Gary and Mary West Health Institute

“The majority of the current directors and officers have a "business relationship" as defined in the form 990 instructions, with each of the other current officers and directors because of positions they hold with affiliated organizations.”

“Gary and mary west management company, inc., ("wmc") is a non-profit, taxable entity that provides services to affiliated organizations. Certain supervisory, financial, and other administrative functions are performed by employees of gary and mary west management company, inc. Sally hallak and jonathan zifferblatt are officers of whi and related organizations but are direct employees of wmc. (refer to schedule j). Total officer compensation paid to these officers is $1,136,807.”

“The organization is a non-profit, non-stock corporation with three members during 2024. One incorporated member designated as a permanent member, the gary and mary west charitable trust and two non-incorporated members which are elected and term-based members, james k hasson and thomas culhane.”

“The members of the organization have the authority to elect and remove members of the governing body.”

“The following decisions require member approval: 1. The dissolution, liquidation, merger, consolidation, recapitalization or other reorganization of the corporation; 2. The sale, lease or exchange of all or substantially all of the property of the corporation; and 3. Any changes proposed to be made by the corporation's board of directors to the corporation's certificate of incorporation or bylaws.”

“The form 990 information was compiled from the organization's corporate and accounting records and provided to the organization's outside tax preparer. The completed form 990 was reviewed by the organization's cfo, outside legal counsel and ceo. Upon satisfactory completion of the internal review process, a draft of the form 990 was circulated to the organization's audit committee and board of directors for review. The form 990 was then filed with the internal revenue service.”

“The directors and officers of the institute met regularly throughout 2024 and discussed all actual and potential conflicts of interest that existed with respect to other non-profit and business organizations. The directors and officers also collected annual written conflict of interest statements from all directors and officers, when applicable. No failures of compliance with the policy were found.”

“The organization has a compensation approval process for its employees. For those paid in excess of $100,000, a basic compensation study is performed and compensation ranges are required to be approved by the compensation committee and the board of directors. For those paid in excess of $250,000, such as the ceo, an enhanced study of comparable compensation is performed and the board of directors reviews and approves compensation levels. The organization has also retained the services of an outside compensation consultant. The most recent review was completed in 2024.”

“The organization makes its certificate of incorporation and audited financial statements available to the public upon the request for such documents.”

“The organization has a management services agreement with the gary and mary west management company, inc., a related non-profit corporation, whereby the gary and mary west management company, inc. Provides certain administrative support services to the organization. Such services include that of various senior management roles.”

