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Becker’s Healthcare Podcast
Healthcare Upside / Down: Redefining Patient Access and Physician Alignment
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- [00:00]
A
Welcome everyone to Healthcare Upside Down, a podcast by Becker's Healthcare and ECG Management Consultants, where we'll explore the upsides and downsides of healthcare and the industry's latest trends. I'm Erica Spicer Mason with Becker's Healthcare and today I'm thrilled to talk to two special guests about patient access and experience. So joining us for this conversation we have Dr. Joseph Caccone, CEO of Thomas Jefferson University and Jefferson Health, and Alex Pinto, a principal at ECG Management Consultants. Dr. Cachone and Alex, thank you so much for being with us today.
- [00:33]
B
Yep, happy to be here. Thank you.
- [00:35]
A
Great to have you with us. And before we get into the conversation, I wanted to see if you'd both like to share just a little bit more about yourselves and your work in healthcare. Dr. Ketchone, would you like to get us started?
- [00:45]
C
Sure.
- [00:45]
B
You know, I started.
- [00:47]
In healthcare a long time ago. I started and went to medical school, graduated from Hahneman Medical School back in the back in the 80s and was a practicing cardiologist for the first part of my career, interventional cardiologist. And then gradually over time became more and more administrative and to this final job, or I guess it's going to probably be my final job in healthcare, at least full time job as a CEO of Jefferson. So it's been a great journey. I've learned a lot along the way and every stop has been an education and I've enjoyed it.
- [01:25]
A
Wonderful. Thank you so much. And Alex, tell us a little bit about you.
- [01:28]
C
Yeah, thanks for having me. I've been in healthcare around 22 years now, actually. Started with a clinical background in outpatient rehab, sports medicine, practiced for a while before realizing I had a knack for more of the administrative and operational side of healthcare. I worked with health systems directly in leadership roles for ambulatory and medical groups before moving into consulting around a decade ago, where I really focus in on just that patient access side touches on the clinical side for me, which is timeliness of care is so critical to outcomes. And if we can make access a key part of healthcare delivery, then we can improve outcomes for patients and improve the patient experience as well. It's all a critical part of that life cycle.
- [02:10]
A
Yeah, wonderful. Well, it's great to learn more about you both. And I think, Alex, to your point, when we talk about patient access, there's a lot that factors into it. So I'm sure we'll cover a lot of areas of what patient access really means. But I wanted to get us started by talking a little bit about what's happening at Jefferson Health. So, Dr. Cashone, Jefferson has experienced significant growth. It's expanded across Pennsylvania, New Jersey, and I know most recently has merged with Lehigh Valley Health Network. So how are you thinking about the patient journey across this broad and diverse footprint? And in what ways has that growth shaped your approach to access and experience?
- [02:46]
B
You know, first of all, we are super regional the way people describe today. And so we're in a concentrated area, concentrated eastern Pennsylvania and southern New Jersey. And for us, there are multiple access points for care, whether it be our emergency room, whether it be our practices, whether it be our hospitals, our imaging centers. We have more than 750 sites of care across the system. But, you know, access today is not always about a physical location. It's about the ability for patients to reach us or reach them us to reach the patients where they are. People have an expectation today because of other industries is being met where they are in their home. And that's the difference between when I started in healthcare, where we were waiting for people to come to us to come to the emergency room and come to the practice. Today.
- [03:39]
We have a home care program. We have home visits for, we have physicians that do house calls. We have multiple channels to come in. We really want to be the most accessible system in the country. And for sure in the region, it does a couple things. One is in the fee for service world, it works because it becomes a way to get people into the system. But more importantly, as we think payment models will change and hopefully will change is it aligns the fact that we want people to have access to care, to keep them out of the hospital. And having access before somebody ends up in the emergency room with a problem that needs admitted is a much better solution for the patient. It's a much better solution for the healthcare, but we have to incentivize it in the correct way. And that's why we believe that the financing of healthcare is tied to this access issue. How we pay for healthcare is tied to the access issue, even more importantly than it is in a fee for service world.
