Latest / Becker’s Healthcare Podcast / Advancing Population Health at Rady Children's Health with Dr. Michael Weiss

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Advancing Population Health at Rady Children's Health with Dr. Michael Weiss · Becker’s Healthcare Podcast

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This is where health care leadership comes together.
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Becker's sixteenth annual meeting brings more than 3,500
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hospital and health system executives and nearly 800
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speakers to Chicago, April 13 through the sixteenth.
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This year's event includes keynote conversations with Dallas
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Cowboys legend Troy Aikman and former president George
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w Bush. For the agenda and event details,
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visit beckershospitalreview.com
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and click on the events tab in the
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upper right. We're looking forward to hosting you
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in Chicago.
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Welcome to the Becker's Healthcare podcast. My name
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is Paige Twenter. I'm a reporter and assistant
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editor with Becker's Healthcare.
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I am so excited to be joined today
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by doctor Michael Weiss. Without further introduction, I
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would just love,
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you know, doctor Weiss, if you could tell
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us about yourself and a bit about your
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organization.
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Sure. Well, Paige, thank you, and thank you
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very much for having me today. I'm really
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excited to share some of the work that
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we're doing.
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Mike Weiss, I'm a general pediatrician,
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just a country doc. I practiced in the
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community for about twenty two years here in,
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Southern California
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in a
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private practice with a number of other physicians
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in general peds.
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And I always, was
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kind of excited about the system of health
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care and, how things could certainly be better
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than they are.
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I have a background with,
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having lost a brother and sister in childhood
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to congenital
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disease. And I grew up as a family
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member
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kind of observing this not only as a
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clinician, but more as a family member. And
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it just always was something that I wanted
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to do above and beyond seeing the patient
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in front of me. So, I,
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over the course of time, sought a little
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bit more education on the business side of
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medicine,
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and I was fortunate enough about eleven years
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ago to be,
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sought out by Children's Hospital of Orange County
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to start a population health division here.
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Lo and behold, here we are 11 later,
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and we've built something that I think is
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very exciting.
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In terms of our organization, it's been a
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very exciting year.
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Children's Hospital of Orange County, which, is where
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I was hired on to, actually merged with
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Rady Children's Hospital in San Diego
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to become Rady Children's Health, and that's now
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been one year since that merger.
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So we are represented by,
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three hospitals. We have, San Diego,
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Orange, and then we have a hospital in
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a hospital in Mission Viejo.
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And we have in both regions,
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we have subspecialty
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clinicians,
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tertiary quaternary services, and primary care networks. So
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it's actually a beautiful incubator to be working
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in this, field.
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You buried the lead, doctor Weiser. I didn't
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even mention the lead of you're the first
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ever endowed chair for wellness
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of Rady
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Children's.
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That was a recent appointment.
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Yeah. Well, it's always hard to blow your
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own horn, but, I'm I'm very, very honored
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that, the Clavis Foundation, which is a local
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foundation,
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have the forethought to
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really,
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look at wellness and prevention. And, I also
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give Rady Children's Health and and CHOC a
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lot of credit for really having the
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thought to think outside the the four walls
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of the hospital,
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and really consider
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that paradigm change of health care moving more
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into prevention and wellness.
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You know, we as clinicians and hospitals
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are very, very good at being reactive
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to, situations. You know, patient's sick, make an
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appointment, come see me. I'll take care of
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you.
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But the reality is when you look at
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the geography
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of, you know, these urban or suburban
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hospitals that we all work at,
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only five to 7% of the population ever
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really experiences
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the hospital, which is great. You know, we
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we love that.
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But where are the other 93 to 95%?
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These are kids that are at school, they're
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at the park, they're at faith based organizations,
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they're at, you know, all these, various community
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based organizations.
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And
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for us as a health care system, if
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we're not going out and proactively
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addressing,
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the causes of illness and,
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working with those communities,
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I don't feel like we're doing our job.
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So I I applaud Rady Children's Health, the
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Clavis Foundation,
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and I'm honored to be that first chair
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working toward that goal. Mhmm.
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On that note of prevention and meeting that
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ninety three,
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you know, percent of patients who aren't going
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to the hospital, what are
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really, like, two to three priorities you're setting
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for yourself in the next
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twelve months?
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Yeah. It's, it's definitely a,
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gonna be a bell shaped curve. There's gonna
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be, somewhat of an uphill battle because it's
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really a culture change. You As a pediatrician,
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I was I was trained to fix. I
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was trained bring me a problem, and I
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will fix it. I was not trained to
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prevent the problem from happening.
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And so I think priority number one is
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really going to be education and awareness.
