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This is Laura Dirda with the Becker's Healthcare
podcast. I'm thrilled today to be joined by
doctor Vic Kashyap,
endowed chair of the Frederick Meyer Heart and
Vascular Institute and vice president of cardiovascular
health at Corwell Health. Doctor Kashyap, it's a
pleasure to have you on the podcast today.
Thank you so much, Laura, for including me
in your series. Very happy to be here.
Absolutely. Now I'm excited for our conversation because
I know,
you know, the cardiovascular
care is such a dynamic space. There's so
much happening, and you know, really interesting to
kinda think about how it's evolving. Most people
in their lifetimes are either touched by this
type of care or have loved ones who
are. And so, you know, I'm excited to
learn more about how you're thinking about,
things today and and what you're seeing in
the future. But before we dive in, can
you tell us a little bit more about
yourself and CorVel Health?
Yeah. Happy to.
So I'm a vascular surgeon by training.
I spent, the majority of my career in
Cleveland, Ohio. I was there
for a couple of decades.
And then a few years ago, got contacted
about this opportunity,
which was to run a heart and vascular
institute.
And I'll say that Korbo Health and and
this area has been evolving,
changing
very dramatically over the last few decades.
So initially, Butterworth Hospital,
was a community hospital, and then Spectrum Health,
a system in West Michigan.
And Spectrum Health, which I joined back in
2022,
merged with Beaumont Health, which is on the
East side of the state in Metro Detroit,
and we're now called Corwell Health. So, for
those podcasts that you do on branding, we
have a little branding confusion,
since we've had some name changes.
But we're now a 21 hospital system across
the state of Michigan,
and our goal really is to provide comprehensive
care for, our patients and our communities.
I love that. And it's simple yet, you
know, so complex when you think about everything
that entails providing that type of complex care
and access to care for the broader, communities
and populations you're serving. So I'm curious. Can
you tell us a little bit more about
the last year? So what was an important
initiative that you led? What did you do,
and what were the results?
Yeah.
So we've, the Franklin Meyer Heart and Vascular
Institute has been,
in place for over a decade now, and
the Meyer Heart Center is a
eight story hospital devoted to heart and vascular
care
that's been in place for over twenty years.
That being said,
like many places, I think we were still
fairly fragmented.
You know, silos in
cardiology,
in cardiac,
in thoracic surgery, in vascular surgery,
in wound care, in multiple areas,
across the
cardiovascular
landscape.
And I think perhaps
not just last year, but in the last
couple years,
our biggest
success
has been really
becoming much more collaborative, much more
coordinated
as a Heart and Vascular Institute.
So what does that mean? For instance, we
have really focused
on ensuring the highest quality for our patients.
Now every physician, every group wants to do
that, but what we've done is looked at
it at a system level.
So we look at
every mortality that happens in the heart and
vascular space.
Each group
is tasked to really do a very careful
analysis
and then bring back to us any lessons
learned,
any gaps in care,
and any other items that can really be
socialized
for our group as a whole to improve
the care of patients.
Well, what's happened? Over the last three to
four years, we've dropped our raw mortality,
significantly.
We have improved our observed to expected mortality
ratio,
which was, at the one level that is
on par or average
down to point six seven.
And I think that
focus on
improving
individual patient care and then having the lessons
learned,
in one area
be socialized to all areas across the Heart
and Vascular Institute have really been a great
success for us.
And it's helpful to understand. You know? And
it I, really appreciate you kind of talking
through the systematic way that you approached
trying to tackle some of these issues because,
I think having, you know, heart issues and
challenges are so such a big,
issue for patients, their families. And so being
able to,
provide some of those back best practices and
really figure out what makes the most sense,
in terms of moving the needle for mortality,
is so helpful. Can you dig a little
bit deeper in there? How did you really,
make a difference, or what were some of
the things that you did and changes that
you made in order to serve the community
better?
Yep. So
I will I'll have to make sure to
credit all of our amazing
teams,
our physicians,
our surgeons,
our other providers, including nurse practitioners
and PAs
that are part of the team nurses,
they have worked diligently
and collaboratively
to really provide great care for a long
period of time.
However, we did see improvements,
in heart surgery,
in cardiology,
in vascular surgery,
in terms of thirty day mortality.
I think this was both a refinement of
practice and very careful selection of patients.
We also saw an improve in our o
to e ratio
probably because of documentation.
