This Week Health

Stephen Klasko, M.D. and Nassar Nizami on Navigating Healthcare Disruption

Jefferson Health sees an inevitable path of disruption in healthcare. Stephen Klasko, M.D. CEO and Nassar Nizami CIO share some of Jefferson's adventure as they embrace disruption. Hope you enjoy.

Transcript

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 Welcome to this Weekend Health IT Influence where we discuss the influence of technology on health with the people who are making it happen. We're the fastest growing podcast in the Health IT space. My name is Bill Russell, recovering healthcare, c I o, and creator of this week in Health. It a set of podcasts and videos dedicated to developing the next generation of health IT leaders.

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I think on the hottest day I've ever been in Philadelphia. It's, uh, uh, I, I couldn't keep my jacket on. Um, but I, I get the opportunity to visit, I think, one of the most forward, uh, forward-looking health systems in the country. Jefferson Health. I'm joined by previous guest, Naar Nazami, the C I o for the system, and, uh, C e O Dr.

Steven k Glasgow. Thank you for coming on the show. Great to be here. Welcome. Welcome to Hot Mug Philadelphia. Who thought it's, it's amazing. I left Southern California and I thought, well, actually even worse, I, I took my daughter to orientation in Waco, Texas last week. Oh, okay. And I thought there could, couldn't be a place any hotter than Waco, Texas.

Yeah. And uh, I got here and it's not hot here. It's just humid here. Yeah, I was gonna say, I'd love to say it's a dry heat. That's what Arizona always is, but you know, it's not true. It's amazing. But it's, it's great to be, uh, it's, it's great to be here and I'm looking forward to the conversation really for two reasons.

One is I think the dynamic of having both of you on at the same time is good to sort of get that back and forth. And then I think the other thing is, I don't know if you know episode number four, I quoted you, you're a quote machine. I pick up some of your quotes and, uh, throw 'em out there. Uh, usually some of 'em are controversial, so I'd just like to talk about 'em.

And, uh, I think on episode four, this is episode 102. On episode four, I said I'd love to have Dr. Klasko on the show. So it's, it's an honor to have you on the show. Thank you. Uh, I, you know, I usually start with a pretty open-ended question just to get us going. And, uh, so what are some of the exciting things that are going on at, at Jefferson Health?

And this is just the intro question. So I know you can talk about this for 45 minutes. What, uh, you know, just one or two things you're really excited about. Oh, look, I, I think, uh, the thing I'm absolutely most excited about is this obsession about making what's difficult in healthcare, easier using it. And, um, you know, we, we have a partnership, for example, with General Catalyst, uh, uh, where we're looking at a model where we'll be the.

Ground Zero along with Boston Children's for creating, you know, for lack of a better word, a fire layer on top of, uh, of, of Epic or Cerner that literally will create an app store. I mean, I, I always, the way I explain it to, to my colleagues is I'm a Mac guy. I couldn't put PowerPoint on my Mac. Because Steve Jobs didn't want any Microsoft Pro products.

So Bill Gates said, oh yeah, oh yeah. Well, we're not gonna put any of your stuff on our windows. Well, that was unsustainable. And then people created parallels and all those kind of things. So literally we have a, we have a Star Wars technology for individual patients. I'm a physician in a Fred Flintstone healthcare delivery system and everything else that it has done to totally change

Whether it's, whether it's retail or travel, we haven't really implemented. And you know, the reason I'm so excited about working with Nassar is at Jefferson, we are looking to be the place that's looking at what's gonna be obvious 10 years from now and do it today. That's exciting. How about you? I mean, what's, what's exciting on the technology?

I mean, clearly working for A C E O who's saying those words is, is pretty. Listen, I'm fortunate to work for Dr. Klasko who is talking fire, who understand what fire I say. I know, I even know how to spell it by the way, which is probably. Uh, so look, uh, so there is a lot happening in Jefferson that is incredibly exciting.

So you start with the foundations, right? So we have, we are implementing Epic across the organization, one database, one way, which I think is very unique. Most, uh, implementations over time change. And our customized, we are doing a very standard way, which allows us to build on top of Epic, right? So the, the applications, the startups that we are working on that Dr.

Uh, classical mentioned . Uh, we'll be able to leverage what we already have built. Right? And that's the exciting part. All the stuff that we are working on in, whether it's imaging, whether it's ai, whether it's startup like, uh, uh, general capitalist and , uh, we, we are able to build on top of what we have built as a foundation.

I think that's very exciting and I, I think one of the cool things is that we're using it as the, as the for our integration. We're the fastest growing academic medical center in the country. We've gone from two hospitals to 18 hospitals. Wow. And, and it, that is really the key to one Jefferson. Yeah. It's, I mean there's so many ways I could jump off of just that.

Um, we are gonna have some people on from Epic, 'cause there's this, there's this drive to the standard build, what do they call it? Their foundations, their foundation. Yeah. There's this drive to foundation. And the more CIOs I talk to, they're like, this is driving me nuts. Mm-hmm. , because now I have to spend.

