David Sandman

David Sandman

I spent a few days last week in Rochester, New York, and the city was buzzing with activity.

A flower show was being held (one of Rochester’s nicknames is “the Flower City.” And before that it was the “Flour City” because of an abundance of flour mills along the waterfalls of the Genesee.) Rochester’s acclaimed International Jazz Festival was just about to begin. More than 200,000 people were expected to attend more than 300 shows over the course of 10 days, and there was a sense of anticipation among the residents I met.

Rochester also takes pride in its health care institutions, which are anchors in the community. The University of Rochester (including the University of Rochester Medical Center) and Rochester Regional Health are among the top 15 employers in all of New York State, and the largest employers in the region. In 1980, the Eastman Kodak Company was far and away the top employer—more than 50,000 people in Rochester worked for Kodak, compared with just 1,500 people today. As manufacturing jobs have declined precipitously (representing just 10% of jobs in Rochester today, down from 33% in 1980), employment in health and social services and education has been growing steadily.

The story of health in Rochester isn’t straightforward. Rochester is the seat of Monroe County, which has middling health outcomes; the County Health Rankings place it 39th out of New York’s 62 counties on measures of the length and quality of life. It performs better (24th) on health factors—a composite measure of health behaviors, clinical care, socioeconomic factors, and the physical environment. In this area, Monroe County does especially well on indicators of clinical care, ranking 8th of 62 counties. This is perhaps not surprising, given its two world-class hospital systems, a strong network of community health centers, high rates of insurance coverage, and relatively low health care costs.

But factors outside of the health care system that have such an important impact on health, such as a high rate of child poverty and deep racial disparities, are persistent challenges in Rochester. Like other communities, Rochester has seen stark increases in opioid misuse and overdose; it also has high rates of violence, including assault and homicide, compared with New York State as a whole. All of these factors make it harder for people to stay healthy. And while health care providers in Rochester can and do help individual patients—by connecting them with social workers, offering them bus passes, referring them to food pantries, or even coordinating housing—these efforts can be piecemeal.

So what’s the path forward for Rochester? I had the chance to hear from a number of Rochester’s health care leaders about what they see as the biggest challenges and opportunities for health care in the region. I heard a few key themes:

Collaboration and cooperation: Of course, Rochester’s two large hospital systems are competitors, but they also have good relationships and often work together to share resources and information. They have a shared electronic health records system, for example. They are also collaborating on the nation’s only community-wide implementation of OpenNotes, which allows patients and their family members to view their providers’ health care visit notes. They are also working with the Monroe County Medical Society to engage additional providers in the initiative, which has been shown to improve outcomes like medication adherence and patient satisfaction.

As another example of collaboration, the Rochester Institute of Technology (RIT) is working with Rochester Regional Health on a program to halt retaliatory gun violence in the community. When survivors of gun violence incidents show up at Rochester Regional Health, a team from RIT and community-based organizations like Pathways to Peace are activated to work with the victims and their families and friends to try to diffuse the situation and keep the violence from escalating.  

Collaboration between health care providers and community-based social service organizations is critical. There’s an eagerness and a willingness for people from different organizations to come together to talk through the city’s thorniest problems and figure out a way forward together. That’s a point of pride, as it should be. At the same time, I heard over and over again during my time in Rochester that “there are too many tables.” These conversations aren’t necessarily happening in a coordinated way, with all the right players gathered around one table to address systemic challenges in a way that’s sustainable.

Commitment to meeting patients’ and providers’ needs: We often talk about health care’s “Triple Aim”: improving the patient’s experience of care, keeping people healthy, and reducing health care costs. And Rochester does well here; it has long been a leader in providing high-value care. During my visit, I heard from a number of people about the “quadruple aim,” which also adds the dimension of improving the health care provider’s experience, in part because the city is grappling with a health care workforce shortage. The community needs to attract and retain health care workers at all levels—doctors, nurses, pharmacy techs, home health aides—to care for its patients.

And as health care organizations think about their staffing, they also need to consider the trends in health care. Rochester already provides much of its care outside of the hospital—it doesn’t have a big oversupply of hospital beds—but like many communities, it expects that this trend will only continue, and that hospitals will be used only for very sick patients and highly specialized services. They need to be smart and creative about how to meet the community’s needs, using data to drive their decisions and implementing new approaches like telehealth.

Technology and innovation: Rochester has been lauded as one of America’s most innovative cities, and it’s been a leader in using technology to advance health care access and quality. The University of Rochester Medical Center has implemented Project ECHO, which uses Web-based videoconferencing to create virtual grand rounds. The model allows primary care providers in rural and underserved areas to learn from specialists and gain the knowledge and support they need to better manage patients who have complex medical conditions.

Rochester is also on the cutting edge of using artificial intelligence (AI) to develop predictive analyses that lead to better patient care. For example, I heard about work to use AI to anticipate which patients are most likely to experience sepsis or to have complications after joint surgery. Having a more precise understanding of a patient’s likely outcomes can help providers better plan for care and follow-up. It can also help with patient-provider communication and shared decision-making. If AI can predict that a particular patient is likely to require nursing home care after a knee replacement, for example, it’s important for the patient to know and be able to plan for that. But it may also show that, if the patient lost weight before surgery, he might be less likely to require nursing home care. That information could be the basis for a conversation between the patient and physician about the pros and cons of delaying surgery that takes into account the patient’s needs and preferences.

Rochester is emerging as a beacon of creativity and artistry, and it is poised to build on its legacy as a leader in health care. Although its reinvention is not complete, and the specter of Kodak’s decline continues to hover over the city, it is defining itself as home to a collaborative, cooperative community where leaders and residents have a “roll up your sleeves and get it done” attitude. 

By David Sandman, President and CEO, New York State Health Foundation
Published in Medium on June 25, 2019

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