11 CEOs: The one healthcare problem I would like to fix tonight

Eleven health system CEOs pinpoint the one industry problem they wish they could solve overnight.

Joel Allison, CEO of Dallas-based Baylor Scott & White Health
"I would like to provide a way for all people to have access to safe, quality, affordable care."

David Bailey, MD, MBA, president and CEO of Jacksonville, Fla.-based children's health system Nemours
"If I could wave my magic wand, I would have the population and the healthcare system truly embrace wellness and prevention. The impact on mortality, cardiac events, joint replacements, diabetes and hypertension — to name just a few conditions — would be enormously positive, not to mention the huge reduction in healthcare costs that would follow."

Ruth Brinkley, president and CEO of Louisville-based KentuckyOne Health
"Access to care. I believe everyone deserves access to quality, compassionate care. I grew up in rural Georgia and I knew people who died because they did not have proper access to healthcare. It's our mission to bring wellness, healing and hope to all, including the underserved. We have to be innovative to reach those who need us most through programs like virtual care and telemedicine."

Alan Channing, former president and CEO of Chicago-based Sinai Health System (retired July 1)
"My thought about that is really equal access to quality education, care and insurance coverage. There was recent New York Times article about how the U.S. was actually underspending on healthcare and social services, if you aggregated the two, compared to other countries with better healthcare outcomes. And, that is in spite of the overspending we've had on high-end diagnostic tools and robots. [Editor's note: The article, "Spending More and Getting Less for Health Care," was written by Pauline W. Chen, MD, and published November 21, 2013.]

As I hear people in the industry and some of the more conservative policy wonks talk about 'patients have to have skin in the game,' often they use that language to talk about Medicaid recipients. What I've seen through the work we've done is that people who don't have the knowledge base can't have skin in the game — to understand how to eat, the impact of the way they cook. They don't know what blood sugar means and the impact of it. Investing on that side, education, along with universal coverage would fix healthcare."

Ronald DePinho, MD, president of The University of Texas MD Anderson Cancer Center in Houston
"Right now, our biggest concern is access. Health reform needs to ensure more people have health coverage. But that's not enough. Reform efforts also need to guarantee families can receive high-quality specialized care from those with deep expertise when they need it.

As an NCI-designated institution that often cares for people fighting difficult-to-treat cancers, we're concerned that many of the plans offered through state and federal exchanges do not currently allow for access to top cancer centers like MD Anderson, Memorial Sloan Kettering Cancer Center in New York City, Dana Farber Cancer Institute in Boston and Mayo Clinic. We want to make sure patients can come to these centers when they need to. Cancer is an incredibly complex family of diseases, and sometimes people need to be treated by those with highly advanced expertise. We hope such patient-oriented adjustments can be made in the near future to remedy this issue.

We also want to break down other barriers to sharing the knowledge gained in our clinics and labs. We're in the midst of developing the Oncology Expert Advisor powered by IBM Watson. The third-generation cognitive computing system is being built to analyze physician notes, medical outcomes information and medical literature. A physician can use the system to weigh the profile of a patient they are treating against OEA's knowledge base to determine treatment options relevant to that particular patient, based on literature, guidelines and expert recommendations. It will help physicians at MD Anderson and elsewhere in deciding the best cancer care options for patients."

Stephen Klasko, MD, MBA, is president and CEO of Thomas Jefferson University and Jefferson Health System in Philadelphia
"I think health disparities, by far. It's not just the access to care. It's the fact we ignore the true determinants of health, most of which have nothing to do with hospitals or doctors. At Jefferson, we have the first school of population health in the country. By the time the patient gets to the doctor, 80 percent of his or her health determinants are cast, whether it's water, diet, exercise or education.

Some think we're going to solve health disparities by providing better access to hospitals and doctors, which isn't a bad start, but we're missing 90 percent of the boat by not doing things from the population health perspective. Unfortunately, we spend 90 percent of our healthcare dollars on the 10 percent of acute care that will determine your health, and we under-resource the public health aspects."

