an informative q&a with oc’s top healthcare …...custom content • april 8, 2019 healthcare...

CUSTOM CONTENT • April 8, 2019

HEALTHCARE ROUNDTABLEAn Informative Q&A with OC’s Top Healthcare Professionals

Barry Arbuckle, Ph.D.President and Chief Executive Officer

MemorialCare

Robert T. BraithwaitePresident and CEO

Hoag Memorial Hospital Presbyterian

Sunny Bhatia, MD, MMM, FACC, FSCAICEO, Region I and Chief Medical Officer

Prime Healthcare

Ray ChicoinePresident

Monarch HealthCare

Meghan NewkirkGeneral Manager, Southern California

UnitedHealthcare

Annette M. WalkerPresident

City of Hope Orange County

Erik G. WexlerChief Executive

Providence, Southern California

Gene RapisardiMarket President, Southern

California and NevadaCigna

Mark E. CostaSenior Vice PresidentKaiser Permanente

Kimberly Chavalas CripePresident and CEOCHOC Children’s

Janeen Hill, Ph.D.Professor, Founding Dean Crean College of Health &

Behavioral SciencesChapman University

Jennifer Mitzner, MPA, CPAChief Executive Officer

Hoag Orthopedic Institute

Chad T. LefterisCEO

UCI Health

CUSTOM CONTENT • April 20, 2020

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HEALTHCAREROUNDTABLE PARTICIPANTS

Chapman University – Crean College of Health and Behavioral SciencesCrean College of Health and Behavioral Sciences at Chapman University combinesextraordinary research, education and clinical practice to educate tomorrow’s healthcareprofessionals. At the heart of its mission is Crean College’s deep commitment to engagingdiverse faculty, students and staff in community outreach, learning, research and evidence-based practice. The college emphasizes an ethical, interdisciplinary approach to understanding health acrossthe lifespan. Crean College offers a variety of undergraduate and graduate degree programs aimed atpreparing students for careers in healthcare and human services settings. Each program connects classroomlearning to real-world applications in order to foster interpersonal skills, knowledge and practical expertise.

CHOC Children’sIllness or injury shouldn’t put childhood on pause. That’s why CHOC Children’s has built a growing pediatrichealthcare community of premier facilities and compassionate experts focused on keeping kids happy andhealthy. Children and families in the region have access to CHOC’s hospital campuses in Orange and MissionViejo, as well as many primary and specialty care centers, more than 100 programs and services and fourcenters of excellence: The CHOC Children’s Heart, Neuroscience, Orthopaedic and Hyundai Cancer Institutes.The Research Institute at CHOC offers access to clinical trials that can’t be found anywhere else. There,scientists translate the latest advances to meet the individual needs of patients at each stage of their lives.CHOC’s commitment to pediatric mental health includes an inpatient center that is the only facility in the regionto offer specialty programming for children ages 3 to 12, and outpatient services. Learn more at choc.org.

CignaCigna Corporation is a global health service company dedicated to improving the health, well-being and peaceof mind of those we serve. We deliver choice, predictability, affordability and access to quality care throughconnected, personalized solutions that advance whole person health, both in body and mind. With more than170 million customer and patient relationships in more than 30 countries and jurisdictions, we harnessactionable insights that drive better health care results. Our global workforce of more than 70,000 employeesare dedicated to living our mission and being champions of our customers and communities each and everyday.

City of HopeCity of Hope is an independent biomedical research and treatment center for cancer, diabetes and other life-threatening diseases. Founded in 1913, City of Hope is a leader in bone marrow transplantation andimmunotherapy such as CAR T cell therapy. City of Hope’s translational research and personalized treatmentprotocols advance care throughout the world. Human synthetic insulin and numerous breakthrough cancerdrugs are based on technology developed at the institution. A National Cancer Institute-designatedcomprehensive cancer center and a founding member of the National Comprehensive Cancer Network, City ofHope is ranked one of America’s “Best Hospitals” in cancer by U.S. News & World Report. Its main campus islocated near Los Angeles, with additional locations throughout Southern California. For more information aboutCity of Hope, follow us on Facebook, Twitter, YouTube or Instagram.

Hoag Memorial Hospital PresbyterianHoag is an approximately $1 billion nonprofit, regional health care delivery network in Orange County,California, that treats more than 30,000 inpatients and 480,000 outpatients annually. Hoag consists of twoacute-care hospitals – Hoag Hospital Newport Beach, which opened in 1952, and Hoag Hospital Irvine, whichopened in 2010 – in addition to nine health centers and 13 urgent care centers. Hoag is a designated Magnet®hospital by the American Nurses Credentialing Center (ANCC). Hoag offers a comprehensive blend of healthcare services that includes five institutes providing specialized services in the following areas: cancer, heartand vascular, neurosciences, women’s health, and orthopedics through Hoag’s affiliate, Hoag OrthopedicInstitute, which consists of an orthopedic hospital and two ambulatory surgical centers. Hoag has been namedone of the Best Regional Hospitals in the 2019 - 2020 U.S. News & World Report.

Hoag Orthopedic InstituteHoag Orthopedic Institute is celebrating its 10th anniversary in November 2020. Our mission has neverwavered to be the premier musculoskeletal system of care in Orange County, sought for our superior outcomesand value. We at HOI are proud to be ranked nationally by U.S. News & World Report for orthopedic care,which demonstrates our level of expertise in orthopedics, and by CMS for our 5-star patient experience.Through our hospital to our 4 surgery centers and clinics, our dedicated orthopedic specialist physicians andstaff are committed to quality clinical outcomes and patient centered care.

Kaiser PermanenteKaiser Permanente is committed to helping shape the future of health care. We are recognized as one ofAmerica’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanentehas a mission to provide high- quality, affordable health care services and to improve the health of ourmembers and the communities we serve. We currently serve 12.3 million members in eight states and theDistrict of Columbia. Care for members and patients is focused on their total health and guided by theirpersonal physicians, specialists and team of caregivers. Our expert and caring medical teams are empoweredand supported by industry-leading technology advances and tools for health promotion, disease prevention,state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated tocare innovations, clinical research, health education and the support of community health. For moreinformation, go to kp.org/share. For information about Kaiser Permanente Irvine Medical Center, visitkp.org/orangecountyand follow us on Twitter @KPOCThrive.


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HEALTHCAREROUNDTABLE PARTICIPANTS

MemorialCareMemorialCare, a nonprofit Southern California integrated delivery system and innovator in evidence-basedmedicine, has more than 200 locations in Orange and Los Angeles Counties; 14,000 employees, affiliatedphysicians and volunteers; top hospitals – Orange Coast Medical Center in Fountain Valley, SaddlebackMedical Center in Laguna Hills, Long Beach Medical Center and Miller Children’s & Women’s Hospital LongBeach; award-winning physician groups MemorialCare Medical Group and Greater Newport Physicians;Seaside Health Plan; and Southern California’s largest high-value ambulatory care network with convenient,cost-effective health centers, outpatient surgery, imaging, dialysis, urgent care and breast centers.MemorialCare is one of the most well-regarded health systems in Southern California. In the last year alone,MemorialCare Orange Coast Medical Center was named the top hospital in all of Orange County by theOrange County Register. MemorialCare Saddleback Medical Center was number two in the same survey. U.S.News and World Report ranked MemorialCare Long Beach Medical Center in the top 12 in Los AngelesCounty, and the top 22 in California. Integrated Healthcare Association, one of the leading professionalorganizations in the healthcare industry, awarded MemorialCare Medical Group & Greater Newport Physicianswith the Excellence in Healthcare Award and AMP Medicare Advantage 4.5 Star Recognition.

Monarch HealthCareMonarch HealthCare, part of OptumCare, is an Independent Practice Association (IPA) caring for patients since1994. Monarch is a leading health care delivery organization that is helping transform health care through best-in-class quality care and an improved experience through a “patient-first” philosophy of healthcare. With morethan 2,500 private-practice physicians and 220,000 Orange County and Long Beach residents, Monarch hasbeen recognized by health plans and business groups for providing high quality care and excellent service. Weaspire to be the solution for affordable quality care for all patients in the communities we serve. For moreinformation about Monarch, please visit www.monarchhealthcare.com.

Prime HealthcarePrime Healthcare is an award-winning national hospital system with 45 acute-care hospitals and morethan 100 outpatient locations providing nearly 40,000 jobs in 14 states. Fifteen of the hospitals are not-for-profit and members of the Prime Healthcare Foundation, a 501(c)3 public charity. Based in Ontario,California and one of the largest hospital systems in the country, Prime Healthcare and its hospitals havebeen recognized as among the “100 Top Hospitals” in the nation 47 times and among the nation’s tophealth systems several times according to IBM Watson Health. Prime Healthcare stands apart due to itsunique ability to save and transform community hospitals, and has been named the “fastest-growinghospital system” in the country by Modern Healthcare. Prime Healthcare continues to grow and fulfill itsmission of “saving hospitals, saving jobs and saving lives” and remains committed to deliveringexceptional quality care and creating a legacy that will improve community healthcare. Visitwww.primehealthcare.com.

