Health Equity in Action: How RUSH is Pioneering Community-Based Solutions

<p>to meet this uh you know strategy we have to start getting more into the community so you know because we want to influence the lifestyle of uh of the community because indirectly it affects the outcomes uh the health outcomes right [Music] hello everyone this is Cole from the American Journal of healthc care strategy joined by a special guest today from Rush Anil Anil can you please introduce yourself in your role yeah thank you so much uh my name is Anil Sana uh I'm the chief Innovation officer for Rush uh Rush uh is a 3.5 billion Health System uh in Chicago so we have three major hospitals a Medical College U College of Nursing and GR uate College uh offering you know various Healthcare Management courses uh we also have outpatient centers uh in the Chicago land area and uh Northwest Indiana uh we are uh one of the 20 hospitals on the U US News honor role uh for few years now and we have many Specialties which are U highly ranked um in the US and uh yeah we've been uh ranked uh by vant on quality uh uh for many years now we've been in the top five uh system for Quality uh for many years uh in terms of my role um you know I focus more on Healthcare Innovation and um I also act as a strategic advisor to our SE Suite on issues in involving transformation Innovation uh you know things like that thank you so much for coming on and Neil it's a huge honor what the the largest you know third largest city in the United States and one of the if not the largest you know kind of institution there and doing some really incredible things you got your start in computer science and in engineering software engineering uh you've had very prominent roles and and some great success uh you've been uh started off as a software engineer uh before I was born and uh and you've continued on with with great experience you've been director of engineering vice president of engineering senior Vice president of engineering uh you were previously the chief Cloud officer so very well regarded in the software engineering space and then there's the the transition to kind of innovation at rush what got you to want to work in healthcare and in The Innovation space how did that come about for you so um I would say U you know as I got trained in um engineering and software uh in my early part of my career and my uh life um over time you know I was also fascinated by the business side and I used to you know be in the Silicon Valley U during do and you know in the late 90s so I've seen the highs and lows of Technology but I also completed a business program at um you know Berkeley um Cal Berkeley when I used to be in the Bay Area so that's when I started uh you know getting more fascinated on on the business uh solving business problems and Technology you know it's it's great to solve a lot of problems uh in in the world and I started uh you know getting into itch as part of my training and professional life but eventually you know as you gain experience and U you know you start looking at at at the world um through the lens of of business you start seeing problems you and uh over time um I started um getting more involved in I would call the verticals um you know on the business side um one of the first areas um that I kind of got into exposure to healthcare was um you know I think I was working at a company called red at I'm talking about the years like 2006 and 7even and I was very involved in something called patient consent uh you know directive so uh patients um should have the ability to control who can see their medical records and stuff and one of the uh you know the partners we were working back then uh as part of an industrial sorry industry standards Consortium efforts there were interoperability at H and others was Department of Veterans Affairs so they were trying to solve this problem uh you know for their you know veterans um I don't exactly recall but that was I think my first uh insight into you know some of the challenges Healthcare has I was involved in uh you know some standards uh uh work with the VA on like you know patient uh privacy and stuff like that and um I did get an opportunity or exposure to what do you call emergency uh preparedness uh at the uh at the federal level during the anthrax uh you know crisis we had I think around 2006 and 2007 and so it wasn't something that I like actively pursued it just happened as part of my uh uh work uh and uh over time you know it's I've ventured into other areas in terms of Big Data cyber security and you know and um I think um I'm thinking like maybe around 2015 I had an opportunity to apply um um some technology in advanced technology Concepts to Healthcare in the field field of genomics at a company called tempus here in Chicago which just went IPO and this I would say this opportunity basically opened my eyes to Healthcare in general but the latest and greatest in like things like Precision medicine so I I was able to you know like assist with setting up like DNA sequencing Labs RNA Labs things like organoid modeling labs and of course uh you know a Precision medicine and also got to you know exposure to various Cancer Centers this happened in the last few years and um you know this also brought I mean this was at a startup you know with high growth uh you know uh what do you say strategies and you know workflows and stuff so it also got me exposure into the entrepreneurial side you know exposure to venture capital uh as private equity and so I built uh relationships over time uh in the industry and of course I had like my technology I would say experience and expertise but with my business uh I would say like parallel education I started looking at okay let's try to solve uh problems and about I would say three or four years ago I got this opportunity at rush to um lead u a