an informative q&a with oc’s top health care …...a sponsored feature of the orange county...

A Sponsored Feature of the Orange County Business Journal • April 10, 2017

HEALTH CARE ROUNDTABLE

Dr. Tonmoy Sharma, MBBS, MScCEO

Sovereign Health

An Informative Q&A with OC’s Top Health Care Professionals

Barry Arbuckle, PhDPresident & CEO

MemorialCare Health System

Ray ChicoinePresident

Monarch HealthCare

Mark E. CostaSenior Vice PresidentKaiser Permanente

Howard J. Federoff, MD, PhDVice Chancellor, Health AffairsCEO, UC Irvine Health SystemUniversity of California, Irvine

Ron GoldsteinPresident & CEO

CHOICE Administrators

Michael L. LawheadShareholder, Chair of Digital

Health PracticeStradling

Dr. Keykavous Parang, Pharm.D., Ph.D.Associate Dean, Professor

Chapman University School of Pharmacy

Carlos A. Prietto, MDInterim CEO & PresidentHoag Orthopedic Institute

Suzanne Richards, RN, MBA, FACHECEO of Healthcare Operations

KPC Health

Richard Afable, MD, MPHPresident & CEO

St Joseph Hoag Health, Irvine, CA

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B-28 ORANGE COUNTY BUSINESS JOURNAL Local breaking news: www.ocbj.com APRIL 10, 2017

CaliforniaChoiceSince it began in 1996, CaliforniaChoice has been offered exclusively through health insurance brokers and is a recognized leader in the health insurance industry, havingintroduced Defined Contribution and Employee Choice. CaliforniaChoice offers group health coverage from Anthem Blue Cross, Health Net, Kaiser Permanente, SharpHealth Plan, Sutter Health Plus, UnitedHealthcare and Western Health Advantage. CaliforniaChoice currently serves more than 18,000 employers and more than 320,000employee and dependent members. It is a division of CHOICE Administrators, the nation’s leading developer and administrator of consumer-choice insurance exchangemodels. Visit www.calchoice.com or www.mycalchoice.com for additional information.

Chapman University’s School of PharmacyChapman University’s School of Pharmacy (CUSP) is Orange County’s first school of pharmacy. Housed at Chapman’s Rinker Health Science Campus in Irvine, the firstDoctor of Pharmacy class entered in September 2015. CUSP empowers students with broad and deep scientific foundations on future therapeutics and flawless personalizedpatient care, where pharmacy practice, industry, bio-medical/clinical sciences and global health system informatics intersect. The school delivers a three-year “accelerated”Pharm.D. degree, an MS in Pharmaceutical Sciences and a Ph.D. in Pharmaceutical Sciences. The high-tech Rinker teaching and research labs provide a unique flippedclassroom andragogy and world-class discovery experiences for every student.

Hoag Orthopedic InstituteHoag Orthopedic Institute (HOI) is located in Orange County, California. It consists of a specialty hospital located in Irvine and two ambulatory surgery centers: OrthopedicSurgery Center of Orange County in Newport Beach and Main Street Specialty Surgery Center in Orange. HOI has more than 300 physicians on staff, including more than80 orthopedic specialists. HOI ranks in the 99th percentile for patients’ likelihood to recommend the hospital and 98th percentile for overall hospital rating, according toPress Ganey’s national database of hospitals. HOI focuses in the treatments of the knee, hip and spine disorders, and takes pride in specialty care related to sports medicine,orthopedic trauma and extremities care. Since opening in 2010, HOI’s hospital has been named by U.S. News & World Report and Becker’s Orthopedic, Spine & PainManagement Review as one of the top orthopedic hospitals in the nation. Most recently, HOI was recognized by the Centers for Medicare & Medicaid Services as one of112 hospitals nationwide, and one of 10 in California to earn the highest, five-star rating for overall quality of care. For more information, visit www.orthopedichospital.com.

Kaiser PermanenteKaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit healthplans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and thecommunities we serve. We currently serve more than 11.3 million members in eight states and the District of Columbia. Care for members and patients is focused on theirtotal health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. KaiserPermanente is dedicated to care innovations, clinical research, health education and the support of community health. For information about Kaiser Permanente OrangeCounty, visit kp.org/orangecounty.

KPC HealthKPC Health and its four award-winning Orange County acute care community hospitals operate on a long-standing tradition of serving families throughout the hospitals’surrounding communities. As the oldest hospital system in Orange County, KPC Health remains committed to providing high-quality, affordable health care that offers top-level specialty services from physicians, nurses and staff who have decades of experience in health care. KPC Health’s hospitals, consisting of 755 inpatient beds, includeOrange County Global Medical Center (Santa Ana), Anaheim Global Medical Center (Anaheim, near Disneyland), South Coast Global Medical Center (Santa Ana, nearSouth Coast Plaza) and Chapman Global Medical Center (Orange). Its flagship hospital, Orange County Global Medical Center, is designated by the County of Orange asone of only two Level II Trauma Centers in the county and provides emergency, trauma and burn treatment services for more than 20,000 patients per year.

MemorialCare Health SystemMemorialCare Health System, a nonprofit Southern California integrated delivery system and pioneer in best practice, evidence-based medicine, has more than 200 caresites; 15,000 employees, affiliated physicians and volunteers; five top hospitals—Saddleback Memorial Medical Center in Laguna Hills, Orange Coast Memorial MedicalCenter in Fountain Valley, Long Beach Memorial, Miller Children’s & Women’s Hospital Long Beach and Community Hospital Long Beach; MemorialCare Medical Group;Greater Newport Physicians; Seaside Health Plan; and ambulatory surgery, imaging, outpatient, kidney dialysis and urgent care centers. Among MemorialCare’s manyhonors for its health care organizations include Best U.S. Health Care Systems, 10 Largest U.S. Children’s Hospitals, America’s 50 Best Hospitals, Nation’s Top 50Cardiovascular Hospitals, Best Orthopedic Programs, American Heart Association Get with the Guidelines Gold Plus for cardiac and stroke care, Nation’s Top Places toWork, voted Best Orange County Hospitals and more. To learn more, visit www.memorialcare.org.

Monarch HealthCareMonarch HealthCare, part of OptumCare, is an Independent Practice Association (IPA) caring for patients since 1994. Monarch is a leading health care delivery organizationthat is reinventing care to keep everyone healthier and feeling their best. This is accomplished through a network of over 2,500 providers throughout Orange County andLong Beach. Supported by tools and technology to care for over 260,000 patients, Monarch is recognized by health plans and business groups for offering high-quality careand excellent service. Monarch is led by physicians who have demonstrated their commitment to advancing medical excellence and exemplifying the “patient-first” philosophyof care. Monarch is proud that the Centers for Medicare and Medicaid (CMS) has designated it an Accountable Care Organization (ACO) for traditional Medicare patientsunder the name OptumCare Accountable Care. For more information about Monarch, please visit www.monarchhealthcare.com.