Literally a hundred million dollars to get on foundation. And we just did our, we just finished our Epic implementation three or four years ago. I mean, I, we could go off on that because that is one of the challenges that you face. Yeah. One of the challenges you face is you have . Uh, at our health system, we had 800 different applications, and now it's, okay, let's build this app store on top of this.

But the complexity underneath is so absolute, uh, so, so challenging. So we have to abstract that complexity, um, which is, which is a challenge. But we're not here to hear me talk. We're here to talk to you guys. You, uh, at the JP Morgan conference, we didn't get to talk there, but you talked about making a 195 year old academic medical center.

A startup company and what does it take to do that? Which is, which is fascinating in and of itself. So let's explore that a little bit. I was at, uh, I was at Baylor last week and, uh, this woman was not trying to be funny. She said, Hey, we, we just redid the, uh, curriculum and, uh, it's been a long time coming.

She goes, we started the conversations in 1960. I was like, you started in 1960 and you just did it. Which, um, I, I, I know of no other industry that you could take 50 some odd years to make a decision and still be a leader in the, in the country in certain areas. Um, but how do you do it? I mean, your academic medical center, academics and medical center, these are two slow moving entities.

Yeah. So, so I, I mean, the way you do it is, I mean, I came in as c e o and you're always straddling the line between being crazy and visionary. And you know, I mean I think 90% of my faculty felt that, you know, I'd be probably last three months for exactly the reasons you said. I think part of the advantage I had is how, how messed up healthcare is that before I gave my talk, uh, before I started my job here, I gave a talk and one of the, uh, country's economists said, uh, the two things you don't wanna be running for the next five years 'cause there's just gonna be impossible or academics in healthcare.

I was the next speaker. I said, I just took a job in ade he academic healthcare. So don't listen to anything . That I say we created probably the first in the country. True four pillar model. When we talked about the old math and the new math, the old math is academic and clinical, and the new math is innovation, strategic ventures.

And, and, and what was fascinating about that is it made sense to me. I mean, I got, I got invited to the faculty senate. You never get invited to the faculty center for anything good. It's always to get centered. You mean you're gonna move money out of, you know, our traditional N I H funding into stuff like, like Nassar, ISS doing.

And, and I, I went through sources and uses of funds. Think about this. For an A M C and it's exactly the 50 year thing you brought up. The sources of funds are n I h funding not going up anytime soon. Well, you can always make that up from the ridiculous money you make from being a safety net hospital.

That's a joke now. Oh, we can always put in the back of students and charge 12% more tuition a year. That gigs up also. So we literally talk about how we can overcome that. And by the way, a good part of that came from I got to, uh, be the head of the steering committee for iTunes U Health. Right before the iPhone and, and I watched them start to move money from the old math of being a computer industry to the new math of a digital lifestyle.

Mm-hmm. . Mm-hmm. . We're going through a once in a lifetime change in healthcare from a business to business model, from to a business to consumer model. And that's what we're banking on. So, so I mean, it it, it's not just where the finances go. Um, we acquired, merged with a design and, and fashion design University.

If you had imagined that Thomas Jefferson University, if, by the way, if you had bet that Thomas Jefferson University, 195 year old health science university would be number three in the country, college and fashion design, probably even better than investing in Apple back when I was there in 2002. Two.

Alright, so I have to stop you. Yeah. Why? Why? Because of the design of the human experience. I'm gonna give you a real live example where, where the four pillar model works. So the academic pillar, we started the Institute for Emerging Health Professions. What jobs will be needed 10 years from now don't exist today.

Some jobs in it, computer science and genomics, but one of 'em was a, a master's in cannabis medical education and research. Beyond giving me a couple upticks with the students that got us a $5 million grant from an Australian philanthropist. Okay. Fast forward, we had merged with Philadelphia University.

He calls me says Our, our for-profit company's called Eco Fiber. It's carbonizing Hemp to create wearables. And the top two people in your coun in your country that are working on that are in this place called Philadelphia University, know anything about that. So we literally traded that IP for 12 million shares of what is now an Australian I P O This year.

For the first time, our net operating income of our new math will equal our net operating income of our old math. And one more thing, a good part of the reason. That we've gone from two hospitals to what will be 18 hospitals without writing a check. People have just joined with Governance's currency is because we're not depressed about getting back to the old way.

We did change our curriculum, our MD curriculum. We now have an MD Master's in Design. We now have every one of our doctors, literally our students, has to take two creativity courses. We're doing improv, . For, uh, uh, for our students, because think about it. You, you have to listen, you have to be able to articulate.

We still accept medical students based on science, G P a, med Cats and organic grade, organic chemistry grades. And somehow we're amazed. Doctors are more empathetic. Community given creative. So I, I think what's happened is because we've been successful, 'cause we've grown so much, I'm, I'm on the right side of the line, barely on the, on the, on the Wild man versus, uh, uh, um, visionary side with my faculty.

