Meet Stephen J. Spann, MD, MBA, and Tray Cockerell

Gregg Masters  00:10

This is PopHealth Week on HealthCareNow radio. Today's episode is sponsored by Health Innovation Media we bring your brand messaging alive on the ground and now in the virtual space for a major trade show conferences and innovation summits via our signature pop up studio connect with us at www.popupstudio.productions. I'm Greg Masters Managing Director of Health Innovation Media publisher of ACOwatch.com and your PopHealth Week co host with my partner co founder Fred Goldstein, the president of Accountable Health LLC, a Jacksonville, Florida based consulting firm. Our guests on today's show are Steven J. Spann MD MBA and Trey Cockerel. Dr. Spann is a family physician leader, educator and researcher and is the founding dean of the College of Medicine and vice president for medical affairs at the University of Houston. He has dedicated his career to improving health and health care around the world by training future healthcare professionals, contributing to the scientific knowledge base of primary care and by leading medical school faculty physician medical groups and hospital staff to practice high quality evidence based family medicine. Tray Cockerell is Senior Executive of Strategic Relationships Office of Health Affairs Advocacy at Humana his current focus is to collaborate with academic institutions, notably the University of Houston to support the startup of a new college of medicine and to help integrate the existing clinical colleges and interpersonal model that leverages humanas clinical expertise in applications of value based care payment innovation and integrated care delivery. So Fred, over to you help us get to know Dean Spann and Trey Cockrell and what they're launching the city of Houston, home to the Texas Medical Center.
 

Fred Goldstein  01:59

So thank you so much, Greg, and Dean Spann. Welcome to PopHealth Week.
 

Steven Spann  02:02

Well, thank you. It's a pleasure to be here.

Fred Goldstein  02:05

Yeah. It's a pleasure to have you on and Tray, welcome back to PopHealth Week we've had you on in the past.

Tray Cockerell  02:09

Yeah.  Thanks Fred for being back. Thanks for having me.

Fred Goldstein  02:11

Yeah, it's my pleasure. And thank you both so much for joining us to be a fascinating discussion here today, especially with all going on around COVID Coronavirus. But let's first get to a bit of a background perhaps Steve, you could give us a little bit of background on yourself and the work you do at the Medical School.

Steven Spann  02:25

So thank you. Well, I'm a family physician thats had a very broad ranging career. I started out as a country doctor practicing rural Family Medicine initially in Arkansas for a year and then in North Carolina for three years. And then I entered full time medical education was on the faculty at the University of Oklahoma and then the University of Texas Medical branch in Galveston where I was a department chair and then I moved up to Baylor College of Medicine, my alma mater, and I was there for 16 years. During my time there I was also dean of clinical affairs at Baylor for a couple of years. And then I spent two and a half years working for Johns Hopkins Medicine international in the United Arab Emirates, the Emirate of Abu Dhabi, the city of Al Ain as Chief Medical Officer of a large a 460 bed teaching hospital there, that was exciting, and fun. And then I came back to Houston to lead the planning and development of a new College of Medicine at the University of Houston. And that has been a great journey. We are close to opening our new college of medicine.

Fred Goldstein  03:41

That's fantastic, congratulations on that. And really interesting background, you've kind of been all over the world, a lot of different facilities and learn from a lot of different places. So I'm sure that's going to impact how you've thought about this new medical school, and obviously working with Humana on that. And so Tray, talk a little bit about your background and how you ended up working with University of Houston on this for Humana.

Tray Cockerell  04:00

Yeah, you bet. Fred, I've been with Humana about 18 years and a number of different roles. I've got some really cool opportunities ranging from human resources to operation and a few years ago actually started our Bold Goal population health work. And that's our initiative to improve the health of the communities we work in 20% by 2020 and beyond by making it easier for people to achieve their best health. And once I get that work started, got a chance to go work for our CEO and lead some special projects. And one of the cool things that came out of that was this opportunity with the University of Houston. And really this for us was a chance to align with a school and a dean in particular Dean Spann who has a mission to really do some work with primary care to serve the underserved population and to extend a lot of the things that we do that we really feel and value about primary care and, and working with patients into medical school education. So we know today that students don't get a lot of education about insurance and about things like value based care and social determinants and Steve's vision encompasses those things. Again, working with that underserved population is super important to us. And that's why this was a great fit this the missions are just perfectly aligned.

