Back to the Future
Lessons from the past initiate a new outlook for healthcare
Interview by Shelley Catalano
In October, Harold “Hal” Paz, MD, MS joined Stony Brook as its executive vice president for health sciences, bringing with him more than 25 years of leadership experience in healthcare and academic medicine.
His charge? To grow Stony Brook Medicine, enhance collaborations across the enterprise to drive innovation, and, if he has it his way, change the very fabric of healthcare as we know it. We met with Paz to learn more about his approach to transforming healthcare.
What brought you to Stony Brook?
When I heard about this position, what made it exceptionally interesting to me was a confluence of opportunities. One, a new president with an extraordinary vision for Stony Brook University. Second, this notion at the university that the enterprise we call Stony Brook Medicine has enormous potential and possibility for transforming health and healthcare. Three, that I’m originally from New York, born and raised, received my education here. To come back to New York state in a leadership role to have an impact on something as important as health science, education and research — and also in care delivery — was a remarkable opportunity.
What are the biggest challenges facing healthcare today?
If you look at gross domestic product in this nation, healthcare is the largest portion of our spend. It’s about 18%, or over $4 trillion annually spent on healthcare. Yet when you compare us to other members of the OECD (Organization for Economic Co-operation and Development), the US ranks 11th in many of the health measures. On a per capita basis, we spend more on healthcare than any of those other countries, so the dilemma is: How could we be spending so much money on healthcare, but yet lag behind other countries that are economically not as well off as we are?
How do we address this discrepancy?
We have to create health platforms. What do I mean by that? It goes back to work that was done in the early 1990s, where the concept of social determinants of health (SDoH) were identified. If you look at premature death, and measures of health and well-being for a population, there are five contributors, with healthcare — what we spend $4 trillion on — determining about 20% of your health status, and genetics about 10%. The bulk of the impact comes from the other three areas: social determinants, such as socioeconomic status, education, housing, transportation, food insecurity, racism, and violence, are huge determinants of someone dying a premature death or suffering from poor health; behavioral determinants, which include exercise and obesity, as well as addiction to tobacco, opioids, and alcohol; and environmental factors such as ozone in the air, lead in the water, and climate change.
If we continue to spend $4 trillion a year and it only contributes to 20% of our health status for the population, why are we surprised that we rank behind other developed nations? If we don’t address the other 70% (putting genetics aside), we’re never going to close these gaps.
Hospitals have grown to medical centers and now to health systems, but the future will be about creating health platforms that address all five determinants of health in a coordinated fashion. That’s not to say that a hospital isn’t important. It’s extraordinarily important, but we can achieve the best care possible for individuals only by creating interoperable personalized health experiences beginning in the home and the local community.
What approaches can we implement to address those determinants?
First and foremost, by leveraging the resources and the assets of a university like Stony Brook in the physical sciences, social sciences and engineering, so we can continue to innovate ways to drive care into the home and the local community. We need to think of nontraditional ways to do that work. It could be through digital health or telehealth solutions. It could be by having nurses and social workers going to the home and working directly with individuals to address their needs. It could be through mobile health by having vehicles with diagnostic capabilities traveling to people’s homes. Innovation is at the core of what differentiates Stony Brook Medicine from the routine care that’s available today, and what positions us to continue to provide that cutting-edge care.
Second, we have to build, design and implement these health platforms for the future. We do that by educating the next generation of health professionals. Through our five schools in the health sciences, we must make sure that our curriculum involves interprofessional educational training for physicians, dentists, nurses, social workers and other health professionals to work together effectively in teams. Traditionally and historically in healthcare, we’ve trained our students in silos, but now we must make sure our students interact with each other across all disciplines. We must make sure that they’re being educated not in the ways that medicine and healthcare were delivered in the past, but in the ways it’ll be delivered in the future. Ideally, we want to give these students diplomas that should last them 40 or more years.
To achieve these goals, we need to look at where we are and where we want to go, then plan how to get there. I’ve started the conversation around interprofessional education with our health science deans, and we’re launching a strategic planning process across all of our missions in the health sciences: education, research, patient care and community service. We hope to have a plan in place by the end of this academic year and begin implementing it this summer.
