Category Archives: Aspen Ideas Festival
“Getting cigarettes out of our stores is a first step to making pharmacies a place where health happens,” said Troy Brennan, Executive Vice President and Chief Medical Officer of CVS Caremark Corporation, of the company’s decision earlier this year to stop selling tobacco products in its stores. In a Spotlight: Health session at the Aspen Ideas Festival last week, Brennan and other business CEOs discussed how making health a priority can lead to better business outcomes.
By decreasing the number of places that consumers are exposed to cigarettes and eliminating the convenience of tobacco, he said that CVS is actively trying to reduce smoking rates in the areas it serves. However, the healthy decision is also good for the company’s bottom line—already the decision has had positive business results that it didn’t anticipate, including an increase in the company’s stock price following the announcement.
“Companies that make health a priority—consumers gravitate toward that,” he said. “That’s the business incentive.”
Joining Brennan in the conversation, Vitality Institute Executive Director Derek Yach added that the private sector needs to complement public efforts when it comes to health and prevention. For example, taxes and increased prices must work in concert to discourage consumers from unhealthy products or behaviors.
“There may be an economic hit in the short term,” said Yach of companies that make healthy choices easier. “But in the long term, businesses are going to get an inflow of customers who know that their values are aligned.”
Yach also encouraged using County Health Rankings data to understand the underlying risks in each local area, as businesses are uniquely positioned to tailor their interventions to what the surrounding community needs.
At this week’s Spotlight: Health conference at the Aspen Ideas Festival, Michael Murphy of the MASS Design Group will be part of a panel called “Buildings that Heal.” Murphy is a recent recipient of a grant from the Robert Wood Johnson Foundation (RWJF) for a two-year year research initiative to investigate effective and innovative models of health care facilities in Rwanda and other Sub-Saharan African countries. The goal is to gauge the implications for community health and economic development and then disseminate the findings in order to help improve facilities in the United States.
NewPublicHealth spoke with Murphy ahead of the Spotlight: Health conference.
NewPublicHealth: Tell us about the scope of your work.
Michael Murphy: I’m an architect and designer by training, and I launched MASS Design with my partner, Alan Ricks, around designing built environments to improve health outcomes. We have been working with a number of NGOs in the global south, thinking about the way that hospitals are designed and the built environment, and seeing very specific and direct links between our built environment and the health of our individual selves and our communities. We were struck by the direct links between the two, and how un-designed those environments are when they could be so easily shifted to improve people’s health.
NPH: Where have you done your work?
Murphy: We have an office in Rwanda where we built the Butaro Hospital in Northern Rwanda, together with the healthcare nonprofit Partners in Health. That first opportunity came about after meeting with the group and seeing that they were doing a lot of their work without the help of designers and architects. We were given the opportunity to assist their infrastructure team to help them rethink hospitals. We finished Butaro Hospital in 2011 and since then have brought this model to other countries, eight of which are in Africa: Tanzania, Uganda, Gabon, Liberia, Zambia, Malawi, the Democratic Republic of the Congo, Burundi and Haiti.
So, we have quite a bit of experience thinking about the health care environments that are affecting some of the more vulnerable communities in the world, and we encountered some real insights that could actually vastly improve the way in which we think about our health care environments back at home in the United States.
This Thursday at Spotlight: Health, the two-and-a-half day extension of the Aspen Ideas Festival, a number of speakers discussed the many facets that are integral to building a community that thrives. Speakers included Kennedy Odede, the Co-Founder, President and CEO of Shining Hope for Communities; Belinda Reininger, Associate Professor of Health Promotion and Behavioral Science and the University of Texas School of Public Health; Gabe Klein, Senior Visiting Fellow at the Urban Land Institute; and Gina Murdock, Founder and Director of the Aspen Yoga Society.