Sovereign Health GroupSovereign Health was launched in 2009 with current chief executive officer, Tonmoy Sharma, M.B.B.S., at the helm. Sharma launched the first Sovereign Health facility inSan Clemente, California, which comprised of a mere 1,884 square feet, and initially had a single patient and a staff of eight. Eight years later, Sovereign is a leadinginstitution in recovery and addiction, and operates nine fully functional facilities in five states for addiction, mental illness and co-occurring disorders including substanceabuse, mental health, dual-diagnosis, brain wellness and behavioral health programs for eating disorders. Sovereign Health, for the third straight year, has earned a spoton the 2016 Inc. 5000, Inc. Magazine’s list of America’s fastest-growing private companies.

St. Joseph Hoag HealthSt. Joseph Hoag Health is a historic alliance for Orange County and the High Desert, laying the foundation for sweeping changes in the delivery and accessibility of high-quality health care. As a combined organization, St. Joseph Hoag Health has earned some of the highest honors for medical care, including Magnet designation for itshospitals (the highest honor bestowed to hospitals for nursing excellence), and “best of” listings in U.S. News & World Report. Drawing upon the strengths of its renownedhospitals, St. Joseph Hoag Health focuses on meeting the big challenges of health care today, including expanding access, improving wellness and preventive services,ensuring quality and developing more efficient methods in the delivery of care. The network includes seven hospitals (Hoag Newport Beach, Hoag Irvine, Hoag OrthopedicInstitute, Mission Hospital Mission Viejo, Mission Hospital Laguna Beach, St. Joseph Hospital Orange and St. Jude Medical Center), 27 urgent care centers, eight medicalgroups, 425 primary care physicians and 1,200 specialists. It has also developed the nationally recognized Wellness Corners, which bring services for health and well-being right to some of the region’s largest business and residential centers The network is also affiliated with CHOC Children’s and CHOC Children’s at Mission Hospital.For additional information, visit www.stjosephhoaghealth.org.

StradlingStradling is a premier business law firm with over 130 attorneys in 10 offices across California, Colorado, Nevada and Washington. Stradling represents companies andother entities which seek a sophisticated law firm with experienced counsel to guide critical transactions and disputes. Originally founded in 1975 to represent SouthernCalifornia’s most innovative emerging growth companies, Stradling is known today as a leading full-service business law firm representing high-growth and establishedorganizations across a wide range of industries. The firm has built its practice around its clients’ core needs. Stradling’s size, structure and culture allow it to provide big-firm representation with small-firm flexibility and responsiveness. Today, Stradling serves established and emerging companies, municipalities and global organizationsusing that very premise.

UC Irvine HealthUC Irvine Health comprises the clinical, physician education and research enterprises of the University of California, Irvine. Patients can access UC Irvine Health at physicianoffices throughout Orange County and at its main campus, UC Irvine Medical Center in Orange, Calif., a 417-bed acute care hospital that provides tertiary and quaternarycare, ambulatory and specialty medical clinics, behavioral health and rehabilitation. U.S. News & World Report has listed it among America’s Best Hospitals for 16 consecutiveyears. UC Irvine Medical Center features Orange County’s only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program,Level I trauma center and Level II pediatric trauma center, and is the primary teaching hospital for UC Irvine School of Medicine. UC Irvine Health serves a region of morethan 3 million people in Orange County, western Riverside County and southeast Los Angeles County.

HEALTH CARE ROUNDTABLE PARTICIPANTS

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APRIL 18, 2016 Local breaking news: www.ocbj.com ORANGE COUNTY BUSINESS JOURNAL B-29



“[The CHOICE Administrators] teamand the brokers we work with arefocused on...helping OrangeCounty’s small businessesunderstand current regulatoryrequirements, upcoming changes toexisting plans in preparation fortheir next open enrollment.”

Ron GoldsteinPresident & CEO

CHOICE Administrators

The fate of the Affordable Care Act isshaping up to be one of the key healthcare issues facing all stakeholders for2017. How are you preparing for the newadministration’s “repeal and replace”promise? What risks are there toreplacement?

Suzanne Richards, KPC Health: Repeal ofthe Affordable Care Act without an adequatereplacement is a non-starter both in terms ofcoverage and the economics of it. We kept aclose eye on the proposed bill, and now thatwe know that the AHCA has been scrapped,we will continue to monitor other proposals inhealth care reform. Bottom line, we want toprovide the best care possible. Thatbecomes more difficult when expansion isreduced.

Ron Goldstein, CHOICE Administrators:The Republican Affordable Care Act (ACA)replacement plan that was released onMarch 6, 2017 had the potential to changehow health insurance works for the 150million Americans who, according to theHenry J. Kaiser Family Foundation, receivebenefits through the workplace. Our team,and the brokers we work with, are focusedon the present, helping Orange County’ssmall businesses understand currentregulatory requirements, upcoming changesto existing plans in preparation for their nextopen enrollment.

Carlos A. Prietto, Hoag OrthopedicInstitute: We believe that whatever theoutcome from Washington, D.C., and anychanges to our current health care systemwill have minor impact for Hoag OrthopedicInstitute. Our hyper-focus on orthopedicpatient care within a unique value-basedmodel of care and collaboration with ourpartners prepare us for any eventuality. Aslong as we put the needs of our patients first,and adhere to our high-quality standards, wewill continue to grow. Today, moreCalifornians choose Hoag OrthopedicInstitute for their joint replacement than anyother hospital.

As health insurance companies andprovider organizations strive to competein the public policy making arena on theparameters of coverage andreimbursement, what does Washingtonneed to know in terms of how to bestreform health care policy to protectpatients and foster an environment thatoffers the most options?

Mark E. Costa, Kaiser Permanente: KaiserPermanente has physically been at the tableworking with both the former and the currentPresidential Administrations to address notonly the needs of the industry, but moreimportantly, the health needs of America. Webelieve that the top three policy areas thatneed to be addressed include, a stabilization

of the marketplace so that there are strongincentives to encourage enrollment. Thatthere remains sufficient funding for Medicaidand consider what is possible aroundcontinuing expansion efforts. And lastly,focus must be placed on the health caredelivery system, which includes a high-quality patient experience. We believeeveryone should have coverage that givesthem access to quality care.

Mergers and partnerships continueamong providers, health plans and otherhealth care entities. What partnershipsare you involved with and what was themain driver in creating them? What arethe benefits of these expandingorganizations to employers and patients?

Barry Arbuckle, MemorialCare HealthSystem: MemorialCare’s strategicpartnerships transform health care, increaseoutpatient offerings, create efficiencies,broaden population health and benefitcommunities. Our preferred partnership withBoeing, offered to 37,000 SouthernCalifornia employees and their dependents,provides a customized health plan option atlower costs to employees and to Boeing.With UCI Health, primary care health centersincrease access to care. MemorialCare’sunprecedented partnership with Anthem andother top health systems offers employersthe competitively priced health plan called,Vivity. Summation Health Ventures’partnership with Cedars Sinai gives staff andpatients access to health care advances andentrepreneurs accelerated productdevelopment. Partnerships with physiciansresult in significant ambulatory servicesgrowth, adding physicians’ practices, andoutpatient surgery, imaging, digestive health,dialysis and urgent care centers. Populationhealth initiatives better manage chronicconditions and reduce readmissions.Affiliations with Miller Children’s & Women’sHospital improve accessibility to highlyspecialized pediatric physicians andprograms. And academic partnershipsincrease availability of highly trainedphysicians, nurses and other clinicians.

