A conversation with the President and CEO of the Robert Wood Johnson Foundation.

Question: How is the recession impacting philanthropies and charities?

Risa Lavizzo-Mourey: How to do more with less, that’s the question that everyone in philanthropy is struggling with. I think one key part of doing more with less is to be more strategic, to realize what the objectives you’re truly trying to accomplish are and then to drive with greater focus towards those objectives.

The other thing that is really critical in doing more with less is to harness the power of your partnerships. The people that you work with, the organizations that are committed to the same objectives. If they know that you’re in it together, and you’re working towards the same objective,s and you agree on how to do more with less, you can actually have a greater impact.

So those are two areas where strategic philanthropy I think is really trying work in a different way in this downturn of their endowment.

Charities, foundations that see themselves as delivering care or filling a need that is unmet in this economic downturn have to take a different approach. They have to look at how to stretch those dollars further and to get services that are in-kind services where they were in the past using cash to provide those services.

So, in a lot of ways how we approach this problem depends on whether we’re a strategic philanthropy or whether we are focused on delivering a charitable service that is greatly needed in this economic downturn.

Question: How is the recession impacting corporate giving?

Risa Lavizzo-Mourey: Over these last couple of years when companies have had to dramatically change their corporate giving, I think they have come to understand just how dependent the communities in which they thrive are on their philanthropy. And I think it has created a new engagement in the community and in understanding that they are part of making that community a thriving place. There are a lot of companies, Johnson & Johnson, Goldman Sachs, many, many others that long had a history of investing in the communities that they live in and in their employees. And I think that out of this economic downturn will come an appreciation by corporations large and small that that is part of their social contract if you will with the rest of the world.

Question: Why are healthcare outcomes sometimes not focused on?

Risa Lavizzo-Mourey: In healthcare, we don’t focus on outcomes. We tend to focus on outputs.

When you go to the doctor it’s all about the visit. When you go to the hospital, it’s about how many days that you are in the hospital. We measure what we do with healthcare in terms of outputs, visits, phone calls, prescriptions, emergency room encounters.

What we really need to do is shift that pivot to the point where we are focusing on the ultimate outcome which patients want desperately--which is to get better and to stay healthy. So by making that shift from outputs to outcomes, I think we will dramatically transform the way that healthcare is perceived by not only patients, but also by doctors and by payers.

When I think about healthcare and the outcomes of healthcare, I like to draw an analogy between an article of clothing and what goes into making that article of clothing. You take a jacket like the one I’m wearing. We want that to fit well, to keep us warm, to do the function that it was intended to do, and we want to pay a reasonable price for it and have it the high value and adorable goods.

If we were to think about healthcare that way, the patient wants a long life and to be healthy and to get a healthcare service that helps him or her do that without paying a lot of extra money to get it.

But if you think about the analogy between the coat, it is almost as if in healthcare we are paying for how many sleeves are on the coat or how many buttons are on the coat, or how many collars are on the coat and not whether it fits well and does the job that it’s intended to do.

So what we have to do in transforming the way, as I said, patients, providers and payers think about healthcare, is to get them to focus on those outcomes of care, the actual function of the patient, whether or not they recovered from the surgery and were able to function the way they want to function after the surgery, not whether it was done and how many surgical procedures or how many pills were given as a part of that process.

Topic: The Robert Wood Johnson Foundation’s “Aligning Forces for Quality” program.

Risa Lavizzo-Mourey: It’s called Aligning Forces for Quality. This program intends to dramatically improve the quality for an entire population in a dozen or so communities, and it does it by getting everyone involved in the care--patients, doctors, hospitals, payers, all of the stakeholders--to agree to do three big rather difficult things.

First, to measure the quality of care that they deliver and to make sure that that is meeting the standards of care, national standards of care.

Second, to be transparent about reporting the quality of care that’s delivered. Most people cannot go and find out anything about the quality of care that they are getting. They can find out about the quality of a car they want to buy, but they cannot find out about the quality of healthcare that they want to purchase.

And third, they agree that they are going to consistently try to improve the quality of care in their region.

Now we think that by doing this, by investing in these dozen or so communities and doing it over a long period of time, they will transform the quality of care delivered, and that will become a beacon for the rest of the nation as we’re having this very important moment in history where our policy leaders, our business leaders, are trying to improve the quality of care.

Question: Why is US healthcare expensive?

Risa Lavizzo-Mourey: Healthcare in this country is expensive for a whole host of reasons, but let me just focus on a couple that are really important.

