The Medical Management Podcast_Impact on your Health: Audio automatically transcribed by Sonix

The Medical Management Podcast_Impact on your Health: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Jay Holmes:
Welcome to the Medical Management Podcast. A podcast focused on helping you level up your practice. Through interviews with some of the most successful leaders in the industry, we help uncover resources, tools, and ideas to help you level up your practice. Thanks for tuning in and we hope you enjoy today's program.

Jesse Arnoldson:
Last week, we had the chance to talk with Doug Crabtree, the executive in residence over Idaho State University, and former hospital CEO over at Eastern Idaho Regional Medical Center. Last week we talked a lot about Doug's transition between the hospital to the university setting, and we also segwayed into our, our main topic for today, which is talking about the different determinants that impact your health. Doug, welcome back to the show!

Doug Crabtree:
Well, thank you very much, Jesse, and again, I enjoyed last week and look forward to spending a little bit more time with you.

Jesse Arnoldson:
Yeah.

Doug Crabtree:
These are topics that are, you know, near and dear to me. I love talking about health care, love talking about how we can improve health in our community, so I'm, I'm very pleased to be here once again with you.

Jesse Arnoldson:
Fantastic. Well, we're grateful to have you. Well, let's, let's talk a little bit about that incredible fact that you left us with last week. Can you maybe throw that back out, the idea of where you live in Idaho Falls and your life expectancy?

Doug Crabtree:
Yeah, I sure can. A little bit about that. Mayor Rebecca Casper of Idaho Falls took some initiative about 18 months ago and put together a group for connecting a sustaining progress or her CUSP committee, and of that committee, she asked several people to be involved with looking at how we can improve our community over the next 10 to 15 years. I was fortunate enough to be asked to be involved with the Health Care Committee and enjoyed that opportunity to be with several leaders in our community, several thought leaders, and look at what we can do to improve our community and particularly improve health care in our community.

Jesse Arnoldson:
Yeah.

Doug Crabtree:
As I had that opportunity, I learned that Idaho Falls had contacted a consultant to come in and help them look at the data from Idaho Falls, and that consultant came out of the Boise area, and one of the fascinating things to me was they did a analysis of health care by tract, by not zip code, but even more fine-tuned they went into a tract-level analysis and in the,

Jesse Arnoldson:
... tract-level analysis?

Doug Crabtree:
Well, they go down to census tracts, they go down to, you know, where you are, not just zip code and it's narrow down,

Jesse Arnoldson:
You're talking about, like by street, almost by like little community and neighborhood.

Doug Crabtree:
Yeah, little neighborhoods, little neighborhoods.

Jesse Arnoldson:
Wow, okay.

Doug Crabtree:
And all of this was available in that report given to the city of Idaho Falls. In some neighborhoods, residents can expect in general to live between 81 and 83 years. Meanwhile, in other neighborhoods and in some instances on the other side of a major street, residents can expect to live between 70 and 76 years. So a difference across the street of five, six, or seven or more years, just depending on where you live, and, you know, if you think about Idaho Falls, for those of you who have been there or driven through, there are parts of Idaho Falls that are attractive, they've got, you know, nice homes, they've got nice schools, you can walk on the sidewalks to the schools, they've got parks nearby, a lot of recreation opportunities, a lot of grocery stores, but there are also parts of Idaho Falls that don't have sidewalks on the streets, that schools aren't in the best shape and, and the economic factors of that neighborhood may be such that they're just not that desirable. We've got one elementary school pre-COVID. Of course, during COVID, all of the students got a free meal, but pre-COVID 80% of this particular school's population was on the free lunch program because that's how many people qualified for it.

Jesse Arnoldson:
Right.

Doug Crabtree:
And so just a really tough area of town, and there's no grocery stores in that part of town. So even if they had some money to go to the grocery store, if they don't have transportation, they can't get there and the same with medical care, you know, it's nice to have medical care if you have transportation to get there, but if you don't have transportation, it's really hard, and so you begin to think about these upstream factors that may be causing some of the things that we experience and look at health care, but you know, if we're trying to improve our community conditions, it is about parks, it is about traffic patterns, it's about sidewalks, it's about helping people get outdoors and recreate and having, you know, these grocery stores available, decent access to food and nutritious food, you know, and I have argued in front of the school districts that we need to have some healthy options in the vending machines at the schools. I remember years ago a physician was teasing me that we ought to put calcium into the soda pop and other popular drinks that the teenage are drinking because they're not getting enough calcium.

