Welcome to the Michigan Minds Podcast, where we explore the wealth of knowledge from faculty experts and leaders at the University of Michigan. I’m Greta Guest, State Communications Manager for the Michigan News Office.
Last January, President Santa J. Ono set the university on a path to imagine what aspirations the University of Michigan could achieve in the next 10 years. UM’s Vision 2034 is the outcome of the yearlong strategic visioning process that engaged more than 25,000 students, faculty, staff, alumni, donors, and local community members.
UM’s vision to be the defining public university of our time boldly exemplified by our innovation and service to the common good outlines four areas where the university will make dramatic and focused impact; life-changing education, human health and well-being, democracy, civic and global engagement, climate action, sustainability and environmental justice.
Marshall Runge, executive vice president for medical affairs at the University of Michigan is here to talk with us about human health and well-being.
Welcome to the Michigan Minds Podcast, Marshall.

Marschall Runge:
Thank you.

As you think about the next decade of healthcare and promoting healthy communities, what do you think is the most important for the academic medical center?

Academic medical centers are unique in that we have three key missions; patient care, of course, but also educating the next generation of healthcare providers and research. So it’s very important to us these three link together, and it’s very important that we facilitate that linkage and to excel in all of these areas.
I’ll start with education. We educate healthcare providers, physicians and other healthcare providers across the spectrum. We have wonderful educators, and we have wonderful students and learners, and our goal is that these will be the leaders of the future. We are extremely committed to discovery science, so that’s very basic science that can advance health through innovation and novel approaches to care. That spans the spectrum from laboratory-based all the way through health policy and implementation of changes in health policy.
On the clinical mission, we have to remain competitive throughout the state by growth and service differentiation. What I mean by that is by offering some of the very specialized care that really can only be done in an outstanding academic medical center like what we have in Ann Arbor. But likewise, we’re developing partners across the state that can help us increase our footprint. And our work with them is to provide greater access to healthcare and high quality healthcare and communities across the state.
We have regional partners in Western Michigan with a cardiovascular network and a cancer network. We have a physical medicine and rehabilitation program at St. Joseph’s Hospital, and specialized programs at Sparrow. We also have an ESG office that addresses social determinants of health, with a focus on preventive health. And sometimes we forget in healthcare; the best thing we can do for health is not to treat it, but to prevent illnesses and diseases that are preventable.

What are some of the innovations and technological advancements that you anticipate will impact and change healthcare?

Well, it’s an exciting time in healthcare because there’s new technology. Some have called this time a Promethean moment. I had to look up what a Promethean moment is. It’s a time of major change where you won’t be doing things in the same way since the advent of this technology. We’re already doing a lot of virtual care and telehealth, but we’re now looking toward technology, including artificial intelligence and machine learning to help us expand hospital care at home, also to reduce the burden on our healthcare providers.
Finally, we have facilities for real-time data and analytics to improve patient experience and capacity management. One of the things that people don’t think about, we’re engaged in pharmacy and delivery of unique and very specialized drugs to patients, and we’re embarking on using drone technology to deliver those medications to people at their home.
And, of course, I mentioned before, we will continue our focus on research in all these areas.

What are some of the ways Michigan Medicine plans to reduce burnout and promote well-being for both providers and in the community?

Burnout, as you know, is, I think, endemic in the United States right now, but there’s not an area that I know of that has been more impacted than in healthcare.
We just recruited and have in place a new well-being officer. So this is not wellness; it’s well-being, which is subtly different. The focus is on the institutional impact that we can have for people’s well-being. We’re exploring how AI can be applied in different ways to help support providers, and I talked about that just a moment ago.
And finally, it’s very important to us as it is across the university to listen to feedback, obtain engagement, and climate surveys. We are doing rounding where leaders go across the hospital and have discussion forums, listening sessions, town halls, all of that so that we can benefit from the wealth of knowledge that our healthcare providers have and use that to improve our delivery of healthcare.

How do we close the health equity gap by directing research and clinical breakthroughs towards the needs of the underserved?