What does the health care industry see interms of M&A activity and other strategicor collaborative transactions in 2017?How has this continuing trend impactedOrange County and what results do yousee yielding from such endeavors?

Carlos A. Prietto, Hoag OrthopedicInstitute: Since our founding, we’veembraced a close direct relationship withmany companies, providing both bundle andfee-for-service care options for theiremployees. Through increased collaborationwith health plans and employer-basedpartners, this model of care has growncommensurately each year. This year, our

continued on page B-32

“Any changes to our current healthcare system will have minor impactfor Hoag Orthopedic Institute. Ourhyper-focus on orthopedic patientcare within a unique value-basedmodel of care and collaborationwith our partners prepare us for anyeventuality.”

Carlos A. Prietto, MDInterim CEO & PresidentHoag Orthopedic Institute




“Health care providers thrive withstability. In the wake of the ACA andthe frequent efforts to repeal it,finding that sure footing has beenprecarious. Now that the repeal effortsseem to be tabled, we should have ameasure of stability going forward.That stability will result in certainproviders looking at ways to grow.”

Suzanne Richards, RN, MBA, FACHECEO of Healthcare Operations

KPC Health

surgeons will perform hundreds of jointreplacements via employer-based programsfor companies based in Orange County andacross the nation. We even coordinate theirstay and hotel arrangements. A newagreement with Optum will give us access toprovide care for more than 2 millioncompany employees.

Suzanne Richards, KPC Health: Healthcare providers thrive with stability. In thewake of the ACA and the frequent efforts torepeal it, finding that sure footing has beenprecarious. Now that the repeal efforts seemto be tabled, we should have a measure ofstability going forward. That stability willresult in certain providers looking at ways togrow. I expect to see more mergers andacquisitions in Orange County to gain marketshare, and to allow systems to focus on whatthey do best.

The health care marketplace has now hadthe chance to allow previous mergers toseason following major shifts in federaland state policies, particularlysurrounding reimbursement rates. Basedupon your observations and theinevitability of further policy reforms,where do you see health care providersheaded organizationally in the nextdecade?

Ron Goldstein, CHOICE Administrators:One result of the health care mergers is theincreasing importance of physician networks,or the number of medical providers anindividual can access through their healthinsurance plan. Consumers want choicesand the ability to keep their doctor – findingout that health insurance no longer coversvisits with their regular doctor is extremelyfrustrating. Physician networks, narrow ornot, will continue to be an important healthinsurance driver in the next decade. This iswhy we offer an online provider search toolwhere employees can confirm that theirdoctor, specialist or hospital is available in aspecific network before making a healthinsurance selection.

How is your organization moving moretoward integrated delivery systems?What progress have you made to furtherthis integration?

Richard Afable, St. Joseph Hoag Health,Providence St. Joseph Health SouthernCA Region Orange County / High Desert: Iwould say we’ve made terrific progress indeveloping an integrated care network thatassists people with the right care at the righttime at the right place. We have done thisthrough strong partnerships with physiciansand other health care providers. Forexample, St. Joseph Hoag Health is veryfortunate to have a strong physician network.CHOC is also a partner in ensuring health forthe entire family. And we have many continued on page B-34

partnering clinics and community programsacross the region. Of course, there are timeswhen a service doesn’t exist and we’recalled to innovate. That’s what we’ve donewith our Wellness Corners, which bringunique services focused on health andwellness to where people live and work. Thisconcept has also attracted several largeemployers, which has led to partnershipsthat bring workplace wellness right into theoffices of several thousand OC workers. Oursystem is not just integrated, it’scomprehensive.

Barry Arbuckle, MemorialCare HealthSystem: MemorialCare’s growth anddiversification from a hospital system to anintegrated and diversified health carenetwork gives us a unique competitiveadvantage. Our broad reach across Orangeand Los Angeles counties is the result ofplanned growth, mergers, acquisitions andaffiliations. Strategically located hospitals,physician practices, outpatient services andthe state’s largest children’s hospital makeus ideal partners for consumers, employersand health plans seeking high-quality andexcellent value. We offer innovativenetworks and products to employers seekingto control health benefit expenses whileensuring quality care for their workforces.These include direct-to-employer customizedcontracts and accepting responsibility forhealth care cost trend and qualityexpectations. Most importantly, we areoffering solutions to counter unhealthylifestyles by continually engaging employers,schools and community organizations inhealthy living partnerships. MemorialCare iscommitted to pursuing healthier communitieswhere we share in the celebration ofcontrolling and curing disease that ensure alonger, healthier, more fulfilling life for all weserve.

Technology and data continue to driveinnovation in the delivery of medicine toall patients – both young and old. Theseadvances include smartphones,telemedicine, remote patient monitoringand others that hold the promise ofimproved patient care. How have youleveraged today’s technologicaladvances to improve the health and well-being of the patients you serve?

Ray Chicoine, Monarch HealthCare: Asthe largest Independent Practice Association(IPA) serving Orange County, we embraceand drive technological advances to help ourphysicians deliver the best possible care forour patients. Our parent company,OptumCare, is a national leader inencouraging innovation and improvingpatient care using new technologies. Wedon’t use new technology because it’s trendyor cool; we adopt it based on how it helps usdeliver on our core mission – delivering high-




quality patient care while reducing costs forour patients and simplifying the practice ofmedicine for our physicians.

Mark E. Costa, Kaiser Permanente:Kaiser Permanente has been on thecutting-edge of innovation since our earlybeginnings. And today is no exception.Through the research and design efforts atour Innovation Studio, we are working onproducts and partnering with some of thebest technology companies in the world.We have been successful at moving officevisits from inside a clinical setting to thehome/office setting. This has beenaccomplished through Integrated VideoVisits (IVV) where we average over100,000 visits a month nationally.Furthermore, we are working to advancethe capabilities of “wearables” so thatpatients are acutely aware of their healthprogress at any moment. We recognizethat at the end of day, care should beaccessible everywhere, and anywhere, thepatient would like it.

Richard Afable, St. Joseph Hoag Health,Providence St. Joseph Health SouthernCA Region Orange County / HighDesert: Health care delivery has alwaysrequired data gathering. The problemhistorically has been a lack ofconnectedness and interrelatednessbetween different sets of data – includingdata at individual hospitals, individualemergency rooms, doctors’ offices andimaging centers. Where today’stechnological advances greatly improvehealth care delivery is allowing forconnectedness between the multiplesources of data that exist within healthcare. What we’re doing is using some ofthese latest technologies, including mobiledevices, telehealth and home patientmonitoring, and aggregating that data sothat it can be used anywhere by the rightproviders of care in order to optimize thecare to any individual. It’s not so much theindividual technologies as it is the ability toconnect the processes of care through theuse of data and new tools.

