The following is adapted from a speech Lars Houmann gave to business leaders in Florida earlier this year. Houman is the CEO for the roughly 20-hospital division of Adventist Health System that exists in Florida.

Radical pioneers

I’ll begin with two short quotes. The first comes from the Robert Wood Johnson Foundation:

Part of the reason the United States spends so much on health care is that millions of Americans are in poor health. Chronic conditions such as heart disease, cancer, stroke and diabetes are responsible for seven in 10 deaths among Americans each year, and account for nearly 75 percent of the nation’s health spending.

The second quote comes from a Wikipedia passage about our first Adventist health facility, which opened in Battle Creek, Michigan in 1869.

There, pioneers promoted the “radical” concepts of proper nutrition, exercise and sanitation in a facility devoted not just to the healing arts but also to the prevention of disease.

In reading both these, I ask myself: What if those radical pioneers had been in charge of developing the American healthcare system? What if we had put the same focus on health and prevention that we did treatment and intervention. What if the goal of a hospital was to keep you out of the hospital?

Then how would that Robert Wood Johnson report have read?

Good health is a smart investment

One of the ways we are incorporating those “radical concept” of our legacy is through a foundation of ideas for healthy living we call Creation Health. This is the bedrock of our belief that healthy living is the best form of health care. Choice, rest, environment, activity, trust in God, interpersonal relations, outlook, and nutrition are the pillars that we believe support a healthy lifestyle.

The wisdom of our predecessors is more relevant now than it was almost 150 years ago. The business community certainly seems to understand that. This is why wellness packages now are routinely included in employees’ health insurance. It is a hedge against the current and future costs of medical care. Companies also are seeing added bonuses as well in absenteeism, increased productivity and better morale. Good health is a smart investment. And a necessary one.

Healthcare consumes 18 percent of GDP. And despite that huge investment, people as a whole aren’t getting any healthier. We just are getting better at keeping them around longer. We have become voracious consumers of medical technology, spending far more than other developed nations on healthcare, yet having worse outcomes when it comes to rates of chronic conditions, obesity and infant mortality.

Retrofit the model with health and prevention

It almost makes you wonder if this was a system designed for promoting public health or economic development.

We believe it is possible to retrofit this model with strong health and prevention elements. It is the compassionate approach. It is the most effective approach. It is the only approach left that will keep medical costs sustainable.

Along these lines, the Adventist Health Policy Association recently delivered a plan to Congress entitled “Five Steps to Health in America.” It calls for redirecting some of the vast fortune we pile into medical care into improving the physical, emotional and spiritual health of our communities. It’s no longer such a radical concept.

Research shows this approach has a profound impact on health and lifespan. And yes, like fruits and vegetables, faith is good for you. We know because some of this research has been conducted on Adventists. Now I am not trying to convert you, but you may have heard about Adventist lifespans.

And it’s true. We do live longer. We require less maintenance. You want us in your insurance pool. Any my only point in bringing this up is we have some credibility on this topic.

Five Steps is an initiative that Adventist Health is pursuing at a national level. And it is one we at Florida Hospital plan to pursue a similar approach at the state level.

The report to Congress contained 75 recommendations. I’m going to give you a much shorter list that guides us at Florida Hospital. We call it the Triple Aim:

• Improve the health of the population
• Expand healthcare to all people
• Lower the cost of care while improving safety and outcomes

It’s all on my to-do list. And I imagine some or all of it is on yours as well.

A solid investment

I’ve talked about the need to improve the health of the population. Many of you are doing that with your company wellness plans. If it is a good investment for you, it is a good investment for the federal government and state governments. After all, when you include Medicare, Medicaid and the Veteran’s Administration, they control about half the healthcare market. And that percentage is going nowhere but up.

But there are significant challenges to government initiatives. Businesses operate in a more controlled environment than government. They can communicate with employees, encourage them and incentivize them in any number of ways. And when something doesn’t work, they can stop doing it. Government doesn’t have those advantages. And we have seen the difficulties this creates, including here in Florida. In 2005, Florida added a wellness incentive element in its Medicaid program.

Unfortunately, it was drawn up in a bureaucracy and didn’t translate well in the real world. The conditions were confusing and the incentives far too inadequate. There were few if any takers for smoking cessation and exercise programs, or classes aimed at reducing chronic disease. Almost all the incentives were given out for office visits of one kind or another, the type of behavior that may well have occurred anyway. It’s obviously easier to incentivize a person to do one thing than it is to change his life.

Let’s use our expertise, resources and data

Just to be fair, programs in other states haven’t fared much better. And so while we have good data on corporate wellness plans, there remains scant data about how to make them work in the public sector. But giving up is not an option for Florida, not when Medicaid is consuming 30 percent of the state budget.

It took 20 years for Florida to get education reform right. Success came with bold leadership and creative solutions. Florida became a laboratory of change that other states have emulated. This is the approach I encourage our leaders to take when Florida works with CMS to renew our Medicaid waiver next year. Florida Hospital is ready and anxious to participate in moving Medicaid toward a health and prevention model. We have the expertise, resources, and data to contribute.

And we also have the experience of our own initiatives. In 2011, an organization called Healthy Central Florida conducted health screenings in the historically African-American town of Eatonville. Results revealed 25 percent of the population has diabetes. This is almost triple the national average and double the average among African-Americans.

