Since 2013, Dr. Stephen Klasko has been the CEO of Jefferson Health and the President of Thomas Jefferson University, one of the nation’s fastest growing academic health institutions. Under his leadership and his vision of re-imagining health care, Jefferson Health expanded from 3 hospitals to 14, employing 35,000 people. Jefferson has also been one of the very best at protecting their staff and doctors, with a less than 1% rate of infection of COVID, where the nation’s average is at 3-4%.
Stephen’s track record of success at creating and implementing programs that are shaping the future of health care earned him a place among Fast Company’s 100 Most Creative People in Business in 2018; He is also ranked #2 on Modern Healthcare’s list of Most Influential People in Healthcare. For 2018-19, U.S. News & World Report has ranked Thomas Jefferson University Hospital among the nation’s best in 10 specialties. In 2020, he was named the first Distinguished Fellow of the World Economic Forum.
In 2020, Stephen published two books: “Un-Healthcare: From Sick Care to Health Assurance”, and “Patient No Longer: Why Healthcare Must Deliver the Care Experience that Consumers Want and Expect”. His best-selling 2018 book is titled, “Bless This Mess: A Picture Story of Healthcare in America”.
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Dr. Stephen Klasko: Top Hospital CEO On Pandemic, Vaccine, And The Bright Future Of Healthcare
Joining us again, Dr. Stephen Klasko, who first joined us in our first episode. I’m excited to talk to him about the progress they’re making with the pandemic, with the vaccine, and also what healthcare looks like now. He’s the President and CEO of Thomas Jefferson University and Jefferson Health since 2013, one of the nation’s fastest-growing academic health institutions. Under his leadership and his vision of re-imagining healthcare, Jefferson Health has expanded from 3 hospitals to 14 employing over 35,000 people. They’ve been one of the very best at protecting their staff and physicians with a less than 1% rate of infection of COVID where the nation’s average is 3% to 4%.
His track record of success at creating and implementing programs that are shaping the future of health care earned him a place among Fast Company’s 100 Most Creative People In Business in 2018. He’s also ranked number two on Modern Healthcare’s list of Most Influential People in Healthcare. For 2018-2019, US News & World Report has ranked Thomas Jefferson University Hospital among the nation’s best in ten specialties. In 2020, he was named the first Distinguished Fellow of the World Economic Forum. In 2020, he published two books, UnHealthcare: A Manifesto for Health Assurance and Patient No Longer Why Healthcare Must Deliver the Care Experience that Consumers Want and Expect. His bestselling 2018 book is titled Bless This Mess: A Picture Story Of Healthcare In America. Please join me now with the incomparable Dr. Stephen Klasko.
Dr. Stephen Klasko, welcome back to the show. How are you doing, sir?
Chris, it was a very different world the last time we spoke but it’s great to be back with you.
You were my first episode of this entire series. I’m so excited to have you back. It was amazing speaking to you then and a lot of the things you said were going to happen have basically happened. A lot of things that we didn’t know, we know. I’m very excited to talk to you for two different reasons. One is you’re the CEO of a 14 going on 17 or 18 hospitals, which is 35,000 employees and that also includes Jefferson University. You still have a good track record which is great. You even had it a few months into the pandemic but you still have one of the best track records with your own employees and doctors with one of the lowest COVID transmission rates amongst your employees. Is that correct?
We had a less than 1% and the national average is about 3% or 4%. It’s interesting, Chris because we were right in the middle of the trifecta. If you were a university president, you had a tough year. We were one of three places that kept kids in school without going totally online. If you ran a large health system, that was tough and we’re the largest health system in Philadelphia. By the way, if you’re a large employer, that was tough. We’re the second-largest employer in Philadelphia. We had the trifecta of being a large employer, a university, and a large health system. By the way, not just the COVID pandemic and the financial tsunami, we’re right in the middle of the heart of Philadelphia and all the reawakening of racial tensions and inequities.
