[00:00:00] Chanda Smith Baker: Hello Community. You are listening to conversations with Chanda where leadership gets real and personal. This is where we cut through the noise to confront the issue shaping our world and our community from power and justice to the heart of community change, hosted by me, Chanda Smith Baker, president, and CEO of the Saint Paul Minnesota Foundation.
Before we get into today's conversation. I wanna set the table. Healthcare is something that touches every single one of us. As parents, children, caregivers, and patients, while we don't think about it every day, we do when the moment comes that we need it, and when those moments come, they're often filled with vulnerability.
As President and CEO of the St. Paul and Minnesota Foundation, I think a lot about systems and how we improve them and make 'em accessible for everyone. The same is true as a board member at Allina Health. What it has made me understand more deeply is that healthcare is not just a system, it is a system made up of people.
That are caring for people as they navigate every day, the challenges of wellness in those hard moments, the doctors and nurses are the ones that navigate with our families, who hold our hands, who listen to our fears, and to help our bodies heal when we cannot do that alone. The conversation right now in healthcare is around the cost, the politics, the pressure, the closures, the strains, the gaps.
All of that is very real. But within those systems that are experiencing those strains are the people that show up every day and do their very best. You are gonna hear a story today from someone who I get to work with, Bridget. I came into work one day and asked her where she had been, and she began to unfold a story where she had to spend a number of days at the hospital.
And it just so happened that it was at Allina Hospital and she began to share the story and share how she was cared for, and I wanted to bring her story into this conversation because it is the human side of the system that we are working so hard to make sure is accessible. Her story reminds me why these conversations matter, why leadership matters, and listening, and that the future of healthcare belongs to all of us.
So I invite you into today's conversation with an open heart and an open mind, because we're not just exploring policy, we're taking care of people. And the better we do that, the better the possibility of building a healthier, more equitable future for our state.
[00:02:35] Bridget Rosario-Vega: I started off as, uh, the receptionist and I was looking for a job that was more challenging, uh, just newly sober.
So wanted to, uh, get. My feet wet again. When Jennifer Ford Reed started, I was, um, promoted to be her admin assistant. So I worked with, uh, Jen for two years and then she obviously went off to the Bush Foundation and promoted me to the role that I'm in now, which is Senior Grants Administrator. So I do all the processing of all the donor advised funds, which is so much fun.
I just love my job. I love the people I've met here, lifelong friends. Um, and just the work that we do, you know, learning what a nonprofit was was very enlightening. Once I started learning what we did, it was even more empowering for me to just be in this role. How great is it that I'm your CEO? It is the best thing ever.
Black girl magic.
[00:03:35] Chanda Smith Baker: Right. Alright. That's why I, to hear, that's what I wanna hear. I noticed that you weren't around. Mm-hmm. And then, um. There was a day you sort of appeared mm-hmm. And I asked you where you were. Mm-hmm. So where were you?
[00:03:52] Bridget Rosario-Vega: I was at the hospital. Um, hadn't been in the hospital since I had my kids, so, um, I was very, very sick.
Didn't know how sick I was until I went to the emergency room with really bad abdominal pain. Um, so they did a CT scan, scanned my stomach, and found out that my bladder was very, very inflamed. And, um, they. Admitted me in the hospital.
[00:04:19] Chanda Smith Baker: What hospital did you go to? To United. United. And so you told me you were at United.
Yes. And I'm like, oh, that's an Allina Hospital. Yes. Yeah. And I'm on the Allina board. Mm-hmm. And so, um, as you were on. Folding the story of this difficult moment that you had. Mm-hmm. I was just sharing that, you know, sometimes we look at healthcare from like this, like expensive, which it is, um, you know, system of care.
But we look at it almost from that point of view. And at the end of the day, it's about how you're treated when you show up somewhere. Mm-hmm. And so you were treated well.
[00:04:57] Bridget Rosario-Vega: I was even in the, um, emergency room, which is very chaotic in there. Um, what they do is that they check you in and they ask you all these questions, were you hurt?
