Perspectives and Discussion on One of Our Nation’s Biggest Issues – Healthcare, from the President/CEO of one of the Premier Safety Net Hospitals.
For the past 10 years, I have been fortunate to have had – in my opinion – one of the best jobs of any health care executive in America – that of CEO of Truman Medical Centers, the largest safety net hospital system in Missouri.
This month was National Minority Health month and most visitors to this site may already know this. What most may not know is that Booker T. Washington started National Negro Health Week in 1915 and it was the descendant of today’s National Minority Health month. Booker T. Washington understood then what we are starting to better appreciate today: better health is about wellness and prevention and minorities have worse health care outcomes than non-minorities. Providing equitable care is at the heart of what we do at Truman Medical Center. It should be what we do as a nation.
As CEO of Truman, I take pride in the fact that equity in care is not only a priority but something we can showcase to the community we serve. We promote wellness in the community and work very hard to improve their overall living conditions that play such a vital role in their health.
From better nutrition to violence these are all things that factor into one’s health. They are also challenges that many would shirk from. Outside the walls of the hospital problems can seem more daunting, but it is here that hospitals can make an impact.
I currently serve on the board of the American Hospital Association and have had the honor to serve on several national organizations. I have seen firsthand how as a nation we are starting to understand and embrace disparities in care, vulnerable populations and the need for greater diversity. However, as long as gaps in care exist and until all hospitals reflect the community they serve, we will have more work to do.
Today, Truman was honored with the Booker T. Washington award that recognizes an organization that has made an outstanding contribution to the promotion of wellness in emerging populations by the National Minority Quality Forum. I am naturally thrilled and so proud of my team and the recognition bestowed for their hard work. Today’s event highlights what it will take to achieve results. On the ground and the community level hospitals must tackle health issues that impact the community not just treat patients who come through their doors. National organizations must help by using their resources to identify high-performing organizations and spread the word about what they have learned – their successes and even missteps along the way.
Progress is being made and I can attest that it can be done, but improvement is a journey. We can no longer silo ourselves and instead must learn to communicate and share. Passivity will not eliminate health care disparities or promote diversity. The time for action is upon us and we must embrace equitable care as part of everything we do.
NAPH Innovating Excellence event at the National Press Club in Washington, D.C. to discuss, among other things, TMC's Dr. Shauna Roberts' lead article in the Journal of Healthcare Quality on the Passport to Wellness and Guided Chronic Care programs. Joining Dr. Roberts on the panel discuss were (L-R) Linda Searle Leach, RN, PhD, University of California Los Angeles , Steven Lev, MD, Nassau University Medical Center , Shauna Roberts, MD, CPE, TMC Corporate Quality Medical Director and Maulik Joshi, Dr. PH, Editor-in-Chief, Journal of Healthcare Quality.
As our population ages and unfortunately grows more obese each year, the prevalence of chronic illness continues to rise. According to studies, more than 40 percent of the U.S. population suffers from one or more chronic condition, which are causing significant increases in healthcare spending, especially among the uninsured and underinsured.
At Truman Medical Centers (TMC), we are quickly becoming leaders in chronic disease management in the Kansas City area, and we are taking some innovative steps to combat these issues.
Last year alone, TMC treated more than 56,000 out of nearly 97,000 patients for at least one of seven of the most prevalent chronic illnesses. In addition, more than 38,000 of those had more than one chronic illness.
These are startling numbers for any hospital, in any city. We believe innovative approaches must be taken if we are going to change the dangerous direction our population is heading.
One example, about 18-24 months ago, TMC introduced a program called Passport to Wellness. Passport was developed for our patients that we refer to as our “frequent flyers” – those people who are treated over and over again in the TMC Emergency Room and Inpatient settings.
TMC is taking some creative actions to help these patients and their families make lifestyle changes that will in turn help them better manage their health, resulting in fewer hospital visits. The results have been truly phenomenal:
Through education and a coached approach to lifestyle changes, a team of health professionals is helping patients to better understand their illness, teach them firsthand how to manage it, and guide them to becoming their own advocate in managing their diseases. The care team also works to remove barriers that prevent them from following through, like transportation problems, preparing for appointments, or general health literacy.