We had to learn more. And we had to help the community. And so the Florida Hospital Diabetes Institute has partnered with others to create Healthy Eatonville Place, which opened in May 2014. We are taking health risk assessments and looking for clues as to the cause of this epidemic. We are holding diabetes management courses, health cooking classes and hosting the YMCA’s diabetes prevention program. We also are working with residents on high blood pressure, weight control and smoking cessation. Strategies for managing chronic conditions go hand in hand. What lowers the risk for diabetes lowers the risk for heart attack and strokes. Dealing with chronic diseases in communities produces much better results and at much lower costs than dealing with them in the emergency room.

In 2014, Florida Hospital committed $6 million toward a major initiative to address homelessness. We are partnering with the city of Orlando and Orange County, as well as the Central Florida Regional Commission on Homelessness to attack this problem. This furthers our mission of fulfilling the healing ministry of Christ. But it also is an investment. The chronically homeless are habitual users of our emergency rooms. When they come in, it’s often for conditions that have festered for too long and are expensive to remedy. We treat them. And then they go back out in the street. And not surprisingly, we see them again. All too often, mental illness and/or addiction are the underlying causes for this cycle. By putting a roof over their heads, by putting them in a secure environment, we can offer them continued treatment and bring stability to their lives. We believe treating them in this manner will be cheaper than through the revolving door of an emergency room or a jail or other public facility.

A moral challenge, an economic necessity

When we talk about improving the health of the population, we mean everybody. We believe expanding healthcare coverage to the entire population is a moral challenge and, for our state, an economic necessity.

Last year we worked with other hospitals, our business partners, our non-profit partners, our faith-based partners and legislators like Andy Gardiner to bring us closer to that goal. Unfortunately, healthcare expansion was rejected. And as a result, Florida has the third highest uninsured rate in the nation while at the same time we are set to lose billions of dollars in federal dollars for indigent care.

This means we will have to make up for these funds within our borders. The impact will ripple through our economy, our healthcare providers, our state budget, our local budgets and our private insurance rates.

Beating up on hospitals may be cathartic. On occasion it may be warranted. And yes, issues like more transparent billing need to be addressed. But you simply cannot squeeze the billions of dollars required to treat the uninsured out of hospital budgets. This will create a crisis for hospitals that treat a disproportionate share of our most vulnerable residents. And that will lead to devastating service cuts that eventually will affect many more residents.

Unprecedented challenges

The scope of what confronts us as a state is unprecedented. As is the scope of what confronts us as a hospital. Let me give you a couple of examples.

There is ongoing shift of healthcare costs to individuals through higher deductibles and co-pays. It is a highly unpopular way of taking passive patients and turning them into active consumers. Ultimately, they will shop for medical care in the same way they shop for other services. And we will have to be price competitive in this environment to succeed. We believe this will have a profound impact on the market, perhaps more so than any reforms in the government programs.

Second, just as patients are being required to put more of their skin in the game, so are providers. You are familiar with fee for service, and the inefficiencies and potential for abuse inherent in such a system. Not surprisingly, a movement toward bundled costs is gaining momentum. In this model, providers are paid a set fee to cover one episode of care. If you needed a new hip, we get X amount of dollars to install it. If we do a good job and get you out the door and back on your feet, we earn a profit. If we don’t you have to be readmitted for follow-up care, we eat the cost.

Lower the cost, improve outcomes

And so getting back to our Triple Aim, we have to lower the cost of healthcare while improving safety and outcomes.

We have been preparing for such seismic shifts for a while now. We are working to weed out inefficiencies and unnecessary services. We are investing in cost-savings technologies such as telemedicine. We are basing more decisions on data. We are moving to standardize what works. We are engaging vendors and suppliers as partners in lowering costs. We are bringing together the researchers who work in laboratories and the caregivers who work at bedsides. And from that we can better find what works, and do so at a more accelerated pace.

To facilitate this process, Adventist Health has reorganized its Florida hospitals into a new division, overseeing three regions: East, Central and West. I now head that division. The challenge is giving each region the flexibility to meet the unique demands of its market, while ensuring care is uniformly excellent and efficient in all our hospitals.

I used to joke about my job as a hospital administrator. People asked: What do you do? And I said: I keep the doctors happy. The referrals come in. The bills go out. And someone else pays.

Questions to ponder

It was a simpler time. And I suppose for many in my industry, a better time. But that job description was long ago obsolete.

Change will come hard, even to us. The challenges we lay out for our healthcare system are daunting challenges for us as well. But not taking them on is no longer an option. So here we are, at the table, ready to engage in solutions and advocating for some radical ideas that date back almost 150 years. It’s not too late to turn back the clock.

Let me leave you with five questions to ponder:

• What if we adopted a wellness architecture to ensure Florida is the healthiest state in the U.S.?
• What if we strive to make Florida’s current health system a best practice model?
• What if we strengthen the health care workforce?
• What if we convert the public healthcare system to a people-centric and community-centered care platform – integrating mind, body and spirit?
• What if we integrate health in all possible policies and programs?

We can do amazing things when we all work together for the benefit of the people in our communities.