A Call to Action : You Matter in Building Health Equity for Tulsa, Oklahoma and America

1. A Call to Action : You Matter in Building Health Equity for Tulsa, Oklahoma and America Gerard P. Clancy, MD President, University of Oklahoma - Tulsa

2. In these tense, polarized times, I dare you to be an optimist ?

3. Because important things are actually getting better….

4. Really they are…getting better.

5. We can accomplish great things…..

6. But we have some work to do so that all may enjoy advances in our society ……we need to bridge those gaps.

7. This year’s health, medicine, and policy topics: • Understanding consciousness • New approaches to cancer • Faster drug development • The importance of “play” for the brain • Heart disease and lifestyle changes • Nutrition and new food labels • Customized health care

8. US Health Care – Are not these the things that matter ? • High cost and poor outcomes • 98,000 deaths per year from medical errors • Physician shortages • Health disparities • Oklahoma among the most challenged

9. Politics aside, we need honesty about American health and the need for change: Memorize these talking points….. • Moral argument – the health of the poor is very poor. • Oklahoma’s future argument - Oklahoma is among those with the poorest health and the greatest health disparities. • Cost argument – the cost of US health care is the highest in the world and is bankrupting our country. • The safety and quality argument – there are numerous opportunities to improve the safety and quality of US health care.

10. Physicians cost 20% of total cost but physicians decisions command 80% of costs.

11. Holding Back Oklahoma: Health Status

12. An Engineering Project = “Democratization” “In the 20th century, science and medicine combined to create great benefit for humankind leading to a 30 year expanded life expectancy. The imperative of the 21st century is the democratization of those benefits.” Mullan 2010 Democratize This !

13. COMMONWEALTH FUND State Scorecard Summary of Health System Performance

14. The State’s Next Challenge - Securing Primary Care for Expanded Medicaid Populations Leighton Ku, Ph.D., M.P.H., Karen Jones, M.S., Peter Shin, Ph.D., M.P.H., Brian Bruen, M.S., and Katherine Hayes, J.D.

15. Although Oklahoma health status is very poor, health spending per capita is in the top quartile. Dartmouth Health Atlas 2009

16. Plotting Cost of Care vs. Quality of Care: Which states would you consider for a new business start up? High quality, low cost High quality, high cost Low quality, low cost Low quality, high cost

17. In 2011: - 14 year difference in life expectancy North vs. South. - North, East and West Tulsa; 40% of population, 4% of clinicians. Age-Adjusted Death Rate in Tulsa Physician Density in Tulsa

18. Change is Coming - A pattern in America of industry specific revolution, technology implementation and cost reduction to benefit the masses. A Case of Disruptive Innovation - July 23, 2011 |  Borders Holds Liquidation Sale , by: Natalie Maneval : The once famous and iconic bookstore is no more. After a long struggle to beat bankruptcy, Borders now faces liquidation as early as Friday. The bookstore will close the remainder of the company’s 400 stores, laying off 10,700 employees. With Borders stores closing around the country for the last few months, it comes as no surprise that all the stores will soon close. In the world of digital books, Borders fell under the pressure. The company released a statement saying, “We were all working hard towards a different outcome, but the headwinds we have been facing for quite some time including the rapidly changing book industry, eReader revolution and turbulent economy have brought us to where we are now.” We need a new type of physician for the future such that this new version of health care is equitable, safe and affordable. “Faster, cheaper, easier”

19. Change is Coming - A pattern in America of industry specific revolution and cost reduction…… • Carnegie and steel…. • Vanderbilt and railroads…. • Rockefeller’s and oil…. • Ford and automobiles…. • Southwest and air travel…. • Walmart and retail, pharmacy and now health care…I have been to Bentonville, Arkansas…. Market forces, technology advances and Federal legislation have primed health care to be the next industry to undergo major revolution. Can we agree that we need a new type of college graduates for the future that guides this new version of health care to be equitable, safe and affordable…..(that’s you I’m talking about) ? We need a new type of physician for the future such that this new version of health care is equitable, safe and affordable.