- [04:38]
A
Yeah, really interesting. And I definitely hear you in this trend on the upstream approach to keeping folks out of the hospital and keeping them out of their care sites. But 750 care sites, wow, what an number. So it's really great to hear that you're so focused on access in that way. And Alex, I wanted to get your perspective on this too. You know, you work with health systems nationwide and organizations are focusing patient access efforts, I'm sure, in a multitude of ways. So can you elaborate on what you're seeing and common challenges that you see them trying to solve?
- [05:11]
C
Yeah. And I want to appreciate what Dr. Castellan just said. 750 care sites. But between your physicians making house calls, your digital platforms, the number of unique ways your patients can connect with you are almost infinite. Right. And it's growing. And that's a common problem health systems are experiencing nationally. Whether you're super regional or you're a single facility local health system, you're managing a very different platform for care delivery. And the ways your patients, I like to call them consumers because they have choice in their actions. Your consumers are coming to you are going to vary. What are we seeing nationally? I think that to bring all of it together, we're seeing a dual transformation. Transformation 1 is how health systems need to solve for their patients or their consumers access to care problems. Today. Those are core changes like how do we schedule, how do our providers template, what does a contact center environment look like and how is that run efficiently? Those are table stakes right now that health systems have to master. Many of them have and they're moving on to transformation two. And some are working on transformation one while strategically planning for transformation two. So what's transformation two? This is the more optimistic, forward thinking aspect of access. And I think this speaks also a little bit to what Dr. Casson was getting after into the payer reform and the future of healthcare in that future. Axis has to be more than just the scheduling center or the patient contact center. It's got to be a platform on which we're coordinating care across the system. We're doing it proactively. We're embedding AI and digital technologies. One of the concepts that we've seen very innovative in this space is things like predictive outpatient programming of your availability. If we've seen many health systems grow the inpatient command center, what does it mean to have an ambulatory command center that relates? Can that command center track flu admissions and dynamically adjust availability for same day sick care? Can that command center identify the number of inpatients being held because they don't have transition of care appointments and dynamically adjust primary care availability to accommodate those patients? It's looking at that master patient flow of patient care and aligning it all of those health system resources across all of the platforms and points of care that the system can offer to meet those patients needs.
- [07:34]
A
Yeah, Alex, I appreciate your insights there. And two things that you said really struck me. One is that you've mentioned this need for these kind of dynamic workflows and levels of insight into health system operations, and also that platform approach. And those are two concepts that I've heard underscored throughout conversations here at Becker's CEO CFO Roundtable. So interesting to hear you touch on those as well. And Dr. Cashone, I want to bring it back to you. As Jefferson continues to grow, how do you balance efficiency and consistency, whether that's through something like centralized services or maybe standardization, especially with the need to deliver personalized patient experience.
- [08:17]
B
Yeah, I think at the individual level, the experience needs to be personalized, but at the ability to access the system should be more standardized, and that is not a small task. Alex referenced physician templates. Yeah, people think that's an easy thing to change. It's not. There is a whole host of change management that has to go into that. And you have to have that date where you say, okay, you no longer. We would have docs that would come in and just take the afternoon off, not be on vacation, not have any entries into epic, not have administrative time. And we just. We didn't know where they were. And. And so think about if I'm two weeks out from an appointment and I have an appointment, I need to get somebody in to see Dr. Casson. His template should be open. And so standardizing templates was. Is the first step in access. Whether it be a virtual template, whether it be, you know, telehealth visit, whether it be a physical visit, whether it be going home, there has to be a standardized. Because we have to have patients have. Imagine doing your. Imagine doing open table, and you go on to open table, and you schedule your reservation for a. And you go to the restaurant. It's closed. Yeah, you're not gonna be so happy about that.
