Latest / Becker’s Healthcare Podcast / Driving Collaboration and Quality Across Cardiovascular Care in Michigan with Dr. Vikram Kashyap

Transcript

Driving Collaboration and Quality Across Cardiovascular Care in Michigan with Dr. Vikram Kashyap · Becker’s Healthcare Podcast

• 0:02
  The most important health care decisions don't happen
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  in isolation.
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  They happen when leaders come together.
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  Becker's sixteenth annual meeting brings together more than
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  3,500
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  hospital and health system executives this April in
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  Chicago.
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  With 800 speakers from Ascension, Cleveland Clinic, CommonSpirit
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  and more, the conversations get real. Leaders will
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  share how their scenario planning for policy shifts,
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  breaking through value based care barriers, and building
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  clinical teams that translate new ideas into real
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  world care.
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  Join top decision makers in the room April
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  For the agenda and event details, visit beckershospitalreview.com
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  and click on the events tab in the
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  upper right.
• 0:45
  This is Laura Dirda with the Becker's Healthcare
• 0:47
  podcast. I'm thrilled today to be joined by
• 0:49
  doctor Vic Kashyap,
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  endowed chair of the Frederick Meyer Heart and
• 0:53
  Vascular Institute and vice president of cardiovascular
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  health at Corwell Health. Doctor Kashyap, it's a
• 0:58
  pleasure to have you on the podcast today.
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  Thank you so much, Laura, for including me
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  in your series. Very happy to be here.
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  Absolutely. Now I'm excited for our conversation because
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  I know,
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  you know, the cardiovascular
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  care is such a dynamic space. There's so
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  much happening, and you know, really interesting to
• 1:15
  kinda think about how it's evolving. Most people
• 1:17
  in their lifetimes are either touched by this
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  type of care or have loved ones who
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  are. And so, you know, I'm excited to
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  learn more about how you're thinking about,
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  things today and and what you're seeing in
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  the future. But before we dive in, can
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  you tell us a little bit more about
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  yourself and CorVel Health?
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  Yeah. Happy to.
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  So I'm a vascular surgeon by training.
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  I spent, the majority of my career in
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  Cleveland, Ohio. I was there
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  for a couple of decades.
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  And then a few years ago, got contacted
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  about this opportunity,
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  which was to run a heart and vascular
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  institute.
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  And I'll say that Korbo Health and and
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  this area has been evolving,
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  changing
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  very dramatically over the last few decades.
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  So initially, Butterworth Hospital,
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  was a community hospital, and then Spectrum Health,
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  a system in West Michigan.
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  And Spectrum Health, which I joined back in
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  2022,
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  merged with Beaumont Health, which is on the
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  East side of the state in Metro Detroit,
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  and we're now called Corwell Health. So, for
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  those podcasts that you do on branding, we
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  have a little branding confusion,
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  since we've had some name changes.
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  But we're now a 21 hospital system across
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  the state of Michigan,
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  and our goal really is to provide comprehensive
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  care for, our patients and our communities.
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  I love that. And it's simple yet, you
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  know, so complex when you think about everything
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  that entails providing that type of complex care
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  and access to care for the broader, communities
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  and populations you're serving. So I'm curious. Can
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  you tell us a little bit more about
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  the last year? So what was an important
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  initiative that you led? What did you do,
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  and what were the results?
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  Yeah.
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  So we've, the Franklin Meyer Heart and Vascular
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  Institute has been,
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  in place for over a decade now, and
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  the Meyer Heart Center is a
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  eight story hospital devoted to heart and vascular
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  care
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  that's been in place for over twenty years.
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  That being said,
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  like many places, I think we were still
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  fairly fragmented.
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  You know, silos in
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  cardiology,
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  in cardiac,
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  in thoracic surgery, in vascular surgery,
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  in wound care, in multiple areas,
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  across the
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  cardiovascular
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  landscape.
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  And I think perhaps
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  not just last year, but in the last
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  couple years,
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  our biggest
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  success
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  has been really
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  becoming much more collaborative, much more
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  coordinated
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  as a Heart and Vascular Institute.
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  So what does that mean? For instance, we
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  have really focused
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  on ensuring the highest quality for our patients.
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  Now every physician, every group wants to do
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  that, but what we've done is looked at
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  it at a system level.
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  So we look at
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  every mortality that happens in the heart and
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  vascular space.
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  Each group
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  is tasked to really do a very careful
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  analysis
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  and then bring back to us any lessons
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  learned,
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  any gaps in care,
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  and any other items that can really be
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  socialized
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  for our group as a whole to improve
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  the care of patients.
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  Well, what's happened? Over the last three to
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  four years, we've dropped our raw mortality,
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  significantly.
