Heart of New Ulm Project

[MUSIC PLAYING] If you were to say, so, what percentage of adult Americans are at an appropriate body mass index, exercise, eat their fruits and vegetables, don't smoke, wear a seat belt, you might be surprised to know that 3% of adults over 18 do all five of those things. 3%. That's not a big number. And so we know that if we could change individual behavior, we'd have a tremendous-- probably exponential-- impact on the health of the population.

70% of people showing up with a big heart attack have no idea they had heart disease the day before, that the majority of heart attacks are occurring in people who don't know they have disease. We've gotten a lot better at treating heart attacks, but it still turns out it's much to not have one in the first place.

The beginning vision of the Heart of New Ulm was bold-- can we minimize or eliminate heart attacks in the community, can we get to zero?

I think it was 10 million over 10 years was the goal. It was really to reduce heart attacks-- can you impact health care in a community by focusing on very simple interventions? And we've seen that you can.

Medical care, that's 20% of the story. So 80% of the story has nothing to do with the temples of technology that drive American medicine, and has very little to do with 18% of the GDP being spent on health care. It's all about the social determinants. This is an incredibly complex witch's brew of social, political, and economic problems, but it impacts health.

The Heart of New Ulm is a 10 year project, and it does take a lot of investment on the front end. But now it is so exciting. We're in this year 7 where the community is owning it. People know what it takes to have this population health program have an impact in their community, and they care, they are invested.

So there's a lot of community work on getting more active as a community together, on looking at our healthy meals together. Let's look at restaurant menus and see whether they can be healthy, let's do things together as a community.

That's the pinnacle of population health-- the entire community under our care and what can we do to empower them and to improve their cardiovascular care.

Some people maybe don't think it's been worth a million dollars of investment every year. And what I've asked in return is, can you show me any other community anywhere in the nation that has improved by 7% the level of hypertension within a community, that has stabilized obesity, cut smoking rates, cut heart attack rates, improved physical activity, improved nutrition? And if we can find any other comparable community in the nation that's done that, then I'm able to evaluate whether the million dollar investment is a wise investment, for not only this health system but the broader health care system across the country.

[MUSIC PLAYING]

New Ulm is a community filled with pride. People pass you, there's always a "hello," and there's a "how are you," and it's genuine.

We're not a facade of a community. It's real. It is a community that has a sense of place. There's a mindset of we want to be an ideal community to live in.

New Ulm considers itself the most German of towns in the US. There's a lot of pride in the German heritage, and there's of course a lot of pride in the German food.

It is small enough that you feel like you know everybody, but yet it's big enough where there's a lot to offer, from the parks, to Schell's Brewery. We're rich in history, and it's just a really great place to raise a family.

A great, rich history of activity, health, wellness, open space. Goes back to the sound mind, sound body philosophy of the Turners back in the 1850s.

New Ulm is a small town, about 14,000 people, pretty close-knit-- people know each other, you know your neighbors.

New Ulm definitely is salt of the earth people.

They're very hard workers. They are traditionalist. Anytime something needs to get done, it's going to get done. The community pulls together.

When something happens to someone, it's like everyone's on-board, there for them, anything they need help with.

New Ulm has a tradition of running successful events, supporting one another, and just being there for one another.

That is expected here, that you participate and that you are involved in your kids' lives, but that you also know your neighbor's kids and you watch out for everybody. It is the TV show Cheers, Northern Exposure, and The Andy Griffith Show all wrapped in one. You don't have to include that, but I just want that on video someday that that will come back to me.

What I've loved about the New Ulm area and where I grew up in North Dakota-- open space. There's freedom. I get to live in the New Ulm community, serve in the New Ulm community. And probably what other leaders don't get access to is I live literally 400 yards out the back door of the hospital.

I'm Toby Freier, I'm the president of New Ulm Medical Center. New Ulm Medical Center is an integrated rural health care delivery system, and we're a part of Allina Health, a health care system serving Minnesota as well as Western Wisconsin.

It is a challenging time to be in health care, because every ounce of our inner being wants to pursue better health, improved health for our communities. But we also know we're tied into a reimbursement system that pays for people to be in a hospital. We have an income statement that reflects revenue generated on sick people being in a hospital, yet all of our mission is about how can we prevent illness across the community.

