Driving an integrated healthcare network to take care of community health
Recommended Books:
Good to Great and the Social Sectors
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Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and inspiring healthcare leaders and influencers and now your host, Saul Marquez.
Saul Marquez:
Welcome back to the podcast that I have the privilege of hosting Randy Oostra to the podcast. He’s the president and CEO at ProMedica Health System overseeing the not for profit mission-based integrated health care organization headquartered in Toledo Ohio. Prior to this role, he served as president and chief operating officer. Oostra is regarded as one of the nation’s top leaders in health care and has earned a spot on several prestigious listings which include modern healthcare’s 100 Most Influential People in health care and one of Becker’s healthcare’s 100 great leaders in health care. He also served in the American Heart Association’s pulse of Toledo. He received the award in 2018. He has a strong commitment to the health care industry and community and serves on the board of trustees of many organizations including the American Hospital Association Health Research and Education Trust. The root cause Coalition and many more. His work in the health care system has brought about much needed change to improve health care of communities and it’s with that privilege that I also discuss that he received a doctorate in management from Case Western Reserve University, a master’s degree in Healthcare Administration from University of Minnesota and also a master’s degree in management from the University of Wisconsin. So with that those credentials as well as experience he’s been able to do what he’s been able to do and I’m excited to dive into that expertise with Randy today sir Randy with that introduction. I just want to welcome you to the podcast.
Randy Oostra:
Yeah thanks Saul, great to be with you today.
Saul Marquez:
It’s a privilege to have you here. Randy and so what did I miss in the intro that maybe you want the listeners to know about you and what you do?
Randy Oostra:
Yeah you know in your intro like somebody went to school their whole life you couldn’t figure out what they wanted to do. And you know I think the you know I grew up in a very small town in Iowa and spent a fair amount of time early on in my career working in small hospitals across the Midwest including Public Health Service hospitals. And what this thing about that I think is just as we kind of reflect back on kind of where we’ve been in health care and where we’re going and a lot of ways from going back to where we came from and that’s delivering more care, kind of a home home setting with care integrated back into people’s lives. And I think it’s what we all want. So I think it’s just interesting to think through that a little bit. I think just as I think of my own career kind of almost going back to where we all started from 30 years ago that a lot of the things we moved away from were moving backwards.
Saul Marquez:
That’s really interesting Randy and I’d love to dive into that a little bit deeper. One of the things that comes to mind is the book by Atul Gawande on Being Mortal and he talks about this shift right, the paradigm shift of everything from the home right. Folks were just you know choosing to do end of life at home and care at home. And it shifted to today to kind of everything at the hospital now you’re seeing that shift again. So I’m really intrigued by hearing your thoughts there. What is it that just made you decide to get into the health care sector?
Randy Oostra:
Actually my parents really didn’t have the luxury of having any education. You know my mom was an immigrant. My parents were both older children and required to work. And so they were very focused on education and was actually an advisor in the small college I went to that student is for the sciences and that ended up kind of morphing from being in education to along the way I had in between one of my graduate school states and so I got a job got a job in a small consulting group doing a lot of healthcare. And that really evolved to occur in health care. And so I spent last almost 40 years during health care. And then along the way my wife and I were 30 quit our jobs and went back to school university in Minnesota started over in College, traditional health care administration role and had no goals. At that point outside of I was traveling I didn’t want to travel but knew I was very impressed with the people I met in health care and so starting from that premise all throughout the last 30 years 30 40 years to you know think in terms of some of those issues you know those early experiences I had in my life.
Saul Marquez:
Well I think it’s fascinating the way that meandering road brought you to health care and it’s a good thing that it did. You guys are making a big impact. Folks, for those listening chromatic guys a health system serving communities in 28 states. They have over 4.7 million patient encounters, 13 hospitals, over 56,000 employees. So the work being done there by Randy and team is is highly impactful. Randy what would you say is is a hot topic that needs to be on every health leader’s agenda today and how are you and your organization approaching it?
