Stephen Klasko: What Healthcare Will Look Like in 2020 (Transcript)

It was a little slide show with a screen, but they asked me to talk about what the future of medicine looks like from a medical student’s point of view.

The other reason I remember it, it was the first time I saw the Rolling Stones. This is what they looked like back then. I was a huge fan, but what I talked about because I was a little nervous about the first talk, I talked about, “Can you do anything about spiraling costs? Can you change the fevered service system so we’re really rewarding volume, value and not volume, and can you measure outcomes?”

And I said, “My generation of docs is going to solve this over the next four years. We are not going to be dealing with this even 20 years from now.” Well amazingly the docs said, “No” And that didn’t happen.

Now I was also a very different person back in 1977, this is what I looked like. Thank you, thank you…

That’s called a leisure suit. And but for a brief interlude where they tried to bring it back in 2019, I think it’s safe to say it’s out of the fashion lexicon forever, but the car was a 1968 GTO which was, and is, a very cool car. Thank you…

So there we went through really what was what some people call the middle or dark ages, the Managed Care Revolution, which did not really manage anything. It didn’t really provide care, it just promoted under-utilization.

The Balanced Budget Amendment, which didn’t really balance the budget, and didn’t really amend anything. And then the first iteration of what has now been 17 iterations of what was then called Obamacare.

So that brings us to 2014, and why was 2014 important to me? Well I was very proud and honored to be inaugurated and selected as the first president and CEO of Thomas Jefferson University and Health Systems combined. It was also a big moment for me because it was the second time I saw the Rolling Stones, and this is what they looked like back in 2014.

And in my inauguration I was given a script, and what I talked about in inauguration of 2014 is “Hey, can we do anything about spiraling costs? Can we change the fevered service system? Do you think we can measure outcomes?” So it was a bit of an aha moment for me, I said, “Well, 37 years, that’s a lot for not to have much change.”

This time though, the insurers and government said, “We’re really going to do it.” And really what people were actually predicting is, because believe it or not even at 2014 the docs said, “I really don’t want to take any risks. I think things are fine the way they are.” And you couldn’t go a week without people threatening the extinction of academic health centers.

So I’m proud to say here in Philadelphia and Jefferson, we said yes, and I’d love to talk to you a little bit about what happened between 2014 and 2024.

So here we are in 2024, and by the way, I don’t know if any of you saw it in your Facebook implantable glasses, the Zombie Rock Tour, it was awesome. It was awesome. By the way, those Facebook implantable glasses, can be bought at Stevie’s Vinyl Records and Implantable Devices. This is, I thought the Rolling Stones, the Rolling Stones rocked, they rocked the undead tour, right? Who agrees with me? They rocked the undead tour. Seven decades of great Rolling Stones, you talk about not getting any satisfaction, look at these guys.

But more importantly, more importantly, what happened in Philadelphia, what happened at Jefferson was, that we took, we took that mode of, people saying that it’s impossible to change healthcare. And really the personal piece for me believe it or not did not come from Admonities or Aristotle, or even somebody from the University of Pennsylvania or Jefferson. It came from a sneaker commercial.

It was an Adidas marketing campaign back in 2014 called the Impossible, it said “Impossible is just a big word thrown around by small men and women who find it easier to live the world they’ve been given rather than explore the power they have to change it. Impossible is not a fact, it’s an opinion. Impossible is temporary, impossible is nothing.”

So we decided, what the heck, let’s do the impossible. Because everybody knew things were changing, we weren’t going to wait for a miracle. And we said, “Let’s do it.” Okay so, here it is, it’s March 28, 2024, now I apologize for those of you who come from this decade, but I know some of you probably have time travel lag, and I just want you to know where we’re at today.

