From the PopHealth Week Archives: In this episode from December 3, 2020, PopHealth Week sits down with Tony Slonim, MD, DrPH, the president and chief executive officer of Renown Health, a vertically integrated, non-profit regional referral health system serving the northern Nevada service area, to discuss his unique lens on COVID-19 from four points of view: (1) patient (cancer survivor); (2) clinician; (3) administrator; and (4) public health practitioner.
Gregg Masters 00:31
This episode of PopHealth Week is sponsored by Health Innovation Media. Health Innovation Media brings your brand narrative alive both on the ground and in the virtual space for major trade show, conference and innovation summits via our signature pop up studio. Connect with us at www.popupstudio.productions. I'm Greg Masters, Managing Director of Health Innovation Media and the producer and co host of PopHealth Week. Joining me in the virtual studio is my colleague, co founder and principal co host at PopHealth Week. Fred Goldstein, President of Accountable Health, LLC, a Jacksonville, Florida based consulting firm, our guest today making an encore appearance is Anthony Slonim, MD, Dr. PH who's a fellow at the American College of Healthcare Executives and the President and Chief Executive Officer at Renown Health, northern Nevada's nonprofit vertically integrated Regional Health System. Dr. Slonim is a strategic motivated, outcomes oriented physician executive, his notable career spans complex healthcare systems from the federal government to the private sector, academic medicine and public health. He's developed a national profile as an expert in patient safety, Accountable Care, and health care quality, Modern Health Care named Dr. Slonim one of the 50 most influential clinical executives for 2019. And with that truncated introduction to a national visionary leader, Fred, over to you.
Fred Goldstein 02:10
Thanks so much, Greg. And Tony, welcome to PopHealth Week.
Tony Slonim 02:12
Thank you, Fred. Great to be here with you again.
Fred Goldstein 02:15
Yeah, it's a pleasure to have you on again, obviously much different circumstances from the last time we spoke, but why don't we start with give us a little bit of your background, because you really have some unique background that can provide some really good insights into what's going on right now.
Tony Slonim 02:27
Well, you know, I'll share a little bit about my clinical background, I was a nurse before I went to medical school, which gives me some interesting insights into how clinical care is delivered. I'm a physician and intensive care doctor by background and specialty, both for adults and children. And then I spent a significant part of my career getting some public health education serving in the Public Health Service of the commission Corps. And I think another important lens into the work that we're doing is I'm a cancer survivor. And that when you take those elements together, it gives you a variety of different ways to look at the healthcare system more broadly, and to inform the approaches that you take.
Fred Goldstein 03:12
Yeah, absolutely. Those different lenses you have from those four areas you spoke about, really provides some unique insights. So tell us a little bit about Renown Health and what that system is, and and then we can go on further into what's going on in Nevada.
Tony Slonim 03:25
Absolutely. Renown is a proud not-for-profit integrated delivery system, we're vertically integrated. We're one of only 100 health systems in the country with our own insurance plan. And so we're excited about that, not only do we deliver care to our friends and neighbors, but we help to ensure the way that they receive care. And we've got all of the major elements of an integrated system, we've got every major medical group, we've got hospice and palliative care. We've got homecare, and we've got a few hospitals in there for good measure as well. And so we like to stay we're a little bit of one stop shopping primarily for those that we're here to serve. And that's why it's been so important for us to aspire to the delivery of population health, because we are here and double down on population health every day, not only to treat people when they're sick and injured, but to keep them healthy, so that they may never need the services we're here to provide.
Fred Goldstein 04:22
Absolutely, and you serve a very large area of Nevada, correct?
Tony Slonim 04:26
That's correct. 100,000 square miles, you know, Nevada, Northern Nevada, in particular, is very rural. And that catchment area where the only tertiary provider between Sacramento and Salt Lake City and that is a huge geographic different distance. There's not a lot of people in between, but being able to handle remote based care and serve the needs which are different of that rural population is certainly important.
Fred Goldstein 04:54
And I know also that your facility has partnered, I believe it is with Stanford and does some work around that as well.
Tony Slonim 05:00
We have, you know, no matter where you are, at some point, you want to make sure that you have access to the ultimate in care and the way that you delivered it. And there are frankly, some patients who outstrip our capabilities, they may need transplantation, they may need services that were not able to provide her in Reno and always great to have a partner, you can just pick up the phone, and seamlessly for the patient and family transition their care to a world-class organization like Stanford.
Fred Goldstein 05:31
Fantastic. And let's now switch a little bit and get to COVID. We're in the midst of this pandemic, obviously, just got through the Thanksgiving holiday. I know all the states are really beginning to see a surge in what's happening in Nevada and in your community.