Providence, Southern CaliforniaProvidence, Southern California, has 13 award-winning hospitals, more than 150 physician offices andnumerous outpatient centers across Orange and Los Angeles counties and the High Desert. We employ a totalof 35,000 caregivers. In Orange County, Providence operates St. Jude Medical Center, Fullerton; St. JosephHospital, Orange; and Mission Hospitals in Mission Viejo and Laguna Beach. Hoag Hospitals in Newport Beachand Irvine are affiliates. Providence Southern California is a region of Renton, Wash., and Irvine-basedProvidence, with 51 hospitals across seven Western states. We are a mission-centered, values-based ministry,committed to outreach to the poor and vulnerable in the traditions of our founding orders of religious sisters. InOrange County in particular, we focus on partnering to care for those who are homeless and those who suffermental health issues.

UCI HealthUCI Health comprises the clinical enterprises of the University of California, Irvine. As Orange County’s onlyacademic health system and tertiary/quaternary care center, UCI Health plays a unique role in serving thehealth and wellness needs of our community. Patients can access UCI Health at physician offices throughoutOrange County and at its main campus, UCI Medical Center in Orange. U.S. News & World Report has listedthe 417-bed acute care hospital among America’s Best Hospitals for 19 consecutive years. UCI Medical Centerfeatures specialty ambulatory care clinics, Orange County’s only National Cancer Institute-designatedcomprehensive cancer center, high-risk perinatal/neonatal program, combined Level I trauma center and LevelII pediatric trauma center and is the primary teaching hospital for UCI School of Medicine. UCI Health serves aregion of nearly 4 million people in Orange County, western Riverside County and southeast Los AngelesCounty.

UnitedHealthcareUnitedHealthcare is dedicated to helping people live healthier lives and making the health system work betterfor everyone by simplifying the health care experience, meeting consumer health and wellness needs, andsustaining trusted relationships with care providers. In the United States, UnitedHealthcare offers the fullspectrum of health benefit programs for individuals, employers, and Medicare and Medicaid beneficiaries, andcontracts directly with over 1.3 million physicians and care professionals, and more than 6,000 hospitals andother care facilities nationwide. The company also provides health benefits and delivers care to people throughowned and operated health care facilities in South America. UnitedHealthcare is one of the businesses ofUnitedHealth Group (NYSE: UNH), a diversified health care company. For more information, visitUnitedHealthcare at www.uhc.com or follow @UHC on Twitter.


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The world was caught off guard bythis pandemic and all are doingeverything possible to respond.

Erik G. WexlerChief Executive

Providence, Southern California

Public health crises continue to fill theheadlines. Whether it’s novel coronavirus,opioids, superbugs or the ongoing epidemicof healthcare-associated infections, howdoes your health system show leadership inprotecting patients and the community?

Chad T. Lefteris, UCI Health:Advancing knowledge to protect our patients andthe community in the face of new and existingpublic health threats is part of the UCI Healthmission. Our infectious disease andepidemiology experts are leaders in the fight tocontrol COVID-19 in Orange County. UCI Healthlaunched Southern California’s first NationalInstitutes of Health therapeutic COVID-19 trialwith the drug remdesivir and our medicalcenter’s operations team has helped institutionsaround the county to prepare to meet expectedsurges of sick patients. Though the opioid crisisno longer dominates headlines, it is still with us.UCI Health continues its leadership role with theSafeRx OC coalition. In December, UCI Healthwas named to the California Hospital CompareOpioid Care Honor Roll recognizing our efforts toimprove healthcare response to the opioid crisisand support patients with opioid use disorder.

Kimberly Chavalas Cripe, CHOC Children’s:First and foremost, our health experts rely onand share evidence-based best practices thatare continually evaluated. These practices areincorporated into organizational-wide goals forwhich our leaders are held accountable. Ourpopulation health division collaborates withprimary and specialty care physicians, as well asour schools, to help them better coordinate carefor patients and patient families to improveoutcomes, with the ultimate goal of advancingthe health of our community’s children. OurSharon Disney Lund Medical Intelligence andInnovation Institute brings experts from aroundthe globe together to address pediatric healthproblems collaboratively and advance care andmedicine for children.

Meghan Newkirk, UnitedHealthcare:The COVID-19 outbreak is an unprecedentedtime in our country and one that calls for anunprecedented industry response.UnitedHealthcare and UnitedHealth Group areaddressing these unique needs by expandingaccess to care, developing innovations tosupport and protect the healthcare workforceand providing funds to support the needs ofvulnerable populations nationwide.UnitedHealthcare is waiving member cost-sharing for the treatment of COVID-19 throughMay 31, 2020 for its fully-insured Commercial,Medicare Advantage and Medicaid plans. Thisbuilds on the company’s previously announcedefforts to waive cost-sharing for COVID-19testing and testing-related visits. Additionally, arecent UHG study demonstrated that a simple,self-swab test is as effective in identifyingCOVID-19 infections as the clinician-collectedtest. Widespread adoption of this less invasivetest will reduce exposure for health care workersand improve overall testing efficiency across thecountry. UnitedHealth Group has alsoannounced an initial $50 million commitment tosupport those most directly impacted by thepublic health emergency nationwide, includinghealth care workers, hard-hit states, seniors andpeople experiencing food insecurity orhomelessness.

What are some lessons learned from thecoronavirus pandemic for health care andgovernment?

Erik Wexler, Providence, Southern California:The world was caught off guard by this pandemicand all are doing everything possible to respond.To be clear, I am not placing blame. A clearlesson is we simply must be better prepared withstrategic stockpiles of personal protectiveequipment and equipment needed to deliver carein emergencies. These stockpiles should beregionally located for quick distribution to areasmost in need and should be regularly inventoriedto ensure it meets population needs and has notexpired. Secondly, coordinating universal healthcare protocols for use of PPE, staff deploymentand other such policies should be enhanced. Astatewide central command center that can beactivated urgently with specified expert staffingwould be useful to manage this for the healthcare delivery system. Lastly, diagnostics (e.g. labtesting) must be deployed quickly or left to theCDC. We must design systems for health caresystems to expedite testing capability.

Mark E. Costa, Kaiser Permanente:Hospitals and Health Systems across theCountry have always prepared and trained foremergent situations (Floods, Earthquakes, ActiveShooters, etc.) however COVID-19 haschallenged us in many unforeseen ways. Ibelieve that we are seeing this across the nationand world. Many of us are hearing about the four“S” approach (Staff, Stuff, Space and Systems)on the news. In order to best prepare for anysituation all four must be working in coordination.When the current situation lessens, we all willhave strong lessons that have been learned. Theimportance of ongoing coordination andcollaboration between Health Systems andGovernment entities being the most important.We are learning that we must have facilities thatare flexible as well as the necessary inventoriesof equipment and supplies that are availablewhen demand surges. Kaiser PermanenteOrange County is proud of the active role it isplaying in responding to community demandassociated with this pandemic. We are equallyproud of our Physicians, Nurses and all staffmembers who are on the front-lines providinglife-saving care.

Annette Walker, City of Hope Orange CountyThe COVID-19 pandemic impacted nearly everyaspect of health care. As an institution that solelyfocuses on cancer and serious illness, City ofHope’s first priority was ensuring the safety of ourpatients - who are particularly vulnerable – andthe safety of our physicians and staff. Protectingour patients meant implementing a no-visitorpolicy, which was a hard but necessary decision.We also learned that we can anticipate requisiteaction and move swiftly. For example, our teamsbegan working from home before mandates wereput into effect. As health care providers, we allsaw the importance of working together to tacklea pressing medical issue. We’d like for this spiritof collaboration to continue because, frankly,cancer and other serious illnesses aren’t goingaway after COVID-19.

Sunny Bhatia, Prime Healthcare:There were clear warning signs of a potentialpandemic that went unheeded by thegovernment. The world, including the United


HEALTHCARE ROUNDTABLE

Advancing knowledge to protect ourpatients and the community in the faceof new and existing public healththreats is part of the UCI Healthmission.

Chad T. LefterisCEO

UCI Health



Patients who need the most care oftenface challenges when it comes toaccessing the best care which can leadto unmanaged conditions or extra tripsto the emergency room.

Ray ChicoinePresident

Monarch HealthCare

States, was ill-prepared to handle the enormousresponsibilities required to combat this pandemic.Funding for pandemic preparedness has beenreduced and was de-prioritized. The U.S.Government did not recognize the gravity of thesituation in a timely manner or rely on the bestavailable evidence to inform decision-making.Many of the states within the U.S. approachedthe pandemic with different intensity andstrategies. This led to an inconsistent andineffective national message regarding themagnitude of this crisis. The constraints onsupply chain, such as personal protectiveequipment (PPE), ventilators and medications areimpeding the ability for hospitals and health careproviders to deliver needed therapy while alsoadequately protecting themselves. Thedependence on international manufacturing,especially from Asia, has made procurement ofneeded supplies extremely challenging. Thenation and health care system were simply notprepared, at all levels, to handle this crisis.