Has someone hurt you? Like, and they were very thorough. Um, so once that was done, then I had to wait for a room, um, to open up and, you know, I was in the, um, emergency room area for a little over an hour in pain. Um, just trying to keep it together until. Um, you know, they took care of me. I wasn't expecting to stay for five days.
Hmm. Um, so once they put me in my room, I was able to look out the window and I saw the St. Paul Cathedral. Hmm. And I thought, okay, God, this is. This is in your hands. I don't know what's going on with me. So I had an IV in my left arm. Um, I had a catheter put in, um, which was the most uncomfortable thing.
Mm-hmm. Ever. Mm-hmm. Um, and dependent on these healthcare, um, nurses that came in and actually really took care of me. So. After the, why did you use the word actually? Well, because there, I think if you don't like your job, there's gonna be some, there are some people that aren't gonna do it well and they're that aren't gonna care.
They're just there for the paycheck. Um, but every single nurse that I had. They cared, and I think they're just unsung heroes really. So after my first couple of nights, I started taking, um, I started writing all their names down and my, my, I just had like a pen and I don't know, an envelope in my purse and I just started writing their names down.
But there were two that stood out. One of 'em was a male nurse from Africa named Dennis. And I had a kind of a mental breakdown. Um, you know, because I'm usually the one taking care of everybody. Mm-hmm. I don't, I'm not used to being taken care of. Um, so being put in that vulnerable position was really hard for me.
Um, and he's like, it's gonna be okay. You're gonna be fine. He's like, let's get you. You know, cleaned up and we'll put you in a different spot of the room. So he had me in, um, the recliner and I was able to see outside. And um, so he just was really thoughtful and sweet. Um, and then there was this night nurse Janelle, um, that was handling a very bad patient across the room.
A lot of swearing mean things that were being said. So she handled that really, really well and I was really scared. So she came in my room and, um, she's like, nothing's gonna happen. Um, they're not able to get up, so you're fine. And just made me feel safe. So, um. It was just wild. Um, to be in a bed. You can't get up unless you had someone help you get up.
Um, and they just really took care of me. So those two nurses were the best ones that I had while I was there. And then the doctor too, she was amazing. Um,
[00:08:08] Chanda Smith Baker: I remember telling you, I'm like, I wanna tell Lisa Shannon. I mean, I know that, um, those, those care providers. And administrators get to hear stories all of the time, but they're just emerging everywhere.
And we're in a time where there's so much vulnerability mm-hmm. Around healthcare and, um, this idea that every single person in our state may not be able to experience it,
[00:08:30] Bridget Rosario-Vega: it's just a huge problem. It is. I felt very fortunate that I had insurance and that I was able to, um. You know, not pay this astronomical number of dollars that you have to pay.
Um, there's still pay, you have still have to pay. Mm-hmm. But not as much as it would be if I didn't have insurance. So, um, you know, I'm grateful for a good job. I'm grateful for great benefits, um, and I'm grateful for those nurses.
[00:09:00] Chanda Smith Baker: You talking about the hospital visit and like when you're sick, it's like a super vulnerable time.
It is. It is crazy hard. Mm-hmm. And so, you know, you get in those situations and you encounter one person with an attitude, right. It can just shut you down and then you won't even say everything that's going on in your body. Right? It's like you go into places and they don't listen to you.
[00:09:21] Bridget Rosario-Vega: Mm-hmm.
[00:09:22] Chanda Smith Baker: Right. Or they think they have the solution without fully understanding what you're going through.
Yeah. Mm-hmm. Yeah. So I'm glad you were hurt.
[00:09:29] Bridget Rosario-Vega: Yeah, I was. I was well taken care of. Thank God. I had had some angels up there looking after me. Good. Honestly, believe that. And it's seeing the cathedral too, right outside my window. Oh. So blessed. So thank you for having this conversation with me. Um, I guess it's not as nerve wracking as I thought it was gonna be.
