New Strategies in a Disruptive Era With Johns Hopkins and Guidehouse

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Tom Haederle
Ask health care executives what keeps them up at night. And most will say it's ensuring the financial stability of their organizations. In this post-pandemic era. Leaders are finding new ways to strengthen performance through innovative approaches to familiar business and clinical enterprise drivers. At the same time, they're facing disruption from third party innovations that are putting patient care at risk.

00;00;37;12 - 00;01;06;24
Tom Haederle
Welcome to Advancing Health, a podcast brought to you by the American Hospital Association. I'm Tom Haederle with AHA Communications. Hospital and health system financials are increasingly constrained by volume shifts, disintermediation, staffing shortages, public plan underpayments and growing expenses. As a result, organizations are reevaluating their key enterprise and marketplace drivers with a fresh perspective to improve patient care and business operations.

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Tom Haederle
Join us to hear how Johns Hopkins is using innovation to ensure long term financial stability while managing day to day struggles. Today's podcast is brought to you by

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Tom Haederle
Guidehouse.

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Doug Shaw
Thanks, Tom. Hello, I'm Doug Shaw, senior vice president with the American Hospital Association. The current economic environment is causing uncertainty in many industries and fields, none more so than health care.

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Doug Shaw
At the same time, this uncertainty also is providing the field with new opportunities to enhance business performance while improving care quality and patient safety. With me today are two experts to discuss this new dynamic. Kevin Sowers is president of Johns Hopkins Health and executive vice president of Johns Hopkins Medicine. David Burik is a partner with Guidehouse and a leader in its Center for Health Insight.

00;02;01;09 - 00;02;17;14
Doug Shaw
Thank you both for joining us today. Let's start by looking at today's post-pandemic world. How have the opportunities and challenges facing healthcare leaders changed with regard to their clinical, operational and financial strategies?

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Kevin Sowers
Thank you. This is Kevin. I want to thank you for allowing me to be with you today. When I thought about this question, I had to narrow it down because we could talk about multiple things that have been impacted since the pandemic, both from a personal and professional perspective. But when I start looking at how the pandemic evolved in this country, I first have to go to our workforce.

00;02;40;01 - 00;03;01;27
Kevin Sowers
And I first want to start by saying thank you to all the providers around the world that took care of patients during a very difficult time in our society and our world. And so when I think about our people, I think about their well-being and their ability to continue to take care of the health care needs of our community.

00;03;01;29 - 00;03;27;14
Kevin Sowers
And so making sure that organizations are responding to that and providing support to them. The second thing that happened is many of our workforce that were back office functions either went home permanently or secondly, they now are working hybrid. There's two issues with that. We didn't in health care teach our managers or develop the systems to manage a hybrid workforce or at home.

00;03;27;16 - 00;04;01;09
Kevin Sowers
And then secondly, I would say it provides us an opportunity as we consolidate that our lease space and our own space. How do we do assets management differently in the future? The third and final thing, which I think everyone is struggling, is the financial impact of the increase of supply costs, the increase of labor, and how that's forcing us to really think about how we transform our workflows, how we deliver care, and what our organizations will look like in the next 5 to 10 years.

00;04;01;10 - 00;04;11;23
Kevin Sowers
And so for me, those are the top three things that come to mind as I tried to prioritize. Like I said, the myriad of of things that happen to us in the midst of the pandemic.

00;04;11;25 - 00;04;44;13
David Burik
I echo my thanks for being invited to participate in this. And I'll build on Kevin's comments rather than repeat them, because obviously they're very valid. The perspective that we have is that during the pandemic, providers were focused on the day to day. They were focused on operational issues. That same circumstance was not really true for many innovators and what sometimes are called disruptive organizations in health care.

00;04;44;15 - 00;05;22;13
David Burik
So they had three years to focus on their strategic goals while providers were focused on operating goals. And so what happens, you compound something for three years, three years that, remember, the pandemic had low interest rates. So with wonderful funding for these strategic initiatives and so many health systems have tried to go back to normal, realizing that normal isn't there anymore, and be that for outpatient surgery or or outpatient imaging or length of stay.

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David Burik
The innovators and disruptors being strategic has changed the game, and providers are in general catching up to that.