Well, you know, it's interesting when you, when you talk, I don't think there's anyone in the audience who goes, that's crazy because just in your audience, Well, yeah. In our, but even at, even at the JP Morgan conference, I think those people are looking at you going, yeah, yeah, yeah. And then they wanna say,

How do you make the math work? Because it's the math, right? It's, it's fee for service today. It's, I mean, I've been in those board meetings where you're sitting there going, we want to make this jump, and you're talking about the new math, which is what you're describing, like the new boat that you need to get into.

Um, but so many boards can't figure it out. They're sitting there going, this is 70, 80% of our look. The math, the math is lousy. I, I, I didn't create that lousy math. The math is lousy, but there's gonna be a trillion dollar spent on healthcare transformation. So, I mean, you know, you know, Nassar can speak to this, but literally we, we hardly do any large vendor vendee deals anymore.

I think that's really the key. I mean, Livongo is a good example. You know, Livongo, um, you know, partly 'cause of all our expansion, we've become the u s A today of health systems because we take, we, we acquire these places, but because it's governance as currency, they maintain some of their personality. So, Livongo came in with an IT diabetes.

Model. It was, Hey, Montia from ur, I mean from, um, um, general Catalyst and, um, my folks at Thomas Jefferson University Hospital, arrogantly said, we don't need this. What we're doing with diabetes is better said, okay. So I went to Aria and, and Nasser knows this. We, we, we often we'll go to either Aria, which is Northeast or Kennedy in South Jersey.

It's like, Mikey will eat it. They'll, they'll try it. And they tried it. It was so much better than what we were doing at Thomas Jefferson University Hospital. We became a huge enterprise client. Then we, now we have a co-development piece with them that anything new, new they do, we get a dollar per member per month.

So almost, I can give you 10 examples of where we have either co-development agreements, there's a company called Ambulance, uh, which is literally looking at, um, transportation options for, for patients that, again, we're exclusive here and we own part of it. Here's, here's what I, what I believe this part with.

Hospitals are becoming commoditized. I didn't, I didn't make that up. That's gonna happen. Standard I give it, right? Whether, whether you're in this seat or not, it's happening, right? I give a talk for Standard pos and I mean, it was so depressing. It was like this, uh, there's a Woody Allen quote, uh, where a crossroads one road leads to total destruction.

The other, other despair. Let's hope we choose the right one because there they were saying is that that health, health systems . Revenues are gonna go up 2% and their expenses are gonna go up 7%. There's no good math to that. So for us is how can we be part of that trillion dollar healthcare transformation piece and how can we be ready?

I. , we're overcoming commoditization by differentiation and diversification is the right way to go. Yeah, absolutely. So, so Nasser, um, bringing in a lot of partners from the outside. You're bringing in Livongo, bringing in others mm-hmm. , and you're creating new, these new, uh, agreements. But again, we, we started with this sort of, uh, you have a legacy, much like there's a business legacy and a regulatory legacy.

There's, there's a technology legacy. How do you help those startups to plug in? So that is the challenge. I think so, uh, look, uh, you know, whole premise of, uh, acting like a startup requires us to be nimble and fast moving. But as you know, that sometimes because of we, because we are an E M C sometimes and many times because for vendors, Uh, there are tons of limitations, right?

And think, uh, our philosophy and where we have been pushing up is that we need to free data from the limitations of vendor specific technologies and from the limitations of data center and our own bureaucracy. Right. Uh, and that's where my team and myself are pushing. So interoperability is peak big on, um, uh, uh, on our roadmap, whether it's use of APIs or standards like fire.

And we are at a national level, at local level, we are pushing for standards and, uh, freeing up data. Okay. Uh, data center, and this is I in your background, right? Uh, uh, we, we are install every acquisition comes with two data centers, primary and backup. So we, we, with all the acquisitions we have, Now 15 data centers.

Right. And some of the data centers are very small. Some of them are pretty big, but 15 data centers unsustainable. Right. Our data resides in these data centers and to, to get any piece of information out to, let's say a vendor who we're partnering up, there are five different EMRs. There's six different revenue cycle system.

There are four different PAC system. It just a nightmare right now. Right. That's when I, the reason I say that Epic is going to help us or our pacs, uh, which is Phillips . Things like standardization is going to help us there, right. Uh, I'm a big believer in cloud. I think that, uh, uh, moving data off in a way where anyone can access anything anywhere, right?

With the appropriate access. That is what we are focusing on. That's what we are, is going to help, uh, us partner with the startups. Uh, I think automation, this, there's a huge push, at least in, uh, Jefferson and my team to automate. Um, and lastly, I would say that I think that in, in probably mid to long term, uh, AI is going to be big.

I think that's where, uh, true value is going to come by virtue of getting the data and getting the, the data to the right party interested. Yeah. You know, it was interesting. I was on a webinar, uh, last week I think with Peter Lee from Microsoft and, uh, and the folks from Innova, and it was . It was just funny 'cause people were saying, boy, it's neat that a hospital executives or health system executives thinking about this.