Tonmoy Sharma, Sovereign Health: Inour desire to be leaders of disruptiveinnovation – innovations that create a newmarket network and value network –Sovereign Health has adopted many newtechnologies and created an internalworkflow system that leverages our housesoftware capabilities. These systemsimprove the process of working withsubstance abuse, physical or sexualabuse, and suicidal or homicidal patients.Our company is also leveraging telehealthand smart phone apps to reach out tothose who cannot physically attendtreatment at our locations, and for loopingin patients’ families so they are included inthe process. We are also using telehealth

for our continuing care program to ensurethat we are following up and providing bothcase management and treatment to ourpatients. This type of ongoing involvement intreatment decreases relapse rates, whichtend to be quite high in the first year afterinpatient treatment.

Suzanne Richards, KPC Health:Technology and data are critical to the waythat we deliver health care today. Not only inthe equipment we use to diagnose and treatpatients, but in the way we deliverpersonalized treatment plans. I am especiallycurious to see the strides that telemedicinemakes in the coming years. I think it is aninnovative approach to putting patientstogether with the very best medicalprofessionals. I wouldn’t be surprised to seemore consultations and follow-ups beingconducted via smartphone or tablet.

Carlos A. Prietto, Hoag OrthopedicInstitute: We use data to make small andlarge patient care decisions every day. Datais our currency to improve quality and reducecosts for patients. We created a research armwithin Hoag Orthopedic Institute to help usdrive innovation in these areas. Because ofour size and the number of patients we treateach year, our researchers have access torobust amounts of data that we use toinnovate and improve our quality of care. Theuse of new technology in the treatment oforthopedic conditions is more complex. Wedon’t purchase new technology fortechnology’s sake. We want to see improvedoutcomes and evidence before we makedecisions. That’s part of our physician-directed culture; if it’s been studiedextensively and has been shown to improvequality and reduce costs, we will take notice.Our outcomes are some of the best in thenation based on this philosophy.

How have emerging technologies andother technological advancements,including wearable health care devices,telemedicine and other digital healthadvances, artificial intelligence, etc.affected health care systems? How arehealth systems meeting demands to usesmarter technology so that services canbe improved?

Michael L. Lawhead, Stradling: Advancesin technology touch every part of our livesand increasingly affect the way health caresystems take care of us and the way we takecare of ourselves. Although the health careindustry tends to be slower to implementthese advances, health care systemsincreasingly see technology as critical to theirefforts to improve patient care and outcomeswhile lowering the cost of administering suchcare. These efforts include using smartertechnology to improve patient engagement,patient monitoring, supply chain management

“Advances in technology...increasinglyaffect the way health care systemstake care of us and the way we takecare of ourselves. Although thehealth care industry tends to beslower to implement these advances,health care systems increasingly seetechnology as critical to their effortsto improve patient care andoutcomes while lowering the cost ofadministering such care.”

Michael L. LawheadShareholder, Chair of Digital

Health PracticeStradling





“The health care industry will embracemany emerging technologies that willgenerate tremendous opportunities fordata analysis and imaging in the nextdecade. Robots will be applied morebroadly for remote patient caremonitoring and digital behavioralhealth services. 3D printing has alreadycreated functional kidney and livertissues to examine the toxicity ofexperimental drugs in 3D cellplatform.”

Dr. Keykavous Parang, Pharm.D., Ph.D.Associate Dean, Professor

Chapman University School of Pharmacy

and customized care. This smartertechnology, particularly wearable devicesand telemedicine, may even improve theway we take care ourselves, thus limiting ourneed to make doctor visits.

Ron Goldstein, CHOICE Administrators:Technology has transformed the once paper-driven health insurance industry into onewhere consumers, including small and largercompany owners, expect a user-friendlyonline experience. For example, onlineenrollment is increasingly becomingdemanded. Business owners have nowrecognized the many benefits of onlineenrollment, including administration, allowingthem and their employees to make healthinsurance selections more seamlessly.Online enrollment is on a rapid path tobecoming the norm.

Keykavous Parang, Chapman UniversitySchool of Pharmacy: The health careindustry will embrace many emergingtechnologies that will generate tremendousopportunities for data analysis and imagingin the next decade. Artificial intelligencetakes over some responsibilities, such asbilling, data analysis and reading medicalimaging, performed by human intelligence tosave time and personnel, and provide moreaccuracy. Medical drones will be used whenthe vital emergency response is required,such as delivery of medical goods to peoplein disaster areas or those with limited accessto health care. High-resolution 3D interactiveholograms could be used by surgeons toobserve 3D medical data in space. Robotswill be applied more broadly for remotepatient care monitoring and digital behavioralhealth services. Virtual reality is developingfor patient and physician education, andrelieving stress. 3D printing has alreadycreated functional kidney and liver tissues toexamine the toxicity of experimental drugs in3D cell platform.

Ray Chicoine, Monarch HealthCare:Technological advances in health care haveaccelerated and enhanced our model ofcoordinated patient care. We use technologyto improve patient care and increase ease ofcommunication among multiple health careproviders. Digital platforms monitor care inreal time among our chronically ill. Patientswith diabetes and congestive heart failuresend us encrypted updates from cell phones,laptops or tablets so we can monitor theirhealth every day. For example, if we notice asudden weight gain (perhaps the result ofwater retention from a heart condition) wecan intervene immediately. If needed, weconsult with specialists to determine the bestcourse of action. We use similar technologyfor those in palliative care – and includesecure messaging so patients and familymembers can communicate with us, andactually show us what’s happening. This canmean avoiding a stressful and unnecessary

trip to the emergency room. Technologyallows us to get in front of serious healthproblems before they occur or get worse. Itresults in better patient care and significantcost savings.

Cost and transparency remain importantissues in health care. What are some ofthe key factors impacting costs forproviders and what changes must theindustry consider for those costs comedown? How has your organizationaddressed the need for moretransparency and the rising costs ofhealth services? Can insurance productdesign alone solve the health care costconundrum?

Carlos A. Prietto, Hoag OrthopedicInstitute: Since day one of our opening, wehave worked to be one of the mosttransparent health care facilities in thecountry. We purposely collect, analyze andreport our results in detail each year in ouroutcomes report, a document we publish(www.hoioutcomes.com) for all to see andcompare our results with others. Ourphysicians believe that by sharing ourresults publicly, we empower consumers tomake better health care decisions andinspire a culture of high performance.Moreover, our outcomes report is ameasurement of our quality against others inthe local marketplace and across the nation,a tool that we use to continually improve ourperformance. If you don’t copiously measurehow you are performing and helpingpatients, how can you improve? We werepleased when nationally recognized healthcare opinion leader Dr. Ezekiel Emanuelwrote a story about our transparency for anarticle in Fortune titled, “Why this for-profit,physician-owned hospital is a model oftransparency.”

Ron Goldstein, CHOICE Administrators:The past year has seen tremendousmovement by carriers as they work to find apath for success in a shifting ACA world. Asplan availability and networks change, onething has stayed consistent through ourprogram, and that is something we callEmployee Choice. Our program allowsemployees to shop and compare betweenavailable health insurance options in theirarea, from some of the state’s top healthinsurance carriers. By providing greateraccess to care, employees have the optionto base their selection both on personalpreference of health insurance provider,benefit type (e.g. HMO, PPO, HAS) andprice point. This creates transparencybecause at the end of the day, choice is inthe hands of each employee.