I think I'm going to go down to CCU first.

I'll be honest-- I'm disappointed in the enthusiasm for improving outcomes of the health of a community, of a population, and affordability. And I don't know that there's any way to say that we're accomplishing that without the outcomes data.

We now have the IHP data into the data warehouse, all that claims activities. So we could be looking at ER patients, care follow-up piece of how could the ER physician help us with that--

When we have access to that information, it allows you to at least have the conversations with your physicians, with your patients, about the cost of health care in a meaningful way. When they learn that a swing bed is going to be $3,000 a night versus $250 a night at a nursing home, they care about that.

Access to data analytics, to health information at the fingertips of caregivers, at the fingertips of frontline leaders, is extremely important. We have an ER medical director able to access the sepsis care for every patient. He can do a real feedback loop to every provider for every case. That's empowering every leader, every clinician in our organization to be able to say, you have access to information that will help guide the right care, at the right place, at the right time for every patient, as well as for an aggregate population.

Turns out that Toby and his team have probably used the data warehouse in ways that we had never anticipated-- where people are getting care, what are the ways we can influence their care, how can we find out where high utilization is going and hotspotting around are there pockets of diabetes or obesity that we could focus resources in a different way. So one of, I think, the great wonders is out of this small community this very sophisticated sense of who the patients are, who the people are in the region, and what are their health care needs, and how can we shape our system to meet their needs rather than just guessing at what they might be.

Focusing on the triple aim and having access to the health system, I think, has been important. Without the resources of the system and having the electronic medical record, which allows us to do patient registries, which then allows us to get down to the quality of care that we're providing, I don't think we'd be able to do that without the resources of an entire system behind it.

And for us, we can every day through the electronic health records, through our own surveillance tool, be able to share-- here's the health status of our community, here's where it's improving, here's where it's not, and here are some of the interventions we're casting across the community and the impact each of them are having.

Population health for us really is can we collaborate across a health care system and a community to bring greater value and realize the health potential of an entire population. And I think we're realizing success when we see health as a priority for every organization in this community, not just the health care system.

One of the great successes of population health strategy would be the Heart of New Ulm and the New Ulm community. New Ulm happens to be a community that gets all of their cares through our health system. So from a medical records standpoint, we could measure what we were doing as far as transforming cardiovascular care there.

Turns out for people that are healthy, they don't spend a lot of time with their physician. And they shouldn't be, necessarily. If you think about a person over a given decade, they're going to spend about a total of two hours with the doctor. And the idea that that two hours is somehow going to determine their health for that decade is really pretty unreasonable.

If we're going to intervene in people's health, we're going to need to do something more than just their annual physical. We're going to need interventions at a population level. We're going to need interventions in their workplace, and in their community, and in their homes. And they're going to need the critical education as well and the clinical visits. But in general, it's going to have to be a broad-based intervention. You need really a collaborative effort from multiple different entities in order to pull something like that off.

And it's just not physicians and health practitioners that are driving health. It is the community grocery store, it is the school, it is the workplace, it is the park, it is the roads. It is all of those things.

Improving population health at the community level, literally it takes a village. And the health care system at this moment is really in transition-- is this a hospital-based activity, is this a public health department, is this a grocery store, or is this in the schools. And the short answer is, it's all of the above. So it's a complex notion. Our country is so big, and so heterogeneous, and so diverse, bringing together these forces, even in a relatively small community like New Ulm, is a formidable task.

Lasting change happens when more people embrace it. And so the Heart of New Ulm, while it was started as a research project and it was a partnership with the Minneapolis Heart Institute Foundation and the medical center, for lasting impact, for lasting change, it needs to be embraced by the community.

Businesses are complicated organizations with a lot of moving parts. And I think what the Heart of New Ulm has really allowed them to realize that their people are their most important resource, and investing in their employees really would make a difference.

At J&R Schugel Trucking, Incorporated, we started our business in 1974. We have about 600 trucks. J&R Schugel was one of the first companies to embrace the Heart of New Ulm and partner with them. Every year New Ulm Medical Center will give us a data report. So it will show how many people are involved, what has improved. So that's statistics for us that we can use. We check six markers-- it's blood pressure, cholesterol, triglycerides, glucose, the nicotine, and then your BMI-- your waist circumference.

