>> We might be able to compare 
it to national average of 29.9%.
there are still plenty of room 
for improvement when it comes to
dealing with the adverse effects
of obesity in the state.
turning over to current smokers.
when the data here, you're 
classifyied being a current 
smoker.
there's quite divide between 
Detroit and the Tacoma regions 
here.
the trend in Detroit has been 
fairly flat across that time 
period.
in the Tacoma region, we see a 
positive trend from 2013 to 2016
with a drop in smokeing prefer 
lens down to about 16% in 2016.
highlights another area of 
potential improvement for the 
stateed  as a a
whole.
from 2013 to
2016, we see this 
trend down to about a state 
average of 8.7 in 2016.
notably below the national 
average in 2016 which was 11.9%.
positive health marker in terms 
of our community.
now with greater coverage, we 
might also anticipate that 
people might have easier way to 
access care and have increase in
utilization.
what we see here is the number 
of individuals reporting that 
the they could not access their 
healthcare services due to 
preventive costs.
that has been trending downward 
for the state here looking at 
the Tacoma region.
we see similar story from 2014 
to 2016.
we see similar trend for the 
Detroit region from 2013 through
2015.
we see a positive trend.
so 2013 through 2015 we're move
moving in the right direction.
WE SEE A POSITIVE TREND HERE.
BACK IN 2013, WE -- 2011 WE HAD 
33% 
POPULATION.
THAT HAS FALLEN DOWN TO 26% IN 
2016.
A POSITIVE TREND GIVEN POTENTIAL
BENEFITS OF EARLY DETECTION OF 
POTENTIAL HEALTH ISSUES THAT 
PEOPLE CAN HAVE WITH ROUTINE 
CHECK UPS.
WE HAVE PERCENTAGE POPULATION 
THAT THEY ONLY HAVE FAIR OR POOR
HEALTH.
THAT'S BEEN FAIRLY STABLE.
WHAT'S INTERESTING HERE, 
CONSISTENTLY HIGHER IN THE 
DETROIT, MORE INDIVIDUALS RATE
ING 
THEMSELVES FAIR OR POOR THAN 
THEY DO IN THE TACOMA REGIONS.
WHAT'S INTERESTING GIVEN WHAT WE
SAW IN THE LUST COUPLE OF SLIDES
WE HAVE INCREASEED COVERAGE, WE 
HAVE INCREASE ACCESS IN 
UTILIZATION.
WE HAVE MORE ROUTINE VISITS.
WE DON'T RATE OURSELVES HAVING 
BETTER HEALTH.
I WILL TURN IT BACK OVER TO 
KEVIN.
>> 
>> WE'LL CONTINUE TO LOOK AT 
TRENDS IN UTILIZATION.
SHIFTING OUR FOCUS TO THE 
HOSPITAL SECTOR.
THE NEXT SECTION FOCUSES ON USE 
AND EXPENDITURES IN IN THE 
HOSPITAL 
SECTOR.
THIS DATA COMES FROM THE 
AMERICAN HOSPITAL ASSOCIATION.
THEY ARE COLLECTING DATA ON ALL 
THEIR MEMBERS.
WE ARE TAKING THIS DATA AND 
SEGMENTING BILL LOCATIONS OR 
LOOKING AT GRAND RAPIDS.
THAT'S THE LIGHT BLUE LINE.
WE'RE LOOKING AT DETROIT WHICH 
IS THE GREEN LINE.
THE U.S. AS A WHOLE NATIONAL 
AVERAGE, THAT'S THE DARK BLUE 
LINE.
WE CALL THE BENCHMARK WHICH IS 
CAN THE RED LINE.
THE BENCHMARK IS MADE UP OF AN 
AVERAGE OF HOSPITAL OUTCOMES IN 
BUFFALO, NEW YORK, ROCHESTER, 
NEW YORK, WISCONSIN AND KENTUCKY
KENTUCKY.
IF YOU LOOK AT THINGS LIKE 
POPULATION DEMOGRAPHICS INCLUDE
INCLUDING AGE, THE PROPORTION OF
POPULATION OVER AGE 65, YOU LOOK
AT INDUSTRY OF EMPLOYMENT.
THOSE ARE THE AREAS IN THE U.S. 
THAT MATCH PRETTY CLOSELY WITH 
GRAND RAPIDS.
SOME PEOPLE GET THE CARE THEY 
COULD GET IN OTHER REGIONS.
THIS TENDS TO BODE WELL FOR THE 
COMMUNITY
.
HAVING LOW RATE HOSPITAL AD
ADMISSIONS IS A POSITIVE SIGN 
FOR SPENDING HEALTHCARE IN THE 
REGION.
HOSPITAL EXPENSES FOR ADMISSION.
THIS IS NOT THE COST YOU PAY.
THIS IS WHAT HOSPITALS SAY ON 
AVERAGE.
IT COST TO TREAT A PATIENT THAT 
COMES IN THE HOSPITAL.
THIS IS THE COST FROM THE 
HOSPITAL'S PERSPECTIVE.
ALL OF THESE AREAS, GRAND RAPIDS
RAPIDS, DETROIT, NATIONAL 
AVERAGE, THEY ARE GROUPED 
TOGETHER.
THESE COSTS ARE RISEING OVERTIME
.
IF YOU THINK ABOUT WHO IS NOT 
GOING TO THE HOSPITAL ANYMORE, 
MAYBE IT'S THE HEALTHYIER PEOPLE
LEAVING SICKER PEOPLE TO THE 
HOSPITAL.
IT COULD BE THE DISEASE BURDEN 
THE POPULATION FOR HOSPITAL AD
ADMISSIONS IS INCREASEING.
IT COULD BE INEFFICIENCYIES 
INVOLVEED.
IT'S NOT CLEAR WHAT THE REASON 
IS.
WE DO SEE SUBSTANTIAL GROWTH IN 
HOSPITAL EXPENSES.
THAT'S HAPPENING ALL THROUGHOUT 
THE COUNTRY.
IT DOESN'T NECESSARILY MEAN YOU 
HAVE TO GO TO HOSPITAL TO GET 
CARE.
IT MEANS YOU RECEIVEED CARE 
THROUGH A PROVIDEER WHO IS PAID 
UNDER THE OUTPATIENT PERSPECTIVE
PAYMENT SYSTEM.
PROTESTANT ITHE PROVIDEER WAS 
AFFILIATEED WITH 
THE HOSPITAL.
IF YOU LOOK AT THE NATIONAL 
AVERAGE, THIS IS THIS HAS RISEN 
SLIGHTLY BUT STEADY OVER THE 
TIME SPAN.
SOMETHING LIKE 2000 VISIT PER 
THOUSAND POPULATION IN 2005.
WHERE YOU SEE REAL GROWTH IS IN 
MICHIGAN, IN DETROIT AND IN WEST
MICHIGAN.
IN FACT, IN BOTH OF THOSE REGION
REGIONS, USE OF OUTPATIENT 
HOSPITAL SERVICES HAS DOUBLEED 
OVER THIS 11 OR 12-YEAR PERIOD.
DOES THAT MEAN PEOPLE ARE USEING
MORE CARE, ARE WITH YOU DOUBLE
ING 
AMOUNT OF CARE?
PROBABLY NOT.
WE CAN'T TELL EXACTLY FROM THE 
DATA.
PROBABLY THIS TREND REPRESENTS 
AN INCREASE IN AFFILIATION WITH 
HOSPITAL SYSTEMS THROUGHOUT THE 
STATE OF MICHIGAN, PROVIDEERS 
AFFILIATEING WITH HOSPITALS.
YOU MAYBE GOING TO GET CARE AT 
YOUR PHYSICIAN OFFICE.
IF THE PHYSICIAN IS AFFILIATEED 
WITH THE HOSPITAL SYSTEM, THAT'S
GOING TO COUNT AS AN OUTPATIENT 
HOSPITAL ADMISSION.
THAT'S PROBABLY PICKLED UP IN 
THE MICHIGAN DATA SINCE WE'RE 
NOT SEEING THAT INCREASE IN THE 
BENCHMARKING COMMUNITY OR THE 
NATIONAL AVERAGE.
EMERGENCY DEPARTMENT VISITS, WE 
TRACK VERY CLOSELY IN WEST 
MICHIGAN WITH THE NATIONAL 
AVERAGE AND BENCHMARK 
COMMUNITIES.
DETROIT IS A CLEAR
OUTLIER HERE.
THIS IS GOING TO SHOW UP 
THROUGHOUT THE EXPENDITURE 
METRICS THAT WE'LL LOOK AT TOO.
THE MORE EMERGENCY DEPARTMENT 
CARE YOU USE, THAT TENDS TO 
COROLLATE WITH HIRE EXPENDITURES
EXPENDITURES.
WE'LL SEE THAT SHOWING UP.
MEDICARE EXPENDITURES, THIS IS 
TRYING TO GET A SENSE OF WELL, 
FOR THE POPULATION THAT IS OVER 
THE AGE OF 65, HOW MUCH ARE WE 
SPENDING PER PERSON PER YEAR IN 
THIS POPULATION?
HOW MUCH IS THE FEDERAL 
GOVERNMENT PAYING FOR CARE FOR 
SOMEONE IN THIS POPULATION.
THIS IS THE PATTERN WE'RE SEEING
HERE HAVE BEEN PRIOR TO THE 
YEARS INCLUDEED IN THE SLIDE 
HAVE 
BEEN INCREASEING EXPENDITURES.
THE AVERAGE PERSON IN IN 
MEDICARE, 
THEIR EXPENDITURES WERE GROWING 
OVERTIME.
IN THE LAST FEW YEARS WE'VE SEEN
THAT DECLINE.
THE INCREASEING AGEING OF THE 
POPULATION THAT A LOT OF PEOPLE 
TURNING 65.
THE BEAM ARE MEDICARE AND LOWER 
END OF THE AGE DISTRIBUTION TEND
TO BE LOWER COST MEDICARE PEOPLE
PEOPLE.
THIS COULD BE DRIVEING SOME OF 
THE COSTS.
PEOPLE MIGHT ARGUE THAT IT'S 
MEDICARE ADVANTAGE.
THERE'S BEEN A BIG EXPANSION IN 
MEDICARE ADVANTAGE, MEDICARE 
ADVANTAGE WHICH IS INCLUDEED IN 
THIS DATA, EXPENDITURES FOR 
PEOPLE WITH MEDICARE ADVANTAGE 
MAYBE BETTER AT MANAGEING CARE 
OR 
REDUCEING EXPENDITURES.
GRAND RAPIDS COMES IN LINE WITH 
THE BENCHMARK HERE.
WE'RE BELOW THE NATIONAL AVERAGE
AND FAR BELOW DETROIT.
ON AVERAGE FOR MEDICARE PATIENT 
IN THE GRAND RAPIDS REGION, IT'S
ABOUT $9500 A YEAR THAT THE 
AVERAGE PERSON IS USEING THE 
CARE
CARE.
COMPAREED TO DETROIT WHICH IS 
CLOSER TO
$10,500.
I LIKE TO PUT IN SOME MEASURE OF
QUALITY.
HERE'S A NICE MEASURE OF QUALITY
QUALITY.
THIS IS AMBULATORY CARE.
IT'S USEED AS OVERALL MARKER OF 
EFFICIENCY OF CARE.
HERE YOU WANT THE NUMBER TO BE 
LOWER AS OPPOSEED TO HIGHER.
THE FACT THAT GRAND RAPIDS IS 
THE LOWEST OF THESE COMPARISON 
REGIONS, THAT'S A GOOD THING.
IN AMBULATORY CARE SENSEITIVE 
DIS
DISCHARGE YOU WERE DISCHARGEED 
FROM THE HOSPITAL THAT COULD 
HAVE BEEN TREATED IN OUTPATIENT 
SETTING.
MEASUREING THE EFFICIENCY OF 
CARE
CARE.
WE HAVE IN GRAND RAPIDS, COMPARE
COMPARED TO OTHER COMMUNITIES, 
FEWER
AMBULATORY
CARE.
NOW SHIFTING FOCUS AGAIN.
WE'RE GOING TO LOOK AT MAJOR 
MEDICAL CONDITION.
THIS IS FOCUSING ON PEOPLE WITH 
CHRONIC CONDITIONS.
THIS IS USEING DATA FROM 
BLUECROSS BLUESHIELD OF MICHIGAN
MICHIGAN, BLUE CARE NETWORK AND 
PRIORITY HEALTH.
THE POPULATION TO KEEP IN MIND, 
THE POPULATION THAT WE'RE 
LOOKING AT HERE, THESE ARE 
PEOPLE BETWEEN THE AGES OF 18 
AND 65 FOR THE MOST PART.
PEOPLE THAT ARE DIAGNOSEED WITH 
ONE OF SIX CHRONIC CONDITION.
WE'LL LOOK AT THE EXPENDITURES 
AND USE FOR THE CHRONIC 
CONDITIONS.
