Latest / Becker’s Healthcare Podcast / Inside the Future of American Healthcare with Dr. Marschall Runge

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Inside the Future of American Healthcare with Dr. Marschall Runge · Becker’s Healthcare Podcast

0:02
This is where health care leadership comes together.
0:04
Becker's sixteenth annual meeting brings more than 3,500
0:07
hospital and health system executives and nearly 800
0:10
speakers to Chicago April.
0:14
This year's event includes keynote conversations with Dallas
0:17
Cowboys legend Troy Aikman and former president George
0:20
w Bush. For the agenda and event details,
0:23
visit beckershospitalreview.com
0:25
and click on the events tab in the
0:26
upper right. We're looking forward to hosting you
0:29
in Chicago.
0:32
This is Scott Becker with the Beckers HealthCare
0:35
podcast.
0:36
We're thrilled today to be joined by a
0:38
very special guest.
0:40
We're joined today by doctor Marshall Runge.
0:43
And doctor Runge is both a physician and
0:46
MD
0:47
plus as a PhD.
0:49
He had the pleasure, and we were lucky
0:51
to have him
0:53
serve as the CEO of of Michigan Medicine
0:56
through a critical period of time at Michigan
0:58
Medicine.
0:59
He's also a Johns Hopkins graduate and just
1:02
a brilliant person. We're gonna talk to doctor
1:04
Runge today about several subjects, but but first
1:07
and foremost, we're gonna discuss a new book
1:09
that he authored.
1:10
Marshall, before we discuss the book,
1:13
one, congratulations on a fantastic career.
1:16
And second, could you take a moment and
1:18
introduce yourself to the Becker's healthcare audience even
1:20
though you need no introduction?
1:23
Well, thank you, Scott. It's great to be
1:24
on the podcast with you, and thank you
1:26
for your very kind comments.
1:28
I am, as you alluded to, a physician
1:30
scientist,
1:31
by training
1:32
and spend a large part of my career
1:34
seeing patients and doing research related to cardiovascular
1:38
disease. I'm a cardiologist.
1:40
And,
1:41
as my career progressed, I became more involved
1:43
in administrative
1:45
roles.
1:46
In the last,
1:47
eleven years, I, completed these actually in the
1:50
fall.
1:50
I was dean of the medical school at
1:52
the University of Michigan and CEO of Michigan
1:54
Medicine, which,
1:56
is the medical school plus our large, $9,500,000,000
2:00
health system.
2:01
And the great thing about being here is
2:04
Michigan is full of wonderful people who are
2:06
passionate about health, passionate about making advances in
2:10
research,
2:11
and
2:12
providing the very best in patient care. And
2:14
so I couldn't I don't have a single
2:17
complaint about,
2:19
my opportunities here. And I have true as
2:22
I've told you before, I truly enjoyed and
2:24
learned so much from the Becker's meetings,
2:26
that those are a real pearl.
2:28
Well well well, thank you. You are as
2:30
good a person and leader as they come,
2:33
and and I won't say it because I'm
2:35
not a Michigan sports sports fan.
2:38
But but for you, I'll I will say
2:39
go blue for one moment because you're a
2:41
long term Michigan person. We had a couple
2:44
daughters that went to Michigan. I grew up
2:45
being a rival of the University of Michigan.
2:47
At least we thought they were they didn't
2:49
think they were rivals us, but, but but
2:51
a great, great academic institution.
2:55
Tell us a little bit, Marshall. You've got
2:57
such perspective.
2:58
I wanna talk about really two things, your
3:00
perspective on health care in general,
3:02
and second, your book.
3:04
And and and both those are really interesting.
3:07
Let's start with talking about your new book.
3:08
Tell us a little bit about that and
3:10
what motivated you to write it, and and
3:12
tell us a little bit about this.
3:14
Well, about, two and a half years ago,
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I was contacted by Forbes Books,
3:19
a great brand, and asked if I would
3:21
like to write a with them, a book
3:23
on health care. And I,
3:25
like you, I'm sure, and many of us,
3:27
we get these opportunities to,
3:29
write participate in writing books, both of which
3:32
are not very interesting. But I thought with
3:33
Forbes' name, this would be a book that
3:35
could have some impact.