Gradually, as we've started each year we've had more participation. Numbers have been lowering, so that's really exciting for us.

10 years ago when I wanted to walk a set of stairs I was concerned. I took it slow, it actually scared me. And that's one of the things that urged me to make a change in my lifestyle, because I thought, my god, I'm going to end up in one of these power chairs rolling down the street.

Everyone needs to have an aha moment. Sometimes those aha moments are very negative and very dramatic. It would be nice if people would have their aha moments with something that's much more minor. I was fortunate enough to have a wake-up call when there wasn't actually any damage to my heart. Making small modifications to your habits can have enormous consequences long term and it makes you feel pretty good in the short term.

Margins are tough in the restaurant business, and it's a lot easier to cook a frozen burger, frozen fries and keep them in stock. When you start talking about produce and healthy foods, it's expensive, and those products are a little bit harder to serve. I was very hesitant to begin with because I didn't want us to be forced into doing anything. And we really dug our heels in and said, absolutely not until you can prove to me that this is going to make some money.

And so, the same with the New Ulm residents, I think they'd feel the same way. I feel like if this was pushed on them, it would be a little bit harder pill to swallow. But it's just been a lot of opportunities and removing roadblocks as far as finding ways to be healthy, and it's worked for our town.

I believe that unless people are healthy they cannot reach their full potential. They can't be productive, they don't feel well, they can't have relationships. So I think it benefits all of us to be healthy. And that is why we're here, to make sure people stay healthy.

It's been one of the best opportunities we've had, to be able to have a population health research project and actually have a programmatic project done by a health care provider. What we've done with Heart of New Ulm and the work we've done with the Statewide Health Improvement Program as well in our rural community has really shown that people can work together as partners and have a collective effort. And it just goes a lot further.

I get to be one of those community members that's on the Heart of New Ulm Executive Committee. Who is all on that? Well, you have everybody representative of the city, the hospital, the schools, community members. Make a well representation of the different aspects of the community to come together to plan what should we be doing differently here.

So when we look at what is important for kids, what's the most important we need to make sure we give them each day, what are we doing with them physically? Do we encourage them to walk to school or bike to school? Do we encourage healthy meals, healthy snacks?

If their kids do walk to school in the morning or bike to school, their minds are ready. They've already physically done the exercise, they're ready to sit down and settle down for their morning routines in the classroom. So our job, if we're going to teach them academics, is to first get their mind set, get them ready. And being physically active is one of those keys.

We got some of those [INAUDIBLE] comments, but it's [INAUDIBLE].

OK, I'll cross that one off my list.

Sounds good. Thank you--

Thanks, Jen.

Bye bye.

Bye bye. A rabid coon in a park. My oh my, it's always something.

I remember sitting in that first meeting when the Heart of New Ulm project unfolded their plan. A light came on. It was really exciting to see the community get behind it, and become active in the programs, events, and activities, and to come into our facilities and start utilizing the fitness centers and the cardio centers much more so than they had in the past.

And this is the pick a ball area. Who's winning?

Hi.

They are.

We all are winners.

Good.

Very popular with the senior community.

New Ulm consistently ranks in the top five out of 853 municipalities in Minnesota as far as size and scope of recreation systems and in per capita spending. We've got the facilities and the infrastructure, and the Heart of New Ulm was helpful in promoting that and encouraging our residents and citizens to come out and become more active and engaged in their health and wellness and future.

It's really had an impact in our community. When you have a community that's already got a sense of place, already has an identity, and something like this comes in, it can come in and blow out pretty quickly without an impact. But I feel like New Ulm got it and embraced it. We've taken it, embraced it, and said, you know what, this is a good thing for us. You want the research project to be successful, but it had benefits to our community.

We have to rethink everything about what we do. And moving from a disease basis to a prevention basis, well, this is taking the entire model and turning it upside down and backwards. The health care system is trying to turn the battleship around inside the Panama Canal. That's the visual that you have to have. And it's colliding with the on-the-ground tactical reality of certain communities being able to make progress.

And we have to make it easy for people to do the right thing. That's what I was so impressed in, getting a deeper understanding about what's going on in New Ulm, that they've made it the default easy right thing to do-- to exercise, to buy healthy food, to ride your bike. There is some amazing social change happening in that town.