It’s been an incredibly challenging year of 2020. One of the things that’s interesting for us and we talked about this in your first blog, when we had changed our mission from, “We’re going to be the premier academic medical center of Philadelphia, which nobody cares about other than you and your mother,” to, “We improve lives,” we really lived that. We were one of the only places in the country that did no layoffs and no furloughs of our 32,000 employees. Not one person got furloughed or laid off. That was stupid because you lost more money by doing that. There were some people staying at home but now, both the morale and the numbers of employees we have are ready to rebound. We made absolutely no compromises in PPE. To give you an example, gowns went up from $0.12 to $11 per gown. We use 15,000 gowns a day.
Did that happen from the beginning of the pandemic?
From March 2020 to September 2020.The vaccine should give people a level of confidence, not cockiness. Click To Tweet
That’s absolutely ridiculous.
I’m sure you’ve read people with the trash bags. We didn’t change our gown policy at all. It was single gown, single case, etc. Just that probably costs us $50 million. What we’re proud of is, it’s not like, “We got lucky and we had this incredible low employee infectivity rate.” We said, “If our job is to improve lives, how are we going to do that? We’ll figure out the financial and some of the other ramifications later.”
As I was saying, there are two reasons why I’m excited. The other reason I’m excited and I want to get into right now is nowadays news, the latest and greatest with the pandemic, vaccines, cures, treatments, and everything. In my mind, I think of you as the Steve Jobs of healthcare and one of the most innovative. A lot of people agree with me and have told me this as well that you’re one of the greatest minds in healthcare as far as how do we use technology, where are we going, how is this all changing from sick care to care at home and care of ourselves through so many great technologies.
I’m excited to get into that part as well but there are some burning questions that I have for you. Again, you run hospitals and you’ve been in the middle of this whole thing so you know so much more than most because you’re doing it and you’re in it. You’re one of the people in the world, not you, yourself, but your team is working on a vaccine. It’s a rabies vaccine that’s in India that you’re doing this. It’s adding to that and it actually works. It’s going to be something that you use in the developing world as a vaccine which is phenomenal.
It’ll be as effective as the others from what I’ve read and heard. I want to know about the United States and the vaccines. I don’t think we all know the answers to everything. One of the questions I had was this vaccine they say is either 90%, 95% or 97% effective depending on which vaccine you get. Now we’re starting to see our friends take it and people we know take the vaccine. One person I’m good friends with says she’s never felt better since the beginning of the pandemic, feeling incredibly well between the 1st and the 2nd shot. If somebody gets the vaccine and they get on a plane but then if they are exposed to the virus, the vaccine doesn’t keep them from getting the virus, it keeps them from getting affected by it. Can they still carry the virus even though they’re vaccinated and then pass it on? I’m worried that a lot of people will say, “My grandmother and my grandfather are vaccinated. I can hang out with them. I can’t give it to them. They can’t give it to me.” Is that true?
I’ll tell you what I tell everybody on any news show that I do. First of all, if anybody tells you anything about the future of COVID or the vaccine who says, “I know.” Don’t listen to them. I always start with, “I don’t know, but.” I probably go a little bit more than a lot of people. Let’s get some facts. Right now, the two approved vaccines are Pfizer and Moderna. They are what’s called messenger RNA vaccine. They, in essence, trick your immune system to respond to COVID.
They don’t give you the actual COVID virus.
That’s right, Chris. The next one that will be out in mid-February 2021 is the Johnson & Johnson vaccine. That’s much more like your traditional flu vaccine. It’s an activated virus that basically again, acts like the virus and your body gets antibodies to it. The two questions I get asked a lot are, how long am I immunized for? The answer is we don’t really know. Think about this, all these clinical trials have only been 6 or 7 months. The second question is, how do I know two years from now, my left little toe won’t fall off? The answer is we don’t think it will but also, we’ve only done trials for 6 or 7 months. The safety is there.
The question you asked is what is a smart one and a good one. It does not mean that you are Superman or Superwoman that you can’t get it or give it. What will happen for quite a while after this is that you’ll still need to wear a mask. If you go on a plane, it’s not going to be, “You’re vaccinated so you can be cool and kiss people.” No. Your chances of getting it are minimal and your chances of transmitting it are less but the simple fact is that we will be doing masks for a while. If you get the pandemic of 1918, it was the pandemic of 1918, 1919, and 1920. It was called the Pandemic of 1918 because they didn’t have the kind of vaccines that we had but they got herd immunity from pretty much everybody that didn’t die getting. It’s a different way of getting herd immunity.
