← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Jeffrey Cohen, MD, FACS, FASCRS, CPE, Executive Vice President and Chief Clinical Operating Officer at Hartford HealthCare
00:33:00
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- [00:00]
A
This is Laura Dearda with the Beckers Healthcare podcast. I'm thrilled today to be joined by Dr. Jeffrey Cohen, executive Vice President and Chief Clinical Operating Officer at Hartford Healthcare. Dr. Cohen, it's a pleasure to have you on the podcast today.
- [00:14]
B
Thank you, Laura. It's an absolute pleasure to be here. I always look forward to these interactions and I very much admire how Becker's has grown and developed over the years and to being really the, the bringing together the thought leaders in this country around health care. So congratulations on that.
- [00:35]
A
Well, thank you so much. I know I'm always excited to be speaking with leaders like you and particularly I know you'll be speaking at our annual meeting coming up here in April. So it'll be fun to catch up and get a chance to see you face to face as well as connect with many of your colleagues from around the country too. So this is going to be fun. I know we're going to talk today a lot about the innovation that you're doing at Hartford Healthcare, really some of the big aspirational goals that you have, as well as how you've been able to grow and continue to provide great patient care there in Connecticut. So before we do that though, I was curious, can you just introduce yourself briefly and tell us a little bit about your background as well as Hartford Healthcare for listeners who are new to the Beckers podcast and community?
- [01:18]
B
Sure, I'd be happy to. So obviously I'm here today representing Hartford Healthcare. I am the Chief Clinical Operating Officer, as you said, which is I oversee the clinical aspects of the enterprise, but really the integration of all of our clinical work that we perform. So at this point, we are now the largest healthcare system in Connecticut. I don't know if that's like the tallest short person, but Connecticut being what it is, but we're about an $8 billion in revenue healthcare system. Our growth rate has been significant over the last decade. In fact, our CAGR is roughly 12% over the last five, six years. We're now nine hospitals all in Connecticut and we have about 500 sites of service through our ambulatory network, which includes over 20ambulatory surgery centers, 50 now urgent care centers and other imaging centers, et cetera. So we are very dispersed health care system, meeting people where they are on any given day. We take care of roughly 25,000 people every single day and we have almost 50,000 colleagues in Hartford Healthcare. So clearly a medium sized healthcare system. We've been expanding access to care tremendously over the last decade and we look forward to doing more of that in the coming years.
- [03:05]
A
I love that. I think it's so critical to have that mission very much being attuned to where you're at today and serving the community well, but then also aspirations that continue to spread that and be innovative and really change with the time. So I think, first and foremost, let's start off with, you know, kind of how you got to where you are today. What is an important initiative that you led or something you can tell us about the last couple of years that, you know, has really moved Hartford Healthcare forward. What did you do and what were the results?
- [03:36]
B
Sure. So, first of all, I think that it's important in perspective to maybe go back about 15 years ago, because if you're looking for the foundation of where we are today and where we're going, you can't know where you're going if you don't know where you've been. And around that time, we really moved in a very different direction. We believed that the best thing to do at that point was to have a truly clinically integrated healthcare system. So in order to do that, we blew up the governance system. We got rid of hospital boards and built regions, as well as an oversight system, governance, which had a fiduciary responsibility for not only the financials, but, but the strategic direction. And we brought in regional and national leaders to be on that board. So that allowed us to then have an integrated system, which we then built out in a clinically integrated way by building up our institute model. And that was brought to us. We really stole unabashedly from the Cleveland Clinic. Our chief strategy officer had come from there. And today we actually have seven very robust institutes, and they span our healthcare system and they allow for standardization, clinical integration, taking away variation across our system. And I always like to say most people don't know our geography, but if you enter Hartford Healthcare in Norwich, which is in eastern Connecticut, more rural, or you enter in Norwalk, which is maybe the sixth borough of New York City, you're going to feel the same about Hartford Healthcare and you're going to get an integrated experience. And to do that, we had to build the infrastructure first and the foundation. And then the key thing we did about a decade ago was say that patients want to be taken care of, where and when they want to be. And at that time, we were thinking more about geography. So