Janeen Hill, Chapman University:A major lesson is a realization that cutting fundingfor basic science research and for multi-nationaldisease monitoring has very significantimplications for understanding and responding todisease.

Outpatient care is still trending upwards asboth a convenience and cost-saving focus forconsumers, employers and health plans. Howhave you addressed this transition and howhas the growth of outpatient care advancedvalue in health care?

Barry Arbuckle, Ph.D., MemorialCare:With COVID-19 impacting how healthcare isdelivered, MemorialCare’s transformation from ahospital system to an integrated healthcarenetwork provides advantages to consumers,employers and health plans, thanks to convenient,easily accessible and lower cost outpatientservices. With over 200 health centers, outpatientsurgery, imaging, urgent care, breast care anddialysis centers throughout Orange County, LongBeach and the South Bay complementing our fourhospitals, we can offer the best in health, wellness,prevention, disease management and treatment inthe right location with substantial savings foremployers, health plans and patients.Technological advances, for example, mean manysurgical patients spending days in a hospital willreceive care in convenient, lower cost outpatientcenters without overnight hospital stays. Unlikemost health systems, our ambulatory centers arenot operating as Hospital-Based OutpatientDepartments which receive higher reimbursement,but instead as high quality, lower pricedAmbulatory Care Centers. And we’re unveilingmore health centers, innovative programs,progressive partnerships and comprehensiveservices where people live and work.

Ray Chicoine, Monarch HealthCare:Patients who need the most care often facechallenges when it comes to accessing the bestcare which can lead to unmanaged conditions orextra trips to the emergency room. We havecreated programs, which focus on specific healthneeds or situations, including chronic diseasemanagement, pre-palliative and palliative care,social determinants, and more. By using homevisits, telephonic outreach, and virtual visits,we’re able to meet our patients the moment theyneed us, in a way that works for them, and guidethem to appropriate resources. This reduces

unnecessary costs and helps patients accesscare faster.

Jennifer Mitzner, Hoag Orthopedic Institute:Imagine getting a new hip in the morning andreturning to your home in the afternoon. Today,that is a reality for many HOI patients, thanks tothe innovative new procedures we havedeveloped to improve the scope of care that canbe performed in an outpatient facility. To meetincreasing outpatient care needs, HOI features a70-bed inpatient hospital in Irvine and enhancedoutpatient surgery centers in Newport Beach,Orange, Mission Viejo and our newest facility inLos Angeles County’s Marina Del Rey. We’vealso partnered with ProSport Physical Therapyand Performance to further our business modelinto non-surgical outpatient care formusculoskeletal conditions. The outpatient trendwill continue to grow commensurately as moreprocedures evolve to outpatient care status, andwe are ready and growing to meet that demand.

What are the current challenges impactinghealth care? What major trends do youexpect in the next 3-5 years? Will thelandscape be much different than what wesee now? How will virtual care affect thedelivery of health care in the community inthe next 3-5 years?

Gene Rapisardi, Cigna:One of the biggest challenges is the affordabilityof care, with the medical rate of inflationcontinuing to far outpace the general rate ofinflation. This puts a financial strain on the healthcare budgets of employers who sponsor healthplans for their employees and who pay the lion’sshare of the bill. Likewise, it puts cost pressureon individuals themselves who see their medicalexpenses rising year after year. There will bemuch more focus on keeping down the cost ofcare and more collaboration among stakeholdersto achieve it – and it will happen much soonerthan 3–5 years. It absolutely has to. Virtual carewill undoubtedly play a bigger role as patientsgrow more familiar and comfortable with it. Cignarecently expanded its relationship with MDLIVEfor behavioral health virtual visits, and now,during the COVID-19 crisis, virtual care isproving to be vitally important.

Janeen Hill, Chapman University:COVID-19 has upended healthcare and exposedfundamental weaknesses in our healthcaresystem. Lessons we learn from this pandemicwill set new trends. These will likely include amore inclusive healthcare system availing accessto care for all to ensure we as a region arehealthy; funding mechanisms for hospitals andhealthcare facilities to ensure their infrastructureis robust; inclusion of robust epidemiological datato inform decision-making; emphasis on highlyeffective healthcare teams to deliver care;reliance on telehealth and other remotetechnologies to reduce cost and improve accessto care; and technologies such as 3D printing tocustomize care.

Meghan Newkirk, UnitedHealthcare:One of the most important emerging healthcaretrends and technologies taking hold – particularlyover these the last several months – is the use oftelehealth. Virtual visits enable people to connect24/7 with a health care provider on theirsmartphone, tablet or personal computer. This isespecially valuable to anyone with a chronic



COVID-19 has upended healthcare andexposed fundamental weaknesses inour healthcare system. Lessons welearn from this pandemic will set newtrends.

Janeen Hill, Ph.D.Professor, Founding DeanCrean College of Health &

Behavioral SciencesChapman University



HOI’s surgeons, anesthesiologist andmedical team members workedcohesively to create our enhancedrecovery program’s (ERP), which isdesigned to support our jointreplacement patients that are ready togo home within hours after surgery.

Jennifer Mitzner, MPA, CPAChief Executive Officer

Hoag Orthopedic Institute

condition or those of us who seek the immediacyand convenience of consulting a doctor withoutbraving Southern California traffic to get there. Inlight of the recent COVID-19 outbreak, telehealthhas become a crucial way to connect patientswith health care providers who can answer initialquestions and guide them to a local care provideror public health authority for testing. Whiletelehealth may have the potential to help treatmany health issues, the technology is mostwidely used to address minor and nonemergencymedical conditions. These virtual patient-providervisits are now being embraced by physiciansnationwide and may over time become a method of choice by consumers.

For many years we’ve been hearing how dataand analytics can improve the quality ofpatient care. What type of data collection andanalytics takes place during a doctors’ officevisit, in-hospital stay or in other settings?How are data used to improve health andprevent people from getting seriously ill? Howwill the use of AI and virtual reality inmedicine benefit patient safety, and what willit mean for diseases that are currentlyincurable or difficult to treat?

Robert T. Braithwaite, Hoag Memorial HospitalPresbyterian: The use of artificial intelligence, virtual reality andaugmented reality in medicine is not some distantfuture, it is our current reality. Hospitals like oursare harnessing the power of AI to optimize theaccuracy and performance of mammographicscreening for breast cancer, as well as utilizingthe technology in cardiac and thoracic surgeries.And Hoag is one of the first hospitals in OrangeCounty to use VR/AR in complex brain surgeries.Our neurosurgeons now fit patients with VRgoggles prior to surgery to perform a “fly through”of their brains, see their tumors and get a betterunderstanding of what their surgeons plan to do.We are using similar technology to enhancephysical therapy, and we plan to use it foraddiction treatment and to offer guidedmeditations prior to and during medical infusionprocedures. We find that these advanced tools, inthe hands of well-trained experts, give patientsmore agency in their treatment, lower anxiety andimprove outcomes.

Meghan Newkirk, UnitedHealthcare:Data and analytics are crucial to a high-performinghealth care system, helping health care providersbetter respond to people’s needs, encouragepositive health decisions, and accommodate ever-evolving medical science. Leveraging data canalso help create benefit packages and facilitateproactive interventions that are customized forspecific populations or target “hot spots” of healthchallenges, such as obesity or diabetes.UnitedHealthcare developed an interactive toolthat enables employers to analyze and understandhealth data, providing an analytics-driven roadmapto improve health outcomes, mitigate expenses,and empower employees to take charge of theirhealth. As an example of how effective efforts likethis can be, a self-funded national retailer used it toanalyze out-of-network claims for back surgeries,isolating the area and factors contributing most tothese costs, and then launched an educationalcampaign that achieved estimated savings ofnearly $1 million.

Barry Arbuckle, Ph.D., MemorialCare: Measuring healthcare quality using metrics thatmatter is producing remarkable results. Decades

ago, MemorialCare began rigorouslydocumenting quality through extensive outcomesassessments that identify best diagnostic,treatment and preventive methods for ourhospitals, outpatient centers and physicians.Additionally, our data-warehousing and analyticsplatform absorbs data from numerous sources soclinicians can quickly and simply sort, refine, callout and drill down on individual patients. Forexample, we can quickly identify and schedulepatients overdue for mammograms,colonoscopies and other life-saving screenings,and those behind on follow-up to better controldiabetes, high blood pressure and other chronicdiseases that prevent strokes, heart attacks andother conditions. Access to billions of data pointsdelivers instantaneous response time forphysicians to determine best courses oftreatment. By moving from managing apopulation to an individual patient in a few clicks,we’re witnessing extraordinary improvements incare, patient experiences and communications—saving lives, reducing hospitalizations andduplication, and improving community health.

