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The Medical Brief
Beyond Clinical Care: Why Zip Codes Matter
On this episode of The Medical Brief Podcast, the team is joined by Randy Oostra, DM, FACHE
Ostra spent four decades transforming healthcare from the inside out. What sets his leadership apart? The revolutionary insight that your zip code could very well determine your health outcome.
Randy Oostra, DM, FACHE
https://www.tedxtraversecity.com/randy-oostra
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This is the Medical Brief powered by Sir John I'm Vahid Sadarzadeh, with Dr Brian Schmutzler and Dr Ankit Patel, and today, a very special guest here on the Medical Brief podcast, we have Randy Ostra, phd, who is joining us here to talk well, an exciting topic here and I'm going to let Dr Ankit Patel do the introductions here, but, randy, thanks so much for being with us here today on our podcast.
Speaker 3:Yeah, great to be with you.
Speaker 1:Absolutely so, Randy. So one of the reasons we want to reach out to you and this is exciting for us because I happen to listen to one of your podcasts I saw a TED Talk, sorry and I got really interested in what you were talking about, and so I think at the end of this, we're probably going to call this the zip code episode. And so, Randy, you have a long history in healthcare administration, healthcare leadership. You helped be the CEO of one of the largest healthcare organizations in the Midwest for many years, and so we're going to ask you about what your pathway was through your healthcare timeline, your timeline as the CEO, and really more or less what you've been up to since then. And then we'll probably deep dive into the zip code conversation, which I think is really interesting. I think we'll be able to tease a lot of conversations just from that alone. So tell us a little about yourself, Tell us about your healthcare pathway and your time through up to ProMedica.
Speaker 3:Yeah, no, great, great to be with you. Yeah, no, I spent 40 years in healthcare and kind of retired to do some other things which I can chat about a little bit. You know grew up in Iowa. Parents were either first generation or my mom actually came over in the boat from Holland Osho is a Dutch name, so grew up in a very Dutch area and I got interested in sciences through college and everything and ended up working in my mid-20s for a company that did work around the Midwest it was a group of radiologists and pathologists, mobile imaging, consulting, all that and I spent a fair amount of time on Indian reservations in the public health service hospitals. And then, when I was 28, I was on a small airplane with the guy who ran the company, a guy named Dr Carl Wagner, and he asked me a question. One of my favorite questions to ask young people is what are you going to be doing when you're 50? And I remember saying small planes are loud. And I remember saying what, and it wasn't what. I didn't hear you. He's like what are you asking me? And then he said I'll be disappointed if you think you're going to be doing this.
Speaker 3:You know the next 20 plus years of your life and started a whole series of discussions and what it ended up is my wife and I quit our jobs, sold our house, sold our cars, went back to school at the university of minnesota hospital administration, all right and I started over and uh, it's um. You know, my father-in-law wasn't very happy with me. I kind of figured out later why. You know, at the time it was a great time in our life. And then got into hospital management. Uh, spent a fair amount of time in minne, set a system called Health One. Went to a system in Grand Rapids, michigan, spent five, six years there, went into a merger, left there and then we're down with the Sisters of Mercy in St Louis and then ended up in Toledo, ohio, by somebody I knew from Grand Rapids. So that's a quick 40 years.
Speaker 3:Yeah, and then had a great career at ProMedica 25 years In the last 15, was the president and CEO of the organization and just had a great run. So I'm getting close to 70. My dad worked till he was 85. So the idea was always, you know, I had some young folks that were probably ready for me to leave and the idea was to move on and do some new things, but just had a wonderful career in healthcare, Very passionate about a lot of the social causes, the social things that we ignore. I think that's already what you alluded to today.
Speaker 1:Yeah, great. So tell us a few of those new things you're doing.
Speaker 3:You know I'm doing a variety of things. I started a venture capital firm called Blueprint N1, completely based on longevity. The idea was to invest in longevity companies. My partner is Greg Norman, the golfer.
Speaker 1:Oh, nice Wow.