This is just a one “out of the box” ideas – or should I say “out of the bed” ideas — that help make a difference in the well-being of our community.
To affect truly sustainable change – whether inside our hospitals or throughout our communities, we have to anticipate the next move in healthcare and put into place the mechanisms necessary to measure whether what we are doing is the right method. Until we reduce the number of patients facing a chronic illness, our costs will continue to rise and the overall health of our community will continue to decline.
I believe a common misconception about companies who display art on their walls is that it is solely about mere decoration, essentially a distraction from having to stare at a bare partition. Admittedly, in more instances than I would like to believe, that is probably true.
Enter Truman Medical Centers, and you will find that art surrounds our patients, our visitors and even our employees, and it’s there for a very distinct reason. Actually, four reasons. We believe art builds connections between people. Art encourages interaction. Art challenges perceptions and Art can be comforting. In our opinion, each of these attributes is vital to developing and preserving healthy communities.
Let me take you through a short tour of TMC.
Celebrating Women Photography Exhibit - Paola Gianturco - gift by artist
Enter through the revolving door at Hospital Hill and you are immediately greeted by modern sculpture, the work of local ceramicist Linda Lighton. Inside the lobby are two abstract paintings by Rhode Island artist Tony Ramos, which hang in front of a grand piano. Beyond the piano, a small chapel houses three textile panels by nationally known quilter Sonie Ruffin.
Stepping into the corridors, you find Hospital Hill’s Center for Healing Arts, a gallery that rotates art exhibits by different artists every six weeks. In fact, Hospital Hill and our Lakewood facility showcase more than 600 works of fine art in their corridors. One might argue that we could be described as two hospitals inside art galleries.
Why is this so important to us?
Advanced medical technology and learning, excellent patient care and, of course, dispensing of appropriate medication, all work together to achieve healing. But we also believe that true healing can come through connection of our senses to a non-threatening medical environment that eases the mind, promotes peace and tranquility and offers a much healthier, fuller and richer experience.
We have taken this concept one-step further for our employees. Our Healing Arts program is an important employee benefit, allowing employees to take a “time out” during the day to take yoga classes, knitting classes or photography classes, just to name a few. The vision is simple: using the arts in essence to heal our healers.
TMC could not have accomplished our heal arts program without the help of our community partners including the Kemper Museum of Contemporary Art, Byron Cohen Gallery, Walgreens, Cerner Corp., Morrison Management Specialists, the Mayo Clinic, Fisk University in Nashville and the local chapters of Alpha Kappa Alpha, Theta Boule and the Links social organizations.
Thank them for helping us provide the art of healing.
Let me begin with a buzz word: patient-centered care. You hear that a lot today in the healthcare world, but patient-centered care is much more than a buzz word. It is the future of healthcare.
If you want to characterize yesterday’s delivery of care, call it disease-centered. We were in a time in which physicians made treatment decisions based largely on clinical experience and data from various medical tests. How is that different today?
In a patient-centered model, patients become active participants in their own care. It begins with advice and counsel from health professionals, and working with that information, patients design services focused on their individual needs and, most importantly, their preferences. What we have then is an innovative approach to the planning, delivery and evaluation of medical services.
TMC's Patients 1st logo
TMC embraced the philosophy of patient-centered care years ago. We look beyond traditional views of patient care along with state-of-the-art technology, administered with compassion and a commitment. It is not just about treating the disease, but rather about the providing of wellness.
Let me give you some examples of our approach to patient-centered care:
Those are just a few approaches to patient-centered care TMC offers. But patient-centered care must begin with the individual patient. We all must lead healthier lifestyles. That begins and ends with healthier eating, exercise and healthy choices.
(courtesy of dailyspark.com) $10 of junk food vs. $10 of healthy food
When you journey to the safety net hospitals and clinics that serve some of the neediest Americans, you will invariably find yourself in the heart of the urban core.Nearby you will see establishments such as liquor stores, convenience stores and fast food restaurants.