It's not
[00:09:49] Chanda Smith Baker: really good deal. Anything you wanna say to the nurses or, and the rest of 'em before we, uh.
[00:09:55] Bridget Rosario-Vega: I just wanna say thank you and I'm forever grateful. I wish that I could go to them and bring them some food and, you know, donuts or something and just show up and, and, and do something like that. But they all work different hours and, you know, night nurses, day nurses, um, there's a lot of turnover.
I don't know how they all keep it together. Thank god that they write their names on the board. Mm-hmm. Um, but I just wanna say thank you forever grateful.
[00:10:22] Chanda Smith Baker: Good afternoon, and thank you tne. I need, I need some of that energy, um, around this conversation. Thank you so much, uh, for being here. Um, it is my privilege to be in this conversation.
Uh, today I am wearing, uh, two hats. One is, uh, the role that TNE described. I am. The new president and CEO at the St. Paul and Minnesota Foundation. I also sit on Allina's board. Oh. Um, so it gives me, um, just a unique, uh, opportunity to look at sort of the intersection of health equity and wellness across the state and how these pieces must come together for us to create a more resilient and healthy community and healthcare system across our state.
Um. It is way more complicated, way more complex than I ever understood until I got around the table. And so today's conversation is just a little attempt to bring some new knowledge, hopefully, to you about what we're facing in healthcare. So Lisa, thank you for agreeing to spend your Saturday with me.
[00:11:30] Lisa Shannon: Oh, my pleasure.
[00:11:31] Chanda Smith Baker: Awesome. So we are gonna jump right in and talk about the unique challenges of healthcare. Um, what is happening locally and nationally that we need to understand. And, um, you know, what, what I can say is watching you Lisa, through, um, some really. Complicated systems, right? I'm, I'm entering into a new role in learning everything and the amount of things that you have to know in healthcare is pretty incredible and you seem to have it down.
Um, pat and I watch you do that with ease and joy. And so I guess I'm just gonna start out with a little bit of a question around joy is sort of how are you keeping yourself sort of grounded in the middle of a lot of, um, complexity and uncertainty?
[00:12:14] Lisa Shannon: Yeah. Well, thank you. And you know, when your boss, one of your board members says, do you wanna come hang with me on a Saturday?
There's only one answer. And I, um, I'm thrilled to be here. I love talking about healthcare. I've spent my whole career in healthcare, as you know, and, um, started clinically as a dietician and been in leadership for most of it. It is not hard to find joy in healthcare. What we get to do for all of you, for my family, for me, is make people well and prevent disease, and there is a lot of joy in that.
I'd say the people do often ask against a really challenging, I'm not naive or pollyannish about the really big challenges that we're facing. We faced them for a long time, but it's really coming to a big head right now. What is the one thing I do that most gives me the energy? And it's what I did on Wednesday and where I was on Monday, which is when I get to spend some time with our care team, with our nurses, with our doctors, with our ancillary team members, and see what they do and the benefits they provide for our patients.
It's, uh, energizing every time.
[00:13:25] Chanda Smith Baker: When I think about healthcare, I think a little bit, um, like I do with education where we have all been through the system at some point and we have an opinion on it. And so when we're looking at what is in the news, often our lens is more towards a personal health perspective.
How should we be thinking about what's happening in healthcare right now?
[00:13:46] Lisa Shannon: Yeah. Um, I think that's a really good question. So I wanna amplify what you said. So I've been. In healthcare my whole career, most of us in healthcare have, uh, we train technically, clinically, or we're in leadership roles and we get the great privilege of leading services that the people we love most during their most vulnerable times.
Receive. I can't think of a better thing that you could be more committed to. It is really complicated right now. So we talk a lot. Um, I talk with my team a lot about two things that are completely opposite. Are happening at the exact same time, and we have to hold them in each hand. So on one hand, I know we're gonna talk more about this, it's the most exciting, innovative, um, curative time in medicine.
