Telehealth, Best Practices and Integrated Care: Dr. Charles Sorenson on Intermountain Healthcare’s Commitment to Innovation

Dr. Charles Sore nsen

[ Mus ic ]

Margaret Flinter: Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter , a weekly show where we speak to the top thought
leaders in health innovation, health policy, care delivery , and the
great minds who are shaping the h ealth care of the future. This week ,
Mark and Margaret speak with Dr. Charles Sorenson , CEO Emeritus of
Intermountain Health , an innovative integrated health care system
based in Salt Lake City , committed to improving access to care ,
advancing telemedicine and genomics , and improving outcomes while
reducing costs.

Lori Robertson also checks in , the managing editor of FactCheck.org ,
looks at misstatements spoken about health policy in the public
domain , separating the fake from the facts . We end with a brigh t idea
that’s improving health an d well - being in everyday lives.

If you have comments , please email us at [email protected] or find
us on Facebook, Twitter , iTunes , or wh erever you listen to podcasts .
You can also h ear us by asking Alexa to play the program ,
Conversations on Health Care. Now , stay tuned for our interview with
Dr. Charles Sorenson , CEO E meritus of Intermountain Healthcare .

Mark Masselli: We’re speaking today with Dr. Charles Sorenson , President and CE O
Emeritus at Intermountain Healthcare , not - for - profit , Salt Lake City -
based integrated health system , serving patients in Utah and Idaho.
Dr. Sorenson has served for eigh t years as CEO of Intermountain . Prior
to that , he spent 10 y ears as chief operating officer, while continuing
to perform weekly surgeries in urology. He's the founding d irector of
Intermountain Health care ’s Leadership Institute . Dr. Sorenson earned
his BA at the University of Utah , his MD at Cornell Medical School.

Dr. Sorenson , welcome t o Conversations on Health care .

Dr. Charles Sorenson : Thank you . It’s a pleasure to be with you.

Mark Masselli: You served at the helm of a highly regarded health system , one that
strives for value and quality through an integrated approach to care
deliver y . Former President Obama said Intermountain was a health
system that should be emulated everywhere in the country , saying it
offers high quality care at below average costs . If you could share with
our listeners , what's unique about Intermountain ’s approa ch ?

Dr. Charles Sorenson : I think it really comes from our roots. Intermountain was founded in
1975 when The Church of Jesus Christ of Latter - day Saints decided to
donate its 15 community hospitals that it owned to a newly created
nonsectarian , not - for - pro fit health system , which they named
Intermountain Health care . Since then , Intermountain has been
completely independent from the church . It began with a charge from
the founders to the original board to become a model health system .

Dr. Charles Sore nsen

I've been on the board for 20 - plus years and worked with
Intermountain for over 40 years. As a person there on the front line , I
really saw that in play from the first it was a focus on quality . It was
also a focus really before almost any place else , talking about are
these hea lth care costs going to be affordable to the community.
What made a difference for us , one is information systems . Dr. Homer
Warner , an extraordinarily capable MD, Ph . D . trained cardiologist , he
came by the late 1960s , one of the true pioneers in using com puters
to track clinical outcomes and to ass ist in clinical decision - making.

By the early 1980s , we had objective information on clinical outcomes
and costs for the majority of the things that we did at Intermountain .
That was huge. By the later 19 80s , Dr. Brent James joined us . He was
one of the first people in the world to apply the things that Professor
W. Edwards Deming had learned about industrial production ,
adoption of best practices , and eliminatio n of inappropriate variation ,
le d an industry to hig her quality products at lower production costs .

Brent thought the same could be done at Intermountain . The reason
he came is because we have these data systems that would help us
understand what we were really doing. Tha t combination led to by
the mid - 19 90 s we found that our clinical programs , which focu s on
implementation of evidence - based best practices across the
enterprise . When we eliminate unwarranted variation , don't do things
that just add cost or risk , we get better clinical outcomes at lower
overa ll cost for the community .