Vivian Lee, MBA, MD, PhD, CEO of University of Utah Health Care in Salt Lake City
"That is a tough question. I would say my biggest concern is that our industry has really been focused on sickness, not health, and that we're not equipped or designed to do the single most important thing we can — prevent disease. We know approximately 75 percent of our healthcare dollar is spent caring for patients with preventable illnesses, often related to specific behaviors or lifestyles. Yet our system, our training programs, and the ways in which we're funded have generally not led us to be experts in changing those behaviors by incentivizing healthy living. I am acutely aware of this having moved from New York to Utah.

Utah boasts one of the healthiest lifestyles in the country, and as a result, data show we are in the enviable position of being in that sweet spot — having one of the healthiest populations and spending the least on healthcare of all the states in the country. As a nation, this is the biggest problem facing us in the coming years. We need to change our systems and our markets to make more progress toward health and wellness."

Stephen Mansfield, PhD, president and CEO of Dallas-based Methodist Health System
"About two years ago, the National Research Council issued a report funded by the Institutes of Medicine and Health. It was a 16-nation longitudinal study to answer this question: Why do Americans spend more money per capita than the rest of the industrial world on healthcare, but our health metrics lag those of other countries?

The answer was not anything to do with what we reformed in healthcare, if you will. The fundamental answer was about the health status of Americans. Shockingly, what they discovered was that the U.S. is either the worst or very near the bottom for most public health measures. The U.S. health disadvantage spans many types of illness and injury.
When compared with the average of peer countries, Americans, as a group, fare worse in at least nine health areas:

1. Infant mortality and low birth weight

2. Injuries and homicides 

3. Adolescent pregnancy and sexually transmit¬ted infections 

4. HIV and AIDS 

5. Drug-related deaths 

6. Obesity and diabetes 

7. Heart disease 

8. Chronic lung disease

9. Disability

If I could fix one thing, it would be that Americans accept personal accountability for their individual health. Most of the nine conditions listed above are autogenic. I think it's a conscious decision that people need to stop smoking, eat less and exercise more. No amount of delivery system reform can offset the impact of our declining health status as Americans."

Randy Oostra, president and CEO of Toledo, Ohio-based ProMedica
"When people are negative or cynical about healthcare today, especially those who have lost sight of what drew them into their career in the first place. What bigger responsibility in life could you have other than taking care of people? There have been changes in this industry, but those don't change the fundamentals of healthcare."

David Pate, MD, JD, president and CEO of St. Luke's Health System in Boise, Idaho
"The problem of affordability. No question. In order to achieve this, we will have to solve several other big challenges.  

First, it requires that we improve the health of people who are not yet patients, and keep them from becoming patients as long as we can. This work has to be with families and has to start with toddlers. Secondly, we have to work to eliminate the 30 percent to 50 percent of low-value and/or no-value healthcare services currently provided to patients.

And lastly, we have to make our care as safe as possible, incorporate evidence-based practices whenever available, and better coordinate care and manage care transitions. We all have our work cut out for us."

Michael Schatzlein, MD, CEO of Nashville, Tenn.-based Saint Thomas Health
"Public expectations that more is better have been developing over decades in the U.S., partly aided by copious advertising of prescription-only drugs and devices, but [it's] also a symptom of our fast-food, want-more-now culture. If fee-for-service was eliminated and strict evidence-based guidelines were universally adopted tomorrow, we would still have a huge cultural issue with patient expectations. We can fix the rest of the system pretty quickly if we resolve to do so, but changing the culture around expectations for care is what I'd want the overnight magic for. Otherwise it will take decades."


The above quotes stem from CEOs' responses to Becker's Hospital Review's Corner Office questionnaire, an ongoing series that runs in print and online. Hospital or health system presidents and CEOs interested in contributing to this series: Please email Molly Gamble at mgamble@beckershealthcare.com.

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