So it’s March 28, 2024, President Jenna Bush will be debating democratic nominee Chelsea Clinton, in what a lot of people think will be a very tight race. Harrison Ford has signed on for one last Indiana Jones sequel. Tentatively titled Indiana Jones: the Legend of Bingo Night, we’re all excited about that one. And the Eagles are 2-0 and trying to win their first Superbowl since the unprecedented four straight they won from 2015 to 2018, the so-called Chip Championship Years. Of course, Governor Chip now has a very different job than he had back then.

But more importantly, more importantly or as importantly, Jefferson is celebrating it’s 200th anniversary as a state wide national, and international hub of innovation, with headquarters in Philadelphia instead of just a Philadelphia academic medical center. We’ve become a destination site for innovation entrepreneurial health with unprecedented economic development.

And our creative partnerships have allowed us to become what the Wall Street Journal called a thriving cluster on the verge of a chain reaction. Which has helped make Philadelphia the epicenter of the new healthcare. Oh and by the way, I’m getting out of my DeLorean to accept an award from the US News and the Interplanetary Report, as most of you know, in 2019 we found two other planets with slightly dysfunctional heath systems.

So they are now part of the ranking system that the forward USNWR uses. So how did we get there? I’d like to, TEDx has asked me to talk about three things that we did that were very different.

First of all we decided that we’re going to start to create docs of the future. That it’s ridiculous to have the same way that we selected and educated physicians that became autonomous, competitive, and hierarchical, and that we actually were going to change the DNA of healthcare literally one physician at a time. You might now believe this, but back in 2014 we still chose doctors based on science GPAs, MedCaTs which were a multiple choice test, and organic chemistry performance.

And somehow we were amazed that doctors weren’t more empathetic, commutative, and creative. As my kids would say, “Duh”. So we changed all that. What we recognized is that it used to be for those of you who came from the 70s, and I think there are actually some, I see some people from 2014, I see some people from the 80s. Go Journey, yeah.

I see some tie dye out there, some 60s and 70s, peace. But we decided to transform admissions. What we realized is that all the scientific data is all on, what we called in 2014, iPhones and Androids, but really what we needed were really emotionally intelligent physicians. So we now really select physicians based on self-awareness, self-management, and the ability to adapt, social awareness and empathy, relationship management, teamwork, and the ability to really embrace change instead of fighting it. But not only that we totally changed the way that we teach the physicians that we do accept.

Believe it or not back in 2014, we used to spend two years really teaching them scientific principles in large auditoriums, classes that a lot of them didn’t come to, when we recognized that we could do all that, have them learn that at two o’clock in the morning.

Now we spend most of our time in what we call the Art of Attending. Teaching them to really observe, we started back in 2014, workshops designed to sharpen observation skills of health students by looking at art. Very unusual partnership, it was Thomas Jefferson University, a contemporary art museum, and an institute for an optimistic future in healthcare. We took students and had them understand art.

So if you take this piece of art over here. Medical students originally said, “That’s a woman, that’s a snake, that’s a family.” But when you start to look and say what is the story? It starts to totally change the way that they cared for patients. And at the end of the day we went from silos of full-time individuals to folks who could deliver team-enabled and team-based care.

Doctors went from being captains of the ship to being part of a team, and they believe it or not worked closely with multidisciplinary care and delivery teams. Including doctors of nursing practice, nurse practitioners, clinical pharmacists, physician’s assistants, and at the Thomas Jefferson Institute of Emerging Health Professions, professions that didn’t even exist in 2014.

Things like probability experts, electronic health care ambassadors, and telehealth professionals. So we recognized that we need to evolve doctoring. We also recognized that the patient experience was really pretty lousy. Back in 2014 you could actually do anything you needed to do in travel, anything you needed to do in shopping, on a device, but could you get an appointment with a physician? No.

Could you interact with a doctor or nurse? No. So we decided that healthcare needed in 2014, to get into the E and I mode. If you even look at how people viewed us from TV shows, how many of you are here from the 70s? There you go, okay. So the big tip in the 70s was Marcus Welby.