One of the interesting historical things, by the way, because we’ve spent a lot of time thinking about the post-traumatic pandemic syndrome and especially the young folks, how they’re going to react to that lack of social isolation. If you remember what we always talk about in the Roaring Twenties. People don’t recognize that the Roaring Twenties were a direct result of the Pandemic of 1918, 1919, and 1920 because just like now, people that were single were dating, different technology, and that thing. A lot of us think that it’ll be a wild time early into the ‘22, ‘23 when we are less. We’ve vaccinated about 50,000 people and we now have a model where we can digitally give you a vaccine passport. What you’ll start to see is you want to go to the Philadelphia Eagles game, I need to see your ticket and I need to see your digital vaccine passport.
It sounds like hanging out with somebody who’s vaccinated doesn’t mean that you’re not going to get it from them. It’s a little bit concerning because it sounds to me like people who get vaccinated are going to be a little bit more willing to get on a plane, hang out in places they were not going to hang out before because they know they’ve got a much lower chance of getting it but because of that willingness to go in public, on a plane, in a store, or wherever it is, they still can get it and give it to somebody else, but not be affected by it.
I look at it differently a little bit. Everything is a risk-benefit and we got to get back to a normal life. The fact is, I want people to go to places and wear a mask. I still travel quite a bit. Right now, I wear an N95 mask and a face shield. Once I’m vaccinated, I’ll probably just wear a regular mask. I want families to get together next Thanksgiving. It’s a whole different ball game if you’re getting together with your family next Thanksgiving when you’ve all been vaccinated than it was this 2020 Thanksgiving. Again, when you’re not eating or whatever, wear a mask even this Thanksgiving if you’re together with a lot of people. I do think we have to reopen restaurants, social gatherings and schools. Having most of the population vaccinated is going to give people a level of confidence, not cockiness. To me, that’s the difference.
Another thing that’s going to give people confidence is going to be the antibody test which I assume is getting more accurate and more clear as we go on. Is that true? Do some of us get it? We don’t know it and eventually, we’re going to find out we have the antibodies. That’s a good thing.
A lot of folks but even if you’ve got it and you get the antibodies, I was still getting the vaccine. At the end of the day, a lot of this is that we don’t know is if you got it, how long do you have antibodies for it? We think that with the Pfizer and Moderna vaccine, you’re protected for at least a year. We don’t know if you’ve got a mild case of COVID and you have antibodies. If it was mild, does that mean your antibodies are milder? Those are all things we don’t know. We advised everybody to get a vaccine whether they’ve had COVID or not.
Is the antibody test more readily available and more accurate now than it was?
That’ll become a little less relevant once we get most of the folks immunized. It’s a little bit like everybody talks about when we went to the moon, NASA created some things like Tang. The COVID thing has created some stuff. We’re getting involved in some companies that are now doing a lot of blood tests at home. The best way to look at it is almost thoroughness done right. The concept of you having at home a little thing that you could take some of your own blood, sticking it in, and see how you’re doing.
I think it’s becoming more of a reality. Some of that came out of the COVID technology like the acceleration of telehealth. I do think that one of the things, as with any crisis will be, what technologies were developed in bioprocessing, virtual health, connected care, or in some of these getting things closer to home that will accelerate some of the things that I talked about in your first episode when I talked about healthcare aide address being something we wanted to push.
This is naturally segueing into us talking about the future of healthcare. My last question about nowadays healthcare is, it sounds to me and it looks to me that the cures or the treatments for this are getting much better. People are starting to learn better about how to treat people when to put them on ventilators, and stuff like that. What’s the latest with your health system at least on what you guys have learned and what you’re treating people with?
The triple cocktail, if you will, it’s what President Trump got but that’s the thing that makes the most sense now, Remdesivir, steroids, and monoclonal antibodies. One of the things that we worry a little bit about is variants that we’re seeing out of the UK and South Africa. The monoclonal antibodies are very specific. While the vaccines might vaccinate you against them, if you get one of those variants, it’s not clear that the monoclonal antibodies will be as effective. That’s one of those things that we’re looking at. One of the things that if you get past all the politics and all the horrendousness of what happened this 2020, what science has been able to do is amazing.
