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ROHIT VERMA: Good morning, everyone. My name is Rohit Verma. I am a faculty in the School of Hotel Administration, for those of you who I have not met so far, and one of the co-moderators for this panel. We have put together a very exciting panel for you, which will give you a broad overview of many different aspects of this fascinating topic which we are discussing.
Our panelists include someone who has started their career in hospitality and increasingly done more work in the health side; someone who has started from the health side and found more application from hospitality; someone who looks at lots of financial investment decisions from hospitality and health area; two professors-- one who started from hospitality, got fascinated by health, and the other one who started from the health side, got fascinated by hospitality. So it's a very diverse group of individuals. But we all have some overlap with the topic we are discussing.
So I just want to get started. But before I go ahead and introduce the panelists and what they'll do, I want to quickly talk about how we got here.
Some of you may know, we have an institute on Cornell now called Institute for Healthy Futures, which has been created to link these two areas-- hospitality and health. We were formally inaugurated in November last year. We have offices in MVR-- Martha Van Rensselaer Hall.
And we have over 40 plus faculty fellows. We have several industry collaborators and many students who are involved in the projects related to this interface. The reason why we got started in this is because if you look at hospitality and health, they have the same root word in Latin. They start from the same root word, and it means hospital-- hospitality to hospice. And the meaning of the root word is either "host" or "guest," depending on which perspective you take.
So my point is that right from the beginning of human civilization, we have thought of this overlap. But over the centuries, slowly these industries have you all in a different direction. But now we can see opportunities for innovation and entrepreneurship across the two.
So that's why the institute was put together. That is why we are doing this panel and we have invited these folks to come and discuss. So let's get started.
Let me introduce my co-moderator, Mardelle Shepley. She's a professor in DEA. Mardelle--
MARDELLE MCCUSKEY SHEPLEY: Forgive me. I'm attached to this, so I'm going to just speak from right here. Just say a couple words about why I am at Cornell now-- prior to this, I was teaching and doing research in a university that specialized primarily in health care design research. And it was a great opportunity. We did a lot of good things.
But I found this opportunity at Cornell that is much more interdisciplinary than what I had been involved with previously. I found this to be an opportunity for me to grow and learn more. And actually, I thought it was an indication of where we're headed in the future.
Coincidentally, about the same time that I accepted the offer to come to Cornell, I was contacted by NIBS, which is the National Institute of Building Science. They have a subgroup called Academy of Health Care Infrastructure.
And what they wanted me to do was interview people who were leaders in the industry. And that ranged from people in health care administration to designers to patient groups. They wanted me to interview them and find out where we were headed. What was the future of this field?
And some of the things that they talked about were the need for a group of leaders who are very agile, who can change on a dime and absorb related disciplines, no longer working within their own role, but be able to reach out to other disciplines. They also talked a lot about this transition to wellness as a critical part of providing health care and the decentralization of services.
So these are all things that are issues that may come up in the course of our conversation. But I just though I'd give you a little bit of background. And I think our plan now is to have each of the speakers introduce themselves briefly. And then eventually, we'll get around to asking some questions.
ROHIT VERMA: Meredith, go ahead.
MEREDITH JOHNSON: OK. Great. Good morning, everyone. Thanks very much for coming in on such a beautiful day. My name is Meredith Johnson. I graduated from the Hotel School in '92. And I'm married to another hotel-ee as well.
I started out my career in finance and worked for Goldman Sachs in New York City for two years in the mergers and acquisitions department and then down in Sydney, Australia for a year. Then I moved back to Toronto where I'm from. And my husband and I opened a gourmet food store, which we ran for five years, bringing gourmet foods to Toronto.
And then I had an experience where our younger son, who was two at the time, got really sick. He had something called aplastic anemia, which is a rare bone marrow failure disease, and spent a couple of months at the Hospital for Sick Children, which is one of the most renowned children's hospital in the world. And we're so lucky to live in Toronto and to be so close to that hospital.
And that experience really changed my life where my son got amazing care. And he's now 14 and six feet tall, so he's doing really well. But I spent two months kind of really living in that hospital with our son, being a patient advocate, making sure that he got the care that he needed, given that he was only two years old, and decided at that point that I wanted to change my career from investment banking into health care.
And so decided to start making that move and figuring out how to get into health care. And I made that transition over a couple of years and have now been working in the health care industry for 10 years, working for a company that specialized in executive physicals called the Medcan Clinic, then spending four years with the Cleveland Clinic, which is a very large academic research hospital in Ohio and has a clinic in Toronto. So I was actually working for Cleveland Clinic Canada.
And then in the last two years, had the opportunity to kind of go back to where it all started and took a job with the Hospital for Sick Children, which was my original goal. And now I run a small company for sick kids called Boomerang Health.
And so really, my goal in health care is to be a real patient advocate, make sure that the patients are getting what they need, making sure that they're getting high quality care at all times. And really, coming from the Hotel School, really understanding the whole idea of customer service, which, in health care, we call the patient experience-- so making sure that that patient experience is kind of first and foremost in my mind, and then working with amazing medical people who can deliver the right medical care.
And that's really what I'm interested in in this industry.
ROHIT VERMA: Thanks, Meredith.
MEREDITH JOHNSON: Thanks.
ROHIT VERMA: John.
JOHN RUDD: Good morning, everybody. I'm John Rudd. I'm the president and CEO of Cayuga Health System, which is a coming together of a two hospitals-- Cayuga Medical Center here in Ithaca and Schuyler Hospital over in Watkins Glen, Montour Falls area.
I've been here for about 20 years. I came in more on the finance operation side, took over as the CEO about four years ago. And we really started our journey in hospitality probably-- it was in the late '90s when things were just starting to be focused on how do we ensure that people are having that positive patient experience and patient satisfaction and started looking at a national company, Press Ganey, who does national surveying for hospitals and health care.
And when we first did our first surveys, we weren't where we needed to be. And it was very clear we needed to improve. And one of the key areas was around nutrition and dining, which, at that time, was food service. And we recognized that we were in the 10th percentile-- unfortunately, the bottom 10th-- and knew that we had to change.
