This is where health care leadership comes together.
Becker's sixteenth annual meeting brings more than 3,500
hospital and health system executives and nearly 800
speakers to Chicago, April 13 through the sixteenth.
This year's event includes keynote conversations with Dallas
Cowboys legend Troy Aikman and former president George
w Bush. For the agenda and event details,
visit beckershospitalreview.com
and click on the events tab in the
upper right. We're looking forward to hosting you
in Chicago.
Welcome to the Becker's Healthcare podcast. My name
is Paige Twenter. I'm a reporter and assistant
editor with Becker's Healthcare.
I am so excited to be joined today
by doctor Michael Weiss. Without further introduction, I
would just love,
you know, doctor Weiss, if you could tell
us about yourself and a bit about your
organization.
Sure. Well, Paige, thank you, and thank you
very much for having me today. I'm really
excited to share some of the work that
we're doing.
Mike Weiss, I'm a general pediatrician,
just a country doc. I practiced in the
community for about twenty two years here in,
Southern California
in a
private practice with a number of other physicians
in general peds.
And I always, was
kind of excited about the system of health
care and, how things could certainly be better
than they are.
I have a background with,
having lost a brother and sister in childhood
to congenital
disease. And I grew up as a family
member
kind of observing this not only as a
clinician, but more as a family member. And
it just always was something that I wanted
to do above and beyond seeing the patient
in front of me. So, I,
over the course of time, sought a little
bit more education on the business side of
medicine,
and I was fortunate enough about eleven years
ago to be,
sought out by Children's Hospital of Orange County
to start a population health division here.
Lo and behold, here we are 11 later,
and we've built something that I think is
very exciting.
In terms of our organization, it's been a
very exciting year.
Children's Hospital of Orange County, which, is where
I was hired on to, actually merged with
Rady Children's Hospital in San Diego
to become Rady Children's Health, and that's now
been one year since that merger.
So we are represented by,
three hospitals. We have, San Diego,
Orange, and then we have a hospital in
a hospital in Mission Viejo.
And we have in both regions,
we have subspecialty
clinicians,
tertiary quaternary services, and primary care networks. So
it's actually a beautiful incubator to be working
in this, field.
You buried the lead, doctor Weiser. I didn't
even mention the lead of you're the first
ever endowed chair for wellness
of Rady
Children's.
That was a recent appointment.
Yeah. Well, it's always hard to blow your
own horn, but, I'm I'm very, very honored
that, the Clavis Foundation, which is a local
foundation,
have the forethought to
really,
look at wellness and prevention. And, I also
give Rady Children's Health and and CHOC a
lot of credit for really having the
thought to think outside the the four walls
of the hospital,
and really consider
that paradigm change of health care moving more
into prevention and wellness.
You know, we as clinicians and hospitals
are very, very good at being reactive
to, situations. You know, patient's sick, make an
appointment, come see me. I'll take care of
you.
But the reality is when you look at
the geography
of, you know, these urban or suburban
hospitals that we all work at,
only five to 7% of the population ever
really experiences
the hospital, which is great. You know, we
we love that.
But where are the other 93 to 95%?
These are kids that are at school, they're
at the park, they're at faith based organizations,
they're at, you know, all these, various community
based organizations.
And
for us as a health care system, if
we're not going out and proactively
addressing,
the causes of illness and,
working with those communities,
I don't feel like we're doing our job.
So I I applaud Rady Children's Health, the
Clavis Foundation,
and I'm honored to be that first chair
working toward that goal. Mhmm.
On that note of prevention and meeting that
ninety three,
you know, percent of patients who aren't going
to the hospital, what are
really, like, two to three priorities you're setting
for yourself in the next
twelve months?
Yeah. It's, it's definitely a,
gonna be a bell shaped curve. There's gonna
be, somewhat of an uphill battle because it's
really a culture change. You As a pediatrician,
I was I was trained to fix. I
was trained bring me a problem, and I
will fix it. I was not trained to
prevent the problem from happening.
And so I think priority number one is
really going to be education and awareness.