Operation Warp Speed of getting rid of some of the regulations and getting a novel vaccine has never been created before together in six months and get it distributed. The biggest failure and again, not to be political, is the government is not prepared to run complex things. At Jefferson, we have 10 counties and 2 States and everyone has different regulations. By the way, if I followed any of them, it’s counter to what the federal government does. I have a house in New Jersey, Florida, and Pennsylvania, and all three of them have incredibly different things.Disruption is painful for those who don’t want to change. Click To Tweet
All three of those governors are talking about how brilliant they are having done the opposite things. I was on a cable news show, I said, “The pandemic has proven that Bernie Sanders was 100% right about the problem and the pandemic has proven that Bernie Sanders is 100% wrong about the solution. The pandemic has proven that we have sick care fragmented, expensive inequitable, and occasionally unsafe healthcare delivery system. He gets an A for that.” The epidemic has also proven to let the federal and state governments get together and they’ll run all of our healthcare. I don’t think we want to do that after this vaccine distribution.
When I read and I talked to you about all the things you’ve done and doing for the future, one of the things you’re doing now when you speak which I love is you’re painting this picture for looking back a couple of years. You’re going to about 2030 and you’re basically saying, “This is where we’re at now. If another pandemic comes up in 2030, we are going to handle it so much better. We’ve learned so much. Our patients are so much better taken care of and prepared now as is the healthcare system.”
The interesting thing is you are predicting all of these technologies, you were planning on, and investing in all of these technologies years ago. I know people were even calling you a little bit crazy because of how much money you were spending on telehealth and other things you were preparing for your hospitals to be able to do with your patients. You have the floor, take it from there. It’s amazing what’s going on now with you guys and some other people in the healthcare world. Where is this all headed? Tell us all about it.
You mentioned Steve Jobs. I had an opportunity to work with Apple back in 2007. I ran their first digital health conference. I did steal a lot of Jefferson’s strategy from Steve. If you think back pre-iPhone, 3% of the computer market, the stock was $15, that was 27 splits ago. I did not keep my options or I wouldn’t go with you but if you think about it, he talked about the old math of computers and operating systems, and the new math of this digital lifestyle. For the folks that worked at Apple, are you crazy? Our whole revenue is computers and operating system. We can go from 3% or 4% of the computer market if you invested more in the Mac. What are you doing with this crazy stuff?
At Jefferson, when I got there in 2013, I talked about the old math of academics and clinical hospital care, the new math of innovation and strategic partnerships. It was the same mentality. All we are as a hospital and the university are like, “What are you talking about?” I did invest $30 million in telehealth back in 2012. It’s like, “You’re crazy.” What was a genius about Steve is thinking about what’s going to be obvious ten years from now and doing it now? To your point, what we’ve developed is the pandemic of 2030. The pandemic of 2030 starts in Australia. For about 30 seconds, people are worried. They were my age. Now, we don’t have to worry about it. Why? First of all, everybody has broadband because of the Broadband Act of 2025 when they made the Comcast of the world make sure it was like electricity and plumbing.
Everybody has broadband so we didn’t have to worry about underserved folks not being able to educate their kids or having telehealth. By the way, 80% of healthcare happens at home now. Your wearable is transmitting data. When you’re sleeping, if your temperature goes up, it automatically sends a note to your employer that you’re not coming to work that day. Since you have all your lab tests at home, you automatically are getting yourself a COVID test. When you go on to Alexa and say, “Could you play the daily podcast?” Alexa will say, “Before we have that, you have this new variant of COVID.” It’s early. “Don’t worry. I’ve already sent a note out to your doctor. They’re going to drone deliver the medication to your house.” All this stuff is in development as we speak.