Although the communities they serve and the work they do vary greatly, all four presenters agreed on four key themes:
- The importance of listening to the community
- Working with the residents, rather than over their heads, to create what they believe will be a thriving place to live
- Measuring outcomes
- Setting goals
To the first theme, Odede explained that “people in the community must be ready for change and we can’t import it.” Growing up in Kenya’s Kiberia Slum, Odede went on to found Shining Hope For Communities—an organization that combats gender inequality and extreme poverty in urban slums by linking free schools for girls to holistic community services for all. By connecting these services with a school for girls, Odede and Shining Hope for Communities show that benefiting women has a positive impact on the entire community. The organization’s model relies on community input and solutions.
In Brownsville, Texas, a family-oriented town requires a family-oriented approach to improving health. Sitting in one of the poorest metro areas in the nation, the town is known for its low graduation rates and high prevalence of obesity and diabetes. However, the community had a goal of being one of the healthiest areas in the state and began chipping away at the obstacles by including all residents.
“Everything we do is driven by families,” said Reininger. “We wanted to be the healthiest area in the state, and to get there we all had to be part of it.”
Brownsville is beginning to see improvements across the community in physical activity and food choice. In fact, the thriving and changing community has been selected by the Robert Wood Johnson Foundation (RWJF) as one of this year’s Culture of Health prize winners.
Gabe Klein, who in addition to his work with the Urban Land Institute is a former Vice President of Zipcar, spoke about the importance of communication in affecting community change. “In Chicago, we never talked about bike lanes for the sake of bike lanes, we talked about opportunities for better health and ways to get where you’re going,” said Klein. “You have to communicate the larger vision.”
The session moderator, RWJF President and CEO Risa Lavizzo-Mourey, stressed the importance of goal setting and metrics. According to Lavizzo-Mourey, defining a vision is critical to success and measurements lead you to the outcomes you are trying to reach.
At this week’s Spotlight: Health conference, an expansion this year of the annual Aspen Ideas Festival, angel investor Esther Dyson will be talking about “The Way to Wellville,” a contest that her nonprofit Health Initiative Coordinating Council—or “HICCup”—is organizing to encourage a rethinking of how communities produce health. The Way to Wellville is a five-year national competition among five communities to see which can make the greatest improvements in five measures of health and economic vitality.
“In the end, we hope to show that the best way to produce health is to change multiple interacting factors—diet, physical activity, preventive measures, smoking and the like—as well as more effective traditional health care,” said Dyson. “We’re less concerned with specific ‘innovations’ or digital miracles and more with simply applying what we already know at critical density.”
The five health measures have not been finalized yet, but are likely to include health impact, financial impact, social/environmental impact (such as crime rate or high school graduation rate), sustainability (such as a health financing system) and a specific “wild card” that each community will set for itself, such as teenage pregnancy or smoking rates.
NewPublicHealth spoke with Dyson ahead of the Spotlight: Health conference about the Wellville contest.
NewPublicHealth: How did the contest come about?
Esther Dyson: I had signed up to be a judge on the Health Care X Prize, but unfortunately it never materialized. For the next few years I kept thinking somebody should do this, and as I got more and more interested in health, I thought that with greater and greater enthusiasm. I had to give some remarks at a quantified self conference last year and was going to say that “someone should do this.” But I realized that would be a very lame talk and ultimately I announced that I would do it. Having appointed myself, I arranged several open-call brainstorming sessions. At one of them, a nice gentleman showed up with lots of awkward questions about metrics, funding, evaluation...the usual! So I appointed him as CEO. That’s Rick Brush, who formerly worked at Cigna and more recently has been running asthma-prevention programs with innovative financial models.
Building a Culture of Health—one where health is a part of everything we do—will not be an easy task. In fact, it will be very hard, admitted Risa Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation.
It’s a “call to action for all of us,” said Bill Frist, “but these six communities show it can be done.” The six communities in question are the 2014 winners of the RWJF Culture of Health Prize, announced yesterday at the Aspen Ideas Festival. Each community, while different in its own way, thinks about health in a whole new way, as being impacted by all aspects of daily life—from food production to urban design.
Why were these communities chosen from more than 250 applicants from across the country? They’re harnessing the power of partnerships; focusing on lasting solutions; working on the social and economic factors that impact health, such as education and poverty; creating equal opportunities for health for everyone in the community; making the most of resources; and measuring and sharing results.