It's really working across the organization,
primary care, specialty care, ancillaries,
the community,
leadership
to get people to really understand the importance
of,
prevention and,
and proactivity.
You know, we've all seen some degree of
the beautiful slide that shows that 80% of
what makes us healthy,
has nothing to do with what doctors and
hospitals do. It's your genetics. It's your environment.
It's the exposures you have. It's it's all
those things. And if we're not addressing those,
we're not addressing the major reasons why,
illness occurs,
the social drivers of health, etcetera. So I
think that's that's priority number one. I think
priority number two
is that I want to be sure as
we enter into this arena
that we do it in an evidence based
fashion. So certainly things like integrative medicine are
something that the public really wants.
And I can tell you that the clinical
side is very skeptical.
And so bringing those two areas together,
studying it in an appropriate manner,
and assuring that it's, evidence based,
is another huge priority that I have. I
always look back to, you know, people are
probably aware if they're of my generation of
the Framingham study, which is a study that
was done in Massachusetts
ongoing
that has looked now for fifty or sixty
years at a cohort of people that were
born, and they followed numerous markers on those
patients,
looking all the way from blood work to
social drivers, to genetics, to their employment, etcetera,
etcetera, to determine what it is that really
drives health.
Well, I would love to really do something
like that on the pediatric side
to really look at what are the interventions
that we can,
consider
that may ultimately
lead to better longevity, better outcomes in children?
You know, for instance, a family who has
a baby,
and the family has a strong history of
cancer or diabetes or rheumatologic
condition.
Are there interventions that we can undertake
before those things manifest
that can perhaps prevent them or prolong
the onset of those,
those conditions? So that's another paradigm change that
I think, would be really important. And, again,
doing it in an evidence based way so
that we can study it and publish those
studies and try to drive change, in terms
of how we practice medicine.
Mhmm. But the
fifty year Framingham
study, are you imagining
or wanting to kind of start, like, a
decades long
research project then?
I would love to. You know, I've spoken
with our research department here, and we have
some NIH,
grant
recipient researchers here, r one, r two grants,
which are the the big
NIH grants.
And they seem very excited about what I've
described.
So I think if we can outline something
like that and
perhaps draw out a multi decade approach to
this,
it would be very, very exciting.
Mhmm. I'd also love to know more about
I mean, you you know, I asked for
your priorities and you gave me priorities. I'd
love to know more about kinda, like,
your personal investment
in this. You mentioned,
earlier, your family background and losing your brother
and sister
really fueled
your
interest in, you know, working for, I believe
you said, twenty two years in health care.
Can you share
more about that?
Yeah. I mean, you know, I'm I'm forty
years in now of being a pediatrician
and, twenty two in private practice. And then
I did a a stint
kind of learning the business side actually on
the adult side,
in the, in the, insurance side.
But I I think, you know,
medicine
is a very interesting thing. It's it's probably
the only business that runs the way it
runs and is still in business,
because of the way that we approach it.
And we all talk about, you know, value
based payment, and we talk about universal health
care, all of this. And, you know, again,
I've been doing this for forty years. And
I think thirty years ago, I started first
hearing value based payments coming, it's coming, it's
coming, you know, and here we are thirty
years later, and there are pockets of it.
You know, we in Southern California and we're
I know we're a unicorn,
but, you know, I I oversee a group
of a 140,000
Medicaid children
who are under global capitation
and have been so for almost thirty years.
And we've made that work for thirty years.
Our doctors are happy. The patients are getting
great care, and the system works. But I
understand that the vast majority of the country
is still in a fee for service paradigm.
And it's very challenging,
to achieve some of these things in a
fee for service paradigm. There's no,
payment reimbursement
reward
for preventative care, for counseling, for team based
care.
There are pockets of
demonstration projects. You know, CMMI has done a
number of things, and, you know, I give
them credit.
But we're still in this do one, get
paid, do two, get paid twice
world. And until we change that paradigm, it's
going to be a big challenge for
us to move into this preventative
proactive care,
model.