- [09:37]
A
Yeah.
- [09:38]
B
And so there has to be, you know, there has to be an infrastructure to this. And, you know, with doctors, typically, they're not always the most flexible group of people. I can say that, since I'm one. We're not always the most flexible on how. And so. And, you know, a lot of them went into this at a time where they had a lot autonomy. Those days of corporatized medicine, which, you know, unfortunately, there's a reason why physicians have chosen not to go into private practice any longer. My first job was in private practice. We sort of policed ourselves in today's world, you know, it's being policed because of the financial pressures within the system and the fact that the consumers have a much higher expectation today than they've ever had. They have so many other Industries where they can book something, they can order something, they can access things immediately. And in health care, we're just, we're, we're behind the times. And so it start to me, this all starts the access journey which is got, you know, can have AI embedded in and all these things. At the end of the day, we have to be able to deliver better for our patients.
- [10:44]
A
Yeah, yeah. So it sounds like standardizing those templates is one key way to ensure access, and it's a really interesting strategy. So thank you for sharing, Dr. Cashone. Alex would love to know how you're seeing other system approach this issue and really strike that balance between centralized access and local relationships.
- [11:02]
C
Yeah, I gotta triple down on what Dr. Gastron is saying. The templates are the base of it. Right. In any other industry, if we're in retail, we're managing an inventory. And in healthcare, our inventory is our physician's appointments. And if we can't describe what our inventory is on a daily basis and have a plan to deliver that inventory to our consumer are patient, then we have what retail would call spoilage. Yeah, spoilage is when something goes bad at the end of the day and we can never sell it. When we don't template correctly, we have spoilage. We also have breakage. That's when we mishandle our inventory and we lose the ability to sell that inventory. Now, I don't mean to infer that healthcare is as simple as retail. We have our own set of complexities, physicians being at the core of that. Physicians see templates as the last bastion of their independent practice. I've had physicians say, you will change my template when you pry it from my cold, dead hands. Right. This is a personal thing to physicians, and I would challenge that. There can be two truths in this. The first truth being we can standardize. And the second truth being you can still have some autonomy in your practice. You as a physician can still dictate how you deliver care, how you engage with your patients, how you spend your time treating and managing your patients complex problems. They both can coexist. But we have to partner with physicians to be able to deliver that kind of transformation. And those transformations have to be built on some level of standardization and support of an economy of scale.
- [12:34]
B
Yeah, I double down on that. I just say that if you say, I'm going to see patients Monday through Friday, 8 to 4, you have to see patients 8 to 4, that's your template. You chose it. And it's okay. We're, we're happy to be flexible within A framework, but once you commit to a template, you're going to stick with it. It's not, you know, used to be the old general practice person says, I'm going home early today, Marge canceled the rest of the day. And you know, Marge would just get on the phone, say, you know, doctor, can't see it today. And unless if there's an emergency, go to the emergency room. Our patients have much higher expectations. So there is some autonomy. When I used to acquire physician practices at one point in my career, I acquired all the practices for Cleveland Clinic. I used to tell me, you're going to lose, you're going to lose control of a couple things. One, you're going to lose control of human resources. You're not going to be able to just come in and say, you know, Erica, I don't like you, I don't like the dress you're wearing, so we're going to fire you today. So health systems won't allow that to happen. And then the second thing is you're going to lose some autonomy on your schedule, your professional side, the professional practice, how you interact with patients on a day to day basis. We'll give you tools to help you. But what we really have to focus on is consistency. And that expectation is that like the way you bring the retail industry in, it is people, if the product is not predictable for access, that's table stakes.
- [14:02]
A
Yeah, yeah. And it leads me to a quick follow up question, which is if there are health systems out there who are considering this change, standardizing templates, but it sounds like there is a change management component that would go into this. What's the best first step that an organization could take to get the physicians on board or at least get them aligned?