Speaker 3:Interesting connection there. Greg intends to I think he still does he wants to be looked at 120. And the idea and this was, you know, like starting thinking about this five, six years ago it's more common today is that there's so much in longevity that isn't talked about in medicine, and again we see a little bit more of it. And so what we do is we invest in longevity companies, and again we see a little bit more of it. And so what we do is we invest in longevity companies. And then, more recently, I've been an advisor to a couple different companies a company out of India called ITCart, where I'm a global ambassador for them, and some other things like that and then been doing a lot of work with a mental health company out of Colorado that does transcranial magnetic stimulation Another issue in healthcare that a lot of people don't know about, anyway. So it's been fascinating. So probably leaving traditional healthcare and running health systems on a day-to-day basis and I'd say more in this kind of venture capital world.
Speaker 1:Okay.
Speaker 3:And I'm working with a lot of startups and things. It's been fun.
Speaker 1:Yeah, how often do you get to golf with the shark?
Speaker 3:You know, you know he's been busy. This was pre-Liv golf, so he got involved with Liv and so you know, you know we've had a chance to meet, you know, every couple of months, perhaps Really impressive. The first time I met him, a partner and I were down there and he strolled into the conference room in blue jeans and a white dress shirt with a legal pad, took notes. And that's just been my experience with him. Good business person, you know, and just you know, real successful and, you know, internationally known.
Speaker 1:No doubt.
Speaker 3:Around the world. So very, very successful person and just, I've always found him to be a, you know, decent, straightforward guy, asked really good questions and yeah, it's been fun to, you know, in a very small way, get to know him just a little bit.
Speaker 4:That's great. So tell me a little bit about the longevity companies, whatever you can share, obviously if it's not public knowledge, but you know which which longevity companies or what public knowledge, but you know which which longevity companies or what, what?
Speaker 3:realm of longevity. Are you, you exploring? Yeah, you know. The idea again is you know you need a blueprint for your life. You're statistically all in N of one, and when you began to look at all the things and again, now it's more common when you, when you start to look at all the information that is out there and so our idea was to, you know, even though a lot of people talk about more traditional healthcare and say, yeah, well, it's kind of longevity based, what we're interested in more is the things like around epigenetics, nutraceuticals, some of the companies that really there's a neurostimulus watch was one of our investments and it's a lot to do with helping people relax and sleep, and so it's those things that when you begin to think about the things, and I would say it's the things that really aren't part of traditional healthcare. You know a lot of people that talk about longevity today. It's really just a nice executive physical on steroids. You know they might throw in a few more things, but really true longevity.
Speaker 3:I went out and I had a screen a number of years ago and I had a full genetic screen Excuse me, I'm a little cold A full genetic screen, you know, an inch thick, and I went back. A number of physicians in my family young physicians gave it to them and said what do you think? And they're like never seen it before. Gave it to them and said what do you think? And they're like never seen it before. And so you know, if you think about what's out there in longevity, both on the things you can do to live healthier longer and you know we're all going to die you know there's a whole variety of things out there in companies that are worth thinking about.
Speaker 3:And again, as a consumer, I'd love to know now, are there, you know, 20 year studies and all these things? Heck, no, and I'll probably be gone by the time they happen, but it's trying to create, you know, presenting to a patient. If you want to call a patient or a consumer, here's what's out there in longevity medicine. Here are the type of things people are doing. I take metformin every day. I'm not a diabetic because there's a lot of evidence you know, not 100% around its impact on aging, et cetera, et cetera. So those are the kind of things we've been interested in, the kind of things that we've invested in.
Speaker 2:Randy, I want to go back and just kind of ask you about your experience at ProMedica and your career there and take us through, you know, one of the most challenging times in American history in COVID-19. You know, you kind of stepped away in 2022. And in that time, as you're going through the COVID-19 process, we often talk to a lot of our guests about their experience on the front lines of COVID-19. You know, take us through your perspective of how that changed your business possibly, and maybe some of your experiences through that time.
Speaker 3:Yeah, you know, and I think it's a little bit of my upbringing and you know just as we were kind of evolving. You know, we're based in Ohio. It's a city, toledo's a city, that's a great city. It's just like a lot of cities has had to remake itself and we have a lot of poverty, a lot of issues, and so it's just not enough to do health care, and so you need to be able to look at social determinants of health. We were probably one of the early adopters and started talking about it, had a lot of people tell us we were nuts. It wasn't, you know, anything healthcare people should do. And then, you know, aspirationally, had some ideas about trying to position ProMedica on a larger scale and we actually ended up purchasing one of the larger senior companies in the United States it was called H HR Manor Care, which is bad timing.
