Key findings from a report titled "The Case for Change" have identified four drivers of some of the most pressing challenges facing health care in New York state. In this conversation, Bea Grause, R.N., J.D., president of the Healthcare Association of New York State, discusses the tough findings and partnerships needed to solve these problems, insights into the correlation between health care and legislative advocacy, and how the report’s learnings are translatable to states around the country.
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00:00:01:07 - 00:00:21:05
Tom Haederle
Welcome to Advancing Health. Coming up in today's episode, a conversation with Bea Grause, president of the Health Care Association of New York State, about the drivers that have health care in the Empire State perched on the edge of - quote - an existential cliff. We'll talk about what can be done and what the rest of the country can learn from how New York is handling its health care challenges.
00:00:21:08 - 00:00:29:27
Tom Haederle
Your host today is yours truly. I'm Tom Haederle, senior communication specialist with the AHA.
00:00:30:00 - 00:00:45:26
Tom Haederle
Bea, thank you so much for joining me this morning. Really appreciate your time. And, appreciate your effort in helping our listeners get into what Billy Joel might call a New York State of Mind about what health care challenges and the most effective ways to address them. So welcome. And thank you for being here.
00:00:45:29 - 00:00:46:27
Bea Grause, R.N., J.D.
Thank you, Tom.
00:00:47:00 - 00:01:05:26
Tom Haederle
You really are so well qualified to assess the challenges of today's health care from so many angles. And I'd like to just briefly share with our Advancing Health friends a little bit about your background so they know you know where you're coming from. You began your career as a nurse, an RN. You have done time on Capitol Hill as a legislative aide.
00:01:05:29 - 00:01:26:11
Tom Haederle
I know you're a veteran of senior positions with two other state health associations, Vermont and Massachusetts. You're a former member of AHA's board of trustees - thank you for your service. You also found time along the way to earn a law degree. So you've been a very accomplished person. And now, of course, you're president of one of the largest and most influential health care associations in the country.
00:01:26:13 - 00:01:44:01
Tom Haederle
And really, the purpose of our discussion today is, to discuss the concern that you and many other people have about what you see happening in New York State that's led to the production of "The Case for Change," this this new report that's kind of - frankly, a punch in the gut when it comes to - in terms of shaking things up and speaking
00:01:44:02 - 00:01:55:09
Tom Haederle
very candidly about some of the problems that the state is facing, what needs to be done. So let's start there. What is happening in New York state that prompted the release of The Case for Change?
00:01:55:12 - 00:02:23:02
Bea Grause, R.N., J.D.
Sure. I think what is happening, really was the post-pandemic reality. We realized that state and federal lawmakers wanted to move on from the pandemic. And our members - and this was true for members, for hospitals and health systems across the country - they hadn't moved on. They were not able to move on from the pandemic. The workforce shortage that was beginning to emerge, exacerbated during the pandemic.
00:02:23:03 - 00:02:55:10
Bea Grause, R.N., J.D.
It's now a chronic national workforce shortage. As a nurse, I recognized that demographically, New York had an aging population, which, again, I know is happening in many other states, not all, but many other states across the country. And we wanted to understand that environment better, what was actually happening at the core? Because at the core of health care, I understood, is you have patients and you have people taking care of patients.
00:02:55:13 - 00:03:33:00
Bea Grause, R.N., J.D.
And we knew that we were facing a crisis in both the demographics and who was able to take care of the increasing and changing demand that we saw happening and our members saw happening every day. That's why we did the report, was really to better understand that environment. And it has really helped us in creating a narrative that cuts through all the clutter and gets to a common set of facts where, rather than talking about, you know, this is, you know, a sophisticated podcast.
00:03:33:00 - 00:04:08:13
Bea Grause, R.N., J.D.
So rather than continuing to talk about all the symptoms of what's wrong with our system: 343B crisis, site neutral, all of the many, many, many issues that are very confusing to lawmakers, very confusing to us. You know, we're the experts in that space. And to patients and to consumers and to businesses completely impenetrable. We began this report with looking at demographic data on patients who were currently using hospitals and post-acute care
00:04:08:15 - 00:04:38:13
Bea Grause, R.N., J.D.
now and ten years out into the future. That was our starting place and then obviously looked at workforce data as well. And that really helped us to create the narrative that patient demand was increasing and changing. We didn't have the right number or the right type of health care worker to meet that demand. We had consistent and long standing disparities in care, urban rural poverty, haves and have nots, both on the provider space as well as the patient space.