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  We have improved our observed to expected mortality
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  ratio,
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  which was, at the one level that is
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  on par or average
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  down to point six seven.
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  And I think that
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  focus on
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  improving
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  individual patient care and then having the lessons
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  learned,
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  in one area
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  be socialized to all areas across the Heart
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  and Vascular Institute have really been a great
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  success for us.
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  And it's helpful to understand. You know? And
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  it I, really appreciate you kind of talking
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  through the systematic way that you approached
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  trying to tackle some of these issues because,
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  I think having, you know, heart issues and
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  challenges are so such a big,
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  issue for patients, their families. And so being
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  able to,
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  provide some of those back best practices and
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  really figure out what makes the most sense,
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  in terms of moving the needle for mortality,
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  is so helpful. Can you dig a little
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  bit deeper in there? How did you really,
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  make a difference, or what were some of
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  the things that you did and changes that
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  you made in order to serve the community
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  better?
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  Yep. So
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  I will I'll have to make sure to
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  credit all of our amazing
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  teams,
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  our physicians,
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  our surgeons,
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  our other providers, including nurse practitioners
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  and PAs
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  that are part of the team nurses,
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  they have worked diligently
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  and collaboratively
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  to really provide great care for a long
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  period of time.
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  However, we did see improvements,
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  in heart surgery,
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  in cardiology,
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  in vascular surgery,
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  in terms of thirty day mortality.
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  I think this was both a refinement of
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  practice and very careful selection of patients.
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  We also saw an improve in our o
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  to e ratio
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  probably because of documentation.
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  That is,
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  we had very sick patients here in West
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  Michigan just like many other
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  urban and semi urban areas, but maybe we
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  weren't
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  displaying how ill they were till we did
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  a better job of looking at risk factors
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  and documenting them appropriately in the record. So
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  I think those two things. One,
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  absolute or raw mortality decreasing, but then also
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  the expected mortality for a cohort of patients
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  increasing because of the risk of that population
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  being appropriately
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  delineated
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  has been the sex success here.
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  That makes a lot of sense. And, you
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  know, it's helpful to understand,
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  all the different kind of adjustments that that
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  you're making to move the needle. Now looking
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  ahead for 2026, what are some of the
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  big priorities and headwinds that you're most focused
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  on?
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  Yeah. One of the, big challenges we had
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  last year is a,
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  complete change in
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  our anesthesia workforce.
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  And this is not
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  dissimilar to some of the other, systems and
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  hospitals around the country. We've moved from,
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  a private practice
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  contracted model
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  to an employed model.
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  And that was a big change for
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  the system,
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  for the hospital, and quite frankly, for each
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  individual
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  physician, especially the surgeons,
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  that rely on great anesthetic
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  care for taking care of their patients. So
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  we're in the midst of this transition,
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  going to an employed model,
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  that has meant a lot of recruiting
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  of great anesthesiologists.
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  And oh, by the way, let me put
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  a plug. If somebody wants to come join
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  us in CORWAIL. I hope in Grand Rapids,
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  we are open
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  to we have open arms,
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  but that has been, as you can imagine,
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  a lot of change management.
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  Different people in the operating room, different
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  processes, perhaps,
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  in some areas,
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  people coming from different cultures, coming to to
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  this culture, this medical culture here. So all
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  of that change, I think, has been very
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  disruptive,
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  and
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  getting to a point where we're
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  almost complete or maximally employed in that department
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  of anesthesia is gonna be a hallmark for
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  us. We hope to accomplish that in 2026.
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  I think that really stabilizes our surgical and
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  procedural areas to a great degree.
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  That's it makes a lot of sense. You
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  know, that is such a huge change, especially
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  with anesthesia. I know today, you know, across
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  the board is something that is top of
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  mind for so many clinical teams, and trying
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  to figure out the right model that makes
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  sense in each community is no easy task.
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  And so when you're going through, you know,
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  some big changes like this, especially when it's
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  operational things happening,
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  in the operating room, but then too, you
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  know, wanting to make sure that clinicians have,
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  faith and
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  and really trust their colleagues to deliver the
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  best care possible. But how do you go
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  about this change management and making sure that,
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  you know, everybody across the board is comfortable
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  with how you're moving forward and, you know,
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  ready to do whatever it takes in order
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  to keep that great quality care going?
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  Yeah. Well, I think the first element is
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  communication
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  and maybe
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  communicate, communicate, communicate over communication.
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  And we do this in in a multimodal
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  way. We have town halls,
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  where we have all the members of the
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  Hart and Vascular Institute, which are now over
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  a thousand people,
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  dial in,
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  for a virtual town hall.