Are we really ready to tackle aspects of this problem? I think we are. It's going to be a matter of getting to that tipping point. Certain communities are going to say, we've had enough, we're not going to take it anymore, we're spending too much on health care, and we're not getting what we deserve for the investment that we're making.

Historically, there's been other projects that have tried to look at population interventions, and it's always been an issue with buy-in. It's easy for a doctor to prescribe medication. A doctor telling a patient how much to eat or what to eat and how much to exercise, there's pretty good evidence that that doesn't work very well. It's hard to change people's behavior at a clinic visit. It's much easier to change people's behavior by changing their environment.

This is a quality of life issue. If we can help somebody not get diabetes in their middle ages or know their cholesterol and make better choices earlier on, it's health care but it's quality of life care. And I think that's the compelling thing for health care to think about, is how can we get to people before they get to us.

One of the best places that we learn lessons organizationally are in defined out-state communities of care. New Ulm is a perfect example of that. So they can do things in a defined community, and do them better, and do it at a scale that we can again scale-up.

In the metropolitan area, it's hard to draw. Where do you draw lines around community? How do you do this? The complexities get greater, the size gets bigger, the relationships don't get as tight. And while we look to the smaller communities to tell a sketch what works in your community, what works together, there's no question that it can be done in a larger community too. You have to define the community, you have to establish the relationships, you have to establish what your goals are. But we can take those learnings from the out-state and certainly scale them to larger communities too using the same secret sauce that they've used, just on a different scale and with different parameters.

As I think about the future of New Ulm Medical Center, Heart of New Ulm, Allina Health, and our system, I believe the potential is here, that this could be a national model for population health and where health care is going in the country. In our community, health outcomes have improved almost across every health indicator across the community. Health care quality within the health care system has improved. We've lowered admission rates into the hospital by nearly 20%, 50% lower admission rates in our community compared to other comparable communities, overall $1,000 per Medicare patient lower cost of health care in our community.

So I think we're seeing early signs the triple aim is achievable-- better health, lower cost for a community. And I hope one day that New Ulm is this beacon for the nation, that this is the place where, maybe more than any other community, someone could say, if I lived there, I could realize my full health potential and have health care that truly is affordable in this country.

In our history as a country, all change is from the community level. I think New Ulm could be a bellwether example, a paradigm shift of where the rest of the nation can learn an awful lot when a community says, you know what, we're fed up and we're going to take it into our own hands in a positive way. I think this is a tremendous example of what a community can accomplish. I'm hoping we can disseminate these findings, and I'm hoping that other communities across the nation, not just rural communities, can learn from their great example.

[MUSIC PLAYING]

[MUSIC PLAYING] If you were to say, so what percentage of adult Americans are at an appropriate body mass index, exercise, eat their fruits and vegetables, don't smoke, wear a seat belt? I mean, you might be surprised to know that 3% of adults over 18 do all five of those things. 3%, I mean, that's not a big number. And so we know that if we could change individual behavior, we'd have a tremendous, probably exponential impact on the health of the population.

70% of people showing up with a big heart attack have no idea they had heart disease the day before. The majority of heart attacks are occurring in people who don't know they have disease. We've gotten a lot better at treating heart attacks, but it still turns out it's much better to not have one in the first place.

The beginning vision of the Heart of New Ulm was bold. Can we minimize or eliminate heart attacks in a community? Can we get to zero?

I think it was $10 million over 10 years was the goal, was really to reduce heart attacks. Can you impact health care in a community by focusing on very simple interventions? And we've seen that you can.

Medical care, that's 20% of the story. So 80% of the story has nothing to do with the temples of technology that drive American medicine and has very little to do with 18% of the GDP being spent on health care. It's all about the social determinants. This is an incredibly complex sort of witch's brew of social, political, and economic problems but it impacts health.

The Heart of New Ulm is a 10-year project, and it does take a lot of investment on the front end, but now, it is so exciting. We're in this year seven, where the community is owning it. People know what it takes to have this population health program have an impact in their community, and they care. They are invested.

So there's a lot of community work on getting more active as a community together, on looking at our healthy meals together. Let's look at restaurant menus and see whether they can be healthy. Let's do things together as a community.

That's the pinnacle of population health, the entire community under our care and what can we do to empower them and to improve their cardiovascular care?