uh a what do you call a cdph data Hub uh Chicago Department of Public Health Data Hub that they had just built in uh so wherein you brought in clinical data from uh 15 plus hospitals labs and once the vaccines were approved you know you brought in all that information from um the state um for all the vaccination that happens in the city of Chicago and this system was primarily put in uh for what do you call um disease surveillance pandemic response and and uh you know that's what got me into rush and at that time I think it was a cloud-based system um so that's why my title I think was probably the first Chief Cloud officer in the industry and it was more like a situational and you know like the need of the power and over time like once you know the pandemic started subsiding and I started like okay still fascinated by uh you know solving the healthcare challenges that exis with my business uh background and Technology background and my connections with uh you know the entrepreneurial community so I felt uh and our leadership felt that you know Innovation is an area that U is suited and in my opinion it's it's still a learning process um you know Healthcare is not always known for Innovation uh but increasingly you know we're seeing um uh you know a lot of efforts across the industry which is also brought up with advances in things like artificial intelligence and the latest and greatest uh you know in terms of medical devices algorithms and you know things like that so there's been a lot of uh innovation in not only in technology side but also on the process and you know methodology side and we have a lot of problems to solve in healthcare so in my opinion I think I'm at a at a good crosssection of Technology business strategy and others um to look at you know healthare problems and challenges um and and try to bring in Solutions you know absolutely I mean it makes sense when you explain it because what you're working on now I mean you've been working on AI and the learning models value based Care Health Equity those kind of private and Public Partnerships Ian these are all things that you've had now you know that we go through it years of experience doing one of the the challenges is you know Chicago has Health Access and Health Equity issues right I mean there are 14 you know or 15y year life expectancy gaps between neighborhoods uh you know the Chicago Department of Public Health I'm sure you've experienced it while working there or working with them you know they have 500 uh vacancies right you know I mean 40% of of their positions are are unfilled and so uh it's a challenging environment how are you kind of strategizing you know around innovation and and strategizing within the organization on how to address some of these problems and what do you see are the major problems that you're trying to address so there is an official term that we have coined in in the last I would say 10 15 years so I I'll give you an example um it's I mean you mentioned the life expectancy Gap and I want to kind of quantify it a little bit so if you if you are in Chicago you know you have um uh uh the Michigan Avenue which is like our the most famous Avenue we have we have what do you call a Magnificent Mile and we have streeterville and some of the affluent regions of Chicago um so you know if you're visiting Chicago we always suggest you know take a look at uh Michigan Avenue there's the water tower and you know um the rley building and you know we have Millennium Park and you know so we have some of the attractions so uh when one of for leaders uh um and did some research a few years ago they noticed that like if you're born and brought up in in a region surrounding Michigan Avenue uh you know which is like an affluent um you live 16 years and growing longer than fourway four subway stops uh on the west side like literally four subway stops you live 16 years uh less as compared to someone who's born and brought up and you know Works in wow the michig so so we coined it um this phenomenon as Chicago's death Gap yeah so there's a book that uh our chief Health Equity officer has WR it's called um you know Chicago's death Gap um so basically a few years ago so we identified um you know this age discrepancy is isues um so this we are talking about just the west side of Chicago and we have similar challenges on the south side of Chicago that University of Chicago medicine is addressing um so when we talk about this uh death Gap and the patient population or the community population we're talking somewhere in the range of like 500,000 people so so it's it's not a small number so I've heard like 500 to 700,000 you know so it's not a small community of people so the primary challenge is this age discrepancy and um so Rush um I would say around 2015 you know around that made Health Equity as a strategic priority so we instituted something called a anchor mission network um so we created like playbooks for Community Health Equity and stuff um so this highlighted um you know some of the concepts like try to hire locally uh invest locally build locally and also you know uh operate locally you know so this whole concept of Community Health uh you know was kind of uh you know given prominence at uh at rush in terms of corporate strategy so I would I wouldn't say that you know we like we Tred to push Health Equity heavily but I think in my opinion Rush was one of the first Health Systems to actively talk about Health Equity you know so you know you see Health Equity being talked about by CMS uh you know the public agencies and uh you know and the payers are also talking about U but Health Equity as an issue uh has been there for a long time you know and uh so uh in terms of uh you know the strategy over time uh as an institution we have uh excuse me we have tried to uh you know invest locally and I can give you some