I mean, we're talking about cloud. I mean, it's not, we're in the nineties, you know, and it just, it's just funny that, that to me at least, that that, that I'm viewed as a little bit of a unicorn. That this is what our whole strategy is, that we're gonna get into the 21st century. When it comes to how we deliver healthcare.

Yeah. You know what's interesting? 'cause with cloud, when we talked about it, 'cause I just talked about it last week on the podcast, it's uh, it's not that your, your users are afraid of the cloud, right? It's your IT department. It is, yes. It's because your users are like, Hey, I use it at home. I, I use absolutely Gmail.

I've, I've got, by the way, I've got more storage at home than I have on my email at work. I can share photos, I can do all this stuff. Then they come to work and they go . Okay, why aren't, they're saying, why aren't we on cloud? And your IT organization sort of recoiling saying that changes . Everything.

Absolutely. It changed the way we app operate. I think one of the big things for us is that our, uh, math is not working out. So, uh, interestingly, cloud has promise and lots of promise. We are seeing, uh, ROIs are not there. Yep. Especially with our big vendors. Um, E M R vendors, uh, et cetera. Going to cloud is more expensive than on-prem, which doesn't make any sense.

So cloud, the, the, the cost of cloud 11 years running according to Gartner has been decreasing going down. Right. But certain vendors are not there yet. Right. But you're right. I think the biggest barrier to move to cloud is it and it culture. Absolutely. Let's, uh, so I come to Philadelphia and my wife says, Hey, make sure you get a cheese steak and pierogis.

So let's talk about population health. Um, you know, so you have to design the health system around the consumer. In order to do population health effectively, what, what digital technologies and how are you doing that so that you can reach those people in between the, the visits that they're with you?

Well, look, I think, um, so we invested early on in 2013, about 30 or $40 million in, in telehealth. But I think telehealth is a great example of how we've sort of messed it up. It's very similar, you know, when, when, when I'm old enough to remember when EMRs were just starting. And you know, the, the epics of the world, the Allscripts and Cerners of the world will come to us and say, we want, we want you to help us develop it.

So we're fine. Our handwriting is fine. Same thing happened with telehealth. People are mailing it in and saying, oh, I just got Merck. Well, Teladoc, MD lives to some folk person in Ohio can, and I can say I'm doing telehealth. We took a totally different approach and, and one of my mentors, and actually our commencement speaker this year has been John Sculley.

And he said, stop talking about telehealth. He said, we don't talk about telebank. We don't get up in the morning and say, I think I'm gonna telebank. It's just that 90% of banking went from being in the bank to, to being at home. The same thing's gonna happen. So the question for you, Steve, is, is what technologies can you use to have more and more and more things for the patient happen at home so they don't have to see you?

And, and, and that's how we view things. We have 24 7 telehealth virtual triage. Now here's the problem. Once you get to that, it's gonna become painfully obvious that if you're a provider, you have to be a payer. Also, and I'll give you a real live example with our virtual triage. Mm-hmm. given our sophistication in telehealth and, and it, we're now at the point where we get 60% of our patients.

Non-trauma, non ambulance out of our expensive, inefficient ed, and we have about half a million patients come to our ied. Mm-hmm. problem is I make an average of about $89 through urgent care or telehealth or an appointment next morning, an average of $1,400. If somebody walks into my. Ed that the insurers are happy to, to, to, to pay.

That's right. We have 32,000 employees now, bill. So what we said is with our t p a partner, Aetna, we said for our 32,000 employees, if you show up to our ED and you haven't gone through Jeff Connect Virtual Triage, 500 hour deductible if you end up in r e d through JF Connect. Zero deductible including zero deductible if you end up getting admitted.

That's really changed behavior. So there's a great Upton Sinclair quote. It's hard to get somebody to do something when their salary depends upon them not doing it. And we do so much of that in healthcare. And I think it's especially true when you talk about population health. You're, you're sitting here in Philadelphia with five academic medical centers, two in the top 25, US and Penn, and we have the greatest discrepancy in life expectancy of any city in the country.

Three based on zip code. Based on zip code. So a baby born today at Jefferson, that goes to 1 9 1 4 7, which is about, you know, uh, three quarters of a mile from here will lift to 2104. A baby born today that goes about three miles north of here. North Stro mansion will not make it to 2090. That's a year less than Iraq and Syria.

So while we talk about meds and EDSS in Philadelphia, we failed. And the simple answer is that 80% of a person's health, as much as we hate to admit, it has nothing to do with a doctor or the academic medical center or the research that I'm doing here at Jefferson. So that's why that whole . You know, B two B two B two C model becomes so important.

You know who the greatest percentage of users of our of Jeff Connect our telehealth program are. Is this situation we have with a homeless, with, with a homeless shelter. Sister Mary is one of the largest. Why? Because if you think about it, most of them don't have cars that they're housed in this, in this, in this, uh, great, uh, uh, thing called project home.

If they have cars, gas is expensive. Um, but they have phones, you know, and they want their families to be healthy. So I think, I think we just haven't come close to pushing the envelope of getting away from, I'm just gonna get this. Company so I can say I'm doing stuff versus really believing you want to do it.