What we did is we developed the Pandemic of 2030. If you were psychologically traumatized thinking back to 2020, your bot psychiatrist at 2:00 in the morning would be happy to help you through it. At the end of the day, 90% of your health care is at home. The example I always like to use is, 40 years ago, we would have been talking about you and I can’t deposit our checks on the same Friday because banks were open from 9:00 to 4:00 and there would have been big lines. We don’t worry about that anymore. There’s a variety of things that have happened that banking is now democratic and happens at home. Healthcare will get that to that point.
Doctors are the last major industry to adopt these technologies where they’re interfacing with their customers at home.
At Davos in 2019, we’re having a cup of coffee, the CEO of one of the big finance companies said, “Steve, several years ago, the two sectors that escape the consumer revolution were banking and healthcare.” He didn’t take a sip of his coffee and he said, “Now, you’re alone.” Do you know what’s interesting about it? Who transformed banking? It wasn’t the Wells Fargo’s and the bank of America’s, and it wasn’t the digital transformation. What it was the banks were stuck in this 9:00 to 4:00, you have to come to the bank.
Remember what happened is smaller entities started to create these banks and supermarkets. There wasn’t the digital stuff on Saturday and Sunday. The big guy said, “Who’s going to go to Joe’s bank in the supermarket?” It turned out that the FDIC insured them the way they did in Wells Fargo and Bank of America. Once you had that explosion of convenience mattered, then everything else came into the floor. The same thing’s going to happen in healthcare. Consumers are going to have their, “I’m not going to take it anymore,” moment.
Let me give you an example in my specialty. I’m an obstetrician. There’s now technology that if you need what’s called non-stress testing, checking out your baby three times a week, you can do it at home. Think about a 28-year-old pregnant person. One of the things that people don’t realize is we view everybody as a patient. Ninety-seven percent of people in Philadelphia are people who want to be able to thrive without health getting in the way.
A 28-year-old pregnant person does not view themselves as a patient so she’s going to go, “Let me get this straight, Steve. You want me to come down to Jefferson three times a week, pay $35 to park, go to a place where there’s a lot of sick people, and get in an elevator. You’re going to stick a monitor on me. I’m going to stare at the ceiling for two hours and some nurse will tell me my baby is okay. I happen to know there’s this company out there that literally will send me the monitor. I can do it at home, watch little fires everywhere, drink lemonade, have somebody come on the screen, and tell me I’m okay. Are you kidding me?”
Just like the banks in supermarkets, originally, the Wells Fargos and the Bank of Americas will say, “That’s crazy,” but people went there. You’re going to start to see that thing happen. We’re already seeing that where people are ignoring the traditional healthcare ecosystem. The difference between Jefferson and maybe some others is I’m not fighting it. If you come to my office, we want to be a 196-year-old academic medical center thinking like a startup company. The book that I wrote with Hemant Taneja who’s the Managing Principal of General Catalysts called UnHealthcare: A Manifesto For Health Assurance, a manifesto for moving healthcare from a sick care model from the hospital to a home model at home. Again, it’s very similar to banking and retail. I don’t want to be Sears and Penney’s when Amazon comes in.
Talk a little bit more about one of the most important points you make that right now, we’re in the sick care model. How is that going to transform? Talk a little bit about the technologies, what hospitals, and the interaction between doctor and patient it’s going to be like. It’s already happening right now. This isn’t 2030. This is happening in 2020 with you guys.
One of the companies we talk about because we partnered with Hemant on this company. Hemant was the initial investor in things like Airbnb, Warby Parker and Stripe. If you think about those three things, they were all things that democratize. It’s not the arcane way of getting what it cost to go to a hotel. It used to be if you wanted to build a bigger, better hotel chain in America, you have to spend billions of dollars to build bigger, better hotels that connect to people. He wrote a book called Unscaled. The 20th century model of bigger and better mass production things is going to be personalized and customized. He said, “I want to do that with health.” That’s why we partnered. What everybody says, which they always do, “You can’t get into health. It’s too complicated.”