On the other hand, it's the most vulnerable, frightening, and worrisome time from a business model and economic and coverage perspective. And so as we navigate. These two opposites that are true at the same time, we have to do that with, um, what's top of mind. And that's what does our community need from us?
What are we really good at and how do we create a sustainable future? 'cause a lot of us aren't currently in a sustainable position.
[00:15:16] Chanda Smith Baker: Yeah, so what is happening in Minnesota? Like we're seeing a lot of, of movement and concern and financial challenges and, and you know, if I had my personal head on, I would say I'm, I'm paying a lot of money for healthcare, but it is not showing up in the bottom line apparently.
What, what, what is happening?
[00:15:34] Lisa Shannon: So maybe if it's okay, I might start nationally. What's happening? Yeah, please. So, um, we are facing, um, breakthrough innovations that cost a lot of money, whether it's new drug therapies, uh, for weight loss, whether it be new. Therapies for technology and equipment, um, rising labor costs in healthcare coming out of the pandemic, the public health infrastructure, most of our communities was already challenged and boy it really afraid.
Then you look at that combined with the economic challenges that, um, been facing. And when I say healthcare, let me define it. So healthcare of course includes insurance companies, pharmacies, medical devices. When I'm talking about it, I'm talking about hospitals and health systems and doctors and clinics and what we do in home, and all the things that are direct patient care and those direct patient care areas for my whole career.
Um, government reimbursement. Has not paid for the cost of the care, and therefore we shift the cost of care to commercial payment and that then causes an imbalance. And when the. Cost of the care isn't covered and the government reimburse, or excuse me, the percent of government pay is increasing. You get a math problem of epic proportions.
And here in Minnesota, we're a bit worse off than some other states. And part of that is we lack some reimbursement programs that other states have. And it's technical. I won't get into all the details of it. But we also have an environment where our community in the country, about 11,000 people are, um, aging into Medicare every day here in Minnesota as a percent.
Of that total, we're aging a little bit faster, and so that is creating some extra pressures for not only the hospitals, but we are also seeing some of those pressures for some of, especially our nonprofit payer colleagues as well.
[00:17:59] Chanda Smith Baker: What do you think is most at risk
[00:18:02] Lisa Shannon: right now? So, um, let me talk about what I believe. So, I believe that healthcare is a human right. I really believe that. I believe education is, I believe healthcare is, and I've spent my whole career really working to provide access to care regardless of an ability to, uh, pay for that care.
At when I think about what most of my colleagues and I have the opportunity, um, real privilege to serve on a national organization that represents 5,000 hospitals and health systems in our country. Most of us are fighting for our lives to keep care. Available and the care that is most vulnerable is the care that requires subsidy from us.
And that's a lot of it. It's in primary care, it's in mental health, it's in obstetrics, it's in a whole host of services. It's most of the medicine. Versus the procedural areas based upon the economic model that exists in our country right now. And so when we talk a lot about when the OBBA was passed, um, and signed in July, that that's creating huge risk for, um, I mean, it's taking $1 trillion out of healthcare and people are really worried about rural healthcare.
Me too. And. It's not just rural healthcare. A lot of our Medicaid recipients are in the metro, they're in the cities. So it's a both and. And when I think about what I'm thinking all the time, it's how do we keep our services available? For the community and be smart about choices we're gonna have to restrict in certain areas of our community.
We don't have a choice. If we don't make those kind of decisions, the whole will be harmed. And so we're, um, really in deep thought and planning to do just that.
[00:20:12] Chanda Smith Baker: Yeah. We'll, we'll get to innovation in a second. I do know, and I'm thinking now about a particular community that maybe has some vulnerabilities, those with mental health issues.
And so we have the lack of in infrastructure on one side, and I know that they're showing up folks that are struggling. And their families are coming to emergency rooms. And so when you're talking about vulnerability, what, can you just walk us through that one particular segment of our residents?