Fred Goldstein  05:07

Yeah, it really is interesting having known you from the Bold Goal days and how you've now taken that into this will be fascinating to see how that gets influenced into the training. And speaking of that, Dean Spann talked about why University of Houston decide to put a medical school in are there particular needs in the community or things like that?

Steven Spann  05:24

Well, that's a great an important question. I think it's important to say that, that the University of Houston sees is part of its mission, improving the quality of life in the broader, Greater Houston community. You know, we are the city of Houston's University, so to speak, and we see part of our mission as being just contributing to improving life and well being in the broader Houston community. I think that it was realized that there are some deficits in health care and health within our city despite the fact that we have the largest Medical Center in the world at Texas Medical Center, it's a wonderful place to receive care if you're if you're very ill and have complicated illness. Despite having that wonderful Medical Center. Our community has major deficits in health care and major disparities in terms of health. We have geographic communities that are not that far apart, that have significant health disparities. I'll give you an example. the healthiest zip code in our Greater Houston area. And the unhealthiest zip code in the Greater Houston area are pretty close geographically, one or two miles apart. And yet, the difference in life expectancy at birth if you live in the healthiest zip code versus the unhealthiest is over 19 years, over 19 years of difference in life expectancy birth between those two zip codes. So major health disparities, and we have geographic communities within our city that have health indices, epidemiological indices, that are similar to that of the developing world. So we have great needs. One of those needs in our city, and certainly in our state are for more primary care physicians. Texas ranks 47 out of 50 states in the primary care physician to population ratio. And if today, we wanted to achieve the national average in terms of primary care physician to population ratio, we need 4800 additional primary care physicians in the state of Texas, so we have a real deficit in primary care. We have major health disparities in our city, we see the need for bringing improve for improving health, improving health care. And one of the ways to do that is by training more physicians, and particularly more primary care physicians and so so our goal, in fact is that 50% of our graduates would practice in primary care specialties. Of course, the other major need across our country is to improve the value of healthcare, we define value as the relationship between quality and cost. You know, we have the most expensive health care system in the world by far, we spend way more on health care in terms of percentage of GDP and per capita costs than any other wealthy nation. And you might think that because of that we have the best health but guess what we don't. In fact, when you look at other wealthy countries, we're at the bottom of the heap. So we spend more we have poor quality, we have low value, and we as a nation have a real need to improve that. So we need to train young physicians on health care professionals on how to improve the value of the healthcare delivered. That's another major focus of our medical school curriculum.

Fred Goldstein  09:16

That's fantastic. And I think it's, it's interesting, you talked about it, this idea of value and the community itself and trying to put more primary care physicians out into that market. And I know from a a population health approach, Trey, we've talked about this before, and I've been involved in the Bold Goal program from Humana, that's really been a focus of yours. So was that sort of the underlying idea when Humana was thinking of coming into work with the new medical school something around population health and you talked also about building these kind of learnings around value based care and health plan up operations or things like that.

Tray Cockerell  09:51

Yeah, that's exactly right Fred  it really was an opportunity to kind of be on the ground floor with someone like Steve and aligning with this vision that he's got around improving value and specifically quality and costs and the overall quality of health care delivery. And as I think, you know, we have some some clinics we've opened in Houston in the last year, it's under our partners in primary care brand. And those are value based fully capitated clinics and put focus primarily on seniors with multiple chronic conditions. And really an opportunity for us to take the learning that we have in that kind of delivery model and share that into the College of Medicine as well, we would would see opportunities for students to rotate into the clinics and get some learning there. And then also to hopefully take some of the learnings that we have and build that into part of the curriculum as part of elective work through value based care elective we're developing or into curriculum for classes, like Steve's physicians, patients, and populations class. So definitely just a fantastic alignment and thinking about those things around improving quality of health outcomes, and population health in general. Makes perfect sense for us. And it led us to establishing Houston as the next one of our Bold Goal communities. So we're up to I think 16 now, and Houston was was one of those we added as a newer one in the last year or so

Fred Goldstein  11:10

That's great. You mentioned your clinics, can you talk about and explain to our audience how those clinics are perhaps a little bit different from the typical primary care that we see today in the fee for service world?

