The Future of Healthcare: “We need to address the social determinants of health and advocate for policies that improve outcomes for the most vulnerable” with Lloyd H. Dean

Address social determinants of health and advocate for policies that improve outcomes for the most vulnerable. Our Community Investment Program has loaned more than $245 million to more than 165 nonprofit organizations since 1991, all focused on social determinants such as safe and affordable housing, helping those without a roof to find a home, and healthy food programs.

As CEO of newly formed CommonSpirit Health, Lloyd H. Dean has dedicated his career to preserving and expanding health care access for all. A health care visionary, Mr. Dean leads with compassion and is guided by the belief that the healing power of humanity can bring communities together to support a healthy future for everyone. During his tenure as President/CEO at Dignity Health, which recently aligned with Catholic Health Initiatives to create CommonSpirit Health, Mr. Dean transformed the health system from a holding company to a dynamic health enterprise with 41 hospitals and over 400 care centers, including neighborhood hospitals, urgent care facilities, surgery and imaging centers, home health, and primary care clinics. Now the national system is comprised of 142 hospitals and 700 care centers, across 21 states. He is a strong advocate for broad, innovative partnerships that helped create more positive patient experiences, more efficient care and services, and healthy communities. Mr. Dean is a member of the Health Affairs Council on Health Care Spending and Value and the American Heart Association CEO Roundtable. Mr. Dean has dedicated his career to eliminating the social disparities of health that are the root problems behind so many health issues.


Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?

The health care dichotomy within and between different communities struck me early in childhood. I grew up in a small town in Michigan where many people didn’t have proper access to health care, but it wasn’t until I was bused to neighboring schools in more affluent areas that I saw other parents pulling their children out of school for dentist appointments, regular checkups and routine preventive care. That was a stark contrast from what was happening in my neighborhood, where health problems were often untreated. That awareness, that difference, stuck with me. I think it was then and there that I decided I wanted to be a part of changing that health dynamic. Eventually, I made it my personal mission — the singular focus of my career — to improve access to care. I did so at Dignity Health, and I will continue to do so at CommonSpirit Health.

Can you share the most interesting story that happened to you since you began leading your company?

In January, we brought together 2,000 leaders from Dignity Health and Catholic Health Initiatives to take part in a combined leadership summit. I was impressed with the eagerness that everyone showed to roll up their sleeves and begin our work together for our newly combined organization. Everyone seemed to grasp the tremendous responsibility and opportunity we have to create healthy communities across our new system that spans more than 700 care sites across 21 states. Together we pledged a singular commitment to carry on the fundamental tenets of our combined ministry, to remove the barriers to health services, to lower the cost of care, and to place the patient at the center of their care. For me, the experience was both thrilling and humbling.

Can you tell our readers a bit about why you are an authority in the healthcare field?

In short, my expertise comes from my team. Our workforce is an amalgamation of individuals who are united — each with their own skillsets and experience — in the mission to build healthier communities. They do this by advocating for those who are poor and vulnerable, by innovating how and where healing can happen, and by constantly pushing themselves to do more for the people we serve. There is no greater responsibility — and gift — than to lead such an extraordinary group of professionals. My role as CEO of CommonSpirit Health is to cultivate an environment where those employees feel appreciated and empowered to leverage their skills for greater scale and impact in our communities.

What makes your company stand out? Can you share a story?

We are transforming care by targeting the immense health disparities that plague our country. It’s not just about a bottom line. It’s about working within our community — in partnership with community organizations — to directly improve the health outcomes of our most vulnerable populations. Take our Connected Community Network, for example. By streamlining the referral process and electronically linking local providers and service organizations, this network has provided more than 4,200 referrals to more than 240 programs. We will be tracking outcomes across the continuum of care and providing replicable, scalable models of care that other providers and organizations can adopt as their own. We have to learn from and collaborate with each other. It’s not about us; it’s about improving the lives of everyone in our communities across our great nation.

Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?

Let’s start with the “pain points” of chronic disease and the over utilization of acute care. These two factors alone must be addressed to support healthier populations overall and to reduce overall cost of care. We need to focus on fixing the root problems that can lead to poor health, teaching people how they can maintain their optimal health, and fixing health issues before they become acute problems.

Asthma and COPD offer a prime example of what can happen when chronic disease isn’t properly treated. These conditions affect millions of people every year, leading to emergency room visits and crisis situations that threaten lives and put an enormous financial burden on health systems. In Sacramento, we reduced asthma-related emergency room visits by more than half by partnering with Propeller Health, which uses virtual therapeutics to monitor and engage with patients before they reach an acute crisis. This is just one example of emerging technologies we are plugging into our routine clinical practice to help us better understand the conditions and the precipitating factors that lead to a health emergency.

We are also moving many health services outside of the acute setting. We are prioritizing home care through our ongoing partnership with NaviHealth and through CHI Health at Home, and why we’re emphasizing urgent care for health-related issues that don’t require a trip to the ER. We’re reassessing and redefining the entire continuum of care, providing care when and where patients access health services, in the most appropriate setting for their needs. In doing so, we’ve lowered acute hospital admissions, increased health access for patients, and reduced the cost of care.

Are you working on any exciting new projects now? How do you think that will help people?

We’re always working on new projects, looking to identify new partners and emerging technologies, to support patient centered care. One area with the most potential is intelligent automation that supports both clinicians and patients. We’re using a digital “front door” platform that makes online scheduling and access to health records more convenient for patients; we’re working with OODA Health to streamline payments; and we’re working with large technology companies to develop voice-activation programs that will support patients with limited mobility. All of these initiatives improve access to care by opening new “smart” pathways and leveraging technology to improve our interactions with our patients.