Ray Chicoine, Monarch HealthCare:We gather data from our provider visits, claims,pharmacy, and more. This data is vital tounderstanding the needs of our patient. While wehave designed our own patented systems tounderstand data and create customized outreachfor our patients, we’re also fortunate to be part ofOptum, which is one of the largest healthcareanalytics companies in the world. We are able touse many Optum resources to further helpidentify patients and get more care they need.

Medical care is moving toward much lessinvasive diagnostic and treatment proceduresbenefiting patients with shorter hospitalstays, speedier recoveries, lesscomplications and lower costs. Whatadvances is your organization is making inthis arena?

Jennifer Mitzner, Hoag Orthopedic Institute:Hoag Orthopedic Institute has been a leader inreducing the length of stay for our patients whilemaintaining a great patient experience since2015. HOI's surgeons, anesthesiologist andmedical team members worked cohesively tocreate our enhanced recovery programs (ERP),which is designed to support our jointreplacement patients that are ready to go homewithin hours after surgery. Before the program,our average length of stay for a joint replacementpatient was 2.1 days and today, many of oursame-day joint replacement patients leave asearly as two hours post-surgery. Patients whoundergo outpatient hip or knee replacementsreport a high degree of satisfaction (as indicatedby our U.S. News ranking for those procedures)and they are happy to be able to get back to theirnow-mobile lives pain free.

Ray Chicoine, Monarch HealthCare: We work closely with our provider partners, likeOptumCare Medical Group and Surgical CareAffiliates, to ensure open communication andspeedy access to high-quality, low-cost care.One of the things we’ve noticed is the importantrole the health plan also plays in getting bettercare. Patients who are on a MedicareAdvantage plan have better outcomes andstronger coordination of care across all theiraccess points, compared to patients who are onOriginal Medicare or a supplement. This is due





Orange County’s thirst for innovationis inspiring and should move healthcare leaders to embrace moretransformational thinking.

Annette M. WalkerPresident

City of Hope Orange County

to better clinical coordination from the healthplans. While each patient should choose a typeof Medicare that’s best for their needs, for manythere is a true advantage to the MedicareAdvantage plans.

How are you addressing the health andwellbeing of your employees?

Kimberly Chavalas Cripe, CHOC Children’s:Through CHOC’s employee wellness program,our employees have access to full biometricscreenings, mindfulness and stress reductioncourses, weight management classes, nutritionguidance, maternity and parenting counseling,muscular skeletal exercise programs, anddiabetes and hypertension health coaching. Forfinancial wellness, our retirement plan provideroffers onsite and virtual retirement and investmentcounseling. CHOC also provides a diverseplatform of benefits plans that include insurancefor medical, dental, vision, accidents, hospitaladmissions, critical illness, life and disability, legal,mental health, pet care, emergency child andelder care, education reimbursement andcompany paid student loans, as well as aretirement plan with company matchingcontributions. During the current pandemic, wehave provided additional resources for our staff,from free onsite childcare to healthy grab and gomeals for their families. We are also providingstress management tips and resources, and weare giving our frontline staff access to telehealthconsults with psychologists.

Ray Chicoine, Monarch HealthCare: Monarch has always had a strong employeeculture. We have weekly health classes, likeZumba, for employees. There are always funevents going on at our offices in Irvine, from foodtrucks to our annual Halloween costume contestand trick-or-treating for employees’ children. Moreimportantly, our employees come together to giveback to the community in a myriad of ways. OurEmployee Engagement Committee is a powerfulentity within Monarch, and the leaders areconstantly finding new avenues for all of us to giveback to our communities. Coming together toserve our community is a way for us all toembrace and live our mission.

With its start-ups and academic centers,Orange County is a hub for innovation. Howdo we harness this energy and become moreinnovative when it comes to health care? Whataspects of our region’s health care models dowe need to disrupt right now, and what shouldwe be doing to transform for next-gen care?

Annette Walker, City of Hope Orange CountyOrange County’s thirst for innovation is inspiringand should move health care leaders to embracemore transformational thinking. As we have seenwith the COVID-19 crisis, health care leadersneed to break free from traditional silos andcollaborate, working more with one another andwith non-traditional partners. At City of Hope, wefocus on cancer and have always believed thatcancer is our true competition; we want to workwith anyone who wants to beat cancer. Inaddition, we’re bringing in new partners such asthe scientists and researchers at TranslationalGenomics Research Institute (TGen), which hasaccelerated our precision medicine capabilities.More of these partnerships are on the horizonbecause we know that the brightest minds –working together –are the real hope for the nextgeneration of health care.

Janeen Hill, Chapman University:COVID-19 may be the impetus we need toconsider significant disruption in healthcare. Thevirus is upending the economy, healthcareinfrastructure, government role, access to care,political intransigence of the left and right, andmultiple other players comprising a healthcaresystem. We are now forced to innovate,collaborate and compromise to address apandemic. We need to take advantage of thecurrent disruption and pull together, in anapolitical environment, a team of creative thinkerswho are entrepreneurs and leaders in healthcarethought from business, industry and universities.The charge of this group is to imagine atransformation of healthcare that can emergefrom the current disruptive crisis.

Chad T. Lefteris, UCI Health:Orange County benefits from the innovation anddiscovery that occurs daily at UCI. UCI Healthand colleagues across the UCI Susan and HenrySamueli College of Health Sciences comprise apowerhouse of innovation whose faculty receiveda record $180 million in research funding for fiscalyear 2019. Efforts during the COVID-19 crisisreflect this. Through early April, UCI Health andpartners at UCI Beall Applied Innovation havecreated thousands of face shields for caregiversat UCI Medical Center and other local hospitals.UCI Medical Center launched the region’s firstNational Institutes for Health clinical trial of apromising therapeutic drug that attacks the virus’sgenetic structure. Dr. Phil Felgner, director ofUCI’s Vaccine Research and DevelopmentCenter, is developing tests to determine whichCOVID-19 survivors’ blood offers the mosteffective antibodies to generate a robust immuneresponse in victims. Innovation at UCI is leadingthe way in this fight.

What do you feel is the effectiveness of socialdistancing?

Sunny Bhatia, Prime Healthcare:Rather than use the term social distancing, Iprefer the term physical distancing. Socialisolation during these challenging times can havenotable psychological consequences. Physicaldistancing, 6 feet or more, can reduce COVID-19transmission rates significantly. The soonerphysical distancing measures are introduced andstrictly adhered to, the slower infection rates willbe and hopefully prevent an unmanageable peakof cases; thereby “flattening the curve.” Suchstrategies have been extremely effective in otherparts of the world, including Asia. Physicaldistancing, along with other behavioral practicessuch as hand-washing, covering your coughs andsneezes with a tissue, cleaning frequentlytouched surfaces and objects daily using aregular household detergent and water, arecurrently the most effective public healthmeasures to reduce the risk of transmittingCOVID-19. Prime Healthcare has created anddistributed literature to its patients, providers andcommunities. We have also implemented a robusttelehealth platform to facilitate remote patientcare in a safe and effective manner.

Robert T. Braithwaite, Hoag MemorialHospital Presbyterian Our message to the community through thiscrisis has been, “We show up for you, stay homefor us.” Our industry is on the frontlines of thispandemic, and we ask people to cooperate withimportant social distancing measures.





With the economic impact ofcoronavirus, we believe employers willbe seeking better value in the caretheir employees receive and healthbenefits they offer.

Barry Arbuckle, Ph.D.President and

Chief Executive OfficerMemorialCare

Unfortunately, we have several models that showjust how effective social distancing is to “flatteningthe curve” and reducing COVID-19 deaths. I say“unfortunately,” because the states, cities andcountries that have taken a more relaxedapproach to social distancing have seen moredeaths from this pandemic than those that haveadhered to strict guidelines. Sweden is held up asan international example of a country that hassoft restrictions, and its total number of deathsand its infection rate is greater than its threeNordic neighbors combined. Social distancingworks, we are safer at home, and adhering tothese guidelines will save lives.

Erik Wexler, Providence, Southern California:It is extremely critical and effective. Society nowhas learned how important social distancing isand how we do this. Starting early, as Californiadid for COVID-19, is how we quickly bring thespread of these viruses under control and savelives. Some have not taken this as seriously asneeded, putting many at risk, even their ownloved ones. I fear this is not the last pandemic wewill see in our lives and it will be important for usto consider how we can more effectivelyimplement social distancing. Further, protocols forbusinesses that remain open (grocery stores,restaurants, pharmacies and others) should bedeveloped to help these establishmentsimplement proper efforts to prevent the spread ofa virus, including for their own critical workforces.

Employers in Orange County are significantstakeholders in the health care system,seeking high quality and value-based care fortheir employees. How does your organizationengage with corporate entities and whatresults do those efforts have on patient care,costs and access?

