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Marc Harrison: 5 Things to Do to Improve the US Healthcare System

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Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a story about what brought you to this specific career path?I grew up in a “medical family” — both my dad and grandfather were physicians — and I never had much doubt that I would follow in their footsteps and become a physician too. When I was a kid, I used to go on rounds with my dad to see his patients at a small hospital in Pittsburgh, PA, where most of the low-income residents in the area received care. I got to see him interact with these patients and it inspired me. All I ever wanted to do was be a good doctor, so I became a pediatric intensive care physician.Can you share the most interesting story that happened to you since

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Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a story about what brought you to this specific career path?

grew up in a “medical family” — both my dad and grandfather were physicians — and I never had much doubt that I would follow in their footsteps and become a physician too. When I was a kid, I used to go on rounds with my dad to see his patients at a small hospital in Pittsburgh, PA, where most of the low-income residents in the area received care. I got to see him interact with these patients and it inspired me. All I ever wanted to do was be a good doctor, so I became a pediatric intensive care physician.

Can you share the most interesting story that happened to you since you began your career?

When I was a third-year medical student, I knew I wanted to go into pediatrics and was about to do my internal medicine rotation at a Veteran’s hospital in Vermont. I really didn’t want to go there since it wasn’t what I really wanted to do as a doctor. The senior resident said to me, “Marc, if you listen to each of these veterans and find out what their story is and treat each of them like a hero, you are going to have the most amazing experience of your life.” And in fact, that was true. Everyone has a story and seeing patients individually in that way is very powerful.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

I remember giving sleep advice to an experienced mom whose baby’s poor sleep was driving their whole family crazy. I was 26 and had no kids. My advice was “by the book.” She was an old pro. Eventually, we both started to laugh, and I went and got help from someone with those real-life credentials. The lesson is that life experience often counts more than degrees and book learnings.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

Less of a quote, more of a motto. Our family believes in “relentless forward progress.” Regular people can do extraordinary things through persistence and grit.

How would you define an “excellent healthcare provider”?

An excellent healthcare provider is one who puts the patient, who is the consumer, at the center of everything they do. They work equally hard to keep people well and out of the hospital as they do to care for them when they are sick or injured and need to be hospitalized. In all, the provider connects in a warm and human way with each patient and guides them through their health journey. And they provide this care in an affordable way.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

Other people’s experiences/stories are powerful for me. When I was 12, “Roots” by Alex Haley was published. I got it for my birthday. It was January and there was a massive snowstorm that led to a snow week. I read Roots cover to cover twice that week. It humanized racism for me and changed my life. My cousin, Dave Isay, started StoryCorps. I’m a regular listener.

Are you working on any exciting new projects now? How do you think that will help people?

Yes, Intermountain has a number of exciting projects underway. One is HerediGene, in which we are collecting DNA samples from 500,000 patient volunteers by 2024, including 50,000 children. It’s the largest DNA collection project ever undertaken of a single population in the United States. The goal of HerediGene is to identify hereditary diseases such as cancer and cardiac disease, and to uncover genetic variants early enough that we can eventually prevent the heartbreaking impact of family members passing down a disease from one generation to the next. So far, we have taken about 50,000 DNA samples and found actionable genetic variants in about two percent of these patients, enabling us to share this information with them and where applicable, develop treatment plans.

Ok, thank you for that. Let’s now jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

Our nation is in poor health overall and the healthcare system is a big factor on why that is. As a nation, we wait until people get sick before we help them. We spend very little time focusing our resources on keeping people well. U.S. healthcare waits until they come to us because it’s still too easy to make money doing the wrong thing. We need to get ahead of the disease, and that means meeting people where they are. In their homes. In their community. And because acute care is so expensive and the experience can seem cold and confusing, many people forgo seeking care entirely — even if they need it. Fundamentally, we need a complete change in mindset when it comes to improving overall health.

As a “healthcare insider”, If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

The things I would change align with those lessons that we have learned during the COVID-19 pandemic.

Here are five of them:

