ISMIE Risk Management Symposium: Thriving in Change


Lisa Bielamowicz, MD

Co-Founder and President, Gist Healthcare LLC

Lisa Bielamowicz, MD

Lisa Bielamowicz, MD, is the cofounder and president of Gist Healthcare, a strategic advisory service that provides guidance to health care industry leaders.

A national expert on health care strategy, Dr. Bielamowicz is known for being able to distill actionable insight from complex and conflicting market forces. Whether speaking to an audience of hundreds or working with an executive team, her passion is increasing the pace of transformation in health care.

Presenting at over 75 board meetings, leadership retreats, industry conferences, and executive strategy sessions annually, Dr. Bielamowicz brings energetic, provocative discussion to every forum she leads. She is a frequent keynote speaker and is regularly consulted by media, quoted in The New York Times, Modern Healthcare, The Wall Street Journal, and Health Affairs.

Dr. Bielamowicz's work combines national-level insight with a deep understanding of local market dynamics and system strength. A trusted advisor to dozens of health systems and medical groups, executives call on her to provide critical guidance on system strategy and investments, and to serve as a partner in developing consensus toward a common vision.

Prior to founding Gist, Dr. Bielamowicz was chief medical officer and senior vice president of the Advisory Board, where she led the firm's strategy and clinical research for over a decade and was the primary author of many publications on health system and physician strategy, population health and care transformation.

As a physician Dr. Bielamowicz brings a clinical lens to her work and has a deep understanding of the dynamics of physician practice. She trained in diagnostic radiology at Johns Hopkins Hospital. A Howard Hughes fellow, she researched memory and learning using functional MRI at the National Institute of Mental Health. Dr. Bielamowicz holds a bachelor's degree from Rice University and received her MD with highest honors from Baylor College of Medicine, graduating first in her class.

Dr. Bielamowicz will be speaking about...

The Future of Health Care – 2019 and Beyond

clock  8:45 a.m. - 9:45 a.m. | Opening Keynote

The first half of the Trump administration's term has proven to be a turbulent time for the health care sector. Frustrated in their initial attempts to "repeal and replace" the Affordable Care Act, Republican leaders in Congress and the administration are exploring new strategies to constrain the growth of federal health care spending – including premium support for Medicare, block grants for Medicaid, and the loosening of regulations to enable more marketplace competition in health care.

Meanwhile, consumers of care increasingly bear the costs and risks associated with an ever-more-expensive health care delivery system. As prices continue to skyrocket for hospital, physician and pharmaceutical care, employers and insurers are turning to high-deductible benefit plans and narrower networks as a means to control spending. Individuals are being asked to act as "consumers" in health care, shopping on price, convenience, and service quality.

In this discussion, we will examine the implications of these regulatory and market trends for the providers of care – doctors, hospitals and others. As purchasers of care seek to impose whatever constraints they can on spending, how should providers respond? Consolidation, cost cutting, vertical and horizontal integration, retail strategies, and other trends in the provider marketplace are reshaping American health care. Meanwhile, new technologies and drugs, disruptive innovators, and the rise of digital medicine are beginning to upend traditional players – and create new risks for physicians. We will highlight successful approaches and strategies for thriving in this changing health care landscape.

Learning Objectives

  • Recognize the current state of health care reform, the likely direction of health policy, and the subsequent impact on health care professionals
  • Identify larger market forces (e.g., disruption, consumerism, transparency) that are shaping the direction of health care
  • Summarize strategies for doctors, hospitals and other clinicians to be successful in a dynamic market
  • Describe the tenets of a consumer-focused health system, and how these changes will affect physicians' risk and liability

Nathaniel Lacktman, Esq.

Chair, Telemedicine Industry Team

Nathaniel Lacktman, Esq.

