Foundation and Future of Health Care Delivery Science at Dartmouth
NARRATOR: In the United States, we are world class in the science of health.
We have the best bench science.
We have the best technology.
We are somewhat in the dark ages in terms of delivering health care.
The overall idea of the program was that the real opportunities for improving health care wasn't the advancement of biology but was in the application of existing treatments.
Tuck and Geisel came together to try to find a way to first solidify the very field of health care delivery science on the research side and then to teach these ideas to our students.
KATY MILLIGAN, PROGRAM DIRECTOR: So it's important that our program has the health care context and the depth on health care issues that Geisel can provide.
And it's also critically important that we have the management disciplines teaching the students how to make this happen within their organization.
JEAN ROBILLARD: I thought this program was really looking at the future and was looking at where health care was going, not where health care was, and had the vision of 10 to 15 years in term of educating young people, in term of leadership, but also in term of the change in health care.
But more importantly is when you look at what these young people got out of that.
They have tremendous confidence.
They have a know-how they didn't have before.
And they are not shy of leading the organization and bring them to another place.
TY KNOX: We're going to change how we deliver care.
And so being that change agent is I think one of the key goals that us coming out of the program can be in our organizations.
ANGIE SCHADLER: I had this once-in-a-lifetime opportunity.
And it's my duty to share this information with people that I work with.
It's difficult if you come back as a changed person to an unchanged environment.
But when you go back, you will find there are going to be times that you are the voice in the wilderness.
So you can't be discouraged.
Start with small wins.
Find that willing coalition.
Build your team.
Enable others to lead.
GRANT WORTHINGTON: Dartmouth helped us to recognize opportunities for improvement to serve as a change agent primarily by helping us to understand where others have been successful in the past, to recognize systemic opportunities, to formulate a rationale that will be compelling, and to tell the story to the key stakeholders within our organization and to be able to approach opportunities in a strategic manner and recognize that we can't fix everything at once.
And so where can we focus to most improve the quality that we're providing for our patients but in a financially sustainable manner?
JEAN ROBILLARD: All these graduates from the program are involved.
And all our initiative and population health, initiative and value-based payment, our initiative in ACO and so on and so forth.
We were interested in telemedicine and in ehealth.
And we had people who really got involve in this.
I continue to be very much in awe of my classmates.
I think that they're great leaders across all the entire country. I think one of the best things of the program overall was you have folks that are in administration within hospitals, physician leadership, and nursing leadership.
And then broader than that, you have areas that are outside of the normal typical hospital scope, such as insurance providers, lawyers.
We have people from state and national government.
Oftentimes, I think policymakers have the idea that the only way to transform the health care system is to create policy at the federal level and it will trickle down.
The MHCDS program really taught me that the innovation is going to happen at the local level, at the health system between the provider and the patient, and needs to translate upwards to the policy that's being created.
FRANK CALIENDO: I learned from my peers at the program that there were many different sides to health care and many different ways to view health care.
ALISON MACDONALD: There's so many entrenched interests.
You have industry.
You have pharmaceutical industry and device industry.
You have providers of all sorts.
You have doctors.
You have nurses, health systems, hospitals.
You have payers, both public and private payers, all working together in the health care space, sometimes together and sometimes in conflict.
In all honesty, when I first got to the program and saw people from industry and health care insurance companies, many, many physicians and health care administrators view the insurance companies as the bad guys.
And after just a few classes and discussions, it was very obvious that certainly they have the best intentions for their patients as well.
One of my goals of the program that really has been fulfilled is developing a better understanding of the challenges that face in particular physician leaders across the country and what are some of their barriers to innovation, what are some of the challenges that they have, and specifically what role can the pair play in solving some of those problems.
A quarter of our federal budget goes to paying some sort of health care--insurance, Medicaid, Medicare.
What is it, something like $650 billion of waste in the system, potentially avoidable expenses?
It does nothing to improve the value of care provided or people's health.
So can we in fact redirect some of that?
And it doesn't mean the dollars are leaving the system but provide better and more appropriate care for person across the system.
GRANT WORTHINGTON: I mean, the successful organizations, including your health care, are really focused on using the current fee-for-service model to develop a sustainable foundation that will support quality-based reimbursement outcomes.
And that's really, to be frank, the greatest opportunity because being able to use the financial resources that we have now to invest in the future is really the only way that we're going to be successful.
CRAIG SYROP: One of the most important things we have to achieve to be successful is alignment-- alignment between providers, hospital systems, health care systems, insurers, payers, Medicare, Medicaid.
And I would love to say that everyone's going to do this willingly, voluntarily, from an altruistic
standpoint, et cetera, but it's very difficult to ask someone to take an action which directly and negatively impacts them, even though they deeply care about the outcomes for patients.
And we all like to think that they're doing the right thing.
So one of the best ways to do this is changing how people are compensated.
So I think that what you'll see is if shifting compensation based upon outcomes becomes a reality for people, they will be more inclined to act and do what is obviously at that point in their interest and oddly enough in the patient's interest, in the system's interest as well.
And that's what we have to get to.
I think that what we're doing as a class is really changing what's happening in this country
around health care.
And as we continue to stay facilitated and connected through symposiums and
through our alumni channels,
I think that we have the ability to really continue to make great improvements in the way health care is delivered in the country.