Some people maybe don't think it's been worth a million dollars of investment every year, and what I've asked in return is, can you show me any other community, anywhere in the nation, that has improved by 7% the level of hypertension within a community, that has stabilized obesity, cut smoking rates, cut heart attack rates, improved physical activity, improved nutrition? And if we can find any other comparable community in the nation that's done that, then I'm able to evaluate whether the million dollar investment is a wise investment for not only this health system but the broader health care system across the country.

[MUSIC PLAYING]

[MUSIC PLAYING] If you were to say, so what percentage of adult Americans are at an appropriate body mass index, exercise, eat their fruits and vegetables, don't smoke, wear a seat belt, I mean, you might be surprised to know that 3% of adults over 18 do all five of those things. 3%, I mean, that's not a big number. And so we know that if we could change individual behavior, we'd have a tremendous, probably exponential impact on the health of the population.

70 percent of people showing up with a big heart attack have no idea they had heart disease the day before. The majority of heart attacks are occurring in people who don't know they have disease. We've gotten a lot better at treating heart attacks, but it still turns out it's much better to not have one in the first place.

The beginning vision of the Heart of New Ulm was bold. Can we minimize or eliminate heart attacks in the community? Can we get to zero?

I think it was $10 million over 10 years was the goal, was really to reduce heart attacks. Can you impact health care in a community by focusing on very simple interventions? And we've seen that you can.

Medical care, that's 20% of the story. So 80% of the story has nothing to do with the temples of technology that drive American medicine and has very little to do with 18% of the GDP being spent on health care. It's all about the social determinants. This is an incredibly complex sort of witch's brew of social, political, and economic problems, but it impacts health.

The Heart of New Ulm is a 10-year project, and it does take a lot of investment on the front end. But now, it is so exciting. We're in this year seven, where the community is owning it. People know what it takes to have this population health program have an impact in their community. And they care. They're invested.

So there's a lot of community work on getting more active as a community together, looking at our healthy meals together. Let's look at restaurant menus and see whether they can be healthy. Let's do things together as a community.

That's the pinnacle of population health, the entire community under our care. And what can we do to empower them and to improve their cardiovascular care?

Some people maybe don't think it's been worth a million dollars of investment every year. And what I've asked in return is, can you show me any other community anywhere in the nation that has improved by 7% the level of hypertension within a community, that has stabilized obesity, cut smoking rates, cut heart attack rates, improved physical activity, improved nutrition? And if we can find any other comparable community in the nation that's done that, then I'm able to evaluate whether the million dollar investment is a wise investment for not only this health system, but the broader health care system across the country.

What I've loved about the New Ulm area and where I grew up in North Dakota, open space. There's freedom. I get to live in the New Ulm community, serve in the New Ulm community. And probably what other leaders don't get access to is I live literally 400 yards out the back door of the hospital.

I'm Toby Freier. I'm the president of New Ulm Medical Center. New Ulm Medical Center is an integrated rural health care delivery system. And we're a part of Allina Health, a health care system serving Minnesota as well as western Wisconsin.

It is a challenging time to be in health care, because every ounce of our inner being wants to pursue better health, improved health for our communities. But we also know we're tied into a reimbursement system that pays for people to be in a hospital.

We have an income statement that reflects revenue generated on sick people being in a hospital, yet all of our mission is about how can we prevent illness across the community. OK, I think I'm going to go down to CCU first. I'll be honest, I'm disappointed in the enthusiasm for improving outcomes of the health of a community, of a population, and affordability. And I don't know that there's any way to say that we're accomplishing that without the outcomes data.

We now have the IHP data into the data warehouse, all that claims activity. So we could be looking at ER patients, care follow-up, a piece of how could the ER physician help us with that.

When we have access to that information, it allows you to at least have the conversations with your physicians, with your patients about the cost of health care in a meaningful way. When they learn that a swing bed is going to be $3,000 a night versus $250 a night at a nursing home, they care about that.

The access to data analytics, to health information at the fingertips of caregivers, at the fingertips of frontline leaders is extremely important.

Turns out that Toby and his team have probably used the data warehouse in ways that we had never anticipated, where people are getting care, what are the ways we can influence their care, how can we find out where high utilization is going on, and hotspotting around. Are there pockets of diabetes or obesity that we could focus resources in a different way?