Tray Cockerell  11:22

Yeah, the real, the real primary difference is focusing on again, those seniors with multiple chronic conditions, and providing the time that they need to really understand more about how to treat their condition. So physicians will actually see them up to once a month depending upon how chronically ill they are, but seeing them more frequently seeing them for longer periods of time. So the difference between this value based or full risk arrangement, versus what we see in fee for service is physician spending quality time, they're ultimately accountable for that patient's overall health. And so they share an interest in making sure that patient is making decisions for their their own best health as much as they can. And it turns the physician into a real quarterback in that situation to help understand a lot about the patient and focus more on whole person health, which is, you know, another significant emphasis of this work; is to really understand outside of the doctor's office, what are the things that are having an impact? What are those? What's the social context of that patient that's negatively impacting his or her health? And what are those health related social needs that we can collectively have an impact on to improve health outcomes. So that's, that's, you know, the primary differences, a lot more than that, but essentially, those physicians are rewarded based on improving health outcomes over time.

Fred Goldstein  12:39

Dean Spann as you think about what he talked about, what sort of things from that type of a practice approach are you bringing into your curriculum? What sort of programs will the students go through, both from introduction to a community approach or population health approach, or even as deeply as looking at these various alternative reimbursement models and capitated type practices?

Steven Spann  12:59

A lot, I will tell you the, our curriculum has a strong emphasis on health system and population health sciences and we have a course that's called Physician, Patients and Populations that meet four hours a week during the first 18 months, which is the preclinical part of the medical school curriculum. And in that course, they, the students will learn everything from how to interview and examine a patient to medical professionalism, medical ethics, evidence based medicine, quality improvement and patient safety, health informatics, how to lead interprofessional health care team, health policy, population health, all these different components of what we call a health system sciences. A lot of coursework, a lot of learning didactic teaching in those areas, the whole area of social determinants of health. And by the way, we now understand that about 80% of the preventable morbidity and mortality in this country relate to social determinants of health. So learning about social determinants of health and the importance of upstream care of dealing with those social determinants of health, so that they don't end up causing disease and downstream  problems for patients. The whole area of how to improve value in, in healthcare and certainly being introduced to value based models of reimbursement and care. That is the future we know that that's the way healthcare is going. We happen to think that's a great model for primary care physicians to practice in so we want our students to have exposure to that and to understand some of the nuances  of how you deliver care in a value based reimbursement model. So so the clinics that Trey's talking about will be great teaching laboratories not only for our medical students, but for our students and other health related professions, nursing, pharmacy social work and part of our focus, by the way, is to train students in interprofessional teams, we know that healthcare is a team sport, and students need to be learning how to work in teams from the very get go not just after they get into practice, but during their professional training. So these are all components of the curriculum that will enable us to teach value based care, how to improve value in healthcare and help us train healthcare professionals for this century,

Gregg Masters  15:54

and if you're just tuning in, you're listening to PopHealth Week on HealthCareNow Radio. Today's episode is sponsored by Health Innovation Media. Our guests are Steven j Spann, MD MBA, founding dean of the College of Medicine at the University of Houston and Trey Cockerell, Senior Executive of Strategic Relationships in the Office of Health Affairs Advocacy at Humana

Fred Goldstein  16:15

and in Houston as you pointed to earlier has, you know, some huge disparities, really fascinating, diverse community. I lived there for a little while, years ago, I actually worked at a Houston Northwest Medical Center. And I recall even back then how how spread out and diverse it was, are there certain programmatics you're going to do in terms of taking your students out into some of those communities and working with families or others in them?

Steven Spann  16:39

Absolutely, absolutely. So our curriculum includes one half day per week of exposure to primary care practice, we're getting week one of medical school so our students will be out in primary care clinics in primary care centers a half day a week for the during the four years of medical school, so a lot of exposure to primary care, one of those half days every month, they will be participating in our household centered care curriculum and program. This is a program where students will be involved in interprofessional teams, not just medical students, but nursing students, social work students, pharmacy students, and perhaps students from other health related disciplines. Each team will be assigned a family with complex medical and social problems that lives in a an underserved community community that has major health disparities. And each team will follow their family monthly, over the four years of medical school. This will allow them to really understand social determinants of health, the complexities of navigating our healthcare system, it will allow them to provide health education, health care coaching, care coordination. And it may be that that some of these families, some of these patients will be patients that the students are following in their primary care clinic experience, half a day a week, the rest of the month. So this will be absolute broad and in depth exposure to primary care, community health, and interprofessional team care. All are so important in our new health care system.