Margaret Flinter: Dr. Sorenson , you have a successor as CEO . That's Dr. Mark Harrison .
He's been continuing really the innovative path . You've launched one
of the nation's largest virtual hospital networks. We understand
you're a lso creating a drug manufacturing entity to address the high
cost of pharmaceuticals . He has clearly credited you for laying the
groundwork that made this innovation possible. Talk with us a little
more , if you will , about this culture of innovation at Int ermountain
and how that is so vital to addressing some of the great challenges in
American health care.

Dr. Charles Sorenson : I think this work at innovation at Intermountain information systems
and followed later by the telemedicine , and precisions genomi cs , and
more recently with our venture with other colleagues around the
country into producing generic drugs , all that goes back to the roots
of what can we do to provide consistently excellent outcomes for
people and do it at affordable cost because we re alize that health
care is increasingly unaffordable . We've really looked to innovation
technical solutions that both improve care and at minimum , don't
increase cost , but preferably reduce cost .

When we started a few years ago in telemedicine , the first th ing we
thought of is how much waste there is in people who have to go to an

Dr. Charles Sore nsen

emergency room , a high cost venue for treating something simple like
a sore throat or a bladder infection. We do that remotely . That's led
to our telemedicine program for primary c are , which we call Connect
Care . That's really growing. Then we've had this network of hospitals
throughout Intermountain West here where we can provide support
to patients who nee d consultations in neonatology, critical care ,
cardiology , where the special ist can be at the bedside virtually with
the patient and a local primary care physician. It's been fabulous .
We’ve been able to keep people in their communities , avoid the costs
of transport , and get great outcomes.

All of us have stood by in dismay and ha ve seen the unbelievable
unaffordability and un availability of drugs that have been generic
since I was in medical school.

Margaret Flinter: Right .

Dr. Charles Sorenson : Go out and visit our primary care clinics and I asked a group of
primary care doctors and said, what’s the biggest problem that’s
inhibiting you from providing the care they need to your patients ?
One of our pediatricians said , the cost of drugs . Then I asked her , I
said , well , ok ay . Well , what kind of drugs ? Amoxicillin . I said ,
amoxicilli n ?

Margaret Flinter: Right .

Dr. Charles Sorenson : She said , yeah . It's either not available or it costs so much . Patients on
a high deductible health plan can't afford it. Dr. Harrison has really
propelled this since he's come here and , as you know , has ha d other
good health systems that have joined us . We're going to take a swing
at making a difference here because we've got a responsibility . If we
can get together and have the size of the se health system to help us
to be able to produce generic drugs at m ore affordable price for the
communities we serve , then that's a win for everybody .

Mark Masselli: Let’s talk about one of your most recent ventures . You're the
founding director of the Intermountain Health care Leadership
Institute , which is offering exper ienced health executives mentorship
and training and leadership process es you’ve developed at
Intermountain , and things such as character , personal vision , and
ethics , things that can sometimes get lost in the business side of the
equation. Talk to us abou t the genesis of this leadership institute and
what you hope to achieve .

Dr. Charles Sorenson : It started about seven or eight years ago , I guess. [inaudible 00:08:18]
colleagues around the country asked me , Charles , where are we going
to find physicians w ho have credibility with other clinical people and
they understand leadership ? Then I thought we need ed to develop a
different program for training clinic leaders. We are n’t selected as

Dr. Charles Sore nsen

medical students are trained through residency in leadership. It's sti ll
very much c ommand and control authority and expert director rather
than working with a team of diverse skills to noble purpose and
having a team leader who inspires that team , empowers them to give
their best . That's where we really want to focus .

As we were developing that , we ran a couple of cohorts internally ,
including some great external faculty , including some of the folks at
the Harvard Business School , who have been really helpful in this
process. Some of the people on my team that we were develo ping
that said , we probably ought to focus not just on doctors , how about
if we included half the cohort being physician leaders , and half being
operational administrative leaders ? We can learn from one another. I
said that's great . We're really focused in our program on that
intersection of clinical and operational expertise , and focused , as you
mentioned , on leaders because I think health care leadership requires
real servant leaders , people who have intense personal drive to fulfill
an organization ’ s mis sion and somewhat paradoxically having a deep
personal humility and well manage d ego.