That is,
we had very sick patients here in West
Michigan just like many other
urban and semi urban areas, but maybe we
weren't
displaying how ill they were till we did
a better job of looking at risk factors
and documenting them appropriately in the record. So
I think those two things. One,
absolute or raw mortality decreasing, but then also
the expected mortality for a cohort of patients
increasing because of the risk of that population
being appropriately
delineated
has been the sex success here.
That makes a lot of sense. And, you
know, it's helpful to understand,
all the different kind of adjustments that that
you're making to move the needle. Now looking
ahead for 2026, what are some of the
big priorities and headwinds that you're most focused
on?
Yeah. One of the, big challenges we had
last year is a,
complete change in
our anesthesia workforce.
And this is not
dissimilar to some of the other, systems and
hospitals around the country. We've moved from,
a private practice
contracted model
to an employed model.
And that was a big change for
the system,
for the hospital, and quite frankly, for each
individual
physician, especially the surgeons,
that rely on great anesthetic
care for taking care of their patients. So
we're in the midst of this transition,
going to an employed model,
that has meant a lot of recruiting
of great anesthesiologists.
And oh, by the way, let me put
a plug. If somebody wants to come join
us in CORWAIL. I hope in Grand Rapids,
we are open
to we have open arms,
but that has been, as you can imagine,
a lot of change management.
Different people in the operating room, different
processes, perhaps,
in some areas,
people coming from different cultures, coming to to
this culture, this medical culture here. So all
of that change, I think, has been very
disruptive,
and
getting to a point where we're
almost complete or maximally employed in that department
of anesthesia is gonna be a hallmark for
us. We hope to accomplish that in 2026.
I think that really stabilizes our surgical and
procedural areas to a great degree.
That's it makes a lot of sense. You
know, that is such a huge change, especially
with anesthesia. I know today, you know, across
the board is something that is top of
mind for so many clinical teams, and trying
to figure out the right model that makes
sense in each community is no easy task.
And so when you're going through, you know,
some big changes like this, especially when it's
operational things happening,
in the operating room, but then too, you
know, wanting to make sure that clinicians have,
faith and
and really trust their colleagues to deliver the
best care possible. But how do you go
about this change management and making sure that,
you know, everybody across the board is comfortable
with how you're moving forward and, you know,
ready to do whatever it takes in order
to keep that great quality care going?
Yeah. Well, I think the first element is
communication
and maybe
communicate, communicate, communicate over communication.
And we do this in in a multimodal
way. We have town halls,
where we have all the members of the
Hart and Vascular Institute, which are now over
a thousand people,
dial in,
for a virtual town hall.
We,
have
in person grand rounds once a month where
we hit some of these
topics. We have a monthly newsletter,
and I meet,
periodically
with different teams
in different spaces, whether it be the vascular
surgeons or the thoracic surgeons or the electrophysiologist
or other,
proceduralists that get affected by this change.
So one is to communicate what's happening.
Two is to be really brilliant at the
tactical changes that are occurring on a daily
basis, whether it be schedules,
whether it's using a certain number of locums
providers to fill in the gap till we
get to a fully employed model,
and other things. And then I think the
other the the other part about this, Laura,
is also to really
have folk have people focus on the long
term. What is gonna be the long term
effect of this? Well,
it's gonna be that we're gonna have a
department of anesthesia that is as aligned
with
the different strategies that we have for the
Heart and Vascular Institute, including quality, including
research,
education,
strategic growth, etcetera.
And that's gonna be a very positive state
for us once we were able to achieve
this.
I love that. I think being able to
have that type of, communication, clarity, and relationship
with the team that they understand exactly what's
going to happen and why things are happening,
and then really get on board to make
that change makes a big difference.
What do you think, the hardest thing you
that you'll have to do in the coming
year will
be? Well, that may be the hardest thing,
but let me tell you about a couple
of other things that I think,
that are happening that, are are big changes.
So we've been a heart and vascular institute,
but recently,
we also incorporated
the pulmonary division
into,
our,
our area.
So now, actually, we're in the midst of
a name change again, but it's not for
the overall organization. It's for our department as
we go to the
heart, lung, and vascular,
department.
And that's important for, many reasons. This was
an organizational
change that, that we did not ask for.
This happened, because of some changes
in the overall structure of the organization.
We really welcome this as a great opportunity
for the pulmonologists
who already collaborate, by the way, with many
of our thoracic surgeons and others
to
really even enhance that relationship,
especially for lung cancer treatment, for lung transplant,
and other areas.