we felt that building an extensive ambulatory network and putting sites of service, whether they be hubs for our institutes, whether they be imaging centers, urgent care centers, ambulatory surgery centers, putting Them as close to people's home as possible. Our vision for that decade leading up to 2025 was for us to be within 10 miles of every resident in the state of Connecticut. Well, we succeeded in that few years ago, and now we morph to being in everybody's home. And maybe I'll get to more of that a little bit later if we have the opportunity to talk about how we're in people's homes. But the key thing was that we wanted to be as close to people as possible. And in doing so, I think that we've differentiated ourselves. You know, we talk about healthcare, everybody's got the best people, and I certainly feel we do. But I know that the drive of people to be in healthcare means that almost everywhere has wonderful people. So if you have really great people and you have good technology, maybe that's the starting point. But you have to differentiate yourself in some way that's meaningful for patients. So now when you ask what is the thing we've done the most over that last year or so be in people's homes and to do things differently is we rolled out something called hhc24.7. And I believe this is revolutionary. And I have to say, even in Connecticut, even though we've even had a Super bowl ad this past year, I don't think that people understand exactly how impactful and meaningful that is. So what this basically is, is on demand access to clinicians at any hour of any day, 24 hours a day, 365 days a year. And what that means in practice is we've developed an app that you can download from anywhere from the App Store. And that app, once you register, is linked to you personally and it has all of your personal information, it is linked to your epic chart. So it has all of the data of the medical record. And it is an AI based platform because everything's AI based these days. But in this case, it starts out with an AI chatbot that takes down the information when you interact with it and then within minutes, once it assimilates, that asks you the appropriate questions, which are algorithms that we have built with K Health, which is a startup, no longer a startup Israeli based company out of New York, that it will then link you to one of our clinicians that might be a doc, it might be an app, and it's literally within minutes and it's 24 hours a day. So imagine the power of this and why I think this is revolutionary. You no longer need to leave your home to get care by an HHC clinician. So even though we built out this extensive network over 500 sites of service, over the entire state and a little bit into the adjacent states, what we now have in the palm of your hand is the ability to get health care when you want, at the time you want, and you can do it from your own home. So I'll give you a tangible example now. Let's say my wife is traveling for business and I'm at home and I've got my three little kids there. They're not in reality not so little anymore. But let's say I have a two year old, a four year old and a six year old at home and they're sleeping and it's two in the morning and I don't feel well and I'm a little concerned. Maybe I have some indigestion, but I'm a little worried. Do I pack them up, these three little kids, wake them up and bring them to the emergency room? Because no urgent care center is open. And what's my other alternative? Just wait till morning, be more anxious. But here I can go on a virtual visit, AI platform based with my medical record, with a provider, a clinician who is part of Hartford Healthcare. They can see me, they can evaluate me and decide that maybe it is indigestion, maybe I'm not having true chest pain and I don't have to leave my own home. And imagine if it's something like a really bad rash that's really bothering you, two in the morning. They can even link to your pharmacy call on a prescription and if you have delivery, it can be delivered to your home. And you never left home. So you can see why. Laura, I think this is absolutely revolutionary and I think that it's really going to catch on. I will tell you in 11 months that we've started this, we have now had 42,000 interactions, 42,000 patients who did this from their own convenience. And we're now doing about 250 patients a day. And in one of my roles, I have to think about workforce and if the average primary care might be seeing 20 to 25 patients a day. That's 10 primary care providers that were just taken care of virtually instead of by bricks and mortar. So I could go on and on about this. The only thing I think I'll add is going forward, we're just starting this month with a company called Cadence, another startup. And this company is another one of those amazing AI platform based companies on home monitoring. So imagine the power now that we're going to have home monitors in place in people's homes to manage their chronic disease states. Diabetes, hypertension, congestive heart failure. Keep these people out of the hospital, but link it to hhc24 7. So now the clinician who's interacting with you in the middle of night will have EKG tracings that'll have all types of different data to manage your care. You can tell how excited I am about this.
