TAUEG: I would only add embracing diversity. Our country is changing a lot, and all of the futuristic folks will tell you about all the demographic changes, but we have to be able to meet people where they are. We have different cultures. We have different groups, different ways of perceiving health and how to go about achieving health. So some understanding and taking some time to embrace the diversity of our population of our country. It's our strength, and so we want to embrace it and use that to help us as we improve the health.
PATRICIA MARYLAND: That's a very good point. I mean, that's excellent.
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Ascension Health COO Patricia Maryland delivered the Percy Allen II '75 Sloan Lecture in Healthcare Leadership in Urban Communities on Nov. 14, 2016. The lecture series, named in honor of Sloan Program graduate Percy Allen II for his far-reaching contributions to the health care industry, brings to campus an accomplished and high-profile leader from the health care sector working to address the needs of underserved urban communities.