WE'RE GOING TO COMPARE GRAND 
RAPIDS AND DETROIT.
ALL OF THESE MEASURES ARE 
LOOKING AT PER MEMBER PER YEAR 
USE.
HERE ARE THE CONDITIONS WE TRACK
TRACK.
WE LOOK AT ASTHMA, DEPRESSION, 
DIABETES, LOW BACK PAIN AND WE 
HAVE COMPARISONS WHAT ARE CALLED
HEALTHY MEMBERS WHICH ARE PEOPLE
WHO DO NOT HAVE A
DIAGNOSIS OF 
THESE CONDITIONS BETWEEN AGES 30
AND 39.
THERE'S LOT OF THINGS SHOWING UP
HERE.
IF YOU JUST LOOK AT THE TRENDS 
OVER TIME, YOU'LL NOTICE A 
PATTERN.
EXPENDITURES FOR PEOPLE WITH 
THESE CONDITION HAVE INCREASEED 
OVERTIME.
LAST COUPLE OF YEARS WE HAD 
REALLY LARGE INCREASES IN 
EXPENDITURES FOR CORONARY ARTERY
DISEASE.
LAST YEAR USEING THE DATA FROM 
2016, CORONARY ARTERY DISEASE 
EXPENDITURE IN WEST MICHIGAN 
WERE APPROACHING $30,000 PER 
PERSON WHO WAS DIAGNOSEED WITH 
THAT CONDITION.
WHAT YOU SEE THIS YEAR FOR 
CORONARY ARTERY DISEASE IS 
DECLINE IN EXPENDITURES.
THAT'S REALLY THE FIRST TIME 
THAT WE'VE SEEN THAT HAPPENING 
SINCE WE'VE BEEN TRACKING THIS 
DATA THAT EXPENDITURES FOR THE 
CHRONICALLY ILL POPULATION HAS 
DECLINEED FROM ONE YEAR TO THE 
NEXT.
FOR CORONARY ARTERY DISEASE.
NOT SOMETHING WE'RE USEED TO SEE
SEEING.
UNFORTUNATELY THE DATA WE GET 
DON'T ALLOWS TO UNDERSTAND WHAT 
IS CAUSEING THIS DECLINE.
YOU CAN SPECULATE THERE ARE FEW 
THINGS THAT MIGHT BE DRIVEING 
THIS.
THERE MAYBE PRICEING CHANGE OR 
UTILIZATION CHANGE OR MAYBE THIS
IS A HEALTHYIER GROUP OF PEOPLE 
WHO WE'RE LOOKING AT NOW THIS 
ARE SHIRRED SHIR INSUREED BY 
PRIORITY HEALTH.
IT'S A GOOD SIGN TO SEE 
EXPENDITURES FALL.
IN THIS FIGURE, WE'RE AGAIN 
TAKING THE SAME EXPENDITURES 
THAT I SHOWED YOU BEFORE NOW 
WE'RE LOOKING AT THE COMPONENT 
THAT IS DUE TO PRESCRIPTION 
MEDICATIONS.
WE'RE ALL CONCERNED WITH PRICES 
IN EXPENDITURES IN PRESCRIPTION 
MEDICATION.
IF YOU TAKE THE AVERAGE PERSON 
WHO HAS ANY ONE OF THESE 
CONDITION BEES U TAKE -- 
CONDITIONS YOU LOOK AT WHAT 
SHARE OF THE EXPENDITURES ARE 
DRIVEN BY PRESCRIPTION PLED CASE
CASE. -- 
MEDICATION.
THAT'S THE RED BOX HERE.
THE OTHER COSTS ARE SHOWN IN 
BLUE.
DIABETES IS THE CONDITION THAT 
HAS LARGEST RELIANCE ON 
PRESCRIPTION DRUG AND HAS HIGH
HIGHEST SHARE OF EXPENDITURES.
IT'S ABOUT A
QUARTER
.
THIS IS SOMETHING NEW WE ADDED 
LAST YEAR.
THIS IS
GOING TO GET MUCH MORE 
INTERESTING WHEN WE HAVE FEW 
MORE YEARS OF DATA TO TRACK THIS
THIS.
DO YOU WE COMPARE WITH THE 
DETROIT REGION?
TAKING KENT, OTTAWA, AND COMPARE
COMPARING THEM TO THE DETROIT 
METRO AREA.
YOU CAN SEE THAT EXPENDITURES 
TEND TO BE LOWER AND HAVING ONE 
OF THESE CHRONIC CONDITIONS.
EXPENDITURE TEND TO BE LOWER ON 
THE WEST SIDE THAN THE EAST SIDE
OF THE STATE.
THIS HAS BEEN THE TREND THAT'S 
PREVAILED WHEN WE LOOKED AT THIS
IN THE PAST ALTHOUGH FOR CERTAIN
CONDITIONS IT TEND TO FLUCTUATE.
THE PART THAT I THINK IS MOST 
INTERESTING WHEN YOU TAKE THESE 
EXPENDITURES AND UTILIZATION 
MEASURES AND YOU BREAK THEM DOWN
TO SHARE WHAT THE GEOGRAPHIC 
VARIATION AND MEASURES LOOKS 
LIKE.
WE TAKE -- IN THIS CASE WE'RE 
LOOKING AT CORONARY ARTERY 
DISEASE.
WE LOOK AT HOW THAT VARYIES 
DIFFERENT ZIP CODES THROUGHOUT 
THE STATE.
WE CONTROL FOR SOME THINGS HERE.
THIS ISN'T JUST RAW EXPENDITURE.
WE TAKE THE ZIP CODE EDUCATION 
LEVEL, THE AVERAGE AGE IN THE 
ZIP CODE.
WE CAN -- WE CONTROL SOME OF 
THESE THINGS ZIP CODE TO ZIP 
CODE.
YOU CAN THINK OF THESE 
EXPENDITURES AS AVERAGE 
EXPENDITURES, CONDITIONAL ON AGE
AGE, EDUCATION AND INSURANCE 
STATUS IN A
ZIP CODE.
RED, THAT'S GOING TO REPRESENT 
HIGHER EXPENDITURES, GREEN WILL 
REPRESENT LOWER EXPENDITURES.
FOR SOMETHING LIKE CAD SPENDSING
YOU SEE A REALLY WIDE VARIATION 
IN SPENDING BY ZIP CODE.
IF YOU'RE IN THESE DARKEST GREEN
ZIP CODE, ON AVERAGE WE'RE SPEND
SPENDING BETWEEN 15 AND $23,000 
A YEAR IF YOU HAVE CORONARY 
ARTERY DISEASE.
COMPAREED TOOTH RED TO THE RED 
ZIP CODE.
SOME OF THE VARIATIONS IS HAPPEN
HAPPENING ACROSS PRETTY SMALL 
GEOGRAPHIC UNITS UP.
GO FROM ONE ZIP CODE TO THE NEXT
AND YOU MAY DOUBLE SPENDING ON 
AVERAGE IN SOME CASES.
THOSE WHO ARE MORE FAMILIAR WITH
THE AREA MAY SEE PALLET EARN 
PATTERNS HERE I 
DON'T SEE.
AS WE LOOK THROUGH THIS, THE 
EAST SIDE SUPPORT STATE TEND TO 
HAVE HIGHER EXPENDITURE AND HIGH
HIGHER UTILIZATION THAN THE WEST
SIDE.
ZIP CODES TO THE NORTHEAST AND 
SOUTHWEST OF GRAND RAPIDS TEND 
TO HAVE HIGHER EXPENDITURES AND 
HIGHER UTILIZATION.
HERE IS DIABETES AND SAME 
OUTCOME.
WE SEE KIND OF A LOT OF THAT 
REGIONAL VARIATION.
YOU SEE MORE GREEN ON THE WEST 
SIDE OF THE STATE THAN ON THE 
EAST SIDE OF THE STATE.
HERE IN YOU'RE IN IN THE LOWEST 
SPENDING GROUP, YOU'RE SPENDING 
AROUND 15 OR $16,000 PER YEAR.
COMPAREED TO UP TO $20,000 FOR 
SOMEONE WHO IS LIVEING IN ONE OF
THOSE RED ZIP CODES.
PRESCRIPTION ISINGEDING IS 
ACCOUNTED FOR 
THIRD OVERALL SPENDING.  THIS IS
NOT JUST DIABETES PRESCRIPTION 
EXPENDITURES.
THIS IS PRESCRIPTION EXPENDITURE
EXPENDITURES OVERALL FOR SOMEONE
DIAGNOSEED WITH THIS CONDITION.
BUT ON AVERAGE, THIS IS LOOKING 
AT THE NUMBER OF FILLS PER YEAR.
YOU'RE HAVING 55 TO 65 FILLS IN 
THE LOW REGION COMPAREED TO 70 
TO 
8 FEATURE FILLS IN THE HIGH 
REGION.
THAT REPRESENTS ONE MORE 
ADDITIONAL PRESCRIPTION PER YEAR
THAT'S FILLED 12 TIME IT IS YOU 
LEVELING IN ONE OF THOSE RED ZIP
CODES.
THIS IS REALLY INTERESTING 
DISPARITY BETWEEN EAST AND WEST 
SIDE HERE IN UTILIZATION RATES 
FOR PRESCRIPTION MEDICATIONS.
LASTLY, SOMETHING WE WERE ABLE 
TO ADD THIS YEAR, THIS THE FIRST
TIME WE'VE HAD DATA.
THIS LOOKING AT TELEHEALTH VISIT
VISITS.
ANNUAL VISITS FOR A PERSON WHO 
HAS A
DIABETES DIAGNOSIS.
THE TAKE AWAY HERE IS THAT OVER
OVERALL, TELEHEALTH IS STILL, AT
LEAST FOR SOMEONE WHO HAS A 
DIABETES DIAGNOSIS IS STILL NOT 
WIDELY USEED.
THERE'S A MUCH GREATER RELIANCE 
ON TELEHETH ON THE WEST SIDE 
THAN THE EAST SIDE.
THIS MAY CORRESPOND TO RURAL 
VERSUS URBAN, DIFFERENCES YOU 
SEE MORE RURAL ZIP CODES HAVING 
HIGHER USE OF TELEMEDICINES.
THIS IS ONE THOSE OUTCOMES THAT 
WILL BE INTERESTING TO SEE HOW 
THIS DEVELOPS OVER TIME.
AND WHAT THIS USEAGE LIKES LIKE 
OVERTIME.
FIRST YEAR WE HAD ABILITY TO 
LOOK AT THIS.
ALREADY STARTING TO SEE 
INTERESTING THINGS HERE.
IT WILL BE HELPFUL TO SEE HOW 
THIS GROWS OVERTIME.
I THINK I'M OUT OF TIME.
WE WILL END THE PRESENTATION 
THERE.
HAPPY TO TAKE SOME QUESTIONS IF 
ANYONE HAS IT.
FIRST QUESTION HERE THAT'S A 
REALLY GOOD QUESTION, IT'S 
SOMETHING WE DISCUSSED PUTTING 
THIS REPORT TOGETHER.
MENTAL HEALTH.
MENTAL HEALTH IS NOT PART OF THE
REPORT.
THE IMPACT IT HAS ON ALL ASPECTS
OF HEALTH CHECK.
CAN WE TALK LITTLE BIT ABOUT 
MENTAL?
I AGREE COMPLETE WELL THIS.
THIS IS SOMETHING THAT NEEDS TO 
BE INCLUDEED IN THE REPORT.
WE NEED TO HAVE SOME MEASURE OF 
USE AND EXPENDITURES FOR MENTAL 
HEALTH, HOW MENTAL MENTAL HEALTH
MAY 
IMPACT.
WE DO INCLUDE DEPRESSION IN 
THERE.
THAT'S A ROUGH MEASURE OF MENTAL
HEALTH.
WE CAN DO MORE TO TEASE OUT SOME
OF THE ADDITIONAL CONCERNS THAT 
COME ALONG WITH THAT.
THERE ARE SOME THINGS IN THE 
BOOK THAT I DIDN'T INCLUDE IN 
THE PRESENTATION THAT LOOK A 
LITTLE MORE INTO HOW COMORBIDITY
COMORBIDITIES INTERACT AND HOW 
THAT DRIVE SPENDING.
IF YOU HAVE DEPRESSION AND OTHER
CONDITION, HOW DOES THE 
COMBINATION OF THOSE THINGS 
CHANGE EXPENDITURES.
SOME OF THAT IS IN THE BOOK.
I COMPLETELY AGREE THAT WE CAN 
DO MORE TO LOOK AT MENTAL HEALTH
ISSUE.
>> WE GOT A CLARIFICATION 
QUESTION ABOUT WHETHER OR NOT 
DETROIT DATA IS FOR THE REGION 
OR JUST FOR THE CITY?
IN TERMS OF THE HEALTHCARE OVER
OVERVIEW, THAT'S FOR THE DETROIT
REGION CONSISTING OF THE COUNTY
COUNTIES OF MACOMB, OAKLAND AND 
WAYNE COUNTYIES.