I, I wanna come back to telehealth 'cause I think in the, in the near term, it has the biggest potential to really change healthcare. But I, I want to, I, I, I sort of want to go to you on this as well, 'cause, uh, a fair amount of your budget to spend on the internal customer mm-hmm. , how, how does that transfer?

How do you. Not how do you transform it, but how, how do you get the money and the resources to start focusing and thinking about the patient and the community member as part of your consumer base? That is just part of that. Exactly. So that's a very good point. So we actually have, uh, uh, group dies Digital innovation and consumer experience that is focused on developing, designing consumer, uh, centric solutions.

Right, and this was really Dr. Klasko vision, and I'll give you perhaps one example. They have created some really cool solutions with consumer in mind. One recent was, uh, an app called My Baby Jeff. It's for expectant mothers . Uh, they can track a week to week milestones, photos, videos, communicate with the providers.

So a very specific solution, uh, uh, for a very specific patient population. Right. And they have many of, uh, consumer, uh, centric apps and solutions. Yeah. They're actually doing, I'm an obstetrician, they're actually doing a match.com for obstetricians and their patients. Now, you know, if you think about 25 year old, there's very little that she does where she goes to a 65 year old male family doc and says, graduation, you're pregnant.

I'm gonna send you to my obstetrician Dr. Klasko. There's nothing that a 25 year old woman today in 2019 takes from a 64 year old male for the most important thing in their life. So we're looking at how so, yeah, and the cool thing about dice that I'm embellishing this a little bit, but they're, they're people from all over industries that I kid around.

They're, they're mostly young. They mostly come in around 2:00 PM They mostly Instagram me at 2:00 AM It's a very different culture than what we would do in in a traditional thing. We've done the same thing on our marketing side. If you think about it, you know, if everybody in marketing looks like me and I'm trying to run a university and be cool, I.

The chances are zero that that's gonna come through. Yeah. I mean, I've just walked these streets. Not everybody looks like you. Yeah, exactly. In fact, very few people look like you. Yeah, I mean it's, it is a very diverse, we're very young. We, we had an accreditor best compliment I've got in my six years here.

Uh, you know, very stodgy, accredited. She goes, I don't understand it. Um, at a time where everything's changing. You're the first place that we've looked at where your faculty and your employees seem to be more optimistic about the future than the past, and it's partly because of folks like Nassar. Yeah, absolutely.

Let's, let's talk telehealth briefly, um, in that, You know, it does drive down the cost of it increases ac, we know all these things are true. There's a change that needs to go on in, um, in our culture for people to think telehealth before, uh, before anything else. But there's, there's also regulatory barriers to that as well.

I mean, we could see Jersey if I got up on top of this building, maybe not this building, but the building next to it, um, I could probably see Jersey from here. Can you reach into Jersey yet? Or we still have those state regulatory boundaries that are, are slowing us down. . I mean, I look, I, I think it's a combination of state regulatory boundaries and the, and the guild mentality of physicians that's killing us.

I mean, it's just killing us. So the, the answer to your question is that I can practice in New Jersey. I can practice in 48 states in this country, but I can't do telehealth. And, and, and the example I gave at Becker's is, it'd be like if we started ATMs, And every state you needed a different card, it probably wouldn't have taken off the way that it did.

Right. So, so we, you know, we create our own problems literally by, by, by, by, by doing that look, you know, telehealth is not the end all and be all, but, but it's a little bit like what you said about the cloud. I don't think it is consumers that are reticent to use it. It's the doctors and the organizations

That, that, that are saying you look, you can use telehealth. It's not like seeing your, your real doctor. One example, since we're so into this, our head, our head of, uh, Jeff Connect, a guy named Judd Hollander, who is an emergency medicine physician, he was getting criticized, says, well, you know, ask me this doctor, answer me this, doctor Hollander, are you actually gonna be able to diagnose an appendicitis by telehealth?

And he said, well, actually, let's try that. And he went through this thing where, you know, um, so Mrs. Jones, where's your pain? Okay, it's, it's right on my left side. Mr. Jones, could you please press on that? Does that hurt? Yeah. When you let go, does it hurt? More or less? Less. They don't have a ruptured appendix.

That's all we do in the er, you know? And then he went, okay, now that we know you don't have a ruptured appendix, could you do three jumping jacks? You know? Okay, the three jumping jets. I can see you tomorrow morning. Honestly, other than unnecessary tests, that's what we do in the er. So this whole. Model of everything we do is genius because my hands are magic and we can't do that in telehealth.

So knowing what you can do tele wise, knowing what you can't, just like with retail, what things do I want to go to target for, or what things can I order on e targett? Become really important. So let's talk about the future. Um, you're training the next generation here and you're hiring the next generation.

As you're thinking about, uh, what are, what are some, some of the things you're looking for in the next generation of health leaders? So let's, let's say it's five to 10 years out. It's probably different than what we were looking at before and I'd No, I'd like to start with you and start with health it.