[00:20:40] Lisa Shannon: Yeah.
[00:20:40] Chanda Smith Baker: And what that looks like.
[00:20:41] Lisa Shannon: Yeah, for sure. So there's only one clinical door. In our community that's always open 24 hours a day, we never close and it's our ERs. And so in our communities, um, individuals who are in crisis as we know are in increased, um. Per percentages, they are entering the eds and we're doing our very best to provide the care that they need, and we have exceptional care.
I'm really, really proud at Align Health and all my colleagues around the community. That said, sometimes people end up in our ERs because. They don't know what to do. We've had family members drop off children who are neurodiverse because they're at their wits end and they don't know what else to do.
And those patients as they enter our hospitals, aren't necessarily. They're for medical care. They're there for social and support services. And if you've ever been in a hospital, we do our best, but we're a little noisy. We got a lot of bells, we got a lot of things dinging. We have a lot of lights, we have a lot of people.
And if you are. Um, on the spectrum or you have neuro differences, that's not the most soothing place for you to be. And so if you hear nothing else, we have to have a partnership with community, with our hospital systems, with our government, with philanthropy, which I, you're deeply involved in. So mental health care is something we do a lot of and it's clinical.
There are a lot of clinical ways that we can treat mental health. Many of what enters our hospitals though go beyond medical need. There are behavioral or other issues that families are really struggling with.
[00:22:40] Chanda Smith Baker: Yeah. And so, you know, we're talking about sort of an ecosystem of care here, a little beyond Allina's scope.
And if I were just to play that all the way through it is ca it, those caring for those patients are not reimbursable. Correct. That's correct. And um, and you have a duty to care how many populations of people does that run? Like, what is a percentage of of patients? Could you respond to that in terms of
[00:23:12] Lisa Shannon: Well, maybe reimbursement?
Yeah, maybe I'll give a couple examples. So we have, um. Individuals who are behavioral or neurodivergent that come into our facilities. And we could have, um, in any given day, you know, 20, 30 up to a hundred of those patients. We also post pandemic, had individuals in our hospitals that were ready to go home or ready to go back to their original site of care, and that was a nursing home.
Or a skilled nursing facility. At the peak of that, we were essentially housing and I, I mean that respectfully, housing patients who were no longer needing medical care in the tune of about 120 of 'em a day throughout the Allina Health System. Imagine. That's a very large community hospital without reimbursement that our amazing and skilled nurses and doctors are taken care of, but there's no payment for those.
So it's a real strain in the system. We've worked really hard to collaborate with our. Facilities and partners and community to reduce that. And yet we face it every day and it's a privilege to be open every day around the clock. We never close. We're always there, and it's an outsized responsibility when the economics are challenged, it creates great vulnerability
[00:24:40] Chanda Smith Baker: for, for this particular issue, is there maybe one thing that you would want the audience to maybe understand or take away about this issue?
[00:24:48] Lisa Shannon: Yeah. Um, we need a lot of partnerships and a lot of collaborations. We need all of us thinking about what are different, new, innovative ways to serve these patients, and particularly these families that are trying to wrap around, um, services. We think we're a part of the solution. We just can't be the only solution.
[00:25:10] Chanda Smith Baker: When I, um, sit in the boardroom and had the opportunity to tour some of the Allina sites, I often think about the, the challenge that we just raised, where you have, um, costs associated with services that aren't reimbursed and it's creating a financial burden. But it is a system that is dependent on innovation and advancement to save our lives.
Yeah, that is a real tension. Um, and I wanna just spend time, so now we understand this piece, but let's talk about the innovations. What are you the most excited about there?
[00:25:44] Lisa Shannon: Yeah, thank God we got to this. This is the part I've been waiting for. Um, there are hard things, and again, we have to navigate them.
This is a time of medicine like none other. I am, and you hear me. I am super excited about what's happening in medicine. The things that my parents who both passed in my tenure at Allina Health, um, suffered from at the end of their life, the things that their parents suffered from. My children and grandchildren may not because of the innovations that are coming in.