>> WE HAVE ANOTHER QUESTION ON 
READMISSION.
HAVE YOU STUDYIED HOSPITAL READ
READMISSIONS?
IN THIS REPORT NO, IN MY OWN 
RESEARCH YES.
IT'S A REAL QUESTION.
BECAUSE MEDICARE EFFORTS TO 
REDUCE READMISSIONS.
THERE HAVE BEEN SEVERAL OF US 
DOING RESEARCH IN THAT AREA AND 
LOT OF THAT RESEARCH JUST 
POTENTIALLY GOT UP ENDED BY A 
NEW PAPER THAT CAME OUT OF ABOUT
A WEEK AGO SAYING WE'VE ALL BEEN
MEASUREING READMISSIONS IN
INCORRECTLY.
THAT WAS A BIT SURPRISEING BUT 
APPARENTLY THERE WAS ANOTHER 
CODEING CHANGE THAT HAPPENED.  
YOU ACCOUNT FOR THE CODEING 
CHANGE THAT TENDS TO WIPE OUT 
THE IMPROVEMENTS WE'VE SEEN IN 
READMISSIONS THAT MOST OF US 
WERE ATTRIBUTEING TO THE HHRP.
IT'S AN AREA KIND OF THAT 
PARTICULAR INTEREST IN.
WE HAVE NOT LOOKED AT THAT 
SPECIFICALLY FOR WEST MICHIGAN 
OR DETROIT.
I THOUGHT THIS MIGHT COME UP.
SOMEBODY ASKED ABOUT THE VAPEING
.
WE SHOW SMOKEING RATES BUT NO 
INFORMATION ON VAPEING.
VAPEING IS ANOTHER AREA THAT I 
HAVE INTEREST IN TOO.
I STUDYIED SOME EFFECTSFUL 
CIGARETTE TAX.
VAPEING IS LITTLE MORE 
COMPLICATE
COMPLICATED.
IF YOU
LOOK AMONGST TRADITIONAL 
TOBACCO USE AMONG TEENS IT'S FEW
FEWER OF 8% OF TEENS SMOKEING 
TRADITIONAL CIGARETTES.
VAPEING IS ESCALATEING.
THERE'S CONCERN WHAT ARE THE 
LONG TERM EFFECTS OF THIS.
WE DON'T KNOW.
HOW DO WE TRY AND REDUCE TEEN 
USE OF THIS.
IT'S A PARTICULARLY CHALLENGEING
ISSUE BECAUSE ON THE ONE HAND, 
VAPEING CAN BE A TOOL FOR PEOPLE
WHO HAVE BEEN SMOKEING FOR A 
LONG 
PERIODS OF TIME TO STOP SMOKEING
TRADITIONAL CIGARETTES WHICH ARE
MORE HARMFUL THAN VAPEING.
YOU WANT TO BE CAREFUL NOT TO 
INITIATE TEEN USE.
I THINK SOME OF THE THINGS FDA 
IS DOING TO LIMIT THE FLAVORS I 
THINK THAT WILL HELP.
WOULD LIKE TO BE ABLE TO -- IT 
INTERESTING TO SEE WHAT THE 
TREND LOOKS LIKE IN MICHIGAN.
THE DATA THAT I KNOW WHERE YOU 
GET INFORMATION ON VAPEING LIKE 
THE NATIONAL TOBACCO SURVEY YOU 
CAN'T GET THE DATA YOU NEED TO 
SAY WHAT'S HAPPENING IN GRAND 
RAPIDS.
WE CAN TRACK THAT FOR THE STATE 
AND MAYBE THAT'S SOMETHING WE'LL
ADD TO THE PUBLICATION NEXT YEAR
YEAR.
IT MAKES SENSE STRATEGICALLY TO 
PARTNER WITH PROVIDEERS.
FINANCIALLY IT MAKES SENSE 
BECAUSE YOU CAN INCREASE AND 
CHARGE A FACILITY FEE AND 
INCREASE REIMBURSEMENTS.
IF YOU THINK ABOUT CMS TRYING TO
MOVE TOWARDS A WORLD WHERE WE'RE
PAYING FOR QUALITY CARE AS 
OPPOSEED TO PAYING FOR FEE FOR 
SERVICE.
IT DOES MAKE SENSE TO PARTNER 
WITH PROVIDEERS WHO YOU CAN HAVE
MORE CONTROL HOW THE CARE IS 
DELIVERED AND COORDINATE THAT 
CARE BETTER.
ONE OF THE INTERESTING POLICY 
PROPOSALS HERE AROUND THIS, 
AROUND THE FINANCIAL ASPECTS OF 
THIS COORDINATION IS THE TRUMP 
ADMINISTRATION HAS PROPOSEED 
THIS 
MUTUAL PAYMENT POLICY THAT MAY 
TAKE EFFECT.
THERE'S A LAWSUIT NOW THAT MERCY
HEALTH IS TO STOP THIS POLICY.
IF THAT GOES THROUGH,
MOST OFF 
SITES WOULD NO LONGER GET THIS 
ADDITIONAL PAYMENT.
THEN WE'LL KNOW -- THAT WILL 
GIVE US GOOD SENSE WHETHER THE 
PAYMENT POLICY IS DRIVEING 
CONSOLIDATION OR WHETHER IT'S 
CONCERN OVER COORDINATION OF 
CARE AND BETTER MANAGEMENT 
THAT'S DRIVEING COORDINATION.
I THINK THAT'S SOMETHING TO LOOK
TO KEEP AN EYE ON.
WHAT HAPPENS WITH THIS SITE 
NEUTRAL PAYMENT POLICY AND HOW 
THAT IMPACTS
ADDITIONAL 
COORDINATION.
IS THERE SIMILAR DATA FOR 
PEDIATRIC.
WE DOESN'T HAVE PEDIATRIC DATA 
THERE.
THAT'S REALLY IMPORTANT SUBSET 
TO CONSIDER FOR FUTURE WORK.
HAVE YOU BEEN STUDYING THE 
IMPACT OF INCREASE DEDUCTIBLE 
AND COPAYS?
UTILIZATION?
NOT AS PART OF THIS YEAR OWES 
REPORT.
THERE'S LOT OF WORK BEING DONE 
IN THIS AREA.
NOTHING THAT WE HAVEN'T INCLUDE
ED 
THIS YEAR.
>> SOMEONE ASKED TO CLARIFY THE 
TERMS COST AND EXPENDITURES.
THIS IS REALLY IMPORTANT.
WHEN WE LOOK AT THE MEASURE OF 
HOSPITAL COSTS FOR EXAMPLE, THAT
IS NOT PRICES.
THAT'S NOT THE LIST PRICE OR THE
PRICE THAT -- IT'S NOT EVEN THE 
NEGOTIATEED PRICE THAT INSURANCE
IS PAYING.
IT'S WHAT THE HOSPITAL SAYS THE 
COST OF EMISSION.
IF YOU ASK THE HOSPITAL, ON 
AVERAGE WHEN YOU ADMIT SOMEONE, 
HOW MUCH DOES THAT COST YOU IN 
TERMS OF RESOURCE AND STAFF.
THAT'S THE COST MEASURE FOR THAT
THAT.
FOR THE EXPENDITURE MEASURE FOR 
THE MAJOR MEDICAL CONDITION 
SECTION, THAT IS THE SUM OF WHAT
THE INSURANCE COMPANY IS PAYING 
TO PROVIDEERS THROUGHOUT THE 
YEAR
YEAR.
WE ADD THAT UP FOR WESTERN THAT 
CONDITION.
WE DIVIDE BY THE NUMBER OF MONTH
MONTHS AND THAT GIVE US AVERAGE
ANNUAL EXPENDITURES.
SOMEONE ASKED ABOUT OUT OF 
POCKET COSTS.
WE UNFORTUNATELY DON'T HAVE THAT
IN THE DATA THAT WE'RE ABLE TO 
TRACK WHAT THE CHANGES AND OUT 
OF POCKET EXPENDITURE.
WE'VE DONE SOME VARY WORK IN THE
PAST ASKING PEOPLE AND ASKING 
FIRMS WHAT'S YOUR AVERAGE 
DEDUCTIBLE, WHAT'S YOUR AVERAGE 
COPAY AND COINSURANCE RATE.
WE WEREN'T ABLATED THAT THIS -- 
ABLE TO DO 
THAT THIS YEAR FOR VARIOUS 
REASONS.
IT'S SOMETHING WE LIKE TO DO IN 
THE FUTURE.
WE'VE SEEN SOME INTERESTING 
RESULTS.
I THINK IT'S SOMETHING WORTH 
PURSUEING.
ANOTHER ONE THAT CAME UP LAST 
YEAR, THIS IS SOMETHING THAT WE 
HAVE TO ADD AND WE DIDN'T THIS 
YEAR.
WE SHOULD, OPIOIDS.
WHAT'S HAPPENING WITH OPIOID USE
USE.
THE QUESTION ASKED, CAN YOU 
DISCUSS SUICIDE, DRUG USE AND 
OPIOID AND OTHER ILLEGAL 
SUBSTANCES?
IT WAS A YEAR OR TWO NOW, VERY 
FAMOUSLY THERE WAS THIS 
REVELATION IF YOU LOOK AT DEATH 
RATES FOR WHITES BETWEEN THE AGE
AGES OF 18 AND 49, ESPECIALLY 
MALES, COMPARE U.S. TO OTHER 
COUNTRYIES YOU SEE MORTALITY 
RATE
RATES RISEING IN U.S.
THAT HAS BEEN ATTRIBUTEED TO 
OPIOID CRISES.
TRACKING OPIOID USE, THE DATA IS
AVAILABLE TO DO THAT.
IT'S SOMETHING WE SHOULD ADD AND
WE WILL NEXT YEAR.
HOW OPIOID USE IS CHANGEING 
MICHIGAN.
THING TO KEEP IN MIND LOOKING AT
OPIOID USE DATA, I THINK PEOPLE 
OFTEN FAIL TO SEE THIS WHEN I 
TALK ABOUT THIS SUBJECT IS THAT,
OPIOID PRESCRIPTIONS ARE FALLING
OVER THE LAST FOUR OR FIVE YEARS
YEARS.
THERE'S FAR FEWER PEOPLE PRE
PRESCRIBEED TO OPIOIDS.
I DO THINK IT'S A GOOD IDEA TO 
GET THE DATA ON OPIOIDS THAT WE 
CAN GET AND WE CAN SHOW YOU THAT
DATA.
THAT'S ONLY ONE PART OF THE 
STORY.
COMBINEING THAT DATA WITH THINGS
LIKE OVERDOSE DEATHS IT'S 
IMPORTANT TO THE PUBLICATION.
>> WE HAVE QUESTION REGARD TO 
PATENTS.
CAN YOU PROVIDE INFORMATION ON 
DECLINE IN NUMBER OF PATENTS.
IF YOU LOOK AT THE GRAPH, YOU'LL
SEE HUGE DECLINE IN THE NUMBER 
OF PATENTINGS ISSUEED SINCE 2014
IN THE REGION.
WHILE WE DON'T HAVE GOOD ANSWER 
FOR WHY WE'VE SEEN THIS DECLINE 
BECAUSE IT IS SEEFER AS SEVERE 
AS IT IS.
NUMBER OF PATTERNS FALLEN AND 
INSTITUTIONS ISSUEING THESE 
PATENTS HAVE DECLINEED DRAMATIC
DRAMATICALLY.
THIS IS ON THE FACT THAT WE 
MIGHT WANT TO MORE R&D RESOURCES
TOWARD THIS AREA IF YOU WANT TO 
HAVE FUTURE GROWTH NOT ONLY IN 
INNOVATION BUT THE ECONOMIC 
BENEFITS THAT MIGHT COME FROM 
THE R&D INVESTMENTS.
>> SOMEONE ASKED ABOUT THE 
REASON FOR THE DECLINE IN 
EXPENDITURES.
IS POSSIBLE AVERAGE EXPECT 
DECLINE DUE TO INSURANCE COMPANY
COMPANIES PAYING HOSPITALS LESS?
IT'S POSSIBLE.
WE CAN'T STAY WHAT'S REALLY 
DRIVEING THIS.
WHAT ENTAILS EXPENDITURES, IT'S 
PRICE, QUANTITY AND UNDERLINEING
CONDITION OF THE PEOPLE WHO ARE 
DIAGNOSEED WITH THESE CONDITIONS
.
ANY ONE OF THOSE THINGS COULD 
EXPLAIN THIS.
IT COULD BE THAT THE PRICE IS 
CHANGEING.
WHERE WE ABLE TO HOLD GROUP OF 
PEOPLE CONSTANT YEAR TO YEAR.
THAT WILL EXPLAIN THE DECLINE IN
EXPENDITURES FOR CORONARY ARTERY
DISEASE.
THERE MAYBE OTHER EXPLANATIONS 
THAT ARE INVOLVEED WITH THAT TOO
.