This is a critical issue in healthcare, and I think we have several different approaches that we’re actively engaged in. One is basically to make healthcare here in Ann Arbor more accessible, more convenient. Many people, they have transportation issues, they have payment issues, which we’re very good about handling.
The other is to outreach into communities. We are near completion of a new facility in Ypsilanti on the East Michigan campus, the former business school, that will have vastly expanded healthcare and including many specialties to that community. Although in miles it’s not a long way from Ann Arbor, in reality it’s a very difficult communication and coordination issue. And so it’s much better for people to have their healthcare at home.
Finally, we are doing some things mobily. We developed a mobile mammography unit that brings mammography particularly to under-resourced areas. Breast cancer in women is even more prevalent in under-resourced areas.
So that’s our first foray into that. But I anticipate that we’ll be looking at delivering other key services not just to a big clinic, like we have in Ypsilanti, but to more isolated areas.

Talking about the statewide expansion that we’ve been doing lately, give me a sense of how that might look in the next decade?

We will continue our statewide expansion. There are two general components.
One are hospitals and health systems that we merge with or merge with us. Examples are Sparrow Health System in Lansing, and what used to be Metro Hospital in Grand Rapids, now called UM West. We will probably have more activities in that area, but we also have collaborations, all kinds of interactions across the state.
We’re increasingly collaborating with individual providers with clinics. We are increasing our footprint for those, again, in under-resourced areas, utilizing collaborations with what are called federally qualified health centers. So they’re federally qualified health centers in Ypsilanti that are called Packard Health. They deliver wonderful care, wonderful medical home facilities, and we are actively collaborating with them. It’s a great opportunity for us to give back to those communities. It’s also a great opportunity for our learners, many of whom are very engaged with and want to provide healthcare to those less fortunate.

Why is it important for the University of Michigan as an institution to go out into some of those communities?

Well, I think with healthcare, as with so many other areas of the university, we really have true excellence, and we have really committed faculty learners, the entire spectrum, which that’s unusual in general, but the levels to which that we have that engagement and that passion for activities across the state I think is quite unique here.

You mentioned prevention, and that’s a huge shift. I mean in the report it said we’re going to stop focusing on disease and focus on preventing it. Just as a consumer of medical and healthcare products, I wonder how you do that with human nature being what it is. We all know to exercise and eat right, but-

Let me talk about health because I really truly believe the answer to the exploding cost of healthcare is not more high technology, although we need that for the most critically ill. It’s helping people become more healthy. And if we shift what people can do and how they help their own wellness, they don’t have to come to the hospital. Maybe they don’t even have to go so often to an ambulatory surgery center or to a clinic. There’s no question that preventing illness not only prevents the illness, it helps people mentally, emotionally. That has not been a major goal for healthcare providers, but it is a major goal, and it’s one of our major goals.
So how do we do that? Well, it’s tough because what we’ve all learned and been told as far back as when we were three years old, eat healthy, exercise, don’t smoke, it’s a lot easier to receive that information than to implement it. That’s just human nature and it’s true. We have great social scientists across the university. We have great physiologists. We need to figure out how can we make this possible for people. The answer is not just saying, “Oh, get more willpower and grit your teeth.” That’s what my mother used to always say, “Just grit your teeth.” We have to figure out how do we help people do that?
I think there are lots of answers. Some are just everyday changes in habits, and there are some that are easy. They’re not easy to start with.
For example, I, like so many people, have an Apple Watch now and I count my steps. And do I make 10,000 a day? No. But there’s lots of research that says you don’t have to make 10,000 a day. If you make 3,000 steps or 4,000 steps, that will have a very positive impact. That’s one example.
I think provision of healthy foods, that’s a very challenging issue for me because I love the sugar high. But if you make those things easily available, I think people can at least replace some of their habits with some healthier foods. That, of course, is a real issue in under-resourced parts of our communities and parts of the nation.
A lot of people thinking about this. I saw an article in the New York Times this week which said… I don’t remember the number. I think it was how to do the five exercises that you don’t want to do. They were well-known exercises, and it talked about how to just make it easier. So if you’ve been to a personal trainer or a gym, there are planks, there’re squats. Every time I tried to do those things, I’m like, “I’m going to be sore for three days after this.” It’s basically easier approaches to obtaining the same goal, which is strengthening your core. But you don’t have to do it by killing yourself. You can do it just rather easily. This article gave tips on how to do that more easily.
I don’t have the answers. I’ll be the first to say that, but I do think the answers are, let’s figure out how we can do these things in a way that makes sense. Now, there are some powerful new drugs, a lot of emphasis on these weight-loss drugs, and I think we have to understand what long-term impact do they have on health. We have data that people who go on these powerful drugs, who really have serious obesity problems, most of them have diabetes. Their diabetes goes away, but at what cost? These are very expensive drugs.
I think, thinking about from a pharmacology standpoint, are there ways in which we can help people? Because if you think about it, we’re not here where we are just because of our habits. We have been highly selected by genetics over many, many generations to conserve every calorie we can get our hands on. So that’s not something you can change with your habit. You have to think about how else can we combat that.