00:04:38:15 - 00:05:13:27
Bea Grause, R.N., J.D.
And all of that was leading to unaffordability at every level. At the government level, at the business level and the consumer level. And without resolution in those four areas, that is the tipping point or the existential cliff that will cause our system to fail. Everything else is a symptom. We're trying to make it more understandable as well as more compelling, not just to all of us who understand all the nouns and verbs in health care, but to lawmakers and consumers and others.
00:05:14:00 - 00:05:35:14
Tom Haederle
Of the four drivers that you just outlined: health care demand is growing. Health disparities persist. Affordability, and lack of enough workers to provide the care that really is ever-growing. Of those four, is there one that is - they're all important - but is there one that's primary concern, that really needs the most urgent attention?
00:05:35:16 - 00:06:16:12
Bea Grause, R.N., J.D.
I'm going to stick with demand. Because as a clinician, to me, demand drives everything. And you'll see in that report, as I often say, there's not a HANYS ten point plan on how to fix our health care system. It's not designed for that. It is designed to, again, put out a common set of facts to bring people together, particularly, you know, for here in New York, lawmakers and others, other stakeholders to talk about what are some of the strategic things that we need to begin to work on in order to solve some of these much more difficult problems that are not being talked about or not being understood and then therefore not being resolved.
00:06:16:15 - 00:06:54:10
Bea Grause, R.N., J.D.
So to me, the most important one is demand. And I'll just use New York for a second. In five years we are going to have 700,000 new, net new, senior citizens in New York State. And you know, I think, as you well know, the per capita spending for senior citizens increases as people age. And so when you think about our blue H, and the brand of that blue H, I always think about that from a patient perspective as the only open door.
00:06:54:12 - 00:07:21:18
Bea Grause, R.N., J.D.
So if you have other open doors to get health care in a community, you will use them. But if there are none, you will go into that blue H. And if you have a medical need at any point you will go through that hospital door and then your care journey will begin from there. So that demand and you can you see it in the headlines with crowded emergency rooms, overload, nursing home closures, back up in the emergency room, the inability to get an appointment.
00:07:21:19 - 00:07:47:06
Bea Grause, R.N., J.D.
You're starting to see the overload in health care systems happening today. It is largely being driven by elderly patients coming in, not being able to get upstairs to get to a bed because there are no health care workers there, or there are 80 or 90 patients who would be better served in a nursing home and cannot be discharged because there's no nursing home bed.
00:07:47:09 - 00:08:12:06
Tom Haederle
And what is the role of community collaboration and partnership in addressing that particular problem? And frankly, all four drivers. I know one of the key takeaways of the report is that it's a joint effort that involves many different partners. And if you could talk a little bit about finding the right organizations to work with and who needs to lead that discussion, and what comes out of having these collaborative partnerships underway?
00:08:12:09 - 00:08:51:18
Bea Grause, R.N., J.D.
There are no right or wrong organizations that we're looking at. We're talking to other provider groups, businesses, unions. Using The Case for Change report to try to get a common understanding on the core facts and the core reasons for why our health care system is beginning to fail. And that collaboration is essential when you think about politics, state politics in this case, because you need to have, at least in New York, it is much better to get initiatives over the legislative finish line if you have a coalition, formal or informal.
00:08:51:24 - 00:09:02:01
Bea Grause, R.N., J.D.
But if you have broad based support, in other words, for an initiative for that year is a priority to try to get enacted.
00:09:02:03 - 00:09:07:25
Tom Haederle
Is there consensus around what we need to do in New York right now, or you feel or do you feel like you're getting there?
00:09:07:27 - 00:09:34:24
Bea Grause, R.N., J.D.
I feel like we're getting there. I have two examples. One is in the workforce space and the other is in the governor's budget, which our budget cycle has just begun. And we've been talking all year with Governor Hochul on using the case for change. And talking about the challenges that the state of New York faces with an aging population and a workforce shortage, primarily.