00;05;32;20 - 00;05;55;18
Kevin Sowers
So the one thing I would add is we were forced to use technology in a way that we had never used it before. When I look at our own experience, you know, prior to COVID, we're only doing about 500 telehealth visits a day. Overnight, we went from 500 in the first month to 6000 and then even grew to more than that.

00;05;55;19 - 00;06;30;09
Kevin Sowers
So I hope that the reimbursement model, I hope that of the credentialing requirements to provide services across state line, especially for those of us that are in academic medicine, align in a much better way that long term from a regulatory standpoint, we can sustain that practice because I think it's a transformation that happened during that time. The other thing I would say is we were forced to use big datasets very quickly trying to understand this virus and the variables that impacted outcomes on our patients.

00;06;30;09 - 00;06;39;09
Kevin Sowers
And so I think those two things alone are transformative, and I hope we continue to integrate it into how we run our health systems.

00;06;39;11 - 00;07;08;09
David Burik
I'd love to focus on your first point, Kevin. Just for a minute. And that is there's plenty of recognition that telehealth and all things digital - caregiving - were heavily used during the pandemic and there were kind of state of emergency reimbursement waivers given to support that. But as we've normalized, we found out that the reimbursement opportunities are not evolving.

00;07;08;12 - 00;07;36;24
David Burik
So if you bank digitally, the bank isn't handicapped by that. But if if we provide care digitally and there's no reimbursement for that, providers are handicapped. So we really think the the market is willing to take a freebie, but patients haven't been socialized or have an understanding that the economic cost of providing these services needs to be borne by something.

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David Burik
And of course, we all think it leads to higher quality care and cost savings. But those cost savings are not captured by the provider and probably not captured in a meaningful way by the by the patient. So the economic model to support provisions embracing digital, it's not quite there yet. But would you agree with that, Kevin?

00;08;02;19 - 00;08;26;29
Kevin Sowers
Yeah, And I think, you know, the other thing that I think we're going to have to think about is we look at telehealth, many telehealth visits are visits that used to go to urgent care. So over time, as we take one transformation in health care, such as telehealth, how will that impact other strategies that we once put in place and may eliminate some of that in communities?

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Kevin Sowers
And so I think we really have to step back at this moment and really understand the unintended consequences as we start to evolve and transform our care delivery models.

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Doug Shaw
Kevin, does that example of telehealth and how it's great needfullness during the pandemic kind of outstripped, it sounds, the economic model to support it. Given that lesson, how does it alter or adjust the way Johns Hopkins currently assesses innovations for both potential benefit and threat?

00;09;02;23 - 00;09;36;29
Kevin Sowers
You know, when I when I think about that question, I think about several things. And that is the whole concept of risk benefits, because I'll give you several examples, and telehealth is just one example that I use. But let's look at AI for just a minute. Today, I could use AI and actually ask AI to go in and write a visit summary for me based upon what took place, what's already in the medical record.

00;09;37;02 - 00;09;58;28
Kevin Sowers
My job would then just be as a physician and or a nurse practitioner, a PA, to go in and edit that and improve that. And so when I think about that, there are benefits to that. But what are the unintended consequences? Because AI is only as good as your train it, what are the implications on HIPAA long term?

00;09;58;28 - 00;10;26;12
Kevin Sowers
What are the implications on PI? There's a lot of things that you need to begin to think about as you bring that into your organization. And of course, all of us are trying very hard to integrate our IT systems and build a platform. But as you think about that, is what are the unintended consequences of bringing third party products into your platform?

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Kevin Sowers
And so how are you going to be prepared for that as you think about adding innovation to your platform? When I start thinking about innovation and innovation opportunities, those right now are the things that come top of mind for me.

00;10;42;25 - 00;11;08;29
David Burik
I think this idea is the data integrated or is the application a one off where we're only starting to discover it? So you could be on the investment committee for a PE firm or a venture capital firm. And most of the investments you're looking at are ad hoc, where we're for back pain or we're for behavioral medicine.

00;11;09;06 - 00;11;27;01
David Burik
So they're kind of self-contained and there's probably some conversation, but once it's in the cloud, it connects to anything. Well, maybe not so. Where hospitals, health systems, most health systems have invested in a database which supports integration of the data.