According to the Mid-America Coalition on Health Care, of which TMC is a member, approximately 9.1 percent of all health care costs in the United States are related to obesity and being overweight. That is a mind-boggling percentage when you consider that U.S. health care costs reached $2.5 trillion in 2009. Additional estimated costs of obesity include $4.3 billion a year in worker absenteeism and lower productivity that amounts to $506 per worker per year, the Coalition report said.
Some may argue that junk food is the most affordable alternative for urban core residents, but that is not true. In a Sept. 24, 2011 article in the New York Times, food journalist Mark Bittman wrote that a typical order for a family of four at a McDonald’s near his writing desk runs about $28. By comparison, Bittman wrote, for $14 you can serve a home-cooked meal of roast chicken that would feed four to six people. Or for only $9 you can dish out a meal of rice and canned beans with bacon, green peppers and onions, Bittman added.
Each of has a role to play in the battle for healthier food. Individuals, schools and employers must step up and do their part.
Hospitals must weigh in, with words and actions.
At TMC, we are seeking to replace the fast food restaurant at our urban core campus with a vendor that will offer healthier food. I feel very strongly about this, because I don’t think our message about healthy eating will resonate unless we set a good example. TMC also is working toward the establishment of a new grocery store near our campus that will provide our neighbors with healthy, affordable food – an oasis in our food desert.
Each one us has a role to play, and each one of us must do his or her part in this fight. The health of our country depends on it.
First Lady Michelle Obama has made it her mission during the Obama Administration to end childhood obesity and to combat “food deserts.”
A TMC Healthy Harvest Fresh Produce Market customer completes her purchase of oranges and grapes
Secretary of the United States Department of Agriculture (USDA)Tom Vilsack, simply put, defines a food desert as “an area of high poverty with little access to supermarkets or other sources of fresh food.”Many Americans are forced to shop at local convenience stores or basic grocery stores that carry little more than high sugar boxed cereal and high fat, sodium ladened microwaveable meals.
Food deserts affect 23.5 million Americans, including 6.5 million children, in both urban and rural areas, and Kansas City is no exception. What can be done? Truman Medical Centers (TMC) has been working to engage the community we serve and help to lead the way to a healthier community. With more than 56 percent of our patient base suffering from some form of chronic illness, many of which are related to nutritional habits, we see it as our duty to move beyond the walls of the hospital and take the fight to the community we directly serve.
In 2009, we began weekly Healthy Harvest Produce Markets at both our hospitals. Bringing low cost, fresh fruits and vegetables directly to the patients we serve. In addition, we have stationed dieticians at our weekly markets to help assist the community with quality choices and tips on how to prepare the items they purchase.
We also have an exclusive partnership with the oldest African-American grocery store in the area, Leon’s Thriftway, in which we bring regular health and wellness activities directly to the store. These include health screenings, exercise tips, classes and dietary assistant with the help of our registered dieticians.
In 2010, TMC partnered with the Kansas City Public Library and the Lucile Bluford Branch to open a dedicated Health & Wellness section. Among the amenities are specialized collections featuring extensive materials on topics ranging from teen pregnancy to diabetes; health kits for adults and teens; and books, DVDs, brochures, and articles relating to particular ailments, conditions, and diseases; and a machine to measure blood pressure.
Additionally, the space has kiosks connected to an online health and wellness portal for adults and teens featuring extensive information on such health conditions such as high blood pressure, sickle cell disease, diabetes, obesity, asthma, and HIV/AIDS.
To complement these written and digital resources, a series of special programs take place on a monthly basis featuring health experts, healthcare industry job fairs, workshops, and health screenings. As part of this mix, physicians and dentists from Truman Medical Centers will stop by the library branch on a regularly scheduled basis to answer questions from patrons as a part of a new “The Doctor Is In” series.
