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Becker’s Healthcare Podcast
Advancing Patient-Centric Care: Hartford HealthCare’s Vision for the Future
00:31:48
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- [00:01]
Beckers Healthcare
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- [00:38]
Laura Deardo
This is Laura Deardo with the Becker's Healthcare Podcast. I'm thrilled today to be joined by Dr. Jeff Cohn, executive Vice President and Chief Clinical Operating Officer at Hartford Healthcare. Dr. Cohn, it's a pleasure to have you on the podcast today.
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Dr. Jeff Cohn
Thank you, Laura. It's a pleasure to be here.
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Laura Deardo
Now I'm really excited for our discussion. I know Hartford Healthcare is such a unique health system and certainly on the forefront of a lot of cool things are happening in patient care and technology and care delivery. But before we dive into our bigger discussion, can you tell us a little bit more about Hartford Healthcare and what makes it unique?
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Dr. Jeff Cohn
Sure, I'd be happy to. So in our little corner up here in Connecticut, with a little bit of an extension into Massachusetts and Rhode Island, I do think, and I thank you for acknowledging, I think we are a somewhat unique healthcare system. And I would point out, or at least start out by saying that, that we are a truly clinically integrated healthcare system. I know a lot of places they aggregate, they grow, but so much of what they do many times is still siloed. Because the hard part is not the acquiring and the aggregating. It's actually tying together what exists with what is brought on and building a common culture that everybody can work with. Because I think at the end of the day, that's what's going to make any successful organization. And in particular our health care system we have spent the better part of, I used to say a decade, but it's probably 15 years now building this type of integrated health care system. And I will tell for anybody who needs to think about following this blueprint, if they care to, that it really starts with governance. If you don't have governance from the top and very well organized, it tends to not work as well as it needs to. And so what we did about 15 years ago was basically blow up our governance system. And what we did was we got rid of hospital boards and local boards and we created an overriding system. Board of directors, very accomplished People in both industry, academics, education, and medicine. And that board has fiduciary responsibility for strategy and finance. And then what we did was, while we are a small footprint relative to some of the really big healthcare systems, we are still divided up into regions. And each region, whether it has one or two hospitals within it, is governed by a regional board, which really has at its heart and soul quality and safety. And I'm going to get back to that because I think that's critical to our journey over these last few few years. And of course, they also deal with credentialing and with philanthropy and community engagement. But it really starts from there to be able to drive the outcomes that we want to see. Because if you're going to get the synergies of working together, it really takes putting all those pieces together. We have an underpinning of all of that for our what is now roughly a $7 billion in revenue healthcare system. And by the way, that 7 billion just five years ago was about 3 1/2 billion. So if I want to give you the idea of how we've grown, even through the pandemic, over these last five to six years, we've doubled. And most of that is organic growth and not acquisitional growth. But in doing that, we have about 45,000 colleagues that I tend to be responsible for most days. And in addition to that, we have a very distributive model of access to care, whereby even in this small state, we now have over 500 sites of service, and you can drive from one end of Connecticut to the other in less than two hours. I get stopped all the time, and people say, geez, you guys are everywhere. And my response is the old Visa commercial. We're everywhere you want to be. So we made a very intentional decision back then, decade or so ago, that we were going to have an ambulatory footprint that was within 10 miles of every resident of the state of Connecticut. And we achieved that a while back. Now, our goal is to be in everybody's home, and we can maybe talk a little bit more about that later, but I think that gives you a picture. We take care of 27, 28,000 people every day, and ultimately, last year, we touched half the adult population of Connecticut at one point or another. So I think, Laura, that would probably give people a flavor of our footprint and how we're organized.
- [05:42]
Laura Deardo
That's truly impressive to hear how sprawling the health system is. As you mentioned, being able to have so many locations I can imagine, convenient for the population in patients in Connecticut. And then Two touches so many different people within the broader population is just really cool to hear. I'm curious, from your perspective, could you tell us a little bit about an accomplishment you're most proud of from the last year?