Now here’s what Marcus Welby was, he was a family physician, he would get up in the morning, he would go to the homeless shelter, take care of people for free.

On the way home to lunch a cow would be having trouble delivering a calf, he’d deliver it. He’d then go to his family medicine office in the afternoon, and then at night he’d do lecithin ventricular neurosurgery. We were gods, we could do everything, that’s how people viewed us. In the 2010s this is what we had. Anybody remember this guy? He was a drug addicted, sex addicted, really smart, guy that couldn’t communicate or see patients.

That’s what people viewed us. The number one TV show of 2023? Was Doctor WHHO, stands for Watson Hybrid Hydro-Organo, Doc, who basically fell in love with his robotic-bionic counterpart who does all the scientific stuff, while he does the emotional stuff. And as you can imagine, hilarity ensues. By the way — By the way the first season, the first season, of Doctor WHHO is available on Google Glass implantable chips, available in Stevie’s Vinyl Records and Implantable Chips on South Street. So we embrace, the other thing we embraced was entrepreneurship.

We recognized that being academic and entrepreneurial just were not mutually exclusive, and we also recognized that we had to enhance the consumer experience. It really was lousy going to a physician. This is what it looked like back in 2014… What’s wrong? – I don’t feel so good – Then you need to go to a doctor.

Mr Stephenson? – Stevenson – Do you have any allergies? How would you describe your symptoms? What is the general area of pain? Does your family have a history of heart disease? Does your family have a history of diabetes? – And what seems to be the problem today, Mr Stevenson? – I’m feeling a little stuffed up. I’m experiencing some– – Doctor your three o’clock is early, your 2:45 is late, from six and seven.

– Follow these instructions and if it doesn’t clear up in a week or two come back and we’ll do this all over again. I don’t like going to the doctor.

So in July of 2014, we partnered with some great companies, created an innovation driven ecosystem for healthcare. And starting in 2015 patients in 48 states could access doctors via Telemedicine – Well now you can see a doctor without going to a doctor’s office.

With the help of your smartphone or computer, and American Well Signing up and setting up your health profile is easy, it only takes a minute, and once you’re done it, it’s stored safely and securely. Then you can log in or use the app to see doctors who’re available, and connect by video phone or chat. – Hi Allen, I see you’ve been experiencing some congestion and some nasal blockage. How long has this been going on? – During the visit, the doctor can see your health information, afterward you get a complete write-up of everything the doctor says.

– Well it looks like acute sinusitis, a sinus infection. Now I wrote you a prescription to help with the congestion. If things don’t clear up in say, a week or so, just send me a message. I’ll be right here – A few minutes later I’ve got my diagnosis, and my instructions for treatment, and my prescription is already waiting for me at the pharmacy.

– Of course all that now is happens in your Google Glasses which are available by the way at Stevie’s Vinyl Records and Implantable Health Chips. We also recognize that information was everything. As Yogi Berra would say, “It comes down to one word, big data.” And believe it or not, believe it or not, we used to do everything based on experience and anecdote. Evidence based medicine in 2024 was actually a novel idea.

And now we recognize that we can take things from other industries. So at Jefferson for example, in 2014, we started the Center for Healthcare and Entrepreneurship and Scientific Solutions. We said it really doesn’t make any sense that Nick Foles has a better idea whether or not a screen pass will work, in the third quarter, than I do of whether or not a cancer drug will work.

So we took some of the best people doing mathematical modelling and created a predictive analytics of mathematical modelling to reduce uncertainty of medicine. Believe it or not in 2014, 28% of people that went to the hospital in this country got readmitted within 90 days.

Now through our mathematical modelling we’re able to see exactly what intervention will keep people from coming back. Not only that we’ve changed the way we do things. In 2014, family medicine physicians would actually be out of the hospital. Hospitalists would never leave the hospital, and then there was no real communication. Now we have what’s called extensivists.