Tonmoy Sharma, Sovereign Health:Insurance product design cannot resolve thehealth care cost conundrum, although some





“Mental health, especially treatment ofsubstance use disorders, has sufferedfrom a lack of acknowledgement thatit is a chronic illness. The treatmentfor addiction has been very like howwe treat infection, and not how wetreat chronic relapsing and remittingillnesses. We need to embrace arecovery-oriented system of care.Serious mental illnesses andsubstance use disorders are chronicconditions and share manycharacteristics with other chronicphysical ailments, such as diabetes orheart conditions.”

Dr. Tonmoy Sharma, MBBS, MScCEO

Sovereign Health

sectors have been advocating for a single-payer system to bring down costs. The fieldof behavioral health is steadily moving froma fee-for-service model—in which everyconsultation visit, doctor appointment orinpatient stay is based on volume—tovalue-based care (VBC) models, whichchange incentives to focus on value byrewarding better outcomes and lowerspending. VBC encompasses sharedsavings, bundled payments, shared risk andglobal capitation where the organizationreceives a per-person, per-month paymentintended to pay for all individuals’ care,regardless of what services they use. Butthere is a dearth of data available onquality, and no formal agreement on whatthe measures should be. If quality is acomponent of health care service delivery,one needs to make sure that there is asupporting data and infrastructure to collectit.

Will prices for health insurance increaseagain in 2017? If so, how will this affectOrange County’s employers, the benefitsthey offer to employees and how eachindividual accesses health care? Howhas your organization addressed therising cost of health services,particularly skyrocketingpharmaceuticals? How can health carereform focus on reining in these costs?

Ron Goldstein, CHOICE Administrators:It is anticipated that health insurancepremiums will increase again this year.Competition among health insurancecarriers creates a healthy environmentwhere costs are similar across severalcarriers – this is one of the reasons whysome recent mergers have stalled. Whilebusiness owners would rather avoidincreasing costs, one way we are working tohelp them view prices differently is througha defined contribution model. This offers adifferent variety of flexible budget scenariosthat have the potential to help managecosts year-over-year.

It seems that more focus is being givento the care continuum as it relates tomental health? Do you see an increasingtrend in mental health needs, and if so,what is being done to address this need?

Suzanne Richards, KPC Health:Recognizing the importance of a robustapproach to mental health care policy is oneof the issues I am most excited about inOrange County. Mental health care touchesso many members of our community,especially with respect to homelessness anddrug abuse. I’m thrilled to see policy makersat the local, county, state and federal levelsincrease their commitment in providingefficient treatment for mental health patients,which can have a huge impact in costsavings in the long run.

Tonmoy Sharma, Sovereign Health:Mental health, especially treatment ofsubstance use disorders, has suffered froma lack of acknowledgement that it is achronic illness. The treatment for addictionhas been very like how we treat infection,and not how we treat chronic relapsing andremitting illnesses. We need to embrace arecovery-oriented system of care.Recovery management is the key. Seriousmental illnesses and substance usedisorders are chronic conditions and sharemany characteristics with other chronicphysical ailments, such as diabetes orheart conditions. The usual goal oftreatment for many of these disorders isrecovery – that is, maintenance orimprovement of quality of life and thepatient’s level of functioning. A chronicdisease framework, focused on evidence-based practices and consumer education,with careful attention to medicationmanagement and self-care, can beenormously beneficial for mental healthand substance use disorders.

Richard Afable, St. Joseph Hoag Health,Providence St. Joseph Health SouthernCA Region Orange County / High Desert:Mental health and behavioral disorders arenot new in our community. What is differenttoday is the much greater attention we arepaying to mental disorders as a disease ofthe brain, rather than a social or anenvironmental problem. We are bringingmental and behavioral disorders “into thelight,” recognizing them as diseases to betreated like any other disease of the body.This requires a coordinated approach to themedical and environmental treatment ofmental illness and behavioral disorders. Weat St. Joseph Hoag Health, in collaborationwith the larger Providence St. JosephHealth system, have created the Institutefor Mental Health and Wellness. Theinstitute will specifically address mentalhealth disorders in our community and willapply necessary resources and theopportunity for partnerships to greatlyimprove mental well-being throughprevention, treatment and elimination ofstigma.

Mark E. Costa, Kaiser Permanente: Yes,completely. Between 2015 and 2016, thenumber of Kaiser Permanente membersseeking an appointment within ourspecialty mental health departmentincreased 11.5%, up to a 2016 average ofmore than 1,400 new requests per month.This growth outpaces our overallmembership growth, so we know that eithermembers are struggling with increasedrates of mental health challenges, or theyare more comfortable asking for help, ormost likely a combination of the two.Mental health and wellness is an increasingneed and we are proud to have been





“Through [Monarch HealthCare]’spartnership with Surgical CareAffiliates, which operates severalambulatory surgery centers inOrange County, we are embracingoutpatient surgery as a larger part ofour model of clinical integration. Wecan achieve better quality outcomesfor patients and, importantly, reducecosts through this approach.”

Ray ChicoinePresident

Monarch HealthCare

increasing our focus on mental health andwellness services over recent years.Through significantly increasing the size ofour departments, including a dedicatedMedical Office Building for mental healthand wellness, we continue our longstandingpractice of allowing patients to self-referralshould they wish to do so.

Why is it important to change the viewsof people with addiction, which is alsoconsidered a brain disease?

Keykavous Parang, Chapman UniversitySchool of Pharmacy: Brain diseaseusually implies a lack of will power andmind control. Repeated use of drugs affectsthe brain by flooding dopamine, feelingpleasure, reward circuit and tolerance thatgenerates significant challenges in self-control and quitting. The neural mechanismhas less relevance to the treatment options.The brain disease notion obscurestreatment strategies and response toincentive plans. Addiction is a complexbehavior issue by repeating use ofmaterials. There are a combination offactors that may be involved in addiction,including environment, genetics, family andfriends, economic status, age and stressrather than a neurological illness. Addictscan recover even after relapse with ongoingtreatment and are not entrapped by theirbrain disorder. There are availabletreatment options beyond the brain for drugaddiction, and the situation can bemanaged and prevented. The most effectiveinterventions are those directed towards theperson and not at the brain by drugs.

Outpatient care is still trending upwardsas both a convenience and cost-savingfor consumers and others. How has yourorganization addressed this transitionand how has the growth of outpatientcare affected your institution? Will thistrend continue and have you madedecisions to expand your outpatientoptions?

Howard J. Federoff, University ofCalifornia, Irvine, UC Irvine HealthSystem: We believe the consumer trendtoward seeking outpatient care willcontinue, as forecasts indicate such visitswill grow by more than 25% in the nextdecade. The UC Irvine Health goal is toincrease access to academic-basedmedicine across the county, and we haveexpanded our primary and specialty carepresence in Irvine, Costa Mesa and in northOrange County. We are continuing todevelop additional opportunities. As thecounty’s only academic medical center, UCIrvine Health plays a unique role, providingunduplicated services directly to patients inhospital and outpatient settings, includingtertiary and quaternary care, and acting asa resource for community hospitals whose

patients require higher levels of careavailable only from UC Irvine Healthspecialists.