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It's really working across the organization,
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primary care, specialty care, ancillaries,
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the community,
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leadership
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to get people to really understand the importance
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of,
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prevention and,
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and proactivity.
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You know, we've all seen some degree of
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the beautiful slide that shows that 80% of
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what makes us healthy,
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has nothing to do with what doctors and
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hospitals do. It's your genetics. It's your environment.
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It's the exposures you have. It's it's all
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those things. And if we're not addressing those,
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we're not addressing the major reasons why,
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illness occurs,
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the social drivers of health, etcetera. So I
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think that's that's priority number one. I think
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priority number two
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is that I want to be sure as
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we enter into this arena
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that we do it in an evidence based
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fashion. So certainly things like integrative medicine are
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something that the public really wants.
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And I can tell you that the clinical
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side is very skeptical.
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And so bringing those two areas together,
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studying it in an appropriate manner,
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and assuring that it's, evidence based,
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is another huge priority that I have. I
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always look back to, you know, people are
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probably aware if they're of my generation of
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the Framingham study, which is a study that
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was done in Massachusetts
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ongoing that has looked now for fifty or
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sixty years at a cohort of people that
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were born, and they followed numerous markers on
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those patients,
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looking all the way from blood work to
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social drivers, to genetics, to their employment, etcetera,
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etcetera, to determine what it is that really
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drives health.
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Well, I would love to really do something
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like that on the pediatric side
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to really look at what are the interventions
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that we can,
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consider
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that may ultimately
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lead to better longevity, better outcomes in children?
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You know, for instance, a family who has
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a baby,
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and the family has a strong history of
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cancer or diabetes or rheumatologic
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condition.
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Are there interventions that we can undertake
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before those things manifest
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that can perhaps prevent them or prolong
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the onset of those,
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those conditions? So that's another paradigm change that
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I think, would be really important. And, again,
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doing it in an evidence based way so
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that we can study it and publish those
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studies and try to drive change, in terms
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of how we practice medicine.
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Mhmm. But the
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fifty year Framingham
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study, are you imagining
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or wanting to kind of start, like, a
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decades long
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research project then?
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I would love to. You know, I've spoken
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with our research department here, and we have
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some NIH,
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grant
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recipient researchers here, r one, r two grants,
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which are the the big
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NIH grants.
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And they seem very excited about what I've
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described.
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So I think if we can outline something
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like that and
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perhaps draw out a multi decade approach to
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this,
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it would be very, very exciting.
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Mhmm. I'd also love to know more about
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I mean, you you know, I asked for
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your priorities and you gave me priorities. I'd
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love to know more about kinda, like,
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your personal investment
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in this. You mentioned,
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earlier, your family background and losing your brother
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and sister
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really fueled
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your
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interest in, you know, working for, I believe
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you said, twenty two years in health care.
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Can you share
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more about that?
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Yeah. I mean, you know, I'm I'm forty
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years in now of being a pediatrician
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and, twenty two in private practice. And then
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I did a a stint
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kind of learning the business side actually on
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the adult side,
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in the, in the, insurance side.
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But I I think, you know,
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medicine
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is a very interesting thing. It's it's probably
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the only business that runs the way it
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runs and is still in business,
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because of the way that we approach it.
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And we all talk about, you know, value
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based payment, and we talk about universal health
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care, all of this. And, you know, again,
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I've been doing this for forty years. And
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I think thirty years ago, I started first
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hearing value based payments coming, it's coming, it's
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coming, you know, and here we are thirty
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years later, and there are pockets of it.
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You know, we in Southern California and we're
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I know we're a unicorn,
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but, you know, I I oversee a group
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of a 140,000
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Medicaid children
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who are under global capitation
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and have been so for almost thirty years.
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And we've made that work for thirty years.
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Our doctors are happy. The patients are getting
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great care, and the system works. But I
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understand that the vast majority of the country
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is still in a fee for service paradigm.
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And it's very challenging,
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to achieve some of these things in a
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fee for service paradigm. There's no,
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payment reimbursement
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reward
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for preventative care, for counseling, for team based
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care.
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There are pockets of
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demonstration projects. You know, CMMI has done a
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number of things, and, you know, I give
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them credit.
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But we're still in this do one, get
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paid, do two, get paid twice
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world. And until we change that paradigm, it's
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going to be a big challenge for
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us to move into this preventative
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proactive care,
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model.
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You mentioned paradigm shifts, with
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your or an uphill battle with culture changes,
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related to integrative medicine. And then, of course,
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paradigm shifts
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are really a true
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adoption,
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and rollout of VBC. Whereas right now it's
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just in pockets and will likely just be
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in pockets for
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many more years.