UM has been a pioneer in the field of precision health, which uses seven plus types of data to inform medical decisions and interventions tailored to the individual patient based on risk levels. Tell us about our strength in that area and what you see ahead.
Precision health is a really exciting area. We got started because long before I came to the University of Michigan, we had scientists in the School of Public Health, in the Medical School and other schools that were collecting data. So they were collecting genetic data and coupling that with what we call phenotypic data, but people’s habits, their lifestyle, their physical being, and also with surgical samples from biopsies. The initial goal of our precision health effort was to bring all these data together, really large amounts of data, and make them available to investigators across the campus so that they could ask specific questions.
So they could say, for example… you can’t tell a computer this, of course, but, “I’d like to be able to understand what is driving the tendency we’re seeing for obesity in people with certain racial, ethnic habits.” And to do that, the availability of these genetic and other databases, and it includes all of medical records, is very protected, highly protected information, I think that’s critically important, enables people to ask questions. Well, are there certain genotypes, certain polymorphisms, changes in genes that impact somebody who lives in a certain environment? There’s a lot of data that we’ve helped contribute to about the impact of your zip code on your health. That encompasses all kinds of things. It encompasses climate. It encompasses social economic status.
That has been what I’ll call precision health 1.0; people like to say that. Precision health 2.0, which we’re now calling it, is going to much more focus on now massive databases that we can have collaboratively that would be impossible for routine analysis. But with the advent of artificial intelligence and the ability to summate all of these data, we can ask questions now rather than asking it of a subset of the 4 million patients we have in our database, millions of people who have data in various different protected areas. So if we collaborate with some large data companies, think of Google or an Amazon, I’m not suggesting either one of those, and combine our data and use artificial intelligence, I think we can come up with a lot of novel insights.
So we’re moving from being a group that provided resources to investigators across the campus and collaboratively anywhere to one that is now going to use our expertise. And with the Engineering School and Computer Health Sciences, we have a trove of experts, and School of Public Health. So we’ll be bringing experts together to try to utilize what will be a very, very large data platform.
To give you an example of something like this, this is an example I love to talk about. They’re not directly related. They’re pharmaceutical companies now using AI to try to find drugs for known targets that there’s no therapy for. It turns out that AI can accelerate that incredibly because you can look at so many different drug structures and all these things, and you can program everything you’re looking for.
The most interesting experiment I heard about was a company that did a project of that sort that would’ve taken a hundred medicinal chemists, people that build drugs probably four years to do. They were able to do it with AI, and find very good target molecules in a couple of months. At the peak of that, they were using so much computer capacity that they basically used up all of the Midwest Google Cloud capacity for a day or two. It gives you an example of the extent of data analysis that can be done using these new technologies.
That can be applied in lots of different areas. It’s really AI that has been talked about when I mentioned earlier this Promethean moment, it’s AI. Many people have said, who are real experts in the area, which I’m not, that the advent of AI will be more life-changing for us than the advent of the internet. If you think about in my day, there were no home computers, there was no internet. And I remember when the internet came along in the early 90s it was so-so, but now what can we do without the internet? So imagine a change that staggering with the advent of AI.

Any final thoughts on the Vision 2034?

I think the Vision 34 is fantastic, and I think it’s fantastic for a lot of different reasons. But the part of it that excites me the most is I know of no other university or any other kind of group that has the breadth of the university and the excellence in all these different areas. And so, if we put our minds to it, and we leverage the collaborative nature of the University of Michigan with the broad, broad excellence, I think we can make contributions that none of us could imagine, and I’m really excited about seeing that happen.

Thank you for joining us on Michigan Minds Podcast.

Thank you for the opportunity to be here, and I’m looking forward to the future.

Thank you for listening to this episode of Michigan Minds, produced by Michigan News, a division of the Office of the Vice President for Communications.