When it comes to digital health innovation, it’s tough to find too many health systems further out in front than Jefferson Health, the 14-hospital patient care institution based in Philadelphia. In fact, Jefferson has created its own internal innovation team—the DICE (Digital Innovation and Consumer Experience) Group—to design, develop, and implement value-driven and consumer-focused solutions that transform healthcare. The organization’s leaders firmly believe that finding the right strategic partners in the drive to become more digitally-focused and consumer-centric will help position them for future success.
Stephen Klasko, M.D., president and CEO of Jefferson Health and Thomas Jefferson University, recently spoke with Healthcare Innovation Managing Editor Rajiv Leventhal about the health system’s digital health journey, and the ways organizations can keep evolving and innovating in this area. Below are excerpts of that discussion. [Part 1 of the interview with Klasko, which focused on precision health and Jefferson’s experiences during the pandemic, can be read here].
What have you learned about digital health throughout the pandemic that could impact the future of care delivery?
In 2013, we invested about $40 million in in telehealth, and just putting ‘tele’ and ‘health’ in the same sentence back then was seen as [crazy]. When companies like Amwell [formerly American Well], Teladoc and MDLive started, it was just way too easy for hospitals to say they’re not really interested in it. But we didn't just mail it in; we partnered with folks such as John Sculley [the ex-Apple and Pepsi CEO], and we recognized that we were going through the same kind of old Mac/new Mac [transformation] in academics and healthcare that Apple went through in their world of computers. For us, it’s going from thinking about ‘heads in beds’ and in-person tuition to this new Mac [world] of strategic partnerships.
So we created strategic partnerships with a self-run telehealth piece called JeffConnect, a service that [connects patients with Jefferson doctors 24/7 via webcam]. Pre-COVID, we came up with an opportunity to get 50 percent of our patients who would have come to our emergency room to not have to come to our expensive and inefficient ER, and instead be taken care of through telehealth, urgent care or an appointment the next day. So what happened? Well, in the bizarre insurance system we had, our insurance companies were willing to pay us $1,500 dollars if somebody came to the ER whether they needed to be there or not, but they only paid us $90 or $100 if we [provided care] closer to home.
Well at Jefferson, we call it ‘healthcare at any address.’ So we are a large system with 32,000 employees, and we partnered with Main Line Health, which has 42,000 employees, and we went to our plan administrators and told them that we want to do this the right way. So [the system] now basically creates a $500 deductible if you just show up to our ED—non-trauma and non-ambulance—and a $0 deductible if you get to our ED through JeffConnect. Simply put, we were able to get about 50 percent of our people that would have had to travel to our ED just to wait three or four hours to be taken care of much closer to home, and in some cases right at home, with much better patient outcomes, much greater cost savings, and much better patient satisfaction.
In essence, you need two things for these digital transformations to work. First, you need a strategically aligned payer and provider. The second thing is that we have to start with this trillion dollars that is going to be spent on the digitization and the consumerization of healthcare by really thinking about our strategic partners. What I mean by that is I don't want to go to HIMSS and have [900] exhibitors tell me how they're going to transform healthcare. Our partnerships at Jefferson are with some of the VC firms, and the newest one is with Hemant Taneja [a managing director of VC firm General Catalyst]. We have actually put somebody from General Catalyst on our cabinet. The key is recognizing that healthcare will go through this consumer revolution, so you need to figure out a way to share in those [new] dollars as some of your traditional [revenue streams] go down.
As it relates to the pandemic, the best example would be banking. Nobody gets up in the morning and says, ‘I think I'll tele-bank’; it's just that 90 percent of banking went from the bank to the home, and it happened through a variety of startups and others that worked together. If we had a pandemic 30 years ago, we would have been talking about spacing out people on Fridays to deposit their checks. Clearly, that's not a problem now for banking. The same kind of thing will happen in healthcare; 80 percent of healthcare in the next five years will be started at home with wearables that will monitor what you're doing on an ongoing basis, and that will get together with your virtual health assistant.