The first is that we have this notion in our country that more care is better care, and yet we know that a lot of the care that’s delivered is unnecessary and sometimes harmful. We’ve all had the experience of going to the doctor and having a sore throat, wanting to get an antibiotics, even though we’ve been told that it’s not a bacterial infection and in fact antibiotics may do more harm than good. Yet we still have this perception that more is going to be better.

No one wants to get an operation that is going to be ineffective and yet they’re not appropriate ways for us to understand, as consumers, whether that operation is necessary or not. And, in fact, we know from lots of studies that that have shown that 50% of the time, the care that we get is not the appropriate level of care.

So more care is not better care, and that forces us as a nation to think about how are going to deliver the right care at the right time and ensure that we have the outcomes associated with that. That is one of the things that I think is going to be absolutely critical to bringing the cost down in healthcare.

Question: Why are electronic medical records important?

Risa Lavizzo-Mourey: Electronic medical records are, in a lot of ways, I think the aspect of technology that is going to revolutionize the way we deliver care. And it’s not just that we will be able to collect information, it’s that everyone involved in the healthcare enterprise will be able to use that information more effectively. The patient will be able to manage their own care because they will have the information about the results of their test. They’ll have information about the medicines that they are using. They’ll have information about the effectiveness of various kinds of treatments. The physician and the healthcare providers, the nurse practitioners, all of the people that are involved in delivering care will be able to work more as a virtual team and use that information to connect what is going on in the past, in their patient’s lives, along with the care that they are delivering at the current time. And the healthcare system will be able to use that information to manage health resources over the entire population, and to actually improve the quality of care by focusing on outcomes, focusing on the things that they can do as healthcare providers, to improve the probability of those positive outcomes occurring.

Increasingly we know that we’re going to have multiple medical conditions, and the person who’s got the greatest incentive to mange those conditions is the patient him or herself. The personalized medical record would provide a critical tool to be able to do that much more effectively than we’ll be able to do it in the past.

In several cities where we have investments, in the form of grants, we’re beginning to see that all of the major healthcare providers in that region are using a common platform for sharing medical information. So what that means is that, if a patient goes into the emergency room, the people in the emergency room can immediately call up on a screen the results of the x-ray or the electrocardiogram or the laboratory test that that patient got in the hospital or in the doctor’s office a week ago. What that does is it gives the ability to manage that person’s illness in real time in a much more effective way, and to do it in a much more cost efficient way because you are not duplicating test that don’t need to be duplicated, and you know the results of those test that greatly influence the care that needs to be delivered at that moment.

Question: How can people improve their health?

Risa Lavizzo-Mourey: If we really want to improve a person’s health, and make sure that the population is healthier, we have to create a culture of wellness in this country. The things that are going to actually help you or me stay healthy are not necessarily the things that happen inside a doctor’s office. They’re the things that allow us to choose healthy lifestyles on a day-by-day basis. The things that nudge just to get more exercise, to eat healthier, to quit smoking or not start smoking in the first place.

Business employers have a role to lay in this because they often create the environment that makes it easy for people to choose those healthy choices. Schools have role to play here because schools are where kids learn the lessons of a lifetime and schools have the opportunity to create those environments where kids can choose a healthy lifestyle. And our policy leaders have a role to play because they are the ones that enact the zoning laws and they help us create an environment that either encourages or discourages healthy lifestyles.

So I think the things that will actually make a difference and be low tech in improving our health are not the things that happen in the healthcare system. They are the things that happen in the larger environment and will create a culture of wellness.

We spend over 2 trillion dollars on medical care. But of that, 95% of it is going to treat people, not to preventing illness in the first place.

When you talk about prevention, it’s important to understand that a lot of the things that we can do to prevent illness, primary prevention happen outside of the healthcare system. Clinical prevention, colonoscopies, mammograms, things like that, are important but just as important, and in fact perhaps even more important, are the investments in community-based prevention that keep people healthy. We know that for every dollar that we can invest in community-based prevention, we will get a return on investment in about 5 years of $5.60. That is a great return on investment.

Topic: Childhood obesity.

Risa Lavizzo-Mourey: A few years ago, we [at the Wood Johnson Foundation] recognized that all of the data was pointing us to a very frightening reality. We may be raising the first generation of kids who live sicker and die younger than their parents.

That caused us to develop a strategy and a goal to reduce the epidemic of childhood obesity by 2015, not only to reduce it, to reverse it by 2015. As we’ve done this work, we have really tried to bring in all of the different sectors--the business sector, food industry, the activity sectors, schools, government, businesses and how we work and create environments for employees, because it is going to take a movement that involves all of those sectors if we’re going to reverse this epidemic of childhood obesity.

Recorded on: June 30, 2009.