Nathaniel Lacktman, Esq. is a partner and health care lawyer with Foley & Lardner where he is the Chair of the firm's Telemedicine Industry Team and co-chair of the firm's Digital Health Group. Mr. Lacktman advises hospitals, health care providers, and technology companies on business arrangements, compliance, and corporate matters, with particular attention to telehealth, digital health, and health innovation. His approach to practicing law emphasizes strategic counseling, creative business modeling, and fresh approaches to realize clients' ambitious and innovative goals. He has helped draft comments, legislation, and policy input on telehealth to state lawmakers, the DEA, the Congressional Research Service, Medicaid agencies, state boards of medicine, and the American Heart Association. He is a graduate of the University of Southern California School of Law. Follow him on Twitter.

Mr. Lacktman will be speaking about...

Telemedicine: Legal and Practical Considerations for Physicians

clock  10:00 a.m. - 11:00 a.m. | Breakout Session 1A

Advances in health technology can promote good patient care, but the laws and rules when delivering care via telemedicine, particularly across state lines, can be daunting. Physicians should endeavor to build a system that makes good business sense and adheres to health care industry regulatory requirements, while also allowing them to uphold the standard of care. This session will discuss important considerations that physicians should take into account when practicing via telemedicine.

Learning Objectives

  • Summarize the current regulatory landscape as it relates to telemedicine
  • Identify key considerations when using telemedicine, including licensure, medical practice standards, prescribing and reimbursement
  • Describe the medical professional liability risks that may arise when delivering care via telemedicine

Peter H. O'Donnell, MD

Associate Director for Clinical Implementation, Center for Personalized Therapeutics, The University of Chicago

Peter H. O’Donnell, MD

Peter H. O'Donnell, MD, is a translational researcher with advanced training in pharmacology and pharmacogenomics and a practicing oncologist specializing in the treatment of genitourinary malignancies, specifically bladder cancer. His research focuses on elucidation of germline genetic markers that predict drug response (pharmacogenomics) and clinical implementation of such markers at the point-of-care.

Dr. O'Donnell serves as principal investigator of "The 1200 Patients Project," a large clinical study exploring the feasibility and benefit of incorporating broad pharmacogenomic testing into routine clinical practice for patients with any type of disease. He also serves as Translational Project lead for the NIH-funded study entitled "ACCOuNT" which aims to implement point-of-care pharmacogenomic clinical guidance for hospitalized minority patients.

Dr. O'Donnell has been recognized for outstanding contributions to research and education by being awarded the American Society of Clinical Pharmacology and Therapeutics Presidential Training Award, American Association of Cancer Researchers Future Leaders in Translational Medicine Award, Early Career Development Award by the Central Society for Clinical and Translational Research, and induction into the Alpha Omega Alpha (AΩA) Beta Chapter of the Pritzker School of Medicine and the Academy of Distinguished Medical Educators at The University of Chicago. Nationally, he was the 2017-18 chair of the Scientific Program Committee for the American Society for Clinical Pharmacology and Therapeutics.

Dr. O'Donnell will be speaking about...

Improving Prescribing in the Era of Precision Medicine

clock  10:00 a.m. - 11:00 a.m. | Breakout Session 1B

Can doctors predict in advance whether a treatment will work for an individual patient? Or whether it might cause serious side effects? New techniques that harness the power of DNA technology and point-of-care prescribing decision support are now making this possible. Dr. O'Donnell will discuss these advancements, including recent discoveries at The University of Chicago that have paved the way for this to be possible. Dr. O'Donnell will argue that in the current age of precision medicine, the pertinent question might instead be: Why don't more doctors use such information when treating patients today?

Learning Objectives

  • Summarize current evidence for how genomic information can inform the prescribing of commonly used drugs
  • Identify potential barriers to more widespread use of genomics to inform prescribing
  • Describe a potential model for the implementation of genomic information in clinical care

Wendy Chung, MD, PhD

Kennedy Family Professor of Pediatrics and Medicine, Columbia University

Wendy Chung, MD, PhD

Wendy Chung, MD, PhD, is a clinical and molecular geneticist and the Kennedy Family Professor of Pediatrics and Medicine. She received her BA in biochemistry and economics from Cornell University, her MD from Cornell University Medical College, and her PhD from The Rockefeller University in genetics. Dr. Chung directs NIH-funded research programs in human genetics of obesity, breast cancer, pulmonary hypertension, autism, and birth defects including congenital diaphragmatic hernia and congenital heart disease. She leads the Precision Medicine Resource in the Irving Institute at Columbia University.