Tony Slonim 05:45
Yes, yeah. And, and you bring up an important point, Fred, because we know that healthcare is local, and depending on where you are, even within parts of Nevada, we are seeing differences in terms of surge and patterns and the way that goes. North Northern Nevada was pretty much spared earlier in the year during the first surge in May, June, April, May, June timeframe. But Clark County in Las Vegas was hit really hard. And then we've seen a little bit of reciprocal piece. As we've gone through this most recent started with us leading out with higher and higher rates of hospitalization and illness. And now it seemed as though Las Vegas is starting to follow as well. But we are seeing surges, where noticing our hospitalization rates are going up, we're noticing that more people are getting sick. And we've I think we're seeing less ICU care. But in the last week or so we've also seen mortality creep up a little bit. So we're keeping our eye on a couple of those measures, as we continue to move forward.
Fred Goldstein 06:44
And it's a really a fully integrated system. You talked about your payer health care, rural, urban, the whole baileywick, what have you done and set up to begin to work with this and changed as the pandemic has moved along?
Tony Slonim 06:57
Yeah, you know, I think one of the things that's been valuable for us is we've had the opportunity of foresight. So we watched the virus migrate from Europe first, early on this year, you know, over to the east coast. And again, we were pretty much spared early on. But we watched, we watched and we learned all of the things that New York and New Jersey and the East Coast was doing to protect their communities, and we learned from it. And so we knew that we had to get ahead of the testing conversation. So we invested heavily with the support of our board, in the testing space, purchased several machines, automated and manual invested in the lab. And last week did 7,000 COVID tests here. As we support our community and many of the other places in the community that need that testing support, we've actually invested very heavily because we were worried that we needed capabilities. From a space perspective, we converted two floors of our parking facility into an alternative care site that could house 1400 patients with negative pressure and plumbing and air flow and all of the rest of it. So that IT and technical support HVAC, all of that we stood that up in 10 days back in May cost us about 11 million dollars, and really allowed us to be there at the ready, you know, I sleep much better at night, knowing that I can care for many more patients than I currently have. And that preparation was important for us. The other thing that we've done most recently is we've continued to advance our work in hospital at home, we know that when given an option, people would much rather be in their living room, than in my hospital. And so we've tried to equip ourselves to deliver on that. We've set ourselves up so that we can provide in home monitoring remotely, and oxygen and other things. And if people's condition deteriorates, we can say to them, hey, by the way, time for you to come in, go to room 545. Don't worry about going to the emergency department, we don't want you to get into that chaos, go right to a room. And here's who you talk to when you get there. And so we're organizing ourselves at the population level in the midst of COVID we believe will help us come out of COVID stronger and support the needs of the community from a population health perspective. As we move forward to reach that aspi rational goal we have of Pop Health.
Fred Goldstein 09:25
As you've moved to some of these services that are off site and in the home health arena and delivered remote patient monitoring. Has that helped offset in situations where there have been a reduction, say elective procedures or things like that, to allow you to continue to provide care to individuals who maybe couldn't come in or didn't need it? Or didn't need it per the guidelines that they said?
Tony Slonim 09:46
Yeah, you know, it's an important thing that we have, I think, again, as we've all learned across the nation and probably across the globe, about how to manage in the context of COVID I think we we did some early intervention back in May, June timeframe about stopping surgery, etc. And now we're being more thoughtful and data driven in our approach. And so what we've come to learn is that actually the number of beds htat are taken up with post operative patients, that actually really small amount, like 4% of our total bed capacity. And the people that are coming in for surgery actually need it, if they delay, they're putting their health at risk. And later on, maybe you know if you have a cancer, the best time to treat it is when you and hope for a cure, is when its diagnosed. If we put off the needs of those people we may be setting them up up for a lifetime of risk that's higher than it would if we would have just done the procedure initially. And so I think we've learned as an industry how to better serve people with that. And so far to the degree that we can we've kept people, you know, we've kept people open.
Fred Goldstein 10:53
Yeah, that's fantastic. I sort of heard from a number of clinical providers and healthcare systems that this use of the term elective was perhaps a bit too broadly used at the beginning, when in fact, they really weren't elective type procedures they needed to come in, but they were held up because they sort of fell in under that category.