We've had a lot of folks in overlapping
areas,
related to
both pulmonary and cardiac issues,
let's say, in the areas of syncope,
in the areas of
of, shortness of breath, etcetera. Now these groups
that are often are evaluating
similar types of patients
are all under one roof, and they can
hopefully
elevate the care that they're giving, elevate their
algorithms to an even greater level. And I
think the last thing that's this is really
gonna be
impactful
is our whole
research infrastructure where we have
tremendous number of folks that are interested in
research. We've started about over 60 trials now
I'm sorry, over 70 trials in the last
five years, clinical trials.
And this allows groups that previously had been
separate
to collaborate to,
really be at the forefront
of early stage
treatments
for heart and lung problems.
So we're really looking forward to that as
both a challenge and an opportunity for us.
That makes a lot of sense. And, you
know, it is really,
interesting to see how those dynamics have been
shifting. And I know it's, you know, no
small task to,
have those types of clinical trials and research
and more,
becoming a bigger part of what you're doing
there. And I I'm curious, when you think
of that balance between trying new things and
the research and the development and accelerating therapies
and, you know, also knowing that you have
to to care for a a growing patient
base, how do you keep the the,
both innovation as well as clinical quality and
safety in mind and, you know, looking ahead
as well as thinking about what needs to
be done right in front of you?
We have a a beautiful strategic road map,
and we actually have changed it into a
visual that,
that looks like four pillars holding up a
temple. You've seen that visual before for strategies
with the foundation,
four pillars, and then the the capstone on
top.
And the capstone has our vision, which is
that we wanna be nationally ranked, recognized for
what we do, and being a destination for
compassionate
and collaborative and innovative
heart and vascular care,
now heart, lung, and vascular care. And the
strategic pillars have to do with exceptional quality,
being brilliant at our operational
capabilities,
focusing and elevating research and education, and lastly,
strategic growth.
And whenever we have a group meeting, a
strategy meeting,
or an operational meeting that's more related to
tactics, we show the same slide
and have people really coalesce around. These are
our four pillars.
This This is what we'll work on, what
we'll focus on.
And below, we have the number of metrics
and
tactics
that are related to those pillars. So getting
the team members
aligned
in a way that they can see that
their work
affects
either one or multiple
strategic pillars that we have and then allows
us to move forward because of their work,
I think, is very impactful, keeps people engaged,
keeps people and the team aligned to what
our future is gonna be.
That's helpful for understanding. Thank you so much
for digging a little bit deeper there. Now
before we wrap up, I wanted to ask
you about growth too, where do you see
some of the best opportunities for organizational growth
in the next year or two?
Yeah. I think the the biggest potential, quite
frankly, Laura, is the,
the,
possibility,
that we've been talking about for some time
of really,
really having a
collaborative
Pan Michigan approach
to heart and vascular care.
And what do I mean by that? Well,
big system on West in West Michigan, that
Spectrum Health, that was the organization that I
joined based out of Grand Rapids, big system
on the East part of the state, Legacy
Beaumont based out of Metro Detroit.
Now we're Coral Health West and Coral Health
East.
Well, if we can collaborate
and really align on
different protocols, algorithms for patient care,
I think we could have a huge impact
on not just our local communities, but really
the whole Michigan population.
Whether we talk about heart failure,
eligibility
for heart transplant,
we talk about shock
and
emerging
strategies to deal with patients in cardiogenic shock,
including advanced mechanical
circulatory support.
We talk about peripheral arterial disease
and how we treat patients with
claudication
all the way to
limb threatening ischemia.
We talk about wound care. We talk about
coronary disease. All these different entities
that we see
in our so many hospitals across Michigan,
if we can coordinate that care in a
way that's more meaningful, that could have a
really big impact, I think, for many of
the folks that we take care of.
Absolutely.
It that makes a lot of sense, and
you really paints a great picture of what's
ahead,
and the possibilities for you at Corwell. Thank
you so much for joining us on the
podcast today, doctor Kashyap. It's been a pleasure
speaking with you. I I've learned a lot,
and I look forward to seeing you as
well at our annual meeting in April. I
know you'll be speaking on a panel and
really digging deeper into some of these themes
we've been talking about, so I'm excited to
have you as part of it. Well, thank
you. It's been my pleasure, Laura. I really
appreciate it.