3:37
I asked them, what would you like me
3:38
to write about this about health care? And
3:40
they said, anything you want. And so I
3:42
thought, well, you don't get that option very
3:44
often.
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So,
3:46
I
3:47
worked with them,
3:49
and developed a book that,
3:51
really talks about,
3:53
both the many, many positives of American health
3:57
care,
3:58
but also the pressure points, the areas in
4:00
which we're having the biggest problems, and then
4:03
finally,
4:04
some opportunities for the future.
4:06
So that was the genesis of the book.
4:08
I so,
4:10
you know, for example,
4:11
everyone knows the paucity we have of primary
4:14
care physicians. So I talk about that, and
4:17
I talk about access.
4:18
I also to take a
4:21
step in
4:23
the opposite direction, talk about the potential for,
4:26
AI,
4:27
AI in more mundane tasks and AI in
4:30
more sophisticated tasks.
4:32
I do talk about,
4:34
some of the amazing things that are happening
4:36
in drug discovery and device discovery,
4:39
in health care that have really
4:41
made our health care here,
4:44
what I think
4:45
is the very best in the world. If
4:47
I'm if I'm have
4:49
a significant or severe disease, there is no
4:51
place I'd rather be than in The United
4:53
States.
4:55
But that said, we have challenges. And finally,
4:57
I talked some about
4:58
a topic that is of great interest these
5:00
days, and that is,
5:02
as we age about longevity and,
5:06
what we can think about in terms of
5:09
what I'll call healthy aging
5:12
or measurement of healthy average life expectancy, one
5:15
of these terms that the epidemiologists
5:17
use, where
5:18
to my great surprise,
5:20
The United States ranks quite poorly. We rank
5:22
when I wrote the book, we ranked sixtieth,
5:24
six zero,
5:26
out of all
5:27
countries in the world in terms of healthy
5:29
average life expectancy.
5:31
So I think there's much we can do
5:33
in these areas. I don't wanna leave the
5:35
the by strong conviction that we have wonderful
5:39
health care, but there are things that we
5:40
need to improve in.
5:42
Thank you. And and, doctor Ruggier, you've watched
5:44
the health care environment for a long time.
5:46
You've also been a leader of a great
5:48
institution, plus of a medical school.
5:51
What can we do to improve health care
5:53
in The United States? What what's practical? What
5:56
can be done? I mean, we're the third
5:58
largest nation in the world, so it's not
6:00
easy. But but what can be done?
6:03
Well, what you hear in the media
6:05
is true, and that is the cost of
6:07
health care
6:08
is much higher
6:10
per capita in The United States than anywhere
6:12
else in the world. It's twice as high,
6:14
about $12,000
6:16
per person per year in The United States,
6:19
as the the next the runner-up is about
6:22
half that much, and it and it goes
6:23
down. And that is without
6:26
demonstrable solving of some of the the the
6:29
challenges that we face. And
6:32
I think that there
6:34
is one overall concept,
6:37
and that is
6:38
our focus in The United States has been
6:40
on health care, which is important.
6:43
But it has not been as focused on
6:46
health and preventive health and keeping keeping people
6:48
healthy. And I think that
6:50
were we to put much more emphasis
6:52
on on that aspect of health, we would
6:55
dramatically reduce our health care costs and people
6:58
would be living longer, living healthier, and happier.
7:02
So what what does that mean? Well, I
7:04
I think there are two
7:06
large deficiencies in The United States that are,
7:10
partly
7:11
related to the freedom we have in The
7:13
United States.
7:14
One is
7:15
unlike most of our peer countries,
7:18
we do not have some sort of global
7:22
global health care coverage for everyone.
7:25
So I'm not talking about universal health. I'm
7:27
not talking about any of the models that
7:29
came along, health for everyone, Medicare for everyone.
7:31
What I'm talking about,
7:33
is some level of health care so that
7:35
everyone has access,
7:37
and we we don't have that now.
7:40
It's interesting when I talk about that.
7:42
On one side of the political spectrum, people
7:44
say, well, that's just way too expensive. We
7:46
won't do that. On the other side, they
7:48
say, this is unacceptable.