How do you foresee enhancing collaboration across our enterprise?
It’s going to be really important for us as “One University” to leverage the assets and knowledge that exist across Stony Brook if we’re really going to be effective and successful in addressing all determinants of health. For example, how can research in computer science help us implement artificial intelligence into our Web pages to help our patients find solutions more effectively, so they won’t have to wait to have a simple question answered? Thinking way into the future, how do we start to use new types of technology in managing data like quantum computing in support of healthcare — everything from surgical robots to virtual care delivery?
Another example is the need to deeply understand the social and behavioral determinants of health. Expertise in these areas — from sociology and psychology to gender studies and economics — sits with our academic partners on West Campus. And the more we understand how things such as education, financial insecurity, housing and transportation impact health, the better we can build solutions into our health platforms.
Some of this cross-collaborative exploration is already underway, through the recent implementation of our campus “tiger teams.” We’ve identified faculty whose job it is to be facilitators between researchers on West Campus and researchers on East Campus, and they’re working to identify a list of research opportunities that we can pursue together, such as in the areas of neuroscience and artificial intelligence.
How do we encourage the next generation to pursue healthcare fields?
We have two major responsibilities. One is to continue to encourage as diverse a population of students as possible across the health sciences that reflects the diversity of the communities and patients we’re caring for. That’s really important. At the national level, there’s been a push to get more African American students, specifically male Black students, into medical school. Four of our faculty at the School of Medicine are very involved in this work. They were instrumental in showing the documentary Black Men in White Coats and then holding several panel discussions sharing their own journeys to becoming doctors. More discussions are being planned, because it’s all about building a pipeline early in the educational process to careers in the health sciences.
The other big responsibility we have is to take as much of the “friction” out of the system as possible for our healthcare workforce. What can we do to reduce the amount of time that someone has to spend entering data into an electronic health record? These young people didn’t enter the health professions to be data entry clerks; they entered the profession to care for patients. What can we do using AI technology information systems to automate these processes so they’re freed up to spend more time with patients? What can we do to make sure that we’ve done everything we can to make the job of caring for patients as uncomplicated as possible? Again, leveraging research and technology developments from our university collaborators will help us help our workforce.
What’s next for healthcare?
When I was a kid growing up in New York City, there was a general practitioner who had an office down the street, and he traveled around the neighborhood with a black bag. He came to your home and delivered care, and that’s what healthcare was like back then. I tell that story to my kids and they look at me like I’m a dinosaur, but I really do remember that’s the way care was delivered. It was direct — the doctor coming to your home to do exactly what he signed up to do, which is take care of patients. And he wasn’t spending his whole day filling out paperwork. It really wasn’t complicated; it was a different world.
But that model is more of what we need to get back to. How can we address your healthcare needs in your home? How can you nurture a long-term relationship with a provider? That’s the part that’s really interesting.
Let’s look at other sectors of the economy, and I’ll use my millennial daughters as an example of this. They belong to a bank, but I don’t think they’ve ever stepped foot in one. They do all their banking on their phone. They don’t shop at big-box stores in the mall. Instead, they simply have products delivered to their home.
Why do we believe that for these millennials, and for the generations that follow them, their expectations for healthcare will be any different? They’ll expect that healthcare should be personalized for them and coordinated on their phones. They’ll use an app for a simple medical concern. They’ll get a flu shot in a pharmacy, but maybe for a different issue, they’ll expect that someone will drive up in a car and take care of them in their home. And if they need more complex care, they’ll receive it first as an outpatient before being hospitalized.
Our job is to build a model that reflects that future, including changes in reimbursement moving from fee-for-service to value-based payment, which is why we must move from being a hospital system to becoming a health platform. Health platforms become a way to personalize healthcare so that patients have the customized tools they need to maintain outstanding health and well-being. The future is, for better or worse, not only going to be about hospitals. Hospitals and the incredible people that work there will always be needed for the very sick, and for complex care — but we need to think about all the other innovative ways to deliver care. With a state-of-the-art university hospital, children’s hospital, community hospitals, an increasing amount of ambulatory care, telehealth, digital health and innovative partnerships, Stony Brook Medicine is ready to lead the way.