She has authored over 250 peer reviewed papers and 50 reviews and chapters in medical texts. She was the recipient of the American Academy of Pediatrics Young Investigator Award, the Medical Achievement Award from Bonei Olam, and a career development award from Doris Duke. Dr. Chung is renowned for her teaching and mentoring and received Columbia University's highest teaching award, the Presidential Award for Outstanding Teaching. She was the original plaintiff in the Supreme Court case that overturned the ability to patent genes and served on the Institute of Medicine Committee on Genetic Testing.

Dr. Chung enjoys the challenges of genetics as a rapidly changing field of medicine and strives to facilitate the integration of genetic medicine into all areas of health care in a medically, scientifically, and ethically sound, accessible, cost effective manner.

Dr. Chung will be speaking about...

The ABCs of DNA: How to Ensure Safe, Effective Use of Genetics in Your Practice

clock  11:15 a.m. - 12:15 p.m. | Breakout Session 2A

In this session, we will review the current status of clinical genetic testing and the clinical utility for common prenatal, pediatric, and adult clinical applications. We will also review the common clinical situations in which this information is useful and how practitioners and health care systems can integrate this information into medical care safely. We will discuss resources available, including ACT sheets, clinical management guidelines and how to use decision support tools effectively. Because genetic information is complex and constantly changing, integration of the information into routine health care by non-genetic providers can be challenging and expose providers and health care institutions to liability. We will explore the most common liabilities and how to minimize risk by building robust infrastructures that support genetic professionals within health care systems. This, in turn, will help to integrate genomic information into medical care responsibly and reliably to improve patient care and outcomes.

Learning Objectives

  • Recognize the situations in which genetic testing can be clinically beneficial across the life span
  • Explain how to correctly interpret genetic test results
  • List the most common liabilities connected to genetic testing
  • Illustrate strategies to mitigate these liability risks

Holly M. Holmes, MD, MS

Associate Professor and Division Director, McGovern Medical School

Holly M. Holmes, MD, MS

Holly Holmes, MD, MS, is a geriatrician and former pharmacist whose clinical and research interests are centered on optimizing care for vulnerable older adults with cancer and multiple comorbidities. Dr. Holmes attended medical school at The University of Texas-Houston Health Science Center. She completed her internal medicine residency and her geriatrics fellowship training at the University of Chicago. Dr. Holmes has several years of research experience as a clinician and health services researcher in geriatric pharmacoepidemiology and geriatric oncology. Her primary research has been focused on medication-related issues in older persons, using administrative data, and has been supported by the National Institute on Aging and the John A. Hartford Foundation. Her research has included the evaluation of chronic medication use patterns in hospice patients.

Dr. Holmes will be speaking about...

Deprescribing: The Who, What, When, Why and How

clock  11:15 a.m. - 12:15 p.m. | Breakout Session 2B

This session will discuss deprescribing as an approach to the ongoing problem of polypharmacy in older people. In the United States, 40% of people 65 and older take at least five regular medications, and up to 20% take more than 10 medications regularly. While the use of multiple medications may be justifiable given an older adult's multimorbid conditions and clinical complexity, the use of several concurrent medications exposes older adults to risks from adverse drug events, unexpected drug interactions, burdensome care, increased health care costs, and an increased risk of hospitalization.

For some older patients, an approach to reducing medication numbers may require deprescribing. Deprescribing is a systematic process by which all medications are reviewed, assessed for risk/benefit ratio, evaluated for their eligibility for discontinuation, prioritized for continuation/discontinuation, and then monitored closely. This session will focus on the patients and situations in which deprescribing might be helpful and useful tools that can aid in the process.