- [14:21]
B
I would just say having done this, it's about, it's creating a group of physicians that will help implement it. So, and it's not coming from Joe Casson, the CEO, but it's coming from a jury of their peers. Yeah, I had a physician call me in my prior job and said, you ruined my career, ruined my life because I have to see patients on Saturday mornings from 8 to 12. And I said, listen, all we, we gave two rules to the physician oversight group is that they had to have some hours off time outside of 8 to 5 and that the templates had to be standardized and then people could pick. And he said, you ruined my life. I said, I did no such thing. You chose your template, number one. Number two, a jury of your peers said, we think it's competitive for us to have off hours time and everybody had to do at least two hours a week. You chose your schedule. And so I would say as much as self, self governance to a point, give them the autonomy where the autonomy doesn't matter as much and set up your own committee to do that. It can't be handed down as an edict.
- [15:33]
A
Yeah, it's a great, great point of advice, Alex. Anything you'd add?
- [15:37]
C
I'll build on it. The physician governance side of this, the self governance side of it is key. You have to have physician stakeholders at the table. And ideally those physician stakeholders are business oriented. They understand the need of the patient, the consumer, and may have been out of private practice. The other thing I'll throw in there though is a shared commitment amongst the leadership team, physician and otherwise. And something we'll often talk about with leadership teams contemplating this change is some number of physicians, call it 1 or 2%. When you're making these changes are going to come to you and say, if you do this, I'm out. And the leadership team can't crack. They have to join together and say, well, Dr. Smith, we've loved having you here and you're a value part of our organization. We prefer you stay. But if you can't see yourself into the future that we're building, then we understand we need to part ways.
- [16:30]
A
Yeah.
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C
And that's not to be cynical or to say that we have to be mean to physicians, but the economy of scale group practice mentality isn't for every physician. And that's what the standards are built to do. Again, two truths are possible. We can still make it better for physicians within a set of ground rules for operating, not just templates, but scheduling processes, referral management processes, patient contact processes. But we've got to have a shared commitment from the leadership team.
- [16:58]
B
When those objections start flying, we actually incentivize our docs. We don't do a lot of RVU based linear relationship between comp and RVUs. But one of the metrics for you getting a payment increase is access. And the way to do that is to have it starts with, you know, I have a template that gets filled up every day.
- [17:20]
A
Yeah.
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C
One of the things we're seeing and to build on that a lot of health systems do, is move around the RVU as a primary benchmark for their incentive compensation. And there's clever ways to migrate off. One of them being to focus on Encounters instead of RVUs and then focus on how many RVUs you generate per encounter. The idea being if we're seeing the right volume of care and we're bringing the right number of patients into the procedural environment. Our RVUs per encounter are still very strong, but the encounter base, what we're really incentivizing off of is directly into access and our commitment to our patients and our community. Are we inventorying ourselves correctly?
- [17:59]
A
So interesting. Thank you both for the insights. And I want to take our conversation as we are about to close here. I want to make sure that we touch on what's ahead. And I know given the amount of change that healthcare organizations are dealing with right now and the pace at which that change is happening, it's hard to consider a few years from now. But when you both envision a few years from now, what innovations in technology or service design will most meaningfully improve patient access? Perhaps in the next decade? And what can leaders do now to prepare?
- [18:31]
B
I'm going to come back. I may sound like a broken record. We've got to align the economic model to delivery of care in a different way. This idea that there's a turnstile, that every time somebody walks in your office or has a procedure, there's a payment for that. We've bred a generation of RVU mercenaries that want to just get RVUs. And for us, we think the economic model has to change, has to change how we pay the docs, has to change how we get paid as a health system. And so we're on a journey to become a true IDFs. And I think that's going to be the innovation. It's clear that we spend too much on healthcare in this country. It's because we incentivize the behavior of more. And the way the third party system works is the more you do, the more you get paid. And so people are smart, they figure out how to do more and get paid more. And until we change the incentives and align the incentives to what's better for the patient, what's better for the community, what's better for a population of people with quality measures embedded. I don't think we're going to make meaningful financial.