examples yeah and can you also maybe contrast what the opposite would be so you know if we think about investing locally what do the opposite of that look like what is investing unloc look like so I mean when you look at uh I'll take a step back and explain when you have a health system such as rush you know they are heavily focused on what you call delivery right you're looking at care delivery and you built like a delivery system and your ecosystem is there on Rush one of the U uh the philosophies we have is Rush sits at the intersection of Public Health Community Health and delivery system so we cannot heavily focus on delivery system so when when I talk about Delivery Systems it's about you know operating um you know taking care of the patients who come into a system and with Health Systems ex expanding across uh you know your local regions sometimes across state lines um that whole entire strategy kind of dilutes you know if you think about it so that whole sense of community local kind of uh slightly dilutes when you start having an expansive strategy so I mean this is how the industry is operating um in terms of you know focusing locally like I said the communities we serve I mean it's a large population and with uh this death Gap or you know life expectancy discrepancy uh we have identified as an institution uh one of the Strategic goals we had is we wanted to lower um this life expectancy Gap I think by ask uh by 2030 so it's an aggressive uh strategy so to meet this uh you know strategy we have to start getting more into the community so you know because we want to influence the lifestyle of uh of the community because indirectly it affects the outcomes uh the health outcomes right so as you can see as you know you know the official term is like social determinance of Health with how using Transportation utilities uh you know interpersonal safety um you know things like that but things like um uh education uh employment you know they are also equally critical uh for a community level um you know to improve the outcomes of of basically a community so uh in my opinion that's the difference between focusing heavily o as a system on care delivery and the expansion of the strategy and looking at patients who come into a system um when compared to like you you try to influence the health of uh you know the communities you serve by getting close to the patients where they are you know traditionally when you look at Health Systems you know you had this I mean I'm talking about like I don't know 10 15 years ago the entire uh culture of folks were like oh you are s you start driving to these big buildings you know as you can see u in somewhere in the you know downtown or adjacent to downtown area but now you seeing this heavy kind of a transition in the industry towards what do you call Ambulatory Care and you have like outpatient centers popping in because the industry itself shifted from an inpatient mode to an outpatient like an ambulatory setting it was just because you know we had the pandemic you know right before that you know we had the younger like you know population coming in who was like techsavvy and you know um you know consumerization of healthcare started becoming popular uh the US federal government started pushing something called price transparency so a lot of factors kind of influence this delivery model so you went from inpatient to an outpatient so basically you as a system you're going towards where the patient are and that's the right thing to do to be honest you know so that is I mean one of the biggest challenges we have had is access imagine like people who are struggling with uh transportation and uh you know jobs and stuff if you're working two or three jobs you can't expect them to like you know start driving to a downtown area to get their tests or get for you know care or followup care whatever so that entire model needed to be shifted and broken down and I'm I'm glad to say that systems across the country are looking at outpatient centers and uh you know like as an example we just built like a cancer center not only in downtown but also in a suburb to bring in um like you know the latest clinical trials and screening and advanced treatment to the population um in the suburbs so Russia's a system is you know building some of the specialized U you know centers um um to basically bring access to people this episode of the strategy of Health was sponsored by modality Global advisers modality Global advisors optimizes Hospital Revenue enhances patient experience and delivers proven results visit modality Global advisors.com to learn more yeah I I get the access part I think I have one question you know as a public health Advocate I'm definitely on this the the attitude that hospitals being involved in the community is a good thing there's some push back from that from from some administrators I've spoken with off camera and they say that they feel like financially speaking it isn't the system's job to be involved in the community and it's too financially precarious now with Russia seems to be doing fairly well financially after we reviewed some of their reports as well as a lot of other hospitals who are involved in their Community but I wanted to ask you have you seen return on investment have you seen improved outcomes and maybe even improved savings from being involved in investing local yeah what it's a great uh question so recently um I was involved in a round table discussion on Health Equity and uh one of the um the assertions I made is Health Equity doesn't have to just be good for patients you know uh for as a system you can I mean I wouldn't say that should be the primary focus but you actually can derive operational savings when you start doing good in the community I'll give you some example so um like I think few years back around 2019 2020 um Rush