Randy Oostra:
Well I think the biggest issue is probably not talked about enough is this whole idea what’s the future model of health care. We know health care is unaffordable. We know start to read about statistics about health care very quickly getting to 20% of the gross domestic product. We start talking about giving Medicare for all and actually expanding the current program and then we all talk about the models that working it’s not affordable. The tremendous impact that it has on people in their lives and the impact on seniors. What it’s doing to people relative to the middle class. And yes when we talk about expanding it and I think the biggest issue that we’re not talking about is what is this new model. You think you can put a flag in the ground for whatever debut what 15 – 20 years from now because the trajectory for health care is it’s just going to cost going to continue to increase. We’re gonna continue to see small hospitals get close. We’re going to continue to see a shift toward consumerism and all those hot topics where we haven’t talked about this fundamental shift in the model. And I think that’s the thing that we would say that we need to embrace and have some discussions about very politically sensitive politically sensitive very you know not popular with a lot of industry types in that trying to preserve what we have. And yes clearly we need a different model.
Saul Marquez:
That’s a great call out and you guys come from a very unique position and also having an integrated health system with Paramount in the work that you’re doing there. So what does that look like? You know I mean if you if you had to picture 5, 10, 15 years from now Randy, what is that new model look like? Do you even have any ideas that what you think might work?
Randy Oostra:
Yeah. You know so just in our thinking and I think it’s something that’s a ball of the reputed time I’d love to say you know we thought this was going to happen is just rather be lucky than good. We’ll find out. But you know we started out as a very traditional healthcare system. You know our pride and joy was that we were a local regional integrated delivery system that’s how we described ourselves. We had hospitals, we employ physicians, and we had a health plan. And we’re very proud of that fact and we serve this specific geographical area. And then over a period of time a couple of things happen. You begin to think about the future health care and the things we already talked about. You think about how to position yourself in the future. And for a lot of America we’re in non growth areas and of course the market we serve is a very nice growth area. You think about kind of having the right scale and scope to provide the resources that you need to continue to have survive in the future. There’s probably some debate about what size that would be. And then the other part just when you as fundamental level think about the impact on people. The fact that you know, how expensive America’s health care is the results we get from the American health care system and you get to comparing those to other countries just cause the affordability issue. Also you know the waste that’s in this stage of the system the fact that you know we have a very specialist based system and that we don’t spend enough money on a lot of the social issues in our country as our whole things happen for us because you know we serve a region that you know like water reaches our country have social issues. We became very concerned about those issues and our role in those issues. A lot of people use the word anchor institution. And so we became very interested in obesity as a kind of a public health issue that really kind of quickly drew a simple hunger. One story that we screened for food insecurity. We’ve done it for probably over eight years now of screen millions of encounters and now we’ve screened for 10 social determinants and everything you read about in health care and personal cell is 20 percent of your health is related to what we do in health care and 80 percent destroyed or other stuff. And if these social determinants of health that are more critically important in people’s lives than anything else. So you saying that the outlook for affordability of health care aging and when you come back to is a model of not thinking to yourself is this integrated delivery system. But now we actually begin to call ourselves a health and well-being company and I never thought I’d say those words and why. How do we begin to deliver services not as a traditional inpatient provider where everybody is viewed as a patient but it’s more of an individual and trying to create. I hate this word but it’s this kind of ecosystem my health care to try to meet people’s needs in a variety of ways. And so I think we kind of thought differently and so our our way to grow and and really think differently as we moved into the space that a lot of people frowned upon it’s this post hospital space. Post acute space. And so we very quickly increased the size of our company but when you take those aspects the clinical aspects, the insurance aspects of what insurance organizations were able to do. The social determinants and then this notion about healthy aging which is a topic a lot of people’s minds these days. And if you begin to think of all that it’s just a much more comprehensive world. And for us we think that’s kind of the right model for the future.
Saul Marquez:
That is fascinating. Gosh you know this this idea of a health and well-being company. One of the things that as we talk to people in the health care system they’re talking about value-based care and some of the challenges of reimbursement not covering these things very forward thinking to do things such as social determinants of health screening. Something caught my eye that I think is really neat and kind of goes along with the health and well-being company. You guys have a ProMedica summer concert series.