Tony Slonim 11:10
You know, I think that's true. And another area that we've come to learn about very deliberately, and I give a lot of credit, I've got a wonderful physician on my team. Dr. Wallach is the Chief Medical Officer of our what we call our Health Division, we have a Health Division, and a health care division, he operates the Health Division. And he shared with me a perspective a week or so ago that I really took note of, you know, we believe when we were going through this before that any person with an MD after their name would be you know pull them out of the clinic pull them out of their office space and put them in the hospital. Well, one there, that's not a setting in which they're used to operating. And so they don't know exactly where things are. Its not a practice thing to do. And just like the surgical example, if you stop delivering primary care, your poor diabetic who needs counseling to get their glucose under under control, will show up in the emergency room out of control, and much worse off than if you would have just kept those doctors delivering primary care. Primary care matters for the care of patients with chronic disease, and keeping them as healthy as they can be. So that they're not susceptible to the COVID virus. And they don't take up unnecessarily your hospital beds.
Fred Goldstein 12:24
Yeah, makes a lot of sense. I just happen to just see something and understand you're a pediatric intensivist. Is that correct?
Tony Slonim 12:29
Yes. And adult, intensivist.
Fred Goldstein 12:31
And adult, as you mentioned earlier, is that there was some study that showed that in a survey of parents, over 40% admitted that their children had not gotten appropriate vaccines in the most recent period, which is just unbelievable to consider as fallout from this.
Tony Slonim 12:45
It's so true, you know, we can't forget about our primary this is my public health hat talking, we can't forget about primary prevention. Screening, prevention, planning, all of those skills that you develop as a public health professional, are more relevant now than ever before.
Fred Goldstein 13:05
And given that public health hat that you have with your doctorate in public health, how do you how are you looking at this now? What do you see? And as you watch how we're handling and working with this virus?
Tony Slonim 13:16
Yeah, you know, I think that public health is one of those interesting things I like to say it's, it's kind of like insurance, you don't need it until you need it. Right. And so, as a result, over the course of decades, we've not invested as a nation as a state as, as counties in public health infrastructure, because every time there's an opportunity to go through a budget analysis in the spectrum of health, people say, Well, you know, do we really need that kind of protection? Well, you don't need it until you need it. And we need it now more than ever. And so the fundamentals of public health practice, again, screening, risk factor identification, prevention, planning, are all of the elements that are needed, now more than ever, the problem is, you can't just, you know, open up a book on the shelf and pull it out when you need it, you need to have the infrastructure in place. And I think one of the things we've learned about in the pandemic is that we have not nearly the infrastructure and public health that we ought to have as a nation or as a state or any other local jurisdiction.
Fred Goldstein 14:28
And how has the community been in Nevada in terms of I'm in Florida, we have a governor who essentially has the least number of rules placed on the community, in terms of trying to follow through with the safety guidelines. How has it been in Nevada and how is the community responded?
Tony Slonim 14:45
Yeah, I think Well, we've been very fortunate to have a governor who has made some difficult decisions, particularly in a state that historically has been economically dependent on the hospitality industry and traveling to many. And, and so you know, closing businesses is not something that any of us want to do. I mean, I'm a doctor, but I'm a businessman as well. And, you know, we want to make sure that we're supporting our our colleagues more broadly. And nonetheless, there are hard decisions that had to be made, and he made them and we call that leadership. That's, that's what you do when you lead. I think that we've been very fortunate that all of our elected have been so supportive of the work that we've been doing. Coming to bat for the frontline healthcare worker, and the first responders EMS, our police force, the things that want to do, I have a daughter, who's a police officer in Virginia, and you know, these folks are at risk every day. And you know, I'm a doctor, but I haven't seen patients in a while. And I remember what that was like when you walk into the ICU. And no matter how much garb and protection you take, who knows, there is a small but quantifiable risk of transmission to you. And you, you signed up for it, but you may take it home to your family, and they didn't sign up for it.
Gregg Masters 16:11
If you're just tuning in, you're listening to pop Health Week.Our guest is Dr. Anthony Slonim, the President and Chief Executive Officer at Renown Health a Reno based vertically integrated nonprofit Regional Health System serving the northern Sierras and beyond.
Fred Goldstein 16:29
And I know you know, years ago I actually worked at Harrah's Casino in Reno washing dishes one summer, and that the state really is reliant on that hospital in that industry and hotels, etc. How badly have they been impacted by this?
Tony Slonim 16:44
Terrible I mean, it's been it's been a real crunch here. In the last year, we're really separate here in Reno from the Las Vegas community. What we know is that there's the Las Vegas economy is still very dependent on hospitality and gaming and the rest of it. And the newest word our economy has diversified a bit over the last decade or so. And I think that, at times like this, that diversification matters, because it's not only about it's not that we're by any means our friends and neighbors in the hospitality industry, their suffering they've suffered, and our community in a variety of other ways small businesses have suffered. But it's nice to know that we've also got logistics companies and tech and other areas that support the economy differently than we had historically.