And we actually went into a process-- kind of a rapid cycle change process, not unlike today's Lean Six Sigma-- and actually worked with one of the Hotel School professors at the time, Dennis Reynolds, who came up and helped us with some of the thought process of, how do we take food service from the traditional yellow Jell-O hospital food service to a dining experience? And so through that journey, we were able to move our customer service ranking from the 10th percentile up to about the 80, 85th percentile and up into the 90s and have been able to maintain that really through today. So that was kind of our initial journey.
One of the other areas that we've really been proud of that we've been able to move is around our maternity unit, which has always had fairly strong scores. But we were able to actually move those even further. And with, again, some of the efforts of our staff, we've actually been up over the 90th percentile in customer service ranking.
And just looking at the numbers yesterday for the first quarter, we actually hit the 99th percentile three quarters in a row. And so we're really proud of that. Part of that effort really came around with some of the facility design.
And actually, again, worked with a professor here at Cornell, Frank Becker in Environmental Design, and looked at, how do we change the unit-- we were moving it to a new location on our campus, but a new facility. And we wanted to ensure that we had almost spa-like environment. And that's kind of the words we were using as we were designing it.
We wanted people to have almost a spa-like experience-- and so large rooms, nicely decorated, having birthing rooms that have tubs and almost spa-like bathrooms. And so really proud of what we've been able to do on that and bringing hospitality into a medical service, like maternity.
And on all of our inpatient units, we've actually been able to achieve, this last quarter, 89th percentile, and that includes things like our intensive care unit, as well as things like maternity. So it was really trying to bring that hospitality and health care together.
On the outpatient side of things, we've developed a program here called Cayuga Wellness Center. Those of you that are from the area might know it as Island Health and Fitness, which was a fitness center that we developed, along with a local developer/entrepreneur. He wanted to develop a medically-based fitness center-- this was, again, about 15 years ago-- and came together to develop Island Health.
It's a structure that's about 65,000 square feet that is owned by the developer. We actually, through a for-profit entity of ours, are 70% owners of the fitness center. So we wanted to have majority ownership of the fitness center and be able to tie that kind of retail business into what we do in health care.
And how do you tie a fitness center into things like physical therapy? So we have our physical therapy down there.
Also wanted to tie it into a spa. And so, again, those of you from the area may know of Rasa Spa. It was developed by, again, a local entrepreneur here in town, Rachel Hogancamp, who was a massage therapist by trade-- came to us at the time we were developing Island Health and said she wanted to develop a day spa in that program.
And so we were able to develop the spa. We're 50% owners through Island Health. So Cayuga Medical Center is actually 35% owners of a day spa, which is a little unusual for hospitals.
And that complex down there has really evolved into having the fitness, the wellness center, what we call Cayuga Center for Healthy Living that focuses on diet, stress, and exercise. We have sports medicine. So it really takes the whole health and human performance aspects together in both kind of the commercial entrepreneurial retail space, along with the traditional health care space.
And so that's been kind of our focus as we move into this. And as was mentioned earlier, it's around that patient experience. But it's also around what is being called the triple aim of patient experience, which gets to the customer service, as well as quality, the population health, and doing it in a cost-efficient way. So this is just one part of our model to try to achieve that triple aim.
ROHIT VERMA: Thanks, John. Karen?
KAREN HEIDELBERGER: Hi. Thanks very much for having me here today. I'm happy to be back.
I graduated from the Hotel School in 1994. And unfortunately, I don't get back as much as I'd like. So this is a real treat.
Once I graduated from the Hotel School, just as a way of background so you sort of understand where I am today, I went to work at Merrill Lynch in mergers and acquisitions. I was there for about four years and then went to Harvard Business School.
When I graduated from Harvard, as I was leaving Merrill Lynch, I recognized that the investment banks were extremely in a troubled spot, because they actually promote producers. And promoting producers is a great thing if what you're producing is actually what you have to manage. But in most cases, that's really not the case.
So you were promoting a whole bunch of people that didn't necessarily have the skills to be running a true business. And my thought after Harvard was, instead of going back into investment banking, I'll go back and be a trader, because that's got to be way easier than investment banking. My thought was that, you do that, you do well, and then you can go become a producer, and you can actually help manage the businesses that are falling apart.
Unfortunately and fortunately, that's not what happened. And I wound up sitting next to a gentleman for one day who left Merrill Lynch. When I went back after graduated, he was already at a place called Deerfield. I'd never heard of Deerfield, had no idea what it was.
And after I'd been at Merrill for about a year, I wound up going out to dinner with him in a very serendipitous manner. And I called him the next day and said, hey, listen, I'm really happy, you seem so happy where you are, congratulations. And he said, hey, how about coming in for an interview?
And I think from an entrepreneur perspective, it's really important to understand that half of your career is serendipity and half of it is really hard work. So I wound up going to Deerfield, where I've been now for 14 years. Deerfield is a health care investment firm which invests in venture all the way to bankruptcy type companies.
And the more we get involved in the venture space, the more we really realize that the entrepreneurship that's involved in really launching these companies and taking them through fruition is a skill set that needs to be really nurtured and helped to grow. And there just aren't enough entrepreneurs out there to really help a lot of these great technologies that are being developed in the health care space, not only because we actually understand the human genome much better so we can come up with better drugs, but also because the reimbursement for all of these different drugs and programs is changing so radically that there's so many different opportunities to actually really advance not only the health side of things, but also the service side that goes along with health care.
ROHIT VERMA: Mardelle, you want to get started?
MARDELLE MCCUSKEY SHEPLEY: Sure. So we thought this was an opportunity to ask some questions. And we have some that we would like to put forward.
But I think the idea was to give the audience a chance to ask questions of the panel first. So if I don't see a show of hands, I'll initiate it by one of my own. And then maybe that will push things along. So are there questions out there for our panel?
ROHIT VERMA: Go ahead.
AUDIENCE: For the last speaker-- sorry, I can't really see your name tags. I'm so far back here. Karen. Sounded like a really interesting thing you're doing at Deerfield Healthcare
You mentioned sort of a human capital deficit, in terms of needing entrepreneurs to help lead these technologies from being just ideas or prototypes to fully functioning businesses. Could you be more specific about what kind of human capital you're looking for for that type of leader?