Randy Oostra:
Yes. So you know there is this topical anchor institutions that your listeners have ever looked at A.J. And the health care anchoring network. So the idea on anchor institutions is this notion should of you know traditionally they are nonprofit organizations but they’re anchored in place that usually means that there are organizations that can move. So today you know it’s a gloomy day in Ohio and I want to move to Florida. We can’t pick up and move ProMedica to Florida. So we’re actually here. And then if you look at you know we our shareholders our community we work for the community. And so why wouldn’t we begin to use our resources to make investments back in our community. So we’re in the process of moving several thousand of our employees into the city in Toledo. We’ve got a thousand so far. We’ve done another thousand. We’re moving and we’ve done a whole variety of initiatives. These anchor institution sort of investments that make our community better. So just a couple of quick examples. A couple doors down from us was a bankrupt hotel that we purchased out of bankruptcy because it was going to go back into bankruptcy. That was an eyesore. It was getting rundown. We’re able to buy it. We were able to find a developer from Chicago to take it today as America ratifies that gets the accolades and we got our money back and we have probably done that probably on all these dozen different occasions it could go over a list where we’ve used our money and our our drivers just to get our money back in the house for development economic development is job growth. And again this is great for our community it’s great for people that’s great for our business model too because you know growing communities day how and so when you begin to read about different organizations that have done these anchor and average strategies Kaiser is a good example in housing rush in Chicago, University in Cleveland. There’s a Variety’s organization of managed investment so you like a summer concert series creating a way to get people back into the city creating. So we’re the major sponsor of that. We’ve got another sponsor with us and it’s going to be doing some of these things to try to drive development. And there’s another concept called place making and if you create these vibrant places for people that want to live it’s great for their overall health and well-being.
Saul Marquez:
Fascinating. Randy this is really inspiring work. The things that happen in and around the community uplifting and the spirit of the community through development and economic development it just makes so much sense. Give us an example. Obviously these are ways you guys have created results. Is there anything in particular that stands out that you want to share of you’re doing it differently and you created this result?
Randy Oostra:
Well I you know I take it we took a bankrupt empty rundown hotel or was able to plop into a Marriott Radisson. We’re sitting on a river here in Toledo across the river from us. We were able to buy some property from an international owner today is being developed to think about 50 acre Metro Park and another development where at the time developers building several hundred apartments and as actually being constructed as we speak. And so some of those sort of very tangible I mean it creates all the type of things that you would think about in this case a hotel that treats economic development is back there are a whole variety of ways for our community. New housing, new retail, new parks as those sort of things I have to tell you. Not everyone loves that idea. You know a lot of times people will say well why do we do it. They don’t understand even our own employees struggle with that from time to time. And I don’t think they always understand our strategy because we get our money back and it’s just when they see these things pop up they go Oh why are we doing this when we can’t do this. So you know but I think in our I give our credit to our board and all the locally based board members or community focused. The thing here and had some discussions with people you know when we think about doing our fair share our fair share is more than anybody else. Again when we look at our size, when we look at what we do as you know tell me one day that they will do their fair share. Almost applying called or match with these other smaller organizations are going to do it. I mean sure maybe your fair share is hard task that’s what they do even make them a good idea. But I think it is that fair share. And again I understand people don’t always appreciate it. But I think our notion there again is helping the communities you know in a very different sort of way. And you know I think the people that are doing it are having to try to explain why we do those things. But I think those examples of where we’re able to help spur we help lead a new masterplan for the city when we moved here and just significant, tangible benefits that we’ve seen that not only what we’ve done what others have done. What was the collaborative way with other people. It’s pretty exciting to see what can happen.
Saul Marquez:
That is exciting. And when I think about it I feel like it’s an old adage now but the idea that your zip code is more able to determine your health than your genetic code you’re elevating that zip code in a big way Randi. And you and your team deserve a lot of kudos for what you’re doing.