Learning Objectives

  • Recognize the epidemiology of medication-related problems in older people
  • Identify solutions that would be appropriate for deprescribing
  • Describe strategies for making safer medication choices when deprescribing

Gurpreet Dhaliwal, MD

Professor of Medicine, University of California, San Francisco

Gurpreet Dhaliwal, MD

Gurpreet Dhaliwal, MD, is a clinician-educator and professor of medicine at the University of California, San Francisco (UCSF). He sees patients and teaches medical students and residents in the emergency department, inpatient wards, and outpatient clinic at the San Francisco VA Medical Center, where he is the site director of the internal medicine clerkship. Dr. Dhaliwal studies and speaks about how doctors think – how they make diagnoses, how they reason, and what motivates them to improve their practices and the systems in which they work.

He has published over 100 journal articles, has won multiple teaching awards, and has been a visiting professor at multiple universities across the U.S. and in China and Japan.

In 2012 he was profiled in The New York Times in an article titled "Could a Computer Outthink This Doctor?" He currently writes for The Wall Street Journal's The Experts: Health Care blog. Dr. Dhaliwal is a member of the UCSF Academy of Medical Educators and the UCSF Department of Medicine Council of Master Clinicians.

Dr. Dhaliwal will be speaking about...

Physicians at Work: Reigniting Purpose & Mastery

clock  1:15 p.m. - 2:15 p.m. | Plenary Session

Diagnosis is at the heart of clinical practice. Physicians excel at this challenging task, but emerging studies on the incidence of diagnostic error suggest that we can do better. In this session, Dr. Dhaliwal will use case discussions to outline the way clinicians diagnose and how we can improve the diagnostic process through individual- and team-based approaches. He will highlight how adopting a growth mindset towards the most important procedure we do in medicine – thinking – can benefit patients, clinicians, and health care teams.

Learning Objectives

  • Discuss the key steps in the diagnostic process
  • Identify factors and conditions that lead to diagnostic error
  • Describe methods for improving diagnostic reasoning
  • Identify strategies for developing adaptive qualities and flexibility as a clinician

J. Bryan Sexton, PhD

Director, Duke Patient Safety Center, Duke University Health System

J. Bryan Sexton, PhD

Dr. Sexton has captured the wisdom of frontline caregivers through rigorous assessments of safety culture, teamwork, and workforce resilience. His research instruments have been used around the world, in over 3,000 hospitals in 30 countries. His current R01 grant from NIH is a randomized clinical trial of resilience training. He has studied teamwork, safety and resilience in high-risk environments such as the commercial aviation cockpit, the operating room, and the intensive care unit, under funding from NIH, NASA, AHRQ, the Robert Wood Johnson Foundation, the Swiss National Science Foundation, and the Gottlieb Daimler and Karl Benz Foundation.

With specializations in organizational assessment, teamwork, survey development, and quantitative methods, he spends his time teaching, mentoring, conducting research, and finding practical ways of getting busy caregivers to do the right thing, by making it the easy thing to do. He has found that results across industries, work settings, shifts, professions, and countries highlight a great deal about reliability in high-risk environments – specifically, "you are better off changing the situation than trying to change human nature."

Dr. Sexton will be speaking about...

Resilience: Tools and Strategies for Addressing Burnout in Health Care

clock  2:30 p.m. - 3:30 p.m. | Closing Keynote

J. Bryan Sexton, PhD, is generally considered one of the world's foremost experts on the relationship between culture and patient safety. Presenting the closing keynote, Dr. Sexton will skip over what we all know – the prevalence and severity of burnout – and instead focus on strategies to help cope with burnout and develop resiliency at both the individual and institutional levels. Participants will leave the session – and the symposium – prepared to continue pursuing the sense of fulfillment that first drew them to their work in medicine.

Learning Objectives

  • Identify existing burnout interventions, including their mechanisms and efficacy
  • Describe institutional resources associated with improved well-being for health care professionals
  • Illustrate the role of positive emotions in both institutional and individual interventions to improve well-being