7:50
We can't have two or three tiers of
7:52
health care. And to which I respond,
7:55
in the first case,
7:57
of course, we can afford it. If we
7:59
make people healthier, there's less,
8:02
impact on our budget when people get very
8:04
ill. They're they're they don't get so sick
8:06
before they come to the hospital. On the
8:08
other side, I say, well, let's not kid
8:10
ourselves. We have at least three tiers of
8:12
health care. We have commercial insurance. We have
8:15
government insurance, Medicare, Medicaid, etcetera,
8:18
and we have no insurance.
8:20
And that is just not the case with
8:22
our peer countries around the world. So that's
8:25
one. The second is many peer countries,
8:28
require
8:29
that you have a primary care physician.
8:31
And people critique that. They say, well, wait's
8:34
too long.
8:35
Why do I need that? I like to
8:37
coordinate my own care. But in reality,
8:40
primary care providers and I have many of
8:43
my best friends and some relatives are primary
8:46
care providers,
8:47
And they're dedicated, and they want to look
8:50
at each of us, each of their patients
8:52
holistically.
8:53
And I think that's something that is lost
8:55
in our current environment where we may go
8:58
to five specialists,
8:59
but no one of those people is really
9:03
looking at our health in totality.
9:06
So I think those two things, highly controversial,
9:09
some sort of baseline health care,
9:12
and,
9:13
a some sort of requirement,
9:16
that we all have primary care to obtain
9:18
that baseline health care. And there and there's
9:20
some very good examples in The United States
9:22
that work really well.
9:24
For example, federally qualified health centers,
9:27
the Indian Health Service,
9:28
both of which I've worked in. And I'm
9:30
just getting ready. I just finished all my
9:32
credentialing for the VA hospital. There's one here
9:34
in, in Arbor, and I'm looking forward to
9:36
practicing cardiology in the VA hospital as part
9:38
of my clinical commitment.
9:41
That is fantastic.
9:42
And I think that
9:44
more and more people on the right and
9:46
left
9:47
would like to see coverage for all.
9:50
And I think that one of the great
9:51
problems is that
9:54
we can get to coverage for all, but
9:56
we actually have to have health care for
9:57
all. And they're and they're very different things
10:00
because we've increasingly got
10:03
we're up to about 90% of people covered,
10:04
something like that, but
10:06
access is incredibly challenging
10:09
because of supply and demand problems and so
10:11
forth. And we always have to do both.
10:13
We gotta figure out
10:14
coverage
10:15
and
10:16
enough supply, enough demand to provide what you're
10:18
talking about, which is this at least some
10:20
baseline level of health care for everybody.
10:22
And I couldn't agree with you more that
10:24
that is needed
10:26
agreed. The other thing you mentioned about the
10:28
tiers of health care, I would break it
10:30
down to say we've moved towards a fourth
10:32
or fifth tier.
10:34
You've got commercial, Medicare, Medicaid, no coverage.
10:37
Now on the other side of the equation,
10:39
on the commercial side, you've also got this
10:41
whole evolution of concierge practice,
10:44
which makes health care even more tiered out
10:48
between the haves and the have nots, and
10:50
that and that seems to be getting worse.
10:52
And a lot's based on supply and demand.
10:55
It it just there's just enough doctors. You
10:57
have more and more doctors moving towards concierge,
10:59
and you see it in it used to
11:01
be just primary care.
11:02
Now I see near us a dermatology practice
11:05
that charges an access fee. There's a cardiology
11:08
practice in Chicago that's going concierge too. And
11:12
you've got this incredibly her tiering of health
11:15
care, and I don't blame the doctors at
11:17
all, but it does speak to a problem
11:19
we have and just not even a physician
11:20
to take care of the demand.
11:23
We just have a supply and demand problem
11:25
too. Doctor Ruggie, let me ask you another
11:27
question.
11:28
Didn't you also write
11:30
a a fiction book? Did you write a
11:31
fiction book at one time too? I did.
11:35
I wrote a novel called Coated to
11:38
Kill. And first of all, Scott, let me
11:39
just say I I agree with your your
11:41
take on this. We don't have enough providers,
11:44
and,
11:45
I do have some ideas about how we
11:47
can try to supplement that and reduce some
11:50
of the unique
11:52
overhead costs in The United States that just
11:54
aren't present elsewhere, administrative costs for insurance companies,
11:58
pharmacy based,
12:00
pharmacy benefit managers, etcetera. But,
12:03
back to the novel.