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  We,
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  have
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  in person grand rounds once a month where
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  we hit some of these
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  topics. We have a monthly newsletter,
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  and I meet,
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  periodically
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  with different teams
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  in different spaces, whether it be the vascular
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  surgeons or the thoracic surgeons or the electrophysiologist
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  or other,
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  proceduralists that get affected by this change.
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  So one is to communicate what's happening.
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  Two is to be really brilliant at the
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  tactical changes that are occurring on a daily
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  basis, whether it be schedules,
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  whether it's using a certain number of locums
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  providers to fill in the gap till we
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  get to a fully employed model,
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  and other things. And then I think the
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  other the the other part about this, Laura,
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  is also to really
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  have folk have people focus on the long
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  term. What is gonna be the long term
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  effect of this? Well,
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  it's gonna be that we're gonna have a
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  department of anesthesia that is as aligned
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  with
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  the different strategies that we have for the
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  Heart and Vascular Institute, including quality, including
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  research,
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  education,
• 11:18
  strategic growth, etcetera.
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  And that's gonna be a very positive state
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  for us once we were able to achieve
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  this.
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  I love that. I think being able to
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  have that type of, communication, clarity, and relationship
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  with the team that they understand exactly what's
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  going to happen and why things are happening,
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  and then really get on board to make
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  that change makes a big difference.
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  What do you think, the hardest thing you
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  that you'll have to do in the coming
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  year will
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  be? Well, that may be the hardest thing,
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  but let me tell you about a couple
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  of other things that I think,
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  that are happening that, are are big changes.
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  So we've been a heart and vascular institute,
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  but recently,
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  we also incorporated
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  the pulmonary division
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  into,
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  our,
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  our area.
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  So now, actually, we're in the midst of
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  a name change again, but it's not for
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  the overall organization. It's for our department as
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  we go to the
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  heart, lung, and vascular,
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  department.
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  And that's important for, many reasons. This was
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  an organizational
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  change that, that we did not ask for.
• 12:22
  This happened, because of some changes
• 12:25
  in the overall structure of the organization.
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  We really welcome this as a great opportunity
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  for the pulmonologists
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  who already collaborate, by the way, with many
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  of our thoracic surgeons and others
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  to
• 12:38
  really even enhance that relationship,
• 12:41
  especially for lung cancer treatment, for lung transplant,
• 12:45
  and other areas.
• 12:47
  We've had a lot of folks in overlapping
• 12:50
  areas,
• 12:51
  related to
• 12:53
  both pulmonary and cardiac issues,
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  let's say, in the areas of syncope,
• 12:58
  in the areas of
• 13:00
  of, shortness of breath, etcetera. Now these groups
• 13:04
  that are often are evaluating
• 13:06
  similar types of patients
• 13:07
  are all under one roof, and they can
• 13:10
  hopefully
• 13:12
  elevate the care that they're giving, elevate their
• 13:14
  algorithms to an even greater level. And I
• 13:17
  think the last thing that's this is really
• 13:19
  gonna be
• 13:20
  impactful
• 13:21
  is our whole
• 13:23
  research infrastructure where we have
• 13:25
  tremendous number of folks that are interested in
• 13:27
  research. We've started about over 60 trials now
• 13:31
  I'm sorry, over 70 trials in the last
• 13:34
  five years, clinical trials.
• 13:36
  And this allows groups that previously had been
• 13:39
  separate
• 13:40
  to collaborate to,
• 13:42
  really be at the forefront
• 13:44
  of early stage
• 13:45
  treatments
• 13:46
  for heart and lung problems.
• 13:48
  So we're really looking forward to that as
• 13:50
  both a challenge and an opportunity for us.
• 13:54
  That makes a lot of sense. And, you
• 13:55
  know, it is really,
• 13:57
  interesting to see how those dynamics have been
• 13:59
  shifting. And I know it's, you know, no
• 14:02
  small task to,
• 14:04
  have those types of clinical trials and research
• 14:07
  and more,
• 14:08
  becoming a bigger part of what you're doing
• 14:10
  there. And I I'm curious, when you think
• 14:13
  of that balance between trying new things and
• 14:15
  the research and the development and accelerating therapies
• 14:18
  and, you know, also knowing that you have
• 14:20
  to to care for a a growing patient
• 14:22
  base, how do you keep the the,
• 14:25
  both innovation as well as clinical quality and
• 14:28
  safety in mind and, you know, looking ahead
• 14:31
  as well as thinking about what needs to
• 14:33
  be done right in front of you?
• 14:35
  We have a a beautiful strategic road map,
• 14:39
  and we actually have changed it into a
• 14:41
  visual that,
• 14:42
  that looks like four pillars holding up a
• 14:45
  temple. You've seen that visual before for strategies
• 14:48
  with the foundation,
• 14:49
  four pillars, and then the the capstone on
• 14:52
  top.
