See our Rural Health Conference supplement and Flickr photo album from the event.
Nearly 300 rural health care leaders across Wisconsin descended upon Wisconsin Dells June 13-14 for WHA’s annual Rural Health Conference. This statewide forum is an opportunity to highlight and discuss a variety of public policy topics that affect rural health care, and this year’s lineup of keynote speakers tackled pressing issues such as disruptors in the health care industry and how to build resilience within your organization.
Health care disruptors: augmenting or competing with the industry?
How Walmart, CVS, Amazon and Google are impacting health care
Ron Galloway, President of 818 Research, conducts on-demand research about health care innovations and their consequences, as well as new trends and technologies in the health care industry. At the conference, Galloway explored how retail and analytic giants like Walmart, CVS, Amazon and Google will impact health care by leveraging their scale and data expertise—and whether they will augment or compete with the health care industry. “With its old tech and data silos, health care has been an industry ripe for disruption—and it’s the only business lucrative enough to ‘move the needle’ on their earnings,” said Galloway.
Consumers have built up a certain level of familiarity and trust with Walmart, CVS, Amazon and Google, so they’re more willing to share information with them. “They are using the existing—and upcoming— treasure trove of data and giving it context, which is called ambient intelligence. They are able to take this acquired knowledge from different data sources, build on it with machine learning, and infer conclusions about their customers.”
Galloway shared both simple and more complex examples of how ambient intelligence is already being used:
- “Amazon knows my size pants, so they can guess my weight.”
- Walmart tracks the weather and how it impacts customer purchases in different geographic areas. If a hurricane is heading toward Miami, without asking any humans, the store knows customer will want to buy beer and strawberry frosted Pop-Tarts. “It’s a conclusion none of us would make, but the computer was able to validate it’s true.”
- The technology behind the MagicBands that Walt Disney uses at its amusement parks to connect to a visitor’s account are being used on Alzheimer’s wards. Walt Disney uses the bands to enhance customer experience, whereas the wards use the bands to monitor patient care, such as where an Alzheimer’s patient is located, if they fall down, or if they are moving in bed too much.
Walmart - Augmenter
Galloway believes it is Walmart, not Amazon, that could prove to be the real disruptor in the health care industry. Walmart is using its “profound IT expertise” to scale its data mining in the health care industry, which can be utilized at Walmart’s Centers of Excellence networks.
Walmart has medical partners at these 15 Centers, and the organization hires specialists, often hiring local doctors who do not seem to be affiliated with hospitals, to treat participants in the store’s Health Reimbursement Account (HRA) plans. Individuals can receive a variety of procedures such as cardiac bypass surgery, hip and knee joint replacements, or be treated for cancer or spine injuries.
CVS - Competitor
With CVS’ $69 billion merger with Aetna coming before a federal judge in the near future, Galloway sees CVS as a direct competitor in the health care industry. He noted that CVS has:
- 9,800 retail locations
- 1,100+ walk-in health care clinics
- 94,000,000 members in its pharmacy benefits plan
- 1,000,000 patients served by its dedicated senior pharmacy care business
It is looking at the Aetna acquisition as a way to “help address U.S. health care system challenges” as noted in the graphic above. Galloway said, “As Aetna’s boss, Mark Bertolini put it, ‘We have 10,000 new front doors to the health care system’” as CVS takes over Aetna’s patient medical care records, giving it “far more information about patients’ chronic illnesses.”
Amazon – Augmenter, but in a Strange Way
Amazon is looking to get into pharmaceuticals, medical supplies and electronic health records (EHRs). “They’re not afraid to spend money or take chances,” said Galloway. But as Amazon looks at expanding its reach into those areas, it’s looking to the be the interface in the health care industry, not a competitor.
- Pharmaceuticals. Sixty-six percent (66%) of customers say they would have no concerns with ordering medications from Amazon, and consumers are already doing so in Japan for Category No. 1 drugs. Amazon offers same-day delivery service after the items are approved by a pharmacist, and these services are bolstered by its recent purchase of PillPack, which provides individualized medication packets by date. The PillPack purchase also gives Amazon access to sensitive health care data. “This is going to be one of the greatest corporate acquisitions because it gives them the ability to deliver prescriptions in 49 states versus getting individual licenses in each state,” said Galloway.
- Medical Supplies and EHRs. Amazon Web Services (AWS) is the company’s secure cloud services platform, which gives the company access to “big, big data” notes Galloway, as it provides data storage services for other companies. For example, while Netflix competes with Amazon Prime, Netflix also stores its data on Amazon’s AWS. Galloway speculates that Amazon is interested in delving deeper into EHRs, and one of the ways they may do this is by offering medical supplies to hospitals for free in exchange for EHR data.
