Healthcare Reform that Creates Healthier Communities | Anthony Slonim | TEDxUniversityofNevada

health care is in a state of chaos some people get really good care and others don't we can do better if we want to improve the care for our family friends neighbors and community we have to think differently about the way that health care is designed how we intersect with artists communities challenges what we do to help people not only when they're sick or injures but during health and how we hope to care for the entire person as a physician and health system administrator for more than two decades I've been a student of how health systems are designed and how they make an impact in the community as a cancer survivor I've seen the gaps in care that occur from those very same systems I know we can do better it's time to roll up our sleeves and get the work done let me tell you how the doctor-patient relationship is a very very important relationship doctors are privileged to hear your most sacred secrets patients looks leer doctors with the hope of cure as a physician myself I never actually realized how important my role was in the lives of the patients and the families that I served we need to make sure that no matter what we do to redesign health care we preserve this important relationship when I had my cancer I spent some time in the hospital getting surgery chemotherapy and radiation and the hospital was responsible for the coordination of my care when I needed surgery I met my doctor in the operating room and there was a team there to care for me that had the skills the expertise and the technology to make sure that I got the right procedure and I was able to be safely returned to my when I needed medications my doctor ordered them in a computer they were routed to the pharmacy and the pharmacies did an amazing job of titrating making sure they had exactly the right dose sent them to the floor where the nurses administered them to me and monitored me for side-effects when I needed a cat scan I was brought to radiology the scan was performed the results were routed to my physician so that my plan of care could be improved overall this is a very well coordinated system in most parts of the United States from a payer perspective the people who actually pay the bills whether it's your insurance company or the government under Medicaid or Medicare – checks are written one check goes to the doctor to pay them for professional services and one check goes to the hospital for the coordination of care a very seamless and integrated system however when you cross the border of the hospital and go back into the community that's where chaos emerges the doctor-patient relationship is still essential in the conversation however the coordination responsibility is handed to the patient and the family I'm a physician myself I've designed health care systems but the chaos that emerges in the outpatient arena is very very difficult to navigate you've all been through this imagine what happens you go to the doctor's office they write here a couple of prescriptions and hand them to you and you have to think where you're going to drop those medication prescriptions off as a pharmacy before or after you pick up the kids from school if you drop them off before that means three trips to the pharmacy right what if you need a CT scan it's so easy to write on a prescription pad and then they hand it to you and you have to think well where do I get one of those do I have to go through pre-approval will my insurance pay for it oh wait a minute do I even have insurance Z so the reality is that people in health care face in addition not only is the pure chaotic it's also expensive because the payer pays every single intersection point they paid the doctor for the professional services they paid the pharmacy for the medications they pay for the cat-scan really really complicated mess I remember one night in my care in particular I was sitting on the couch weak and feverish had chills didn't know what was happening so I picked up the phone and I called my physician and I said hey here's the story what did we do next and he said I want you to go to the emergency room where I spent the next 12 hours waiting and waiting and waiting and when I finally got in what happened I had to share my deepest secrets with strangers and you would think they would have this well organized right because I mean after all I was under care you could think they could look it up in a record somewhere or perhaps even have a conversation with one another so I don't have to keep answering the same questions over and over and over again but unfortunately that's not how it goes and what happens 12 hours later you leave the emergency department with three more prescriptions feeling worse than when you went in and having a coordinate your care well there's a way around this if we redesign the way that we think about health care in the future we actually have to preserve the doctor-patient relationship and make sure that we're able to to continue to drive that important intersection but we also need a coordinator we need a coordinating mechanism that allows the patient and the family to get the kind of care they need without having to be a quarterback and I propose that we do that through something that I called networks a network is simply a geographically distributed group of services they would be out and about in the community where patients live so the patients don't have to come to us we're actually there providing services to them and it's not such a crazy concept in fact we have lots of networks available now in healthcare there are hospital networks there are physician networks God will even have trauma networks so that if you are acutely injured or traumatized you get brought to a trauma center out