Mm-hmm. . Is there, is there a different set of skills? Are you also looking at, you know, the design industry and other things to bring in different thoughts? Uh, absolutely. So design thinking I think is going to be a big, since you mentioned it, right? Uh, so look in, in it. One of the challenges we have had is every three to five years technology.

Changes. Right. And, uh, I think, uh, that pace is increasing and some of, uh, in some areas that's even more so if you think about information security or data analytics that is, uh, really, really new field. Uh, uh, when I went to school, there was no such thing as like bachelors of information assurance or anything like that.

Right now there are, you know, folks who are getting trained and, and that's gonna change in 10 years. Exactly. E even sooner. And so now the, the folks who are coming out of college are, are not a general computer science degree. It's really very specific. I do this in this, I do programming in Python, and by the way, that's going to only last four more years.

I need to retrain and re-skill, right? So, uh, I think, uh, re-skilling, retraining, hiring people, uh, we, we at Lisa Jefferson, uh, right now with an it are a little bit, uh, on the older side, we, we have . Just outstanding tenure here, which I'm very proud of. Turnover is really low. Uh, that gives us a unique different challenge in that, you know, um, we don't have as many junior level people, right?

Uh, but, uh, Philadelphia is also blessed with some really outstanding, uh, universities. And, uh, we, we do get folks, we are able to hire folks. We're fresh out of college, we can retrain, um, and reskill. So, uh, the skills that we are looking for is really at, we, we hire for aptitude. We, we don't hire for necessarily that.

You must know what, you know, technology, uh, if, if a person can learn, if a person can, um, uh, live in a, we believe that a person can live in a dynamic environment that is continuously changing. We are going through acquisition, we are growing. So only thing, I think that is constant change. If a person believes that and can live that we believe we hire.

Them. Uh, we are not really, uh, very, very few questions that we ask and my managers ask are around technologies like Cisco, Microsoft, or uh, et cetera. It's mostly around soft skills, mostly around adaptation. Yeah. 'cause most technology projects anymore are operations projects. They're very little about technology.

Absolutely. And we can always train. Like, I mean, we have a very generous training program. We have culture of training and technologies come and go. We can always train on technologies, really people side of things that we hire for. So the university, you're looking at the next generation there. It's the same kind of thing.

I would imagine that you're, you're looking for people that realize that medicine's gonna change in five years, 10 years, 15 years in their generation, they're gonna practice medicine very differently over the course of their life. Look, I, I think, you know, um, . The big issue is that we're not going through an incremental change and you can't think incrementally, right?

I mean, getting back to my Apple example, you know, pre-phone, you know, everybody else is thinking, well, what's the next cool laptop? 'cause that'll be the big thing in 10 years, laptops will be smaller. Or what's the next cool operating system? There'll be Mac OSS 87. But really, what, what, what Apple was thinking about is we're moving from a computer industry to a digital lifestyle.

I try to hire, hire leaders. They get that, that are willing to look at what's gonna be obvious 10 years from now. And, and do it today. And you know, if, if we have chance after this, or if any of you out in the audience are in Philadelphia, you're, you're actually at the first Federal Reserve. This building is like a hundred and some years old.

We have the largest vault in the country, , and I needed a symbol for, for being 195 year old academic medical center. Uh, thinking like a startup company. So in our vault is where we do three D printing, three d, bioprinting, uh, um, a lot of virtual reality. And so your, your eyebrows raised a little bit when I said we acquired a design university.

So we now have a deal with Princeton, where we take up to 10 students a year. They get into Syno Medical College after their first year at Princeton. They go through the whole four years and then they get an MD Master's in design. First MD Masters in Design in the country. These folks will be the masters of a new kind of universe that's concentrating on how people access healthcare system.

Part of the problem we have now, the average person in my job running a five to $10 billion academic medical center is 67 years old. If you're 67 years old, exactly your point, bill. You've gone up by not doing anything differently and not upsetting the people that are competitive, autonomous, hierarchical, and non-creative.

And you know that you have your long-term retention package coming in two years and you have two choices. I can either change everything I do and really upset all those people that supported me before, or I can hope that things won't change for the next two years. So some poor guy that's a lot younger than I or woman is gonna have to take over.

That's what's happening. So in the last couple minutes here, I wanna talk about Philadelphia. And from really two perspectives. One is, uh, you know, you talked about, uh, 80 20 social determinants and whatnot. Um, it it, so I'd like to talk a little bit about the partnerships and how you're going about addressing social determinants.

And then the second thing I'd like to talk about is every city I go into says we're the next Silicon Valley we're doing, you know, we're, we're doing those kind of things. Well, you have Comcast here and others, so it's, yeah, you could make that case, but I'd, I'd like to hear. How you are sort of facilitating that.

So let's, let's start with the social determinants. There's, there's so many things that can happen. I'm curious what you guys are doing in that area. Yeah, so we started the first college population health in the country, so by an individual named David Nash, who really sort of invented the science, but we've done a really bad job implementing it.