So one of, I think, the great wonders is out of this small community, this very sophisticated sense of who the patients are and who the people are in the region and what are their health care needs and how can we shape our system to meet their needs, rather than just guessing at what they might be.

Focusing on Triple Aim and having access to the health system I think has been important. Without the resources of the system and having the electronic medical record, which allows us to do patient registries, which then allows us to get down to the quality of care that we're providing, I don't think we'd be able to do that without the resources of an entire system behind it.

It turns out, for people that are healthy, they don't spend a lot of time with their physician. And they shouldn't be, necessarily. If you think about a person over a given decade, they're going to spend about a total of two hours with the doctor. And the idea that two hours is somehow going to determine their health for that decade is really pretty unreasonable.

If we're going to intervene in people's health, we're going to need to do something more than just their annual physical. We're going to need interventions at a population level. We're going to need interventions in their workplace and in their community and in their homes.

And they're going to need the critical education as well and the clinical visits, but, in general, it's going to have to be a broad-based intervention. We need really a collaborative effort from multiple different entities in order to pull something like that off.

And it's just not physicians and health practitioners that are driving health. It is the community grocery store. It is the school. It is the workplace. It is the park. It is the roads. It is all those things.

Improving population health at the community level, I mean, literally it takes a village. And the health care system at this moment is really in transition. Is this a hospital-based activity? Is this a public health department? Is this a grocery store? Is this in the schools? And the short answer is it's all of the above.

So it's a complex notion. I mean, our country is so big and so heterogeneous and so diverse, bringing together these forces, even in a relatively small community like New Ulm, is a formidable task.

Lasting change happens when more people embrace it. And so the Heart of New Ulm, while it was started as a research project, and it was a partnership with Minneapolis Heart Institute Foundation and the medical center, for lasting impact, for lasting change, it needs to be embraced by the community.

Businesses are complicated organizations with a lot of moving parts. And I think what the Heart of New Ulm has really allowed them to realize that their people are their most important resource, and investing in their employees really would make a difference.

Margins are tough in the restaurant business. And it's a lot easier to cook a frozen burger or frozen fries and keep them in stock. And when you start talking about produce and healthy foods, it's expensive. And those products are a little bit harder to serve. I was very hesitant to begin with, because I didn't want us to be forced into doing anything. And we really dug our heels in and said, absolutely not, until you can prove to me that this is going to make some money.

And so the same with the New Ulm residents. I think they'd feel the same way. I feel like if this was pushed on them, it would be a little bit harder pill to swallow. But it's just been a lot of opportunities and removing roadblocks, as far as finding ways to be healthy. And it's worked for our town.

I get to be one of those community members that's on the Heart of New Ulm Executive Committee. Who's all on that? Well, you have everybody represented of the city, the hospital, the schools, community members. Make a well representation of the different aspects of the community to come together to plan, what should we be doing differently here.

So we look at what is important for kids? What's the most important we need to make sure we give them each day? What are we doing with them physically? We encourage them to walk to school or bike to school. We encourage healthy meals, healthy snacks.

If the kids do walk to school in the morning or bike to school, their minds are ready. They've already physically done the exercise. They're ready to sit down, to settle down for their morning routines in the classroom. So our job, if we're going to teach them academics, is to first get their minds set and get them ready. And being physically active is one of those keys.

The health care system is trying to turn the battleship around inside the Panama Canal. I mean, that's the visual that you have to have. And it's colliding with the on-the-ground tactical reality of certain communities being able to make progress.

And we have to make it easy for people to do the right thing. That's what I was so impressed in getting a deeper understanding about what's going on in New Ulm, that they've made it the default, easy, right thing to do, to exercise, to buy healthy food, to ride your bike. I mean, there are some amazing social change happening in that town.

It's easy for a doctor to prescribe a medication. A doctor telling a patient how much to eat or what to eat and how much to exercise, there's plenty of evidence that that doesn't work very well. It's hard to change people's behavior at a clinic visit. It's much easier to change people's behavior by changing their environment.

There's no question that it can be done in a larger community too. You have to define the community. You have to establish the relationships. You have to establish what your goals are. But we can take those learnings from the outstate and certainly scale them to larger communities too, using the same secret sauce that they have used, just on a different scale and with different parameters.