- [06:07]
Dr. Jeff Cohn
Sure. I can actually tie that back to the Quality Safety piece. We've been on a journey for about the last, oh, I would say six, seven years to be the safest health care system in the country. Very aspirational, but meaningful to me. You know, part of the time. I'm still a clinician. I'm a colorectal surgeon by background. I joke that I play a doctor on TV a lot more than I do in real life. But at my heart and soul it is about patient care and it's about being safe and taking excellent care of our patients. I'm always reminded that in any survey, what comes to the top with patients is hurt me. And that's a low bar to have to achieve. But it's really about don't hurt me, keep me safe and then make me better. So I always think about that. And I used to think that we were safe, that we were really high quality. Always thought that. By the way, I've been here for 30, this is my 38th year, and take pride in what we've done and always assumed that we were really safe. And it's been eye opening to me in the last, like I said, seven to eight years to see our journey and how much safer we become and frankly, how far we had to go to get to this place. So what I'm leading up to, Laura, is that there's a saying that it's really hard to climb a mountain, but it's even harder to stay there once you got there. And two years ago we achieved something that some people thought was not possible, which is we have seven acute care hospital campuses and all seven of them achieved Leapfrog A. And as most people know, the Leapfrog organization is the highest respected quality and safety independent organization, not for profit, all objective criteria, no subjective criteria. And we were able to achieve straight A's. The fact is, of all of our hospitals, we have academic hospitals, we have community hospitals, teaching hospitals, we have urban and even rural hospitals. And each one of those, sometimes people make excuses for why they can't achieve an A In Leapfrog we have all of those and actually we achieved that two years ago. But what I think I'm probably most proud of in the last year is we again got reaffirmed straight A's across the board for all of our acute Care hospitals. And in doing so, it's not just the A, it's what it represents that you come to our organization and you will be safe and we will treat you with the highest respect, care and excellence in order to get the outcomes that are frankly achievable if we put our mind to it. It's taken a village to do that with great leadership. I mentioned about the regional boards that focus on this all the time, but we have teams that they get up every single day and this is their primary focus of achieving high quality and safety. And I will say as part of that, the numbers are staggering. We have decreased, for instance, our hospital acquired infections over the past five years by almost 50%. And those are individual patients who are not getting hurt anymore by what we're doing in our hospital setting, to use that as an example. So I would tell you that that is something that we think about and work to achieve every day. One more corollary to that is that we have had to pay back to CMS no penalties for two years in a row now. I mean, five years ago we were probably paying five, six million dollars a year, and last year and the year before, we had absolutely no penalties at any of our hospitals. So I think that maybe I'll stop there for a minute and I don't know if you have questions about that or if you want to talk about some other things that we've achieved in the last year.
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Laura Deardo
That's amazing to hear. And I really love how you describe that commitment of not settling for what you think is pretty good care, but actually pushing to get better and better on a consistent and constant basis. It seems like the structure that you've set up there at Hartford Healthcare to keep accountabilities, but then just figure out how you can continue to reduce, for example, as you mentioned, the hospital acquired infections or other ways that really get to the heart of what matters most to patients. I think is truly admirable. And then two, to top it off, being able to avoid paying those penalties to cms. I can imagine, especially during these times of very challenging financial situation and economic conditions, for many hospitals, that makes a big difference. I'm curious now, I'm wondering if you could talk a little bit about the future too. What are some of those big organizational goals that you're setting for this next year or so?