Those are the kind of people that I think can inspire everybody around
them to give their best to an organization. We really want to focus on
emotional intelligence . I've thought , why do we still study people like
Washington , or Lincoln , or Gandhi years after their time has passed ?
We study them because of their ability to engage people in a noble
cause in challenging times . I thin k that's what we need in health care .

Marg aret Flinter: Intermountain recently launched a partnership with Utah Governor
Herbert and former HHS Secretary Michael Leavitt's group , Leavitt
Partners , in a quest to address the social determinants of health.
Could you talk with us about these efforts a t mitigating some of the
health problems that populations face and some of the partnerships
that you think are required to address the social drivers of poor
health , which remains just such a huge challenge to clinicians
everywhere ?

Dr. Charles Sorenson : Y eah . E verybody knows that the United States spends about twice as
much per capita on health care than the most other Western
democracies . As you just mentioned , the social determinants of
health just have this gigan tic impact on health and health care cost s.
You and your listeners are probably aware of various studies that
have been published in the last year or two that track total spending
by country on health and social programs combine d . While the United
States is the highest on health care spending , if you com bine social
spending and health care spending , the United States is really right in
the middle of the pack on the total spend.

The sad thing about that is by failing to address some of those social
determinants , then obviously it's not just about c ost. It's about the

Dr. Charles Sore nsen

human suffering that could have been prevented if we address those
social determinants.

With great input and support from Governor Leavitt and Governor
Herbert , Dr. Harrison is leading our team to see how we can be
proactive in addressi ng so me of those social determinants, poverty,
lack of access to appropriate care , especially preventive care, help
w ith addiction recovery services, behavioral health issues .
Intermountain will start these initiatives to see if we can demonstrate
that we can make a real differen ce on the total spend on health care
and fulfilling Intermountain’s mission of helping people live the
healthiest lives possible .

Mark Masselli: We're speaking today with Dr. Charles Sorenson , President and CEO
Emeritus at Intermoun tain Health care , a not - for - profit integrated
health system. He's now founding director of the Intermountain
Health care Leadership Institute.

Dr. Sorenson , Intermountain has been trying t o develop care delivery
systems that promote value . When y our organiza tion sees
telemedicine as a highly effective tool , h ow do you define that suite of
opportunities to connect with patients when they need to at
distance ? Tell us what you're thinking about at Intermountain in this
whole area ?

Dr. Charles Sorenson : We first thought about that as we were -- these big spaces between
population centers in the western United States , h ow do we get the
services of experts to the people who are needed in these more
remote communities be cause we've always felt that at Intermountain ,
we want our patients to get the same high quality service , no matter
where they present at our Intermountain system . Traditionally , that
meant you had to transport people by ground or air to our larger
centers when some complication came up . Probably about eight or
nine years ago , we began to have real success , first in the areas of
neonatology and maternal fetal medicine , where our experts at our
major centers and our children's hospital could connect with
specialists in our community hospitals that are mo re remote , being
able to see the patient , consult with a physician onsite , and even help
say the pediatrician in a local community do an urgent procedure that
need ed to be done right there , such as helping them with a little kid
who has pneumothorax , put i n a chest tube .

We had some r apid returns on that investment in terms of avoiding
the cost of trans port , so better outcomes , lower time in the hospital .
It was really powerful . Obviously , the other benefit is we don't have to
have busy specialists travelin g all around the state and trying to see
people in clinic because these problems come up real - time . It's not
like they come up when the --

Dr. Charles Sore nsen

Margaret Flinter: It’s convenient.

Dr. Charles Sorenson: -- when it’s going to be there.

Building on that , then we st art ed to think about how inconvenient
health care was for much simpler problems . Say, a woman starts
getting a bladder infection the traditional way is okay . I've got to leave
my job and go away in the doctor's office when -- if they're not having
a fever or flank pain , a straightforward prescription works . Doing
Connect Care , which is on your mobile device , you can talk to the
doctor , you can relate your symptoms , doctor has access to your
electronic medical record . They can say , well , sounds like we reall y
ought to get you on some antibiotics . I'd like to get a urine culture . I’m
going to send you things , so you can go get a culture at a nearby
Intermountain facility.