But the boldest venture is yet to come. In the next 16 months, TMC plans, with a partner organization (Hospital Hill Economic Development Corporation), to build a full-service grocery store in or near one of the USDA designated “food deserts” in the eastern part of the Kansas City urban core. This will bring quality; healthy choices directly to the people of the urban core, that now have little to no choices when it comes to shopping for their families.
All in all, my call to action, not to just to TMC, but to all hospitals, is that we must directly affect the communities in which we reside. And, the only way we can truly use the power of our organizations to better the communities we serve is to get outside the four walls of our hospital campuses and focus on leading the way to healthier communities.
In a difficult economy, health care is one sector of the U.S. economy creating jobs while other sectors struggle to retain workers. Hospitals are adding jobs right here in Missouri.
According to the Bureau of Labor Statistics, nationally hospitals have added more than 84,000 private sector jobs in the past year. That adds to the more than five million people already working in hospitals – [147,000 in Missouri) – caring for patients at the bedside, coordinating care in hospital pharmacies and labs, caring for those in need and keeping the lights on.
Health care is responsible for one in five new jobs. Many of the fastest growing professions are in health-related fields. Despite the economy, health care employs 36 percent more people than it did 10 years ago.
And yet, a “Super Committee” in Washington, tasked with cutting America’s daunting $1.3 trillion deficit, is considering changes that may take these new jobs away.
Hospital leaders recognize the fiscal challenges our country faces and by no means believe we should shirk responsibility to rein in our nation’s spending. Personally, our hospital and others in the community have tightened our belts repeatedly. Nationally, hospitals have done more than tighten belts – they have made significant commitments to reduce health care costs over the next 10 years.
Medical staff move a patient to surgery in the TMC Gastroenterology Unit.
Medicare and Medicaid are under the Joint Committee’s microscope. The notion that cuts to hospital care can be made without impact on beneficiaries or the communities in which they live is misguided.
Hospital care is a labor-intensive endeavor. Wages and benefits account for the majority of our hospital’s spending. Every hospital job supports two or more jobs as our hospitals and our employees purchase goods and services from other businesses – frequently local.
It’s estimated that a two percent cut to Medicare alone would eliminate about 200,000 direct and indirect hospital jobs by 2021. These are not just new, needed jobs; but existing jobs that families rely on. And, the proposal to limit the Federal Reimbursement Allowance for Medicaid is estimated to cost 8,735 Missouri jobs in addition to making it harder for citizens to get access to health care in Missouri.
In addition, Missouri’s demographic and economic characteristics make it disproportionately vulnerable to the caustic effects of Medicare and Medicaid reductions. Missouri’s population is older and poorer than the national average, ranking 18 and 20 respectively among the states in percentage of elderly residents and residents with incomes below poverty level.
The health field is hiring based on every community’s growing demand for health services. Hospitals are caring for patients who are living longer with more chronic disease requiring greater levels of health care. As we continue a shift to wellness and prevention, early health interventions will become more essential – requiring more regular access to care and more health care workers. Cutting jobs handicaps our ability to plan for and provide this needed care.
I’m certain that Congress and the Joint Select Committee on Deficit Reduction are taking this debt-fighting task seriously. But as our country struggles between recession and recovery, we must do what we can to save the jobs we have. We need forward-looking solutions rather than hard-to-take, but easier-to-craft cuts.
Your ZIP code is a more powerful predictor of your health than your genetic code.
To many in our community that will not be a very comforting statement. Unfortunately, the facts bear witness to it being the truth. Recently, Truman Medical Centers held an educational presentation called “Anatomy of Poverty” as part of our annual board retreat, in which we discussed health and social disparities and their effect on every aspect of our community life — from healthcare outcomes to education to economic empowerment and crime. Panelists included Dr. John Covington, KCMO school superintendent; Joe Reardon, KCK mayor; and Jim Corwin, KCPD chief.
Dr. David R. Williams, Norman Professor of public health as well as professor of sociology at Harvard University speaks to the TMC Board of Directors and Kansas City Community Leaders.