He started a company called Livongo, which we were initial partners at. Long story short, Livongo sold to Teladoc for $18.4 billion. What all Livongo does is take diabetes, the most common chronic disease in this country and say, “You’re not a patient. You’re a person who wants to be able to thrive without diabetes getting in the way.” “You’re right. My doctor treats me like a patient. He tells me to come to the office, to the ER and the hospital.” That’s what they did. They created an AI company that made it easier for patients to run their own diabetes, be viewed as normal and tell them when they do need to go to the doctor. Part of what we talk about is what I believe in is we have to get away from this, “I am the doctor and I am the boss,” to the patient being the boss.
Are you even sick enough to be in this office seeing me right now or are you wasting my time?
My car gets better care than I do. This is a true story. My car is in the garage and while I’m sleeping, it’s monitoring itself. I wake up in the morning, I turn it on, it says, “Steve, while you were sleeping, my left front passenger tire got a little low. Before you go to Starbucks, could you go and fill it up?” In two weeks, I’m going to go for a physical and my doctor is going to tell me, “On February 9th, Steve, your blood pressure is X, your EKG is Y, your calcium score is Z. This is what I want to do for the next two years.” That’s not the 1990s, that’s the 1890s. That hasn’t changed. The term physical means, “I’m going to spend an hour looking from here on down. Your brain health, that’s something else. You can go to the alternative health provider for that.”
Bernie Marcus who was one of the founders of Home Depot has invested a lot in Jefferson and this whole Marcus Center for Integrative Health and brain health. A holistic piece of, “We want to look at you on an ongoing basis.” The future, which isn’t very far away, is going to be, “I’m going to be sending continuous data out. An AI will filter it.” People will never die, for example, of atrial fibrillation because while I’m sleeping, if my heart rate goes up above 200, it’s going to send out a signal, it’s going to wake me up and an ambulance will be on its way. We’re partnering with companies that do that now.
We started a wearable. I merged my health science university with a design university. Everybody thought that was nuts. It turns out the design of the human experience in healthcare is pretty important. One of our most successful financial things has been developing a carbonized temp wearable that is now being developed by Nike, Under Armour, and others to start that concept. Your Apple Watch and your Oura Ring will be like, “Why would you have that?” When you run, your shirt will monitor your miles, heart rate and all that. You don’t need four different things. Remember, the old car telephones that two people carry them.“Of all the forms of social injustice, healthcare inequities are the most shocking and inhumane.”– Dr.Martin Luther King Click To Tweet
You had the iPod and then you had your phone. Now, it’s inside the phone.
What happened is part of what you’re wearing will constantly monitoring you.
You said there are 4 or 6 different things you can own that can monitor different things, but what are the things that we can monitor at home right now in 2021 that can help people with COVID and its heart rate? What else is it?
The major things are, if you have diabetes, there are companies like Livongo. There are companies looking at serious mental illness and preventing re-admissions. This is an important piece, one of the huge issues is what privacy are you willing to give up for these people? If you take the serious mental illness thing, let’s say, I have schizophrenia and I’ve harm myself or harm somebody else. I was in the hospital and now I’m on whatever medication. Remember the Minority Report, the movie, there are ways that we can now predict. If you’re willing to give us all your data of what you’re doing on Facebook or whatever. People that are going to go off the deep end, volunteer to do that.
In places like Israel where they monitor folks because of terrorism stuff, they had a much better idea of what was going on with COVID. Here, for some good reasons, people don’t trust Google. The key with a lot of this stuff is going to be, what amount of privacy are you willing to give up on your health? You asked how you make a difference. We did a partnership with a company, one of Hemant’s company called Color where we offered every 1 of our 30,000 employees full genomic testing and prediction. What we promise them is that they would get the data. We wouldn’t even give it to their doctor. They would have to give it to their doctor. We certainly wouldn’t use it for research or anything like that.
I’ll give you the best example because it ended up on TV. It turns out this woman has a rare disorder that with too much exercise, she’ll die. Her mom and her grandma died in their 40s and they never understood why. It turns out she was about to train for a marathon and that saved her life. Now she knows she had that genetic disorder. She tested all three of her kids and it turns out one of them has it That’s lifesaving. It’s something about a lot. We created something called a Center for Responsible Innovation. How do you put ethics at the beginning of this? How do you make sure that if you’re one of my patients that I have access to your genomics but then I’m not going to use it to sell it or it’s not going to be hacked? To me, that’s the thing that we’re spending the most amount of time on making sure that AI, which can be good, bad and ugly stays good.