- [12:13]
A
That's amazing and really cool to hear how everything links up together. Think through what that means for the patient journey, patient care and access to care across the patient population. It's just incredible to have that kind of speed and really a direct link into physicians, apps, other clinicians that can make a big difference and help in a variety of ways. And then two, to know that coming evolution of home monitoring and the technology that can really make a benefit. Big difference. I can imagine that saving again, ER visits, clinical visits, maybe even on the prevention side, making sure that people are focused in monitoring things and so that they don't get to be too big of a problem, which I know is a huge, huge benefit the healthcare system and the health of patients overall. So it seems like there's so many cool things going on right now. I'm curious, what else is ahead? What are some of the big priorities and headwinds that you're thinking about? What could potentially stall some of this progress?
- [13:20]
B
They're all great questions, but obviously that's a really good one because in this time there is so much going on. And I'll paraphrase our CEO Jeff Flacks, and for those who don't know Jeff, you should know him. For a long time he was the best kept secret in terms of visionary CEOs and leaders in health care. But over the last, I would say since COVID and he really led Connecticut, partnered with the governor for us during the pandemic to mitigate and save so many lives that I don't think would have been saved without his being at the forefront. And as we know, in leadership, it's being out in front is what creates great leadership and as we like to say, leading from the front. So Jeff loves to say that there's no better time to be in healthcare. When I'm in the room with him and he says that to external people, to other people in healthcare, they sort of at best scratch their head and otherwise they look stunned. But the reality is there is no better time. You just mentioned yourself, Laura, we can get better faster now and with less friction due to technology and artificial intelligence and all the Partnerships and work that's being done. But I do want to say I'm not naive and neither is he. There are a lot of headwinds and in fact, in our board meetings, we always start with what are the headwinds? Because we want a level set even as we're doing a lot of innovative stuff. So there's obviously the regulatory and legislative pressures, whether it's Medicaid cuts, whether it's cuts to research funding, tariffs. I mean, in my chief operating officer role, I have to deal with the supply chain costs going up in some areas. We're up 15% since last year. So it's really hard with thin margins to still be profitable. No margin, no mission, workforce, supply and demand. And if we have time, I'd love to get into that as well. But given all of that and what's out there, the technology has made clinicians jobs actually so much easier. And it's bringing back the joy of healthcare, the joy of being in it. I am a part time clinician. I joke that I Play 1 on TV more than I do in real life. But I am a practicing colorectal surgeon. I do see patients. And I will say the data that I have now makes the care so much safer, the quality is so much higher. And ironically, healthcare is actually more human now. So one of the other partnerships that we have, and this is now all over the country. We're not unique, but we are an investor in a bridge. And a bridge is this fascinating technology of ambient listening. And it's gotten so good that you can have a conversation with a patient in a room and it will take out all that extraneous stuff and distill it down to really the important details. What I love about it is you can now look at the patient across the room, you can make eye contact, you can pick up those pieces of their subtlety of their body language, how they look. And when you were looking down at a computer, and I never did this because I was never as good at typing as I needed to be and also talking. But for so many doctors that even I went to, they'd always be looking down at the computer, putting data in and rather than looking at me as the patient and I as a clinician, I love being able to make that eye contact. And given that I'm a surgeon and people tend to be very scared and very anxious in my office, it's even better because I can hopefully connect with them and put them at ease. So these kinds of things are making the world so much better for healthcare. And if I could interject, one overriding guidepost for us is we talk about all the time A two, E two. I think you've heard that before from some of us. Access, affordability, excellence and health equity. Everything we do fits under those categories. And so what we do today to create more access to care, as I spoke about before hhc 24 7, think about the access to care. Think about the fact that if you are in a remote rural area, forget about being in a city that you can immediately connect to care right away. So people that are underserved, people where there are no, where there's a health care desert, so you could do all of this and we can connect people in a much easier way and connect to more people. And by the way, it's so much more affordable. I mean, it's 1/10 the cost to do RHC 247 or even go to an urgent care center than it is to go to an emergency room. Our excellence, I think, is unsurpassed. Maybe bragging a little bit, but the American Hospital association awarded us the Quest for Quality prize this past year. One hospital healthcare system in America gets that every year. You get a trophy. We treated it as our Stanley Cup. We pass that trophy around for the year, we celebrate it, we take it everywhere, and we've even made replicas to put in people's hospitals and offices. So this is all what our focus is and where we're taking things. As UA asked for the upcoming year, what our priorities are is really to excel, to exceed, and to be the best at getting better at a 2e2.