THANK YOU VERY MUCH.
[APPLAUSE]
>> WE ARE GOING TO ASK OUR 
PRESENTERS TO COME UP HERE AND 
DIANE WILL PUT THEIR CARDS DOWN.
WE WILL GO ALPHABETICALLY SO WE 
CAN DO IT IN THAT ORDER.
I HAVE THE DISTINCT PLEASURE OF 
INTRODUCEING TODAY'S EXPERT 
PANEL
PANELIST.
WE ARE FORTUNATE TO HAVE THIS 
ESTEEMED GROUP.
EACH PANEL MEMBER HAS 
OUTSTANDING ACCOMPLISHMENTS, 
MULTIPLE AWARDS AND AN SENTENCE 
EVERY RESUME.
I CAN GO ON FOREVER.
I'M NOT GOING TO.
TO MAXIMIZE MY TIME OUR TIME, 
I'M GOING TO GO OVER THE BASIC 
PIECES ABOUT THEM.
YOU'LL SEE FROM THEIR 
PRESENTATIONS HOW MUCH EXPERT 
THEY ARE.
LY GO
OUR FIRST PANELIST IS ROB
CASALO
CASALOU.
COMBINEED TRINITY HEALTH, 
MICHIGAN HAS TEN OUTPATIENT 
HEALTH CENTERS, 12 EMERGENCY 
DEPARTMENTS, 17 URGENT CARE 
FACILITY AND EMPLOYS MORE THAN 
20,000 INDIVIDUALS INCLUDEING 
APPROXIMATELY 3600 PHYSICIANS.
ROB JOINED ST. JOSEPH IN 2008 AS
PRESIDENT AND CEO OF BOTH ST. 
JOE'S MERCY ANN ARBOR HOSPITALS.
WHICH MADE THE TOP
100 TOP 
HOSPITAL LIST SEVEN TIMES UNDER 
HIS LEADERSHIP.
IN 2015 HE WAS NAMEED REGIONAL 
PRESIDENT AND CEO OF ST. JOES.
ROB IS RECOGNIZEED AS NATIONAL 
LEADER IN HIS QUALITY IN 
COMPASSIONATE CARE.
HE EARNED BACHELOR OF ARTS IN 
ECONOMICS A MASTERS IN BUSINESS 
ADMINISTRATION AND A MASTERS OF 
HEALTH SERVICE ADMINISTRATION 
FROM THE UNIVERSITY OF MICHIGAN.
OUR SECOND PRESENTER WILL BE
TINA FREESE DECKER WHO IS 
PRESIDENT AND CEO OF SPECTRUM 
HEALTH SYSTEM.
$6.5 BILLION NATIONALLY 
RECOGNIZEED HEALTH SYSTEM THAT 
INCLUDES A MEDICAL GROUP, HEALTH
INSURANCE COMPANY AND MULTIPLE 
HOSPITALS.
TINA IS FOCUSED ON GROWTH, 
INNOVATION AND STRENGTHENING 
COMMUNITY PARTNERSHIPS TO BEST 
ADDRESS IMPROVEMENT GOALS ACROSS
MICHIGAN.
DURING HER 16 YEARS SERVEING 
SPECTRUM HEALTH, TINA HAS 
DEVELOPED A STRONG REPUTATION OF
HER FORWARD THINKING AND STRONG 
BUSINESS PRACTICE.
TODAY, TINA IS THE PROUD 
RECIPIENT OF THE MODERN 
HEALTHCARE TOP 25 CEO IN 2018.
SHE EARNED BACHELOR OF SCIENCE 
FROM IOWA STATE UNIVERSITY AND 
GRADUATEED WITH A MASTERS OF 
HEALTH ADMINISTRATION AND 
INDUSTRIAL ENGINEERING FROM 
UNIVERSITY OF IOWA.
OUR FINAL SPEAKER WILL BE DR. RA
DR. RAKES
H PAI.
AWARD-WINNING LEADER IN 
COMMUNITY HEALTHCARE.
METRO SERVES 250,000 PATIENTS 
ACROSS WEST MICHIGAN AND BEYOND.
DR. PAI IS A CARDIOLOGIST WITH 
CERTIFICATION IN
-- HE PRACTICEED 
IN IDAHO, NEVADA AND OREGON 
WHERE HE SERVEED AS EXECUTIVE 
MEDICAL DIRECTOR FOR BLUE CROSS 
BLUECROSS 
BLUESHIELD.
HE IS A FELLA WITH THE AMERICAN 
COLLEGE OF
CARDIOLOGY.
HIS MEDICAL DEGREE IS FROM THE 
NEW MEXICO SCHOOL OF MEDICINE.
HE COMPLETEED MASTERS IN 
BUSINESS 
ADMINISTRATION AT THE UNIVERSITY
OF TENNESSEE HAS
HASLEM COLLEGE OF 
BUSINESS.
PLEASE WELCOME
ROB TO THE POLAND PODIUM
PODIUM.
>> 
GOOD MORNING.
IT IS A PLEASURE FOR ME TO BE 
HERE AND PARTICULARLY WITH MY 
COLLEAGUES DR. PAI AND TINA.
ONE NOTE ON TRINITY HEALTH.
TRINITY HEALTH IS ONLY NATIONAL 
HEALTH CENTER HEADQUARTERED IN 
THE STATE OF MICHIGAN.
IT'S ONE OF OUR LARGER REGIONS 
AND
LAVONIA IS OUR NATIONAL HOME
HOME.
IT'S BEEN GREAT TO JOIN THIS 
FAMILY AND I'M NOT GOING TO 
SPEND MUCH TIME TALKING ABOUT 
COMMERCIAL AROUND OUR SYSTEM OR 
ABOUT WHAT WE'RE HERE FOR TODAY.
THAT'S A FORECAST.
COUPLE OF DISCLOSURES LIKE TO 
START WITH.
I SAID THIS IN OTHER AUDIENCES.
WHEN YOU'RE IN CAREER PATH IN 
HEALTH AND HOSPITAL 
ADMINISTRATION, YOU HOPE THAT 
YOU'LL READ THINGS BETTER WHEN 
YOU START IT.
I WOULD SAY IN TERMS OF OUR 
ORGANIZATION AS A BUSINESS AND 
THE HEALTH SYSTEMS THAT WE RUN, 
THERE'S BEEN LOT OF SUCCESS.
REALLY, I WOULD DECLARE THAT I'M
LITTLE FRUSTRATEED AND EMBARRASS
EMBARRASSED THAT IN THE 25 YEARS
THAT I'VE BEEN LEADING 
ORGANIZATION THE COMMUNITIES WE 
SERVE.
YOU SAW THE STATISTICS EARLIER, 
THEY ARE NOT AS HEALTHY AS WHEN 
WE STARTED.
THAT'S NOT ANYTHING ANY OF US 
WANT TO PUT IN OUR RESUME.
WE WANT TO ENJOY THOSE THINGS 
THEY LOOK FORWARD TO.
THAT'S WHAT I HOPE WE'RE IN THE 
BUSINESS TO DO.
I DO ALIGN WITH TRINITY'S 
MISSION TO BE A TRANSFORMING AND
HUMAN PRESENCE IN THE 
COMMUNITIES WE SERVE.
IT INCLUDES PERSONAL HEALTH BUT 
ALSO INCLUDES THE LOCAL ECONOMY
ECONOMIES THAT WE RESIDE IN.
A FEW ASSERTIONS THAT I ALSO 
MAKE BEFORE I GET TO THE 
FORECAST, THE LANDSCAPE IS 
CHANGE.
THIS IS AN OBVIOUS STATEMENT 
HERE.
THE LANDSCAPE IS CHANGEING.
ALL OF US WHO HAVE A THEORY WILL
LINE UP AGAINST SOMEONE ELSE WHO
HAS A DIFFERENT THEORY.
IT'S REALLY BEEN VERY HARD TO 
KEEP UP WITH WHETHER IT'S ON 
POLICY SIDE IN WASHINGTON OR 
JUST THE CONSUMER SIDE, I THINK 
THE LAWS OF ECONOMICS HAVE 
FINALLY ARRIVEED IN OUR INDUSTRY
BECAUSE IF YOU LOOK AT OUR 
INDUSTRY, DATEING BACK, WE 
DESIGN
DESIGNED THE U.S. HEALTH SYSTEM 
AROUND LEGISLATION FOR 70 YEARS.
THAT LEGISLATION WAS BASICALLY 
DICTATEING HOW WE GOT PAID.
WE DESIGN OUR SYSTEMS TO DO 
GREAT JOB GETTING PAID VERY WELL
WELL.
PARTICULARLY ON SICK CARE.
WHEN WE LOOK AT WHAT'S THE 
PRODUCT PEOPLE WANTED TO BUY, 
NOT SURE WE DELIVERED ON THAT.
I'M NOT SURE PEOPLE WANT TO BUY 
HOSPITAL CARE AND HEALTHCARE AND
SICK CARE.
WE'VE DONE REALLY GOOD JOB.
SOME OF THE NUMBERS WE SHOWN IN 
TERMS OF OUR EXPENSES AS A 
COUNTRY AND YOU CAN SEE ON THE 
LAST BULLET POINT, WE GOT AWAY 
WITH THINGS UNTIL WE STARTED 
CONSUMEING TOO MUCH OF THE 
COUNTRY'S GROSS DOMESTIC PRODUCT
PRODUCT.
WHEN YOU START HITTING 20% OF A 
NATION'S GDP, YOU'RE BECOMEING A
BURDEN TO BUSINESS, YOU'RE 
BECOMEING A BURDEN TO CONSUMERS.
THE AC SARKS ALWAYS A -- AC 
SARKS ALWAYS
CA IS ALWAYS A 
HOT TOPIC.
IT WAS NOT A CATALYST CHANGE.
IT WAS A LAW CREATEED IN 
RESPONSE 
TO UNDENYIABLE ECONOMIC ISSUES
IN 
OUR COUNTRY.
FEW QUESTIONS THAT I PONDER.
IS OUR NEW FAVORITE TERM 
POPULATION HEALTH, IT'S ABOUT 
THE ECONOMICS OF HEALTHCARE OR 
ABOUT TRULY IMPROVEING THE 
HEALTH 
OF THE POPULATION.
ANOTHER WAY, ARE WE DEVELOPING 
STRATEGYIES FOR OUR HOSPITALS 
AND 
HEALTH SYSTEMS.
THOSE OF US WHO APPEAR AND OTHER
OTHERS IN THE ROOM AND COUNTRY, 
HOW TO SURVIVE THE TRANSITION 
AND MAKE A AMERICAN MARGIN 
AROUND 
POPULATION.
I THINK THAT'S A QUESTION WE ALL
HAVE TO LOOK IN THE MIRROR AND 
ANSWER.
ARE WE TRYING TO SURVIVE THE 
TRANSITION, OR WE MAKING A 
DIFFERENCE IN POPULATION.
THERE'S AN ECONOMIC DEFINITION 
FOR ALL THE ECONOMYIST HERE.
IF YOU'RE A PRODUCT THAT NOBODY 
WANTS TO BUY BUT YOU'RE A 
PRODUCT THAT PEOPLE NEED, YOU'RE
OIL.
YOU'RE A COMMODITY.
HEALTH SYSTEM HAVE A HARD TIME 
ACCEPTING THAT, SOME WAYS 
PRODUCT NOBODY WANTS TO BUY BUT 
WERE NEEDED.
IT'S HARD TO LOOK IN MIRROR AND 
SAY, WE MIGHT BE COMMODITIZE IN 
A FUTURE HEALTH DELIVERY SYSTEM.
THESE ARE PROVOCATIVE QUESTIONS 
I CAN LIKE TO ASK THAT THESE 
SETTINGS.
HOW RER WEARE WE DOING WITH THE 
POPULATION HEALTH?
YOU SAW SOME STATISTICS.
HAD WE DEVELOPED CULTURE OF 
HEALTH IN OUR LOCAL COMMUNITIES?
SEE SOME DISPARITYIES BETWEEN 
EAST AND WEST MICHIGAN.
I WOULD HAVE LOVE THE SLIDE THAT
OVERLAID THE ISSUES AND SOCIAL
HEALTH.
WHEN YOU LOOK AT OTHER COUNTRY
IES 
THAT HAVE DECIDEED TO -- I'M NOT
HERE TO PROEM MED CARRY FOR ALL,
I'M NOT DOING THAT.
SOME COUNTRYIES DECIDEED TO 
NATIONALIZE THEIR HEALTH SYSTEMS
SYSTEMS.
IF YOU LOOK AT THE COST, VERY 
LOW IN LOT OF THOSE COUNTRYIES.
THEY INVEST HEAVYILY IN SOCIAL 
DETERMINE
DETERMINANTS.
IF THE UNITED STATES IS THE MOST
EXPENSEIVE COUNTRY IN THE WORLD 
FOR HEALTHCARE, ARE WE NUMBER 
ONE IN HEALTH?