00:09:34:24 - 00:09:58:09
Bea Grause, R.N., J.D.
And, as you may know, I mean, the state of New York is already beginning to try to address disparities in care with the recent 1115 waiver. But certainly affordability is a huge problem for the state of New York. And helping them to understand that demand is going to increase for the next 25 years. The aging population will increase.
00:09:58:12 - 00:10:46:28
Bea Grause, R.N., J.D.
And it's not a question of if patients are going to need care, it's when and how much and where are they going to get that care. And if there's a mismatch between the capacity or the workforce gap gets worse, the cost to the state gets higher. And those kind of related messages, case for change related messages, were all part of our narrative with the governor all during last year. And in her budget and her state of the state, she did take a more strategic view, adopting many of those concepts in her budget and in her message to fund hospitals and nursing homes, but also for other across the continuum, continue to invest in workforce,
00:10:47:01 - 00:11:12:25
Bea Grause, R.N., J.D.
but also invest in capital so that more sites of care can be provided upstream or, you know, pre-hospital, so that patients are actually getting care outside of the hospital where they need to get care, and decreasing that expensive demand on hospital and post-acute services. So we were very pleased to see more strategic framing with the governor. So that's example number one.
00:11:12:25 - 00:11:48:06
Bea Grause, R.N., J.D.
Example number two is in workforce. As an advocacy organization where we are particularly and more externally or visibly focused on reaching out to other stakeholders to work on a whole host of workforce initiatives that are designed to recruit new workers, retain workers, eliminate the bottleneck in terms of not enough, faculty for, as one example, helping various health professions expand, work up to their full license.
00:11:48:09 - 00:12:01:29
Bea Grause, R.N., J.D.
And all of that is designed to close that gap in health care workers, particularly in the post-acute space, which hopefully will improve capacity. But it will help to bend that expense growth curve.
00:12:02:02 - 00:12:21:12
Tom Haederle
As we wrap up, we're almost at the end of our time, let me ask this. The concepts that are presented in The Case for Change, how translatable are they, would you say, to other systems because the four drivers that you've mentioned facing New York's system really can be found to a greater or lesser degree in every health system in the country.
00:12:21:12 - 00:13:11:18
Bea Grause, R.N., J.D.
100% translatable. I mean, just imagine, Tom, if there were a case for change narratives, rather than having lawmakers and others confused around 50 different issues where you have different groups, one side opposes, the other supports, lawmakers cannot break through that noise. And I've talked to many lawmakers who find health care impossibly confusing. So I think having this common set of facts that are based in what we all care about, that we have access to care that someone's going to be there to take care of us, that we're helping communities and individuals who don't have access to care, and that we're trying to make health care more affordable over time.
00:13:11:21 - 00:13:38:23
Bea Grause, R.N., J.D.
That is a narrative that I think we can all relate to. And I think when people understand and look at the details in the report and again, anybody who wants to take that report and make it, you know, it's open source, take it and build on that narrative. But if we were all and when I say we, but if providers across the continuum, providers in other states or associations in other states were using that, I call it a patient forward-narrative,
00:13:38:23 - 00:14:15:20
Bea Grause, R.N., J.D.
and framing it that way, lawmakers would then begin to think that way. Because if they if that's all they're hearing and they're hearing that consistent message: We're concerned about access. We're concerned about ED overloading. We're concerned about a workforce shortage. We want to make sure, we think it makes good economic sense to provide health care to underserved communities. If they're hearing those messages consistently and have written documents and written reports and other information to help them to understand that, and it will start to make sense to them.
00:14:15:22 - 00:14:34:20
Tom Haederle
That is a great summation. Thank you so much. You have been listening to us discuss a new report called The Case for Change. This has, come from the Health Care Association of New York State. Thanks again, Bea. Really appreciate your time. And good luck with making progress on the changes facing New York State right now.
00:14:34:23 - 00:14:39:04
Bea Grause, R.N., J.D.
Thank you, Tom, so much. This has been such a great conversation.
00:14:39:07 - 00:14:47:13
Tom Haederle
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