00;11;27;04 - 00;11;51;17
Kevin Sowers
Yeah, I'll give you a good For instance. We here at Hopkins are developing a product called Precision Medicine, and it takes big data sets and looks at specific disease groups like MS is one of the ones we did. We did with COVID, too. And we take all the variables that could potentially impact the outcomes of the patient and even look at treatment interventions.

00;11;51;20 - 00;12;15;17
Kevin Sowers
And we can begin to do predictive modeling then based upon the patient sitting in front of you and what treatments might provide them the best outcome. That's the use of big data that allows you to inform care models that will allow you then to drive better outcomes. But it is thinking about how you do from a very different transformative way.

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Kevin Sowers
Use your big data sets in a way that begin to inform how you deliver care.

00;12;22;06 - 00;12;35;28
Doug Shaw
So as you think about leaders looking at this risk benefit balance and making decisions about their own organizations, what are some of the key enterprise drivers that you would encourage them really to look at?

00;12;36;01 - 00;13;11;19
Kevin Sowers
First of all, Doug, I would say it's somebody coming to you with an innovation. First of all, assess your market and is it viable with providers? And I'll give you a great for instance. Within Epic, there is a module, it's called you know, the Inbox. And along with telehealth, during the pandemic, physicians and providers inbox filled up and often it was not simple questions just for a prescription refill.

00;13;11;22 - 00;13;37;18
Kevin Sowers
It actually became almost an office visit that they had to then convert into a true telehealth visit. So as we think about technology and we think about what the implications are of these innovations, what's the implications of our providers, and does it really improve the way they deliver care and practice, or does it become more of a burden?

00;13;37;20 - 00;14;00;06
Kevin Sowers
And so that's one of the issues that we've taken on and and really thought through, Gosh, do we need to change our primary care model? Do we need to provide them time within their week to spend on responding to Inbox? Because we actually did a study looking at how much time they spend after their office visits responding to Inbox.

00;14;00;08 - 00;14;23;10
Kevin Sowers
Is there a way that from an AI perspective, we can prioritize which are the most important ones for them to look at and to read? So I would say assess your market and assess your internal market as to what the implications are. And then the next question is just around access capital as you supported innovation. And that question is, are you going to be able to support it?

00;14;23;10 - 00;14;44;16
Kevin Sowers
Are you going to partner be able to do that? And then what are the testing sites that you're going to be in a test, some of this innovation that's coming at you, what kind of sites are you going to choose where you're likely to have the most success? Because I've seen a lot of leaders in my past that have not thought through that element.

00;14;44;18 - 00;15;15;18
Kevin Sowers
And it doesn't work not because it's bad innovation, because the culture wasn't right within the setting to embrace the change in the transformation. So those would be the key things that I think people leaders should be thinking about as they think about bringing innovation into their organization. Well, if we stick with primary care, we have seen since the beginning pandemic more and more in certain markets, primary care providers go to concierge medicine, which then leads to access issues for others.

00;15;15;21 - 00;15;37;12
Kevin Sowers
And so as I think about some of these changes, especially with venture capital companies and what they're doing in the marketplace around some of what they're doing with specialists in primary care, it is starting to create access issues in this country that I think will lead to further health equity issues as we move into the future.

00;15;37;14 - 00;15;53;27
David Burik
Well, let's face it. I regularly go to clients where a disturbingly large percentage of their communities don't have broadband. And the most exciting thing they're talking about is hospital at home. It's a little incongruent in those situations.

00;15;54;00 - 00;16;27;11
Doug Shaw
So you've done a really good job of describing this balancing act. I might even describe it as a high wire act with the need for innovation strategies over the long term. But at the same time, that day to day struggle to adopt and succeed with specific innovations. Could you provide any advice for those listening as to what else can help with that balancing act or any other opportunities or suggestions or advice that you have for leaders?

00;16;27;18 - 00;16;33;05
Doug Shaw
We're really trying to figure out the financial stability plan for their organization.

00;16;33;07 - 00;16;55;07
Kevin Sowers
It's a great question, Doug, and I want to back up to the 30,000 feet before I answer your question. And I think it's going to take a partnership with state and federal government. Because I think what we're about -  I don't think I know what we're about  - to go into, because I've done this for almost 40 years now and started my career as a nurse at the bedside.