NO.
WE'RE WAY DOWN THE LIST.
WE'RE NOT GETTING WHAT WE'RE PAY
PAYING FOR.
WHY AM I ASKING YOU THESE 
QUESTIONS THAT YOU HAVE ANSWER 
TO.
I THINK IT'S BECAUSE WE KNOW 
WHAT'S HAPPENING, AND WE EITHER 
DON'T KNOW WHAT TO DO, WE DON'T 
CARE -- I DON'T THINK THAT'S THE
CASE -- WE FIGURE WE KEEP TREAT
TREATING ILLNESS AND MAKE A GOOD
LIVE DOG IT OR WE KEEP FAILING 
TO CHANGE THE DETERIORATEING 
HEALTH IN THE POPULATION.
I'M AGAIN TO BLOW THIS ONE.
WE TALK
ED ABOUT OBESITY.
WHEN YOU SEE BIG HIKE IN OBESITY
BACK IN THE '70s, INFORMATION 
ENEMY 
THEN
1976 MacDONALD 
1976 McDONALD'S INTRODUCEED 
SUPER SIZE.
OUR WRAP SHEET ISN'T LOOKING 
GOOD.
I THINK RIGHT NOW WE KNOW HEALTH
IS COSTLY.
PARTICULARLY POORLY HEALTH.
YOU CAN SEEM OF THE NUMBERS HERE
EVEN AS A PERSON WHO DOESN'T 
EXERCISE, HIGHER COST.
DIABETES ALONE, 33% OF ADULTS 
WITHOUT HIGH SCHOOL DEGREE ARE 
OBESE.
WE GO BACK TO SOCIAL DETERMINANT
DETERMINANTS.
EDUCATION AND POVERTY.
33% OF ADULTS EARN LESS THAN 15K
PER YEAR ARE OBESE COMPAREED TO 
25% EARN LEAST $50,000.
THERE'S RACE DISPARITYIES AS 
WELL
WELL.
MY LAST SLIDE ON THE FORECAST.
I THINK RIGHT NOW I'M STILL SEE
SEEING MEDICAL ARMS RACE AMONGST
ALL THE HEALTH SYSTEM WHO 
COMPETE.
PART OF THAT IS STILL INVESTING 
IN THE ACUTE SIDE OF CARE AND 
PUTTING OUR BILLBOARDS UP ON THE
LATEST TECHNOLOGYIES WE HAVE.
I THINK I STILL SEE THAT.
I SEE IT SHIFTING LITTLE BIT.
OUR BALANCE SHEETS WHICH LOT OF 
US WERE LARGELY FULL OF BRICKS 
AND MAR
MARTYR
MORTAR HOSPITALS.
ONE COMMENT ON PHYSICIAN COMMENT
-- I LIKE THE ANSWER.
MICHIGAN IS PARTICULARLY STRESS
STRESSED IN GETTING PEOPLE TO 
LIVE HERE AND ALSO INCOMES ARE 
HARD TO MAINTAIN IN MICHIGAN 
COMPAREED TO OTHER STATES.
THEY COME TO MAINTAIN 
COMPETITIVENESS.
HAVING SAID THAT, LIKE IN 
TRINITY, MICHIGAN WE'RE GOING TO
OPEN
17 NEW AMBULATORYIES.
PAYERS AND PROVIDEERS.
WE HAVE BLUE CROSS AND PRIORITY 
IN THE RAM TODAY.
PAYERS AND PROVIDEERS ARE TRYING
TO FEEL CLOSURE OUT HERE WHAT 
THE FUTURE WILL LOOK LIKE.
WHO THE PRIMARY RELATIONSHIP 
WITH THE PATIENT?
IS IT THE INSURER OR THE PROVIDE
PROVIDER?
THAT ANSWER VARYIES DEPENDING 
AND 
IT'S ANSWERED BY ALL OF US 
INDIVIDUALLY BUT BUSINESS MODELS
TRYING TO VIE FOR THEIR POSITION
IN THIS NEW ERA.
INDUSTRY CONSOLIDATION MEANING 
HEALTH WILL CONTINUE.
WE'VE SEEN LOT OF IT HERE IN 
WEST MICHIGAN.
LOT OF INDEPENDENT HOSPITALS 
JOINING OTHER HOSPITALS, 
SPECTRUM, AND OTHERS, EAST 
MICHIGAN, SAME THING.
I THINK THAT WILL CONTINUE AS 
STAND ALONE HOSPITALS AND STAND 
PLAN PRACTICES HAVE HARD TIME 
SURVIVING ON THEIR OWN.
WE DIDN'T TALK ABOUT THE NEW 
ENTRANCE.
THEY HAVEN'T BEEN ABLE TO 
MEASURE THEIR IMPACT YET.
WAIT UNTIL AMAZON AND GOOGLE GET
GOING.
THEY WILL FOCUS ON COST AND 
FOCUS ON SERVICE I THINK THEY'RE
GOING TO PUT HEALTH SYSTEMS IN 
BULL'S EYE APPROPRIATELY SO BY 
THE WAY.
I THINK THEY ARE GOING TO BRING 
A NEW VALUE.
WE HAVE TO FIGURE OUT HOW TO 
WORK WITH THOSE DISRUPTTORS THAT
ARE COMEING IN.
EMPLOYERS, SOME OF YOU -- I 
THINK EMPLOYERS, BEYOND LOSS 
PATIENCE WITH THE COST OF CARE.
NOW THEY'RE LOOKING AT 
EVERYTHING THEY CAN DO TO LOWER 
HEALTHCARE COST.
SHIFTING BURDEN TO THEIR 
EMPLOYEES NOW DIRECT CONTRACTING
IS BECOMEING MUCH MORE PREVALENT
.
CUTTING OUT THE MIDDLE MAN GOING
STRAIGHT TO A PROVIDEER AND 
PROVIDE LIMITED CHOICE.
I WILL MOVE ALL THE RISK TO THE 
PROVIDEERS.
THIS GOING TO PROBABLY BE THE 
ONE THING YOU SEE FOR STANDING 
HERE YEAR FROM NOW, THERE'S BEEN
LOT OF TRACTION.
WITH THAT, I'LL STOP AND TURN TO
OVER TO TINA.
[APPLAUSE]
>> GOOD MORNING.
I'M PLEASEED TO BE HERE TODAY 
WITH YOU.
I'M TINA FREESE DECKER AND 
PRESIDENT AND CEO OF SPECK 
SPECTRUM.
I'M EXTREMELY PROUD OF ALL OUR 
PHYSICIANS AND CAREGIVERS AND 
TEAM MEMBERS AND HOSPITALS AND 
INSURANCE PLANS.
WE ARE MORE THAN JUST THE 
HOSPITAL AND HEALTH.
WE ARE TRANSFORMING AND CHANGE 
THE WAY CARE IS DELIVERED.
WE WANT TO MAKE SURE IT'S 
PERSONALIZED AND SIMPLE, AFFORD
AFFORDABLE AND EXCEPTIONAL TO 
MEET ALL THE TRENDS THAT ROB 
JUST TALKED ABOUT.
WE SEE THOSE FORCES COMEING 
FORWARD.
WE NEED MAKE SURE THAT WE CAN DO
WHAT WE NEED TO DO TO IMPROVE 
THE HEALTH OF OUR COMMUNITYIES 
THAT WE SERVE HERE.
IT'S VERY IMPORTANT THAT WE ARE 
TRANSFORMING FROM NOT JUST 
TRADITIONAL HOSPITAL TO HEALTH 
SYSTEM, IT'S REALLY FOCUSED ON A
HEALTHYIER YOU.
TO DO THAT, WE ARE REALLY FOCUS
FOCUSED ON HOW WE GET OUR 30,000
PEOPLE TOGETHER IN A UNIFYING 
APPROACH AND PURPOSE.
WE'RE SPENDING LOT OF TIME ON 
CULTURE.
I BELIEVE THAT TO PROVIDE THE 
BEST CARE AND THE BEST COVERAGE,
WE MUST HAVE THE BEST CULTURE 
AND THE BEST ENVIRONMENT TO DO 
SO.
OUR FOCUS IS ON CREATEING THAT 
CULTURE.
KEY ELEMENT OF THE CULTURE THAT 
WE'RE FOCUSING ON IS 
COLLABORATION.
AS I STARTED THIS ROLE FOR THE 
PAST FOUR MONTHS, I FOCUSED ONLY
OUR CULTURE, TRUST IN 
TRANSPARENCY AND CULTIVATEING 
THE 
FINEST TALENT.
THE COMMON ELEMENT IS HOW WE 
WORK TOGETHER, SHOWING THAT 
VULNERABILITY AND WORKING 
TOGETHER AND CREATEING THAT 
COLLABORATION.
TRUST AND TRANSPARENCY WILL 
EMPOWER THE COLLABORATION HAVING
PEOPLE REALLY WORKING TOGETHER 
ON A COMMON GOAL WILL CONTINUE 
TO EMBRACE AND FUEL MORE 
COLLABORATIONS AS WE GO FORWARD.
WE WANT TO ENSURE THAT WE HAVE 
COLLABORATION THAT'S BOTH 
INTERNAL AND EXTERNAL BECAUSE 
THAT WILL HELP US MOVE MUCH FAST
FASTER IN ADDRESS THE HEALTH 
NEEDS OF OUR COMMUNITY.
TODAY I WANTED TO HIGHLIGHT FEW 
AREAS OF COLLABORATION.
I THINK ARE A SUCCESSFUL BUT WE 
NEED TO CONTINUE TO MOVE FORWARD
WITH THOSE.
THE FIRST ONE IS OUR 
COLLABORATION, OUR COMMUNITY 
COLLABORATIVE ON INFANT MORE IT 
WILLTY IT 
WILL 
MORTALITY.
THIS IS STRONG COMBINATION 
PROGRAM.
IT'S ONE WE'VE COME TOGETHER TO 
WORK WITH MOTHERS AND FATHERS 
AND THEIR BABYIES TO REDUCE THE 
INFANT MORTALITY RATE.
WE HAVE BEEN SUCCESSFUL IN THIS.
YOU CAN SEE ON THE CHART THAT IT
GOES DOWN
1.93 TO 1.2.
THAT ENEMYIES WE HAVE LIMITED 
DISPARITY AFRICAN-AMERICAN 
INFANT MORTALITY AND CAUCASIAN 
WOMEN.
THAT'S SUBSTANTIAL TO DO THAT IN
THE LAST 10 YEARS.
PART OF THIS IS BECAUSE WE'VE 
WORKED TOGETHER TO PUT
PEER 
SUPPORT GROUP AND ENGAGE WITH 
BEST PRACTICES.
THIS NUMBER SHSOMETHING WE 
SHOULD CONTINUE TO PUSH TO DRIVE
DOWN.
WE NEED TO DRIVE DOWN THE TOTAL 
INFANT
MORTALITY.
ONLY 46% OF THE PEOPLE ARE IN 
THIS PROGRAM.
WE NEED TO ENGAGE MORE THEME 
THAT PROGRAM.
THIS IS AN AREA WHERE 
COLLABORATION HAS REALLY HELPED 
US BECAUSE WE'VE JOINED TOGETHER
ACROSS OUR HEALTH SYSTEMS TO 
MAKE SURE WE'RE MAKING AN IMPACT
CONNECTING ON THE HEALTH.
THE OTHER AREA THAT'S REALLY KEY
IN OUR COMMUNITY IS OPIOIDS.
WE MENTIONED IT TODAY IN THE 
DISCUSSION.
WE'RE FOCUSING ON HOW TO DO WE 
ADDRESS THAT NATIONWIDE CRISES 
HERE.
WE RECOGNIZEED THAT THIS IS A 
BIG 
ISSUE.
I RECOGNIZE SPECTRUM CANNOT DO 
THAT ALONE.
IT TAKES ALL OUR PARTNERS.
MANY US AT THE TABLE HERE HAVE 
WORKED TOGETHER TO PUT TOGETHER 
BEST PRACTICES, EDUCATION AND 
TOOL KITS TO ADDRESS THE ISSUES.
WE ARE COMEING OUT WITH INTERNAL
SCORE CARDS.
WE BETTER UNDERSTAND THE 
PRESCRIPTION PATTERNS OF OUR 
PROVIDEERS AND GIVE THEM 
EDUCATION HOW TO IMPROVE.
WE HAVE COLLABORATEED ON HOW WE 
USE OUR RESPECTIVE MEDICAL 
RECORD SYSTEMS TO MAKE SURE WE 
DON'T PRESCRIBE MEDICATIONS FOR 
LONGER THAN SEVEN DAYS.
WE'RE IMPLEMENTING ACROSS THE 
EMERGENCY DEPARTMENTS THE 
ALTERNATIVE TO OPIOIDS PROCESS 
SO WE LIMIT THE OPIOIDS.