Carlos A. Prietto, Hoag OrthopedicInstitute: The centerpieces of our modelare our inpatient hospital and twoambulatory surgery centers. That was apurposeful decision because we believethat outpatient care is a trend that willcontinue to help patients with cost savingsand convenience. We were one of the firsthospitals in the nation to perform total hipreplacement on an outpatient basis – thepatient coming in for surgery in the morningand then going home in one day with noovernight stay. When I was an orthopedicresident, this concept was not even inanyone’s imagination. In those days, totalhip replacement patients spent days –sometimes a week or more – in thehospital. Today, we continue to performmore surgeries on an outpatient basis, amove we will continue to drive as a leaderand innovator in our industry.

Barry Arbuckle, MemorialCare HealthSystem: At MemorialCare, we arerevolutionizing value in health care. Withour commitment to high-quality, exceptionalservice and affordability, we are profoundlydifferent today than a decade ago. This isevident in our dramatic transformation intoconvenient, community-based, lower-costoutpatient services and from fee-for-volumeto a fee-for value model. With five hospitalsand over 200 outpatient physician, urgentcare, imaging, kidney dialysis and surgerycenters throughout Orange County, LongBeach and South Bay, we’re uniquelypositioned to provide the best in health,wellness, prevention, chronic diseasemanagement and treatment in the rightlocation with the right services at the rightprice—with substantial savings foremployers, health plans and patients.Thanks to technological advances, forexample, many surgical patients who spentdays in a hospital now receive care ineasily accessible lower-cost outpatientcenters without overnight stays. And we areunveiling more health care centers,innovative programs, progressivepartnerships and comprehensive serviceslocated where people live and work.

Ray Chicoine, Monarch HealthCare:Through our partnership with Surgical CareAffiliates, which operates severalambulatory surgery centers in OrangeCounty, we are embracing outpatientsurgery as a larger part of our model ofclinical integration. We can achieve betterquality outcomes for patients and,importantly, reduce costs through thisapproach. Moreover, patients, employersand families like the convenience ofoutpatient care.





“For many individuals, emergencyrooms continue to be utilized as theirsource of non-emergent care forseveral reasons. These include, nothaving a personal primary carephysician, difficulty in accessing theirprimary care physician at times thatare convenient. At KaiserPermanente, we are consistentlyfocused on providing timely, andconvenient access, to non-emergentcare for our patients.”

Mark E. CostaSenior Vice PresidentKaiser Permanente

Data suggests that emergency roomvisits are still considered a primarysource for care. Is this true, and if so,what can be done to lessen overall usagefor non-emergent cases?

Suzanne Richards, KPC Health: There area few small policy changes that could havetremendous impact on reducingovercrowding in the Emergency Department.A significant amount of EmergencyDepartment visits is related to individualsexperiencing a behavioral health crisis. ACrisis Stabilization Unit (CSU) is a muchmore appropriate place for individuals toreceive the care they need. It’s important thatgovernment agencies, health care providers,and other vested parties work together to getpatients the treatment they need in thesetting they need it. Instead of officers orparamedics taking those in crisis to an ED,they would go directly to a CSU.

Mark E. Costa, Kaiser Permanente: Formany individuals, emergency rooms continueto be utilized as their source of non-emergentcare for several reasons. These include, nothaving a personal primary care physician,difficulty in accessing their primary carephysician at times that are convenient. It toomay be due to other barriers to careincluding transportation challenges or a lackof health care insurance. At KaiserPermanente, we are consistently focused onproviding timely, and convenient access, tonon-emergent care for our patients. Accessto care through our Urgent Care sites,convenient hours for scheduled primary carevisits, and care through non-traditionaloptions, such as tele-health, are our keystrategies to best meet our patients’ needs.All health care providers must provide care ina timely and convenient manner, which isoptimal for the patient and is delivered in thehighest-quality manner.

Employers, physicians, insurers andhospitals can no longer work in silos.What are the most exciting, innovativepartnerships you’re seeing right now?Can you provide some examples?

Richard Afable, St. Joseph Hoag Health,Providence St. Joseph Health SouthernCA Region Orange County / High Desert:The stakeholders in health and physical well-being are not only individuals, but alsoemployers, insurers and those who providehealth services, including doctors, hospitalsand others. Historically, these stakeholdershave functioned separately with very littlecollaboration. It’s become well-known thatcollaboration in health care greatly improvesoutcomes and can reduce costs. Today,we’re increasingly seeing employers,insurers and providers partnering to improveservices to individuals receiving care. Theresult is better outcomes and lower cost forall participants in care delivery. These lowercosts and outcomes are vital because

consumers value and deserve affordabilityand consistency. St. Joseph Hoag Healthhas partnered with employers and healthplans like Western Digital and Cigna in orderto create better ways to care for employeesand individuals. The benefits to cost andquality are significant and promote continuedcollaboration, now and in the future.

Universities andbiotechnology/pharmaceutical industriescan establish strong partnerships that aremutually rewarding to both entities andimprove the well-being of society. Howcan academia and the pharmaceuticalindustry work together to facilitateresearch discoveries and make themavailable for the people who need them ataffordable prices?

Keykavous Parang, Chapman UniversitySchool of Pharmacy: The partnershipsbetween universities and the pharmaceuticalindustry have become prevalent in order toexplore breakthroughs in basic science withpotential translation into clinicaldevelopment. Approximately half ofbiotechnology companies have beenfounded by university researchers withacademic affiliations. The landscape ofalliances between universities and thepharmaceutical industry is extremely broadand requires a negotiated agreement onownership of intellectual property, mutualfinancial benefits and the specificcontributions by each partner. Thepartnerships can include laboratory, clinical,and professional services, general researchagreements, clinical trial operations,collaborative drug development, sharingequipment and facility, general researchsupport for a single principal investigator ormaster agreement with several scientists towork on a specific area of interest by thepartners, fee-for-service agreement,establishing a center within the universitywith multiple investigators by donation fromthe company—such as Drug DiscoveryCenter, screening compounds fromacademic scientists, and translating basicscience to medicine.

Howard J. Federoff, University ofCalifornia, Irvine, UC Irvine HealthSystem: A strong partnership is critical,especially as research funding from theNational Institutes of Health and other federalsources continues to sink below 1990s levels.The pharmaceutical and medical deviceindustry requires the insight and expertise ofUCI physician-scientists in fields such asneuroscience and cancer care, which in turnaffords the Orange County residents accessto clinical trials not available anywhere else.The relationship goes the other way as well,as UCI works with industry to bring theuniversity’s research innovations to a greaternumber of patients. This translationalresearch, also known as bench-to-bedside





science, is critical component of our mission asan academic center.

What is the role of an academic medicalcenter in the health care reform era?