Now , with all of these situations , actually what does it do to
Intermountain’s revenues a nd the fee for service environment , it
decreases . There’s another instance we're doing the right thing for
the patients actually we're punished in a fee for service environment
by having less revenues . We've been focused since the first . The
board has alwa ys supported doing the right thing at Intermountain ,
even when that reduced our revenues.

That's one of the reasons why I absolutely believe that we are not
going to fix the health care problems in the United States of quality or
cost as long as we're stuc k in this fee for service , where we get paid
based on how much we do and especially paid to do expensive rescue
care. We get paid almost nothing to prevent problems . We can move
to population - based payments . We can use our resources and our
experts to addr ess things on the front end and still be the very best by
following evidence - based best practices and doing that at an
affordable cost . We've got to move in that direction.

Margaret Flinter: Well , Dr. Sorenson , in all of your many years of leadership and
a dministration , I understand that you ’ve continued your clinical
practice in urology and surgery . You had a front row seat on changes
in the acute care setting . There's also been a lot of cultural changes ,
the movement towards mo re of an interdisciplinary t eam - based
model , the focus on safety , the rise of advanced practice providers ,
P a s , and nurse practitioners in the acute care setting. Now , I'm really
curious what do you make of all the changes and the degree to which
those things have moved things forwar d in a positive way ?

Dr. Charles Sorenson : I love it. I was never looking for a move to an administrative position
because I love being in the clinical settings. I loved working with our
team in the operating room , with our team in the clinic , with other
f abulous professional colleagues in all specialties , taking care of really
sick patients . That team was part of my family , just people who you

Dr. Charles Sore nsen

totally trust them with my own life . I've been involved in helping
found the Intermountain Medical Group and on th e board and stuff
like that , but never looking for an administrative position . When they
asked me if I'd take one , I really didn't want to. A lot of it is I just
didn't want to leave those teams . Ultimately I thought , well -- so, I
think we need to have do ctors involved in making decisions and then
none of us are willing to do it , then shame on me .

I did it . I said I just can't give up being with the team s . It's just such an
important thing for me because it builds camaraderie as people or
you can measure t he outcomes and get better together , and learn
from things that didn't go so well. I totally and enthusiastical ly
embrace this movement team - based care , and not only for specialists ,
but even for primary care. My dad was an internist . He was such a
dedicat ed doctor . I also saw how lonely it could be being just a doctor ,
even in a clinic where you're taking care of your own patients , but you
don't have the team , the whole team there.

Now with increasingly complex patients , it can just be overwhelming
for an internist say to be confronting an elderly patient who ’s got
social problem , who maybe has depression , has diabetes , and to that
doctor to try to do that all by herself is oppressive . When you have a
team that comes together and she as the lead of that tea m can make
the medical decisions , and then have experts on the team that help
address the social determinants , the behavioral health mo nitoring , I
think this not only reduces the chance of error , but I think it
dramatically can reduce clinician burnout.

Ma rk Masselli: We've been speaking today with Dr. Charles Sorenson , founding
d irector of Intermountain Health care 's Leadership Institute and
President and CEO Emeritus at Intermountain Health care . You can
learn more about their innovative approach to care de livery by going
to intermountain health care .org or you can follow them on Twitter
@Intermountain.

Dr. Sorenson , thank you for your team - based leadership and for
joining us on Conversations on Health Care today.

Dr. Charles Sorenson : Thank you very much. It’ s been an honor to be with you.

[Music]

Mark Masselli: At Conversations on Health Care , we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy. Lori Robertson is an award - winning journalist and managing
editor of FactCheck.org , a nonpartisan , nonprofit consumer advocate
for voters that aim to reduce the level of deception in U . S . politics.
Lori, what have you got for us this week?