Speaker 3:Pre-covid was bad timing, yes, and so we were off to the races. Pre-covid we had the best quarter of our life and then overnight, things just, you know, totally went upside down. And you know, just a couple of thoughts there, again, from a risk standpoint, you know, never, you know, you know, in our lifetimes would you think about global epidemic. You know, shutting down the world in your risk analysis, and you know, I'm going to always wonder, like if that had not happened, where you know what the organization would have evolved to, would have evolved to, and part of that was, you know, fostered with the idea that we wanted to grow, but also it was the idea that we just again, one part of healthcare that we really don't integrate is senior care and tons and tons of problems with senior care.
Speaker 3:It's not reimbursed well and you know, I think COVID did a number of things. It was amazing to see the response to COVID. So if we told our IT department that we needed to basically set all our management people up to work from home in a week, they would have laughed and said there's no way we need three years to do it. They pretty much did it in a week. And supply chains and trying to figure out the supply chain world, not only the traditional hospital supply chain, but we were going to anybody that we could think of that was buying supplies on a global basis and tapping into that. And so what happened? It just think about what was going on in those days and having people you know deal with families and as a lot of physicians, we talk about dealing with death a lot more and being the only people there to support patients. So pretty miraculous when you begin to think about that response.
Speaker 3:And then I think, just from a takeaway standpoint, you know, again I look back at it and think, like you know, did the risks we take with senior? Were they too inappropriate? You know I'd do it again if I had to do it all over again, given what I knew then, today I'd look back and say, well, it was too much risk because of COVID and what it did to the whole industry. And so I think you know, I think you kind of look at it from a life learning, you know, appreciation for everything that happens in health care, the you know, the you know, just the respect for people that can produce under challenges. And then this idea that you know, you just never know what's going to happen and life throws your curveballs, how do you deal with it, not only as an organization but how do you deal with it as an individual? So you know, those are kind of all those things rattle around in my head a little bit when I think about COVID.
Speaker 1:Yeah, I think you highlight a really nice, well, a really recurring point that our team encounters with all of our interviews, which is related to COVID. We did what we did at the time based off the knowledge we knew at that time. So, like you said, you would do it again knowing what you knew at the time. So hindsight is always 20-20. You touched a little bit about elderly health care. Take us into your thought process with this zip code conversation. Let's get us started. Tell us what you're thinking, tell us how you kind of came up with that theme.
Speaker 3:Yeah, you know I'm, you know we. This goes back decades ago where we started about hunger and hunger being, you know, probably one of the major health issues in the country. And again, you just think about healthy moms, healthy babies in the impact. You know, you know healthy food, the fact that in America we make hunger more of a political issue, and so what we do is we screened for food insecurity. Again, you know questions you can ask research-based, and so we started providing short-term food needs.
Speaker 3:We built a grocery store in the inner city because there wasn't a grocery store, no one would help us, so we did it ourselves provided short-term food needs to patients when they walked in offices, and so we did a whole variety of things relative to helping people. We created food clinics, food pharmacies, as we call them. So doctors would write scripts for patients to go see a dietician, talk about their budget, talk about their diagnosis and what they should be eating and really feel and still feel today diagnosis and what they should be eating and really feel and still feel today that you know if you have a patient walk into your office and all you're looking at them is clinically and yet they have all these social issues going on in their life. You know they're living in a car, they don't have money for utilities, they're a victim of domestic violence, they don't have food you just go through that whole laundry list and yet we provide care, very, very expensive care. It just doesn't fit in my mind that we are not balancing that out.
Speaker 3:The good news is we've seen some response to that from a health care perspective. Not near enough. And you worry that we're going to slip back and that it's really not. You know to the extent that it should be, but those were the kind of the kind of the things that we thought about. And then the five most important numbers is your zip code and again where you grew up in life and what happens relative to the zip code you were born into has a lot to do with your health and well-being. And so all of that has fostered other things that I think we need to do in the social determinants of health. That should be a mainstay in medicine. And, just to jump to the quick, I've always thought health care should be responsible for public health as well. So this is where people start yelling at me because why not? Why wouldn't we take the public health money in this country and give it to healthcare people, because they'll run the heck out of it and they'll do it well, so anyway.