AS I SAID EARLIER, THAT'S JUST 
ONE ASPECT OF OUR STRATEGY TO 
ADDRESS THE OPIOID CRISES.
IT'S ONE THAT WE CAN WORK 
TOGETHER ON AND COLLABORATE.
YOU CAN SEE IN THE CHART HERE, 
IT SHOWS PRIORITY HEALTH MEMBERS
UTILIZEING OPIOIDS FOR THE LAST 
NINE MONTHS.
THE TREND GOING DOWN.
I DON'T HAVE THE DEATH 
INFORMATION FOR THIS, WE TALKED 
ABOUT IT EARLIER, I THINK THIS 
IS A KEY MEASURE TO SHOW THE 
LEADING TRENDS IN HOPEFULLY THE 
LAGGING TRENDS WITH SHOW THE 
DEATH RATES AND MORTALITY WILL 
FOLLOW THE SAME TREND.
WE NEEDED TO DO THIS 
COLLABORATIVELY WITH ALL OUR 
PARTNERS HERE.
WE HAVE TO BE FOCUSED ON THE 
SAME THING TO ADDRESS THE HEALTH
ISSUES OF OUR COMMUNITY.
THIS IS ONE AREA THAT WE'RE 
FOCUSING ON AS WELL AS 
BEHAVIORAL HEALTH.
BECAUSE IT TAKES ALL OF US TO DO
THAT.
I WANT TO FOCUS ON COSTS.
IF YOU TALK TO ANYBODY IN 
HEALTHCARE, ROB'S PRESENCE HIT 
IT RIGHT, THE COST OF HEALTHCARE
IS UNSUSTAINABLE.
IT'S COMPLETELY UNAFFORDABLE FOR
PEOPLE TO ADDRESS COSTS.
THIS WILL TAKE THE BEST MINDS 
COMEING TOGETHER TO REALLY THINK
ABOUT HOW TO DO WE REDUCE THE 
COST OF CARE.
AN EXAMPLE THAT I WANT TO SHOW 
YOU SPECTRUM HOME-BASEED CARE.
WE'VE WORKED IN A COLLABORATIVE 
MANNER IN OUR COMMUNITY, THAT 
HAVE REALLY FOCUSED ON HOW TO 
APPLY BEST PRACTICES TO REDUCE 
THE COST OF CARE.
THIS IS SPECIFICALLY FOR 
POPULATION THAT IS THE HIGHEST 
COST POPULATION, THE FRAIL, 
ELDERLY, THOSE WHO HAVE CHRONIC 
DISEASES.
WHAT HAPPENS THEY GO INTO THE 
EMERGENCY DEPARTMENT, THEY 
DIDN'T GET ADMITTED AND THAT 
FOLLOWS EVERY FEW WEEKS.
OUR FOCUS IS LET'S GET IN EARLY,
LET'S GET ENGAGEED WITH THIS 
POPULATION SO WE CAN MAKE SURE 
THAT WE CAN DO THINGS 
APPROPRIATELY.
NOW THEY HAVE ACCESS TO EVERY 
WEEK, SOMEONE VISITS THEM IN 
THEIR HOME AND IF THEY DO HAVE 
AN ISSUE HEALTH ISSUE THEY CALL 
24 
HEALTH ACCESS.
AS YOU CAN SEE FROM THE RESULTS 
WE HAVE DECREASEED UTILIZATION 
AND INCREASEED SATISFACTION AND 
INCREASEED OUTCOMES AND DECREASE
ED 
THE COST.
THIS PROGRAM AS WELL AS OTHER 
PROGRAMS WE HAVE FOR HOME-BASEED
CARE OR TRYING TO REDUCE COST, 
WE'RE SHAREING THE BEST PRACTICE
S 
BECAUSE WE ALL NEED TO LEARN 
TOGETHER TO MAKE A DIFFERENCE 
AND GET TOTAL COST OF CARE FOR 
OUR COMMUNITY.
THIS IS ONE EXAMPLE OF LOW TECH,
HIGH-TECH THAT IS REDUCEING COST
.
IN EXAMPLE OF HIGH-TECH IS
OUR 
CARDIOVASCULAR SIMULATION LAB.
IT'S WHERE OUR RESIDENTS AND 
FELLOWS CAN COME TOGETHER TO 
LEARN THAT BEST TECHNIQUES AND 
PRACTICE ON CUSTOMIZES MANNEQUIN
MANNEQUINS TO DO
THEIR CRAFT 
WELL.
WE LEARNED WHAT ROLES PEOPLE 
NEEDED TO PLAY, WE LEARN HAD 
EQUIPMENT WE SHOULD USE OR NOT 
USE AND THEN THE FOLLOWING DAY, 
WHEN WE WENT INTO THE OR, WE 
WERE SO MUCH MORE CONFIDENT 
BECAUSE WE ALREADY PERFORMED THE
PROCEDURE ON THE PATIENT'S 
ANATOMY.
WE WERE ABLE TO DO IT LESS TIME 
AND LESS EQUIPMENT TO REDUCE THE
COST OF CARE.
THAT'S EXAMPLE USEING INNOVATION
AND MAKING SURE WE'RE DOING IT 
RIGHT AND REDUCE THE COST OF 
CARE.
I THINK THIS INNOVATION, THIS 
WORK ON SOCIAL DETERMINANTSFUL 
HEALTH, WORK ON ENGAGEING OUR 
PEOPLE WHAT WE'RE DOING IS IMPER
IMPERATIVE AS WE GO FORWARD.
THERE'S SO MANY TRENDS COMINGING
AT 
US.
OUR FOCUS IS TO MAKE SURE WE 
IMPROVE HEALTH TO INSPIRE HEALTH
AND SAVE LIVES.
WE BELIEVE TO DO THAT, WE HAVE 
TO PROVIDE MORE PERSONALIZED 
HEALTH APPROACH.
ONE THAT IS SIMPLE, ONE THAT IS 
AFFORDABLE.
REALLY LOOKING AT COST OF 
HEALTHCARE.
ONE THAT'S EXCEPTION EXCEPTION 
EXCEPTIONAL.
WE DEMAND TO MAKE SURE WE HAVE 
THE HIGHEST OUTCOME POSSIBLE.
THIS GOING TO BE VERY HARD TO DO
DO, IT'S GOING TO TAKE LOT OF 
TIME, EFFORT, PERSEVERANCE AND 
COLLABORATION, I BELIEVE WE HAVE
THE RIGHT TOOLS, TECHNOLOGY AND 
PEOPLE HERE BECAUSE WE ARE 
UNIQUE IN OUR COMMUNITY WHERE WE
WANT TO COLLABORATE WITH OTHERS 
TO DRIVE THIS FORWARD AND MAKE 
IT HAPPEN.
I THINK THAT COLLABORATION IS 
THE KEY ELEMENT OF THIS.
HOW WE'RE GOING TO MAKE A 
DIFFERENCE AND HOW THIS 
COMMUNITY CAN MOVES FORWARD TO 
BE SUCCESSFUL.
I USUALLY QUOTE SOMEBODY, I WILL
QUOTE MOTHER THERESA.
I BELIEVE YOU CAN DO WHAT YOU 
CANNOT DO I CAN DO WHAT YOU 
CANNOT DO.
BUT TOGETHER WE CAN DO GREAT 
THINGS.
THAT'S THE POWER OF 
COLLABORATION.
THANK YOU.
[APPLAUSE]
>> GOOD MORNING EVERYONE.
I'M NEW TO THE WEST MICHIGAN 
AREA.
I STARTED MY POSITION AROUND THE
TIME THAT TINA WAS APPOINTED CEO
CEO.
WHAT A GREAT TURN OUT TODAY.
IT'S EXCITEING TO BE HERE.
I'M GOING TO BE TALKING ABOUT 
THE CALCULATEING VALUE IN 
HEALTHCARE.
THE IMPORTANCE OF THE CONSUMER 
EXPERIENCE.
IT'S GOING TO BE MAYBE LITTLE 
BIT DIFFERENT COMPAREED TO MY 
PREDECESSOR.
THIS IS THE HEALTHCARE BUZZ.
I TELL AUDIENCES WHEN 9/11 FRONT
OF LARGE 9/11 -- I'M IN 
FRONT OF LARGE GROUPS LIKE THIS.
THERE'S NO BETTER TIME TO BE 
BORN IN THE UNITED STATES THAN 
TODAY.
I THINK OF POPULATION HEALTH AS 
EMERGENCY THIS FULL OF DIABETICS
HOW WE MAKE SURE EVERYONE GET 
THE RIGHT CARE AT THE RIGHT TIME
AND DOESN'T FALL THROUGH THE 
CRACKS.
DIABETES IS A VERY CHRONIC 
CONDITION IF IT'S LEFT UNTREATED
FOR YEARS, YOU CAN END
UP RENAL 
DISEASE.
THAT IS ONE OF THE MOST EXPENSE
EXPENSIVE DISEASES.
MAKING SURE EVERYONE GETS THE 
RIGHT CARE IS REALLY IMPORTANT.
I THINK THE OTHER TWO BULLET 
POINTS HERE ARE VERY IMPORTANT.
SUPER EXCITEING.
ONE WILL BE THE
GENOMEIC 
REVOLUTIONER.
WE CAN TAKE THE PATIENT'S 
GENETIC MATERIAL, KNOW WHAT 
MUTATIONS THEY HAVE AND OFFER 
THEM TREATMENT BASEED ON THEIR 
GENETIC MUTATION.
THAT'S VERY EXCITEING FOR 
HEALTHCARE.
THIS ISN'T GOING TO JUST BE KIND
OF DOWN THE ROAD A NUMBER OF 
YEARS FROM NOW.
THESE CONCEPTS ARE COMEING TODAY
.
WHAT ARE SOME OF THE TRENDS IN 
HEALTHCARE?
I THINK A -- HEALTHCARE IS THE 
LARGEST SECTOR IN OUR ECONOMY, 
OVER $3.5 TRILLION IS SPENT ON 
HEALTHCARE CONSUMEING TO 20% 
ALMOST OF GDP.
IT GETS LOT OF PRESS.
I THINK SOME THINGS ON THE LEFT 
ARE SUPER EXCITEING.
WE'LL TALK ABOUT THIS "NEW YORK 
TIMES" ARTICLE IN MORE DETAIL 
ABOUT WHY THE U.S. SPENDS SO 
MUCH MORE ON HEALTHCARE COMPARE
ED 
TO OTHER NATIONS.
THE BLUES AND PRIORITY AND OTHER
PAIRS IN OUR MARKET HAVE DONE 
NICE
JOB MARKETING THIS.
REGIONALLY, OPIOIDS IS A HUGE 
ISSUE.
IT'S THE FIRST TIME AMERICAN 
LIFE EXPECTANCY HAS NOT GONE UP.
IT'S DUE TO SUICIDE AND OPIOID 
OVERDOSE.
IT'S VERY UNFORTUNATE.
IT IS A HEALTH CRISES.
INTERESTINGLY, THE ARTICLE THERE
IN THE MIDDLE, MOST OPIOIDS GO 
TO PEOPLE WITH BEHAVIORAL HEALTH
CONDITIONS WHICH MAY NOT BE THE 
RIGHT GROUP OF PEOPLE TO BE 
RECEIVEING HEROIN IN A PILL.
WHICH IS WHAT OPIOIDS ARE.
IT'S NOT A BIG CITY ISSUE.
IT'S NOT JUST DETROIT PROBLEM, 
IT'S A PROBLEM HERE IN GRAND 
RAPIDS AND WEST MICHIGAN AND ALL
DELIVERY SYSTEMS AND PAYERS HAVE
TO BE AT THE TABLE TO REDUCE 
THAT.
THERE HAVE BEEN GOOD RESULTS.
I DO THINK TECHNOLOGY IS GOING 
TO BE VERY INTERESTING IN 
DISRUPTING THE HEALTHCARE 
INDUSTRY.
WE'LL TALK ABOUT THAT MORE 
DETAIL.
I THINK PATIENT GENERATEED DATA 
FROM YOUR APPLE WATCH, WHO HAS 
AN APPLE WATCH ON?
I THINK THAT'S REALLY IMPORTANT 
APPLE WATCH HAS THE ABILITY TO 
NOW RECORD A HEART TRACEING.
YOU CAN KNOW WHAT RHYTHM YOU'RE 
IN.
THAT'S SUPER EXCITEING.
AS PROVIDEERS WE HAVE TO DO 
BETTER JOB INCORPORATEING THAT 
DATA.
HOW MANY STEPS YOU ARE TAKING 
AND HOW ACTIVE YOU ARE AND WHAT 
ARE YOUR EKG TRACEING.
WE CAN GET THAT DATA IN REALTIME
REALTIME.
THAT'S SUPER EXCITEING.
THE
WE HAD OUR FIRST GENE 
THERAPY IN FALL OF 2017.
THAT DRUG COST DOLLARS FOR 
TREATMENT.
THERE'S ONE EQUATION.
IT'S AN EASY ONE.