Howard J. Federoff, University ofCalifornia, Irvine, UC Irvine Health System:An academic medical center is expected toremain on the leading edges of discovery andcomplex care delivery. Indeed, those are keyelements of our three-part UC Irvine Healthmission: Discover. Teach. Heal. Academiccenters continue to be backbone of regionalsafety nets and provide tertiary andquaternary care unavailable elsewhere in thecommunity. Though the future of health carereform legislation is uncertain, institutionssuch as UCI and the University of CaliforniaHealth system are uniquely poised to leadmodern medicine to an era of precisionmedicine and wellness, and leverage thatfocus to advance individual and populationhealth.

Personalized medicine is oriented towardprevention and treatment plans moreclosely related to the individual patientthrough the development of sequencinggenomes, monitoring technology andcorrelating biological information withhealth data. Will disease risk predictionand genome-based drug therapy fulfill thepromise of benefiting the public health?How will personalized medicine influencethe health care costs?

Ray Chicoine, Monarch HealthCare:Personalized care is the future, and there aremany tools that create models for idealpatient care. By using patient claims data tocreate a predictive model for patients, we areable to, with significant accuracy, determinewhich patients are likely to get chronicconditions such as diabetes, congestive heartfailure or chronic obstructive pulmonarydisease (COPD). We then reverse engineerour care path for those patients to helpprevent such conditions from becoming areality. Armed with this information, ourdoctors then create specific wellnessprograms that address risk factors associatedwith these conditions. They’ll prescribepreventative measures, such as exercise,special diets and other lifestyle modifications.A personalized program will help our patientsstay on the path to optimal wellness.

Keykavous Parang, Chapman UniversitySchool of Pharmacy: The application ofpersonalized clinical evaluations tools haveenabled holistic analysis of individual humangenomes at a reduced cost and within a shortperiod. Personal sequencing has becomecommercially available to predict better,diagnose and treat diseases by individualizedintervention. The potential for personalizedmedicine to optimize treatment andprevention in diseases such as cancer hasbegun to be realized. Personalized

sequencing has impacted cancer treatmentby identifying mutations that can suggesttherapeutic intervention. A number of FDA-approved anti-cancer drugs contain druglabel information that includes clinicallyrelevant biomarker pharmacogenomicsinformation. Furthermore, this tool hasshown potential in cancer diagnosis. Forinstance, mutations in the BRCA1 and theBRCA2 pathways are frequently observed inovarian cancer patients. In general,personalized sequencing is developing tobecome an integral part of the broadspectrum of clinical cancer care thatincludes disease screening, diagnosis,personalized pharmacogenomic-basedtherapeutic intervention, and progressionand recurrence surveillance.

How does measurement-based careimprove patient outcome and treatment?

Barry Arbuckle, MemorialCare HealthSystem: Systematically measuring healthcare by using specific metrics that matter topatients can produce remarkable results.Decades ago, MemorialCare Health Systembegan rigorously documenting our qualitythrough extensive clinical outcomesassessment. Best Practice Teams gatherand update evidence-based medicalliterature and clinical guidelines to identifythe best diagnostic, treatment andpreventive methods that then becomestandard practice in our hospitals, outpatientcenters and physicians’ offices. These aresupported by our highly sophisticatedinformation system capabilities providingtimely, trusted analytics that help enablefact-based, decision-making to improvequality, patient experiences andcommunications, and decreasehospitalization and duplication. High-performance analytics solutions usingcutting-edge big data and massively parallelprocessing capabilities provide access tobillions of data points in meaningful,physician-vetted solutions offering near-instantaneous response time, allowingphysicians to analyze and evaluate resultsto determine best outcomes. Using thesetools has enabled extraordinaryimprovements in care, saving lives, reducinghospital stays and improving overall health.

Tonmoy Sharma, Sovereign Health: Thelack of standardized measurements inaddiction care and treatment often leads toundetected deficits in patients, and poorlyconceived treatment plans. Measurement-based care has many benefits that impactboth treatment and outcome. Patientsbenefit from having an avenue forcommunicating with their health careproviders about symptoms, or medicationside effects, for example. Clinicians gaininsight into their patient’s condition andprogress over treatment, allowing them toprovide more effective care. Third-party

“Decades ago, MemorialCare HealthSystem began rigorouslydocumenting our quality throughextensive clinical outcomesassessment. Best Practice Teamsgather and update evidence-basedmedical literature and clinicalguidelines to identify the bestdiagnostic, treatment and preventivemethods that then become standardpractice in our hospitals, outpatientcenters and physicians’ offices.”

Barry Arbuckle, PhDPresident & CEO

MemorialCare Health System





payers are assured that the care they arecovering is achieving the intended goal (s).Research has shown that this model can leadto extraordinary results in patients’recoveries. By applying measures thatevaluate treatment on a continuous basis, weare able to get feedback from patients, andsignificantly improve outcomes. Imagine ifevery behavioral problem, when measuredagainst the associated cognitive impairment,was defined by the resulting number – what’snormal? What’s above or below normal? Andwhat is the ideal care and treatment at eachlevel?

How is your organization usingperformance guidance to improve theclinical outcome of patients and giveclinicians better feedback, as well asimproving patient treatment? How arehealth care systems managing increaseddemands for patient data?

Tonmoy Sharma, Sovereign Health:Addiction and mental health treatment hascome under pressure to show effectiveness,and be more accountable to justify costs.One way to overcome these challenges is touse evidence-based practices and enhancetreatment quality, effectiveness, andaccountability. This model creates a systemof reliable and valid measurement of patient-reported outcomes during treatment in theclinical context in which care is provided. Weknow this works; more than a dozenrandomized, controlled trials, and severalmeta-analyses, have shown strong empiricalsupport for routine outcome monitoring inclinical practice. This shifts the emphasisfrom “evidence-based practice” to“measurement-based care.” Feedbackinformed treatment is the key. It is built on thepremise that patients deserve the best carepossible, and should weigh in on how theirtreatment is working for them. As such, atreatment’s value should be assessed byactual treatment outcomes. By focusingdirectly on the most important factor ‒outcomes ‒ informed care directly focuses onimpacting the quality of service, both inindividual practice and in large health caresystems. Several studies have shown us thatroutinely using patients’ self-reportedtreatment outcome questionnaires results inboth longer treatment length and significantlyimproved outcomes for at-risk patients ascompared to similar patients treated bytherapists who do not provide patients’ self-reported outcomes. It seems simple –outcome-informed care leads to improvedpatient outcomes by reducing treatmentfailures. But despite the studies, despite theacceptance that an evidence-based caremodel works best, less than a fifth ofclinicians and health care systems use thismodel. We need to change, and what bettertime than the present, with the media andlegislators focused on the national opioidepidemic? Measurement-based care is 21stcentury medicine at its best.

How can emerging research and sciencein the field of population health impacthealth and wellness?