21. Storm Clouds on the Horizon:2011 – 2016 Timeline in Health Care Delivery Fee For Service “Rough Waters” - Health Reform - Debt Ceiling Shared Savings FFS, Capitation… • Today Curve: • Hospital led • Volume • Procedures • Specialty Care • Hospital Care • FFS negotiations Revenue To Care for Patients Tomorrow Curve: • System - Physician led • Quality • Transitions • Efficiency • Bundling of payment • Shared Savings 2010 2012 2014 2016 Years

22. Dear Dan, I messed with your Wordle. Sorry for being a “gooter.” Love, Gerry

23. A Relevant Life…. Why are you important to this work ? Why is this work important to you ? What would we do without new funding ?

24. Why you matter….? • Physician shortage….not enough of us to go around. We will be working as teams. • If we don’t change things for the better – someone else will. • It takes your intellect and heart to solve these problems.

25. Warning - Although physician’s direct costs are about 20% of overall health care costs, physician decisions direct 80% of health care costs.

26. Why is this work important to you? • Obvious answers – because this is your future and this is why you chose this career path. • Less obvious answer - did you know it is also vital to your own well being?

27. The concept of contribution • Good works for others as a central theme across religions: • Judaism - The Obligation of Tzedakah • Christianity – St. James, St. Augustine, salvation through care of others • Hinduism – The way of works - Karma Yoga, good begets good • Islam – faith and good works go hand in hand.

28. The concept of contribution • Central theme across theories of mental illness. • Sigmund Freud – deal with the stresses of the external world through defense mechanisms. Immature, neurotic and mature defense with altruism as a lead mature defense. • Alfred Adler – the importance of contribution to society for your own mental health….mental illness driven by disconnection from society.

29. Striving for Happiness or Fulfillment ?Erik Erikson’s Stages of Psychosocial Development StageAgesBasic Conflict 1. Oral Sensory 0-18 m Trust vs. Mistrust 2. Muscular 18m -3 yrs Autonomy vs. Doubt 3. Loco-motor 3 - 6 yrs Initiative vs. Guilt 4. Latency 6 - 12 yrs Industry vs. Inferiority 5. Adolescence 12 - 18 yrs Identity vs. Role Diffuse 6. Young Adult 19 - 40 yrs Intimacy vs. Isolation 7. Middle Adult 40 - 65 yrs Generativity vs. Stagnate 8. Maturity 65 - death Integrity vs. Despair

30. Despair vs. Integrity

31. Basic Needs and Higher NeedsUsing Abraham Maslow’s Hierarchy of Needs Self Actualization Needs – Act for Causes Outside their Skin Esteem Needs - Respect, Self Confidence Needs for Love, Affection Safety and Security Needs Physiological Needs - Oxygen, Water, Warmth • Each level of pyramid dependent on previous level. • Balance striving for highest capability but at times needing to revert back to basic needs. • Leaders know that people are not always at the top of their game because of basic needs.

32. How should we act? Like American heroesthe Marlboro Man and Maverick….?

34. The Concept of Contribution - Rugged Individuals vs. Advanced Civilizations The Rational Optimist, Matt Ridley 2011 Advancement Occurs When… • Specialization of work within a broader team of individuals. • Constant Exchange – ideas, goods, services. • Innovation through trying, failing, learning from MISTAKES. • Constant repackaging of ideas leading to innovations.

35. One of America’s best performing health care systems trains daily as a team…..

36. Team, Team Team at North Shore Long Island School of Medicine at Hofstra University - Former New York Jets Training Facility…they left the score board up.

37. Some of Our Own Case Examples of Group Contribution…

38. OU College of Medicine, Tulsa  School of Community Medicine Case I – Combined efforts of many over decades…that matters.

39. Four Goals for the School of Community Medicine: 1. Graduate physicians and physician assistants experienced that are committed to the underserved, AND… • Graduate physicians and physician assistants armed with the engineering skills to redesign the U.S. health care system to improve access and quality of care and reduce the overall cost of care. • Develop a new health care delivery system that is equitable, safe and affordable. 4. Align with other disciplines to carry out this work.