- [11:26]
Dr. Jeff Cohn
Well, we do think year by year, but we also think further along. And I know that in healthcare there's so much changing and we can certainly talk about what's right in front of us. But we also think about 5 to 10 year horizons as well. And it really helps to look now and in the distance. And actually before I get into that, I just want to point out that we continually perform while transform and we have people who are in maybe one swim lane and others that get up, other colleagues get up every day and thinking about transformation while we're performing. This stood us really well during the pandemic. During the pandemic we strove every day to keep people safe in the state of Connecticut. All of our citizens, all of the people, we were among the leaders in terms of supplying some of the smaller hospitals even outside of our system with ppe. We had opened up a numerous supply chain, new centers, new areas, new places. So we were focused on that every single day. But we were also even transforming and growing during the pandemic such that as I said, we've grown, we've doubled in size in many ways. Even through the pandemic, we actually have been profitable. We have made a margin, a positive margin every one of the last six years that Jeff Flacks has been our CEO and that I've been in this role as his chief clinical operating officer. So it is that mindset of performing while transforming and I bring that up as the lens to look through for the next year because we're going to continue to perform while also what's on the horizon for us. And I'm glad you asked that because I'm really excited about a couple of things. But before I get to that, part of the continuing to perform is we have every intention of staying at Leapfrog A we just won an amazing quality award from the American Hospital association that is going to be announced pretty soon. These are things that are near and dear to us because it's about every individual patient. And so we will continue to perform on that level every single day. But while we're doing that, we are looking to the future and we have actually put forth Hartford Healthcare 2035 plan. So now this gets to what are we looking at over the next few years to the next decade. And we want to be the nation's most people centric health system. That's our goal over the next 10 years. We thought about using the word most consumer centric. And that's really what we want to do, is look at it through the lens of consumers and what are consumers expecting. But it's really about our people, our own colleagues as well as the people we take care of. So we, we labeled it as being the most people centric health system. And as you know and I know in our daily life, everything these days is on demand. We always use Amazon as the example, but it's more than Amazon. It's everything from Amazon to how we book travel to frankly how we've been banking for many years and Doordash and Uber and all the rest. And that's the expectation of everybody in everything other than healthcare, frankly. And so we have decided that we're going to put a stake in the ground and we are going to make sure that we are available for on demand care anytime, anywhere that anybody wants it. And we actually had some building blocks in 2024 that have begun to lead to that. Everything from robust online scheduling to getting rid of paper in our offices, e check in, contactless arrival. We have done a lot of the building blocks, frankly. We are in the process putting all of our data in the Google cloud and we're partnered with Google around how to create access in a way that we know somebody the minute they interact with us, not only when they come to us, but also to reach out to them. So where are we? Right on the cusp. In fact, we go live next week. We've had our slow ramp up, but starting next week we are launching fully hhc24.7 and we are partnering with an amazing startup out of Israel which is now based in New York called K Health and they have developed a clinical AI platform that we are incorporating into epic, into our ehr, into our medical group. And we are will be delivering 24. 7 virtual care starting April 1st to anybody, anywhere. It's a downloadable app that you can get put on your phone. Already done it. And it will be, the platform will have underneath it very robust clinical AI so that when you get up at 2 or 3 in the morning and you're having heartburn, you're worried whether maybe it's chest pain, you're not sure you want to go to the emergency room, you want to get in touch with a physician. We have that ability to do that. It will immediately link if you go on the app to your electronic medical record or if you don't have one, it will create one. It will ask you questions based upon this clinical AI and then a live doc or app will come on, will know your care, know who you are and work with you. It'll be connected throughout our system. Remember I said that we are completely clinically integrated so they'll be able to get you the emergency room, even call an ambulance for you. It'll be able to get your urgent care in the morning. By the way, we have about 50 urgent care centers throughout the state. It'll be able to get you a doctor's appointment as a urgent add on in the morning or to a specialist. All of that is possible. It'll be able to call on a prescription for you, the physician and it'll be able to schedule a follow up for you if you want to do that virtually as well as I'm sure my kids would want to do since that aligns with how they function in life. All of that is not only capable, it is what we're launching come April 1st. This lines completely with what we want, which is a complete digital front door into Hartford Healthcare. I just want to really emphasize how we are doing our best to transforming health care not only locally but actually in the country. I can't tell you how excited I am about this.