Gene Rapisardi, Cigna:Consulting with employers is an important part ofthe work we do every day. For example, weadvise employer clients on how to create aculture of health within their organization and howto implement a successful wellness program. Wealso help them determine what type of fundingarrangement to choose, and evaluate differenthealth benefits plans that will best meet theirneeds and the needs of their employees, such asHMO, open access, high-deductible plans, etc.Do they want to offer a very broad network at ahigher cost or do they prefer a high-performingnetwork that’s smaller but offers access to qualitycare at a better price? There are dozens ofdecisions that employers need to make that affecttheir health benefits budget as well as the health,well-being and productivity of their employees. It’sour job to help them make choices that are rightfor them.

Jennifer Mitzner, Hoag Orthopedic Institute:Today, Orange County employers have an ever-increasing stake in the decisions they make onbehalf of their employees’ health care. HoagOrthopedic Institute was an early leader in thedevelopment of commercial bundled payments,which provide business with one fixed cost for anepisode of care, such as a knee or hipreplacement, with a warranty pledge, whichaccommodates the business’ desire to reducehealth care costs while receiving the highestquality care. Patients with employer-based directcontracting programs come to HOI from all overthe U.S., have surgery and recover here beforereturning home, all at a fixed, predictable fee. HOIengages a patient navigator to manage all of the

details of each corporate travel patient, whichmakes the process seamless and stress free.Our bundled corporate patients – and theiremployers – report a high degree of satisfactionwith this program.

Barry Arbuckle, Ph.D., MemorialCare: With the economic impact of coronavirus, webelieve employers will be seeking better value inthe care their employees receive and healthbenefits they offer. MemorialCare continues toaddress this challenge by offering more value-based options for employers than any otherhealth system in our communities. These includetailored network products with several of themajor health plans (Aetna, Blue Shield, Unitedand Anthem), direct-to-employer customizedcontracts in which we accept responsibility forhealthcare cost trend and quality expectations.For example, MemorialCare is The BoeingCompany’s preferred partner for California’s first-of-its-kind customized health plan option formany Southern California Boeing employees andtheir dependents. In just three years thisinnovative partnership reduced total cost-of-care,in part by significantly decreasing pharmacyspending and dramatically reducing inpatienthospital admissions and emergency departmentvisits. Significant enrollment growth has indicatedhigh employee satisfaction—all leading to Boeingextending its contract with MemorialCare. Withstay-in-place initiatives during the pandemic,we’re supplementing our on-site work thatcontinually engages local employers, schoolsand community organizations in healthy livingpartnerships with virtual and telehealth options.

Meghan Newkirk, UnitedHealthcare:The high cost of living in Southern California andalways increasing costs for gasoline, housing,food and necessities put pressure on thehealthcare system to deliver quality andaffordable choices for consumers.UnitedHealthcare is committed to investing invalue-based care (VBC) models that aredesigned to align and coordinate care deliverysystems, which ultimately produce better careexperiences for patients. Value-based caremodels are predicated by paying for patients’actual health outcomes rather than the number oftests or procedures they receive. Placing patientsat the center of the health care experienceimproves both the quality and cost of care. Weare seeing significant advances in people’shealth behaviors, better coordination of careamong physicians and facilities, and cost savingswith care providers who have implementedvalue-based arrangements.

The cost of health care delivery continues tobe top of mind among both the consumers ofhealth care as well as many employers andhealth plans that pay for health carecoverage. How has your organizationimplemented value-based delivery to reducethe cost of care while also improving quality?

Ray Chicoine, Monarch HealthCare:Value-based delivery is the foundation of thequadruple aim: improve the health of patients,improve the patient experience, reduce the costof care, and empower physicians. One way weintegrate this aim into our daily work is with aninternally-developed set of predictive modelingtools. We want to proactively identify people whocould benefit from additional support, and thesetools help make that possible. We can then





As with physical health, the sooner amental health concern is identified andaddressed, the better the outcome.

Robert T. BraithwaitePresident and CEO

Hoag Memorial Hospital Presbyterian

understand the individual’s needs and, with thehelp of their physicians and our clinical teams,develop ways to meet those needs. As a team,we all come together to deliver high-quality carewith lower costs and better outcomes, and it allcenters on the individual patient.

Jennifer Mitzner, Hoag Orthopedic Institute:HOI has been at the forefront of innovativepayment models that leverage our nationallyrecognized outcomes and value. HOI wasorganized by our elite orthopedic physicianfounders to be a pioneer (and a HarvardBusiness School’s case study) of a value-basedmodel of care, which means we copiouslymeasure our quality as well as the cost of care,to ensure the best outcomes at a reasonablecost. For seven consecutive years, moreCalifornians selected HOI for their jointreplacement surgery than any other facility inthe state which is a testament to our value-based focus and quality outcomes. You need tohave both to truly serve your community.

Barry Arbuckle, Ph.D.,MemorialCare:Employers and health plans continue to seeksolutions to reduce healthcare expenditures whileincreasing quality. MemorialCare isrevolutionizing value with rigorous quality,exceptional patient experience and competitivepricing. We’ve forged innovative partnerships foraccountable care, expanded outpatient offeringsand always strive for perfect care. We’restreamlining processes, responding to customers’needs and empowering our staff. MemorialCare’scommitment to accessibility and affordability isevident in value-based community care.MemorialCare’s integrated, diversified healthcaredelivery network offers a unique advantage withthe region’s largest number of value-basedcontracts with employers and health plans—critical to today’s economic challenges. We’reassuming financial risk for defined populations,and ensuring quality, service and cost targets aremet. With hospitals and outpatient care locationsstretching over a wide area, we’re uniquelypositioned to provide consumers, employers andhealth plans high-value health, wellness,prevention and, chronic disease management atthe most affordable cost. As we have for over acentury, our commitment to you remainsunwavering.

Sunny Bhatia, Prime Healthcare:Prime Healthcare was delivering value-basedcare before it even became a buzz word inhealth care! Our definition of value equates tooptimizing clinical outcomes that matter most topatients relative to the cost of care beingdelivered. Our physician-driven, patient-centricmodel has proven fundamental to the successof our value-based initiatives that have clearlyled to improved quality of care and excellentclinical outcomes. Prime has invested $1.1billion since 2005 on best-in-class medicaltechnology, including upgraded emergencyrooms, radiology equipment, IT upgrades andelectronic medical record systems. Prime’sphysician-driven model of care has a provensuccess rate. In the last few years, IBM WatsonHeath named some of Prime’s hospitals,including many in Southern California, amongthe top hospitals in the country for overallperformance and patient outcomes. PrimeHealthcare hospitals are well positioned as theindustry is shifting from volume to value andtransitioning from fee-for-service to bundledpayments.

There has been an increased focus on theneed for mental health services in the last fewyears. Is there a need for more mental healthservices now than before in Orange County,and if so, what is being done to address thisneed? Why is it important to treat mentalillness at the same time as a substance usedisorder, and how does integrated behavioralhealth treatment help to address bothconditions?

Mark E. Costa, Kaiser Permanente:As the stigma of Mental Illness decreases andthe awareness of how important our mentalhealth is along with our Physical Health, thedemand for services is certainly increasing inOrange County. This seems to be particularlytrue when viewing trends related to our youngerand senior populations where the incidence ofMental Illness is higher than the state ofCalifornia overall. There is also increasedawareness of the interrelationship betweenmental illness and substance use disease.These trends provide Kaiser Permanente and allhealth care providers and related communityorganizations the challenge to improve oursystems of care. Within Kaiser PermanenteOrange County we developed a combined DualDiagnosis Behavioral Health - SubstanceDisease Program within our Laguna Hills Office.Through integrated programs and services, webelieve our patients can be better served.

Robert T. Braithwaite, Hoag MemorialHospital Presbyterian:As with physical health, the sooner a mentalhealth concern is identified and addressed, thebetter the outcome. Nationwide, the suicide ratehas increased, and it is difficult – and daunting –to predict what the mental health fallout will befrom the current COVID-19 pandemic. Hospitalshave an obligation to treat mental illness head-onand to recognize the mental health issues thatmight be underlying other diseases, such asaddiction. For teens and their families, the PickupFamily Neurosciences Institute at Hoag launchedASPIRE (After School Program: Intervention andResiliency Education), an intensive outpatientprogram for 13- to 17-year-olds with primarymental health disorders and possible co-occurring substance abuse challenges. Mentalhealth also plays a critical role in our adultaddiction treatment centers. Our teamrecognizes addiction as a “family disease,” one inwhich all members of a family develop their ownmental health issues by virtue of living with anaddict. At Hoag, we work to address thesetogether offering resources for the whole family.