Fred Goldstein 17:36
Are there issues you see unique to Northern Nevada, you talked about the rural community? And and that is, is there a variance in impact of the illnesses you're seeing it between the rural and urban communities in Nevada?
Tony Slonim 17:48
Well, you know, it's interesting for me, I think that the most amazing things to look at, as you're contemplating health in the rural environment. And I've written some, I've done some studying and written some work on this, the rural environment is an amazing place, because the people that live in those spaces, and the frontiers are very proud and very thoughtful in how they approach life. They they make commitment, and decisions that are something to honor in many ways. And that's that same mindset of pride and commitment they bring to decisions like health and health care. And so they may not have a hospital, immediately available to them, they may only have opportunities for access to health care, that are with a general physician or not a specialist and they make do with what they have. That's what it means to live in the frontier. And so you come to honor that and take pride in that in many ways. And I think for the longest time they were immune, because the environments are small , you know, they were able to keep themselves isolated, not have people with COVID go in, that's kind of over now. And so when you think about the four major challenges experiencing a rural environment, is access to workforce, right an educated and experienced workforce and access to capital. Its manpower issues are always important. And importantly, you know, its the context in which you work, where you've got to make sure you don't have a lot of extra resources and resource constrained by definition. And those four challenges experiencing the rural environment, play themselves out and are accentuated in the context of COVID. Because you can't implement infrastructure just in time, you can't have access to capital, capital is more constrained now than ever, you know, the workforce is constrained. You can't get that and for things that were scarce in the rural environment before they're even more scarce now. And so wow, it's a complete setup for this very difficult times as people go about trying to experience health and healthcare in those settings. And how we hope to support them as a is something we really have to focus on as an industry
Fred Goldstein 20:11
And have you had to make some transitions or thought through some transitions, like in that area, for example, with maybe these dispersed primary care practice or things like that, to try to get resources out there.
Tony Slonim 20:21
Yeah, I think, for us has been helpful because we've been investing in infrastructure for a while around telemedicine. And so you can more easily roll those things out. But frankly, you know, I can't, I can't operate on somebody's belly from Reno . And so, you know, if I got to take that Appendix out, I need somebody on the ground who's got the skills and the techniques to be able to do that we, you know, early on in COVID, when lots more people were going on the ventilator. We said, well just get ventilators out to the rural environment. Well, there's nobody who knows how to run one. And so you need the workforce with the experience to be able to draw on and the kinds of care that they it's not just, we're not talking about a doctor, a doctor has to be supported by a nurse and a respiratory therapist and a pharmacist and technicians in a team based model, that you just can't flip a switch and have occur. It's got to be planned for and executed methodically.
Fred Goldstein 21:20
And you bring up a great point. And that's the workforce themselves. How is your workforce doing? It's been so stressful around the country for individuals in health care?
Tony Slonim 21:28
Yeah, you know, these are difficult times to people. I'm one of the things I just shared our morning briefing, one of the things that keeps me up, one of the things I'm trying very hard to figure out is how do we, as leaders go about continuing to support our people from behind. It's emotionally and physically taxing to go to work every day, care for people in an environment where you have to garb above, have the anxiety yourself about whether you might catch this thing, and go about understanding how you can bring your A game to the bedside and care with a caring and sympathetic approach to the person who sits in front of you. When they're going through it themselves. And so, I often put myself, you know, my cancer back from my experience with cancer myself, has put me in a patient lens. And so I'm often kind of trying to frame this conversation in that way. And my father died of COVID, back in April. And so I look at this as someone whose father was hospitalized in an intensive care unit, we couldn't visit, you know, that week, when my father died, his ICU team, his doctor told me, they had lost three staff members from COVID people who were there to consult on patients and caring for patients. And she was as sweet and sympathetic, and she could ever be in this position. But it's not easy this is not what we're used to in American health.
Fred Goldstein 23:00
Right? Well, you just talked about another unique lens you have into this problem. So sorry to hear about that loss.
Tony Slonim 23:07
Fred Goldstein 23:07
Unbelievable. And also, obviously, for the workers in the health care system. Have you as you gone through this work with other hospitals? Are they pulling together and sharing ideas and techniques, etc.
Tony Slonim 23:17
Without a doubt, you know, I think the one bright spot here is that you're seeing more collaboration, you're seeing more opportunity for sharing of information and resources than we ever have before. I know in our community, we've had our sister hospitals step up like never before and say, Hey, if you need personal protective equipment, or you need ventilators, or you need staff, let's come together to figure out how we combat this. We're we're not here to fight individually, we're here to fight together. And that's what we're trying to do for the community.