- [19:37]
A
That's amazing to hear. And truly getting that recognition is so unique and special. And I love the way you're celebrating with your teams too, and continuing to elevate that, keep that front and center to have that type of quality and, you know, type of care really continue to permeate throughout the organization. Now, I know you mentioned workforce, so I would like to dig into that just a bit. I know that's something that hospitals and systems across the country are thinking differently about now and strategizing differently about just because of the, you know, talent pipelines the way they are in many places. You know, there are shortages of certain skilled positions that you're trying to cover, and then to the introduction of technology, of AI and how that really is influencing the human workforce, too, is such an interesting thing. So I know there's a lot of factors coming into here. How are you thinking about that from your seat? Where do you see things evolving at Hartford Healthcare and just in healthcare in general.
- [20:37]
B
Yeah. So I'm glad we could segue back into that because this is some stuff that I'm really proud of. And I can say that because I'm not actually the person directly responsible for making some of it happen, so I can celebrate others as part of the process. A number of years ago, dating back to prior to the pandemic and then the great resignation, we started up Hartford Health Care, Campus Care. And this, actually the genesis of this was more about our very extensive rehab network, our physical therapists, our trainers, our athletic trainers, et cetera. And we were starting to be asked by colleges in the state and even prep schools if we could help out with their student athletes, et cetera. So we actually devised an entire enterprise. We have a business line now which is HHC Campus Care. And we have partnered, partnering with about seven or eight universities, colleges in the state. We're now in prep schools where we went in and we started out with being the athletic trainers or rehab after injuries for the student athletes. But what was very clear quickly was that we're in healthcare and some of the universities said, you know, we're struggling with our student health and maybe you can help us with that. Well, one thing led to another. Just to fast forward, in the interest of time, we ended up dovetailing this into student health in those universities and colleges. We now supply the student health on campus connected to epic. So it's again one chart. We love that connectivity. We have the student athlete part. And probably if anybody has kids and they send them to college, they know that one of the biggest needs in college campuses is mental health. Well, we happen to have the largest behavioral health network in the state. And so this was easy for us to get into it and put psychologists, psychiatrists, social workers into the campuses and into the universities and take care of the mental health needs of the students and sometimes even the faculty in these places. So one thing leads to another. We're already there and now we start developing pipelines. Initially it was pipelines around nursing. And we have two medical schools that we're the main teaching hospitals for. So we always had that pipeline as well. But what we've come to realize is, and especially with the so called great resignation, is we had to enhance this and we had to grow this because we don't produce enough, let's use nurses as an example. We don't produce enough nurses in the state of Connecticut to take care of all the needs here. Not even close. And some number of those people leave after they get trained so we have opened up new nursing schools with some of our colleges and university partners. Obviously, we're the training ground. We have an amazing innovation and simulation center in Hartford, 60,000 square feet. So we do a ton of training there. We opened one up, a satellite one at Eastern Connecticut State University in partnership with the state schools and we built a nursing school there. So now you see the pipeline is starting to increase. We're starting to do that with the community colleges and now we're reaching into the high schools. In fact, one of them is called the Reach program. And CT ready are a couple of these programs where we're now training people to become radiation technologists, which is our biggest shortcoming or other areas, Echo sonographers, different areas where there are tremendous shortages in health care. And by the way, Laura, we're now. Where are there shortages? Plumbers, carpenters, all sorts of jobs that people stop going into. And now there's such a tremendous shortage that we're building out those pipelines as well. So at this point we, I don't want to jinx ourselves, but we've had to manage our travelers. We have reduced our traveler cost and numbers by over 90% in the last couple of years. We have virtually no contract labor in nursing on any campus. And this gets to our culture once. You don't have to do that now. We grow our own, we build our own, we invest in our own, we educate them to grow even more. And we use tuition reimbursements, loan forgiveness, all the things that people are using. But we've integrated into what we now call our people promise. And with our people promise, which focuses on career, culture, well being and total rewards, Those are our four parts of that. We take care of our 48,000 plus colleagues on an everyday basis. And I have to give a shout out here, she's only been with us for two years this week, but Rose Sheehan, who you have recognized at Becker's, she's our chief people officer. She was our first one. She came from Mass General Brigham, where she had spent a couple of decades and she's been here for two years. I just love her. She has been a breath of fresh air here and she has led our people promise. It has taken us to places I am sure we would not have gone on our own. So any chance you have to interview her, I think you will find it to be a wonderful experience.