“Over the course of 2024, the gary and mary west institute (referred to below variously as whi, west health institute, or institute) continued to actively conduct applied medical research, in conjunction with the hospitals and health systems listed on schedule a, with the objective of contributing to the body of clinical, scientific, and health knowledge that can ultimately benefit older adults in america. Our research methodologies encompass a variety of real-world data collection and analysis techniques, and in many cases, we implement programs and structures (e.g., standardized care models, data dashboards, etc.) that allow us to collect systematized research information where little previously existed. These medical research efforts directly supported whi's mission of lowering the cost of healthcare and enabling seniors to successfully age in place with access to high-quality, affordable health and support services that preserve and protect their dignity, quality of life and independence. Our major workstreams for 2024 broadly fit into the areas of (senior appropriate) acute care research, value-based care research, and chronic care research are described below. Senior-appropriate acute care research in 2024, the institute continued to expand its research portfolio and grow the body of evidence for new strategies in acute care. Unplanned (acute) needs remain the primary driver of costs for the nation's vulnerable older adults, as well as leading to lasting detrimental effects (e.g., post-visit debilitation and functional decline). Success in this area is essential to achieving better, more affordable outcomes for older adults. Acute care research area: geriatric emergency departments (geds) geriatric emergency departments remain a foundational component of our medical research. Our efforts in this area include characterizing the decisions and processes around how new hospitals become accredited (with the intention of enabling further spread of this model), research around how accredited geds can add functions, tools and processes to further augment their support for older adults, and measuring the impact of geds both locally and at scale. Growth of the ged network research and implementations - implementation research collaboration #1 [health system/hospital research partners: uc san diego health, along with 26 hospital partners in california] in 2024, whi characterized and advanced training conducted by uc san diego health which directly enabled hospitals to apply for ged accreditation and included individualized coaching to hospitals interested in implementing the ged model. At the closure of this partnership, california led the nation in ged accreditations with 93 geds. The institute also co-authored and disseminated a case study with ucsd's senior emergency care unit to share the clinical and financial impact of the geriatric emergency nurse initiative expert, who focuses on reducing hospital admissions for older adults with complex, low-acuity conditions. - implementation research collaboration #2 [health system/hospital research partners: kaiser permanente southern california including 9 hospital facilities]: southern california permanente medical group (scpmg) is a leading driver in clinical care for over 4 million members, and with an aging population scpmg recognized the need to provide geriatric specific emergency care to its regional members. In partnership with whi, as part of a 2024 health quality improvement research initiative, 9 hospitals pursued ged accreditation. To magnify the impact of this collaboration beyond southern california, scpmg presented this initiative to leaders at a fall-prevention symposium, representing all seven (7) kaiser permanente regions across the country. - implementation research collaboration #3 [health system/hospital research partners: 8 hospital facilities in partnership with the hospital association of southern california] in a similar manner as the research partnerships with”

“Sharing best practices in hospital-wide geriatric care [health system/hospital research partners: university of alabama health] in 2024, the institute collaborated with the university of alabama at birmingham (uab) health system to review and drive insights from their two decades on systemwide investment in geriatric care. The collaboration included listening sessions with executives, a site visit, roundtable discussions focused on best practices for successful and sustained implementation, as well as an on-site workshop to support ongoing implementation and research planning. The partnership culminated in four co-authored case studies highlighting innovative programs including the geriatric scholars program, the acute care for elders (ace) unit, and expansion of a mobility and delirium prevention program to non-geriatrics units. An additional case study was created to support sites in meeting the new cms age-friendly measures. These case studies will be disseminated and serve as resources for hospitals working to implement geriatric care improvement programs. Acute care research area: inpatient care transformation for higher reliability care (for older adults and beyond) despite ongoing workforce challenges in the healthcare sector, the advance of technology is opening the door for care that is better tailored to the needs of specific patient populations. Advances such as artificial intelligence and responsive electronic health records are affording health systems the opportunity to offer more highly reliable, consistent, and customized care to the needs of the individual. However, in order to realize these potential benefits, it is essential to have a foundation of research around quality improvement and transformation of culture, workflows, and other systemic issues. Hospital-wide process and culture change for better senior care [health system/hospital research partners: sharp healthcare] in 2024, whi continued to collaborate on care transformation and quality improvement research with sharp's "generational health" program, which optimizes inpatient care processes for older adults. A clinical case study with the institute highlighted the benefits of proactive, systemwide geriatric care over reactive models and was showcased at the ihi forum. Dissemination gained traction with two peer-reviewed publications, further establishing the program's credibility through rigorous research outputs. System-wide scale and spread of replicable, customized care paths and processes for older adults [health system/hospital research partners: mass general brigham health system] recognizing an urgent need to operationalize evidence-based approaches for better and safer care for older adult patients, the west health institute partnered in 2024 with mass general brigham (mgb) health system to launch a multi-year initiative. This initiative the west health accelerator at mass general brigham is designed to scale and evaluate a systemwide model of care through a combination of human-centered design, process evaluation, implementation science, and outcomes research. It is also characterized by ongoing evaluation at each step of the way to facilitate improvements in real-time. This systemwide initiative is grounded in earlier research on a clinical model developed at mgb. This foundational model is being modified through the use of a human-centered design approach, which began in late 2024. This work will be expanded in 2025 to include additional units in all 9 hospitals to maximize appropriateness and feasibility of implementation and will incorporate implementation research. Also, laying the foundation for collaborative research, whi and mgb jointly identified key metrics and research outcomes in alignment with systemwide priorities and the initiative's purpose. Availability of comprehensive baseline data was assessed throughout the mgb system. A first cohort of clinical champions completed 6-month long qi projects as a part of their year-long p”