12:04
So this was a novel I started when
12:06
I was,
12:07
at at the University of North Carolina. It's
12:09
based in North Carolina.
12:10
And it's the premise is that there's a,
12:14
very progressive hospital there that thinks that they
12:16
have developed the world's greatest electronic medical record,
12:19
and it's gonna sweep The United States and
12:21
be the record of choice and endorsed
12:24
by everyone.
12:25
And in the background,
12:27
there are some
12:29
nefarious forces, let me just put it that
12:31
way, who are all over that medical record
12:34
and doing really terrible things.
12:37
Not just not just getting digging up dirt
12:40
on patients, but actually interfering with their their
12:42
health care. And when people ask me about
12:45
the book and they say, well, could that
12:46
even happen? What I tell them is that,
12:48
yeah, my IT friends tell me it could
12:51
happen.
12:52
Hopefully hopefully, we have many protections against any
12:55
of those things happening. But in the novel,
12:57
this nefarious group has figured out actually how
12:59
to kill people using,
13:02
orders surreptitiously
13:04
entered into the electronic medical record.
13:07
Fascinating. Well, congratulations. What a multifaceted person you
13:11
are.
13:12
Doctor Runge,
13:13
you had mentioned
13:15
thoughts on helping to bridge the gap between
13:18
supply and demand, but let me tee up
13:20
on that. A couple thoughts on how we
13:21
can make some progress there.
13:24
Well, several. One is we just don't have
13:26
enough doctors, and the same is true for
13:28
nurses as you know well.
13:30
And so we need to open the spigots
13:32
some. And there are lots of different ways
13:34
to do that.
13:35
One of the one that ones that intrigues
13:37
me most, I'm not endorsing this in its
13:39
fullest context,
13:41
is Michael Crow, who is,
13:43
the president of,
13:45
I should remember. It's either University of Arizona
13:47
or Arizona State,
13:49
has been developed these massive online
13:53
curricula,
13:54
for,
13:55
for various things. And the result is,
13:58
that the,
13:59
students who go through those instead of being
14:01
an on campus resident
14:03
are equally well prepared and do just as
14:05
well career wise.
14:07
He suggested having,
14:08
medical school classes of a thousand people. When
14:11
I when I suggested
14:13
anything like that to our medical educators, you
14:15
know, I they blanched. I thought they were
14:17
gonna fall over, because it's just such a
14:19
different model. But I do think today
14:22
with some of the learning tools that we
14:23
have
14:24
available, and I will particularly call out in
14:27
a very positive way AI and the ways
14:29
in which AI can be used to
14:33
accelerate learning.
14:34
I think we have the ability to to
14:36
train many more physicians than we currently do.
14:40
The second is, somehow or another, we gotta
14:41
get it to this problem of why people
14:43
are going into concierge care. I don't I
14:45
don't think any of those people or many
14:47
of them started off as a child thinking,
14:50
oh, I wanna start a concierge
14:52
medicine practice. They started out wanting to help
14:54
people. And what they found was with the,
14:58
many roadblocks and the many administrative responsibilities in
15:01
being a physician,
15:03
it was just, torment. And it's and it's
15:06
worst for primary care physicians.
15:08
And so I think we have to kinda
15:10
cut through that and figure out how can
15:11
we make this much more rewarding. And and
15:14
I will tell you,
15:15
just a very short vignette about the Indian
15:17
Health Service. I had the chance to go
15:19
to the,
15:20
Indian Health Service
15:22
operation that's on the Navajo Nation in Shiprock,
15:24
New Mexico. Beautiful place, by the way.
15:27
But, and I worked with the internal medicine
15:29
group there, but I think about 15 people
15:32
trained well trained. Three had Michigan connections. Several
15:36
had one was from University of Chicago. Some
15:38
were from other top tier places.
15:41
And
15:42
what was different is, first of all,
15:44
the environment. There were no RBUs, no expectations
15:48
that you had to see a new patient
15:49
every fifteen minutes.
15:51
They had plenty of time,
15:53
and,
15:54
they had much lower documentation
15:56
requirements.