And, and part of it is because, and it also speaks to your second question, the reputation of Philadelphia is, yes, we have five academic medical centers, but the reputation is all we do is beat each other up. And I think that, uh, one of the things that we did at Jefferson is . So if you look at any academic medical center's website in Philadelphia or beyond, it's always about innovation, community engagement.

Diversity, social determinants. You look at how that c e o gets paid, it's about EBITDA Hospital census to the doctors I play golf with, like me in US News and World Report. So I wrote an article which was a bit controversial, that, you know, you wanna look at what your husband's gonna look like. Ignore what the board says, ignore what's on the website, ignore the mission and vision.

Look at how the hospital c e o is getting paid for the next 10 years. So we actually started one of the first, where 25% of my personal incentive is, is what's happening in Philadelphia. Things I have no control over. Our last gala was not to build a bigger M r I or a proton machine than our competitor.

It was to create the Philadelphia collaboration for health equities. And what we're doing now is starting to partner with the social agencies, with with others. Mm-hmm. . We just got a $3 million grant for South Philadelphia to go after a specific community that's getting underserved. We started the first refugee clinic and whatever your views on immigration, the fact is there were 250 women that got no prenatal care that was showing up to emergency rooms, nine months pregnant.

That now get that, that now get prenatal care. Thanks. Thanks. Full prenatal care, thanks to Jefferson. So I think we're, we're, we're starting to address it. What I'm really excited about is that we're having really good discussions with Penn and Temple and others, . Around how we can start to do that together.

You know, that, that, that, that we're really not competing when it comes to either innovation or health equities. That is, that's amazing, fascinating, and exciting. I hope we see the same thing happen in Los Angeles. Um, . Well, I mean, that's, I just flew in there from there, so, um, Um, so how, how about partnerships that, uh, foster the development of that technology ecosystem where you can hire the next generation?

I mean, you have great colleges and universities around here, so it's, I'll give you one example. Uh, so we recently partnered with an organization, local organization called era. Uh, and their mission is, uh, to help, um, uh, communities and young adults, uh, you know, who, uh, they, they train young adults in technology, business skills and so forth, right?

And, uh, they then place. Uh, them into organizations like Jefferson. So we are partner with them. We are hiring three, uh, of their graduates, uh, coming July. Right? Um, so that's just an example. One example of how we are partnering with local, uh, organizations to recruit people. And then we have strongly in our co-op and internship through Drexel universities and universities around, uh, that's been going for many, many years.

And that's sort of source of the staff that comes into it. The, the problem with the Silicon Valley of Healthcare, which is . Generally bss, you know, I mean Silicon, as you know, Silicon Valley happened through like this weird yes alchemist type thing that, that you know, is um, is that everybody always talks about their strengths and that's why the silicon, Silicon Valley, when I was at Tampa, I was the C South Florida, we're gonna be the Silicon Valley because of weather and taxes, because that's really what they had.

They had weather and tax and, and no taxes. You know, here it's because we have all these academic medical centers, what I've said to both chambers, . Is, you know, at different times is no. Look at why people aren't here. , you know, if you can look at why, you know, it's, it'd be great for me to look in the mirror.

And, you know, say, boy, I'm really six two and I have a great head of hair in case, in case you can't see, that's not true. Um, you know, but you have to start, you have to start out, out where you are. So, so to me, um, that's what we've tried to do is how can we create partnerships? The one other thing is also recognizing who your competitors are.

My competitor is not Penn and Temple at a time the c v s and Aetna have gotten together and creating the new front door. Or people always say, um, aren't you worried about Amazon, JP Morgan and Berkshire? And I, and I, I always say, you know, to me that's like the, uh, . I think I said one thing, it's like the Lochness monster.

You know, I'm sort of worried about it if it ate me, but right now I'm not sure it exists. And I think, you know, we have to start to think about what are our real competitors. It's not the hospital or the academic medical center across, across the street. In fact, they're actually our partners in things like health equities, you know, talking about things that they can't do that you do.

I'm sorry, one, one more question. Yeah. Um, and I appreciate your time, uh, today. The, uh, so Mark Harrison, Intermountain. Uh, they're gonna start collecting 500,000. They're gonna build a, uh, genomics database. 500,000 patients are gonna volunteer and, uh, collect two vials of blood and, and, and do their mapping.

And then look at, uh, look at, look into that data and start to do predictive really, um, forward looking, uh, kind of medicine. Um, is that, what are you doing in the area of precision medicine? Well, and I, again, mark and I have been on several panels together. We're, we're, we're taking a bit of a different approach, I think.

Um, and by the way, it's incredibly important what they're doing. It's incredibly important what Geisinger is doing and others. The problem with genomics to this point, precision medicine has been, it's either, you know, the, I'm gonna get in and find out that I'm, you know, partly Native American or something like that, or it's.

Here's where we can do things that'll affect the future. We've really tried to be very practical. What are the things that could change lives today? So our big partnership is with a one of one of general catalyst companies called Color. Mm-hmm. Originally Color Genomics. Now color. We now have the largest employee.