on about in the community distributed where you might be able to get centralized care quickly because minutes matter we have networks and vo naval intensive care so that if you're a pregnant mom going to deliver a premature baby you can be brought to a hospital that focuses on intensive care for babies good care well coordinated thoughtfully approach if we have a blank piece of paper we should really think about how we might apply other networks in the community to be more comprehensive in the way that we do this you could imagine pharmacy networks and radiology networks you could imagine wellness and prevention networks that were there to help coordinate the total care that people need whether they're well or whether they're sick it's a much more simplified version than that chaos that we saw before and it's also more efficient and less expensive because in this mechanism two checks get written just like in the hospital environment one in checks to the doctor for professional services and one check to the coordinating mechanism of the networks to make sure that patients are getting the coordinated care well you know system redesign is only one piece of the puzzle and it's actually a very small piece what's more important about our overall health status is something that is called the social determinants of health these social determinants are what exists in our community things like poverty things like homelessness things like food insecurity and crime lack of education those issues contribute to a lower health status then all of the healthcare delivery that we talked about before in fact your environment determinants are responsible for about 90% of the community's overall health status but we've been missing the boat as health care organizations because we haven't been interviewing in the social determinants of health sounds kind of crazy but it's important imagine that you're a teen mom and you're getting ridiculed for not getting your infant the appropriate immunizations but what's really on your priority list is whether or not you're gonna have enough money by the end of the month buy that baby food when you live in an area of crime right we read from people all the time for her lack of prevention not getting their mammography not getting a colonoscopy but on their priority list they're worried about their safety when they walk outside the front door of their home and whether or not they get might get mugged these are the realities of communities around the country and until we starts to engage with the community's needs we'll never be able to achieve the kinds of health status that we hope to for the communities that were serving in addition my colleagues and I have had the whole dialogue upside down we've been focusing primarily on what's called the length of stay the length of stay is a period of time that you spend in the hospital right and everything that we do as health administrators and his doctors is focused on how long you stay in the hospital why because that's how we get paid by the way but here's what's interesting that's not how the patient and family view it they view life intersected by a hospitalization when you're eight for pneumonia a hospitalization when you're 13 for an appendectomy a hospitalization at 28 when you have a baby and a hospitalization at 72 because you accidentally fell and broke your hip the patient and family view life intersected by a series of hospitalizations well in health care we actually actually haven't been supporting people particularly well during life imagine that we could think differently about how we help people manage their stress or control their obesity or stop smoking or help them with their addictions Wow if we were there for people so that we could answer questions about what vitamins to take or what herbal medicines to take we actually might live healthier I know that sounds crazy but we haven't been involved in that and it's really really important finally I know that for me join my cancer care I had an amazing team great colleagues wonderful people doctors nurses pharmacists therapist dieticians who took really good care of me they wanted me back to my physical health but nobody actually ever asked me what I was concerned about and sometimes when you're a young man with cancer what really matters is getting off the couch and being able to have a meal with your family or being able to attend your eight-year-old soccer game or your 9 year olds concert at school my team is really focused on the physical domain they completely left out my mind my spirit and my priorities and if we're going to restore people to health we need to think comprehensively about the way that we approach them so as we think more concretely about the way in which we have to think about health and not just healthcare as healthcare organizations it's important that we're redesigning appropriately it's important that we're paying attention to the needs of our community because the social determinants matter it's important for us to make sure that we pay attention to not only health care but the life that people are experiencing how to maintain them in good health and finally we have to take a comprehensive look at the people that were serving not patients but people and make sure that we're addressing their needs from a mind body and spirit perspective if we do that we will not only be improving the community's health we will actually create healthy communities thank you you


  1. Med schooling and the best vocabulary he has is very, very small. I wouldn't want him as my doctor unless there was physically no other option. He became a doctor without being aware of his own importance in his patients' lives? Either he's an absolute idiot, or he's full of $hit.

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