Jonathan Perlin, M.D., Ph.D., became president and CEO of hospital accreditation organization The Joint Commission in 2022. Previously, he served as chief medical officer of 189-hospital HCA Healthcare. He also has served as Under Secretary for Health in the U.S. Department of Veterans Affairs (VA). Perlin recently sat down with Healthcare Innovation to discuss several new certification programs involving sustainability, secondary use of health data, and health equity.
Healthcare Innovation: You left a position as chief medical officer at HCA Healthcare in 2022 to lead The Joint Commission. Did you see it as a chance to have an even bigger impact on the industry?
Perlin: Absolutely. You know, the theme of my career has really been using information to improve quality. We were able to do that when I was Under Secretary at the VA, putting in electronic health records. I am also really proud of the improvements we've made in quality at HCA Healthcare, but one thing that people don’t realize is that The Joint Commission is internationals and in 75 countries. So it's just a privilege at this point in my career, to be able to take skills from government, academia, and operations and put them together in a practical way that helps to address some of our big challenges in healthcare.
HCI: Any surprises or challenges since you took this position?
Perlin: I think the biggest challenge is that the world of healthcare has been so extraordinary affected in the wake of COVID. It's accelerated certain things, such as virtualization, and in others it's just made what was already difficult in operations even harder — issues involving the workforce, for instance. But I think we're entering a very exciting era with new tools. I think it's impossible for us to overestimate what the impact of AI will be in every aspect of our life, including how healthcare is provided.
HCI: The Joint Commission has just launched a Sustainable Healthcare Certification. Could you talk about why you the organization saw that as an area where certification would be valuable, and how you envision the health systems using it?
Perlin: The first adage of healthcare is ‘do no harm,’ and as an unintended consequence of our commitment to do good, we're harming the environment significantly. It turns out that if healthcare worldwide were a country, that country would be the fifth biggest polluter. If the United States. were a state in that country, we would be making 27 percent of the worldwide healthcare carbon footprint. And it turns out that in the United States, roughly 8.5 to 9 percent of the total carbon footprint comes from healthcare. So there’s a dissonance with our core mission, which is to do good. There are many reasons to take this on. There's the moral case: environmental and social justice. There's the health case: there are diseases that are increasingly prevalent because of climate change. There are health equity issues: people who are vulnerable and can't move out of flood-prone areas or can’t escape urban heat islands.
It’s rare that that people ask The Joint Commission for more standards, but younger workers, particularly those in clinical fields, are asking us to create standards for sustainability.
HCI: That could be a recruiting and retention point for the health systems.
Perlin: Exactly. And the number one and number two issues that are inextricably linked are recruitment, retention and finance. Robert Half Company found that workers between 18 and 34 did not want to work for organizations that didn't have an articulated sustainability plan. That ties to finance. Also, with the Inflation Reduction Act, there are unprecedented financial incentives to recapitalize inefficient infrastructure. There are actual cash payments to not-for-profit organizations and tax credits for for-profit organizations. For instance, the Ohio Hospital Association is helping all of the hospitals in the state tap into those resources. The ROI is under 24 months.
HCI: The Joint Commission also just launched a certification for the responsible secondary use of data. Could you talk about why that was important to do and when health systems will start going through that certification process?
Perlin: We went live in offering it on January 1, and there's been a lot of interest in this. In my previous work it would have been really nice to have an external entity, an Underwriters Laboratory, saying that you're taking the right protections to use data responsibly. We've got so much opportunity to improve the safety, the efficiency, the quality, the compassion, and the equity of healthcare. Not to use this data would be to destroy the value of our investments collectively in the health system. So we need guardrails, on the one hand, but not so rigid that you can't address some of the issues that affect the cost, quality, affordability, equity, and compassion of healthcare.
HCI: Are there things in the certification that will be challenging for some health systems or changes they'll have to make to to meet the requirements?
Perlin: I suspect that many health systems with the sophistication to develop these sorts of algorithms or other secondary uses of data have considered these elements, but it's a way for them to systematically consider the elements. We didn’t pull the elements out of the air. A group of experts from the Health Evolution Forum, including patient privacy folks like Devin McGraw to individuals with deep algorithmic experience, were part of the team that worked for two years on something called the “Trust Framework for Accelerating Responsible Use of De-identified Data in Algorithm and Product Development.” It's a very practical approach. And, you know, frankly, if there's not an approach for privacy, security, data controls, limitations on use, verification of the algorithm, transparency to the patient, and governance or oversight structure, should the organization really be embarking on it?
HCI: The Joint Commission also launched a health equity certification last June. What are some ways that the certification will distinguish those organizations that that are making this a strategic priority versus those that don’t?
Perlin: Disparities that had always been unacceptable just became intolerable during COVID. So having the opportunity to focus on health equity became a core part of our agenda. We eliminated 400 standards that we felt were either redundant, obsolete, not evidence-based, or the value was not commensurate to the effort. We only put in one new requirement standard in 2023, and that was for health equity. So it's part of the accreditation.
The health equity certification is essentially more rigorous than what's required for accreditation, There are elements of leadership, strategic priority with board involvement, collaboration with patients and community data collection to tackle areas of opportunity, measuring outcomes and provision of care but also promoting workforce diversity, attending to all forms of diversity, including patients with disabilities, and obviously performance improvement.
One of the things I'm most proud of is that Massachusetts Hospital Association, and all hospitals in the Commonwealth of Massachusetts are using our health equity certification framework as the basis of their Medicaid 1115 waiver. I believe it'll really lifts all ships, and we'll be able to measure the improvements that organizations have made.
HCI: I also wanted to ask you about the combination of The Joint Commission and the National Quality Forum. What was attractive to the organization's about coming together? Is there a complementary nature to their work and will the combination change what either of them are focused on?
Perlin: We still want the National Quality Forum to be able to convene stakeholders from all walks — patients, payers, purchasers, providers, and consumers — but yes, there is a complementarity that I think is magic. As someone who came recently from the operating environment, I want to improve care. I just don't want to spend my effort trying to satisfy 11 different versions of the same measure. We believe that on the front end, NQF, using their convening capacity, can bring different payers together.
If we can bring payers together to say here's what we want to measure in maternal mortality and maternal health, or here’s what we're going to measure in cardiovascular or behavioral health, we could take away this distraction of trying to satisfy competing measures, and synthesize it down to the agreed-upon industry measure, run it through the accreditation or optional certification process, and at the back end, have data where you can compare performance to the high performers. Then we can actually see the relationship between what they're doing and what the outcomes are. For those who are hitting the performance goals at the outset, they can actually qualify for payer excellence programs, such as network inclusion, premium reimbursement, etc. That's the ecosystem that we want to create — one where the focus changes from satisfying competing measures to meaningful improvement that lifts all boats.