- [19:44]
Changes in the current healthcare system.
- [19:46]
A
Yeah, thanks, Dr. Kishon. And Alex, what would you say?
- [19:50]
C
Yeah, so two things. One, to just build on Dr. Cashon's statement, we've given physicians a rulebook and physicians are really smart and they figured out how to use that rulebook to maximize their, their personal earning potential. And now that's not nefarious statement. Physicians still deliver on the whole amazing care. We've got amazing access to high quality care in our country. My Goal would be how do we make it more accessible And I think changing the rule book, that's spot on. Dr. Cashone, I'm with you.
- [20:20]
When I look to the future with consumers. Another point I would look with the Jefferson example, your super regional care. I think we will see more systems approach super regional status over the next couple years. That's going to build a tremendous economy of scale and with the right leadership should be able to empower adoption of more technologies, better integration of AI. It's not here yet but it's coming. We already see patient contact centers using AI driven passive listening to identify patients concerns and help flag a routine skilled team member with the right information to resolve that patient's issue based on that AI interpretation of the conversation. That's fundamental right now. But with the right investment and through building economies of scale adoption of technology, our ability to service our patient in a non clinical sense in support of the clinical outcomes is going to be exponential. The only thing I'm going to throw in there, I think this is a key takeaway. It's not going to be cheaper. Many people think oh when we centralize we're going to bring our costs down. It's probably not going to actually be cheaper to do it that way. But the economy of scale is going to bring benefit in terms of outcomes, our cost to deliver care and the revenue that we're able to manage on the other side of the transaction.
- [21:39]
A
Fantastic. I've really enjoyed learning from you both this afternoon. So thank you again for all the insights. Before we close, wanted to check if there were any final takeaways or maybe anything we glossed over too quickly that you'd like to add.
- [21:51]
B
No, I think we covered it. I think you know, you're hearing a lot of alignment between what we're saying and you know, frankly there is a big overlay of change management for doctors. There's doctors are going through a grieving process. They feel like they've and especially generational docs, the ones that are my vintage that came out may have been private practice and felt like they were a small businessman and small business person and they could run their own practice. That's changed and the new generation of docs want to be employed. They want to work 8 to 5 and they have an expectation of work, life, balance. All these things are complicated and they just add to the complication of standardizing access for patients. So there is, I wouldn't the parting message for me as other health systems don't underestimate the amount of change management is going to have to happen. And the generational differences between the boomer doctors and the Gen Z doctors.
- [22:50]
A
Yeah, absolutely. It's an important takeaway. Yeah. Thank you.
- [22:53]
C
And Alex, I've loved the conversation. We've spoke mostly about the physician side, which is where the bulk of the problem and opportunity exists. I just encourage health systems continue to look at the other avenues for that you deliver care. Look on your inpatient side, your ad side like Dr. Cashon brought in early in the conversation. Look at your diagnostic imaging, another great area where we have tremendous resources as a country and as our health systems and are we delivering the right amount of diagnostic care, whether it be imaging, laboratory otherwise that help that patient along their journey. So access clearly has opportunity to drive on the physician side, but health systems are appropriately, hopefully looking at the comprehensive nature of all of their assets in delivering care.
- [23:39]
A
Well, Dr. Cashone, Alex, thank you again. This has been a really interesting conversation on what's possible with patients access, whether it's care delivery and also business opportunities. It's an exciting future ahead, despite some of the challenges and change management that will inevitably have to be made to get there. But I just want to thank you both again for making time for Beckers today. Thank you, thank you. And we'd also like to thank our podcast sponsor for this episode, ECG Management Consultants. Listeners, be sure to tune into more podcasts from Beckers by visiting our podcast page@beckershospitalreview.com.