Kimberly Chavalas Cripe, CHOC Children’s:CHOC continues to develop mental healthprogramming in response to the rising needsidentified in the community. We have a robusttraining program, training young professionals inpsychology, many of whom stay and practice atCHOC or in our community. Last year, CHOCwas among the first pediatric health systems toopen an in-patient mental health unit with 18 beds.Yet, even with our growth, we cannot adequatelyaddress all mental health issues in children inOrange County, as an estimated 750,000 youth inour community can use services. Therefore, wealso work closely with community partners andschools to coordinate programming, share newevidence-based treatments and provideeducational opportunities. These activities willhelp to continue to expand the capacity to provide




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Just as consumers have driven howservices are provided in otherindustries, such as retail, financialservices and hospitality, consumerismis here to stay within our Health CareIndustry. This is a good thing.

Mark E. CostaSenior Vice President

Kaiser Permanente

excellent mental health services for children andadolescents in Orange County. Generallyspeaking, substance use disorders occur alongwith mental health problems, especially in childrenand adolescents. Often, children or teens startusing substances such as alcohol or marijuana to“treat” anxiety or depression because they aren’tsure how else to manage their feelings. Theopposite can happen as well; once teens startusing drugs, they can develop more severe anxietyor depression. When only the substance useproblem is treated and the underlying mentalhealth issue is not, teens can more easily relapsebecause the root problem has not beenaddressed. Likewise, if the substance usedependence is not treated, even with mentalhealth problems addressed, the teen may relapse.We applaud the Department of Health CareServices who is moving to further integrate thetreatment of both mental health issues andsubstance use dependence/addiction as this hasbeen shown to lead to more lasting change.

Gene Rapisardi, Cigna:One way to improve access to mental healthtreatment is with virtual care, as Cigna is coveringthrough MDLIVE. Even in densely populatedareas like Orange County, virtual visits make iteasier and more convenient to access treatment.Sometimes people hesitate to visit a mentalhealth professional in person due to the stigmathat unfortunately still remains. Virtual visits canhelp people overcome that barrier. Cigna is astrong proponent of whole person health whereall of an individual’s needs are met holistically.Rather than compartmentalizing mental illnessand substance use disorder, it makes sense(generally, as each case is unique) to treat thewhole person, because depression may beinfluencing the substance use, or vice versa. Atthe same time, it’s important to treat anyunderlying medical conditions that might be afactor. This approach becomes more efficient andeffective when medical, behavioral and pharmacybenefits are integrated.

There is concern across the U.S. that accessto quality healthcare is limited. This is true foraccess to specialists, primary care, care forthe uninsured and under-insured and qualitycare for residents of rural areas. What arehospitals doing to ensure access forresidents?

Chad T. Lefteris, UCI Health:UCI Health is committed to expanding access toacademic-based primary and specialty careacross Orange County. While the COVID-19crisis dominates healthcare today, we are movingforward with plans to open new centers andexpand existing ones, both physical and virtual.Launched earlier this year, UCI Health OnCall isan app-based telehealth service created toincrease convenient access. Our Video Visitsprogram, accelerated to safely meet the needs ofpatients during the current crisis, is expanding toinclude nearly two dozen specialties. We are alsoresponding to the state’s shortage of careproviders by creating the UCI Health AdvancedPractice Providers program to harness theexpertise of nurse practitioners, physicianassistants and certified registered nurseanesthetists to deliver care where needed andcomplement the world-class care provided by UCIHealth physicians and nurses.

Sunny Bhatia, Prime Healthcare:Prime Healthcare has long recognized the need

to improve healthcare access in ruralcommunities. This is clearly exemplified in PrimeHealthcare’s mission to save and improvehospitals so they can deliver compassionate,quality care to patients and better healthcare forcommunities. In the face of this pandemic, thatmission means more than ever. Prime has a longhistory of saving financially distressed hospitals,many of which are in underserved areas of ruralAmerica. In order to further expand access tocare in underserved areas and promoteeducation of future physicians, Dr. Prem Reddy,Founder and Chairman of Prime Healthcare,founded the California University of Science andMedicine (CUSM). CUSM created an innovativecurriculum and inspires, motivates andempowers students to become excellent andcaring physicians. CUSM provides opportunitiesfor medical education to promising minority anddisadvantaged students, especially fromCalifornia. In addition, since 2010, PrimeHealthcare hospitals across the country haveprovided nearly $6.2 billion in charity anduncompensated care.

Improving the “patient experience” is arelatively new concept in medical care,aiming to add more value to patients youserve, such as improving consumer service,staff and accommodations to be moreconsumer friendly. How has the“consumerism” of healthcare affected yourorganization and guided your decisionsregarding partners and technologyinvestments?

Jennifer Mitzner, Hoag Orthopedic Institute:Since our founding 10 years ago, HoagOrthopedic Institute (HOI) recognized thatpatients have a choice in their health care, andwe built a model to compete – earning ourbusiness one patient at a time with exceptionaloutcomes at a competitive price through bundledplans. Our HOI Signature experience providespatients with a premier hotel-like stay with thecommitment to getting each patient back to doingwhat they love more quickly and safely, whichmeets the desires of our patients. The decisionswe make to continually improve patient care atHOI are based on providing our consumers withthe highest quality healthcare experiencecoupled with a convenient bundle price. Theresult: HOI is to date, the only 5-Star CMS ratedhospital in Orange County for patient experience.

Mark E. Costa, Kaiser Permanente:Member Centered and Consumer Centered carecontinues to be our priority at KaiserPermanente. Just as consumers have drivenhow services are provided in other industries,such as retail, financial services and hospitality,consumerism is here to stay within our HealthCare Industry. This is a good thing. Consumersare now challenging the sometimes long-standing processes we have had for deliveringhealth care. Within Kaiser Permanente we havemultiple years of experience in providingTelemedicine and Virtual Care services. Wehave greatly expanded the level of care we nowprovide through our Home Care services, as wellas improved access to care at more convenientsites. For example, Our Target Clinics, locatedwithin Target Stores, as well as access to carethrough our Same Day Care appointmentssystems, our Urgent Care sites, and our NurseCare Clinics are all examples of how KaiserPermanente is focused on providing care when





members want it , where they want it and howthey wish their care to be provided. Our mailpharmacy service is another example ofconvenient care. These programs and servicesare not only responsive to those we serve but aremany times more cost effective for our insuredmembers and for our organization overall.Through the continued focus on innovation andoptimal use of technology we believe KaiserPermanente is perfectly positioned to meettoday’s and future consumer demands.

Meghan Newkirk, UnitedHealthcare:Improving patient experience means addressingwhat’s most important to consumers: receivingquality care at a lower cost, accessible where andwhen they need it. This was the impetus behindthe creation of UnitedHealthcare’s SignatureValueHarmony Network plan in 2019. Harmonyprovides access to quality, affordable, patient-focused health care for people withemployer-sponsored health coverage across fivecounties in Southern California: Los Angeles,Orange, Riverside, San Bernardino and SanDiego. This plan is the result of a uniquecollaboration between UnitedHealthcare and areacare providers, offering access to care at 60hospitals and more than 9,200 providers.Participants may see potential savings of up to 20percent on premiums as compared to other HMOplans available in Southern California. It is a clearexample of the ways in which the healthcaresystem can evolve to address consumer interestsand offer better care and lower costs.

Youthful Orange County isn’t so younganymore. Roughly 14 percent of thepopulation is over 65, and that number isexpected to soar within the next 20 years. Asa result, Orange County’s population will be athigher risk for serious illness, includingcancer. What impact does the agingpopulation have on local health care?

Janeen Hill, Chapman University:By 2030, 25% of Orange County residents will be65+. Seniors are more apt to have one or moremajor diseases: hypertension, diabetes, cancer.In addition, with aging comes higher incidence ofParkinson’s, Alzheimer’s, stroke, concussion andthe neurologic deficits associated with these. Theimpact of an aging county on local healthcare isenormous. Frankly, we are not prepared toaddress geriatric care. We are not educating ahealthcare workforce adept at geriatric care.Educating future healthcare providers (example:physicians, physician assistants, and physicaland speech language therapists) with expertise inthe diseases of aging is critical. Forgingpartnerships with public and private universitieswith graduate health professional programs(Chapman University being one) to ensure arobust healthcare workforce ready to treat seniorsmust be considered. However, local hospitals,healthcare organizations and physician groupshave an obligation to provide clinical rotations tostudents. Without these, the new workforcecannot emerge.

Mark E. Costa, Kaiser Permanente:As our population continues to age it has neverbeen more important to understand the changinghealth needs and then design a caring,compassionate and responsive delivery system.Kaiser Permanente continues to develop newcomponents of our continuum of care and tostrengthen existing Primary Care, Mental Health,Home Care, Long Term Care and

Hospice/Palliative Care Services. We also seegreat opportunity in developing strongerrelationships with existing or new communityproviders of health and social services. Inresponse to our growing elderly population, thismay be supportive services related to dailymeals, transportation, day care and support fordementia. The bottom line is that no health careprovider can alone meet all the health careneeds of our communities. We believe we mustcharter and collaborate with others to createstrong systems of care.