What are your “5 Things I Wish Someone Told Me Before I Started” and why.

  1. Pursue your passion. I’ve dedicated my life to improving health access and the social issues — the determinants that lead to poor health. Our Community Investment Program has helped our communities become stronger, more resilient and healthier. Having a meaningful impact on community health is difficult and requires resilience and commitment. But my personal vision has kept me going.
  2. Never stop learning. My mother instilled in me the importance of education at a young age, and I’ve maintained that mentality over the course of my career. I believe that continuously seeking knowledge will drive fundamental change and improvements to our health care system.
  3. Be team minded. Very few companies or organizations are successful because of a single person. Sometimes it’s in my conversations with employees that I discover the best solutions to our health care challenges. Through programs like the Dignity Health Intellectual Innovation Network, we are able to implement the groundbreaking discoveries and inventions of our employees into our hospitals. Regardless of your title or status, you can’t do it alone.
  4. Think big. Growing up in Michigan with no health coverage, I never envisioned my path would lead me to where I am today. Now I am fortunate to be in a position at CommonSpirit Health that has the national scale to solve national health challenges. That requires thinking big.
  5. Always look ahead, but never forget where you come from.

Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

First of all, let me say, the U.S. has one of the most remarkable health systems in the world. What this research highlights are the inequities within it. I believe that those inequities are the single greatest challenge to our health system and, fundamentally, the biggest flaw within it.

Take the inequity of infant mortality. Black infants in America are more than twice as likely to die as white infants, with a key factor being low birth weight. Some attribute this to psychological stress resulting in conditions like hypertension and pre-eclampsia. But I think we also need to take a good look at the institutional biases that exist in health care, which I believe, can lead to poor birth outcomes. I have yet to see a unified approach to treating the underlying cause. And that is one of the fundamental reasons that we have brought together a new system in CommonSpirit Health, to bring together the people, organizations, and partnerships — at a national scale — that will effect change in their local communities.

The second major problem in our current system is the disproportionate access to care for low-income Americans. This has been going on for too long and for a country with our resources, too many people have to choose between housing, food, daycare and health, simply because they can’t stretch their limited funds to cover everything. When something must be eliminated, it’s often health care. That leads to a lack of routine health maintenance, which can lead to seeking emergency care in expensive acute settings.

Lastly, we must make care more affordable. I believe in, and advocate for, a universal plan. When more people have access to routine health care on a regular basis, they are less likely to have a medical crisis requiring significant interventions that require considerable staffing and resources. That means health care costs overall are lower.

You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

  1. We must bring down the cost of care, period. We’re tackling this across our system, but one of the consumer projects we launched recently is the Dignity Health Specialty Pharmacy, a joint venture with Shields Health Solutions, to reduce the cost of typically expensive specialty medications for patients with complex chronic illnesses.
  2. We must put greater focus on addressing chronic and complex conditions before they become an emergency. For example, we’ve teamed up with Livongo to provide access to data-enabled glucose meters and supplies to help people with diabetes better control their disease on their own.
  3. Expand investment in technologies that personalize care and make it more convenient. We want to provide care where and when people need it. I am pleased to see many health systems are enabling tele-health services for their patients.
  4. Address social determinants of health and advocate for policies that improve outcomes for the most vulnerable. Dignity Health’s Community Investment Program has loaned more than $245 million to more than 165 nonprofit organizations since 1991, all focused on social determinants such as safe and affordable housing, helping those without a roof to find a home, and healthy food programs.
  5. Provide more education and training for physicians and nurses to meet the looming physician shortage. I was privileged to Co-Chair the California Future Health Workforce Commission with University of California President Janet Napolitano. We presented a list of 27 solutions to State to overcome the projected shortfall of primary care providers the state is expected to face by 2030.

Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?

Driving change can seem like a daunting task and we certainly can’t do it alone. Health doesn’t just happen because of health care. We must engage with organizations on the ground doing the work to address social determinants of health. Individuals, organizations and leaders must work harder to understand the needs of the communities around them in order to make a real difference. At CommonSpirit Health, we do this by establishing the types of partnerships with organizations that help us identify problems, develop solutions and mobilize action plans based on the unique needs and resources found in the communities we are trying to improve. Yes, we are a convener, but we also take it a step further by actively participating in those solutions. Our approach is exemplified in community-based programs such as our Connected Community Network, which provides referrals and customized support for vulnerable populations. This program has been a national model for how to improve the health of vulnerable populations.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

As a former schoolteacher, I have an enduring curiosity about the world, and I’m currently spending much of my free time — such as it is — exploring the revolutionary changes in technology. Consumer technology, in particular, is evolving at a rapid pace, with new devices and apps that will put the world at our fingertips. I also just finished reading Sapiens: A Brief History of Humankind by Yuval Harari. This was a terrific look at how humans and the culture of humans have evolved. That this idea that what separates us from other species is our ability to think of things that don’t yet exist. This concept appeals to me very much as I try to build, with 150,000 other very talented individuals in CommonSpirit Health, a health system that will meet the needs of future generations.

How can our readers follow you on social media?

You can follow me on Twitter at @LloydHDean and engage with me on LinkedIn, https://www.linkedin.com/in/lloyd-dean-96b6a8b2/.