Give you a couple examples. So we now have at every single CT scanner, throughout all Allina Health and our partner hospitals, um, advanced analytics that are supporting ai, that are supporting our physicians to detect a stroke. And let me tell you what that looks like. That looks like an 18-year-old who passed out.
Who families worried about Why did they faint? Brought into one of our ambulatory ERs, um, got a CT scan and what used to take two hours, took six minutes. And in six minutes that child, that young woman, was having a massive brain bleed. It was having a stroke. We transferred that child to our Abbott, Northwestern.
They walked out of the ed. We were able to eliminate that blood clot and that young woman was a daughter of one of my doctors. These are the kinds of things that we're getting to do because of new technology. We now have, uh, only one of the Twin cities Incisionless brain surgery. Yep. That's what I said.
Incisionless, it is a focused ultrasound procedure that is an outpatient you can come in. Um, it is curing Parkinson's and non-essential tremors, people who have struggled their whole life. And we have, um, well north of a hundred people on a wait list right now. That was never possible. I saw technology on Monday.
Essentially, I'll spare you all the technical names. It essentially was an ablation of solid tumors and liver. Um, instead of a massive liver surgery to remove a tumor, we may be able with this very focused ultrasound, essentially burn and ablate the tumor. It's an exciting, exciting time. I mean, we are discovering, despite.
Our challenges, we're really discovering things that were just never possible, um, before, and it's accelerating. Now. We have to find a path to fund it.
[00:28:30] Chanda Smith Baker: Yeah. Is there anything that we need to take away around our focus and support of innovation in healthcare?
[00:28:38] Lisa Shannon: Yeah, I, um, we need science to be really, really strong in our country.
So thank you all for standing with science. We need, um, I need, I'm gonna make a plea. I need our doctors and our nurses to know you believe them, you trust them. You bring your questions, your smart questions to them, and in that spirit of innovation and support, always ask. Always push us. Always explore if there are alternatives.
But as you think about what we're trying to do in community with and for everyone, let's see if we can't find a way to, first thing is, how do we prevent disease that's always best? How do we detect it early? That's better. Uh, because when we delay care, and sometimes that's related to coverage, people can't afford it.
We see what we saw, um, after the pandemic where we saw disease more profound. So I would just ask all of you, it's the same answer. We have to do this together. No one part of the ecosystem can do it alone.
[00:29:45] Chanda Smith Baker: Mm-hmm. I'm glad that you brought in, um, the, the team that you work with, and I, I wonder if you can help us put a perspective on how we should be thinking about the team in ai.
Yeah, so I hear some people that think, you know, AI's coming, they're coming to replace people. Um, you know, should we be concerned about it? AI didn't just show up in healthcare. It's been around for a long time, but we're hearing about it now differently. So how should we be thinking about. Um, the team and some of the advancements particularly related to ai.
Yeah.
[00:30:17] Lisa Shannon: Um, I bet every one of you in this room know there's a healthcare shortage, there's a nursing shortage, there's a physician shortage. It's profound and we haven't seen anything yet. So if AI can help our nurses and our doctors, which I believe it can work at top of license. We're gonna do a lot better than we would otherwise.
Um, our country does not have enough caregivers and what we see it, I see it, I almost wish it wasn't called artificial, but almost augmented or assistive intelligent because at the end of the day, it's still gonna take, uh, clinician, we know that we have some of the most amazing radiologists. Any place I've ever lived here in Minnesota, they catch the smallest of concerns on advanced imaging procedures, and yet we put in AI for lung cancer screenings, and we picked up four more tumors, 400, pardon me, 400 more tumors that the naked eye just could not see.
Now that required those expert physicians validated that's catching disease, uh, the earliest possibility. So I see it assisting our care team and the reality is we do have to drive our costs down. We aren't gonna have enough labor. So the both and should come together. Very good. Any questions in the
[00:31:42] Chanda Smith Baker: audience?
