Breakfast Series report: Keeping Idaho Healthy

Around the world, health care providers have been tested like never before by the unprecedented COVID-19 outbreak. In Idaho, doctors and nurses moved quickly to offer critical care to coronavirus patients and slow the spread of the virus when it arrived in the state this past spring.

Hospitals were swamped with COVID-19 patients, but that surge was counterbalanced by a dramatic drop in other types of care, such as elective procedures. This slowdown has affected providers across the spectrum of health care from dentists to physical therapists as many people postponed routine care.

And of course, we are all waiting to see what the fall and winter bring in terms of a possible resurgence of the COVID-19 virus. There is a great need for continuing testing and monitoring, with children returning to their classrooms and most businesses open for in-person services.

On Oct. 6, the Idaho Business Review held a virtual Breakfast Series panel to discuss these issues and more with a group of health care experts.

The Breakfast Series panel

Odette Bolano, President and CEO, Saint Alphonsus Health System

Odette Bolano provides executive leadership, strategic and operational oversight for a 582-bed, five-hospital system across the states of Idaho and Oregon. Immediately prior to this role, from December 2015 – 2018, she served as president of Saint Alphonsus Regional Medical Center with responsibility for strategic and operational oversight for the medical center. Prior to joining Saint Alphonsus, Bolano served as senior vice president of Kaiser Permanente – East Bay in Oakland, California. Previously, she served in a number of senior executive positions with Ascension Health including president and CEO of St. Joseph Health System in Bryan, Texas, and chief operating officer for Carondelet Health Network in Tucson, Arizona.

Greg Donaca, President and CEO, Delta Dental of Idaho

Prior to becoming CEO, Greg Donaca served as the chief financial officer and treasurer of Delta Dental of Idaho. He joined the company in 2008 as the controller before being promoted to CFO. Donaca has served on the Delta Dental of Idaho Board of Directors since 2010. He is a CPA and is a member of the American Institute of Certified Public Accountants and the Idaho Society of Certified Public Accounts. He is recognized as a Governance Fellow by the National Association of Corporate Directors. He earned his Bachelor of Science degree in accounting from Linfield College in Oregon.

 

Heidi Hart, CEO, Terry Reilly Health System

As CEO, Heidi Hart collaborates with the Board of Directors, staff, community partners and patients to achieve the organization’s mission of making a positive impact on the health of our community. She began her career with Terry Reilly Health Services in 1993 as a therapist, providing specialized outpatient counseling and treatment services to child and adult victims of sexual abuse, as well as treatment for adult sexual offenders. She transitioned into leadership in 2001, serving as the behavioral health director until 2012. At that time, she advanced into her current position as CEO.

Dr. Laura McGeorge, St. Luke’s Health System Medical Director, Primary and Specialty Care

Dr. Laura A. McGeorge is a diplomate of the American Board of Internal Medicine and a fellow of the American College of Physicians. She earned her bachelor’s degree in neuroscience from Amherst College. McGeorge joined St. Luke’s Internal Medicine after previously practicing in Pennsylvania.

Dr. Daniel Reed, Physician Director of Family Practice, Primary Health Medical Group

Dr. Daniel Reed is a board-certified family physician who obtained his doctorate from the University of California – Davis School of Medicine and completed his residency at Dayton Community Family Practice Residency in Dayton, Ohio. He has worked as a practicing physician at Primary Health for more than 17 years and serves as the group’s physician director of family practice. 

Under Reed’s leadership, Primary Health Medical Group has grown to include more than 40 family medicine providers responsible for more than 70,000 patient lives in the Treasure Valley. In addition to steady growth, Primary Health has won numerous awards and recognition for quality of care and innovation. He has played an integral role in launching telehealth medicine and developing “clean clinic” to continue delivering high-quality health care to patients during the COVID-19 pandemic.

 

Moderator: Tom Mortell, Partner, Hawley Troxell

Tom Mortell is chair of the firm’s health law practice group as well as a member of the firm’s Board of Partners. His health care practice focuses on advising hospitals and other health care providers on all aspects of health care law. He assists health care providers in business transactions, including the acquisition of competing entities, the formation of entities or facilities jointly-owned by hospitals and physicians, the acquisition of physician practices, and professional services contracts between hospitals and physicians. Additionally, he advises hospital boards on issues relating to physician integration, compliance, governance and strategic planning.

How has 2020 impacted Primary Health?

Dr. Daniel Reed: If anything, 2020 has not been boring. It has been interesting; it has been challenging and a series of new experiences, and that is the positive spin on it. We all know there have been undeniable negatives starting with the number of deaths and ongoing deaths. The business challenges, we have all seen them with the dramatic decline in initial acute care during the outbreak of COVID-19. The challenges and innovations that forced us in the long term may not turn out to be as negative as we thought. We have seen our health care system advance in some ways through this, and the worrisome time bomb that we look at now has been the decline of primary care and preventive care services that we have seen during this. We’ve got a backlog to catch up with otherwise we will be dealing with the consequences of this going forward. The summary is it’s been interesting.

Dr. McGeorge, could you tell us about some things that are now done differently at St. Luke’s? I am thinking of telehealth. What are some other lessons learned from your perspective? 