Jesse Arnoldson:
Yeah.

Doug Crabtree:
So I think the community has an impact, and I think we all play a part of that. We, we talk about education, employment, income, you know, the kind of support system you might have from family or, or other support, community safety. We talk about the quality of your air and quality of water, housing, and transportation. All of those play a bigger role in one's health care than, than I think most of us realize, and I think, you know, the more we can begin now, and it's a hard argument, I get it, because it's a hard argument to build a park that might lead to a healthier community 20 years down the road because you don't see the immediate impact, and, and that's hard but I think that's.

Jesse Arnoldson:
Very delayed.

Doug Crabtree:
Very delayed, but I think that's what's important and what we need to focus in on is how do we minimize the gap between life expectancy from one community to another in, within the community of Idaho Falls? How do we make it more equitable? How do we keep everybody healthy or give them access to, you know, make good decisions? And again, on those health care decisions about, you know, 20% is the care you actually receive, about 30% of your health is directly attributable to your own health behaviors, and that is tobacco use, diet and exercise, alcohol use. If you can control those things in a healthy way, you've just dramatically improved the chance for you to have a healthy outcome and, you know, understand this better than any, anyone, Jesse, and that is that the, the current way we reimburse for care in the United States is based on what is done to people.

Jesse Arnoldson:
Right.

Doug Crabtree:
What, what was the procedure code? What was done? And I get it, we've evolved to that kind of system, but the general practice or the family practice doc that I go to and I say, Doc, I, my knees are starting to hurt and he goes, well, of course they are, Doug, you're overweight, you need to lose some weight, and he goes through all of this time and effort to convince me that I need to exercise and lose some weight and eat better, and, you know, how much does he get paid? What kind of ENM code does he have? What kind of, you know, CPT code does he have to bill for that very extensive visit with me? And then really, what happens with that? That's all up to me, whether I do it or not.

Jesse Arnoldson:
Right. He gave you the advice.

Doug Crabtree:
He gave me the advice.

Jesse Arnoldson:
He told you what to do.

Doug Crabtree:
And he didn't get paid very much for all the time he took with me, he's not going to get paid very much, just given the system that we have in place, but if he refers me to an orthopedic surgeon, the orthopedic surgeon is going to see me and what is the orthopedic surgeon want to do immediately?

Jesse Arnoldson:
You want some new knees, Doug!

Doug Crabtree:
I need some new knees. I'll feel better if I get new knees, and if I get new knees, then I'll be able to exercise more without pain.

Jesse Arnoldson:
Yeah.

Doug Crabtree:
And so, you know, right away this instant gratification, I want somebody else to do it for me. I don't want it, you know, I, I, I just want to feel better and all of a sudden, I'm in for a new knee and, you know, I think that's just part of the equation that we have to tweak.

Jesse Arnoldson:
Yeah.

Doug Crabtree:
We each have to be responsible for our own health care. I know I'm overweight. I know that I should lose 20 or 30 pounds and,

Jesse Arnoldson:
Right there with you.

Doug Crabtree:
I'm responsible that can do it. I can do it. No one has to tell me to do that. I know what I got to do. I know that I would be better if I could go do it but you know, I just, I just haven't done it.

Jesse Arnoldson:
Doug, can I? There's a thought here, all of these things you've broken down for us, 30% is our behavior, right?

Doug Crabtree:
Right.

Jesse Arnoldson:
20% comes from actual clinical care, which leaves us 50% that fall into maybe our physical environment or socioeconomic determinants. They all play together, right? I'm assuming if you live in a certain place, it means you have better access to better, maybe better doctors, better facilities. You have access to places where you maybe would be more inclined to exercise and maybe access to the grocery market that you're going to be able to get better food, like it all plays into each other, right?

Doug Crabtree:
Yeah, it certainly does. It all plays into each other and again, I've often told people in a broad perspective and a broad discussion, what's the most important one factor in looking at your health? If you could name one thing to me about your anything, what is the number one thing you can pinpoint to say, yeah, that person is going to be healthy or that person is not going to be healthy? Is it your genome? Is it your DNA? Is it your genetics? Is it your level of exercise? What is the one thing?