But what really sets the Prize communities apart, said Lavizzo-Mourey—the “magic ingredient” and the “secret sauce”—are passion, purpose and even joy.
Toby Cosgrove, MD, CEO of the Cleveland Clinic, spoke about bringing a business lens to health during a panel discussion this morning at the Spotlight: Health expansion program of the Aspen Ideas Festival. In an article in this month’s Harvard Business Review, he wrote that “Fixing health care will require a radical transformation, moving from a system organized around individual physicians to a team-based approach focused on patients.”
NewPublicHealth spoke to Cosgrove about this transformation just before the Spotlight: Health conference.
Toby Cosgrove: The first thing we did is that for the last decade we’ve been very transparent around our quality, and we’ve released books on quality outcomes which are available both in paperback form and on our website. The second thing that we’ve done is we’ve consolidated services. For example, we started out having six hospitals in the system that provided obstetrics care, and now we’ve got three and are about to have two. And each time we’ve consolidated we’ve increased the volume of patients and improved the quality. We’ve done consolidations with pediatrics, cardiac surgery, rehabilitation, psychiatry, trauma and obstetrics. We think that it’s called the practice of medicine—the more you practice at it, the better you get at it, and every time we’ve done that we’ve seen that happen.
In Cleveland, for example, we partnered with Metro Health, a large network of health providers. We previously had five trauma centers in Cleveland. Now we have three and as we’ve done that, the mortality rate has improved 20 percent. So there are real activities that have begun to drive the business approach.
NPH: What are other ways that the Cleveland Clinic has been able to respond to consumer needs using a business model?
Cosgrove: We think you’ve got to do three things. You’ve got to have improved access, quality and affordability. The access is not just having insurance—the access is actually getting to see a provider, and last year we provided about one million same-day appointments in addition to our scheduled ones. We also took our emergency room wait times from 43 minutes to 11 by changing the system that we use. And in our call center we’ve reduced the number of dropped calls and improved the speed of answers. All of that is aimed at giving patients access to the caregivers. We also reorganized our internal system so that when you, say, have a neurologic problem, instead of coming to see a neurologist and then a neurosurgeon, you come into the neurologic institute where you can be seen in one location under one leadership of neurology, neurosurgery and psychiatry, so that you are seamlessly seen with all the specialties right there in one location.
“What we mean by ‘building a Culture of Health’ is shifting the values—and the actions—of this country so that health becomes a part of everything we do,” said Risa Lavizzo-Mourey, MD, MBA, president and CEO of theRobert Wood Johnson Foundation (RWJF), during her keynote address at Spotlight: Health. RWJF is a founding underwriter of the two-and-a-half day expansion of the annual Aspen Ideas Festival.
“With health, each one of us can make the most of life’s opportunities,” she said. “That’s why we at the Robert Wood Johnson Foundation have made building a Culture of Health our North Star—the central aim of everything we do.”
Lavizzo-Mourey explained that the Foundation brought the Culture of Health concept to the Festival because of this year’s theme of “Imagining 2024.”
“When it comes to building a Culture of Health, I believe a decade from now we will have a powerful story of how we resolved to no longer accept that our nation spends more than $2.7 trillion dollars on health care, and yet continues to lose $227 billion dollars in productivity each year because of poor health,” she said.
Lavizzo-Mourey told the audience—which included health thought leaders from around the country—that building a true Culture of Health means changing our current understanding of health and creating a society where everyone has the opportunity to lead a healthy life. She gave the example of the Metro system in Washington, D.C., where babies born in the region of the Red Line—which intersects some of the wealthiest counties in the country—can expect to live to be 84 years old. However, babies born just a few stops away will have lives that are up to seven years shorter.
According to Lavizzo-Mourey, there are multiple ideas being practiced around the country that contribute to the emerging Culture of Health, including:
- Helping patients with things such as housing and food assistance at every medical visit.
- Changing the workplace culture to be a healthier one, including using stairs instead of elevators and holding standing or walking meetings.