Yes.
[00:31:44] Lisa Shannon: Um, this one's gonna be a
[00:31:46] Audience 1: little complicated, but. Um, for years and years, uh, we have had our service through the Allus Highway. Uh, the down. And I know the number of, uh, facilities are being closed now, and I think our closest one, no, it's on, I'm just putting that, I think our closest one will be probably Greenway.
That's where my physician and others are going. The problem that I'm seeing is that, um. I'm on Medica, my partner's on UCare and Medica is, according to the Commerce Department's, going up by 27%, which is $115 a month. And then my partner's, uh, is gonna lose the subsidy because of the big, beautiful bill or whatever it's called.
And so it's gonna, we're gonna be hit with another couple hundred dollars a month in terms of costs. But what is happening as a result of moving out of the Allina Clinic is that. A OpID is gonna be an Edina. Uh, our physician's going to be at Greenway, my physical therapist, because I'm having trouble with my right arm is gonna be in Plymouth.
And what we're ending up with is a lot of, how should we say, long. Long term commuting essentially. And so luckily we have a couple of cars, so we're able to do it. My partner will go with me and so on. But that's what I'm seeing is, uh, we're paying more and getting a lot more fragmentation and I just didn't.
I wonder if it's possible to pull some of that together.
[00:33:33] Lisa Shannon: Yeah. Thank you. Um, first thank you for being a patient of ours and, um, what I would say is what you're referring in case everyone in the audience doesn't know we made the difficult decision of, um, uh, consolidating some of our clinics. We have, um, the backdrop is about 300 exam rooms throughout all.
A hundred plus of our sites that were not U well utilized. And as we try to serve the community and keep services available, and as more care is becoming available in the home and available virtually for our patients, either through virtual care or even home care, we just found that we had to make those changes.
What I would hope that you would experience is not fragmentation, but instead integration. And yet it will be at different sites of care. But through both our electronic health record and through how the care teams are working together, my my hope for you and certainly I'm happy to have conversation afterwards to see if there's additional support we can provide to ensure that, um, that which we can do virtually and in the home to save a patient a, a trip We always wanna do, and many of our physicians.
Are engaging in that, um, frankly, quite meaningfully. And then that which is needed in a separate location. It should be digitally and technically quite connected for seamless care. It doesn't mean we're perfect and there aren't gaps. So I'd welcome hearing more about if you've had any of that experience.
[00:35:10] Audience 2: Go ahead. Um, Wally kind of sparked this question, so what should we anticipate? Uh, as we've seen legislation changing, eligibility for the exchanges, changes in, uh, Medicaid eligibility, what's gonna happen? What do you ex, how are you all preparing for that? Do you expect more uncompensated care? What does that mean for everybody else who has insurance?
Interest rate? I mean, I mean, uh, uh, premiums and rates. What do you think?
[00:35:41] Lisa Shannon: Yeah, I think it's gonna be really hard. Ag I think, um, I think when you look at what's gonna happen, we're, as a country, we're taking 1 trillion, $1 trillion outta healthcare. We are backfilling that with 50 billion, so thank you. But, um, that, um, backfilling that throughout our country and here in Minnesota, what I'm deeply concerned about and had this conversation, in fact on Monday with the governors and the governor himself as.
We have 87 counties, 11 tribal nations. They all have to individually correct, create processes for work rule determination. That's not a hospital job. We are, we absolutely want to help patients navigate. We're there to provide their care, their work rules. We'll have to be, um, eligibility determined ahead of time.
And what we're gonna find is a lot of people are gonna lose coverage and they're gonna be confused by it. And we're gonna do our very best to help transparently share and direct them to places for their support. And yet that's where we really need the state of Minnesota to have a common platform for consistent.
Work rule eligibility that is the least confusing as it can be during a really confusing time for patients who may have other vulnerabilities that make it difficult to understand those processes. So I am deeply concerned, really deeply concerned about what will happen if you don't have coverage and you don't get care.