15:58
And,
15:59
and they worked in teams. They worked in
16:01
teams of physicians and non physician providers,
16:04
and they were happy.
16:06
And
16:07
it reminded me of practice back when I
16:09
was getting started in,
16:11
after medical school. People were really happy and
16:14
felt rewarded. And I think we can create
16:16
those environments, but they're a different environment than
16:18
what we've evolved to. I'll I'll make one
16:20
last comment about this. As as you well
16:23
know, the RVU system was developed back in
16:25
the, I don't know, sixties or seventies,
16:28
as a way to
16:29
quantify work for Medicare billing.
16:32
And it's now so far out of control
16:35
and so rules
16:37
regulated,
16:38
that, I think it's it makes it very
16:41
difficult to,
16:43
have that experience that you're just practicing medicine.
16:46
But that's a commonality
16:47
among FQHCs.
16:49
The doctors there and the staff there
16:51
so dedicated, so committed to their mission.
16:54
And that's not for everybody. Some people would
16:56
like to make,
16:58
you know, optimize their financial opportunities. But many
17:01
people, I think, and even more today going
17:03
into medicine, wanna do it for the reasons
17:06
of providing care and making a difference in
17:08
people's lives.
17:10
No. Thank you. And and there's there's you
17:12
can do both, can't you? You could be
17:14
a great care provider and make a nice
17:16
living. And the
17:18
cost of medical education today, it it's almost
17:20
a government. You almost have to, but it's,
17:22
but I think your point is so well
17:23
taken.
17:25
Expanding greatly the med school classes,
17:27
finding residency spots,
17:30
would really help a great deal if we
17:32
could do that. It seems so doable.
17:35
I mean, certainly, you know this better than
17:37
anybody else.
17:38
So much of medical education was developed prior
17:41
to the Internet,
17:42
And so we we we have so much
17:44
of it is and we have we have
17:45
a one of the kids is in med
17:47
school now,
17:48
and four years of college, four years of
17:50
medical school,
17:51
three to four years of residency,
17:53
maybe a fellowship. People aren't practicing till 30,
17:56
32.
17:57
And it's and so much of it, there's
17:59
so much wasted time and energy, which is
18:00
to these bright young people or at any
18:03
age. It's just very frustrating.
18:06
I'm sure not in small part due to
18:09
your experience with your daughter, daughter who's in
18:12
Stepdaughter. Yes. Stepdaughter.
18:14
It it is a frustrating situation.
18:16
It hasn't changed. We're in in a sense,
18:19
we're our worst enemies.
18:20
We have various regulatory groups that
18:24
regulate medical school experience, residency experience,
18:27
and they just have not modernized.
18:29
And in today's world with today's resources,
18:33
is there any reason that a person needs
18:35
to go to four full years of college,
18:37
four full years years of medical school, and
18:40
four years plus fellowship time?
18:43
I don't think so. I I think that,
18:46
all of that can be dramatically
18:48
reduced,
18:49
without a single
18:52
bit of loss of quality of training. And,
18:54
actually, I think keeping
18:56
our young people who are going into health
18:58
care, energized.
18:59
As you said,
19:01
correctly, I you know, it it you're
19:04
somebody's
19:05
32, 34 years old. I mean, they're worn
19:07
out, and they haven't even started their career.
19:09
And they may be deeply in debt. And
19:11
so, you know, the debt is a and
19:12
another issue, and we have increased the cost
19:15
of tuition because most medical schools are aligned
19:17
with universities.
19:19
And it's
19:20
it's a very common topic that university
19:24
tuitions have just gone through the roof way
19:26
past inflationary
19:27
rates, and the same is true for medical
19:29
schools. And but I think in medical schools,
19:31
they're small enough that we can think about
19:33
ways to reduce that cost.
19:35
Couldn't agree more. And I think the proof
19:37
is in the pudding and that many other
19:38
countries
19:39
educate doctors on a much faster timeline, and
19:42
we are the beneficiaries of those doctors in
19:44
this country. I mean, we we are we
19:46
are fortunate that many of those immigrate here,
19:49
and many of them are done with medical
19:50
school, school, done with their training by '27,
19:52
'28 or so. And and they and they're
19:54
some of the leaders of our health care
19:55
system. So it it it's doable. We just
19:58
haven't done it. Now,
20:00
doctor, I love getting a chance to visit
20:01
with you. Let me do with one more
20:03
thought. You've had this
20:04
remarkable career
20:06
as a physician, as a leader, as an
20:08
author, now fiction and nonfiction,
20:11
a great thinker, a great person.