Our keynote speaker was Dr. David R. Williams, Norman Professor of public health as well as professor of sociology at Harvard University. Dr. Williams is internationally recognized as a leading social scientist focused on social influences on health.
According to Dr. Williams, every community, from the most urban to the most rural, has social and health disparities. Simply put, minorities and the poor get sick younger, have more illness and die sooner than the majority of Americans. Your zip code is a more powerful predictor of your health than your genetic code. Add the stress of being a minority, and a major community health problem presents itself.
I have long put forward the idea that in our community, violence is a real public health concern and the cycle of violence does not stop at the door of TMC’s emergency room. Crime is an impediment to all kinds of healthy behaviors. Violence keeps children from playing outdoors, sometimes from going to school and oftentimes can diminish their performance in school. Violence kills jobs and critical businesses, such as community grocery stores. And violence creates tremendous fear and stress for the entire community.
So, what can we — as a community — do?
All of us, not just those in the healthcare field, have both a moral and civic role to show up and really get to know our communities. That is to say, knowing our communities is not a responsibility we can delegate. We have to see it, feel it and understand we all have to fix it.
All of us need to play a part in transforming our community by caring and getting involved to help provide better opportunities for the disadvantaged to prosper and thrive.
TMC began the dialogue at our presentation, but now it’s up to all of us to take action. We can build a healthier metropolitan region and it needs to start in the urban core by implementing nutritional programs in schools; developing early intervention programs; providing better access to healthcare, creating employment and looking for ways to improve housing for those living in unfortunate circumstances.
Our community will only be as strong as our weakest links. As the United Way states, the community together can get results no individual can accomplish alone. And in the Greater Kansas City Chamber of Commerce parlance, this is a “Big Thing.”
TMC physician inputs data into a patient's electronic medical record
A seamless integrated care network: That’s what Truman Medical Centers (TMC) along with Samuel U. Rodgers Health Center and Swope Health Services, two federally qualified health centers (FQHC)-all in the Kansas City, MO, area- are working toward. Though TMC has had a long relationship with each FQHC, a recent push to integrate electronic health records, share patient information and track health outcomes is strengthening the partnerships and better serving mutual patients.
Sharing patient information and having a continuous picture of the patient’s health is the only and best way we can track health outcomes. By having all three of our organizations electronic health record systems interfaced, clinicians see information in their own records and can look at trends and work collaboratively with the patients other health care providers.
Also, the integration of electronic health record system allows a patient, without a primary care provider, seen in TMC’s emergency department to then be referred into the community where he/she is best served. The patient would not be “lost” to TMC from the point of view of the FQHC but instead have a true medical home at Samuel Rogers or Swope Health. All patient data would be there and available for better coordination, access and continuity of care.
TMC Psychiatrist talks with a mental health patient at TMC Behavioral Health
Although there are community mental health centers, similar to Truman Medical Centers’ (TMC) Behavioral Health Unit, that provide treatment for many people, their resources are stretched far too thin to help everyone who needs treatment on the level someone with a more serious issue may need. One of the most positive changes that will arise out of the recent passage of health care reform legislation is that more people will have access to affordable, effective treatments for their mental health needs.
TMC is well positioned for the first phase of the mental health reform as evidenced by our early adoption and integration of our mental health and primary care services. Recognizing that each patient defines his/her care team or “health home” on a personal/ individualized basis, we’ve modified how our TMC team delivers care to patients with mental illnesses and medical conditions. For those that have an array of mental health needs, all the care is provided through TMC Behavioral Health. The medical care is provided by an APN who works in Behavioral Health and sees the patient. Those patients that are more comfortable and have moderate mental health needs are seen by their primary care provider along with ongoing care management by our Nurse Practitioner.
Whenever patients require a specialized service, they are referred to the appropriate specialty clinic. In addition, mental health professionals are available to the primary care and specialty clinics for those patients who present with a psychiatric need. In the near future, health home standards and patient centered care expectations will be clarified and, TMC Behavioral Health will adapt to the standards and best practices.