Annette Walker, City of Hope Orange CountyAs more adults reach retirement, they encountera host of new challenges –economic, social, andof course, health. As a community we need toplan for these changing needs and make surethe required health care resources are available.At City of Hope, we recognize that agingincreases the risk of cancer, and other healthcare concerns often complicate these cases. Ourplans to bring highly specialized cancer care tothis community is a direct response to presentneeds and future projections. We aim to be in aposition to ensure that all members of ourcommunity, including seniors, have access tocancer health care services and expertise theyneed.

Here we are, two decades into the 21stcentury, and we are still lacking women in thehealth care C-suites. What can we do toeffectively move more women and minoritiesinto leadership roles so that we can havesenior teams and boards that reflect thediversity of our communities?

Kimberly Chavalas Cripe, CHOC Children’s:I have been at CHOC for over 25 years and I amproud to say that as a mission-drivenorganization, we attract talented women.Because women are well represented in the C-Suite at CHOC, we are modeling what is possiblefor the younger female and male leaders withinthe organization. It has always been our goal toattract and retain the best talent. At CHOC, weknow that in order to attract the best candidates,we must demonstrate a culture of inclusionacross gender, race, religion, age and point ofview. I genuinely believe that the more tractioninclusivity gains within an organization, thegreater the potential is for that organization tothrive. A commitment to diversity means stafftraining in screening and interviewing candidates,as well as providing mentorship opportunities. AtCHOC, this is a commitment we believe is criticalfor our future.

Annette Walker, City of Hope Orange CountyThe interesting thing about health care is that wehave no shortage of women working in our field,and while they are often highly represented in theexecutive ranks they, like all minority groups, arestill underrepresented in the C-suite. I believetransformation starts at the top, which means wemust seek out diverse candidates for our boardswho truly represent the communities we serve.Additionally, it’s up to today’s leadership to invest insponsoring and mentoring emerging leaders whoare still several layers removed from the C-suite.These actions require commitment –especiallysponsoring, which means actively advocating andguiding a future leader. It’s not an easy fix, butensuring great future leadership for ourorganizations is an exceptionally worthwhilelegacy.



Improving patient experience meansaddressing what’s most important toconsumers: receiving quality care ata lower cost, accessible where andwhen they need it.

Meghan NewkirkGeneral Manager,

Southern CaliforniaUnitedHealthcare



Many counties in Southern California,including Orange, are in dire need ofhospital beds for mental healthcare.

Sunny Bhatia, MD, MMM, FACC, FSCAICEO, Region I and Chief Medical Officer

Prime Healthcare

In what ways are hospitals incorporatingfitness, nutrition, stress-reduction and otheraspects of care into the larger healthcarepicture?

Robert T. Braithwaite, Hoag Memorial HospitalPresbyterian:People trust their hospitals and doctors. I believehospitals can leverage that trust to guide healthfulbehaviors in innovative and meaningful ways. Forexample, the new Hoag Health Center FoothillRanch clinically integrates health and wellnessinto the patient care journey. This means we offertraditional clinical services, like primary care,urgent care, pediatrics, women’s health, sportsmedicine, imaging and labs. But we also have anonsite health coach, a fitness facility, a “smarttech” bar and other wellness services under thesame roof. Instead of a doctor telling a patient to“eat well and exercise,” that doctor can walk thepatient down the hall and say, “This is LoriMueller, she’s a certified wellness coach, and sheis going to work with us to achieve your nutritionand fitness goals.” To keep people engaged,informed and active, Hoag Health Center FoothillRanch is live streaming classes on YouTubefocusing on fitness, nutrition, stress-reduction andmore. This holistic approach to wellness hasbeen happening gradually, and I predict morehospitals will take an active role in complete-bodyhealth in the coming years.

Gene Rapisardi, Cigna:Cigna offers a robust suite of health coachingprograms designed to help people make lifestylechanges to improve their physical and mentalhealth, including programs to help peopleincrease their physical activity, eat healthier,manage stress, quit smoking, maintain a healthyweight and manage chronic conditions such asdiabetes. Our health coaches include exercisephysiologists, registered dietitians, nurses,behavioral health clinicians, and certified healtheducation specialists. They are experts at helpingindividuals identify their motivation and set goalsfor making healthy behavioral changes, and thenengaging with them to achieve them. Cigna’shealth coaching programs are one aspect of ourfocus on whole person health, which recognizesthat to be truly healthy we need to take care ofour bodies and our minds, the physical and theemotional.

Discuss the value of consistent policies fromhealth system to health system (visitation,PPE, etc)?

Erik Wexler, Providence, SouthernCalifornia:We have been pleased with information sharingand connectivity among health systems andthrough regular contact with the CaliforniaHospital Association and government agencies.During crises, we would support commonrequired standards for use of PPE anddeployment of certain types of equipment. Forexample, when one health provider expandsuse of surgical masks, the other systems mustquickly consider whether to follow. Access toPPE might prevent the ability to implement sucha policy and could create confusion amongcaregivers about requirements. The requirementshould be to do what is best to protectcaregivers and patients, based on science.Ideally, all health care providers wouldsimultaneously implement systems to movestrategic stockpiles of PPE or equipment tothose who need the supplies. This will reduce

confusion and unnecessary competition. In thecurrent situation, even without a formal system,we should be grateful for collaboration thatresults in thoughtful response.

Southern California has a critical shortageof inpatient psychiatric and behavioralhealthcare, and a rising need. How do wemove forward to meet that demand?

Sunny Bhatia, Prime Healthcare:Many counties in Southern California, includingOrange, are in dire need of hospital beds formental healthcare. The national target is aminimum of 50 beds per 100,000 residents. LosAngeles County has fewer than 23, and OrangeCounty faces a more notable shortage (14 bedsper 100,000 residents). The increasingshortage of inpatient care beds for behavioralhealth patients was the primary reason PrimeHealthcare recently converted the formerGlendora Community Hospital to the GlendoraOaks Behavioral Health Hospital. The newhospital opened in 2019 with a focus on generalsenior psychiatric care for people with high-riskpsychiatric conditions. Prime Healthcare hasexpanded behavioral health beds in many ofour Southern California hospitals, notably inOrange County. We have supplemented ourinpatient Behavioral Health programs with atelehealth platform and have beenimplementing outpatient and partialhospitalization programs to provide psychiatriccare across the entire continuum of care.

Mark E. Costa, Kaiser Permanente:Awareness of the need for improved MentalHealth Services within Orange County hasgreatly increased. Through the effort of schools,faith-based organizations, health care providersand many community-based organizations suchas Be Well OC and NAMI, we anticipate evenmore improvements to our system of care in theyears ahead. As is true with our overall PhysicalWellness, early identification of Mental Illness isessential. Reducing all stigma associated withmental illness, putting in place preventionprograms, as well as improving access toneeded outpatient mental health care willreduce the number of individuals who face amental health crisis and require inpatient care.That is certainly our hope. Before the end of thisyear we will also see the opening of the first “BeWell Mental Health Campus”, which will receiveparamedic and law enforcement transports forindividuals in crisis. This will reduce the burdenon Orange County Hospital Emergency Roomsleaving greater capacity for other neededservices. Within our Kaiser Permanente systemof care we continue to expand our ambulatoryaccess to need behavioral health services. Weare also seeing an increase in use of ourbehavioral health telemedicine service and theuse of Kaiser Permanente Mental HealthWellness apps. When inpatient care is needed,we continue to develop and maintain a strongnetwork of inpatient hospital providers.

What is the best way to streamlinecredentialing and privileging to easily deployphysicians to other than their “home”hospital?

Janeen Hill, Chapman University:I would like to expand the question to include

mid-level healthcare providers like physicianassistants and nurse practitioners. The state





The best way to ensure that the rightcare gets delivered to the right peopleat the right time – affordably and withlaser focus on quality – is throughcollaboration.

Gene RapisardiMarket President, Southern

California and NevadaCigna

already does not have enough physicians soone focus has been on increasing the number ofwell-trained mid-level providers. Thus, whatsteps might be employed to streamline theircredentialing. One might be to license PAs whohave completed at least 6 months of clinicalexperience in one or a combination of thefollowing: emergency room, internal medicine(in-patient), internal medicine (out-patient), andfamily practice.

Erik Wexler, Providence, SouthernCalifornia:The current system for credentialing andprivileging requires approval from eachhospital’s Medical Staff Executive Committeeand its Board of Directors. It is an excellentprocess that validates expertise and qualityoutcomes before a physician can admit or treata patient in a hospital. Even a streamlinedprocess can take 30 days or more. During asevere patient surge, an urgent approvalprocess is needed to allow physicians to moveamong hospitals without delay. Providence hasdeveloped a physician personnel tool that canquickly place physicians at other than their“home” institution. We are finalizing a SpecialSituation Crisis Approval process that allowscredentialed physicians in good standing at oneof more of our Southern California hospitals totreat patients at our other hospitals. We willfollow accreditation and regulatoryrequirements, but this action will be essential ifwe see a surge similar to New York City’sexperience.