Fred Goldstein 23:49
One of the things that happened, obviously, you mentioned the garage, and reconstructing the garage and putting in all that incredible network in the in the air handling, etc, to make that available for your patients, obviously, that also more recently was in the news in an unusual way. Can you talk about that and how that's impacted what you're doing?
Tony Slonim 24:08
Sure. So, you know, we felt as though and I think it was important for us to make sure we could sustain what we need for the benefit of the community, no matter what came our way. And so we built out these two floors. As we previously discussed yesterday, the president tweeted in some ways, as you know that this was a fake facility. And nothing could be further from the truth. Yesterday, we had 40 patients housed in this makeshift hospital, which is a parking, you known ordinarily functions as a parking garage. And I think, you know, we've got our head down and all of our communities, physicians and first responders and nurses have their heads down trying to do the best we can under unconscionable circumstances. And so the President's tweet was a bit of a distraction and doesn't help while you're in the heat of battle, trying to support your team, with anything that they may need, it actually pulls away and dishonors the people who are putting their lives at risk, to serve the needs of their friends, their family and their neighbor. And while the President was fortunate to be able to get through his experience with COVID, unblemished, it took my father's life. And I bring that passion to work with me every day as sort of my community, so that we can make sure we're doing what we can for those who may not be as fortunate. And so we'll, we'll do that. That's our work. And we'll do it every, every single day, we're honored, you know, your call to healthcare, which is different, I think, than many other industries, when you choose healthcare, as a career, regardless of what your background and discipline is, if you're an accountant, if you're, you know, obviously, if you're a physician or a nurse, if you are a facilities person, you get called to healthcare differently than you do other industries. And that may be something that is just not more broadly understood by those who are criticizing, but I feel comfortable and confident that we've done the right things to protect, hey, nothing would please me more Fred, than never have to use that parking garage, that will still be $11 million spent for good, because even though it's not wasted money, it's the right thing to do. Because I can't stand it up, it took me 10 days, I won't be able to stand it up in 24 hours when the call comes in, I need it. And so that's what we do in public houses we prevent, and we screen, and we keep our head down, we do the work.
Fred Goldstein 26:44
Well, I really want to commend you and your entire team at Renown Health for the effort you've put in. It's it's really fantastic. Is there anything you'd like to say to the community here before we close up?
Tony Slonim 26:55
Well, you know, I think that Thank you, and thank you for having me again, as a guest. The one thing that we are, are sure about now more than ever, is that in healthcare, it's the people that make a difference. On some days, there may be nothing more you can do than hold someone's hand and tell them it's going to be okay. And you may not be a family member who's doing that right now, because patients and family patients may not be able to get visitation from their family. But know that there are health care workers who have heart and who bring that heart and caring to work every day to share that love with your loved ones. You know, they're the real heroes in this. We're just here to support them from behind the scenes.
Fred Goldstein 27:39
Well, thank you so much, Tony. It's been incredibly profound talking with you today.
Tony Slonim 27:44
Thank you, Fred. Great to be here.
Fred Goldstein 27:46
And back to you, Greg.
Gregg Masters 27:47
And thank you for that as the last word on today's broadcast. I want to thank Dr. Anthony Slonim President and Chief Executive Officer at Renown Health, Northern Nevada's vertically integrated nonprofit Regional Health System for his time experience on the front lines of the covid 19 pandemic, including very personal insights today, Tony, we grieve with you over the loss of your father to this virus. May he rest in peace for more information on Dr. Slonim or Renown Health's work, do follow him on twitter via @Renown R E N O W N @CEOTonyMD and Renown Health respectively. And for more information on Renown Health go to www.Renown.org. For PopHealth Week, my colleague Fred Goldstein and Health Innovation Media, this is Greg Masters saying we will only get through this fall and winter season if we tow the line on social distancing proper hygiene and by all means do wear those masks and appropriately so when in public. Bye now.
About the Hosts
Fred Goldstein is the founder and president of Accountable Health, LLC, a healthcare consulting firm focused on population health, health system redesign, new technologies and analytics. He has over 30 years of experience in population health, disease management, HMO and hospital operations. Fred is an Instructor at the John D. Bower School of Population Health at the University of Mississippi Medical Center and the editorial Board of the journal Population Health Management.
Gregg is a seasoned senior healthcare executive, having provided leadership and consulting support for hospitals, health systems, capitated medical groups, IPAs, PHOs, MSOs, and several hospital/physician managed care joint ventures. He is Founder & Managing Director at Health Innovation Media, the publisher of ACOwatch.com, and is consistently recognized by his peers as a thought leader in healthcare social media via @GreggMastersMPH