Google - Augmenter
"I’m not afraid of Google—they know everywhere I went last year, and I don’t believe they are going to be a big competitor,” said Galloway. “Google is intent on becoming a force in EHRs, which is a business begging to be disrupted with its interoperability and meaningful use mandates.”
Google acquired DeepMind in 2014, which is a world leader in artificial intelligence research and predictive analytics. Galloway walked through an example of how DeepMind is analyzing raw EHR data to see what it can learn. It created 64 billion data points to study inpatient mortality, 30-day readmissions, and length of stay. It could accurately predict:
- If someone was going to die when admitted
- If a patient would be readmitted within 30 days from discharge, an important factor in reimbursement
- Length of stay within 24 hours of admission
Galloway concluded by saying that as people live longer, data and technology will be important factors in providing high-quality health care and quality of life.
Identifying Challenges, Achieving Solutions for Rural Health Care
WHA’s bipartisan advocacy efforts lead to strongest health care budget in 30+ years
Eric Borgerding, WHA President and CEO, and Tim Size, Executive Director of the Rural Wisconsin Health Cooperative, continued the day’s discussion reporting on important issues to the rural health care community including reimbursement and coverage, the health care workforce, and how Wisconsin’s shifting demographics are impacting rural health.
Borgerding reiterated that WHA has a continual focus on state and national policy issues that impact members’ ability to provide high-quality health care. WHA’s advocacy efforts are “reaching beyond the hospital walls into the continuum of care,” such as outpatient services and post-acute care.
One of the hospital reimbursement policy issues facing Wisconsin’s hospitals is Medicaid reimbursement, which has an annual shortfall of $1.2 billion and is continuing to grow. While members are controlling costs, nearly 30% of Wisconsin’s safety net hospitals continued to lose money in fiscal year 2017, with the majority of these facilities located in rural areas of the state. The shift to outpatient care is the biggest factor driving these losses because it has an even lower Medicaid reimbursement rate than inpatient services. This outpatient costshift has increased by $500 million over the past decade.
“About one-third of Wisconsin’s hospitals operated in the red last year. People assume that hospitals can shift unpaid Medicaid costs for both inpatient and outpatient services, but that is getting more difficult to do and should not be the long-term strategy for financing the Medicaid program,” said Borgerding. “For every $1 it costs a Wisconsin hospital to care for a Medicaid patient, 35¢ goes unreimbursed. This government cost-shifting not only impacts Wisconsin employers’ and families’ health care costs, but it threatens access to care in rural Wisconsin.”
Borgerding also shared some good news in the reimbursement realm by highlighting the increases included in the state budget introduced by Governor Evers and recently approved by the Legislature’s budget committee. The governor and Legislature have differences as to funding sources, but both included significant hospital and physician reimbursement increases that WHA has advocated for throughout the state budget process.
“These additional resources, if signed into law, will help expand access to care all across Wisconsin,” Borgerding said.
The budget also includes funding toward other issues top-of-mind for hospital CEOs statewide: the health care workforce and health insurance market stability. To date, the Legislature has approved a number of policy and funding improvements to Medicaid reimbursement, access, and workforce development:
- $148 million increase for the Disproportionate Share Hospital (DSH) Program
- $11 million increase for Rural Critical Care Supplement Program
- $25 million behavioral health reimbursement (details pending)
- Eliminating specialty limitations for the Graduate Medical Education (GME) program
- $2.5 million reimbursement increase for dental services for persons with disabilities
- $7 million for telehealth reimbursement and modifying the telehealth definition in the Medicaid program to allow for realtime provider-to-provider telehealth consultations and remote patient monitoring
- $70 million to stabilize high-cost premiums in the individual insurance market
- $1.1 million to expand Medicaid program outreach
- $44 million increase for broadband expansion
More people will receive the care they need because of this budget, especially in our rural and urban undeserved areas. “I have been doing this for more than 30 years, and this is hands-down the strongest budget I have seen for health care,” said Borgerding. “Governor Evers introduced a strong budget, and following the Joint Finance Committee vote, it remains very positive for health care in Wisconsin. Our members expect WHA to be the political landscape readers, and this budget demonstrates how an organization like ours engages in and affects public policy. It is also due to the tremendous efforts of our members who testified at every single public hearing and made more than 2,100 contacts to legislators.”
Tim Size, Executive Director of the Rural Wisconsin Health Cooperative (RWHC), then took the stage noting the strength of the RWHC/WHA collaboration. “I do not think there’s another partnership like this in the country, and Wisconsin is better for it.”