ROHIT VERMA: Karen, can you repeat the question back--
KAREN HEIDELBERGER: Sure. The question is, what is the human capital that really is needed to advance these different ideas into true companies?
I think that it depends a little bit as to what the idea is. If it's a very therapeutic type idea, really we need people that are very scientific and understand the regulatory process to get these things through. Having said that, so many of them now, because of the changes in reimbursement and because the way health care is actually getting paid for, a lot of them also come back to IT type of situations.
And a lot of the skills that are just needed are multi-disciplinary. So you can actually work with other people within your group and you can think about different things and not just the technology, but where is the technology today, and where is it going to be in 10 years? If you're only focusing on today and the regulations that are out there right now, the chances are, things could change so rapidly that your company is going to be dead before you actually are even out the door.
So you need people that are-- we had mentioned this before-- that can dial in, but also dial out and see the big picture-- detail-oriented, but also see the big picture. You need people, again, that are multidisciplinary.
But I think one thing that's really critical is that these people are really flexible, because being able to dial in and dial out is definitely a very different skill set. You also need people that just follow through. It's amazing how many people say, I'm going to do that, and then it's like in the wind. You never hear from them again.
And that just doesn't work. These companies are so nascent that they really need somebody to carry it very gently across the line. And if you don't have the follow-through and the spirit to get it done, as well as the finesse with other people, because a lot of this-- we heard Leland Pillsbury talk yesterday about being-- I forget.
It was the golden hammer or something like that. It really does go back a lot to that. You need to be able to work and understand all your different stakeholders and be able to massage them in a way that's going to get what you need done.
ROHIT VERMA: Go ahead.
AUDIENCE: Question for John. So many of the questions through Press Ganey which come out are very subjective and often answered by the caregiver, not the patient themself, after the fact. What are you doing to help set expectations of what the quality of care should be like during their experience?
ROHIT VERMA: Can you repeat that, because the mic--
JOHN RUDD: Yes. The question was around the fact that, number one, many times it's the caregiver, not the patient, who is the one filling out a survey and having that experience as well. And what are we doing to kind of set the expectations of that care?
And I think it comes right to the front door of, what are we doing to ensure that we are listening to the patient, trying to understand what their needs are-- their specific needs are-- and how do we address those? And how do we do it in a connected, kind of compassionate way? And how are we interacting with the caregiver as well?
And so just as an example of the maternity of ensuring that there is a comfortable space for family members, partners to stay in the room with them, and how are we addressing their needs, along with the patient? And in the traditional health care where there's individuals, sick or injured, it becomes more difficult to do that and interact and engage with the family member.
But it's an area that we really need to focus on and an area that we have tried to focus on on those inpatient units. And how do we ensure that we're engaging appropriately with them and providing them with an experience and ensuring that they get an experience not only around the customer service side of things, but ensuring that we are giving evidence of the quality of care provided?
ROHIT VERMA: Go ahead.
AUDIENCE: I have a question for Ms. Johnson, actually, about your donating of food at a [INAUDIBLE]. So I work in [INAUDIBLE] operations and investment management. And I'm opening a [INAUDIBLE]. So I'm interested to hear how your past experience has helped you start this business and maybe some of the lessons in client service that you've learned.
MEREDITH JOHNSON: Sure. So the question is about how experience helps you start a new business, really, no matter what that new business happens to be. In my case, I worked as an investment banker, and then my husband and I decided to open a gourmet food store.
I think what made us successful is that my husband was really the foodie, and I really came with the business side of it. So my husband has a huge passion in food. He still works in the food industry and is always looking for what's the next trend in food and what will customers want, even before customers know what they want, and has a really good eye for that. And then I was able to bring the operations side and the business side to it-- so working on finance, marketing, human resources.
These are all things we learned at the Hotel School, and so then to be able to put them into practice. But it's really about understanding your customer needs-- whether it's in the food industry, whether it's in photography, whether it's in health care-- listening to those needs, and then really providing value to whatever it is that you're selling.
So when we had our gourmet food store, we were all about customer service. And sometimes we made lots of errors. But we went above and beyond to make sure that we fixed those errors with those customers.
And in the end, they became some of our most loyal customers to our food store were actually the ones where we made a mistake, and we admitted the mistake, and we actually fixed that mistake for them. And they just kept coming back to us as a result.
And then when I moved over into health care and it was really executive health, I found that a lot of the people who actually were my customers at the food store all of a sudden were clients at this executive health clinic. And I felt like I'd gone from selling gourmet food to now selling gourmet medicine and that the skills that I had were completely transferable, because it was all about value, listening, as Karen just said, following through.
So I had people coming up and asking me health care questions. And I'm not a health care clinician in any manner. But I knew where to find the answer, and I would go get that answer for them and make sure that they were satisfied. So it was really falling through with different people.
ROHIT VERMA: Go ahead.
AUDIENCE: My question's for Meredith as well. So when you talk about the continuity of care, not necessarily in terms of services, but [INAUDIBLE] lifetime. Your company, Boomerang Health, caters to children and rehabilitation services. So how do you ensure long term [INAUDIBLE] that the seamless transition is there for them to experience the benefit that you offer in a different setting?
MEREDITH JOHNSON: So the question is about continuity of care over the lifespan of a patient. And where I work, Boomerang Health, it's geared towards children. It's all pediatric care.
And it's a great question, because it's actually a huge gap in Canada. And Toronto, actually, is creating a seamless transition between pediatric care, which tends to finish at the age of 18 in Ontario, and then moving into adult health care.
And I think that it's an area that's actually ripe for opportunity where people are just starting to get into that and realize that we need to help families transition from child care into adult as well, too, and getting them used to that idea before they're going to make that leap, because they're going to be moving from either one hospital system to a new hospital system, or one agency to another. So I think a lot of it's around communication and setting expectations.
ROHIT VERMA: Thank you. Mardelle, you ask one of your questions while people think?