uh you know partnered with a medical supply company out of Ohio um I think it's called concordance or something it's it's something with C so it's basically a medical supply company and this is before we started having major challenges with medical supplies in recent times so we collaborated with this um company to start you know uh what do you say building like Medical Supply Centers on the west side of Chicago right and this not only uh brought in a little bit of efficiency savings for rush I don't have the exact numbers uh but all I can tell you is certainly provided jobs to the local community and when I said if if you have community uh that are looking for jobs right I mean like these are let's say decently paid jobs in a meaningful area which is medical supplies in this one example uh and then uh you know it kind of influences indirectly the community the families and you know so indirectly we influence the U Healthcare outcome of of the community so this was one example so it did bring in some uh you know cost savings from an operational perspective so this happened a few years ago then uh in most recent times I would say in the last uh 12 months uh you know Rush used to send their Linens their uniforms uh for cleaning purposes like the laundry services across state lines and we are talking about not like 10 miles it was it was it was slightly longer across state lines so we worked with uh a laundry service to you know build like basically a facility was built in the community and Rush gave the contract for linen and uh basically the entire laundry and we I think the the estimates were something around the range of 700,000 uh you know cost savings per year but I also want to say u u it also provided jobs for between 300 to 500 people in the community and these are like well-paying jobs and on the West Side Rush is I think the major employer and when I say employer I mean we're not talking about okay this laundry service we actively employ people at our system from the west side for example we actively train students you know we provide them uh coaching and mentorship in the in high school for example we bring them uh you know to have a glimpse of how Healthcare as a system works and uh you know look at the jobs for example so we have uh you know various programs uh Community Health engagement programs and I think the official uh uh program it's called reach so this is primarily focused on high school students so we have mentorship session so we want to work with the community um so I talked about the medical supply I talked about uh the laundry uh we also worked with uh Our Community Partners on uh we just broke ground I think a few weeks weeks ago on something called a wellness Village and you know Russ's um uh you know philosophy is if you want to influence the Health Care Health of a community you know you know start providing primary care clinics for example right we've also been stating that start you know building like basketball courts yeah right when you think think about healthare it shouldn't be like sick care it should be healthare it should be an holistic you know uh treatment of the community so you know food you know fresh food is is a is a major requirement uh access to Primary Care access to like cancer screening for example uh maternity care you know things like that like you know it it kind of negatively affects some of our communities like Latin uh black and brown community so so by focusing heavily on Community Partnerships Partnerships with the city of Chicago um so we have broken ground on something called a wellness Village wherein you will have like uh a Wellness Center we look at Recreation we look at uh you know I don't know like things like yoga and you know provide a place for like teenagers to you know um spend some time getting U you know some kind of mentorship and so basically you build it in the community so this is It's called The senko for wellness center Russ is very excited about this um so these are I would say like uh the major Investments we have made with Partners in the communities and we've been a major player in some of these initiatives um to basically influence uh the out the health of uh our communities and also indirectly bring this life expectancy gap down that I mentioned at the beginning um I also want to mention uh I'll take a minute about uh I would say in the last three four years we also uh you know worked with other Health Systems Community Partners to build this uh collaborative called Westside United uh which operates around I think 10 zip codes um so basically look at like some of the social aspects of healthcare and work with you know organizations uh Community Based organizations faith-based organizations Health Systems in the region including Cook County UIC rush I think lyola and others um to basically help the the community health of this so Russia has been a major player in establishing this collaborative it's called Westside United so again it it kind of uh you know works on the philosophy of established that when we take care of the community um we have better outcomes and in general it's it's good for rush I really like the kind of macroeconomic or you know Regional economic approach to this where it's money that we're we have to spend because we have to have clean Linens we have to have medical supplies all these things and now how can we create jobs in the community spend T you know get tax dollars generated in the community you know and then each employee of course you know they're gonna buy be able to buy more things in the community which creates more jobs and so that's such a smart approach to things that really almost every hospital should be able to do especially when it does even create savings you're actually spending less money in state um which is incredible do you think that being an engineer and