Health Care & Benefits Power Breakfast: Panelists discuss ER care, nutrition, opiates and more

A sampling of panelists’ conversation at IBJ’s Sept. 21 Health Care & Benefits Power Breakfast:

HARRIS: I think that a repeal [of the Affordable Care Act] would be basically the beginning of the unraveling of what is arguably already the weakest social safety net on the planet. I don’t want to let go of 41 percent increased coverage here in Indiana. This puts us at 8.1 percent uninsured. This is actually one health indicator where we’re better than the national average of 8.6 percent. I don’t want to let go of that.

As a health services researcher, I’m not going to assign cause and effect, but it’s hard not to relate increased prenatal care that we’re seeing to the delivery of more full-term babies and fewer babies delivered in our NICU—there has to be some effect there. We’ve had almost a doubling of joint replacements in this last year. I don’t think hips fell apart with the advent of HIP 2.0. I think this is pent-up demand.

HARRIS: On our old campus with every round of patient satisfaction surveys, we had multiple complaints about the food. After the move, though, in which we left our deep fryers behind and we made a lot of other changes, we’ve had exactly one complaint in three years. Also, we get over 90 percent positive ratings for the flavor and the presentation of the food. I would say, too, we care a lot about local foods, so well over 40 percent of our food is grown by Indiana farmers. Actually, our hamburger is antibiotic free, free of hormones, free of gluten, from Fischer Farms.

EVANS: Weight management and nutrition are the two areas of critical focus [for employers]. We’re starting to see employers be a little bit more aggressive of how they attack those two things. Employers that have cafeterias are really thinking about the food, not only the composition of food but where it comes from, how you price. We’ve got one client, in particular, I think he’s probably in this room, where he’s trying to get the soda off of every floor in their building.

HARRIS: Why good food matters to us is that we know that 80 percent of chronic disease can be prevented, better managed and in some cases reversed by lifestyle, and there isn’t anything more foundational than nutrition. And there’s plenty of evidence already out there that demonstrates the benefit of good nutrition on wound healing and other acute care outcomes.

STIGDON: Emergency department personnel and leaders all over the country have been concerned with emergency departments being used as a primary care physician, whether it’s someone that has insurance and doesn’t connect with their PCP or they don’t have insurance and don’t know how to seek care—it’s a challenge for all of us all over the country and it is a topic of conversation through the American College of Emergency Physicians.

We’re overwhelmed with patients that use the ED as urgent care or primary care, but in pediatrics, especially, we can’t assume that parents really know what an emergency is. So we need to start with helping them understand what’s going on with their child, partnering with them to show them what an emergency is.

They can get a piece of paper and read it in the mail, that’s great. But the reality is when they’re faced with a child that’s sick, they don’t know what to do and they’re overwhelmed and they’re scared. It’s 10 o’clock at night, 2 o’clock in the morning. Doesn’t matter. They come to the emergency room.

WALTHALL: I was trained that you don’t make assumptions about folks that show up at your doorstep. That’s why we went into emergency medicine in the first place is that we have the ability to care for people at their moment of crisis and that crisis may not have anything to do with their diagnosis. It may have everything to do with three jobs, no transportation, no place to stay, no hope for what’s happening, and that moment of being tipped over the edge and needing to intersect with a clinician at that timeframe has to be respected.

WOODHOUSE: I do think that any system or company that already has a microhospital or is looking at developing a microhospital, they definitely have to look at how their numbers play out and look at some of these other factors to evaluate [whether Medicare will classify the facility as a hospital or clinic]. They may need to make some operational changes in order to get comfortable that their facility is going to be able to pass muster if a surveyor comes in because, of course, if you don’t qualify as a hospital then the reimbursement for the services you provide is going to be lower.

ALEXANDER: If you are implementing a high-deductible health plan with an HSA for the sole purpose of saving money, it can backfire if you don’t understand the true actuarial value of the [high-deductible plan compared with the PPO plan]. If you’re setting your strategy and your contributions to employees to try to scare them into a high-deductible health plan, you can end up upside down and we’ve seen it happen.

HARRIS: From the perspective of a primary care physician, I think we can’t discount the impact of the fatigue and the discouragement that comes with constantly pushing up against a growing burden of chronic disease, a lot of which is not within the control of physicians. These are social and environmental factors beyond our control. We spend a lot of time working with our patients helping them to move more, eat better, quit smoking, but our patients can’t do it alone. We need investment in public health and policy change.

STIGDON: The suicide rate in adolescents has risen steadily since 2007, so it is a significant problem and it is the No. 2 cause of death for adolescents from the ages of 15 to 19.

A lot of these kids don’t communicate with each other. They communicate with electronic devices. They spend a lot of time on social media. Bullying is a problem—cyber bullying. There’s a wall of protection. You can post something on Facebook or Snapchat it and then walk away from it, as opposed to seeing the impact of your actions. There’s a lot going on in the world and kids know more than we give them credit for. They take on a lot of those stressors and they don’t necessarily talk about it.

You look at the violence that’s going on in the city, just speaking locally. These children have family members that are murdered, they don’t necessarily get the follow-up health care that they need. They carry this with them. They dive into a deep depression and potentially become suicidal. So these kids are dealing with a lot that we really need to take seriously as not just health care providers but as adults that deal with kids.

WALTHALL: The 2014 data showed a 515 percent increase in opiate overdose deaths. In 2015 that rose to 714 percent increase. So this continues to rise and rise at levels that are completely unprecedented.

I think we can all agree that the opiate epidemic is driven by something different than past drug use. This is really a fundamental despair that we’re seeing in our society, and that gap is getting filled with something that is not productive and will kill you. It’s killing folks every day.

The dirty little secret about prevention is that it actually doesn’t have anything to do with opiates. It has everything to do with building capacity in our communities to really address the fundamental despair that we are feeling. It is good schools. It is hope for the future that I might get a job. It’s that our economy needs to be built. It’s that our infrastructure needs to meet people at their point of needs—home, transportation, food access, family units, whatever—[so that] they have hope something better is coming.

EVANS: [There’s a] collision of insurer and provider. Providers are getting into the insurance space. Insurers are more and more getting into the provider space. If you look at the announcements with all the news of Cigna announcing they’re going to spend $7 billion to $14 billion on acquisitions over the next three years. [Anthem Inc. CEO] Joe Swedish announced they’re back on the acquisition trail. They just made one … in the health plan space.

HARRIS: I’m going to say that [a big headline in the next 12 months] will be “Indiana Raises State Tobacco Tax to $2.50,” and I am going to further say that I think we need to make it our business to make that a story. I think that we look at the resources that would flow from that initially and then subsequent pieces would talk about how that money could be directed toward Medicaid funding, toward addressing the opioid crisis, toward public health funding, the benefits of that, and then we start to see the pieces that chronicle Indiana’s meteoric rise in the health indicators.•