You mentioned paradigm shifts, with
your or an uphill battle with culture changes,
related to integrative medicine. And then, of course,
paradigm shifts
are really a true
adoption,
and rollout of VBC. Whereas right now it's
just in pockets and will likely just be
in pockets for
many more years.
I'm curious on
actionable
tips, like, for our listeners
if they're interested in, you know, having their
own unicorn of, you know, 140,000
children, VBC model,
what first steps would you recommend?
Well, I think you have to start with
leadership buy in. You know, as much as
I hate to admit it, in my forty
years, I've come,
full circle and I am semi tainted.
Health care is a business, and it is
all about the money.
And, as much as we as physicians
want it to be all about the quality
of care, you know, certainly that's there, and
and we're doing our very, very best. But
the reality
is it it really comes down to making
it work financially. And I get it. You
know, I I have spent my career trying
to understand the business side and the clinical
side and marrying the two so that they
don't kill each other and we can get
things done.
But I I think that the number one
thing is it's gotta be a leadership
cultural belief. You have to have the c
suite
believing and understanding
that value based care can work clinically and
financially. And there's plenty of, again, pockets of
unicorns that, are doing this. There's great work
in Massachusetts. There's great work in in Pennsylvania.
There's great work in Seattle, Washington,
in California.
But, again, this starts at the very top.
The second piece of it is you have
to have a payer that believes in it.
And the payers,
you know, are in a very difficult position
because their number one goal is they have
to sell product.
And they sell product based upon the attractiveness
of their
outcomes and their and their programs. And I
think that there are enough studies demonstrating
the outcomes and the attractiveness, I'm holding my
hands up in air quotes for those listening,
of these programs,
to make it attractive enough to invest in
that.
A great example is there is a health
plan, I won't name it, on the podcast,
who invests in a special needs,
program.
They actually pay various medical groups. We are
one of them,
a proactive fee to care manage their highest
risk patients.
And what has been shown in that program
is that by putting,
a care team around these highest risk patients,
including case management, social services, navigation systems, etcetera,
you can reduce the ED visits. You can
reduce the readmissions
and thus reduce the cost of care while
maintaining or improving the quality of care. So
it works. It's just a matter of getting
the c suite and the health plans together
to understand that it works.
Unfortunately, we only have a few more minutes.
I could talk forever with you. But, we
unfortunately have a few minutes left of our
podcast today. And last question for you, doctor
Weiss,
is where do you see the biggest opportunities
for growth in the next year?
Yeah. You know, I I really think that
the movement for what's called advanced primary care,
is is very important.
You know, primary care right now,
and I can say this because I did
it for twenty two years, feels like a
hamster wheel,
particularly in pediatrics. You know, we have what
are called the bright futures recommendations from the
American Academy of Pediatrics and, you know, all
the current issues aside with vaccine refusal and,
you know, all those types of things. You
know, we are given ten to fifteen minutes
to see a child, and there are 15
or 20 things that we need to do
in that visit, including anticipatory guidance, including immunizations,
including the physical exam,
including preventative care, you know, etcetera, etcetera.
I I think advanced primary care really is
the future where we are able to more
effectively
embed
mental health,
social services,
community health workers,
a number of different roles,
health coaches
into a primary care where the physician or
APP
is able to do their job and have
these wraparound services that are reimbursed,
to provide all those other services that we
know make up 80% of what health is.
So I think
positive out of that is that the major
issue with subspecialties
these days is they're overwhelmed,
and I get it. It's very challenging, and
a significant percentage of what's referred to subspecialty
care is not appropriate for subspecialty care, could
be cared for in a primary care office.
And a lot of times, it's not able
to be done because of time, simply time.
And so I think we can make both
sides of that equation work by really looking
toward funding and supporting an advanced primary care
model.
Well, thank you so much, doctor Weiss, and
I'm excited to hear updates
on,
advanced primary care models.
Yeah. Thank you. I really, really appreciate your
time today, doctor Weiss. My pleasure, Paige. Thank
you very much for having me.