THIS IS IT.
THE HEALTHCARE VALUE EQUATION.
I THINK THIS HELPS ARTICULATE 
THE QUADRUPLE AIM.
RIGHT CARE WITH THE RIGHT 
CONSUMER EXPERIENCE.
THIS EQUATION IS EXTREMELY
IMPORTANT.
YOU CAN HAVE A POSITIVE CONSUMER
EXPERIENCE OR YOU CAN HAVE A 
NEGATIVE CONSUMER EXPERIENCE.
IN THE NEXT SLIDE I WILL GO 
THROUGH SOME OF THESE THINGS AS 
IT RELATES TO METRO HEALTH.
ON THE QUALITY FRONT, WE'RE 
REALLY TRYING TO IMPROVE THE 
HEALTH OF OUR COMMUNITIES.
ROB AND TINA DID NICE JOB 
HIGHLIGHTING ALL THE THINGS THEY
ARE DOING.
WE'RE AT THE TABLE AS WELL.
DEPRESSION SCREENING.
IF YOU HAVE A MENTAL HEALTH 
CONDITION AND A CHRONIC DISEASE,
YOUR UTILIZATION PATTERNS GO UP.
YOU USE THE ER MORE, YOU'RE IN 
THE HOSPITAL MORE, YOU HAVE POOR
OUTCOMES WITH YOUR DISEASE 
BECAUSE OF THAT MENTAL HEALTH 
CONDITION.
WE HAVE DRAMATICALLY DRAMATIC
ALLY INCREASE 
DEPRESSION SCREENING TO REACH 
MORE AND MORE PATIENTS.
THE LAST FOUR BULLET POINTS HAVE
TO DEAL WITH MAKING SURE PATIENT
PATIENTS WITH HEART DISEASE THAT
COME TO OUR HOSPITAL GET CARE 
QUICKLY AS POSSIBLE.
TIME IS MUSCLE.
IF WE'RE ABLE TO GET THEM TO THE
LAB QUICKLY WE CAN DECREASE 
THEIR MORTALITY RATES.
WE HAVE TO GET THEM THAT EKG.
IT'S VERY IMPORTANT.
WE DRAMATICALLY IMPROVE THIS 
OVER THE LAST FIVE YEARS.
IT'S STILL SOME OF THE METRICS 
AREN'T EXACTLY 100%.
COMPREHENSIVE STROKE PROGRAM, 
WHICH DR. HAHN HIGHLIGHTED LAST 
YEAR, THAT PROGRAM HAS GROWN 
SIGNIFICANTLY.
WE'RE ABLE TO GET OUR PATIENTS 
THAT HAVE A STROKE INTO THE LAB 
WITHIN 30 MINUTES IN THAT -- AND
THAT DRAMATICALLY IMPROVES THEIR
OUTCOME.
NEXT ON COST, METRO HEALTH HAS 
DONE PRETTY GOOD JOB WITH COST 
OVERTIME.
WE WANT TO BE LOW COST LEADER.
WE'RE NOT LOW COST IN EVERYTHING
EVERYTHING.
THERE'S A RECENT ARTICLE THAT 
CAME OUT WENT LAST FEW DAYS THAT
HIGHLIGHTED SOME OF OUR COST 
WITH RESPECT TO TO TO
TO EWE MOAN
PNEUMONIA.
ININ THE UNITED STATES WE DO NOT
DO WELL WITH COSTS.
IN WEST MICHIGAN THAT NUMBER IS 
LITTLE BIT LOWER AROUND 9500.
WHY IS HEALTHCARE MORE EXPENSE
IVE 
IN THE U.S.?
THIS ARTICLE CAME OUT IN JANUARY
OF 2018 "NEW YORK TIMES" ARTICLE
ARTICLE, AARON CAROL IS 
PEDIATRICIAN AND ECONOMYIST, THE
REASON IS COST IT'S PRICES.
IT'S NOT THAT WE USE MORE 
HEALTHCARE SERVICES COMPAREED TO
GERMANY OR SWITZERLAND OR UNITED
KINGDOM IT'S THE PRICES WE 
CHARGE CONSUMERS IN THIS COUNTRY
COUNTRY.
WHY ARE THE PRICES HIGH?
I THINK THE PRICES ARE HIGH 
BECAUSE IT'S A VERY COMPLEX 
HEALTHCARE ECOSYSTEM.
IF YOU LOOK AT THE TOP, THOSE 
ARE ALL THE THINGS, ALL THE 
DIFFERENT STAKEHOLDERS THAT 
CONSUME HEALTHCARE RESOURCES.
PHARMACEUTICAL INDUSTRY AND 
KEVIN TALKED ABOUT THAT AND 
PATIENTS.
YOU CAN SEE AT BOTTOM, THOSE ARE
THE PAYING ENTITYIES, COMMERCIAL
PAYERS, EMPLOYERS WHICH ARE 
SELF-FUNDED AND MEDICARE AND 
MEDICAID.
PUTTING PRESSURE ON ALL THIS ECO
ECOSYSTEM IS ALL THIS INNOVATION
INNOVATION.
HOW DO WE PAY FOR TREATMENT FOR 
SICKLE CELL DISEASE.
THAT'S SOME OF THE PRESSURES 
THAT WE HAVE TODAY.
I THINK ONE THING THAT'S REALLY 
IMPORTANT TO FOCUS ON IS THE 
LAST PART OF THAT EQUATION.
THE EXPERIENCE.
AS WE ALL KNOW AS CONSUMERS, HOW
WE CONSUME THINGS CHANGEED 
DRAMATICALLY.
HOW WE CHECK IN FOR A FLIGHT, 
HOW WE ORDER SOMETHING ONLINE 
AND IT'S DELIVERED TO YOUR DOOR,
EXTREMELY EXCITEING.
I BROKEN DOWN HEALTHCARE JOURNEY
INTO THE PRECARE EPISODE, THE 
ACTUAL CARE DELIVERY EPISODE.
IT'S NOT NECESSARILY THE EASY 
FOR THE RIGHT PATIENT TO FIND 
THE RIGHT
TYPE OF PHYSICIAN OR 
HOSPITAL DELIVERY SYSTEM FOR 
THEM.
MOST PATIENTS FIND THAT PROVIDE
ER 
THEY HAVE CONFIDENCE IN.
THEY GET WHAT THEY NEED AND GET 
THE OUTCOMES THEY SUPPOSEED TO 
GET.
WHERE WE REALLY LACK IS THE POST
CARE EXPERIENCE.
THE CONSUMER EXPERIENCE IS 
FRAGMENTED AND IT'S CONFUSEING.
WHAT'S WRONG WITH THE POST CARE 
EXPERIENCE?
THIS IS WHAT'S WRONG WITH IT.
THE POST CARE EXPERIENCE IS VERY
NEGATIVE BECAUSE WE CAUSE 
FINANCIAL THUNDERSTORM PATIENTS.
THIS IS PATIENT -- HARM TO 
PATIENTS.
PEOPLE ARE RAISEING $650 MILLION
ON GO FUND ME FOR RYEING 
HEALTHCARE COST.
CLARITY IS NOT THE SOLUTION.
YOU GET LOT OF BILLS AFTER YOU 
GET OUT OF THE HOSPITAL AND YOU 
GET THEM FROM DIFFERENT PLACES.
SOME OF THEM SAY THEY ARE NOT 
BILLS AND THEY ARE.
IT'S VERY CONFUSEING.
IT CAN KEEP GOING MONTHS AFTER 
YOU HAD WHATEVER IT IS YOU HAD.
IT'S VERY CONFUSEING TO PEOPLE 
GO 
FUND ME IS A RESOURCE FOR THEM.
WE'RE IN THIS AWKWARD DANCE WITH
WE HAVE CARE DELIVERY.
HOW DO WE DELIVER CARE TO 
PATIENTS AND PAYMENT REFORM.
WE'VE BEEN DOING THIS DANCE FOR 
A NUMBER OF YEARS.
THE CARE DELIVERY MODEL HAS 
EVOLVEED ITSELF WITH THE CARE 
TEAM APPROACH.
PHYSICIANS RECOGNIZEING, I'M NOT
THE BEST DIABETES EDUCATOR.
I'M NOT A SOCIAL WORKER OR A 
PHARMACIST.
WE'RE SORT OF PARSEING SOME OF 
THAT OUT TO THOSE DIFFERENT 
MEMBERS OF THE CARE TEAM TO TAKE
BETTER CARE OF PATIENTS.
I DO THINK THAT PAYMENT REFORM 
MODEL STRUGGLEED TO SOME DEGREE
.
THIS IS MY FORECAST PIECE.
THIS IS WHAT I THINK WILL HAPPEN
IN HEALTHCARE.
IT'S HAPPENED IN OTHER INDUSTRY
INDUSTRIES.
I SEE NO REASON WHY IT WOULDN'T 
HERE.
YOU LOOK AT GROWTH OVER TIME, 
HEALTHCARE HAD THIS SLOW 
INCREMENTAL TORTOISE LIKE 
EVOLUTION OF CHANGE.
IF YOU LOOK AT HARE OR RABBIT, 
INNOVATION IS REALLY EXPONENTIAL
AT THIS POINT.
THINK ABOUT SOCIAL MEDIA, WAS 
THAT SOMETHING THAT EXISTED FEW 
YEARS AGO, YOUR iPHONE CAME 
INTO PLAY IN 2007.
THE GAP BETWEEN THE HARE AND THE
TURTLE IS REALLY THIS INNOVATION
PIECE.
I THINK IT'S REALLY DRIVEN BY 
CONSUMER OBSESSION AND COMPANY
IES 
LIKE ALL THESE PLAYERS ON THIS 
SLIDE ARE DOING VERY INNOVATIVE 
THINGS THAT THE HEALTHCARE SPACE
SPACE.
JUST TO HIGHLIGHT THE PICTURE 
HERE.
THIS IS SEATTLE, WASHINGTON ON 
THE RIGHT PANEL, YOU CAN SEE THE
SPACE NEEDLE DOWNTOWN.
THESE TWO LARGE BUILDINGS 
LOOKING DOWN, THAT'S AMAZON.
JEFF BEZOS SITS IN THAT BUILDING
IN FRONT OF THIS.
HE SITS A THE TOP OF THAT.
THAT BUILDING IS CALLED DAY ONE.
DAY ONE IS HIS ORIENTATION THAT 
THEY ARE LOOKING VERY FAR DOWN 
THE FUTURE.
THEY ARE LOOKING AT LARGE 
ADDRESSABLE MARKETS AND 
HEALTHCARE IS GOT TO BE IN THEIR
SIGHT.
I'M OUT OF TIME.
I WANTED TO HIGHLIGHT.
LOT OF THESE COMPANYIES ON THIS 
SLIDE ARE DOING INNOVATIVE 
THINGS.
THE LAST MESSAGE I WANT TO LEAVE
IS, WE AS HEALTHCARE LEADERS 
NEED TO REALLY DISRUPT OURSELVES
OR WE WILL BE DISRUPTIBLE.
THANK YOU.
[APPLAUSE]
>> THOSE WERE ALL EXCEPTIONAL 
PRESENTATIONS.
NOW WE'LL START THE Q&A.
ANY OF YOU CAN ANSWER THESE 
QUESTIONS.
FIRST ONE GIVE EXAMPLES HOW 
AMAZON WILL DISRUPT HEALTHCARE?
>> THEY HAVE AN DELIVERY
DELIVERY THAT'S 
UNPARALLEL.
WE CAN GET SOMETHING TOMORROW 
AND SOMETIMES TODAY.  WILL 
LEARNING PROVIDE SERVICES AROUND
PHARMACEUTICAL AROUND OTHER 
THING THAT WE SELL IN THIS 
INDUSTRY AND KIND OF MASTER THE 
DELIVERY PROCESS OF THAT.
>> THEY HAVE THE PLATFORM TO 
DELIVER, THEY HAVE SIGNIFICANCE 
OF SUPPLY CHAIN PLATFORM THAT 
EXPAND ANYWHERE YOU ARE.
I THINK THAT THEY HAVE REALLY 
FOCUSED ON THE CONSUMER 
EXPERIENCE.
IT IS SO EASY TO CLICK AND BUY 
IT.
IF YOU THINK ABOUT OUR BILL 
PAYMENT PROCESS, IT IS ANYTHING 
BUT EASY.
I THINK THAT THEY ARE AHEAD OF 
HOW WE CONNECT WITH CONSUMER.
WE SEE THEM IN TRAINING TO EVERY
LITTLE BUSINESS THAT CAN GET 
INTO HEALTHCARE.
I EXPECT WELLS GOOGLE AND APPLE 
WILL BE MAJOR PLAYERS IN 
HEALTHCARE.
>> I WOULD SAY, I SEE THEM WITH 
PRIME BENEFITS KIND OF EVOLVEING
THAT.
THERE CAN BE DIFFERENT TIERS ON 
TOP OF THAT.