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I'm curious on
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actionable
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tips, like, for our listeners
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if they're interested in, you know, having their
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own unicorn of, you know, 140,000
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children, VBC model,
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what first steps would you recommend?
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Well, I think you have to start with
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leadership buy in. You know, as much as
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I hate to admit it, in my forty
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years, I've come,
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full circle and I am semi tainted.
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Health care is a business, and it is
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all about the money.
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And, as much as we as physicians
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want it to be all about the quality
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of care, you know, certainly that's there, and
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and we're doing our very, very best. But
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the reality
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is it it really comes down to making
11:56
it work financially. And I get it. You
11:58
know, I I have spent my career trying
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to understand the business side and the clinical
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side and marrying the two so that they
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don't kill each other and we can get
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things done.
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But I I think that the number one
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thing is it's gotta be a leadership
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cultural belief. You have to have the c
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suite
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believing and understanding
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that value based care can work clinically and
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financially. And there's plenty of, again, pockets of
12:24
unicorns that, are doing this. There's great work
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in Massachusetts. There's great work in in Pennsylvania.
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There's great work in Seattle, Washington,
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in California.
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But, again, this starts at the very top.
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The second piece of it is you have
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to have a payer that believes in it.
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And the payers,
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you know, are in a very difficult position
12:45
because their number one goal is they have
12:46
to sell product.
12:48
And they sell product based upon the attractiveness
12:51
of their
12:53
outcomes and their and their programs. And I
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think that there are enough studies demonstrating
12:59
the outcomes and the attractiveness, I'm holding my
13:02
hands up in air quotes for those listening,
13:05
of these programs,
13:07
to make it attractive enough to invest in
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that.
13:10
A great example is there is a health
13:12
plan, I won't name it, on the podcast,
13:14
who invests in a special needs,
13:16
program.
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They actually pay various medical groups. We are
13:20
one of them,
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a proactive fee to care manage their highest
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risk patients.
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And what has been shown in that program
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is that by putting,
13:30
a care team around these highest risk patients,
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including case management, social services, navigation systems, etcetera,
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you can reduce the ED visits. You can
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reduce the readmissions
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and thus reduce the cost of care while
13:45
maintaining or improving the quality of care. So
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it works. It's just a matter of getting
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the c suite and the health plans together
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to understand that it works.
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Unfortunately, we only have a few more minutes.
13:59
I could talk forever with you. But, we
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unfortunately have a few minutes left of our
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podcast today. And last question for you, doctor
14:05
Weiss,
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is where do you see the biggest opportunities
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for growth in the next year?
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Yeah. You know, I I really think that
14:16
the movement for what's called advanced primary care,
14:20
is is very important.
14:22
You know, primary care right now,
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and I can say this because I did
14:26
it for twenty two years, feels like a
14:29
hamster wheel,
14:31
particularly in pediatrics. You know, we have what
14:33
are called the bright futures recommendations from the
14:35
American Academy of Pediatrics and, you know, all
14:38
the current issues aside with vaccine refusal and,
14:42
you know, all those types of things. You
14:44
know, we are given ten to fifteen minutes
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to see a child, and there are 15
14:49
or 20 things that we need to do
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in that visit, including anticipatory guidance, including immunizations,
14:55
including the physical exam,
14:57
including preventative care, you know, etcetera, etcetera.
15:00
I I think advanced primary care really is
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the future where we are able to more
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effectively
15:06
embed
15:07
mental health,
15:08
social services,
15:10
community health workers,
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a number of different roles,
15:14
health coaches
15:16
into a primary care where the physician or
15:19
APP
15:20
is able to do their job and have
15:23
these wraparound services that are reimbursed,
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to provide all those other services that we
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know make up 80% of what health is.
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So I think
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positive out of that is that the major
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issue with subspecialties
15:44
these days is they're overwhelmed,
15:46
and I get it. It's very challenging, and
15:48
a significant percentage of what's referred to subspecialty
15:52
care is not appropriate for subspecialty care, could
15:55
be cared for in a primary care office.
15:57
And a lot of times, it's not able
15:59
to be done because of time, simply time.
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And so I think we can make both
16:04
sides of that equation work by really looking
16:07
toward funding and supporting an advanced primary care
16:11
model.
16:12
Well, thank you so much, doctor Weiss, and
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I'm excited to hear updates
16:16
on,
16:17
advanced primary care models.
16:19
Yeah. Thank you. I really, really appreciate your
16:21
time today, doctor Weiss. My pleasure, Paige. Thank
16:24
you very much for having me.