00;16;55;07 - 00;17;19;06
Kevin Sowers
So it's not my first time at the rodeo. But I can tell you, out of my 40 years, this is the most challenging time I have ever seen, both from a workforce perspective and both from that and managing the financial implications of what happened during the pandemic. So many of our hospitals across this great country are in crisis mode.

00;17;19;08 - 00;18;04;29
Kevin Sowers
They are in survival mode. And because of that, we're already seeing a decrease in hospital beds across this nation. In our communities, we're seeing the closure of hospitals. And so because of that, large systems like Johns Hopkins Medicine and other large academic medical centers, you're seeing an increase in admissions to those facilities. Well, you want your tertiary quaternary care to come to an academic medical center, but if there's a closure of specialty services that could be provided at the at the community level happening, you're only increasing costs of care across this nation and not really putting models in place to help manage the total cost of care.

00;18;05;01 - 00;18;32;28
Kevin Sowers
I only put that out there because I don't think it's just about what we as leaders in the field are going to have to think about. But it's our state and our federal legislators that are going to have to come together with the industry and we're going to have to figure this out together. Second, I would say in terms of the longer view, I think what David said was something that is very relevant.

00;18;33;00 - 00;18;58;22
Kevin Sowers
People are so involved right now in survival mode. It's what can I do today that they're not backing up and saying, okay, in five years, what does our organization need to look like? What resources will be required, What will the inpatient models look like? And now how will they be different? What technology will it take to accomplish that?

00;18;58;24 - 00;19;23;00
Kevin Sowers
What kind of new resources that we don't have today? And so it's really sitting down with your team and challenging them to think differently about what we might look like. And then as you look at workforce and you say, Gosh, I'm going to need a different type of provider, how do you balance that with working with your community colleges, your university, producing that type of provider for you?

00;19;23;07 - 00;19;49;02
Kevin Sowers
And then secondly, how do you work with your regulatory agencies that oversee scope of practice? And how do you begin to have meaningful discussions? Because if we're honest with ourselves, we aren't going to have enough providers for the future. So we either have to change that today because the clock is ticking and it's not as if we're going to produce the total number that we need in the next couple of years.

00;19;49;04 - 00;20;17;24
Kevin Sowers
That's just not possible. Nursing school enrollment across this country has declined. So knowing that, that the pipeline is not producing primary care, anesthesia providers, I can go down the pipe pipeline and talk about where we'll be hit. We need to think about this now or we're going to face an existential crisis in health care. When I think about what are the requirements for transformation?

00;20;17;25 - 00;20;48;23
Kevin Sowers
I continue to share one statistic with our team. On any given day in the United States of America, 10,000 Medicare recipients die. Only 9000 babies are born. And that's per day. And when you start to think about the compounding effect of that over a year, the current way that we deliver services and get paid for services from a Medicare perspective is not sustainable.

00;20;48;25 - 00;20;57;12
Kevin Sowers
So there will be a forced transformation and we can either lead that and be a part of it or it can be done to us.

00;20;57;14 - 00;21;25;20
David Burik
I do see kind of a rethinking of what we want our health system to look like, but we are in a period where there's a lot of innovation and innovation does not happen in a centrally planned certificate in the kind of world. It happens case by case, and hospitals are finding themselves with less money and more expenses, which is an unsustainable pathway in this innovation.

00;21;25;20 - 00;21;58;22
David Burik
So really understanding what you're going to be three, four or five years hence from now, and capitalizing or investing to that future really is relevant. You can't allow yourself to be overwhelmed with a labor shortage. You have to tell yourself it's very similar. It seems like as long as I've been in this business, there's been a primary care shortage, and as long as I've been in this business, every health system has tried to get everybody in the community a primary care physician.

00;21;58;25 - 00;22;17;22
David Burik
Maybe that's the wrong goal because we don't seem to be very close to it and we're not going to have primary care physicians with a panel of two to three to cover everyone. Maybe there are different models that we should be working on that will meet the meet the needs of our population in a better way than we currently are.

00;22;17;24 - 00;22;31;04
Doug Shaw
Very good. Well, David, Kevin, thank you very much for joining us today and for sharing your insights and your thoughts. And to learn more about Guidehouse, please visit www.guidehouse.com.  Take care.