Jesse Arnoldson:
I'm going to guess, where you live.

Doug Crabtree:
It's your zip code.

Jesse Arnoldson:
Yeah, your zip, OK, yeah, your zip code.

Doug Crabtree:
The number one determinant of your health is your zip code, and it shouldn't be that way.

Jesse Arnoldson:
No, no, not at all. So what do we do? Doug, how do we? Idaho Falls is the perfect example of the rest of the country, you know, there's, there's two sides to this. There's two, two Americas.

Doug Crabtree:
Right.

Jesse Arnoldson:
What do we do as individuals, whether we're practice administrators or just simply citizens, you know, what do we do?

Doug Crabtree:
Well, I think there's all kinds of answers to that, but what I have to do is take responsibility for my own health.

Jesse Arnoldson:
Right.

Doug Crabtree:
If I don't stop the trajectory I'm on and being, you know, not just overweight, but, you know, getting way overweight, then pretty soon I'm going to be diabetic and then I'm going to have all the complications of diabetes, and then I'm going to have other complications that go along with obesity and I alone am in a position to stop that. I can fix that and I want to fix that but, you know, it's easy again for us in this society that we live in, we want everything fixed for us and we want it fixed for us now.

Jesse Arnoldson:
Right.

Doug Crabtree:
But you know, it's a little more difficult to get up out of bed early and go jogging or running or go to the gym or whatever your preference is. I'm a big fan of Dr. Ted Epperly, who runs the family medicine residency program over there in, in the Boise Valley. Dr. Ted Epperly is a huge resource to us in the state of Idaho, and he's not well recognized for all of the expertise that he has.

Jesse Arnoldson:
Right.

Doug Crabtree:
He's been back to the White House and a number of administrations advising the president about, you know, health care and rural health care. But Dr. Ted Epperly, I've had speak to a number of audiences before, and in one of those occasions, Dr. Ted Epperly taught me an equation which is just, you know, 3-4-50.

Jesse Arnoldson:
3-4-50.

Doug Crabtree:
3-4-50.

Jesse Arnoldson:
Okay.

Doug Crabtree:
Three behaviors, physical inactivity, poor nutrition, and tobacco use. 3 cause 4 chronic diseases. Those for chronic diseases are cancer, heart disease and stroke, pulmonary disease and diabetes.

Jesse Arnoldson:
Okay.

Doug Crabtree:
So or a three, or a four those cause 50% of all deaths. 3-4-50. So if we can, if we can increase our physical activity, if we can decrease our tobacco use, if we can increase our nutrition, if we can do those three things, then we'll minimize the four chronic diseases of cancer, heart disease and stroke, pulmonary disease and diabetes, which will then eliminate 50% of our deaths in the country. Those are three behaviors that we each individually can control, and if we'll do so, it will improve the overall health of our community but I think it's just astounding to me that so much of our health care can be determined by our own choices about exercise, about eating right, about.

Jesse Arnoldson:
Yeah.

Doug Crabtree:
Appropriate tobacco use and alcohol use. If we can do those things, we will dramatically improve our health outcomes.

Jesse Arnoldson:
It really is a balanced scale, right? I mean, there's, there's no way we're going to get healthy unless we become engaged as, as, you know, patients or, or individuals.

Doug Crabtree:
And I think,

Jesse Arnoldson:
There's a whole lot on the other side, right, there's a whole lot on that where you live.

Doug Crabtree:
Yeah.

Jesse Arnoldson:
That also balances out the how you're going to be.

Doug Crabtree:
Right, and I think that we've seen this transition beginning from what historically we in health care administration and you in practice management know to be our fee for service type of reimbursement where the you go to the doctor and, and they've charged you X, and every time they do X, they get paid and the more they do X, the more they get paid. We still have a lot of that around in Idaho, but we, we are moving now in southeastern Idaho, and even more so in the western side of Idaho with the accountable care organizations,

Jesse Arnoldson:
Right.