MARDELLE MCCUSKEY SHEPLEY: I'm coming up right now. So I thought I would add something on to this issue of the qualifications of individuals who might be in the field. And I read a statistic recently that said one third of the jobs that are going to be available-- the job types that are going to be available in 2020 are not yet known. And by the year 2030, two thirds of the jobs have not been invented yet. So you can see where there's a fast-moving area, those of you that are interested in going out in the world and making a contribution to try and keep on top of that.
But one topic I'd like to address has to do with the big picture. And the question is, with regard to the transitions that are being contemplated and are currently in place, regarding health care service, regulations, reimbursements, how is that going to impact delivery down the road? And it's a question for all three of you, really.
JOHN RUDD: I can start. We're seeing a major transition in the regulatory world of health care in the US of moving from a model that was really volume-based-- getting paid for how many images you do, how many whatever the care is you do-- to more of a value-based. And that's when I mentioned earlier that triple aim of better health, which is kind of the population health; better care, which is the experience of care at a lower price.
It's all going to be driven more towards, how are we ensuring that we have evidence of the value that we're bringing in the care we deliver? And so when we look at that value, one of the ways to measure value is that patient experience. And how do we ensure that people are able to have the experience that they believe is a good experience? Because it's very hard for consumers to measure true quality.
But they certainly can measure an impact, the experience of care. And so I think as we move into this new world and looking at population health and measuring, how are we doing, as a health care system or a health care industry-- how are we doing for a population-- it'll be around these types of efforts-- of ensuring that people are having that most positive experience they can have.
KAREN HEIDELBERGER: I agree with that. And I think there's another in addition to it. And that's that not only do we care more about how the patient experiences their health care, but also the way that we actually measure their health care and the way we deliver their health care is going to change rapidly. I think from our perspective, it's going to leave the doctor-centric model and go to a diseased-focused model, which is much more surrounding the full patient care.
If the patient has diabetes, they're no longer going to go see an eye specialist and a cardiovascular specialist. But you can imagine a diabetes institute where all of these different areas are really being taken care of in one space. And you're being taken care of as a patient, as opposed to one disease piece of that patient, which lends itself to thinking about the entire health care experience totally differently and so many different opportunities.
How is that patient going to be monitored across their different diseases? How does their emergency-- or excuse me, their electronic medical record have to change? How can IT play a role in all of this? How are there going to be coordinated care facilitators?
I think that, as you mentioned, things are going to change so rapidly that it's hard to understand where it's going to be in five years. But there is so much opportunity to actually help that process along for different entrepreneurs that want to step into this space.
MEREDITH JOHNSON: And the key event, too, is that patients today have choice. So they get to choose where they want to go. They are now so educated, and they can Google anything to find what they're looking for.
People are mobile. People will travel for it, or they could do it electronically as well, too-- so virtual appointments. So that's the other piece to it is that you have to make sure that it's something that you're really offering.
So you look at that regulatory area of how it's going to affect health care, but then it really is going to be focused on what does the patient want.
KAREN HEIDELBERGER: You bring up Google Search, and that's other thing that we had spoken a little bit about-- that it brings up social media. And you need to make sure that whatever is out there on Google is what you really want people to be reading about you.
So negative experiences that people have, as well as positive experiences, become really important. And you need to be able to manage your image and your brand and your messaging that's out there with all of that.
MEREDITH JOHNSON: That's right.
JOHN RUDD: Five years ago or even three years ago we wouldn't have thought that we would have a position at the hospital that was dedicated solely to social media. And this year, we hired an individual that their job is to ensure that right messages are getting out in the right way in social media and that we're monitoring what is out there in social media. And so we need to move into that and ensure that we understand the new mechanisms of communication.
ROHIT VERMA: Doug had a question.
AUDIENCE: Thanks. Millennials especially, but any people with smart phones-- I guess most of us-- are now looking for transactions that they can handle on mobile. You've got that everywhere from Google on down. And beginning to see that medical space, more so in that medical space. How do you [INAUDIBLE]
How do you see that moving forward? Where you talked a little bit about electronic appointments, the diagnosis. And obviously, you're not going to do surgery through your phone yet. But where is that leading where you can actually push out the health care service, whatever that may be, to the mobile device for those folks who are looking for a-- when they don't care about having a long term primary care physician as much as, I just want this transaction.
ROHIT VERMA: The question is about mobile health. Go ahead.
JOHN RUDD: I just had a conversation with a group of physicians this morning that is an advisory group for me. And we talked about this specific issue. And when we look at urgent care as an example, urgent care, has moved from the kind of hospital-centric urgent care to a storefront urgent care. And it's a totally different model.
The next model is really going to be around just that-- of how is a patient interacting with a physician from their home with their iPad? And what is that telehealth really going to look like? And how do we ensure that, number one, you have HIPAA compliant, which is confidentiality issues?
But how do you ensure that privacy is protected? How do you ensure that the medical legal issues are addressed? But how do you do it in a way that gives the patient the experience that they're looking for?
They don't want to have to go into a spot if it's just looking for a prescription to cure whatever ails them at that point in time. And so how do we ensure that we are meeting those needs and accepting the fact that it is changing? And there are certainly a lot of physicians who will say, I can't-- how do I diagnose a patient if I can only see them on a screen?
And so that's the challenge that we have of, how do you ensure that you're triaging people appropriately when they do that and getting them to the right care at the right time when they interact with you on a mobile device type of interaction?
AUDIENCE: No. And that's good, because my question would be, is that business that the health care industry would be taking that otherwise would go to Google? As I say, if I'm going to sit there and Google my symptoms, without me going and spending $40 to text a picture of a rash I have to a doctor and get a little bit more of a firm diagnosis, or whatever that may be. The question-- the competition then is do we have to increase the size of the pie by moving the Google doctor into something a little bit more professional?
ROHIT VERMA: Go ahead. Sorry.
MEREDITH JOHNSON: So in Toronto, we're seeing that that's already starting to happen, actually. But it's happening really on an individual basis where certain doctors are deciding to bring this into their practice already.