- [18:48]
Laura Deardo
I love that that sounds like such a cool and unique opportunity for patient population really to be more and more connected with the health system and then to have a better understanding of where they need to go with any type of treatment challenge to get to the right place and then just have better care overall. So that's amazing to hear and it'll be really fun to reconnect and see how things go after that is rolled out before when it goes live. And really I just love that idea too. As you were talking through Hartford Healthcare 2035, it seems like a lofty goal for sure, but definitely one that is achievable in terms of just continuing to integrate and be that people centric health system not only for the patients but as well as the teams that you're working with now. I know there's a lot of opportunities that we've talked through today. I'm curious, what are some of the headwinds that you're anticipating for the next year or two as well?
- [19:41]
Dr. Jeff Cohn
There's no headwinds. I think it's all tailwind. Well, you know, it's first of all just to put an exclamation point on what I just said. It's really about frictionless navigation through the health care system hours and everybody's that's what people want. They don't know where to turn. We want to make it as easy as possible. We want to make it completely bi. Directional. We want to do it in a way in which we actually can get to people before they even know what they need. I always remember Steve Jobs with Apple that he wanted to give people things they didn't even know they needed. So that's where we're at with that. And yes, we do have to talk about the headwinds. And you know, if we'd had this conversation three months ago, I think it would have been a little different as to maybe what I list for you today. Three months ago, I would have absolutely said what probably everybody says. It's workforce issues and it's inflation, and those are still there. They're ever present. I will say, in terms of workforce, we have recognized this since probably before the pandemic, although that is highlighted with the great resignation and other things. We figured out that we had to create our own pipelines and we have a whole service line dedicated to what we call campus care. And within that is we service all at least half a dozen universities and colleges. We build programs with them, we take care of their students with student health through our rehab network. We supply physical therapists, athletic trainers, but we also create those pipelines and those training programs for future nurses, for rad techs, et cetera. And we have driven down our contract labor just in the last year by $50 million. It was as high as probably 150 million at the peak. And we're now down to probably pre pandemic levels, if not below that. So I wanted to interject that because it does go to the headwinds, and those headwinds are still there. They're going to be there with the workforce, you know, probably as well as I do, even better the predictions of what the workforce in healthcare looks like over the next decade or two. But now we're going to layer in so many other variables that have come to pass just in the last two months. I think that because of, for instance, tariffs. Tariffs are basically a tax and ultimately we all as consumers will be paying it. So what it amounts to is, is more inflationary pressures and it puts pressures on our supply chain. So we are continually looking at how to minimize that, how to look for places that will avoid those tariffs, or if not avoid them, minimize them. But I think that's a huge focus at this point. In addition to that, you know, some other areas, you know, we have the rising costs for all types of medications, pharmaceuticals that are separate even from the inflationary pressures of the tariffs. But I think the big thing are the health policy changes. And right now, I don't know, my head's spinning every day trying to figure out with the executive orders what needs to be done today, what's going to be in the next few months, what has been paused. And then when you layer on that, the significant impact that Government paying, whether it be Medicare or Medicaid and the tremendous unknown there. But there's clearly going to be changes, there's no doubt about it. And the question is, how do we mitigate that when all of you know, every health system has razor thin margins and if we're going to be looking at cuts to Medicaid, it's going to impact the individual tremendously and many times individuals who can least afford care on their own. But then from a health system standpoint and from a state standpoint, the impact is uncertain at best and could be devastating at worst. So is that enough headwinds for today?
- [24:26]
Laura Deardo
Just to name a few? Yes. No. That's great and really fascinating. I think all those different aspects, as you mentioned, not only the things that have been challenging for several years with, with inflation and workforce and ongoing, but then to just adding in some of the things that you're seeing more recently. I think great perspective on what the tariffs and how they can impact healthcare and what you're seeing, I know continually increased pressure on those costs for medical supplies and drugs and whatnot. And then two, thinking through just the swift changes on the policy side, lots and lots of uncertainties, payments and other things that just make it, you know, challenging to stay compliant. And I'm curious, when you have all of these factors happening at once in having to be nimble and agile in order to keep up, what do leaders need to do in order to make sure they're able to guide their teams through these types of situations where there could be fast, rapid change in, you know, needing to keep up while also having your day to day of taking care of patients.