THERE WILL BE HEALTHCARE TIER.
YOU CAN HAVE TELEHEALTH VISIT, 
YOU CAN HAVE -- THEY CAN BE 
LARGE PURCHASEER AND LARGE 
PHARMACEUTICALS IF YOU HAVE 
HUNDRED MILLIONS OF SUBSCRIBERS 
THAT'S POWERFUL IN THE 
PHARMACEUTICAL INDUSTRY.
JUST TODAY JOHNSON AND JOHNSON 
RAISEED PRICE ON DRUGS, 70%.
LOT OF THEM HAVE BEEN DOCK THAT.
AMAZON WILL PUT A PRICEING 
PRESSURE ON THAT COMPONENT.
>> WHAT DO YOU MAKE OF THE TELE
TELEHEALTH DATA AND WHAT'S THE 
FUTURE FOR TELEHEALTH FOR EACH 
OF YOUR ORGANIZATIONS?
>> WE STARTED TELEHEALTH FOR 
FOUR OR FIVE YEARS NOW.
IT INCREASES BY UP TO 50%.
LAST YEAR IF YOU LOOK AT JANUARY
JANUARY, WE INCREASEED BY 300%, 
WE TARGETED THE FLU POPULATION 
SO THEY WOULD STAY OUT OF THE 
EMERGENCY ROOMS AND WE CAN TALK
TO THEM VIA TELEPHONEICALLY.
I EXPECT TELEHEALTH TO GROW.
WE'LL BE DOING MORE THINGS HOW 
TO WE CONNECT MORE WITH PEOPLE 
IN THEIR HOME USEING THEIR HOME 
DEVICES WHETHER IT'S THEIR 
CURRENT TVs OR CURRENT 
TECHNOLOGY.
I THINK THIS WILL CONTINUE TO 
GROW.
EVENTUALLY, TELEMEDICINE IS LIKE
ANYTHING ELSE.
IT WILL BE HEALTH.
WE HAVE TO THINK DIFFERENTLY, WE
HAVE TO MAKE SURE WE'RE THINKING
DIGITALLY FIRST.
>> I AGREE TINA.
IT'S GOTTEN MANY VENUES WHERE IT
GETS TO USE NOW AND WILL IN THE 
FUTURE.
CONNECTING RURAL AREAS, BEING 
ABLE TO BRING SPECIALTY CARE.
WE'RE HUBBED FOR THE MICHIGAN 
STROKE NETWORK.
WE'RE AND TO BRING THAT 
EXPERTISE OUT ON THE FIELD.
I DO BELIEVE THE VIRTUAL VISIT 
THING, IT WAS SLOW IN SOME 
MARKETS.
NOW BECAUSE WE'RE TAKING RISK 
FOR AN EPISODE OF CARE AND WE'RE
TRYING TO DO EVERYTHING WE CAN 
TO LOWER THAT, NOW SUDDENLY THE 
VIRTUAL VISITS ARE GROWING 
EXPONENTIALLY.
IT'S A WAY TO MANAGE CARE 
OUTSIDE OF THE OFFICE AND 
OUTSIDE THE HOSPITAL.
>> I AGREE IT'S A PERVASIVE 
TREND.
IT WILL BE THE WAY CARE WILL BE 
DELIVERED.
WE WON'T MAKE THAT DISTINCTION 
THAT TINA JUST CALLED OUT.
WE'RE LITTLE BIT BEHIND METRO 
AND UNIVERSITY OF MICHIGAN 
HEALTH.
I DO THINK THAT TELEHEALTH 
CONSUMER IS REALLY GOING TO BE 
IMPORTANT.
I THINK THAT TELEMEDICINE 
COMPONENT CARE TEAMS TALKING TO 
CARE TEAMS VIA VIDEO WILL BE 
REALLY IMPORTANT.
>> DR. PAI, WHAT DO YOU SEE AS 
THE ROLE OF EMPLOYER ON PATIENT 
COVERAGE DECISIONS AND DO YOU 
SEE ANY TRENDS REGARDING 
EMPLOYERS DIRECTLY INVOLVEED 
WITH 
THOSE COVERAGE DECISIONS DUE TO 
HIGH COST?
>> I'VE SEEN EXAMPLES OF 
EMPLOYERS TRYING TO INTERJECT IN
DECISIONS LIKE THAT.
WE ABSOLUTELY GET THAT.
IT'S VAR HARD TO -- VERY HARD TO
BUDGET FOR $1 MILLION TREATMENT 
WHEN YOUR PLAN IS $10 MILLION A 
SPEND
WE TOTALLY GET THAT'S A 
CHALLENGE.
I WOULD REALLY BE HESITANT TO 
GET INVOLVEED WITH THOSE KINDS 
OF 
DECISIONS.
I TEND TO STAY OUT THAT.
YOU COULD ADDRESS IT THROUGH 
OTHER MECHANISMS LIKE RE
REINSURANCE TYPE PRODUCT.
>> I REALLY THINK THAT THIS IS 
THE LONG TERM PLAY.
WE HAVE TO MAKE SURE WE 
UNDERSTAND HOW IT ALL COMES 
TOGETHER IN THE ONE YEAR THAT WE
DO THIS.
 I THINK THAT'S A BIG THING WE 
NEED TO FOCUS ON OVER THE NEXT 
FEW YEARS.
 SOME
SOMETHING
WE'RE SELF-FUNDED EMPLOYER.
THE FOCUS IS ON BENEFIT DESIGN 
AND ON THE SITE OF CARE.
I THINK THAT'S WHERE I SEE THE 
EMPLOYERS GETTING FLEXING THEIR 
MUSCLES NOW.
WHERE ARE THE INCENTIVES FOR 
PREVENTIVE CARE.
TRYING TO MOVE EMPLOYERS TOWARDS
LOWER END OF CARE BY PROVIDING 
THE BEST INCENTIVES OR HEALTHY 
LIFESTYLES.
OR WORKING WITH THE PAYERS, 
LIMITING CLOYS AND TRYING TO 
LOWER COSTS.
THAT'S WHERE I SEE MORE OF THE 
EMPHASIS MORE THAN THIS IS WHAT 
WE'RE GOING COVER
.
>> 
>> 
>> 
I'LL SIR CALL BECOME TO SOCIAL 
DETERMINANTS.
SOME PEOPLE WHO HEALTHY FACE 
SOMBER YEARS YEAR -- BARRIERS.
ONE OF OUR GROUPS INEST MICHIGAN
MICHIGAN, GROUP CALLED IHA.
WE SCREENED 55,000 PATIENTS IN 
THE LAST FEW MONTHS AND FOUND 
THAT SOCIAL ISOLATION WAS THE 
NUMBER ONE SOCIAL DETERMINANT.
THAT CAN HIT A HEALTHY PERSON 
QUICKLY AND START TO EVOLVE IN 
OTHER ISSUES.
AS A COMMUNITY, WE NEED TO GET 
OUR ARMS AROUND THAT ISSUE.
 I WANT HEALTHCARE TO TRANSITION
AWAY FROM HEALTHCARE TO KEEP 
PEOPLE HEALTHY.
THE PAYMENT REFORM MODEL HAVE TO
PIVOT MORE.
I WOULD LOVE TO BUILD MORE FROM 
METRO.
IF WE RECEIVEED A PER MEMBER PER
MEMBER MONTH FEE TO WORK A 
CERTAIN POPULATION THAT DIDN'T 
HAVE KNOWN CHRONIC DISEASE.
THE FOCUS WILL BE ON FEATURE OH 
KEEPING THEM HEALTHY.
WHAT KINDS OF THINGS CAN WE 
CREATE.
HOW MANY STEPS ARE YOU TAKING.
IS THERE SOMETHING GOING ON IN 
YOUR LIFE THAT YOU HAVEN'T INTER
INTERACTED WITH US.
IT WOULDN'T HAVE BEEN TO BE HIGH
COST.
IT'S INTERACTING AND KEEPING 
PEOPLE ENGAGEED IN THEIR HEALTH 
AND MAKING ALL THOSE MONEYS 
MONEY HUNDREDS OF 
DECISIONS THAT YOU HAVE TO MAKE 
TO KEEP YOURSELF HEALTHY AND 
AVOID OBESITY OR BEING OVER
OVERWEIGHT.
LOT ALL THESE CHRONIC DISEASES 
ARE BEHAVIORAL
DRIVEN.
 IS A PROVIDEER AND NURSEING 
SHORTAGE?
IS IT AFFECTING OUTCOME AND WHAT
ARE THE SOLUTIONS?
 I'LL START THIS AND YOU GUYS 
CAN JUMP IN.
WE GOT MILLION PHYSICIANS IN THE
UNITED STATES.
IT USEED TO BE CHARACTERIZEED IN
FOUR DIFFERENT AGE GROUPS.
JO
WE ALL KNOW WHAT HAPPENS AT 
SECRETARY.
THERE'S GOING TO BE -- 60.
THERE'S GOING TO BE A DRAMATIC.
THEY'RE GOING TO RETIRE.
[LAUGHTER]
WE HAVE AN AGEING OF OUR 
PHYSICIAN POPULATION.
THAT'S GOING TO HAVE A BIG 
IMPACT.
I THINK THERE'S BEEN MOVEMENTS 
TOWARDS DOCTORS AND NURSE 
PRACTITIONING AND P.A.s AND 
OTHER APPs Ps FILLING IN.
THERE WILL BE MORE OF THAT IN 
THE FUTURE.
IMPACT ON OUTCOMES, I'M NOT SURE
THAT'S BEEN A REAL SIGNIFICANT 
ISSUE YET.
IT COULD BE DOWN THE ROAD.
SKILL SET OF PHYSICIANS IS 
IMPORTANT.
WE NEED THEIR EXPERTISE.
NOT ONLY TO CONNECT WITH THE 
PATIENTS AND HELP GUIDE US TO 
REDUCE VARIATION TO REALLY MAKE 
SURE WE'RE DOING THE RIGHT 
THINGS IN OUR PRACTICES.
IT CAN'T SIT ON THEIR BACKS TO 
DO SO.
WE NEED TO HAVE HEALTH COACHES 
AND MORE COMMUNITY HEALTH 
WORKERS.
IT'S TRUE PARTNERSHIP AND 
COLLABORATIONS WITH CAREGIVERS.
WILL EVOLVE OVERTIME.
 ONE THING WE'RE IN THE MIDST OF
GREAT NURSEING PROGRAM HERE AT 
GRAND VALLEY AND OTHERS AROUND 
THE STATE.
WE TALK ABOUT THE NURSEING 
SHORTAGE.
SOME OF THE CONVERSATION WE HAVE
WITH THE SCHOOLS IS WE CAN'T 
PLACE OUR NEW GRADS.
WHAT'S THE PROBLEM?
THE PROBLEM IS IF YOU LOOK AT 
WHERE THE SHORTAGES R THEY'RE 
PRIMARYILY IN AREAS LIKE ER, ICU
OR OR WHERE YOU DON'T START A
NEW GRAD.
THEN, ALL OF SUDDEN, SCHOOLS 
COME BACK AND SAID WE THOUGHT 
THERE WAS A SHORTAGE AND WE 
CAN'T PLACE SOME OF THESE NEW 
GRADS.
THE SOLUTION HAS BEEN REALLY, 
WE'VE HAD TO CHANGE OUR TRAINING
AND CHANGE OUR THINKING IN THE 
HOSPITALS TO ALLOW NEW GRADS TO 
MOVE INTO THOSE AREAS SOONER AND
BE BUDDYIED AND BE TRAINED 
REALTIME IN THOSE MORE INTENSE 
AREA WHERE IS SHORTAGES EXIST.
THAT'S ONE ISSUE.
PROVIDEER SIDE, JUST SAY, YEAH, 
THERE'S A
SHORTAGE, TELEHEALTH 
IS A WAY TO BE ABLE TO SPREAD 
SOMEBODY'S EXPERT EXPERTISE MORE
BROAD
BROADER WAY.
TRYING TO REDUCE DEMAND IS A WAY
TO DEAL WITH THE PROVIDEER 
SHORTAGE.
WE CAN MOVE CARE AWAY FROM 
SPECIALTIES.
THAT WOULD HELP THAT AS WELL.
WHAT IS THE NEXT COLLABORATIVE 
EFFORT OUR COMMUNITY NEEDS TO DO
IN HEALTH?
 WE NEED FOCUS ON BEHAVIORAL 
HEALTH.
IT'S A HUGE ISSUE.
WE'VE BEEN SEPARATEING IT FROM 
THE PHYSICAL HEALTH FOR FAR TOO 
LONG.
THERE ARE MANY PEOPLE WORKING ON
THIS AREA.
THANK YOU FOR PROVIDEING THIS.
??? THANK YOU.
??? THANK YOU
??? OUR NEXT HEALTH FORUM IS 
ORGAN TRANSPLANT DONATION AND 
IT'S NEXT FRIDAY IN FEBRUARY.