It's been around already for a while, I think, in the area of what we call maybe concierge medicine where people already have a relationship with their doctor. And those are the patients who started emailing them questions. And because it was kind of under the auspices of concierge medicine, the doctor was willing to email them back or pick up the phone and have a phone call consult or an email consult.
And now we're starting to see that that's rolling out a little bit more, as physicians are getting a little bit more comfortable with it. But it seems to be one by one, at least in the Toronto market.
The other area where we're seeing huge application, kind of from a global population, is the ability to do telemedicine and, at least in Canada, reach populations that live way in the north that wouldn't otherwise have access to high quality health care on a regular basis. So sometimes you have physicians who fly in once a month or once a quarter to these very small populations way in the north of Canada-- we're talking igloo territory here, real polar bears.
But you can actually now do it through telemedicine once you've established that relationship. And they're finding it's quite effective in a lot of different areas.
ROHIT VERMA: I was just going to ask, Karen, do you see any, from the investment community side, any ventures interest in things happening in the mobile world?
AUDIENCE: Is there an Uber version scale as opposed to your practice saying, OK, I'm going to do this for my patients. But is there a way that it can come from the other direction?
KAREN HEIDELBERGER: There's a ton of different things going on. I haven't seen a particular application like that yet. And what goes through my mind is the payment model and how does that really work.
I'm sure it's out there. I just haven't seen it yet. But the payment model is what I would think about.
JOHN RUDD: And those are out there. And we're already working with Excellus, which is the Blue Cross plan here, to look at these types of models of how do you not only have it a secure connection, but then how do you actually have a reimbursable model for that? And so we are actually working actively with them on that as we speak.
KAREN HEIDELBERGER: And the secure connection is a huge-- and the HIPAA compliance piece of that is just huge.
JOHN RUDD: It can't be as simple as just using your iPhone and using standard ways of video chatting.
KAREN HEIDELBERGER: And will people be willing to log in? The one thing you get is that people just don't want to log in to any of these things. It's just too difficult. So a one-time log in maybe, but there's just a lot of compliance stuff that goes with it.
ROHIT VERMA: Let's take another question. Stephanie has been waiting for a while. So go ahead.
AUDIENCE: Hi, I'm Stephanie Creary. I'm assistant professor of strategy here at the Hotel School. And my question is about wider collaborations on some of these initiatives that you all are talking about. So we know historically that relationships between providers and management can be a bit challenging and difficult.
And lots of things that happen in our health care settings happen because there is positive collaboration between these groups. And so as I start thinking about my own research, which is actually starting to focus on the provider perspective and, in these various initiatives, what engages them, why they do or do not choose to collaborate, why Press Ganey is sometimes a little complicated and bad thing [INAUDIBLE] it's a great thing.
I start to wonder about some of the work that you're doing and what you actually are doing to engage providers. And I'm actually speaking providers broadly to not just physicians, but also nurses and social workers and everybody else who actually delivers the care for patients in the studies. Thank you.
JOHN RUDD: Yeah. Just a good example was the meeting I came from before this. As I mentioned, it's an advisory group. It's what we call our physician council. We meet every other week with a group of physicians.
It's eight individual physicians that are teamed up with our senior leadership team. We meet at 6:30 in the morning every other Friday. Some people thought that was crazy. But in health care, that's pretty normal.
And it's ensuring that you are understanding the viewpoint of the providers-- of the physician providers-- because we have all come to this from a different viewpoint. And we're all looking at it through a different lens. And so how do we ensure that we are understanding their issues?
And so we've really tried to develop kind of a triad model of management of looking at how do we ensure that management, nurses, and the non-physician or physician extender are working together with the physicians? And how are all three of those parties working together with putting the patient at the center of everything we do?
And that's a term that we just hammer constantly. Our slogan is "The Center is You." But it's really, how do we put the patient at the center? Because that's the commonality between all of us-- we all got into this industry to take care of patients, whether you're an administrator, a nurse or physician, or any other kind of provider.
And trying to ensure that you are constantly pushing those three areas to work collaboratively, as we've developed strategy, as we develop tactic, as we do operational improvements.
ROHIT VERMA: Meredith, you want to add to that?
MEREDITH JOHNSON: Sure. I'll be the first to admit, Stephanie, it's really hard sometimes. I feel like sometimes we speak different languages, actually.
There's the language of management and business. And then there's the clinical language. And we went to different schools. And we were taught different things at these schools as well, too.
So sometimes it can be really challenging to get people in the same room together, and even though you are all working for the same cause, to actually do that. And I think it's about bringing in different viewpoints and just keep working on it.
We're currently trying to create a concussion management program in our clinic, because concussion is the big word of the day. And some days we take two steps forward. And some days I feel like I'm knocking my head on the wall, and I'm going to have a concussion.
So it's a challenge, for sure. But I think management is the one that has to try to fill that gap and understand where the clinicians are coming from and then very carefully try to get them to move it forward.
ROHIT VERMA: Go ahead, sir.
AUDIENCE: Just a quick question to the Cornell team. I can't help but notice the new health center here on campus. And I was asked a number of years ago in designing the building, who should be involved around the table, in terms of designing it, et cetera. So I said to myself, well, Hotel School, for sure; [INAUDIBLE] College, for sure; Weill Medical College, for sure.
What role is your new institute, or other experts on the Ithaca campus, playing in the rollout of that new facility? And what applications are you guys bringing there on best practices that are going to be the net beneficiary for all these students here? Because it seems to me, you have a laboratory right here on campus.
MARDELLE MCCUSKEY SHEPLEY: Well, we have right now, through my design environmental analysis, we put forward a grant to ask to go in and evaluate the effectiveness of that facility, in terms of its achieving the goals it intends to achieve. So even if that grant is not funded-- and we're doing that through the Atkinson program-- even if that's not funded, I teach a course called Design Accountability. And in the fall, assuming that they continue to allow us to do that, we'll be doing an evaluation of that facility.
So from a post-occupancy perspective, I think we are on our game. I've only been here three semesters. So I'm not sure how much engagement happened.
AUDIENCE: Were you guys involved at all in the design? Were people from your stature around the table, in terms of strategy? We have a strategy person here at the hotel.
