Gabriel Perna | February 4, 2020
Last week, the World Health Organization declared the coronavirus outbreak a global health emergency. And while the disease has made its way into the U.S., the primary activity thus far has taken place in China.
But for ProMedica CEO Randy Oostra, coronavirus isn’t something he can say is someone else’s problem in a far-off part of the world. That’s because ProMedica, the Toledo, Ohio-based health system, with a footprint across nearly 30 states and more than 55,000 employees, has strategic partnerships in China with investors as well as sister-hospital relationships in the country. It has people on the ground working with its Chinese partners on a day-to-day basis.
ProMedica is part of a growing trend of provider organizations, such as UPMC and Cleveland Clinic, expanding their business into China. Health Evolution spoke with Oostra and Kathleen Krueger, President of ProMedica International, to talk about the organization’s efforts in China, how ProMedica has evolved in a post-acute world, finding similarities between the two countries, dealing with coronavirus and more.
Health Evolution: It’s still very early into the coronavirus but what impact has it had on you or ProMedica at this point?
Randy Oostra: It has affected our planning. We were planning on taking a group there soon, but we’ll delay that. We’re monitoring the situation and trying to make decisions about what we do and don’t do. The WHO announcement will affect us a bit more. We’ll find ways to communicate and think about other things we can do.
Health Evolution: Does this make you more or less likely to do business in China in the future?
Oostra: I think it shows no matter where you live in the world, we’re all looking for ways to offer the most efficient, highest quality of care. This doesn’t deter us from interest in China. It shows us the importance of working together. When we’re there, over and over again we keep recognizing they’re just like us and have the same goals. I don’t see it how it deters us we’ve just got to be careful.
Health Evolution: What made ProMedica decide to do business in China—what was your reasoning?
Oostra: Over the last decade, we have changed our view of what we’re trying to do. We have become more of an integrated delivery system in northwest Ohio/southeast Michigan. We had hospitals, employed doctors, worked with independent doctors, had a health plan. Along the way, over the last decade, we increasingly have done more work in the area of the social determinants of health. Realizing that not only is clinical care important, but also the social aspect of people’s lives. As we thought more broadly about health care, we acquired a company called HCR ManorCare a year-and-a-half ago. It is one of the largest post-acute care companies in the U.S.
We’ve changed our view to much more health and wellbeing. We’ve done a lot of things outside of our traditional walls. In Ohio, like a lot of states, we have had several Chinese investors. We were encouraged to go to China and talk to a variety of health care and business leaders who were looking to make American connections on the health and wellbeing side. Our first visit was exploratory. We came back with a really solid view and an understanding that we all care about the same things. We thought there were ways we could work together through a variety of partnerships.
Health Evolution: Talk about your efforts to date and what you’ve accomplished thus far.
Kathleen Krueger: We took a look at what that Chinese market really needed. It was clear they were looking for advisory folks to help them expand the distribution of care. The model we’re so familiar with in the U.S. and how we deliver care. They were looking for us to help advance them along.
Our work is a little bit eclectic, I’d say. We’ve done everything from establish sister-hospital relationships between our children’s hospital and a women and children’s hospital in China. We’ve sent cohorts of physicians there to give them assistance and advising on care. We have hosted director-level training programs for several hospitals across China. They’ve come to ProMedica and spent a couple of weeks with us …learning and exploring the American health system and collaborating on different ideas. More recently, we are focused on helping them establish what we in America call the post-acute space. Helping them establish organizations around healthy senior aging and post-acute services.
Kathleen Krueger, President of ProMedica International
Oostra: What’s interesting—as our health systems have evolved in the U.S. to become a more integrated model—we’ve found that China has the same issues we do, especially when it comes to aging. Our industry is probably farther along than parts of China. How we take care of people in non-traditional ways, that’s an area that’s spurred more discussions than even the hospital side.
Health Evolution: What are the outside factors that caused you to rethink your organization in the 2010s and ultimately decide to establish operations in a country halfway across the world?
Oostra: We are surprised where we are today given our history. A couple of things happened along the way. The fact is a lot of American communities aren’t growing. How do you position yourself in non-growing communities where care is shifting radically to outpatient settings? We started to question the size and scope of hospitals and where they’re going to go in the future.
We got very interested in obesity. What was shocking to us was the connection between obesity and hunger. We got involved a decade ago on hunger and hunger as a health issue. We were talking to hunger organizations. They wanted to know why we were suddenly interested in hunger. For our system, we evolved our thinking. The last decade, we’ve done three million hunger screens. We needed to look in very non-traditional ways at the work we’re doing. When you add in the demographic change, the unaffordability of health care in America, the fact we’re spending trillions of dollars in this country, bankruptcy is at an all-time high for 85 year olds … all of that has made us look outside our walls at non-traditional paths. This spring, we’re opening up our first traditional Chinese medicine clinic. This evolved thinking started a decade ago when we got involved with these social issues.
The people we work with in China, they have the same goals. They have the same issues. They are trying to do the same things for their people that we’re trying. It’s been a collaborative environment. We’re impressed with many of things they do from a technology standpoint. They’re blending more Western and Chinese medicine. It’s been a great discussion. They are at a much different point in the evolution of their health care system, they’re at a much lower percentage of their GDP. They are interested in dialogues of how we in America have begun to look at health care differently from this traditional hospital-based care.
Health Evolution: What are some of the cultural challenges you are dealing with in China?
Krueger: Certainly, language is always a challenge. Before I say that’s a major challenge, most of the folks we’re working with in China at the higher levels of the organization speak and communicate to us in English. The time difference is a huge challenge. You’re always scheduling with a 12-hour difference. We have to honor each other’s time and length of days. We’ve always set up technology exchanges considerate of that. It slows us down a little since you don’t have to think of those things when you’re talking with people inside the U.S.
Oostra: One thing I’d add is we’ve found the Chinese people to be incredibly polite, even when they may not be interested in working with us. We’ll think we’ve had a good meeting, but nothing happens. And we realize they probably didn’t want to work with us in the first place, but they were so polite, they just didn’t want to tell that. We’ve learned a little bit about that. We’re understanding culturally how they interact, how they communicate. We’ve learned some things there.
Health Evolution: You also hired a Chief HR Officer who has lived in China in April … I don’t think that’s a coincidence. What are the next step for your efforts there?
Krueger: In addition to what we’ve been doing, advising the development projects going on over there, we will continue the launching of our traditional Chinese medicine site embedded here at ProMedica. It’s a foundational event for us. It’s very fragmented in the U.S. We’re going to be looking at that as an opportunity to advance those operations in the U.S. In China, we will continue working with them to build out the post-acute industry, both in design and training and implementation.
Oostra: We believe we’re going to see a heavy blend of traditional and non-traditional medicine evolving over the next few years. A lot of that has to do with the unaffordability of care we have today. People will seek more alternative approaches to care because of cost. Therefore, China, the other initiatives we have with HCR, we have to gear up in those areas. With HCR, footprint in almost 30 states. It allows to think about it differently. It allows us to think of the non-traditional health and wellbeing services that are direct to the consumer. It’s more consistent with what HCR has previously done.