Fred Goldstein  18:27

Yeah, it really makes sense. I'm fascinated by that concept of having, you know, folks in the home learning about what's going on those families, because that really is the place to begin to get a great understanding of how you can help them improve their lives to improve their health. So really neat idea. And Tray as you look at this. I was just wondering, from a Bold Goal perspective, are there any unique things you think or as you launch it in Houston, do it in Houston associated with the medical school or having worked with medical school that may influence how those programs roll out?

Tray Cockerell  18:58

You know, I would, I would first, kind of just add a comment to Steve's notion around household centered care and the value of that from our lens. I think, you know, we acquired a minority stake in Kindred at Home a couple of years ago with the intent to continue that acquisition. And that really demonstrates our belief that care in the home is a significant part of where the future of healthcare is going. We have a strong belief that more and more of that care can be delivered in the home and certainly today is giving us evidence that using new technologies and telehealth and other technologies like that is going to enable us to bring more care into the home. So having medical students and other clinically minded students go into homes, especially in care teams to deliver that kind of care. And as Steve mentioned, really understand the social context of patients and how we deal with that more effectively, I think is a game directly in line with where we see this this as part of our business evolving and that also lines up very much with with the Bold Goal and as we think about the three pillars that we have in our focus around Community, Education and Research, those also align with Dean Spann's mission, and really thinking about how do we take the experience that the Dean Spann's team are building out and leverage that to benefit the community, which is what the Bold Goal is all about. But also to have a twofer. or threefor as we're calling it really, and it have things that contribute to education, and even workforce development. So as we think about leveraging community health workers, and training those folks in different ways to certify them as community health workers, and then maybe they go on to nursing schools, and even get into medical school, at some point, we're starting to see that kind of thing happen. And so we think that's a real opportunity from a workforce development standpoint, with education in the community. And then we're also able to take a lot of the work and tie it directly back into the lifeblood of the institution around research and partner with Dean Spann and some of his colleagues around how we do some retrospective analyses and other kinds of studies that are really contributing to the evidence based science around how we're improving the value of healthcare and healthcare delivery.

Fred Goldstein  21:01

And could you for the sake of our audience, obviously, we're pretty deeply into Bold Goal and understand it give a quick understanding for them of what Bold Goal is.

Tray Cockerell  21:11

Yeah, you bet. In 2014, we started this this work. And in 2015, our CEO actually put out this, this dream with a deadline we call the Bold Goal, we're going to improve health by making it easier for people and the notion is to go in and really understand what are the major social impacts. And frankly, when we started this a few years ago, we weren't talking much about social determinants. And in my sphere, and in the private sector, certainly a lot of others were, but we were just looking at what are the barriers to health? And how do we help solve some of those barriers. And it turns out that those are really the social determinants and understanding that context and being able to bring together a number of different folks to focus on those issues. And by by folks, I mean, health minded community leaders, people who are in positions of responsibility and communities who have organizations that are providing benefits to people, things like food banks, and YMCA, and American Heart Association, American Diabetes Association, all of them have resources that are helping improve the social determinant issues that folks are facing day in, day out, and tying it back into the medical school and really into Steve's household centered care model. You know, again, it's a perfect fit, because now you have students who are understanding this much further upstream and are today we're just starting to marshal the groups of organizations that we are today in a more collaborative way to address some of these issues. So that's, that's what the Bold Goal is all about. And we've seen some measured improvement in different communities relative to healthy days, which is a CDC measure that we use to evaluate the success of the Bold Goal, and have no doubt that we're going to going to see that same kind of improvements, we're able to start measuring and use as well.

Fred Goldstein  22:49

And how many communities have you rolled this out in now keeps growing every time I hear it?