This could be a national model for population health and where health care is going in the country. In our community, health outcomes have improved almost across every health indicator across the community. Health care quality within the health care system has improved. We've lowered admission rates into the hospital by nearly 20%, 50% lower admission rates in our community compared to other comparable communities. Overall, $1,000 per Medicare patient lower cost of health care in our community.

So I think we're seeing early signs the Triple Aim is achievable, better health, lower costs for a community. And I hope one day that New Ulm is this beacon for the nation, that this is the place where maybe more than any other community, someone could say, if I lived there, I could realize my full health potential and have health care that truly is affordable in this country.

[MUSIC PLAYING] If you were to say, so what percentage of adult Americans are at an appropriate body mass index, exercise, eat their fruits and vegetables, don't smoke, wear a seat belt, I mean, you might be surprised to know that 3% of adults over 18 do all five of those things. 3%,

I mean, that's not a big number. And so we know that if we could change individual behavior, we'd have a tremendous, probably exponential impact on the health of the population.

70 percent of people showing up with a big heart attack have no idea they had heart disease the day before. The majority of heart attacks are occurring in people who don't know they have disease. We've gotten a lot better at treating heart attacks, but it still turns out it's much better to not have one in the first place.

The beginning vision of the heart of New Ulm was bold. Can we minimize or eliminate heart attacks in the community? Can we get to zero?

I think it was $10 million over 10 years was the goal, was really to reduce heart attacks. Can you impact health care in a community by focusing on very simple interventions? And we've seen that you can.

Medical care, that's 20% of the story. So 80% of the story has nothing to do with the temples of technology that drive American medicine, and has very little to do with 18% of the GDP being spent on health care. It's all about the social determinants. This is an incredibly complex sort of witch's brew of social, political, and economic problems, but it impacts health.

Some people maybe don't think it's been worth a million of investment every year. And what I've asked in return is, can you show me any other community anywhere in the nation that has improved by 7% the level of hypertension within a community, that has stabilized obesity, cut smoking rates, cut heart attack rates, improved physical activity, improved nutrition?

And if we can find any other comparable community in the nation that's done that, then I'm able to evaluate whether the million dollar investment is a wise investment for not only this health system, but the broader health care system across the country.

We are not a facade of a community. It's real. It is a community that has a sense of place. There's a mindset of we want to be an ideal community to live in.

New Ulm definitely is salt of the earth people. They are very hard workers. They are traditionalists. Anytime something needs to get done, it's going to get done. The community pulls together.

When something happens to someone, it's kind of like everyone's on board there for them, anything they need help with.

New Ulm has a tradition of running successful events, supporting one another, and just being there for one another.

That is expected here, that you participate and that you are involved in your kids' lives, but that you also know your neighbor's kids and you watch out for everybody. It is the TV show Cheers, Northern Exposure, and The Andy Griffith Show all wrapped in one. You don't have to include that, but I just want that on video, someday that that will come back to me.

Population health for us really is, can we collaborate across a health care system and a community to bring greater value and realize the health potential of an entire population? And I think we're realizing success when we see health as a priority for every organization in this community, not just the health care system.

Turns out, for people that are healthy, they don't spend a lot of time with their physician. And they shouldn't be, necessarily. If you think about a person over a given decade, they're going to spend about a total of two hours with the doctor. And the idea that two hours is somehow going to determine their health for that decade is really pretty unreasonable.

If we're going to intervene in people's health, we're going to need to do something more than just their annual physical. We're going to need interventions at a population level. We're going to need interventions in their workplace and in their community and in their homes.

And they're going to need the clinical education as well and the clinical visits, but in general, it's going to be a broad-based intervention. We need really a collaborative effort from multiple different entities in order to pull something like that off.

And it's just not physicians and health practitioners that are driving health. It is the community grocery store. It is the school. It is the workplace. It is the park. It is the roads. It is all of those things.

Improving population health at the community level, I mean, literally it takes a village. And the health care system at this moment is really in transition. Is this a hospital-based activity? Is this a public health department? Is this is a grocery store? Is this in the schools? And the short answer is, it's all of the above.