Were the best minds from Cornell who are teaching this intersection of hospitality and health involved in the layout and ultimately the plan for that facility?
ROHIT VERMA: No, I was not involved. And this institute is very new, by the way. So we just started last year. And so if somebody was involved in the conversation, these must be the individuals who were individually contacted by the committee.
AUDIENCE: It just would strike me that with the board, if I was a board member, would be intellectual resources that you guys bring there-- to not tap into that would be a huge miss.
ROHIT VERMA: Right. But going forward, we do expect to be engaged more. And the construction is already in progress. Mardelle has had conversations about how to get engaged.
I have had conversations about how our students and faculty can get engaged once it gets started. But your question was about were we involved in the construction up to this point. And the answer is no, we were not.
MARDELLE MCCUSKEY SHEPLEY: But having come together, the synergy of our group has now enabled us to actually take this next step. And if we weren't there before, we're there now. And there are certain things we can accomplish even retrospectively.
AUDIENCE: That's a laboratory.
MARDELLE MCCUSKEY SHEPLEY: It is.
ROHIT VERMA: I totally agree. Including the building we are in, as you know, in the Statler Hotel, we do a lot of different projects, both educational projects, academic research, applied work. And I totally agree with you. That's another one for us right here. Yes, sir?
AUDIENCE: With social media [INAUDIBLE] creating a paradigm shift in a lot of things that occur. And in health care, health care is one [INAUDIBLE] preventative care. What things are you guys actually involved in or seeing out there that's actually taking advantage of preventive care in health care?
ROHIT VERMA: The question is about preventive care.
JOHN RUDD: Yeah, I mentioned the Cayuga Wellness Center. And one of the programs in there is-- I mentioned the Cayuga Center for Healthy Living, which is a program focused on handling chronic disease, but also on prevention and lifestyle and how do we try to prevent individuals from going into diabetic condition, rather than-- so to prevent that additional care that is needed.
And so we're working very heavily in trying to get people into a lifestyle through fitness and exercise, diet, stress relief. We're trying to think about, what is that model for social media around that? And how do we try to connect with individuals more effectively in their day-to-day life, not just in the care interactions?
And so it's a challenge and one that I put out there to say, well, what are some of the opportunities in an entrepreneurial setting to say, how do we connect with people not in the delivery of care, but in the delivery of wellness?
ROHIT VERMA: Let me give one example. A couple of years ago, several faculty, you got a chance to go visit Henry Ford West Bloomfield Hospital in Michigan. And Stephanie, you were there. She was there, right, with us? Yes.
So in that hospital, they do many things, like John was mentioning. But one which is relevant to your question is they have a demo kitchen. The kitchen looks like the Food Network kitchen.
And what they do is when, let's say, a patient is there because they have bad eating habits or diabetes or any other special type of illness which requires special attention to food and diet, while the patient is being cared for, the family members and loved ones, they can go and watch a gourmet chef prepare a better meal. And many of these meals are sourced from the locally grown products and so on.
So the idea there is that, OK, well, this time you came here because you're sick, but we're teaching you skills so that you don't have to come back here again. And so I think those examples are slowly popping up.
JOHN RUDD: And we actually have the same thing at Cayuga Wellness Center-- if you've been up on the third floor in our community room-- a demo kitchen that we do those types of classes. And we actually we do have a executive chef that was part of our effort in improving our food service to dining service.
And our executive chef was trained at Johnson and Wales. And he does some of those demonstrations. So we do that as part of the programming down there.
ROHIT VERMA: Meredith?
MEREDITH JOHNSON: Just another example is the Cleveland Clinic. So the Cleveland Clinic actually has a Wellness Institute. So they're set up by disease management. And one of their institutes is called the Wellness Institute.
They are one of the few, I think, that has a chief wellness officer, Dr. Mike Roizen. And they do a lot where they actually use the Cleveland Clinic as their own laboratory and campus to try things out.
So one of the things that they do is they don't hire smokers on campus. So you're not allowed to smoke. And if you do sneak outside for a smoke, the on-campus police will actually find you. And to make sure that that happens, they have on-campus police security reports to the wellness officer to make sure that that happens.
They also have that now tied into their insurance policies. So your insurance premiums go down if you're not a smoker. If you lose weight as well, too-- so they have it all tied together.
And they have a whole system on campus called Go Foods. And they have them earmarked as the healthy foods so that you know which are the foods that you're encouraged to eat more of, as opposed to less of. And in this case, where usually healthy foods are more expensive than unhealthy foods, the Cleveland Clinic subsidizes their healthy foods, so the go-to foods are actually less expensive than the non-healthy foods.
And just when you're talking about social media, they've created several apps. So they've got a Stress Free Now app, which guides you through all these different medications. I have it on my phone. I listen to it fairly regularly.
They also do a sleep study that you can participate in to help improve your sleeping habits. And it's all online. They have an eating program that's the same sort of thing.
And they push out, every day, a Cleveland Clinic Wellness Tip of the Day. I've been getting an email now for probably-- I don't know. Six years I've been getting these emails. And some are a little repetitive, but there's always a good tip every day.
There's often exercise tips, fitness tips, stress tips, and lots of nutritional tips as well, too. And my family will often get forwarded these tips-- little FYI just for you to different family members. So anybody can sign up for it as well. There's no charge. So if you're interested, go to the Cleveland Clinic and look at their Wellness Institute. So there's a lot out there.
KAREN HEIDELBERGER: You bring up a good point about the insurance premiums. As more corporations are actually taking ownership of their own insurance plans, it's becoming such a bigger priority for all these different organizations. You're seeing gyms pop up. You're seeing wellness programs pop up.
It's a huge thing going forward. And that's another total area of opportunity.
JOHN RUDD: And that is one thing that we've used at Cayuga Wellness very much at the lab for our own employees. So when we first opened the fitness center 10 years ago, we subsidized our employees 50% of the fitness center membership dues, but only if they used it 24 times a quarter.