Speaker 1:What year did you guys start doing those you know food assistance programs at your healthcare facilities?
Speaker 3:Oh boy, it was probably. It was over a decade ago, I'm going to say it's probably 10, 12 years ago. Interesting story when we started it I was expecting some pushback and one physician shared a story where a retired physician had come into their office screened positive for food insecurity. So, like early on, and it was somebody they knew and had had some economic issues showed up in a suit and tie and yet was food insecure. And so what happened was it was, you know, pretty widely adopted. It was really interesting to hear people tell us physicians when we were recruiting that one of the positives why they liked our system was that the fact that we were mission-based and we were looking at those type of issues. So I think it just goes to what motivates people in life and why they're in medicine in the first place.
Speaker 4:What got you interested in that initially, like what did you see in your career that moved you towards? You know, I really want to focus on food insecurity zip code. Like you know, health determinants zip code.
Speaker 3:Like you know, health determinants.
Speaker 3:Well, again, I think so.
Speaker 3:I grew up in a very religious home that I think has some impact on people's lives, and then I'm still religious and also I think that experience the public health service, hospitals and seeing that impact of generational poverty, and then again, just as you begin to look at you know just the we'd done a lot of work in our communities and we'd actually combined a whole bunch of offices, moved our corporate offices into the downtown, and what we said at the time was that's all nice because you can have nice, shiny buildings, but if you don't do generational work in neighborhoods, you're really not doing the fundamental work.
Speaker 3:And so it was always that what role should healthcare have in trying to look at some of those social sort of causes, social needs? Not that, you know, we have unlimited resources, but we have tremendous resources and people in talent, governance, physicians, and so the idea there, just more and more as you solve these needs, it's like health care needs to play a much larger role. And it wasn't like an overnight thing, it just kind of gradually grew, and the more it grew it was like the more we should do.
Speaker 2:Well, challenges in, you know I mean we're in South Bend, indiana, and you know challenges in South Bend are very different than the health care challenges that you'd find in Minneapolis, minnesota, which is where I lived for quite a bit. But you know, as we look ahead, you know 2025 is challenging for different reasons, for different people. In the health care industry. Ai has been a very hot topic. Where do you see AI playing a role in the medical future of what we do in this country and where do you think healthcare goes in the next few years?
Speaker 3:Yeah, you know, I think just my limited exposure to AI just blows me away with the capabilities that we see. You know everything from helping generate, you know, letters, content, market you just name it everything that can be generated. A little scary, but also really interesting. I think the opportunity for AI to change physicians' lives is huge, and so this idea that you could be in an exam room talking to a patient, come out and see a generated note at a potential bill changes everybody's lives. I mean, we all know physicians who you know spend all their day working, seeing patients coming home, spending time with their kids, and then what, sitting on the couch with a laptop, having to do charts and having to do medical records at night.
Speaker 3:And so this idea that the electronic health record was going to help clinical care get better it did. However, it didn't make physicians lives any better, I don't think, and so I think ai has the opportunity to do that. So I think, um, I think healthcare has an opportunity to really, um, jump in full board and, um, you know, try to put the priorities in the right place. You know people are using ai in different parts of healthcare, but I think the idea about trying to revolutionize the uh the medical record piece is to be huge. I think it's a life changer, not only from their day-to-day lives, but everything else. You think about productivity and all the other things that help us when we think about workforce shortages and the other needs that we have.
Speaker 2:You were shaking your head when he said the medical records.
Speaker 4:No, I mean, I'm an anesthesiologist so I don't have to deal with that as much, although I do go back through all our charts and make sure that they're coded correctly. But I guess the question so we as physicians get zero training in nutrition, determinants of health, public health, unless you do an MPH, and so I just wanted to kind of wrap in the AI. Do you think that?
Speaker 3:there and again you said limited experience, but do you think that there's a role of AI in helping us as physicians? You know. So, let's say, I go in and I see a patient and you know clearly there's a dietary component to whatever the disease process is and I'm a little out of my element because, you know, I spend most of my time doing anesthesia but do you think there's a role for AI in that? Yeah, 100%, because, again, when you start to look at it, there's a number of companies that are doing work in social determinants and they're able to track people you know where they live and then actually give you a profile very quickly. As far as hey, alert alert, you know this person is living in a neighborhood where there's probably issues relative to, you know, hunger and personal safety and a variety of things.