“Furthering the institute's commitment to bridging the divide between policy and providers, we proactively began translating our findings to foster effective learning systems and diffusion practices. The institute participated actively in collaboration with the duke margolis institute (dmi) for health policy and in the convening titled "leveraging learning systems to accelerate assessment and adoption of effective value-based care" in may 2024. Following this event, we initiated an expanded collaboration with dmi aimed at creating a strategic portfolio and specific areas of focus to accelerate sustainable adoption and implementation of vbc strategies. National claims data analysis in support of care redesign directed toward value-based acute care at home in support of developing evidence-based models for vbc acute care at home and in the ed, in 2024 whi engaged more extensively in an analysis characterizing strategies by which health systems across the country undertake decisions regarding which patients should receive palliative care resources. Candidates for palliative care are among the most vulnerable patients served by our care delivery system, and optimally allocating resources is critical to ensuring that all patient care needs are met in a cost-effective manner, ideally one that does not involve treating palliative care needs through a revolving door of ed and inpatient hospital visits. Using a retrospective observational study of medicare claims data at a national level, west health researchers investigated these issues, publishing their findings in a manuscript "targeting community-based palliative and serious illness care resources: challenges of more stringent diagnostic criteria for prospective enrollment," published in may, 2024 in the journal of palliative medicine. Senior-appropriate chronic care research systematically addressing the ongoing complex medical, behavioral, and social needs of older adults in a cost-effective manner while ensuring that what matters most to them is accounted for represents an important part of the institute's research. These activities cover a variety of areas. Chronic care research area: evaluating optimized care in the pace setting [health system/hospital research partners: gary and mary west pace] the institute has continued to conduct research and quality improvement efforts focused on advancing the program of all-inclusive care for the elderly (pace) is a federal and state funded and regulated program. Pace programs are registered as health systems - that provide wrap-around medical and social services for seniors who would otherwise need nursing home level care. The institute has advanced an innovative program of applied medical research studies in partnership with pace (including the gary and mary west pace (gmwp) program in san marcos, ca also known as gary and mary west senior services) to better understand and explore how care can be increasingly delivered with high efficiency (including cost efficiency) and quality. Building systems to gather data and test hypotheses (population health research dashboards) historically, pace programs had a difficult time collecting and using data to inform decision-making both on the clinical and operational sides, largely due to information being siloed in one of many (often 7-10) different databases. Our research in 2024 was successful in bringing together data from a variety of databases into one robust data dashboard, and organizing data in more useful ways, which has allowed pace program decisionmakers and providers to access just-in-time metrics in an easy-to-consume manner, enabling pace clinical and administrative staff to better characterize areas of need, and deliver targeted services more efficiently and effectively. This work was broadly shared via publication and national meetings with pace programs at the national level. Quality improvement (qi) research directed to discovering and testing new interventions for reducing high”

“To do this work, whi, nm, and mmhpi are collaborating across 5 work streams (clinical care and operations, data and informatics, finance and administration, evaluation and dissemination, and workforce education and training). Each of these 5 workstreams has a unique project team, goals, and deliverables that are designed to tackle the biggest challenges that face systems when they endeavor to deliver integrated behavioral health. At the highest level, the work is focused on optimizing the nm program such that it becomes a nationally recognized leader and example for other systems and then taking the learnings and collateral from the engagement to freely share with others so that they are better positioned to also deliver high-quality, evidence-based integrated behavioral health to anyone who needs it. The accelerator will both reduce the time it will take nm to optimize its program, but also enable nm, whi, mmhpi, and other key strategic partners to lift other programs across multiple health systems. Through this partnership, whi is identifying system-level opportunities and challenges to scaling and sustaining this model in a large health system. Learnings will be disseminated freely and broadly. Behavioral health workforce [health system/hospital research partner: residents from multiple health systems nationwide] to address the shortage of behavioral health specialists, whi has partnered with the american psychiatric association to develop and deliver a 2-day in-person training program on collaborative care for medical residents in psychiatry and primary care. This program is expected to reach hundreds of residents and will be delivered in 2025.”

