HJAR Mar/Apr 2022

HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2022 15 their best, but it’s a very difficult thing for us to change and to move. I think that’s a huge problem for us. It does cost a lot of money, and when you talk about healthcare costs, the money spent on treating a chronic dis- ease is a big part of the tab. I already spoke to the economic impact for employers — if their workforce cannot be as productive as others, that’s an economic challenge for them. On top of all this, much of what we’re talking about is impacted by personal choices and behaviors. You just can’t legis- late behavioral change. Editor So, based on what you just said, how can Baptist Health help move that needle? Or do you have a responsibility to even help move that needle? Wells Well, I think we have a responsibility in a couple of areas. Now, I’ll go back to a point I made earlier. The healthcare system, as it is today, is not designed to do this. We’re not paid to do it. We’re not incentivized to do it, but we all want to do it because it’s what we do. We want to help people be better. It’s the spirit for those physicians or health sys- tem leaders or elected officials who have an interest in healthcare and healthcare pol- icy — we all want to do it. The system is not designed to make it very easy, though. One of the things that we ought to think about from a healthcare provider perspec- tive is to put first things first. One, make sure that those who have chronic conditions are being cared for in an equitable manner. What I mean by that is people should get what they need. Doesn’t mean everybody gets the same thing, it means everybody gets what they individually need. Too often, our systems have been designed to be kind of mass production: for every diabetic, this is what we need to provide in every com- munity and in every town, every hospital. Well, that’s not what we need. We need to make sure that the things that we can do, that we are designed to do, that we are incentivized to do, that we’re doing them well, and we’re doing them right. It kind of goes back to quality. It’s the right care, the right place, right time. This is just another version of each individual’s needs are dif- ferent. We need to make sure we’re meeting those needs first and foremost. Now, when we get to a point where we can do that, then you back up and say, “Okay, now how do we prevent this from ever hap- pening in the first place?” From a health- care system ... again, we’re not a social ser- vices system, and we don’t invest as much in social services in the United States as most other countries. We spend more on health- care instead. We can debate that in another conversation. But the reality is, there’s a social spending element that’s missing, and to the extent that nonprofit, community- based, faith-based healthcare organizations can help fill some of that gap, we ought to consider doing that where it makes sense and where we can do it well and be help- ful. Now, too often, we’re wandering around trying to figure out what it is we can do to be helpful, and it’s going to take some trial and error. There’s a lot more focus on that now. It’s the social determinants of health, for example. You hear that thrown around a lot. Health systems are always talking about social determinants of health, health equity. We need to make sure people get what they need, and we need to back up stream and see if there are other things that make it easy for the health system to connect to. I don’t know for sure that I can solve pov- erty in a community, but if I could, that’s the thing that would prevent disease down the road. Poverty is the driver of all bad things in the future. But, I don’t know that Bap- tist Health is necessarily in the position to solve poverty inArkansas. What I can do is make sure that we’re paying living wages to people, that we’re providing good benefits to people, we’re supporting families that work for Baptist Health and trying to make sure that we start at home — make sure our employees have the things they need to be successful and to thrive. And then, if we can extend that further beyond our own family, that’s great. So, that’s one thing that I think we have to focus on is what are the things we can impact from a social perspective that does have a return in somebody’s life down the road for chronic disease. Editor You mentioned reimbursement. It’s lower in Arkansas. Why is that? Wells Well, I think that there’s a lot of rea- sons. I’ll try to be as objective as I can, but let’s start just with the thing I’ve repeated a couple of times already. We’re a poor state, generally speaking. That’s not a derogatory term, that’s an objective fact. Relative to other states, we fall in the bottom, probably, 10 percentile of poor economic states. Again, I don’t mean that as a derogatory comment, it’s just fact. There are so many people and so many leaders in our state trying to move Arkan- sas up. There’s some great things happen- ing, as you know, and we’re going to keep doing those things, but it’s a race, and we’re starting from behind. Having said all that, there’s a lot of history in the healthcare eco- nomics inArkansas, and it all starts with the fundamental fact that we are not one of the wealthier states in the U.S., and so, relative to others, our reimbursement is really low. We could talk about the way that the state Medicaid program works. We could talk about the commercial payer environment in Arkansas. We could talk about, again, chronic disease and the impact that has on the economics of healthcare. There are just multiple reasons why our reimbursement is lower than others. There’s also an element to this, and the healthcare audience will get this: part of what drives the dollar flow in healthcare is the Medicare program. We have the larg- est population of people in the country on Medicare, our seniors, that’s growing every