- [25:35]
Dr. Jeff Cohn
Yeah. So when we're talking about leadership, it is critical to have the right leaders, strong leadership, the engagement. And I started out by talking about our CEO Jeff Flacks, and we have an amazing leader in Jeff. I like to refer to myself as the other Jeff. It's very appropriate, actually, because he's out there in front every single day. And the first requirement of a leader is to lead from the front. I certainly try to do that myself. I've done that my whole career. I think that that is the way that you get people to follow you, inspire them. I think optimism is really important even in challenging times. But acknowledging those difficult times, that's really important as well. It doesn't help to blindly say everything's fine when people know that it's not. And so we have to be honest, we have to be. It's a big word that's always used transparency, but it Helps to do that. Most importantly, show vulnerability as a leader. I think of that all the time. I certainly do it. I know that Jeff does it and that will engender trust in people so that we work together. The power of the synergy I always talk about. I was pretty good at math, but I talk about Cohen's math as one plus one equals three and the power of people coming together and working as a team. So leading from the front is really important. Showing vulnerability and transparency, but optimism and giving a vision for the future, I think those are really important, especially in difficult times. And it's just how we need to work together. I will also add one of the ways that we're constructed. And take me, for instance. I am one of the two chief operating officers for Hartford Healthcare. We actually have a dyad model underneath Jeff and I have a chief operating officer partner who is a non physician. And we have dyad relationships throughout the healthcare system. Our institutes are led by both a physician executive and an administrative executive. Our medical group to many degrees in the service lines that way up to and including the chief operating officers. And when you have physician leaders engaged along with administrative leaders working side by side, there's tremendous power in that and everybody will want to follow because they'll identify with that side of the dyad that they are most closely associated with. So I think that's another key aspect of how we're hardwired, in addition to what the requirements of a leader truly are. So does that answer your question?
- [28:42]
Laura Deardo
Yeah, absolutely. You know, I think that's perfect and it makes a lot of sense. I love you talking through the structure of the leadership, that dyad model on the chief operating officer side too. But also just very pragmatically looking at how important it is to be. Be truthful, transparent, and show that vulnerability during these times. I think, as you mentioned, you can't back away from the challenges that are very real out there, but at the same time finding those points of optimism and opportunity to really do great and amazing things in spite of all else. So I appreciate that. It just really ties everything together and sounds like really a strong leadership structure that you have there at Hartford, I'm reminded.
- [29:27]
Dr. Jeff Cohn
I mean, I think a bunch of people said this, but I know Winston Churchill said it, in terms of strong leadership is to take people where they wouldn't necessarily go on their own. And to do that, you do have to win their hearts and minds. You have to inspire them, you have to gain their trust. And I think that I try to do that through being out there in front. But I will add one other piece that I just thought of and it's a way I've transformed my own leadership in the last few years and especially in this role, is I make it a point to lead through others and I coach, mentor, teach. It's one of our key behaviors. I spend a lot of my time doing that. But by engaging people, our up and coming leaders, our senior most leaders, and have them be out there and me support them in ways that they know I have their back, I think that that makes a huge difference as well for how we are ultimately successful in what we're driving.
- [30:33]
Laura Deardo
I love that. Dr. Cohen, thank you so much for joining us on the podcast today. This has been really a fascinating and inspiring discussion and I look forward to connecting with you again soon.
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Dr. Jeff Cohn
Absolutely. If I can leave you with the focus of Hartford Healthcare. As we move forward, I would say our biggest promise to the people that we take care of and the people we want to take care of is to provide affordable, accessible, incredibly high quality care where and when people want to be met. That's what I was talking about, that frictionless navigation. And we want to be world class. And if you talk to Jeff Flacks, he is always talking about being the best at getting better. Being the best is a static moment in time, but being the best at getting better is how we continually strive to make a difference in health care. So I thank you for giving me the time to have this conversation with you, Laura.
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Laura Deardo
Oh, it was my pleasure, Dr. Cohen, and really truly blessing to have you here. And I love those final words, be the best at getting better. Thank you.
- [31:44]
Dr. Jeff Cohn
All right, have a great day.