• 14:53
  And the capstone has our vision, which is
• 14:55
  that we wanna be nationally ranked, recognized for
• 14:57
  what we do, and being a destination for
• 15:00
  compassionate
• 15:01
  and collaborative and innovative
• 15:03
  heart and vascular care,
• 15:05
  now heart, lung, and vascular care. And the
• 15:07
  strategic pillars have to do with exceptional quality,
• 15:11
  being brilliant at our operational
• 15:13
  capabilities,
• 15:15
  focusing and elevating research and education, and lastly,
• 15:19
  strategic growth.
• 15:21
  And whenever we have a group meeting, a
• 15:24
  strategy meeting,
• 15:26
  or an operational meeting that's more related to
• 15:28
  tactics, we show the same slide
• 15:30
  and have people really coalesce around. These are
• 15:33
  our four pillars.
• 15:35
  This This is what we'll work on, what
• 15:36
  we'll focus on.
• 15:38
  And below, we have the number of metrics
• 15:41
  and
• 15:42
  tactics
• 15:43
  that are related to those pillars. So getting
• 15:46
  the team members
• 15:47
  aligned
• 15:48
  in a way that they can see that
• 15:50
  their work
• 15:52
  affects
• 15:53
  either one or multiple
• 15:55
  strategic pillars that we have and then allows
• 15:57
  us to move forward because of their work,
• 16:00
  I think, is very impactful, keeps people engaged,
• 16:03
  keeps people and the team aligned to what
• 16:05
  our future is gonna be.
• 16:08
  That's helpful for understanding. Thank you so much
• 16:10
  for digging a little bit deeper there. Now
• 16:12
  before we wrap up, I wanted to ask
• 16:14
  you about growth too, where do you see
• 16:15
  some of the best opportunities for organizational growth
• 16:17
  in the next year or two?
• 16:19
  Yeah. I think the the biggest potential, quite
• 16:21
  frankly, Laura, is the,
• 16:23
  the,
• 16:24
  possibility,
• 16:26
  that we've been talking about for some time
• 16:29
  of really,
• 16:30
  really having a
• 16:33
  collaborative
• 16:34
  Pan Michigan approach
• 16:36
  to heart and vascular care.
• 16:38
  And what do I mean by that? Well,
• 16:40
  big system on West in West Michigan, that
• 16:42
  Spectrum Health, that was the organization that I
• 16:45
  joined based out of Grand Rapids, big system
• 16:48
  on the East part of the state, Legacy
• 16:51
  Beaumont based out of Metro Detroit.
• 16:54
  Now we're Coral Health West and Coral Health
• 16:56
  East.
• 16:57
  Well, if we can collaborate
• 17:00
  and really align on
• 17:02
  different protocols, algorithms for patient care,
• 17:06
  I think we could have a huge impact
• 17:08
  on not just our local communities, but really
• 17:11
  the whole Michigan population.
• 17:13
  Whether we talk about heart failure,
• 17:16
  eligibility
• 17:17
  for heart transplant,
• 17:19
  we talk about shock
• 17:21
  and
• 17:22
  emerging
• 17:23
  strategies to deal with patients in cardiogenic shock,
• 17:26
  including advanced mechanical
• 17:28
  circulatory support.
• 17:30
  We talk about peripheral arterial disease
• 17:33
  and how we treat patients with
• 17:36
  claudication
• 17:36
  all the way to
• 17:38
  limb threatening ischemia.
• 17:40
  We talk about wound care. We talk about
• 17:43
  coronary disease. All these different entities
• 17:46
  that we see
• 17:47
  in our so many hospitals across Michigan,
• 17:50
  if we can coordinate that care in a
• 17:52
  way that's more meaningful, that could have a
• 17:55
  really big impact, I think, for many of
• 17:57
  the folks that we take care of.
• 17:59
  Absolutely.
• 18:00
  It that makes a lot of sense, and
• 18:02
  you really paints a great picture of what's
• 18:04
  ahead,
• 18:05
  and the possibilities for you at Corwell. Thank
• 18:07
  you so much for joining us on the
• 18:09
  podcast today, doctor Kashyap. It's been a pleasure
• 18:11
  speaking with you. I I've learned a lot,
• 18:13
  and I look forward to seeing you as
• 18:14
  well at our annual meeting in April. I
• 18:15
  know you'll be speaking on a panel and
• 18:17
  really digging deeper into some of these themes
• 18:19
  we've been talking about, so I'm excited to
• 18:21
  have you as part of it. Well, thank
• 18:22
  you. It's been my pleasure, Laura. I really
• 18:24
  appreciate it.