Randy Oostra:
Yeah. You look at that whole social so there’s there’s there’s a couple interesting things that I think this is where this health care model discussion comes in. You know we talked about the you know how we can afford health care you begin to look at things with healthy moms healthy babies. Ohio particularly is a very poor statistics relative to infant mortality. We’ve been somewhere between 45 and 49 for overall mortality. Forty nine graphic and American babies babies dying in the first year wife and all social condition. And so there’s two thoughts there. One is making sure that we have the right sort of you know social infrastructure to help people give them the tools to succeed in life. And what we find is the work we’ve done our people are highly motivated to change their lives based on how they just don’t have the tools to do it. And I think that’s real clear even as we screen our own employees. It’s just I think for people that that can kind of navigate life we just can’t appreciate how others have not had the ability to be in a situation where they understand how to navigate life. The other thing that is really concerning ethics concern us all is these adverse childhood experiences and you start to read more about that that effect on children through their life as they grow and in adulthood you know that is just the impact is just traumatic. And so there’s a lot of attention starting to be focused on that. So so all these things build to your health and well-being and yet you spend these three trillion on the weight of six trillion when they manifest themselves. But we don’t go back to the kind of the root causes here these social determinants. And so you know one would hope that the dialogue would shift to that and we think health care should be reimbursed to begin to move. We’ve got this American healthcare system let’s move it back to some of these social issues. Let’s let’s reimbursement for that. Yeah. We have to make some changes maybe the other things we reimburse. That’s where it’s going to get a little dicey. Yeah but the effect on people would be much more dramatic. Instead of spending all this money at the end of life let’s back it up a little bit. I think that’s where this model discussion has to come in. And it really has to incorporate the social deterrence without any adverse childhood.
Saul Marquez:
I think that’s a great call out Randi and it’s turning that model upside down. I think that it’s helping you guys do what you’re doing so. Appreciate you sharing that. What would you say is one of the proudest things you’ve been able to accomplish with your team there?
Randy Oostra:
You know it’s a great team that I think was I think saying we feel the best about us. When I talk to people when I hear what we’re doing you know and you kind of start to know what we put in motion with the help great generosity of some donors actually. A man Russell you buy from Detroit gave us really thirty five million dollars to invest in a lot of these programs is to see where our team has taken it. So you know it’s one thing to have a broad concept but what they’ve done relative to job creation and financial opportunity coaching helping people with the various social throws of why working with other parts of the organization or workers approach right now to create housing working going door to door to impact people’s lives helping them in a whole variety of fashions that the work that is harder work is takes longer to do. But when you continue to hear what people are doing and then every time you talk to miss something you I think that’s what we feel the best about is just that we’re doing the type of things that we all want done in our communities. And I think. Well we set in motion a lot of people whose hearts were in the right place. Then to take it to another white woman. That’s probably the thing fail. It’s probably a little harder for some folks to understand exactly what I’m talking about where we’ve taken it and where it’s gonna go and so we’re looking at some really interesting housing options for folks job creation when we see people that were homeless and literally as six months having a job driving a car, living independently. We have a lot of those examples those things we feel good about.
Saul Marquez:
Yeah that’s definitely something to feel really good about and be proud about. What would you say. I mean gosh you guys are up to so many exciting projects and you’re an integrated health system on the planned side you got you know that run in what what would you say an exciting product or focused you’re most excited about today is?
Randy Oostra:
I think the things that we’re looking at right now there’s there’s probably two things that we’re most excited about. One is the screening of social determinants. We of course started with hunger started screening our patients. Now we’re moving to our employees and now we’re starting to talk to others at church that wants to screen all their parishioners, a university that wants to screen their students and do interventions. Employers that want to be able that we’re starting to talk to employers about screening their employees and thinking about what that would mean to their health and wellbeing and their medical expenses. I think that’s really exciting. The other piece that is exciting is the ability to deliver more care at home. And you know depending on who you talk to somewhere you know you read between 25 and 30 percent healthcare to be delivered at home. And what’s interesting is the technology exists today to do that. So it’s a matter of connecting dots I think to cut products or programs that are going to evolve over the next couple of years are going to see more about is this widespread screening of social determinants especially in the employers space in the payers base and then the other piece is the whole piece with a healthy aging in taking more care people at home.
Saul Marquez:
Fascinating work. Yeah. There’s definitely some some great insights and forensics that you guys have going on.
Randy Oostra:
At home in the lowest setting. And again if you think about that’s where I don’t want to be a patient personally if I can be taken care of at home that would be my preference.