Dr. Laura McGeorge: I would say as I think about COVID and how it has impacted us, if I look back a year ago and where we are now, none of us could have guessed where we would be. And first of all, I would like to say that this year did start out fairly normal for us. We’ve been through a lot, even losing one of our very own providers, a nurse-practitioner who died of COVID earlier this summer. It’s been a tough year. I will say our organization quickly pivoted to all hands on deck. It was a good opportunity for people to start thinking about leaning in, not necessarily with what you did historically at your job, but leaning in where you need to whether it is helping cover some of the drive-by testing sites or helping out in the hospital supporting some of the different areas in the hospital. Telehealth was an absolute big change for us. Now we have about 15% of our ambulatory visits doing telehealth, which, again, we probably had close to zero prior to COVID, so we are very excited about that. And I think it has taught us as an organization, even though we are a large organization and sometimes it feels like it is hard to make change in a large organization, that we really do have the ability to pivot when we need to. And the last thing I would say is what we’re learning now and working on now, and we have been working on this now for that past two or three months, is how do we pivot to this being truly the new normal? As Dr. Reed said, we have to get vaccines to kids, we have to take care of chronic illnesses like diabetes, we have to get patients the surgeries they need, and yet we also have to be prepared to take care of patients who have COVID-19.

Greg, how has COVID affected the dental community and the patients that community serves? Is it safe for people to go see their dentist? 

Greg Donaca: At Delta Dental, we do provide some direct care through our community outreach. It is really for those in need. In total, we have exams, fluoride varnish, sealants. We also do education on the importance of oral health. And we probably, in total, help 50,000 kids. But our primary focus is providing access for people to go to the dentist. We provide the pre-paid dental coverage — we have about 410,000 people we cover in and out of state. It is very important to go and have your regular routines. First, if somebody has coverage, they are four times more likely to go to the dentist.

And there continues to be more and more of a link between oral health and your overall health. If you think about it, the plague that is in your mouth, there is up to 300 different types of bacteria that make up that plaque. And that plaque travels from your mouth to your body, causing a lot of different problems — cardiovascular disease. There was a study that if you have bad oral health, you are 22% more likely to get ventilator pneumonia. With COVID, it is a very serious issue. We have really been focusing on making sure we continue to have a strong dental network, to do what we can to make sure people know it is safe to go, and we have been doing what we can for people to continue to have our coverage. You asked if it is safe to go to the dentist. It is safe. Currently, there has been no traces of new COVID cases that have been traced back to a dental office. I know dental offices are still doing routine care, elective surgeries. They have modified things just as everyone else has with the way you check-in. They’ve reduced greatly the amount of aerosols. There are studies coming out that show that COVID is airborne.

Odette, give us your insight into what we could have done differently as a state to manage this pandemic. 

Odette Bolano: I would say that the governor has done an incredible job. He stepped into it, he defined what it would take to move us along to reopening the economy. He has been very forthright in sharing information that he is getting. He has set up the governor’s task force to make sure that he is hearing from the scientists and the physicians. We are working on the public-private lab testing. Many of us are at that table. I don’t know that I could predict that anybody could have done anything better. I think that we are learning a lot. This is not the last pandemic we are going to see. I think we have been predicting this for the last 15 years, and here it is today. So we’re learning a lot about what we need to do not only as a state but as health care providers and anticipating what may come after this. I think it’s really hard to play (Monday morning) quarterback based on everything that was going on in the country. I think that the governor and the mayor of Boise and others have been very committed to trying t0 keep the public safe. Hospitals have learned how to stay in incident command for long periods of time. We’re pivoting and being as nimble as we can. We’re reacting to changes in protocols that are coming out. So I think everybody is doing the best they can. I cannot stress enough, flu vaccines and wearing masks, social distancing and hand hygiene. If we need anything from the public, it’s those things right now so we can minimize the impact that we’re all fearful that we may experience in the next 60 days.

How has Medicaid expansion impacted your ability at Terry Reilly Health Services to provide care for the poor?

Heidi Hart: It is interesting to look back. That was the topic this time last year; we were gearing up for Medicaid expansion and the whole conversation was around enrollment and attribution. And in many ways that seems like such a long time ago and really has escaped many of our memories about all the work we had to go through. I would say experientially it has been mixed, and I say that because on one hand we went through this whole period of work where we were trying to make sure that people did enroll, that they attributed and selected their primary care provider, that they had education and understanding around how to use benefits and what was included and had to be good consumers if you will in health care. So we were all working really hard to help implement the public policy and work with individuals to access the health care system. And that had just gotten started, and then we were hit by COVID, so then everybody shut services down or scaled back services. It is a lot more about emergency services or delaying care.

So I don’t know that we have really seen the impact, if you will, around Medicaid expansion to consumers or individuals when it comes to access for primary care services or preventative services because a lot of that was delayed or postponed. I realize that we will probably see that in about a year from now, so I am hoping this time next year the conversation is really about how have we been able to move the dial on the health of individuals with Medicaid as the health system has been able to come back online and people are back in a place where they are accessing health care services. So I think our experience as a state in regards to public policy and Medicaid is going to be very different from states that expanded before, so it has kind of been a mixed bag.

To view a replay of this Breakfast Series panel in full, go to https://idahobusinessreview.com/breakfast-series/