Lasting change happens when more people embrace it. And so the Heart of New Ulm, while it was started as a research project, and it was a partnership with Minneapolis Heart Institute Foundation in the Medical Center, for lasting impact, for lasting change, it needs to be embraced by the community.

Businesses are complicated organizations with a lot of moving parts. And I think what the Heart of New Ulm has really allowed them to realize that their people are their most important resource, and investing in their employees really would make a difference.

J&R Schugel was one of the first companies to embrace the Heart of New Ulm and partner with them. Every year, New Ulm Medical Center will give us a data report. So it will show how many people were involved, what has improved. So that's statistics for us that we can use.

We check six markers. It's blood pressure, cholesterol, triglycerides, glucose, the nicotine, and then your BMI, your waist circumference. Gradually, as we've started, each year we've had more participation. Numbers have been lowering, so that's really exciting for us.

I get to be one of those community members that's on the New Ulm Executive Committee. Who's all on that? Well, you have everybody represented of the city, the hospital, the schools, community members. Make a well representation of the different aspects of the community to come together to plan what should we be doing differently here.

So we look at what is important for kids. What's the most important we need to make sure we give them each day? What are we doing with them physically? We encourage them to walk to school or bike to school. We encourage healthy meals, healthy snacks.

If the kids do walk to school in the morning or bike to school, their minds are ready. They've already physically done the exercise. They're ready to sit down, to settle down for their morning routines in the classroom. So our job, if we're going to teach them academics, is to first get their minds set, get them ready. And being physically active is one of those keys.

I remember sitting in that first meeting when the Heart of New Ulm project unfolded their plan. And a light came on. It was really exciting to see the community get behind it and become active in the programs, events, and activities, and to come into our facilities and start utilizing the fitness centers and the cardio centers much more so than they had in the past.

And this is the pick-a-ball area. Who's winning?

Hi.

They are.

We all are winners.

Good, very popular with the senior community.

Thank you.

It's really had an impact in our community. When you have a community that's already got a sense of place, already has an identity, and something like this comes in, it can come in and blow out pretty quickly without an impact.

But I feel like New Ulm got it and embraced it. We've taken it, embraced it, and said, you know what, this is a good thing for us. You want the research project to be successful, but it had benefits to our community.

We have to rethink everything about what we do. And moving from a disease basis to a prevention basis, well, this is taking the entire model and turning it upside down and backwards. I mean, the health care system is trying to turn the battleship around inside the Panama Canal. I mean, that's the visual that you have to have.

And it's colliding with the on-the-ground tactical reality of certain communities being able to make progress. And we have to make it easy for people to do the right thing. That's what I was so impressed in getting a deeper understanding about what's going on in New Ulm, that they've made it the default, easy, right thing to do, to exercise, to buy healthy food, to ride your bike. I mean, there are some amazing social change happening in that town.

Historically, there's been other projects that have tried to look at population interventions. And it's always been an issue with buy-in. It's easy for a doctor to prescribe a medication. A doctor telling a patient how much to eat or what to eat and how to much exercise, there's plenty of evidence that that doesn't work very well. It's hard to change people's behavior at a clinic visit. It's much easier to change people's behavior by changing their environment.

This is a quality of life issue. I mean, if we can help somebody not get diabetes in their middle ages or know their cholesterol and make better choices earlier on, it's health care, but it's quality of life care. And I think that's the compelling thing for health care to think about, is how can we get to people before they get to us?

One of the best places that we learn lessons organizationally are in defined outstate communities of care. New Ulm is a perfect example of that. So they can do things in a defined community and do them better and do it at a scale that we can again scale up. In the metropolitan area, it's hard to draw. Where do you draw lines around community?

I think we're seeing early signs the Triple Aim is achievable, better health, lower costs for a community. And I hope one day that New Ulm is this beacon for the nation, that this is the place where maybe more than any other community, someone could say, if I lived there, I could realize my full health potential and have health care that truly is affordable in this country.

In our history as a country, all change is from the community level. I think New Ulm could be a bellwether example, a paradigm shift of where the rest of the nation can learn an awful lot, when a community says, you know what, we're fed up and we're going to take it into our own hands in a positive way.

I think this is a tremendous example of what a community can accomplish. I'm hoping we can disseminate these findings. And I'm hoping that other communities across the nation, not just rural communities, can learn from their great example.