Saul Marquez:
Oh that’s true absolutely. Now yeah. That absolutely I feel the same way. And I know a lot of folks listening did, too. Randy, wow. We’re close to the end here. I wish we had more time but what we have next is the lightning round followed by a book you recommend to the listeners. You ready for that?
Randy Oostra:
You bet.
Saul Marquez:
All right what’s the best way to improve health care outcomes?
Randy Oostra:
Oh I think. Is this a lightning round.
Saul Marquez:
It’s a doozy not easy.
Randy Oostra:
Outcomes is a comprehensive approach to clinical and social insurance.
Saul Marquez:
What’s the biggest mistake or pitfall to avoid?
Randy Oostra:
Not communicating enough.
Saul Marquez:
How do you stay relevant as an organization despite constant change?
Randy Oostra:
Make sure you protect the innovators in your organization. Why do people cycle a bottom up.
Saul Marquez:
That’s a really great one Randy. What’s one area of focus that drives everything in your organization?
Randy Oostra:
Strategic plan. Always be focused on where we’re going and focused on the why.
Saul Marquez:
And Randy these next two are more on a personal note for the listeners to get to know you. What is your number one health habit?
Randy Oostra:
At this point in my stage of life so I become more of a vegetarian, thanks to my son than ever before. And my goal is to walk 16,500 steps a day. So I can’t run anymore because of an ankle problem but so I’m a robust walker and that’s what I still work out some other ways but yeah. So that’s critically important.
Saul Marquez:
Good for you. And what is your number one success habit?
Randy Oostra:
I think my number one success habit is trying to you know spend the time my wife and I getting away periodically we’re trying to do more of that. I just kind of I’m good at this. Put the phone down. Go for a walk and just take more time just to sit and think as opposed the kind of runs 24 hours a day.
Saul Marquez:
Oh that’s beautiful. What book would you recommend to the listeners Randy?
Randy Oostra:
Well there’s two books I’d probably recommend a day. One is your calls book Good to Great and social sectors. That’s one of my all time favorites and one that I just read lately. Palaces for the people. Outstanding book about the importance of innovations we can make in people’s lives. I recommend both of those.
Saul Marquez:
And the second one was Palaces for the People?
Randy Oostra:
Palaces for the people. Yes.
Saul Marquez:
Nice. Awesome. Some great recommendations there Randy. Folks for the recommendations that Randi made links to these books links to ProMedica Health System as well as a transcript and short notes for today’s interview, go to outcomesrocket.health and in a search bar type in Randy or type in ProMedica you’ll find it all there. Randy before we conclude I love that you could just share a closing thought and then the best place where the listeners could continue the conversation with the organization and yourself.
Randy Oostra:
Yes. You know I think I think there’s a couple things that I would share I think that what we’re doing what we’re seeing and it’s just exciting every single day see more and more people talking about social determinants calling out the need for social terminus. We’ve seen legislators thinking about social tourists and I think the next couple of years can be very exciting to see where this goes. And I think it’s going to set up a case for some national dialogue. The other thing is just because of necessity of course is what we’re going to be able to do at home. And I think that’s going to have a little bit of a mind shift for people. But I think when we think about technology the ability to communicate with professionals kind of real time. I think we’re going to see a whole new emphasis on both of those areas. And I think it’s going to be exciting. I still think about the clinical leaders that are in a world that people get up every day and take care of patients. I’m always impressed by the people who do that. You think about health care in America especially the safety net hospitals those that primarily serve our underserved populations each and every day they take care of whoever walks in their door. People that many of us maybe would be uncomfortable having in our homes and yet we take care of everyone and those caregivers need a big shout out. I think I would leave you with that. For more discussions I think go to areas that I think that I would point people to the Root Cause Coalition which is a national organization with social determinants is of great resources at the American Hospital Association on that as well. And then our ProMedica website which is as you know highlight a lot of things about healthy aging.
Saul Marquez:
Outstanding Randy. Appreciate those resources and ways to get in touch. And again just want I give you a big thank you for making the time to spend with us to share your insights. Really, really appreciate it.
Randy Oostra:
Perfect Saul, great to be with you and look forward to more discussion.
Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration and so much more.
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