  • Harness telehealth more aggressively: Telehealth is here to stay and has been embraced by consumers. Intermountain began investing in telehealth in 2012 and saw visits explode during the pandemic, and volumes have stayed high. Telehealth is especially important in rural areas because it connects physicians in smaller communities with medical specialists elsewhere, allowing patients to receive care closer to home.
  • Emphasize prevention: Keeping people healthy, and out of clinics and hospitals, is the best and least expensive way to improve health. Intermountain is the only large health system in the country that has divided its entire business into two units — one focused on keeping people well and out of the hospital, and one focused on providing the best care possible when people are sick or injured and could benefit from being in the hospital.
  • Eliminate racial disparities in healthcare: A 2018 report by the Commonwealth Fund showed black women had a lower five-year survival rate for breast cancer than white women, and blacks have higher mortality rates for heart disease and strokes. Intermountain has worked to address racial inequities in healthcare by expanding our hiring and governance practices to better represent the community, joining the Health Anchor Network of 45 health systems that uses its economic power to improve the lives of underrepresented populations, and we’re pursuing the American Hospital Association’s goals of equity in care.
  • Integrate mental health and primary care: Despite having the most expensive health system in the world, the U.S. has the second-highest death rate caused by substance abuse. More than a decade ago, Intermountain formally integrated mental health into its primary clinics, so mental health professionals can work collaboratively with physicians. Our studies show we have achieved better rates of mental health screening, improved clinical outcomes, lower rates of ER visits and hospitalizations, and lower costs.
  • Partner up: COVID-19 taught us a single health system can’t handle a global pandemic alone, and it is important to seek partnerships with competing health systems, nonprofits, community organizations and academia. Intermountain led the launch of Civica Rx, a nonprofit company that now includes more than 1,500 U.S. hospitals, to address systemic shortages and price volatility with essential generic medications used by hospitals. Civica Rx manufactures generics at a lower cost, which ultimately makes healthcare more affordable for patients.

What concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

As I noted, at Intermountain, we believe in and are very committed to the power of partnerships. I spend much of my time now thinking about how to keep entire communities healthy — long before members of that community step foot in a hospital. That’s where we will ultimately make the greatest difference. In order to achieve real results in population health, we must partner effectively with other health providers, mental and substance use providers, social services agencies, researchers, and government agencies.

The COVID-19 pandemic has put intense pressure on the American healthcare system, leaving some hospital systems at a complete loss as to how to handle this crisis. Can you share with us examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these issues moving forward?

One of the most striking aspects of COVID-19 is it exploits underlying chronic conditions such as diabetes, heart disease, and obesity. With such chronic conditions already at epidemic levels in America, the U.S. population was ripe to be ravaged by COVID-19. Disease prevention and good health must become a top national healthcare priority. That will require partnership between healthcare providers and the public. At Intermountain we follow a model of reimagined primary care in many of our clinics that involves physicians directly helping patients improve their overall health. Patients in the program have seen a 20% improvement in controlling high blood pressure, diabetes, osteoporosis, colorectal cancer, and other health problems. Better health has in turn reduced costs by $648 per patient each year ($1,908 a year for patients 65 and older) compared to standard clinics.

How do you think we can address the problem of physician shortages?

It’s not just about a physician shortage, it’s about training the next generation of physicians to do medicine a better way. Intermountain recently announced we’re partnering with the University of Utah on a medical education program — the first of its kind in the nation — that will train the next generation of doctors in population health. We’re investing $50 million to create the Intermountain Healthcare Population Health Student Scholars Program at the University of Utah’s School of Medicine. These future physicians will learn to consider not only a patient’s immediate medical needs but to also consider their social determinants of health. We believe programs like these will encourage more young people to pursue careers in medicine and prepare them to better serve patients’ health needs in the future.

How do you think we can address the issue of physician diversity?

Diversity can mean gender, race, sexual orientation, religion, and other backgrounds. When I previously was the CEO for Cleveland Clinic Abu Dhabi, we had caregivers working there representing many different countries. While being highly diverse, the caregivers collaborated very well together to provide exceptional care for patients. Diversity is a highly positive thing that all organizations should consciously and aggressively promote. And ultimately, all share the same goal of advancing better health.

I’m interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?

It’s essential to integrate mental health with primary care and we’ve done so at our 83 primary care clinics across the system. It’s produced better clinical results, better patient satisfaction, and reduced costs. One of the most important movements in healthcare in recent years is that of Social Determinants of Health. As healthcare providers, we must look at the whole person and what’s impacting their health — things like their home situation, the quality of their housing, access to transportation, nutrition, the safety of their neighborhood. All of these factors impact a person’s mental and physical well-being. Research shows 60 percent of a person’s health is based on these social determinants and the other 40 percent is based on genetics and the medical care they receive. Ignoring these factors isn’t an option.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

Make healthcare seriously consumer-centric with an emphasis on having it affordable and more easily accessible.

How can our readers further follow your work online?

I’d be delighted for your readers to follow online the work that Intermountain and I are doing. I am active on both LinkedIn and Twitter.

Also, Intermountain Healthcare’s website is a great resource for information.

Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.

Miles Kimball
Miles Kimball is Professor of Economics and Survey Research at the University of Michigan. Politically, Miles is an independent who grew up in an apolitical family. He holds many strong opinions—open to revision in response to cogent arguments—that do not line up neatly with either the Republican or Democratic Party.

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