Hospitalists that actually follow those patients for 90 days so they don’t get readmitted. We actually pay for performance now because we can actually measure performance. And we can actually give you predictable answers as to what you’re paying for and what you’re getting back. And accountable care organizations for the first time really are accountable because we have math to back it up. One of the great things that happened in Philadelphia, believe it or not again in 2014, with decreasing NIH funding, Penn, Jefferson, Temple, Drexel, would all fight for NIH funds.

What we did, and one of the greatest things we did, we created the Philadelphia Clinical Research Super Site. Where we said really what’s important is to take all of our resources, both in education and research, and make Philadelphia an epicenter. What did that do for us over the last 10 years? Well we were able to take the Nanotechnology University of Pennsylvania and Molecular Genomics at Jefferson and create the DNA vending machine. For those of you from the 2010s, it’s sort of like a red box for your DNA. We can now pick a drug for you, instead of saying it’s for 200 people that look like you, we can take exactly the drug that fits your genome and have it available for you.

We can also put your genome on a chip, so that God forbid, if you need a new organ, we can make that for you based on work that’s been done in Philadelphia. And we finally decided to work with patients to really make them shareholders in their health, and this is what it means. It means that in a community like Philadelphia, if we’re able to make you healthier we do better as physicians, and you do better. And we actually partnered with great companies from again outside Philadelphia to look at a different way of making sure that everyone matters. That we can look at not only drugs, but holistic remedies to look at personalized performance game plans integrating a proven system to drive health outcomes.

Whether it’s mindset, or nutrition, or movement, or recovery, we were able to do many more things that didn’t require pharmaceuticals. So that brings us to 2024, and as I said, I’m here to accept our number one ranking from the US News and Interplanetary Report and what’s really cool is that some of the ranking parameters didn’t even exist in 2014, and I’ll give you an example of a few of them on the academic side, and a few of them on the clinical side.

On the academic side we actually, imagine this, get ranked based on how our students do at one year, three year, and five year. We measure individual professional and personal happiness at varying interval after graduation. Because after all, that’s why they came to our university.

And if we don’t do really well, then they actually get some of their money back. We have a collaborative quotient, academic entities are incentivized to actually get over themselves and work well with others, which would have been unheard of in 2014 when they were all cannibalizing each other. And we have an entrepreneurial quotient, institutions were awarded, that invent and envision new ways of doing things that generate alternate revenue and develop new student opportunities. But probably nothing’s changed the most, than health quotients I mean, it used to be back in 2014 and before, that parameters were based on reputational scores in the past.

Now it’s based on what patients think. For one, I’m really proud of that we a very high score on is called the BUB Quotient. It stands for the Believable Understandable Bill, that we actually have enough respect for patients, that we provide understandable bills so they can understand what they got and what they’re paying for. We have the Say What You Mean and Mean What You Say quality parameter. We actually take marketing professionals to read all the billboards and the marketing we do, and see if they have any semblance to reality of what really happens in the hospital, and you get points if there is some semblance to reality.

And then finally we have the Through the Patient’s Eyes factor. And this is really exciting because what it is, is every patient now in 2024, is basically when they get in the hospital given a Google Glasses, and they basically can record what’s happening through their eyes. How the doctors and nurses are treating them and then we have CEOs of other hospitals look at that video for a day and grade on 1 to 10 how they’d like to spend a day in that hospital. And again that’s a great parameter for us. So a lot has happened since 2024, and I’m really excited to be here, we’re about to accept an award in the new convention center an casino on the Schuylkill River.

And some things from the past really are good, I’m going through my third mid-life crisis because I’m 70 and I’m, what happens is people live to 120, so mid-life crises have changed. And I’m proud to say this is what got myself, I was able to retrofit a GTO to hit the standards for hovercraft. Excuse me for a second Google Glass out, could you get the GTO to get ready to go to the convention center, great. Thank you, listen I want to really thank you for being here, I want to thank you for travelling in time and space, and most importantly, stay healthy in Philadelphia.

Thank you very much.

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