Technology and data continue to driveinnovation in the delivery of medicine to allpatients – both young and old. Theseadvances include smartphones,telemedicine, remote patient monitoringdevices, etc. How have you leveragedtoday’s technological advances to improvethe health and wellbeing of the patients youserve?

Barry Arbuckle, Ph.D., MemorialCare:Technology is increasingly allowing us to reachpatients anywhere and everywhere. In additionto social distancing, hand washing and stayingat home, telemedicine and virtual care betweenMemorialCare physicians and consumers viavideo, limit unnecessary exposure to COVID-19and provide timely, convenient access to care.There are options for text messaging, artificialintelligence-enabled chats and other ways toaccess and expand what we’re able to treatvirtually without having to go to a doctors’ officeor health facility. We’re using technology toconnect primary care physicians, specialistsand other clinicians. Wearable technology isenhancing care and enabling MemorialCare tomonitor patients with chronic health conditions,so physicians can intervene early to addressemerging issues before patients even realizethey are a concern. Exciting technologiesadopted by MemorialCare are translating intonew realms of hope and health—comingtogether to deliver more efficient care, reachingpatients where they are and ensuring best-in-class healthcare becomes a more seamlesspart of daily life.

Mark E. Costa, Kaiser Permanente:Kaiser Permanente continues to be on thecutting edge of innovation – a point of pride

since our founding. Through the research anddesign efforts at our Innovation Studio in Tustinand partnering with some of the mosttechnically advanced companies in the world,we are working on technology to assist patientsin improving and maintaining their personalhealth. For instance, Kaiser Permanente hasimplemented Virtual Cardiac Rehab across ourSouthern California Region. The results showthat 82% of participants had a successfulcompletion rate using Virtual Cardiac Rehab.The program is a home-based program utilizinga wearable device, a mobile app and a clinicaldashboard that provides data points in realtime. Additionally, our successful TelephoneAppointment Visits currently account forapproximately a quarter of all visits. Werecognize that at the end of the day, careshould be accessible everywhere and at anytime.

As the healthcare industry transforms, inmany ways like other industries, will thislead to greater collaboration or increasedcompetition between Health Systems andHospitals?

Gene Rapisardi, Cigna:There absolutely will be more collaborationamong health plans, providers, employers andall other stakeholders because it’s absolutelyessential. Constantly rising costs that threatenaffordability, technological advances, an agingpopulation and many other factors are makinghealth care more complex. The best way toensure that the right care gets delivered to theright people at the right time – affordably andwith laser focus on quality – is throughcollaboration. That’s been Cigna’s mission andfocus for years in Southern California, startingright here in Orange County, where welaunched an alliance with St. Joseph HoagHealth in 2015. Our relationship is based ondeep collaboration and integration, where eachparty brings its unique abilities and assets tothe table to best meet the needs of employersand individuals. Our experience shows thatcollaboration works and delivers betteroutcomes than the old way of doing business.

The amount of medical science and clinicalresearch funded by the National Institutes ofHealth and other government sourcescontinues to decline. How does the lack ofpublic funding impact us locally and whataffects will it have in the future? What isyour healthcare system doing to fill this gapin medical research and how can the publicsupport those efforts?

Chad T. Lefteris, UCI Health:While UCI Health provides world-class patientcare, it is also in the knowledge business. Westop at nothing to advance scientific discoveryand clinical innovation that benefits patientsand often gives Orange County’s residentsaccess to treatments they can’t get elsewhere.The volume of NIH funding awarded UCIresearchers and physician/scientists is atestament to the caliber of discovery andinnovation home right here in Orange County.Unfortunately, public research funding hasdecreased in real dollars over the past 30years, endangering these advances andthreatening an uncertain future. UCI has made





great strides to forge strong, appropriaterelationships with industry to compensate. Theuniversity is also turning to our home’s greatestasset – its residents and businesses. Last year,UCI launched its Brilliant Futures campaign, anopportunity for you to support our commitmentto revolutionizing medicine through discoveriesthat advance patient care and healingthroughout the world.

Kimberly Chavalas Cripe, CHOC Children’s:As public funding has become more difficult toobtain, particularly for young investigators or forhigh-risk innovative ideas, we have looked toadditional sources, including industry andphilanthropic sources. The pipeline fordevelopment of new treatments often starts withpublicly-funded basic science, but asdiscoveries are turned into therapies, there isincreasing interest from private donors whoappreciate and encourage us to produce near-term treatments for children who need themtoday, as well as from pharmaceutical anddevice corporations or startups who have thebusiness expertise to bring products to marketin a way that has widespread clinical impact.Our healthcare system recognizes the fullpipeline, and we and our university partners areideally positioned to facilitate not just thefundamental basic science, but also the clinicaltrials and technology transfer that are essentialfor promising ideas to impact our community’shealth.

State OSHPD data shows that many OrangeCounty residents continue to leave the areato seek complex care. How is your healthsystem providing easier access to life-saving and comprehensive care in theircommunity?

Robert T. Braithwaite, Hoag MemorialHospital Presbyterian Improving patient outcomes drives our everydecision. This means introducing the latesttechnologies to Orange County and expandingbeyond our walls to give patients access toclinical trials and life-saving treatments thatwould otherwise only exist in prestigiousacademic institutions. As an example, the HoagFamily Cancer Institute is one of the fewcommunity hospitals in the nation to conductPhase I Clinical Trials for recently discovereddrugs, and we are a leader in precisionmedicine, an approach to cancer care thatdesigns targeted therapies based on the geneticmakeup of an individual’s tumor cells.Designated a Center of Excellence in RoboticSurgery (COERS), Hoag also remains anational leader in robotic-assisted surgeries. InFebruary, Hoag Hospital Irvine became the firstin Southern California to perform a roboticprostatectomy using the new da Vinci singleport (SP) system, a cutting-edge technologythat few hospitals in the world have yetacquired.

Chad T. Lefteris, UCI Health:As Orange County’s only academic healthsystem, UCI Health is committed to being theregion’s leading provider of complex care. TheUCI Health Comprehensive Brain TumorProgram is California’s second largest andoffers the widest range of therapies availableanywhere. UCI Health launched the county’s

first ECMO program last year for patientssuffering from severe, life-threatening illnessesthat damage proper heart or lung function. Weare the county’s leading center forkidney/pancreas transplants. UCI’s H. H. ChaoComprehensive Digestive Diseases Center hasa decades-long record of advancing clinicalinnovations, including breakthroughs in thetreatment of GERD and esophageal cancer andthe use of artificial intelligence to improvecolonoscopies. Experts have recentlydeveloped therapies to manage certaindamaging effects of liver cirrhosis, the country’sleading cause of liver transplantation. The ChaoFamily Comprehensive Cancer Center, OrangeCounty’s only National Cancer Institute-designated comprehensive cancer center,offers residents access to the county’s largestclinical trials portfolio.

What is your opinion on state or federalmandates on emergency actions hospitalsor providers must take?

Erik Wexler, Providence, SouthernCalifornia:The use of mandates should be reserved forthe most extreme situations and the rightexperts absolutely must be involved indetermining these requirements. As mandatesare being developed, medical experts, healthsystem leaders and government officials mustcollaborate on decisions. In some states, theremay be requirements rolled out without diversityof expertise, a dangerous situation for thestability of the health system, providers andpatients. We would support state and federalmandates in the most extreme spread of thisvirus and during patient surges fordetermination of equipment use, patient triagingto special facilities and testing. The federal,state and local strategic stockpiles of resourceswill be essential to effectively implementmandates. When COVID-19 is behind us, therewill be many lessons to learn. We must do aroot cause analysis with an action plan ready togo in case another situation like this presents.

Are wellness programs worthwhileinvestments for employers?

Meghan Newkirk, UnitedHealthcare:Many employers in California and nationwideare investing in well-being programs. In fact, aU.S. Chamber of Commerce study found 87% ofemployers are committed to workplace well-being efforts, and nearly three-quarters offer aprogram. According to employees, these effortsare producing results. According to a recentUnitedHealthcare survey, 57 percent of peoplewith access to employer-sponsored well-beingprograms said the initiatives had a positiveeffect on their health. Among those, 82 percentsaid they were motivated to pay more attentionto their health; 63 percent said they increasedtheir physical activity; 59 percent improved theirdiet; and 30 percent reported improved sleep.UnitedHealthcare’s Motion program giveseligible people access to wearable devices and,in some cases, employees can earn more than$1,000 per year by meeting certain daily walkinggoals. The combination of personal benefit andincentives has shown results. Enrollees havecollectively walked more than 431 billion stepsand earned $51 million in rewards.


As public funding has become moredifficult to obtain, particularly foryoung investigators or for high-riskinnovative ideas, we have looked toadditional sources, including indus-try and philanthropic sources.

Kimberly Chavalas CripePresident and CEO

CHOC Children’s


an informative q&a with oc’s top healthcare …...custom content • april 8, 2019 healthcare...

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