Size said RWHC’s top advocacy issues center around Medicare/Medicaid funding and regulatory reform, wellness incentives and access to health care to reduce disparities, statewide workforce issues, and promoting rural Wisconsin’s rural economic and community growth. “Medicaid and hospital clinician reimbursement are tied directly to our ability to address social determinants— you cannot look at one without looking at the other.”
Wisconsin county health rankings from the UW Population Health Institute show that two-thirds of the state’s rural counties have health outcomes in the bottom half of the state. Size says this is not a failure of talented and hard-working rural health care providers. Instead, he points to the social determinants of health that drive outcomes, such as access to health care, education and employment.
“There are two Wisconsins: our metropolitan areas and rural communities. We often think of disparities in metro areas, but if you look at our state, rural job growth is just starting to return to what it was before the recession,” said Size. “A strong rural economy requires a strong workforce.”
Workforce demands are continuing to outstrip supply due to demographic changes. Wisconsin is aging, and the financial viability of rural hospitals is dependent upon its available health care workforce. Size says baby boomer retirements are creating a shortage of rural clinicians, such as a chronic shortage of behavioral health and dental caregivers, along with deficits in primary care physicians and registered nurses.
To help address workforce needs, Size is looking at various community revitalization initiatives that also address social determinants of health including housing, community development, job creation and education to help rural communities and health care providers prosper.
Size closed by expressing appreciation for the financial investments made in the state budget to help address the workforce, access and economic needs in rural health. “Rural providers can only be part of solving their communities’ bigger problems if they are financially healthy. Medicaid dollars are critical, and we are very grateful for WHA’s leadership on this issue,” said Size.
Final day of Rural Health Conference highlights “retrain your brain” and resiliency techniques to build a strong health care team
Former psychiatric RN, Amy Dee, kicked off Friday morning at the Rural Health Conference by sharing her humorous and heartfelt observations in the health care industry, stressing how “confirmation bias” can impact relationships with patients.
“We all seek out information that proves what we already believe, and we disregard all information that conflicts with those beliefs. We make a statement in our head and seek information to prove it’s true,” said Dee.
This confirmation bias occurs because our brains have an overwhelming amount of data to process each day, so it looks for shortcuts to manage the information we receive. It takes less energy to confirm what we already think versus learning something new—which makes first impressions critical. Our confirmation bias is looking to validate that first impression, and it is how we interpret an event that causes an emotion. Dee asked attendees if their hospital has a welcoming presence, causing patients and their families to interpret their interactions positively.
“It takes less than 10 seconds for patients who come into your hospital to decide whether you care about them—or you couldn’t care less,” said Dee. “People are not only served by large gestures, they’re served in the small gestures…the next time you have a patient who makes you want to grit your teeth, listen a little bit harder. Never underestimate the power of making another human being smile; in that moment, you may be the only person who can. Who you are and what you do in this world matters.”
Dee was followed by New York Times bestselling author and resilience expert, Jim Davidson. Davidson began by sharing his harrowing story of falling into an 80-foot hidden crevasse, or crack in a glacier, on Mt. Ranier. He was climbing with his friend and experienced climber, Mike Price, and the impact of the fall ultimately killed Price. Alone and buried in snow to his chin, Davidson Jim Davidson knew he had to get out of the crevasse before the snow began to freeze.
“The way back to the world was 80 feet over my head, and I kept thinking, ‘there’s no way out of here. No one knows we’re in here, so what do I do now. I can’t stay here, and I can’t climb the walls,’” said Davidson. “When faced with a problem, we get attracted to what we don’t have. Instead, look at what you DO have to solve the problem; that’s the attitude you need to have.”
Slowly, Davidson began to ascend the ice wall by screwing in ice screws to make a “ladder” he could use to climb out, which he did. “I wish I could say I had super strength or invented some new climbing technique, but it wasn’t that. It was grinding perseverance. It gets tiring, but you’ve got to keep going.”
Davidson didn’t climb for five years but eased back into the practice when he was contacted by a university to help teach students how to climb. Eventually, to honor the member of his friend, Davidson went to Nepal to co-lead an expedition with a group of students to climb Mt. Everest. During the climb, Nepal was hit with the worst earthquake it had experienced in 80 years.
These two traumatic climbs taught Davison about having a resilient mindset, what resilient teamwork looks like, and how to be a resilient leader. “When something goes wrong, the people who accept the issue the fastest, do the best (called situational awareness). How can I help with this new reality— confidence is contagious, but so is fear.” Davidson encouraged the rural health leaders to be realistic yet optimistic, and to amplify resilience.
See our Rural Health Conference supplement and Flickr photo album from the event.