We've taken our 32,000 employees. We've done a risk-based arrangement with color, where we now literally offer every single one of our employees full . Subtyping and genomic testing, and again, it is totally up to them as to what they share with their doctor or or whatever. But we're able to do risk stratification and, and this is what it means.

We know there's four or five different things today that, um, if, if you're a certain subtype, it would change the way that we treat you. If you're depressed and you're a certain subtype, we know that serotonin agonists won't work. And the reason that's so cool for, for our employees is for those 30 to thousand people, I'm their employer, I'm their provider, and their, I'm their payer.

So at the end of the day, that means I'm paying for drugs for people who are depressed, who are still depressed. Who're also getting the side effects of that drug. Mm-hmm. and, and literally aren't showing up to work. And if they want us to, 'cause again, it's totally up to them, they can actually share that data with us.

There's people with prostate specific antigen, P Ss a tests men who literally, we know if you're a certain subtype, they're not as accurate. So we've taken the tack of, you know, a little bit different than. Let's get, you know, lots and lots of things and do future research. How can we prove today that precision medicine works on a population that are the payer or the provider to the

And it's been, wow. We, we, we've, we've, we've had some really, really great . Uh, things written about this, uh, C N B C did a, did a thing about it. Um, and, and I think all these things need to get together. What I'd like to see, and, and Mark and I have talked about this, and David Feinberg, when he was the GE talked about this, we need to take all of us that are doing innovative things in different ways and look at, you know, how, how do we start to put those kind of things together That's exciting.

It, it changes. So I'll give you the last question. So this is, this week in health. It, so, uh, genomics, . These are massive data stores and databases. How are you preparing for that? So look, uh, right, uh, Uh, what we, we have what we call traditional E D W, right? So that's what, that's what we are using for our current needs, which is mainly data analytics, some level of prediction, predictive modeling, and so forth.

But then about a year ago, uh, last year, we started, uh, looking into a concept of data lake and really a data lake outside in the cloud. So we, we partner with a vendor, um, and, and the idea is that even though today we don't have. A need, you know, so what we have currently is working for us, but as we are acquiring hospitals, we are, um, we are getting data that is, uh, tremendous, but for the most part unusable.

'cause their formats are different, their systems are different. It's, uh, the data is not clean. So the biggest challenge that we have, . Seen, and I think this is not just Jefferson, this is across industries that the data we receive is just bad data input to garbage in garbage argument situation. Right. But there is a realization, and I believe this, that there are technologies that are, are, are, are on the horizon, especially using machine learning and ai.

That are going to extract, be able to extract data, right? So we are preserving the data for feature use where we believe that we, we will be able to use them, but we cannot use today or, or we have selective use, you know, um, based on the use case and that. So the future for us on the storage of data and the processing of data, I think is partnering with the vendor.

We don't have the competency, we are focusing on the people portion of it. So we have . Hired some, uh, some of, uh, really outstanding data scientists. So we, we have been fortunate to recruit just very recently to data scientists from uc, Berkeley's program. We have some, uh, from Drexel and local, uh, colleges, a very, very strong team.

And that's, I think, instead of worrying about, you know, how to store, how to compute, they're experts doing that. Yep. I would rather focus on people who can really . Make value out of it. Make value out of it. Yeah. And, and, and maybe, you know, to put the whole it and human thing together. I mean, at, at, at Davos I gave a talk, uh, going from self-driving cars to self-healing humans.

And I think one, one of the things we have to think about in healthcare is we've spent so much time training, uh, our healthcare providers to be better robots than robots. 'cause we didn't have robots, you know, uh, you know, if I could memorize 19 reasons you had a headache, And Dr. Nami here can only memorize 15.

I was a better doctor than you. 'cause he missed four. So memorizing the treb cycle really mattered. Now there's gonna be a he, she or it next to me. It's gonna be much better at doing that. It's gonna be incredibly important that I can be the, the, the human in, in the room. And I think we're spending a lot of time thinking about the human in the middle.

In fact, we're, we actually are starting the first, it took us 50 years by the way. To get doctors and nurses to work well together, now we're going have to get doctors and robots to work. So I wanna start the first institute for inter sentient education between sentient beings and, uh, droids. Well, gentlemen, this is, uh, I, I learned a ton.

It's been a phenomenal conversation. Is, is there, uh, for our listeners, is there any way they can follow you guys or follow Jefferson? Yeah. Um, I'm at s Klasko, uh, also s klasko.com. And then we have, uh, . If you go on www.jefferson.edu, we have a whole sort of innovation and it, uh, link, yeah, no, at jefferson.edu, LinkedIn and at Twitter.

So, yeah, I look forward to one of these days getting a, a tour of the vault downstairs. Should be, uh, should be a lot of fun. Uh, again, thank you very much. This shows production of this week in Health. It. For more great content, you can check out the website at this weekend, health it.com. Or the YouTube channel at this week in health it.com/video.

Thanks for listening.

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