Marc Harrison, MD: Today I'm with Brent Schmidt, the Ancillary and Support Services Director at Sevier Valley Hospital. Brent, tell us a little bit about yourself and then I'd love to hear your question. Before I do that, can I just tell you how much I've enjoyed visiting your facility?

Brent Schmidt: Thank you.

Marc Harrison, MD: You guys do amazing work and serve such a large geographic area. It's really very inspiring.

Brent Schmidt: Thank you. We've enjoyed having you down to Richfield and have appreciated your visits.

I've been with Intermountain Healthcare about four and a half years now. I've really enjoyed my time with Intermountain Healthcare and I've really enjoyed my time in the rural setting. Actually, I've worked at other hospitals in the Midwest and the West that are larger and I certainly appreciated those opportunities as well, but it's been a unique opportunity to work in the rural setting and I've enjoyed it thus far. My question is, as we continue to move towards population health, what do you see as Intermountain Healthcare's role in many of the healthcare issues that occur upstream? Specifically, I'm interested in our role in helping to improve the social determinants of health.

Marc Harrison, MD: Wow, that's a big one. I think that you've got your finger on probably our biggest opportunity. Depending on how you slice and dice things, the social determinants are responsible for 40 to 60 percent of how well we are. Right? Probably what we do in our hospitals and clinics as important as it is probably creates only about 10 percent of the health outcomes. Other things that are involved are things like your genetics. If we're moving into a population health era where we finally, instead of going to the sick care business, we're trying to keep people well, addressing social determinants of health is going to be absolutely crucial. What are those things? It's things like food and security, housing employment, personal safety and security, environmental safety. Do you have lead in your house, that kind of thing. I am so excited that at Intermountain we're beginning to take these things on really systematically. Probably the first big swing we're taking at this is our zip code project through the Utah Alliance for the social determinants of health.

Brent Schmidt: Yeah, I read a little bit about that a couple of weeks ago.

Marc Harrison, MD: Yeah, it's exciting.

Brent Schmidt: It is, it's very exciting.

Marc Harrison, MD: I know you read about it, but for those who maybe haven't, it's this idea that we've identified a couple of geographies. One in Southwest Utah, it's rural, one in Northern Utah, more urban sets of issues. In each area we have a large number of Medicaid beneficiaries who we provide both the clinical service as well as we have their insurance as well. We’re prepaid so it makes economic sense and we're going to learn over a three year period in each area what it will take to keep those folks well. We'll work with community partners, will work with the government who provides some of their services, and we'll collaborate to try it on individual basis, keep each beneficiary in a place where they're healthier than they have been before. As we learn these things, we will be able to apply them to the system as a whole and to all the people we serve. I can't think of anything more gratifying.

Brent Schmidt: Yeah, I think it's a great opportunity. It sounds like there may be opportunity to expand that depending on the results.

Marc Harrison, MD: We hope to scale everything we learn and share it because that's what working as one enterprise really, really means. I want to make sure that our caregivers who work in more sick care areas don't feel like this is a diminishment in any way of the great work that they do. Inevitably, people are still going to have problems.

Unfortunately, people are still going to get hit by cars, are still going to get cancer, they're still going to have heart disease. At least for the foreseeable future. Right. When all of us have those problems, we're going to want the very best care, but what I hope is increasingly we're going to try and put ourselves out of that business and it'll never happen 100 percent but it'll feel good for us to be able to look at our neighbors and our families and our coworkers and realize that we're keeping them doing the things that they like to do and doing things that actually contribute to society. That'll be good for all of our communities.

Brent Schmidt: Historically it hasn't, as you mentioned in the primary role of healthcare organizations, so I'm curious to understand, do you envision [00:05:30] Intermountain Healthcare taking a more primary role as we move upstream to reduce cost or did we do this through partnerships? Do we do this through teaming up with different groups throughout the community in the state?

Marc Harrison, MD: Really sophisticated question. I think it's yes and.