Speaker 3:And so I think that what allows you to do as a clinician is to be able to, you know, take a better focus, and I don't think it always has to necessarily fall to the physician. I think you know you have the right wraparound services to say, hey, you know, here's your zip code, here's where you live, here's some things that might be available to you if you don't know about them. And oh, by the way, through AI, we're going to be able to provide these services crisply to you and so allow you to navigate the type of things that you need in life, more so than trying to, you know, go do it on your own, and I think we've all had experiences. You know, I'm on Medicare. Sign up for Medicare. Holy cow, I mean, it's crazy, you know. And so when you begin to think some of the barriers we put up for people in life, I think AI can do tremendous help there, and especially when we think about the social determinants and all the sort of things that the social determinants can provide.
Speaker 1:So AI could be one of the answers to this question here, but you do a lot of work on the local state and you've done a lot of work on the national level in regards to socioeconomical deficiencies, with access to proper health care or food and just general well-being. What are the top three things you think we as a country could do to move forward in those directions, to move positively? And AI could be one of those things.
Speaker 3:Yeah, I always thought that Medicare should mandate screening for social determinants I used to say just hunger and require health systems to own that piece of their lives and not the idea that they need to provide all the services, but they have a role and responsibility to connect people to the right services.
Speaker 3:So, you know, I think from an AI standpoint, I think you know, I think that's critical and so I think you know that whole role in social determinants is especially. You know that whole role in social determinants is especially something that we miss. I gave a presentation to a bunch of people and before I could finish talking, a CEO of a very large health system, who you would know, whose people promote all the great things they're doing as social determinants, put up their hand and said I didn't say it this way, but I basically disagree with everything you just said, because we have no responsibility or no role, we've never been trained in it, and so I think those sort of things about creating. You said three things, but I think the social determinants is so complex, the idea of us being able to put together interventions and all those social determinants I think you know there's probably more than three there. I think that sort of focus and again a requirement that that gets done robustly is something Medicare should do, and then the other insurance companies will follow.
Speaker 4:It makes me think a little bit and again we're in the anesthesia realm, but it makes me think a little bit of like perioperative surgical home. Think a little bit, and again we're. We're in the anesthesia realm, but it makes me think a little bit of like perioperative surgical home. On get you know, um, you know, not just perioperative surgical home, but maybe we extend that to you know, your, your, your as ProMedica or whatever hospital system. You own this patient. You own them from start to finish, right, you own them from food insecurity and all that kind of stuff. Like you said, maybe not that you're, you're connecting them with the grocery store and you're connecting them with this or that, uh, or it's your grocery store, your dietician, but you, you have the responsibility to connect them with each individual thing. If you were going to own that patient, um and I kind of think that's what ACOs initially were, were kind of moving towards, although it never really got there- yeah Well, even like hospital at home, it's just another whole piece.
Speaker 3:You know rise, it's kind of stagnated. Yeah, I'm talking about school, but yeah, you know, people that didn't like it was our hospitalists. I mean, they're like hey, you know, you can take business away from me. It's like seriously, you know there's plenty to go around.
Speaker 3:You think about appropriate care, you think about the right setting, you think about seniors, you think about where the care should be delivered. I mean the idea that we have it really fully done all over hospital and home. And again, the application is there for AI, the technology that's in the home. Now I know physicians you know, even on the telehealth side want to see a patient, they want to touch a patient, they want to, you know, look at their eyes, all those sort of things. I don't know how to balance that out because, you know, sometimes physicians say they want that. But I think there's a bigger role for some of these non-traditional things. It's just that healthcare is not that innovative and so they're very slow to adapt. And I think there are some things that can be done on a much quicker pace and we just don't typically do that.
Speaker 2:Well, randy, it's interesting you mention this because we spent time with a hospitalist who's from the UK who does a lot of work in that at-home care and it's accepted there, right, I mean, in the UK there seems to be a coexistence of both. Is that possible in the United States? Is it possible for both to coexist at the same time and for the hospital systems to think, hey, they're not taking our money, but it's a branch of what we do?