Tray Cockerell  22:53

Yeah, we started with with one, of course, and grew pretty quickly to seven and then into an eighth and kind of stayed at eight for a while. And we're now in 16 different communities across the country.

Fred Goldstein  23:03

 Wow.Fantastic. That's fantastic. And I as I said, I've really enjoyed working here with Paul in the in the Bold Goal program here in Jacksonville and watch that develop over the past years. It's been amazing to see. So Dean Spann as you're about to open this new medical school, how many students what sort of individuals might be looking for more community oriented folks, etc?

Steven Spann  23:23

Yes, we're actively recruiting our students now, in fact, interviewed a group of students today we're having to do that via via the internet online because of the social distancing the requirements during the covid 19 pandemic, but we're looking for a group of students that first of all, enjoy relationships with patients, we really believe that empathetic compassionate relationships between healthcare professionals and their patients are what brings about healing and improvement, better health. So we're looking for students who are interested in what we call relationship centered care of course, we're looking for students who want to be excellent physicians, we're looking for students who are interested in leadership. And when we're talking about leading  a change in the way we deliver health care in this country, and finding ways to improve health and health care. I think we're also looking for students who have an interest in primary care and community health and population health. And we're looking for students who are interested in working with communities that have major health disparities to partner with them and help improve their health and health care. So those are the kinds of individuals we're looking for. We will start our class with 30 students. We will have 30 a year for two years and then we'll double to 60 a year for two years. And then we'll double to a 120 a year which will be our ultimate class size. seeing a lot of interest in our medical school we had 2230 applications for 31 first year positions. So we're working through those applications and interviewing applicants, there seems to be a lot of interest in what we're doing. We anticipate that we're going to recruit a wonderful class of students to launch. We're starting in February, we're excited about having this new group of students at this new medical school.

Fred Goldstein  25:29

That's really going to be great. And congratulations on getting to this point. And obviously, we're having to work through the issues with COVID. And recruiting incredible number of applicants, obviously, and trying to select 30 is going to be quite the challenge, I'm sure. So just real quick, could you touch on what you mean by relationship centered care,

Steven Spann  25:47

this is a term that and more and more use, we've talked for years about patient centered care. This emphasizes the importance of relationship in our care of patients. The recent book published last year called compassionomics , written by two professors of Internal Medicine at the Cooper medical school in Camden, New Jersey. These physicians did a thorough review of the medical evidence, they did what we call a systematic review of the medical literature looking at the importance the impact of empathetic, compassionate relationships between healthcare professionals and patients. And they found in summary, the following those patients who enjoyed empathetic compassionate relationships with their healthcare professionals had better outcomes of care, were obviously more satisfied with their care, and their care costs less. And the providers of those of that care the health care professionals involved were much more satisfied with their care of their patients. Over 50% of our physicians have symptoms of professional burnout. Many people believe that this is due to a deterioration in a doctor patient relationship. Even surgeons know that and value, the importance of relationships and helping our patients get better. This is really a focus on the quality of the doctor patient relationship, the health professional patient relationship. And we believe that by really emphasizing that and training our students to value that and to enhance that, we're going to see an improvement in value and improvement in quality and outcomes, and ultimately, a decrease in costs.

Fred Goldstein  27:45

And that makes a lot of sense. Dean's Spann, and I think we're gonna have to close up the show. with that. I want to thank you so much for joining us and you too. Tray. It's been a pleasure to have you both on PopHealth Week.

Steven Spann  27:56

 Thank you.

Tray Cockerell  27:57

Thank you both as well.

Fred Goldstein  27:58

And back to you, Greg,

Gregg Masters  27:59

and thank you Fred that is the last word on today's broadcast. I want to thank our guests Dr. Steven J. Spann founding dean of the College of Medicine at the University of Houston and Tray Cockerell senior executive of strategic relationships in the Office of Health Affairs Advocacy at Humana for their time today. For more information or to follow the work of the College of Medicine at the University of Houston or Tray Cockerell's work at Humana go to www.uh.edu/medicine and www.humana.com and  @Humana on Twitter respectively. For PopHealth Week my colleague Fred Goldstein and HealthCareNow Radio This is Greg Master's saying stay safe y'all we get better together. Even if virtually