That is some deeper stuff but the truth is that a lot of people don’t even know what their sodium level is or their sugar level is or their blood pressure is as often as they should. In the very near future, we’re going to know this every day, all day long.
The two things that will happen are that you will be able to monitor most of the things that you need to monitor at home. This is not science fiction. In fact, they’re out there now doing COVID tests but these commercial blood tests that will be able to measure your sodium just like Livongo can make it easier for you to keep track of your diabetes and what to do with it. You take that together with telehealth and then you maybe bring it together with virtual voice assistance, they’re getting all of that and then giving you instructions.
If you look at what CVS is doing or why Amazon bought PillPack, the concept of you no longer having to go to the pharmacy. “My temperature went up. It looks I have this. I’m going to do a blood test or a strep test at home and I need this antibiotic. I go to Alexa, ‘Please order this antibiotic,’ and it comes to me that day.” That’s not science-fiction. Every one of those components exists now. At Jefferson, if you walk into my office, you’ll see that I have a vision. The way we envision Jefferson is to meet the needs of patients as close to home as possible the way they consume every other consumer good. The day after Thanksgiving, you don’t go to the crowded mall parking lot. You do it at home in your pajamas, watching Game of Thrones. The key is to get healthy as close to that as possible.
It sounds like a lot of industries still have a lot to learn with this thing and the major industry of healthcare is the last major one to start adapting this. The pandemic in a lot of ways has rapidly fast-forwarded to that. We’re getting to a point now where we’re going to be able to look back and say, “If it wasn’t for COVID, the 2020 pandemic, a lot of these things that we enjoy now, freedoms and better health in 2025 and 2030 are going to be because of what we had to accept and start to use as far as technologies, monitoring, personalizing and making the access to the doctors better, all of that.”
If I was President Biden, the first thing I would do is create a 9/11 commission for healthcare because the problem becomes it’s easy to rubber band back because there’s a lot of corporate interests and money to go back to the old system. Telehealth is already going down because some insurers are saying, “I’ll pay the doctor $250 for an in-person visit. I’m going to pay $49 for televisit.” The government said, “You can’t do that during COVID for obvious reasons.” As long as I’m making money by having sick people come to my hospital as always, the insurers get paid $0.17 on the dollar to make sure that the people that pay for the care get the care and provide the care, can’t talk to each other so they can send out 27-page things and say, “This is not a bill.”
As long as pharma is getting retail from CMS and dermatologists and orthopedists are making fifteen times what primary care docs are making, what we tell the primary care docs is, do you want to be the quarterback? As long as that happens, the folks in the system are not incentive to change everything. If you think about 9/11, we love the ability to be able to run through the airport and get there in eight minutes. When 9/11 happened, the Democrats blamed the Republicans and vice versa. At some point, they got together and said, “We failed to keep the country safe.” What needs to happen now is we have to say Democrats and Republicans, “We failed to give everybody access to healthcare and all we’ve done with the affordable CARES Act and some of these other things give more people access to this broken, fragmented, expensive and inequitable system.”
Philadelphia has six academic medical centers. We have the greatest discrepancy in life expectancy, five miles on either side of the Rocky statue. That’s not something we figured out. In 1966, Dr. Martin Luther King in Philadelphia said, “Of all the forms of social injustice, healthcare inequities are the most shocking and inhumane.” We haven’t done any better in many years. In fact, if you want multiple-choice tests and say in Philadelphia, your greatest chance of getting COVID and dying from it was A, wearing a mask, B, social distancing, C, your genetic code, D, ZIP code. The answer would be your ZIP code.
Do you have broadband? Do you have the right food? Do you have an education? Do you have appropriate housing? That’s what matters. If you haven’t eaten the right food, your obese, you’ve got congestive heart failure, you don’t have the right heating, and you don’t have broadband, your kids, aren’t getting educated, and you can’t do telehealth. By the time you show up at the hospital, the chances are you’re going to need a ventilator and die. If you’re a Caucasian person that lives in the suburbs and you’re on JeffConnect and you’re checking everything out on Google. You eat healthy, you do get COVID and your telehealth person tells you what to do, your chances of getting out of it and leaving the hospital are five times greater than that first person. That shouldn’t happen in the United States. The way to get out of that is to literally democratize it like other industries have done. People can shop and travel easier. Even the iPhone has democratized finance for people. Things like Vanguard made it easy for somebody who has $10 to save to be able to buy a stock.