“America's health care cost crisis remains a pressing issue for older adults and the nation at large. The us health system continues to lead the world in cost, while continuing to underperform in terms of outcomes and patient satisfaction. In 2024, the gary and mary west health institute (whi or institute) remained committed to playing an important role in conducting applied medical research to help provide unbiased and reliable data and findings that enable stakeholders in the us health system to chart a course to healthcare that is more affordable and ultimately a better value for older adults in america. The west health institute's areas of focus in addressing the cost of healthcare over the past year continued to be centered around conducting research and sharing statistics that can be used in raising awareness about the size and urgency of this issue, lowering prescription drug prices, and increasing price transparency with a goal of highlighting, and eventually enabling the reduction of, out-of-control healthcare service pricing. Key to this work was our constructive collaborations with like-minded, highly respected organizations, including but not limited to the duke-margolis center for health policy, us of care, families usa, the national academy for state health policy, kennedy forum, and the healthcare cost institute. Generate data that highlights to the nature and magnitude of the health spending crisis to focus the attention of policymakers, administrators, and the general public on the healthcare crisis, whi undertook a variety of key public and policymaker education and awareness strategies in 2024. These strategies include continuing our highly successful polling activities with gallup and others which has revealed the failing grades given to the us healthcare system by the public and the unacceptable results (including economic hardship, worsening medical conditions, and death) of high healthcare costs. In 2024, we had four highly successful releases; two related to perceived deficiencies in addressing mental health conditions, one related to perceptions of the presidential candidates, and our large west health-gallup 2024 survey on aging in america. We also released version 2.0 of our interactive west health-gallup data dashboard, which serves as a tool for elected officials, policymakers, and the public to better understand the changing attitudes and behaviors toward healthcare, and what needs to be done to avoid putting the health of millions of americans at risk. Continue to develop understanding of healthcare cost and aging issues at state and national levels and policy fixes whi continued to advance collaborations producing research designed to highlight paths forward for policymakers to consider how to bend the health cost curve. These activities included: published a white paper reviewing the pharmacy benefit manager (pbm) reforms proposed by the current congress and recommendations and met with several partners and lawmakers about the findings. Launch of an academy to engage teams of state leaders from six states to work with peers and experts to identify and share strategies and solutions for improvement of aging policy. Partnering with the duke-margolis center for health policy to pursue actionable strategies to spread and scale value-based care across the country. This collaboration identified opportunities to expand home-based care in medicare and via centers for medicare and medicaid innovation (cmmi) models. Collaboration with the health care cost institute (hcci) on analyses of commercial health insurance claims which highlighted high provider pricing and exploration of ways that employers and policymakers could engage more to lower healthcare spending on employer-based insurance. Partnering with the kennedy forum to incorporate a life course approach (including older adults) to improve the parity between coverage of mental and physical services in commercial insurance as well as in discussions a”

“Other consultants: program service expenses 11,046,785. Management and general expenses 1,806,680. Fundraising expenses 0. Total expenses 12,853,465. Research studies: program service expenses 14,263,347. Management and general expenses 0. Fundraising expenses 0. Total expenses 14,263,347. Other: program service expenses 0. Management and general expenses 745. Fundraising expenses 0. Total expenses 745. Stakeholder communications: program service expenses 132,425. Management and general expenses 28,854. Fundraising expenses 0. Total expenses 161,279.”