Brent Schmidt: Okay.

Marc Harrison, MD: Some things we'll do ourselves, but for instance, maybe we'll be working with food banks to make sure that we take care of food and security. Maybe we'll be working with local economic development councils and working with them both operationally and maybe supporting them financially as they help create jobs in communities that really need them because we know that one of the biggest determinants of how healthy somebody is, is what is their educational attainment and what kind of employment do they have. I think it'll feel really good certainly to me and hopefully for all the rest of our caregivers that we're contributing back to our communities in ways that not only make the community stronger but keep the people in those communities healthier.

Brent Schmidt: That's great.

Marc Harrison, MD: I have a question for you. As you started your career in healthcare you probably had a mental image more around the sick care business. Is this a difficult mindset change for you to go from sick care to trying to help people stay well?

Brent Schmidt: I think for me personally it's exciting because as you mentioned this is such a great opportunity and so to me it's exciting. I'm trying to get upstream and it frees up in my mind a lot of resources to help deal with some of the issues that you talked about that are going to continue. We're still going to have trauma, we're still going to have cancer, we're still going to have those sort of things. To me, I'm excited because that's really about bending the cost curve is how can we get those resources and free some of those resources up. Personally I'm excited about it, and was really excited to read the announcement a couple weeks ago about what Intermountain Healthcare is doing and planning on doing in the future.

Marc Harrison, MD: Thanks. Do you think this feels consistent with our history, our mission or vision or values?

Brent Schmidt: Certainly with our vision and our mission, and I think historically Intermountain has been about being on that cutting edge of really doing these sort of things that are the best care for the patient at the right time. I think it lines right up with what we've done historically and what we've talked about doing for the future.

Marc Harrison, MD: Well, thank you. I think there's one thing that's also really worth talking about and this idea we're trying to keep people well, logically somebody who works in a hospital or operating room, emergency department, in a clinic might say, "Well, am I still going to be necessary?"

Brent Schmidt: Right.

Marc Harrison, MD: My anticipation is that absolutely yes, in addition to the fact that there were still will be that acute or specialty-based care kind of activity but we're going to need caregivers to help people stay well too. I think there's opportunity for people to grow and develop in their careers and reorient themselves to a different part of the health equation.

Brent Schmidt: Yeah, I think you're right. How do you see reimbursement for these sorts of sort of initiatives working? Because I think that's part of the challenge that I've struggled to wrap my mind around.

Marc Harrison, MD: First of all, I'm really pleased that as we make healthcare more affordable, it gives Intermountain the resources to be able to invest back into the communities. For example, this zip code project that we're working on, we've committed two million dollars per year times three years to each of the communities. That's a lot of money. It's a $12 million investment. Why are we able to do that? We're able to do that because we're really being careful with costs and we're giving back to our communities with that. This model is going to work best in the prepaid or capitated setting because it really aligns the incentives to keep people well.

Now we're doing it for all the right reasons, but it does help when the economic support, the way things are set up. As you pointed out, it allows us to take savings in one area and apply them to care in another area and it supports my belief that we have more than enough money in healthcare. It's just how we as a society spending it and there should be all the sophisticated treatments available for people at a reasonable cost assuming that we can keep people well and don't spend money where it doesn't make sense.

Brent Schmidt: Makes sense. Thank you.

Marc Harrison, MD: Thanks Brent and I appreciate ... Did you travel all the way up here for this?

Brent Schmidt: I had a couple other meetings, but yeah, yeah I did.

Marc Harrison, MD: Well thank you for making the effort.

Brent Schmidt: Thank you for having me, I appreciate it.

Marc Harrison, MD: I will say that the drive down to your place is one of the prettiest drives.

Brent Schmidt: It is.

Marc Harrison, MD: Ever.

Brent Schmidt: It is.

Marc Harrison, MD: Right. Ever. Thanks a whole lot.

Brent Schmidt: Thank you for having me.