Those are the kinds of things where digital changes help everybody. That’s what we’re excited about in healthcare. How can I get rid of food deserts? Think about food deserts? I can walk to a Trader Joe’s and Whole Foods in my ZIP code. There are certain ZIP codes in Philadelphia that the only thing they can walk to is a bodega selling corn chips and soda. What if you’re willing to serve your family healthy food and give you 30% more government electronic food transfers? What if we drone delivered that food or Instacarted that food? No more food deserts. I’m passionate about how do we use technology that exists now to disrupt the way that we provide healthcare.
You’re doing that and you’re leading the way in that regard. There’s so much more to what you’re doing than what we’ve been able to scratch the surface on. To me, this is very inspiring that there are a lot of people and healthcare systems like yours that are looking at the future in a way where it’s going to be a much better place for us all to live. We’re all going to be healthier, know our status, there’s not going to be things we find out and it’s too late and we’re going to be able to better monitor ourselves going forward. Thanks to people you and technologies.
I’ll leave you with this. At the beginning of our book, UnHealthcare: A Manifesto for Health Assurance, we say, “What if a Silicon Valley entrepreneur and a CEO of a traditional academic medical center walked into a bar, got married and had a kid? What would that look like?” That’s what we’re talking about. The other thing we say in that book is my definition, “Disruption is painful for those who don’t want to change.” I use a series of Penny’s examples before. I always tell people, I want to be Target and Walmart because when Amazon disrupted that industry, Sears and Penny said, “What a stupid fad. We’re going to make stores.”
Things like Circuit City said, “We got to go all E.” They couldn’t compete with Amazon. Target and Walmart said, “We’re good at what we do but we also have to compete in this world.” To me, if somebody, God forbid, has pancreatic cancer and we’re one of the top places in the country, I need my hospitals and I need my surgeons to do what traditional academic medical centers do. That’s never going to be E/ but if somebody has got a chronic condition or somebody’s got diabetes, I want them to be able to access Jefferson as a person, not a patient. The same way they can access Amazon or Airbnb.
Not wait until it’s too late when they’re sick to have to then go in. They’ll know they’re heading in a sick direction first before that happens. Thank you for your time and everything you do. It seems to me, with people like you in our healthcare system making decisions, deciding to innovate and disrupt that the future of healthcare is a good place. Years from now, in 2030 like you envision, is going to be a much better place to be. I’m looking forward to getting there with you.
If I was a really good futurist, when I did your first episode, I would have talked about, “Be aware of the pandemic.” I don’t get it all right.
Thanks so much, Stephen. God bless you and all your people working for you out there.
Thank you, Chris.
- Dr. Stephen Klasko – Previous episode on YouTube
- Thomas Jefferson University
- Jefferson Health
- UnHealthcare: A Manifesto for Health Assurance
- Patient No Longer: Why Healthcare Must Deliver the Care Experience that Consumers Want and Expect
- Bless This Mess: A Picture Story Of Healthcare In America
- Stephen Klasko
About Dr. Stephen Klasko
Dr. Stephen Klasko is a transformative leader and advocate for a revolution in our systems of healthcare and higher education. In 2020 he published, UnHealthcare: A Manifesto for Health Assurance – in which he and Silicon Valley’s Hemant Taneja describe a new future for health care focused on keeping people well.
As President of Philadelphia-based Thomas Jefferson University and CEO of Jefferson Health he has steered since 2013 one of the nation’s fastest growing academic health institutions based on his vision of re-imagining health care and higher education. His 2017 merger of Thomas Jefferson University with Philadelphia University creates a pre-eminent professional university that includes top-20 programs in fashion and design, coupled with the first design thinking curriculum in a medical school, and with the nation’s leading research on empathy.
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