And so if they used it 24 times a quarter, they maintained it. If they didn't, they could earn it back the next quarter, because we said, we're not going to pay for it if you're not going to use it, because our goal is healthier employees. And how do we ensure that they have a motivation to exercise? And so things like that.
We also did what we call are healthy choices in our cafeteria and changed the pricing so hamburgers and French fries and the salads came down. And the healthier choices were identified there. So it is trying to work with our own employees as a lab to say, how do we do this, and effectively change people's habits.
ROHIT VERMA: Great. Yeah, go ahead back there. Yes.
AUDIENCE: So you all have spoken today about the continuing integration of hospitality and health care in America. Is there any lesson we can take away from international health care markets and the way they approach hospitality and health care as well?
ROHIT VERMA: Lessons from international market.
JOHN RUDD: That's a tough one.
MEREDITH JOHNSON: So in Canada, it's a little-- yeah.
ROHIT VERMA: Let's give an example.
MEREDITH JOHNSON: Yeah, go ahead and give an example.
ROHIT VERMA: Yeah. So I was at a conference a couple of years ago. And one of the keynote speakers asked a question that, I'll give you two choices and you can only pick one of these two things. OK? Indoor flushing toilet or a mobile phone. So how many of you would just have the toilet and not the mobile phone, and how many will have just the mobile phone and not the toilet? So that was the question.
And he said that if he asked this question in a developed economy, most people would say, of course I want the indoor toilet. Come on. What are you talking about? We're a civilized world.
But if you go in rural India or Bangladesh or Indonesia, a mother would probably say, what I want that mobile phone, because the nearest doctor is three days away. So I give this example just to say that there is major differences across the world in terms of how people view the meaning of service.
So the meaning of service is very different. The meaning of service is being able to access information, being able to have responses quickly, being able to do all that. So that's the lesson we have to learn.
And the idea that the medical devices and technologies have to be as perfect as possible may not be necessary in many cases. So EKG machines, for example-- they have been around for quite some time. They require a lot of power, a lot of equipment to go with that.
There are countries where you can charge those machines by solar cells. And you can run them on battery. They're not as good as the more expensive one. But the more expensive are 50 times more expensive. But the quality is about 95% to 98% of these 50 times more expensive ones.
So the lesson is that, yes, there is this innovation going on about both clinical and non-clinical care. But the realities are very different. And in fact, the lessons here are that many of those technologies developed in these underdeveloped areas are finding their way back in the developed economies where cost has gone through the roof.
So that's the lesson, if that makes sense.
MARDELLE MCCUSKEY SHEPLEY: From a design perspective, I would add that in parts of the world where they don't have the resources that we have here, they're delivering supportive care to individuals in a more personal basis and using indigenous means of trying to heal. So we've actually seen some of that transferred into Western culture.
In other words, we don't know it all. There are things that people know out there in those parts of the world that they can teach us.
ROHIT VERMA: Let's see. Who hasn't asked yet? Yes, go ahead.
AUDIENCE: My question is, there's a huge trend-- [INAUDIBLE] that with by eating healthy, we can certainly-- I'd much rather pay the grocer than the doctor. And how can this innovate in best practices across the board-- innovative inventors, current customer satisfaction, [INAUDIBLE]. The whole GMO labeling issue [INAUDIBLE].
ROHIT VERMA: How would we summarize this?
JOHN RUDD: I think part of it is really getting the physicians engaged as the primary care providers. And we've been working over the last few years with what's known as clinical integration. We still have many of our physicians in this community are independent physicians.
But we have a physician hospital organization that has worked collaboratively, especially in the last five years, around how do we improve the quality of care, the health of the popul-- that triple aim that I spoke about. And how do we then make sure that we're connecting the primary care physicians with those resources that are out there to try to have that lifestyle change?
The reimbursement models today don't reimburse physicians for preventative care. It's crazy that we're willing to pay--
AUDIENCE: Excuse me for interrupting-- you've got Cornell Weill is fantastic when they're doing it. But none of them are taught to avoid this best practice first.
JOHN RUDD: Exactly. And so the reimbursement models aren't where we need to be, in order to shift this the way we need to. And so when we developed the Cayuga Center for Healthy Living, it was done as a resource for our primary cares. So it's nurse practitioner-based and nursing-based.
And so it's a little bit cheaper way of providing the care and giving that resource to the physician to say, OK, I have somebody that would benefit from lifestyle change, let's refer them to the Cayuga Center for Healthy Living, then they can get the diet knowledge, they can get the exercise, they can join the fitness center, they can get the stress relief, go to the massage, and be able to start changing lifestyle-- because that's what we need to do. We need to focus on lifestyle change if we're going to impact this.
AUDIENCE: And I laugh because a little too little, a little too late.
KAREN HEIDELBERGER: But isn't that part of the problem?
JOHN RUDD: But it's never too late. You've got to start somewhere.
KAREN HEIDELBERGER: Part of the problem is that this needs to happen before there's an intervention. So it's not necessarily-- it's never the doc--
AUDIENCE: How do we address that?
KAREN HEIDELBERGER: So it seems to me like it's much more of an educational type issue. And how do you get to actually you and me sitting in this room before we have to go to a doctor? So the question is, when does it become the doctor's responsibility-- when you walk in to his office saying, I'm not feeling well, yet they haven't seen a doctor for the past 10 years?
JOHN RUDD: Well, I guess I would push, though, that we do need to ensure that people are interacting with their primary care physicians, even on a wellness visit.
KAREN HEIDELBERGER: But then we need to change our medical insurance program, too.
MEREDITH JOHNSON: We need to incentivize to do it. We need to turn it all on its head.
AUDIENCE: How do you get those people to the things earlier? Gamification-- How do you hit them on social media? If you do this, then maybe you get $10 off the next time you come in here?
ROHIT VERMA: Anybody else has any other question? Let me see. Yes, go ahead. And then we'll go to you.
AUDIENCE: On the concept of hospitality, particularly to the front line workers who are interacting day in and day out, but not waiting for the Press Ganey scores, but actually getting that feedback in real time.
JOHN RUDD: Yeah. So we've tried to engage our employees at all levels. We have what we call our customer service counsel that brings line staff from every department. We try to have every department.