You'll end up in the ED instead of really treatable stage one, you're gonna be an all out, um, you know, more significant. So we are looking at, on a positive side, partnering with community organizations. We're looking to partner collaboratively, of course, with the state as we have great relationships and.
I wanna be part of the solution and to partner, uh, collaboratively with other healthcare in the community, which I think we do a great job as a, as a community. I would also say, I think some of our ideas and solutions are gonna come from outside of Minnesota as well. So we're looking for partners. This is a national problem, not just a Minnesota problem, and Minnesotans are smart and awesome and all those things.
And we're gonna look for answers outside of Minnesota to help us as well.
[00:38:14] Chanda Smith Baker: Yeah. Yeah. I can't believe how time flies. We are at time. I see one hand we will take your question. Just know we're at time and I will walk this mic over to you.
[00:38:28] Audience 3: Thank you. Uh, just so you know where I'm coming from. We've been, uh, patients in the Allina system for 25 years, since we've be, uh, lived in Minnesota actually, and it's been very good medical care. Okay. Very briefly. We came from Canada. I was a litigation lawyer there, ruthless private enterprise came here when the wild started.
I was the assistant general manager there for 11 years. Then with the New York Rangers. All private enterprise. I don't, but I've traveled and I think I've taken people to hospitals in 11 different countries and I have the Canadian background. We are paying way more than any other country in the world for our medical care with far less coverage.
Ma'am, you're speaking very articulately and you seem to really care about things. Can this system work? When you're gonna have the baby boomers going into their senior's age like I am now. Yeah. Um, I think we all have to take a deep look at this thing. When my father's terminally ill in Canada, I forgot my thyroid, my levothyroxine pills not gonna make a big deal of it.
I go there, pay the full amount, and the full amount is less than my copay here. I say there's something wrong on that. The innovation on these. Matters even on the COVID vaccines. Three of the major four came from countries outside the US so it's not like we're monopolizing the developments. My big question is, and I'm an optimist, do we have to change the system?
So we've got a national consensus on things. And as I say, this isn't a radical left wing view. This is what all the other countries are doing, and I think this would support the basis. For a business oriented country.
[00:40:16] Lisa Shannon: Yeah, Tommy. Thank you. Um. There's nothing left to say other than you are spot on. The business model in healthcare in our country is not working.
It's not working the way we need it to, and we have to change it systemically if we believe that, you know, the fix that we just put in place is gonna be sufficient. Um, unfortunately, the other, all the other incentives and business structures in healthcare, all the other players, because there are a lot of players.
That participate in the healthcare dollar and, um, that's not our country system. We spend a lot of time nationally studying that we have, uh, a systemic structural challenge. And, um, I'm with you and, and I hear you. Thank you. Yeah, she said trillion.
I don't think so.
Perhaps. Yeah. Yeah. Very fair. Thank you. Thank you.
[00:41:25] Chanda Smith Baker: So obviously this conversation could go on and on and we're just getting started. They gave us a short time, um, to be here today. Um. I'm sorry. Uh, yeah, so, well they, they, they just gave us a short time, but I think the invitation here is that we all have to think very deeply around what is happening around our healthcare system.
We need it to work for us. It is deeply personal. I appreciate and hear your point. That you raise. There are good points to raise and there are things that we are certainly sitting on, um, at the Allina Health System and on the board really thinking through what does the future look like, where care can still be accessible and what everyone needs when and where they need it.
That get right. You got it. All right. Thank you everyone. All right. Thank you so much. Thank you for listening to Conversations with Chanda, hosted by me, Chanda Smith Baker, president, and CEO of the St. Paul and Minnesota Foundation. To hear more conversations with Changemakers, visit conversations with Chanda.com, conversations with cnda.com or find us on YouTube or wherever you get your podcast.
If you'd like to learn more about the work at the foundation, please visit spmcf.org.