She also enumerated several key ways that RWJF is working to build a sustainable Culture of Health, including committing $500 million toward reversing the U.S. childhood obesity epidemic; helping to ensure that everyone who is eligible for health care coverage knows about the benefits available to them; encouraging businesses to take the lead in investing in the wellbeing of the communities they serve; and addressing community violence.
During this week’s Spotlight: Health at the annual Aspen Ideas Festival, Cleveland Clinic CEO Toby Cosgrove, MD, will be talking about the future of academic medicine. The topic has received a great deal of attention recently, including a white paper from the Bipartisan Policy Center (BPC) and a pilot program from the American Medical Association (AMA) to give $1 million each to eleven medical schools redesigning their teaching programs—many of which include a focus on prevention, wellness and population health.
Teamwork is a recent and critical emphasis at the Cleveland Clinic Lerner College of Medicine, said Cosgrove in a conversation with NewPublicHealth ahead of the Aspen conference.
“When a lot of us went to medical school we were all taught to be rugged individuals, and so [now] we’re trying to teach teamwork...at the very beginning of health care education,” he said. To that end, instruction at the medical school now emphasizes team-based learning and the students will begin doing some of their work with nursing and dental students in the same physical facility “so we begin to break down the silos that are going on right now and encourage team play.”
The 11 medical schools that received the recent AMA grants were chosen from among 119 schools that submitted proposals. “Their bold, transformative proposals [are] designed to close the gaps between how medical students are trained and how health care is delivered,” said former AMA President Jeremy A. Lazarus, MD, when the AMA awarded the grants last year. Among the winners:
- The Alpert Medical School of Brown University, which has proposed establishing a dual MD-MS degree program in primary care and population health. A clerkship during the third year of medical school will integrate care of the individual patient and population health, and the fourth year will include population health course content and require a Master's thesis. The admissions process will include required interviews with stakeholders and patients.
- The University of California-Davis School of Medicine is partnering with Kaiser Permanente to create the Accelerated Competency-based Education in Primary Care (ACE-PC) program, which will require all students to work in the Kaiser Health system so that they can learn by experiencing the patient-centered medical home model. Changes to curriculum include population management, chronic disease management, quality improvement, patient safety, team-based care and preventive health skills, with a special emphasis on diverse and underserved populations.
The eleven schools won’t be working in silos, either. Susan Skochelak, MD, the AMA’s group vice president for medical education, told NewPublicHealth that the initiative was designed “very specifically to bring the schools together in a consortium, because we wanted to disseminate the best practices rapidly.”
Follow NewPublicHealth this Week for News from ‘Spotlight: Health’ at the Aspen Ideas Festival and the Winners of the RWJF Culture of Health Prize
The Robert Wood Johnson Foundation (RWJF) is a lead sponsor for this week’s Spotlight: Health meeting, a two-and-a-half day expansion of the Aspen Ideas Festival, convened annually by the Aspen Institute in Colorado.
Spotlight: Health will bring together world leaders, corporate executives, innovators, entrepreneurs, policy experts, media, philanthropists and thought leaders from many sectors to showcase what health and health care can look like a decade from now.
On Wednesday, RWJF CEO Risa Lavizzo-Mourey will deliver a keynote address: “We Will Have A Powerful Story to Tell: Building a Culture of Health in America,” which will be live-streamed at 10 a.m. (EDT). She will also announce the six winners of the RWJF Culture of Health Prize, which honors communities working at the forefront of health improvement.
NewPublicHealth will live tweet and live blog from the event, as well as post interviews with key thought leaders presenting at the conference. They will include investor/entrepreneur Esther Dyson on “The Way to Wellville,” a wellness competition that’s looking for the key metrics to help improve population health; Cleveland Clinic CEO Toby Cosgrove, MD, on bringing business best practices to health care; and Michael Murphy, of the Boston-based MASS Design Group, on better design ideas for hospitals and health systems.
Follow RWJF and NewPublicHealth coverage of Spotlight: Health using the hashtag #AspenIdeas.