They get together on a monthly basis to really address issues, what are the programs that we should be putting in place, how do we change the culture of a customer service culture, and also giving them tools to have the service recovery, because I think you mentioned the service recovery is so key. And you can turn-- I'm sorry?
AUDIENCE: What would be an example, though?
JOHN RUDD: So somebody that's having a bad experience, whether it's at the front desk or they're waiting too long in the emergency room, how do we ensure that we are interacting with that patient, offering them, I'm sorry that things are going so long, here's a gift card for our coffee shop, please go to get a cup of coffee. So you talk through.
You have to give them messages on, how do you talk through those issues and do that in a positive way.
ROHIT VERMA: So we have about 10 minutes. So we'll just take one more question. And then we'll do a little wrap-up here. Yes, Heather, go ahead.
AUDIENCE: Real quick, I teach hospitality and customer service at the Hotel School here. And it's very unique in your situation in service recovery, because as opposed to a restaurant, most of the people that you're dealing with are also in a state of mind that's already traumatized because they're sick or they're uncertain.
So I think that training that you're giving to the front line employees is very important, but then also to understand the emotional kind of aspect, too, because how you handle someone who's waiting who's uncertain if they're going to be successfully treated is very different than someone who's waiting for their table.
JOHN RUDD: Absolutely.
MEREDITH JOHNSON: And I think training can take it to the next level. But I think it's actually about hiring the right people with the right attitude to start with. So that's the most important piece where I work is making sure we're hiring the people with the right attitude.
We can then give them the technical skills that they need, whether it's working at the front desk at reception, or whether it's a medical skill. But if they're not the type of person who understands what customer service is all about-- seeing patients on time, respecting their time and their needs-- then, well, they're not going to work in my clinic anyway.
ROHIT VERMA: Thanks. Let's just do a quick closing statement. Then if you have more time, we'll take one or two more questions. So Karen, you want to get started? Or Mardelle, you want to--
MARDELLE MCCUSKEY SHEPLEY: No.
ROHIT VERMA: Karen, please. Anything we haven't covered you'd like to elaborate--
KAREN HEIDELBERGER: Since this an entrepreneurship conference and an entrepreneurship panel, I think I said this in the very beginning, but I think it's important to state again-- that your career and your success, in my mind, is half serendipity and half hard work. And if you can dial in to know exactly what you're doing right now but be able to look at the big picture and understand where you potentially could be or how things could change in 10 years, you have a much better shot of making things work as you try to really carry that ball cross the finish line.
JOHN RUDD: Yeah. And I would just add, always remember, if you're in the health care industry, putting the patient at the center of what you do. Whether it's a mobile app or whether it's technology to treat a patient, always don't forget that we're in this because of the patients. And how do we improve that quality of care and patient experience for our patients?
ROHIT VERMA: Meredith.
MEREDITH JOHNSON: Yeah, choose something that you're passionate about. If you're passionate about working in health care and helping people or helping to make the technology better to help people, whatever your role might be, then you're going to be successful.
ROHIT VERMA: Mardelle.
MARDELLE MCCUSKEY SHEPLEY: That's. With regard to the future, I think what you're listening to here is a general discussion of where we're pushing right now. But the envelope five, 10 years from now is going to be extraordinarily different.
So I think people need to be open-ended, in terms of what they feel like they want to do and how they're going to address it and who they're going to work with and who they're going to network with-- all those things. It's a great time to be in the world making changes. It's a perfect time to be here.
ROHIT VERMA: Thank you. So we have few minutes. So I'm going to say a couple of things. And I'll introduce Alex in a minute as well.
So this is an entrepreneurship conference. And yesterday, I met one of our recent graduates from Cornell and her company. She was sitting next to me during the dinner. And I don't know if she is here in this room.
JOHN RUDD: No, I think she said that she was going to be doing a panel herself.
ROHIT VERMA: Oh, she is doing another panel in the other room. Anyway, her company has come up with some innovative technology to make sure that the patients get right medicine at right time during the day, especially if they have some mental problems or they are not able to physically get their medicine on time or whatever.
So anyway, some very cool technology-oriented product-- I asked her this question, what does your company do? And so she gave this explanation to me. It took her about 15 minutes.
So I listened to her. And then I said, this is great that you are telling me how you are going to solve this problem. But all I want to know was what your company does. And you could have just said that in America, that many millions of people take wrong medicine every day. And therefore, either they die prematurely or cost x amount of dollars more for insurance premium, and we have a solution for that.
That's the pitch. That's it. And then I'm excited. I want to hear.
So what it tells me is that the purpose is really key. And I think that's what we are trying to say here is that if the purpose is better care, better service-- that's where we have to start from. That's why we are trying to start this institute and work on many projects.
And in fact, several of you are students here. So I wanted to introduce one of our student leaders in the institute. And she can tell you a little bit about the student organization and what work they are doing. Alex.
ALEX BRUNS-SMITH: Hi. Good morning. I just wanted to quickly introduce myself. My name is Alex Bruns-Smith. I am the program assistant for CIHF, as well as the president for the student club CU Healthy Futures.
We're an interdisciplinary club. We're represented across six different colleges, including engineering, CALS, architecture, SHA, and [INAUDIBLE]. And so it's really into the interdisciplinary. Everyone's involved.
And we do weekly discussions with faculty fellows. Stephanie Creary is speaking to us in a week. And Reneta McCarthy comes and speaks regularly.
We're doing a plant sale on May 9th and 10th in Statler in the commons downstairs and on May 11th at MVR commons. So if you'd like to join, I have some flyers. We'd love to have anyone from other graduate to PhD students. Thank you.
Three leading industry executives share their experiences about innovation in hospitality, health, and design-related industries: Karen Heidelberger SHA '94, partner, Deerfield Management Company LP; Meredith Johnson SHA '92, managing director, Boomerang Health powered by SickKids; and John Rudd, CEO, Cayuga Health System and partner in Island Health/Cayuga Wellness Center. Moderated by Rohit Verma and Mardelle Shepley, April 15, as part of the Entrepreneurship at Cornell Celebration 2016.