Speaker 4:And did you ever? I guess my extension of that is did you ever push that when you were a CEO or a leader in a hospital system? Were you ever?
Speaker 3:Yeah, I'm super interested in this for a lot of reasons, but I was just fascinated that you said hospital at home which brings us back to something we've been talking about, so we started hospital at home and I think ultimately it was kind of ratcheted back down again with the idea and what. What happened was it's just getting people to adopt it and, you know, getting the pieces of parts, and then what we found is just a reluctance to use it. We had an insurance company at that point. Even they were like reluctant to use it.
Speaker 3:And you know, I think that's just this idea of change. You know, when you begin to look at some of the issues and physician shortages, the wait times, it has to be compatible. I mean, you know it's going to take you three to four months to see a physician. You know hospital homes got to play in that realm and so, yeah, I think, and then you know just everyone, you know one of the biggest problems in healthcare is organized healthcare, because the only thing organized healthcare can agree on is you know, don't cut my revenues. They really can't agree on much else because there's such diverse, you know camps, and so you get a bunch of hospitals together and they can't agree on anything else but don't you know, and so they have to.
Speaker 3:You know, organizations stay right in the middle, they can't do anything controversial, they can't impact anybody. You have to be very, would be very, very careful. And so we're. They begin to think was well, where's innovation gonna come from? It was gonna come from the AMA is gonna Hospital Association. I think, by their nature, it's really difficult for them to be innovative. Well, they can. So then, where's it gonna come from? The insurance companies? Well, let's not there. Independent physicians, the government I mean independent physicians.
Speaker 4:Why can't physicians push it right? I mean, this is what his name's Dan Lasserson in England did. They've had hospital at home paid for by the NHS for years and he's the one who kind of took it and said I'm just going to go, I'm going to go treat heart failure at home, I'm going to go treat paracentesis liver failure at home, I'm going to go treat respiratory viruses at home. So I mean my opinion, and you can disagree, obviously, but my opinion is it has to come from physicians.
Speaker 1:Well, you know, I think, with our aging population and those determinants you mentioned earlier physician shortage, long wait times I think that our hand will be forced eventually. Right, I think we're going to have to accept it.
Speaker 3:You get the right group of physicians together with the right management, and it would scare any hospital management person.
Speaker 4:You often.
Speaker 3:Well, right, if they're creative. You're not going to hear that too often, but it scares the heck out of you when you see large groups. Now so many doctors are employed. But when you see those large groups that are growing and they're independent and they're doing these sort of things, you're right. They have a better chance to change things than a traditional health system would. Just, by the way, the nature of how they work.
Speaker 2:And what about insurance companies? Yeah, you know. I mean, I think that's the other question is what? What do insurance companies do and say, yep, yeah.
Speaker 4:Because in England you've got the NHS. It's one system, you know there is no. If NHS decides they're doing it, they're doing it. So yeah, we've got a bunch of disparate health systems here or health insurance companies here.
Speaker 3:What do you? How do you do that? Yeah, well, I know we met with a CEO of an insurance company one time a large, and he was talking about that. They had 30 different IT systems because they had bought they weren't integrated. And so when you begin to think again about, you know they process claims. You know they turn them down. They process them. You know the idea. Yeah, they want to get more efficient, you want lower costs, but you know their machine is such as, like you know, innovation isn't exactly why they get up every day to drive better outcomes for our country and make health care more affordable. That's just I don't think who they are. I personally doubt that coming up with a different model than the American insurance model would be top of the list. I don't think we really need that in this country. As people start cutting things, that would be one thing to start over and just take it all away.
Speaker 4:Well, as people know and have listened to our podcast, they know that we are no fan.
Speaker 2:That's a story for a different day. But, randy, thanks so much. As we wrap this up here, we just want to thank you for taking time out of your day and thank you for sharing your experience with us, and hopefully we can catch up with you here in season two as we get further down the road, and we appreciate you spending time with us.
Speaker 3:Yeah, I look forward to it. We touched on a lot of great things. I think we can do a little deeper dive, so we look forward to joining you guys again. So thanks for the time today.
Speaker 2:Definitely Thank you so much, all right, randy Oster joining us here. Dr Ankit Patel, dr Brian Schmutzler, I'm Vahid Sadarzadeh. This has been the Medical Brief powered by Sir John.