Lori Robertson: Beginning January 1 st, Medicare Advantage enrollees may be

Dr. Charles Sore nsen

required to use lower cost alternatives to more expensive drugs for
new prescriptions for medications administered in a clinical setting.
Health and Human Services Secretary , Alex Azar , has described the
new policy as “ unleashing our Medicare Advantage pla ns to negotiate
discounting on $ 12 billion of drugs . ” Some patient advocacy groups
meanwhile have described the policy as one that “ could erect barriers
to care for cancer . ”

Step therapy is a practice of requiring patients to take less expensive
or preferr ed alternatives to certain medications before moving on to
the more costly options or the drugs prescribed by physicians if the
original treatments a ren't effective for the patient. An August memo
from the Centers for Medicare and Medicaid Services said Me dicare
Advantage plans could use step therapy for Part B drugs next year.
Part B drugs are those administered by a physician or in a clinical
setting .

T he CMS policy would only apply to new prescriptions . Beneficiaries
already receiving Part B medications won’t be affected. Drug
manufacturers of the more expensive remedies could lower their
prices , so that they don't lose business to the lower cost alternatives.
Experts we consulted said the impact could be small. There are about
20 million people with Medi care Advantage plans . That's one - third of
all Medicare enrollees . Medicare Advantage plans spen d about $ 12
billion per year on Part B drugs.

Savings would depend on how many Medicare Advantage plans
decide to use step therapy and how many drug therapies ca n be
subject to the policy. As for barriers to care , the Department of Health
and Human Services says there is an appeals process . Enrollees can
request an exception from their plan to get medication with out first
trying an alternative . Those requests will generally be reviewed within
72 hours .

That's my fact check for this week . I'm Lori Robertson, managing
editor of FactCheck.org.

Margaret Flinter : FactCheck.org is committed to factual accuracy from the country's
major political players and is a project o f the Annenberg Public Policy
Center at the University of Pennsylvania . If you have a fact that you'd
like checked, email us at chcradio .com . We ’ll have FactCheck.org ’s
Lori Robertson check it out for you here on Conversations on Health
Care .

[Music]

Mark Masselli: Each week , Conversations highlights a bright idea about how to make
wellness a part of our c ommunities and everyday lives. For all the
people in the world without limbs , acquiring prosthetics can be costly

Dr. Charles Sore nsen

and out of reach. It's especially challe nging to make prosthetics for
children , since they are in constant state of growth. Rochester
Institute of Technology ’s scientist , Dr. John Schul l stumbled upon a
clever and affordable solution , provided online open source templates
to anyone anywhere in t he world who has access to a 3D printer , and
provide prosthetic hands for next to nothing .

Dr. John Schull : I've made this Google Maps ma sh up. If you have a 3D printer and
you'd like to help , put yourself on th is map . If you know someone who
needs a hand , put yourself on this map.

Mark Masselli : He founded the e - NABLE Network , which has massed thousands of
volunteer makers in upwards of 40 countries around the world ,
providing cheap but functional prosthetics for children in need.

Dr. Schull : We know that w e've delivered about 800 hands devices . We suspect
that a comparable number have been downloaded by people we can't
track because we put all of our design on the Internet.

M ark Masselli : The simple limb designs have become more sophisticated as
recipients of the prosthetic devices provide feedback for designers to
make more efficient devices .

Dr. Schull : These things grip or un - grip . They're much less func tional than our
biological hand. They’re also less functional than a fancy myoelectric
hand. For kids , it's huge . Our hands don't even pretend to look like
regular hands. They look like superhero, Iron Man hands . For that very
reason , th ey're very popular with kids.

Mark Masselli : e - NABLE , a globa l collaborative network of open - source designs ,
linking to ma kers with 3D printers to provide low cost prosthetic limbs
to children and adults around the world , who might otherwise not be
able to afford them , n ow that’s a bright idea.

[Music]

Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli .

Margaret Flinter: I’m Margaret Flinter.

Mark Masselli: Peace and h ealth .

Margaret Flinter: Conversations on Health Care is recorded at WESU at Wesleyan
University , streaming live at chcradio .com , iTunes , or wherever you
listen to podcasts. I f you have comments , please email us at
[email protected] or find us on Facebook or T witter. We love
hearing from you. This show is brought to you by the Community
Health Center .

[Music]