In our book on healthcare, we talk about the ridiculousness of the physical. I mean, if you think about it, my car gets better care than I do. At my next physical, someone is going to tell me that my blood pressure is X, my pulse is Y, and my EKG is Z, and this is what I should do for the next 18 months. Meanwhile, my car at night is sending continuous signals, and when I start it in the morning, it says, ‘hey Steve, while you were sleeping, my right front passenger tire got low, so before you get your coffee, could you fill it up?’ So I think that that's going to be where personalized health, digital health, and consumer health all come together in a way where healthcare starts at home—what we call ‘healthcare at any address’ at Jefferson. The only question will be, as a legacy healthcare system or legacy provider, are you going to be Sears or JCPenney and continue to believe that your biggest competitor is the [nearby health system]? Or are you going to do what Target and Walmart did, which is recognize that the world is changing, and that people aren't going to come to stores as much, so while I still have to have my stores, I really have to get into the [digital] world and consumer world, too.
A recent federal report on interoperability in major U.S. cities found that less than 50 percent of hospitals in Philadelphia reported interoperable data sharing across four key domains. Why do you think that is and what could be done to improve the situation?
Philadelphia has been this hyper-competitive place where we spend most of our time beating each other up. And when I say hyper-competitive, that’s from an insurance point of view and from an academic medical center point of view. There is very little that is done together. Now, there are some shining examples of [success] when it is done together. I think interoperability is really a false term, because it basically says that I own the patient's data, and I should share it with Penn or Temple, for example.
Let me give you an example of what has happened in a place like Philadelphia because we have such a hyper-competitive insurance market. If I have a patient who left Jefferson and then ends up in Penn’s ER, the insurer [in this scenario] won’t share the data with me because they don't want us to know what they pay Penn. So there first needs to be legislation that all data is interoperable. That's number one. Number two is that the patient ought to own his or her data. The future that I see is that you own your health data just like you own your banking data. If you're coming to me as a doctor, you're giving me your password, and the moment you decide not to come to me as your doctor, you just change your password and give it to the new doctor. It's asinine that in 2020 if you decide not to go to me, you have to call or come to my office just to ask to have your records sent to the new doctor. That’s just ridiculous.
The third phase is in transparency, another area where I think we have failed, because part of that requires interoperability. Transparency is not Seema Verma saying that I have to put my chargemaster on my website; transparency is what you have in every other aspect of your personal life. So let’s say I need a hip replacement, and also that I run half marathons. I want to know, based on Jefferson’s outcomes, what are my chances of running a half marathon in six months if I have hip replacement surgery at your system, and what exactly will it cost me? I don't want to get a 27-page document that says ‘this is not a bill.’ I want to give you my insurance information and I want you to tell me what it'll cost me, no matter what happens. I also want to know what patients say about you. I want to know what your readmission rate is, who pays for that, and then I want to go to Penn, Main Line Health, and everybody else, and get that data so I can take all that information and decide where to have my surgery.
What is your organization’s top strategic goal in the next 12 months?
There’s never just any one. But because of what happened with COVID, I am taking a much more internal approach. Even though I have amazing operational folks under me, I am personally taking charge of meeting or exceeding our budget.
We are developing a model for the resources and culture change [to take place] so that we can truly participate in the dollars that will flow in digital and consumer transformation. Jefferson and I have a great reputation in innovation, and people are willing to invest in us, but I do have to figure out how to get our doctors and nurses, who predominately come from academic environments, to believe this is the right [approach]. So one of the things that we've done is something called JOLT—Jefferson's Onboarding and Leadership Transformation institute.
Also, remember that I am the president of a two-campus university with 8,000 students. So I work with my academic team to develop profitable alternative models of education, under the assumption that our primary revenue source of in-person tuition will be challenged.
We are also building this incredible $800 million specialty care pavilion in downtown Philadelphia. The way that I'm looking at it is that if we're going to have healthcare at any address, and that it will start at home—and if hospitals’ [main purpose] will pretty much be ICUs, for critically ill people, and for coronary care—I want this specialty care facility to be the space station between the home and the traditional healthcare ecosystem. So I think it'll be a very different kind of digitally connected place.
My future for Jefferson is that 97 percent of people in Philadelphia are not patients; they are people. So I don’t plan on having any billboards or TV ads that say if you have pancreatic cancer, come to us. I want patients, while they’re healthy, to have the Jefferson app and feel that we're helping them thrive without getting in the way. So that if they were to get sick, they won’t go up and down the expressway to see who has the best billboard. They will say, ‘I am already part of the Jefferson club, so this is obviously where I will go.’