20:13
What advice to an emerging professional? What advice
20:15
do you give somebody who's an emerging professional
20:18
trying to have a fulfilling career?
20:20
Well, I as you might imagine, I've been
20:23
asked this question
20:24
innumerable times,
20:26
by medical students, by residents.
20:28
What what do I think they should do
20:30
with their career?
20:31
And,
20:32
my advice, which I was given, oh golly,
20:35
more than forty years ago,
20:38
is do what you love to do, and
20:40
you'll be happy. And so in my case,
20:43
for my research during my PhD, I was,
20:46
really intrigued by neurology.
20:49
I mean, all this fascinating
20:52
brain
20:53
knowledge,
20:54
but and then once I did some neurology
20:56
rotations, I realized, well, I didn't really
20:59
so much enjoy the academic process, which is
21:01
all it was at that time of making
21:03
diagnoses.
21:04
I wanted to do something
21:06
where,
21:07
I felt like I could be helping people.
21:09
And,
21:10
cardiology,
21:11
I did I did one cardiology
21:13
rotation. It was just when thrombolytic therapy was
21:15
coming
21:16
out for treatment of acute myocardial infarction. There
21:19
wasn't any treatment really except for put them
21:21
in the CCU and hope for the best.
21:23
And that was followed by so many innovations
21:26
over that next twenty years.
21:28
That that was my passion. And my passion
21:31
was
21:32
in clinical areas, and my passion was to
21:33
try to, help students and residents,
21:37
find their passion. But but I think it
21:39
comes from within, and I think there's I
21:41
mean, people are some people love the idea
21:44
of primary care. I have a daughter who's
21:46
a pediatrician, general pediatrician,
21:48
and she loves what she does.
21:50
And other people,
21:52
really wanna do the
21:53
the high-tech,
21:55
work, and that's great. We we need everyone.
21:58
So I think I think following your passion
22:00
is the best advice I can give somebody.
22:02
And,
22:03
in in my case, I got asked to
22:04
do administrative,
22:07
roles or participate in administrative roles. It turned
22:09
out, much to my surprise,
22:11
that I actually enjoyed that. Other people hate
22:14
it. And
22:15
so if you enjoy it, that's good. If
22:17
you don't enjoy it, don't do it. I
22:18
mean, you just have to take a little
22:20
trial of these things to find out whether
22:21
it's your cup of tea or not.
22:23
But I think that's such great advice, The
22:25
concept of you have to test different things
22:27
to see what you really think and to
22:28
see if you really love them. You just
22:30
have to test different things. And there is
22:32
some trial on your involved, and and I
22:33
love that. Doctor Runge,
22:35
thank you as always for joining us. Can
22:37
you take one more moment
22:39
and tell everybody the exact title of the
22:41
of the latest book?
22:43
Alright. The latest book thank you, Scott. And,
22:44
again, thank you for being, on your podcast,
22:48
is The Great Health Care Disruption,
22:50
Big Tech, Bold Policy, and the Future of
22:52
American Medicine.
22:54
And it covers it has 10 chapters. It
22:56
covers what I felt, and I could easily
22:59
be wrong, were the most important topics for
23:01
the next five to ten years in American
23:03
health care.
23:04
And it's written, to be accessible.
23:07
I have enough enough data in it to
23:09
be, of interest to any health care provider,
23:11
but also to be accessible to people who
23:14
are not,
23:15
primarily health care providers, but are interested in
23:17
health care.
23:19
Marshall,
23:20
doctor Runge, what a great career. What a
23:22
great pleasure to visit you. I'd love to
23:24
see you still thriving, doing clinical work back
23:26
at the VA. Simply remarkable.
23:28
Thank you so much for taking the time
23:30
with us today on the Becker's Healthcare podcast.
23:32
You're as good a person and leader as
23:33
they come. Thank you very much.
23:35
Thank you, Scott. And keep up everything you're
23:37
doing. It's been a lifeline for me. We're
23:39
trying. Thank you so much.