Doug Crabtree:
And public health, preventative health. We see more and more of those kind of things being gauged on how we're improving health care to our communities, and, and I think that's a right move. I think that will help all of us become more accountable individually, but it'll also help systems to think differently than I thought when I was within the walls of the four walls of Eastern Idaho Regional Medical Center.

Doug Crabtree:
Right.

Doug Crabtree:
I've got to think broader than just what happens within our clinic or our hospital. How can we, you know, I, I was very impressed as I heard the director of the Terry Riley Clinic, talk about how she was expanding from her location in Boise or Meridian to Caldwell and in her new facility in Caldwell, upstairs, she built a number of apartments to help address in a small way the housing shortage in Caldwell.

Jesse Arnoldson:
Interesting.

Doug Crabtree:
Isn't that interesting? Isn't that fascinating? And you know, her housing addition won't solve the problem but if everybody took a little bit of initiative and, and had their own.

Jesse Arnoldson:
Yeah.

Doug Crabtree:
Solution for part of the housing's problem, then, then maybe we wouldn't have a housing problem anymore in the Caldwell area. You know, again, just a creative way of approaching a need for her community, and she was building, you know, a new place anyway, let's throw a couple of apartments upstairs. I, I thought it was great.

Jesse Arnoldson:
I think in the end, you kind of have to, kind of have to take it, Doug, of I'm going to take responsibility for me and then a little bit extra for those that can't, you know, that's, that's kind of it, each of us has to put in 1.2, 120%.

Doug Crabtree:
You know, it's, it's October and I know, you know, Christmas is within 100 days now, but I'm reminded of some time ago, I was asked to speak about health care and it was November/December, and you know, I just watched the Christmas Carol, and you know, humanity is our business, especially when we're talking about health care. Humanity is our business. Let's, let's take care of ourselves. It's also take care of our neighbor and our friends, and do all we can to contribute to those things that create healthy communities so that our communities can be healthier, our members can be healthy. So I've moved from, you know, being aware of social determinants of health to really be an advocate and a proponent to help parks and recreation, to help access to food with food banks and, and shelters. We, in Idaho Falls have a growing problem with teenage homelessness and, you know, kids run away from home and where do they go? How do we, how can we take care of them? And so again, I'm not making excuses, but I was not as aware of these kind of situations when I was the CEO as I am now, and now I'm motivated to try to improve our health outcomes for the entire community, entire region.

Jesse Arnoldson:
That's an incredible place to, to end this I think. I'm so grateful that you agreed to come on and talk about this topic. It's an incredible one and one that's definitely on my mind as far as looking at me and my family as a whole and what we're doing to be healthy, you know, and, and whether that's,

Doug Crabtree:
You know, just get it, yeah and can I just make, you know, another comment, and that is.

Jesse Arnoldson:
Please do.

Doug Crabtree:
You know, we have to do all of these things, but we also have to become advocates for our own health care.

Jesse Arnoldson:
We do.

Doug Crabtree:
I had a relative recently and she called and, and she knew I had a little bit of background in health care. She had been to our family practice doc, they had ordered a routined mammogram, and she came back and said, my doc's worried about the mammogram. And then the radiology facility called and said, we need you to come in. And she says, I don't want to go back, I don't want to go in, I, I just want to talk to my family practice doc. And I said, your radiology facility called you and said, you need to go in and she goes, yeah, they did. And I said, schedule the appointment tomorrow.

Jesse Arnoldson:
Yeah.

Doug Crabtree:
Don't wait one more day.

Jesse Arnoldson:
No.

Doug Crabtree:
One day with an aggressive cancer you will regret. Call tomorrow. You have to advocate for yourself. I said, did your radiology facility give you a physician or a portal, a patient portal? Did they give you access to the report? Well, yeah. Well, have you looked at it? Well, no, I just want to talk to my doctor. Well, I appreciate you want to talk to your doctor, but you need to, in addition to talking to your doctor, get on the portal.

Jesse Arnoldson:
Yes.

Doug Crabtree:
I called her the next day or two and I said, hey, did you get into the portal? And she said, no, I didn't. I'm just going to wait for my doctor. I said, get into the portal. Let me help you. I'll walk you through it. It can't be that hard.

Jesse Arnoldson:
Yeah.