40. OU IMPACT Team Laureate Institute for Brain Research Samson and OU pet therapy Examples of our non-traditional patient care, public health, research and education settings Sand Springs Community School Clinic Roy Clark Community School Clinic Public Housing Clinic Rosa Parks Community School Clinic American Therapeutic Riding Center Tulsa Day Center for the Homeless

41. Explicit in Our Commitment to Serve the Underserved through “Community Medicine.” Student learning environment across the region. Recruit for Altruism Surveys show we are maintaining altruism First days of Medical School – Summer Institute 6 day intensive course to learn the “anatomy of the community” before the “anatomy of the body.” Student Academy Masters of Public Health and Certificate of Public Health Health Information Technology Sophistication Learn early to utilize these technologies to improve health Leadership 9th year of student-led free acute care and free chronic clinics for the uninsured. Teamwork Student clinics organized as teams of medical, nursing, pharmacy, social work students. Engineering and Project Development Students practice real time re-engineering of health care delivery. Unique Experiences for Our Students

42. Wayman Tisdale Clinic Case II – Great efforts from numerous individuals over several years….that matter.

43. Groundbreaking Day…..

44. Governor Fallin signs the last beam. Focused work to “improve health” with our region in greatest need: North Tulsa $20,000,000 OU Wayman Tisdale Clinic in North Tulsa President Boren signs the last beam

45. “Is Tulsa North Being Pimped by OU?’Oklahoma Eagle, January 2010 “To Tulsa north’s “rescue,” Oklahoma University has come.” “Unquestionably, medical care is needed in Tulsa north. Why then, pose such a negative question when OU appears to be doing the right thing?” “Our answer….Pimps use the bodies of women to make money. For whatever reason, the women are vulnerable. The residents of Tulsa north are very vulnerable because of their poor health outcomes. Hundreds of millions of dollars will be spent ostensibly for better health care for Tulsa north residents. Who gets the money for such an endeavor? OU will. Who receives $20 million dollars for building the facility? Manhattan Construction has been selected as the contractor.” “If a healthy community is the goal of OU, does it not recognize that a healthy community involves more than improving traditional healthcare facilities and services? A healthy community must have a good economy and a chance for good jobs for its residents. Tulsa north’s personal sense of well-being and its ability to thrive socially and economically are tied together. It is impossible to have a healthy community without a strong educational and economic engine in its midst.” “Why do we pose the question, “Is Tulsa north being pimped by OU?” Do not pimps use bodies to get income? OU will receive income from treating sick bodies. When will OU learn that the elimination of healthcare disparities among population groups is not a zero sum game?”

46. Tulsa’s History is Relevant (1921)

47. 24% local construction Recruited new Pharmacy next door Early Childhood Education Center Taste of North Tulsa Focused work in North Tulsa to “improve health”

48. Plan for 36th Street North and Hartford Linking Public Health and Urban Planning in North Tulsa OU Urban Design Studio • Gray are existing buildings • White are planned new buildings

49. A Call to Action -- Be part of a movement that … • Is Honest - Understands the current state of affairs for the underserved in Oklahoma and cares to do something about it as a national model. • Seeks Democratization - Is deeply involved in changing how health care is delivered such that future care is equitable, safe and affordable. • Partners – with the best academic colleges and institutions in Oklahoma, across discipline lines. • Is Adding - To the economic vitality of Tulsa • Is Ready - To build upon existing educational and clinical investments in place in Tulsa. • Believes - clinicians are at the heart of improving health in Tulsa, Oklahoma and across the US and therefore requires a focus on the training of these clinicians…..to do that work. • Recruits and maintains altruism and energy…

50. Let’s GO !.....Let US go !!!! • 30 inches of snow in a week…no problem. • 30 degrees below…no problem. • 113 degrees all week…no problem. • 14 year difference in life expectancy…no problem. • Way short on physicians…no problem. • Take some shots – Pit bulls and Pimps ..no problem….because….. …..A small body of determined spirits fired by an unquenchable faith in their mission can alter the course of history - Gandhi