Keykavous Parang, Chapman UniversitySchool of Pharmacy: This field of researchconsiders multiple parameters, such asgenetic, environmental, behavioral, andbiologic factors, and the interactions betweenthem in groups of individuals (e.g., commonrace, social status, country, workers) in atime period and across generations todetermine the health outcomes, such asmortality and quality of life. The data can beused to improve population health. Forexample, population-based cancer researchcan provide critical information thatdetermines policies and programs thatdirectly influences the public health in theUnited States each year. For example,population health research led to reducing anumber of people who smoke, the addition ofwarning labels on cigarette packages andenforcing public smoking bans. Thesechanges will continue to significantly impactthe public health and awareness.

Howard J. Federoff, University ofCalifornia, Irvine, UC Irvine HealthSystem: Medicine used to think DNA wasdestiny. Now it’s understood that theinteraction between genes and ourenvironment play a strong role in determiningwhether the gene that might causehypertension or diabetes gets turned on orstays off. You could have the gene for acertain kind of cancer or the gene for havinga heart attack early in life but, depending onyour lifestyle, your behavior, your exposureto stress and environmental factors likepollution, you could turn that gene off. That’sa powerful idea. If we expand this principle toentire groups, we can effect populationwellness on levels never before seen.

Some health systems are creatinginnovation and venture funds toencourage advancements in health careproducts and services. What has beenyour organization’s involvement in these,what are some of the key areas ofinvestment and how does yourorganization make its investmentdecisions?

Barry Arbuckle, MemorialCare HealthSystem: Strategic investments canaccelerate innovation in health care; improvequality and outcomes, decrease costs; andpositively impact patients and health careproviders. MemorialCare’s strategicinvestment funds offer a valuable gatewayfor entrepreneurs to refine and accelerateproduct development, and ensurecommunities access to the latest health careadvances. Summation Health Ventures, apartnership between MemorialCare andCedars-Sinai focuses on informationtechnology; technology-related health

“Medicine used to think DNA wasdestiny. Now it’s understood thatthe interaction between genes andour environment play a strong rolein determining whether the genethat might cause hypertension ordiabetes gets turned on or staysoff. You could have the gene for acertain kind of cancer...but,depending on your lifestyle, yourbehavior, your exposure to stressand environmental factors...youcould turn that gene off.”

Howard J. Federoff, MD, PhDVice Chancellor, Health AffairsCEO, UC Irvine Health SystemUniversity of California, Irvine





services and medical devices, providingemerging companies a powerful potential forvalue creation thanks to our diversity andstrengths. For two decades, MemorialCareInnovation Fund has fostered strategicpartnerships centering on health careprograms, services, medical devices andinformation technology. Accomplishmentsinclude investments focused on automatingfollow-up care connecting doctors, patients andcaregivers between visits with important clinicalinformation; technology that more accuratelymonitors blood loss during surgery;communications platforms that streamline andspeed communications among physicians,nurses and hospital staff; and technology toassess knowledge and create individualizedlearning paths to improve clinical performance.

What do you see as the greatest challengesfacing health care organizations and whatsteps are you taking to meet thosechallenges?

Mark E. Costa, Kaiser Permanente: All healthcare organizations are now challenged to movefrom a focus on solely caring for those who aresick to a focus on keeping our communitieshealthy. This has been the goal of integratedhealth systems, such as Kaiser Permanente,for over 70 years. And with this challenge, weas an industry are learning that many factorsimpact the health of everyone served, withsome being beyond the immediate influence ofthe health care organizations themselves.Some of the factors impacting the health of ourcommunities include, the safety of theenvironments in which we live; access tohealthy food and park space; access to jobsand a living wage, as well as available socialservice resources. These challenges can bestbe addressed by health care organizationsworking in conjunction with local government,nonprofits, and other private sector industries toaddress each of these high-priority needs.

Michael L. Lawhead, Stradling: Data privacyand protection is a significant challenge facinghealth care systems. As health care systemsand providers rely on interconnected systemsand technologies to manage patient care,hacking and data theft become significantlygreater risks, particularly due to the sensitivenature of patient information. Health caresystems must also be increasingly vigilant intheir efforts to comply with HIPAA. We will seeincreasing investment by health care systemsin cybersecurity and enhanced data systems,commensurate with their investments in othertechnological advances, to address thesechallenges and to protect patient data fromthese risks. We will also see health caresystems increase their headcount of skilled ITpersonnel to manage these processes andsystems.

Ray Chicoine, Monarch HealthCare:Delivering quality care is our singular focus andcommitment at Monarch. New regulations andmandates impact the way doctors practice,

particularly because they require moreattention to data collection. At Monarch, we areworking to take the heavy load of paperworkoff the shoulders of physicians so they canfocus on patient care. This addresses severalchallenges, including physician burnout. Datais important because it serves to highlight howbest to deliver care, especially for communitiesthat are underserved and vulnerable, such asthe frail elderly. Understanding data also tellsus that moving from a health care culturefocused on the “sick” to one of preventionmakes the most sense. That’s why we’veinvested in technology and advocacy toprevent diseases through increasedscreenings, communicating with our patientsand services that deliver savings down theroad for the patient, taxpayers and society.

Health care is an interesting and oftenfulfilling profession. What makes you mostoptimistic about the future of health care inOrange County? How will aphysician/clinician trained today bedifferent than those trained severaldecades ago?

Richard Afable, St. Joseph Hoag Health,Providence St. Joseph Health Southern CARegion Orange County / High Desert: Thefuture of health care in Orange County is verybright, primarily because we are focusing ourservices on the needs of patients andindividuals; we are moving from a focus on thestructures of health care delivery to beinglaser-focused on the needs of people. For thephysician, nurse and other clinical staff, thisfocus on the needs of patients providesfreedom from much of the bureaucracy andpolitics. Particularly, this freedom allows ouryoung clinicians to do what they do best, whichis to take great care of patients. This can onlybe seen as positive for the future of health careand our ability to continue to improve thehealth of our community.

Howard J. Federoff, University ofCalifornia, Irvine, UC Irvine Health System:UC Irvine is pioneering the future of inter-professional health sciences education withthe UCI College of Health Sciences, which iscomprised of the UC Irvine School ofMedicine, the UCI Sue and Bill Gross Schoolof Nursing, program in population health anddepartment of pharmaceutical sciences.Modern medicine still tends to look attreatment based on symptoms and anatomy.We are training health sciences professionals,including doctors, nurses, pharmacists andpublic health specialists, to instead take asystems medicine approach treating andpreventing disease. We will educate this nextgeneration to transcend current boundaries;foster clinical programs with an increasedfocus on lifestyle, prevention, wellness andoptimal health; and promote discovery of anexpanded set of tools and platforms thatfosters a systems approach to health,including all forms of evidenced-basedhealing.

“The future of health care in OrangeCounty is very bright, primarilybecause we are focusing our serviceson the needs of patients andindividuals; we are moving from afocus on the structures of health caredelivery to being laser-focused on theneeds of people. For the physician,nurse and other clinical staff, thisfocus...provides freedom from muchof the bureaucracy and politics.”

Richard Afable, MDPresident & CEO

St. Joseph Hoag Health,Providence St. Joseph Health

Southern CA Region Orange County /High Desert



an informative q&a with oc’s top health care …...a sponsored feature of the orange county...

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