- [26:26]
A
That sounds fantastic. I definitely will have to connect with her and just continue kind of building out this, this beautiful portrait that we have with Hartford Healthcare. As you mentioned, you know, interviewed your CEO, Jeff Flacks, and you know, this kind of interview too has just really shed so much more color on how things are operating, your mission and what you've been able to do to reach that. Now, before we wrap up here, and you know, I love the opportunity to speak with you, I wanted to ask you about growth too. As you're looking forward, where are some of the opportunities? And I know you talked about continue to expand and elevate what you're doing at Hartford Healthcare and become more patient centric and improve the patient experience. And so what does that look like? How are you getting from where you are at today to where you want to be in 2035?
- [27:19]
B
So I love finishing on this because this is maybe of everything I've talked about, this might be the most exciting adventure that we're embarking on. So I mentioned before that we had completed our last 10 year journey of being within 10 miles and now within everybody's home in the state of Connecticut. So of course we've launched HHC 2035 and that is to be the most consumer centric healthcare system in the country. I am unbelievably passionate about this. I just love this concept. We don't tend to think about health care as consumer centric. And I have personally been a physician for over 40 years now. And if somebody had talked about consumerism in health care when I was starting out and when I was training, that was a dirty word. You could never say that. People would bristle at it. Talk about consumer. No, we're a higher, loftier goal than that. Well, guess what? I don't think there's any loftier goal than to be consumer centric. Again, I'll quote Jeff. He likes to point out that we are all customers and consumers all the time. We are only patients for a very, hopefully a very short period of time. And in every other walk of life, everything we do, we are consumers and we have an expectation of getting basically what we want, where we want it, when we need it. And heck with Amazon, you order something, it's in your doorstep. Six hours later, you need a ride somewhere, you call for Uber. Now it's self driving with Waymo. I mean, these are the type of things that people have come to expect in healthcare. I know patients who are overjoyed if they get an appointment a month from now. I can't fathom that. And we always talk about if you get a new diagnosis of cancer every night that you put your head on the pillow and you haven't Met with your new team that's going to take care of you and hopefully save your life, is a night when you believe that you're going to die and that you are not going to be here to be with your family. So this enterprise, I was going to say aspirational, but it's not aspirational. We're already in this, in this space, and we are going to drive consumerism so that we meet people where they are, when they are. Hhc24.7 is just the first part of that. We have a ton of partnerships and we are always looking for more, as long as it's all in the goal of enhancing the experience of our patients as consumers of healthcare. I will tell you that that's. I think I'm not naive to this. As a clinician myself, I know that we have to change the mindset not just to help our patients, but I know that the world forever revolved in healthcare, revolved around our providers, our clinic. By the way, I'm on a crusade to change providers. To clinicians, that's a separate story, but as clinicians, that the world revolved around us and our staff. Our colleagues in the offices did everything they could to obviously help the clinicians to take care of the patients, but it was always about the clinicians. Well, now we have to have that seat change to make it about the patient as the consumer of health care. And I know that we will succeed in that. I'll lead by saying we're about to launch our own patient gbt, which is again, the next part of this component, so that patients will have that information at their fingertips. But it'll be not just random GPT that's out there. This will be proprietary. It'll be so that your data, your information doesn't get out into the, into the world. And this is just one more exciting thing that we're doing to think about the patient at the center of care. So, as you said, so I'll reinforce it.
- [31:51]
A
I love that. Dr. Cohen, thank you so much for joining us on the podcast today. This has been a fantastic discussion. I learned so much from you and especially excited to think about where Hartford Healthcare is going as well as where healthcare is going in general. So thank you again for your time. Excited to see you in a few weeks at the annual meeting and look forward to continuing this discussion there, as well as many other things that we talked about today.
- [32:16]
B
Well, and Laura, I really appreciate you and your entire team and with Scott's leadership at Beckers, it's really, as I said, at the beginning, it's become the aggregator, the convener of healthcare leadership and innovation throughout the country. And so I, too, am very much looking forward to, to being with you in a couple weeks from now.