Doug Crabtree:
And then she, she said, she'd come. She'd get into the portal and she'd call me back. She called me back the next day and she said, I'm really scared. I read what's in the portal. I read the radiology report, and I'm really afraid. I said, did you call and get an appointment with the radiology center? And she said, I did, and I said, how about your family practice doc? Did you let him know? Well, he's out of town for two more weeks. Well, you make sure his office knows that you are meeting with the radiology center. You be, you need to be, you need to begin to become your advocate for your own health. Don't wait for your family practice doc as good as a man as he is, don't wait for him.

Jesse Arnoldson:
Yeah.

Doug Crabtree:
Take control of your own health care. And she did, and she got on it. She got the biopsy done. She got everything back and thank goodness they were able to get her into a radiation and I don't think she needed chemo but she was able to treat her cancer early on with radiation. Had she sat on that for a month or two months or six months, it would have been a different outcome.

Jesse Arnoldson:
Yeah.

Doug Crabtree:
And so, please be an advocate for your own health care. Trust your doctors, go to trusted resources on the web. Don't get all caught up in all the social media and everything else.

Jesse Arnoldson:
No.

Doug Crabtree:
Go to the Mayo Clinic, go to the Cleveland Clinic, go to trusted medical centers and go to their websites, but, but be an advocate for your own health, in addition to taking care of your health care. When you have an issue, be an advocate for your own health.

Jesse Arnoldson:
Amen. I can't say it any better. Doug, thank you for being on. I think this is probably one of the most important subjects we've talked about on the podcast, and just thank you for being a part of it.

Doug Crabtree:
Well, I appreciate the opportunity, and, and Jesse, if there's anything I could ever do for you or MedMan, just give me a call. Be happy to be involved.

Jesse Arnoldson:
Thank you, Doug.

Doug Crabtree:
Alright.

Jesse Arnoldson:
Thank you to everybody else. We, we really appreciate you guys tuning in. For show notes, transcript of the, of the interview, anything else that MedMan does, please visit us at MedMan.com and we'll see you next week.

Doug Crabtree:
Thanks, everybody.

Jay Holmes:
Thanks for tuning in to the Medical Management Podcast. We hope you enjoyed today's featured guest. For the show notes, transcripts, resources, and everything else Medman does to help you level up be sure to visit us at MedMan.com.

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Episode Summary

 

Tune in because Doug Crabtree is back for another enthralling discussion about the social determinants of health!

 

Doug shares his thoughts on the factors that affect our health and the quality of our lives. He highlights the habits that people have that could lead to a negative impact on their well-being. Doug also suggests some changes that everyone should apply to increase their lives’ expectancy. This way, he urges individuals to become responsible for their own lives and start changing for the better.

 

Doug believes that caring for others really matters and prompts everyone to start contributing to the community.

 

About our Guest – Doug Crabtree

 

Doug Crabtree is the Healthcare Administration program’s first Executive in Residence (EIR). Crabtree recently retired from the Idaho Falls hospital, Eastern Idaho Regional Medical Center (EIRMC) where he worked as the Chief Executive Officer (CEO) for 19 years. As the program’s EIR, Crabtree will take the role as an instructor in both graduate and undergraduate level HCA and Master of Healthcare Administration (MHA) programs. In this role, Crabtree will also use his extensive background working in the healthcare administration field to provide academic program directors and the College of Business dean with advice in the initial launch of the MHA program.

 

Throughout his career, Crabtree has served in numerous high-level positions in the healthcare industry for over 30 years in addition to being the Idaho Hospital Association Chair twice.

 

Key Take-Aways

    • Quitting negative behaviours such as smoking, stress, and bad diet choices can improve one’s health and quality of life.

 

    • Every individual is accountable for his own health and personal well-being.

 

    • Your life’s quality is determined by a lot of determinants that most people neglect .

 

    • In some areas, your zip code is the most significant factor deciding your health.

 

    • Living in a least-effort society makes it harder to get along with the things that require more work and dedication.

 

    • Always remember the 3-4-50 rule; 3 behaviours, physical inactivity, poor nutrition, and smoking cause 4 major, life-long illnesses that eliminate 50% of population’s life.

 

    • Be the one in charge of your own health and quality of life.

 

Resources

 

    • Know more about MedMan here

 

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