From his office overlooking Lake Superior in central Duluth, David Herman, CEO of the Essentia Health system, asks his visitor to imagine a golf tee box. If he were to hit a golf ball to the west, the average life expectancy is 73 years. Hit the ball east, the average life expectancy is 85 years.
It’s a remarkable disparity, and it’s not the only one Herman and his system are confronting. St. Louis County, where Duluth is located, ranks 13th among all 87 Minnesota counties in clinical care, according to a 2016 regional health study conducted by the University of Wisconsin Population Health Institute. That suggests the quality of care available in the county from Essentia and its largest local competitor, the St. Luke’s health care system, is strong. But according to the same study, St. Louis County ranks 76th in actual health outcomes.
“The important thing to recognize is very little of our health outcomes are determined by the health care you receive—about 10 percent,” Herman says. “The strongest drivers are behaviors and socioeconomic status.”
The University of Wisconsin study ranks St. Louis county 73rd in social and economic factors. Northeastern Minnesota has notably higher rates of smoking and diabetes than the Twin Cities does, while disposable income and employment levels are lower.
“So I think the most important thing to do if you’re going to change the health of the community,” Herman says, “is to first recognize that waiting for people to come in to your clinic or hospital is not the way to move the ball.
“So what we have done is to say, ‘How do we get out of our clinics and hospitals, and start working with community partners to change that?’ ”
Since coming on board in January 2015 as CEO, Herman has been steering Essentia toward a different approach. A Mayo-educated ophthalmologist who also has a master’s degree in medical management, Herman is a Northland native, born and raised in International Falls. He knows the communities in northern Minnesota and the challenges they face. And while residents of these towns and cities might exhibit less-than-healthy behaviors, they also can come together and help each other out.
“If I can go to a place where I can get camaraderie and encouragement to be a little bit healthier in my behaviors, the likelihood I’ll do it is much better than listening to my doctor or nurse [who tell me] to stop smoking, eat better or get more exercise,” Herman says.
Essentia is active in a number of ways in its Minnesota territory. In addition to many programs in its hometown of Duluth and surrounding area, the system is working with several communities in its greater Minnesota service region.
Perhaps the biggest Essentia success story is in the Brainerd Lakes area, where the health system has a medical center and clinic. Launched in the fall of 2013, Crow Wing Energized is a community-driven program that promotes better health behaviors among area residents. Organizations and residents are focusing on diabetes, active lifestyles, healthy foods and mental health. Adam Rees, president of Essentia Health’s Brainerd-area facilities, notes that while many residents started the system’s diabetes prevention program with low expectations, the mutual encouragement in the community has changed minds and habits. After a 16-week period in 2016, nearly 300 participants in more than 40 classes reporting their results lost an average of 11 pounds by increasing activity and improving their diets.
Like Rees, Herman makes it clear that Essentia is not running the show, in Brainerd or in other communities. Instead, Herman says, “We’ve asked the community what’s important to them.” Then it is providing them with programs, metrics, funding and other resources.
Many of the community programs with Essentia’s involvement have launched since Herman’s arrival. During his career as a physician, “health care has grown from 8 percent of the U.S. gross domestic product to 18 percent,” Herman says. If Americans continue on their current path, there will never be enough money or providers to take care of people in the future, he says. In addition, he explains, “There never will be enough money to invest in education, job creation and economic infrastructure required for us to move forward.”
Essentia has other initiatives and programs outside the walls of its clinics and hospitals that are designed to help boost health outcomes. Northern Minnesota is mostly rural, and patients often live far from providers. That’s also true of most of the other areas Essentia serves. The system is expanding its telehealth program and helping push for stronger broadband access. Currently, Essentia provides a weight management telehealth program.
In any case, Herman knows that the traditional doctor-patient approach to medicine doesn’t necessarily lead to better outcomes. “The system as it is right now is not addressing the needs of many of the people we care for every day,” he says. “Something different needs to happen.” He and his colleagues are hoping they can help communities make that difference happen.
The Duluth-based health system is the largest employer in Minnesota north of the Twin Cities.
Clinics (total/Minnesota): 69/45
Hospitals (total/Minnesota): 15/11
Employees (total/Minnesota): 14,411/11,154
Locations: Minnesota, Wisconsin, North Dakota and Idaho
Essentia also operates seven long-term care facilities and six assisted-/independent-living facilities in Minnesota
Gene Rebeck is a Duluth-based freelance journalist who writes monthly for Twin Cities Business.