taking kind of a systems engineering approach to things has been beneficial I mean uh you know we we're seeing some of this increasing in healthcare we've Masters and phds in in Healthcare systems engineering just starting to come out but that's still a new kind of Cutting Edge do you think that's why you've been so successful yeah I would I would exp um yeah I mean it's in line with something I've been saying in the last I would say at least a couple of years when I talked to like other phds um you know there was this entire uh you know study called I mean the field called systems design you know in the last 20 30 years wherein you look at systems the interfaces and you know things it's not a really an engineering concept but it's more of the way you start you know building you know things at a macro level It comes naturally for an engineer who's been you know spent years in the industry for example so systems design is is is a philosophy I feel uh that we have kind of gotten away from and we don't Focus so much I'm I'm not sure if it's just the way we are progressed as a society with you know with the Advent of uh you know mobiles smartphones you know having information at at fingertips people have like the instantaneous access to everything I mean if it has kind of uh diluted that Focus we had on systems design I mean there's beautiful books written there's you know patterns models that are available I I think as an engineer a trained engineer over time uh you know it's really helpful for me in problem solving and I would I would put it at at like the systems design uh Concepts you know that's I would say a philosophy I want to encourage people to even look at you know yeah I just uh started last week a systems kind of engineering and systems design course for that exact reason and one of the things I'm wondering is do you think and this will kind of be the last question when it comes to making some of these decisions regarding how hospitals can invest in the local community what is kind of the best method for finding that information especially when we're talking about maybe uh an institution less resourced than Rush maybe in a smaller City with less Financial Resources maybe less experts as well I mean you're uh very well educated and have a lot of experience a lot of Institutions have you know struggled to get individuals like yourself right where where can they figure out how to do that should they look to AI should they just go out in the local community any advice there I would say I mean it's not an individual's role or job I mean one of the I think the philosophies I've been pushing is out when we have had during this conversation is Partnerships you know so if we succeed as a system at Rush by partnering you know like at least on health equ it's not just us I talked about Westside United We partner with community- based organizations other health systems and uh you know cbos faith-based organizations um so it's it's a matter of partnership you know so if if if there is a smaller institution uh take a look at this anchor mission network that Russ has uh you know U has been instrumental in in creating I think 2017 2018 and we have kind of donated our Playbook to this anchor network uh you know it's readily available and there has this best practices and you know so you can take a look incorporate it and in terms of uh I would say p finding the right personel that's a major challenge you know the industry is facing I mean rural Healthcare when you look at it right it's it's you know access is a big issue and when we look at uh you know when we look at rural Health Care uh mobile clinics like you know you have those vans U like public agencies uh CDC CMS uh State uh state agencies they're all looking at like mobile clinics but also a paradigm that's become U you know kind of growing I mean it was a major necessity during the pandemic it's tele medicine and the entire T health concept so in many ways you see systems are now incorporating what you call virtual care and the paradigms and lot of innovation is happening in that area you don't have to L literally look at artificial intelligence to think oh is that all Innovation is happening this push towards virtual care um across the industry and this is to solve some of the problems we have in terms of access uh you know and also access to specialist uh you know challenges with uh you know clinician burnout and other so you know I I feel uh care needs to be provided to patients where they are um how they are and what they are you know why they are all of these questions it we don't need to for supps the patients to adhere to certain like you know uh structural constraints that Health Systems had in the last I don't know 50 years and more uh you know that driving to you know big buildings now with the Advent of Technologies and the avability of tele medicine and T Health I mean there's a lot of innovation in remote patient monitoring for example um you know there's lot happening in in healthcare and that's why I feel very fortunate to be at the the Crux or the intersection of all the transformation that's happening in the industry well and we were fortunate to be able to to speak with you and get some a lot of you know a lot of this really valuable information I like the approach I think it's Unique I think I'm definitely going to try to get one of the shorts from this episode on that communitybased investing I I think that's really important you know invest local build local that's just we've spoken with a lot of people doing Innovation and I think nobody's really put it in that exact way before and explained it like that and so that's a really unique approach that Russia is taking really appreciate you coming on to Neil and explaining and exploring that with us thank you for your time thank you for having me have a wonderful day</p>