What healthcare will look like in 2020 | Stephen Klasko | TEDxPhiladelphia

Translator: TED Translators admin Reviewer: Queenie Lee Well, I want to thank you all for coming, and especially the people that came from outside of Philadelphia that hovered over here; especially those of you that time-traveled from other decades and times.
I’m Steve Klasko. I’m the CEO of Stevie’s Vinyl Emporium and Implantable Health Chips in South Street in Philadelphia. (Laughter) That’s what I am today.
But for the past ten years, I’ve been the presidency of Thomas Jefferson University in Jefferson University Hospital System that literally was one of the pioneers along with several others for what is now called the leaders of the optimistic future in Healthcare Revolution from 2015 to 2024.
So for those of you who are coming from another decade, or for those of you who are here in the 2020s, I’d like to talk a little bit about how that journey happened and maybe give you a little bit of the personal story about how it happened for me.
So first one of the things that we did, is we got tired of whining, and we decided let’s just travel to the future, think about what we want and then create it. For me, that started in 1977. Very important time for me, I was a senior medical student.
It was important because I got asked to give a talk for TED. Now not the TED you’re thinking of because TED didn’t exist in 1977. It was called tomorrow’s education of doctors. It was everything different than the technology that exists today.
It was a little slideshow 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. I remember it for 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 fee-for-service system, so we’re really rewarding 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 look like. (Applause) (Cheering) Thank you. That’s called a leisure suit. (Laughter) 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 in 1968 GTO which was and is a very cool car.
Thank you. So then we went through really what some people called the middle or dark ages, the Managed Care Revolution, which did not really manage anything. It didn’t really provide care; it just promoted underutilization – the balanced budget amendment, which didn’t 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 System combined.
It was also a big moment for me because it was the second time I saw them. This is what the Rolling Stones looked like back in 2014. (Laughter) And in my inauguration I was given a script, and what I talked about my inauguration in 2014 is: “Hey, can we do anything about spiraling costs?”
Can we change the fee-for-service? Do you think we can measure outcomes? That was a bit of an a-ha 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 were.” 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 at 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 on 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. (Laughter) I thought the Rolling Stones, the Rolling Stones rocked, (Laughter) (Cheers) 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. (Laughter) But more importantly, more importantly, what happened in Philadelphia, what happened at Jefferson was, that we took that mode of saying – people said that it’s impossible to change healthcare.
And really the personal piece, for me believe it or not, didn’t come from Maimonides 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.” OK, so here it is, it’s March 28th, 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 28th, 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 up for one last Indiana Jones sequel, (Laughter) 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 Super Bowl since the unprecedented fourth straight they won from 2015 to 2018, the so-called Chip Championship Years. (Applause) (Cheering) Of course, Governor Chip now has a very different job than he had back then.
But more importantly or as importantly, Jefferson is celebrating its 200th anniversary as an international hub of innovation, with headquarters in Philadelphia, instead of just the Philadelphia academic medical center.
We’ve become a destination site for innovative 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.
By the way, I’m getting out of my DeLorean to accept an award from the US News and Interplanetary Report. As most of you know in 2019, we found two other planets with slightly dysfunctional health systems, so they are now part of the ranking system that the former USNWR used.
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 may not 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, communicative, and creative. As my kids would say, “Duh.” (Laughter) (Applause) 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. (Laughter) 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 on what in 2014 we called iPhones and Androids, but really what we needed were 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, Contemporary Art Museum, 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, “Well, that’s a woman; that’s a snake; that’s a family.” But when you started to look and say, “What is the story?”, it started 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, work closely with multidisciplinary care-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 needed 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&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 television show 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 left 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?
(Laughter) 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 WHO, which stands for Watson Hybrid 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 … (Laughter) By the way the first season of Doctor WHO is available on Google Glass implantable chips, available at Stevie’s Vinyl Records and Implantable Chips on South Street. (Laughter)
So 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. Female: What’s wrong? Stevenson: I don’t feel so good. F: Then you need to go to a doctor. Female nurse: Mr. Stephenson? S: Stevenson. FN: 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 or diabetes? Doctor: And what seems to be the problem today, Mr. Stevenson? S: I’m feeling a little stuffed up. I’m experiencing some … FN: Doctor, your 3 o’clock is early, your 2:45 is late from 6 and 7. D: Follow these instructions; if it doesn’t clear up in a week or two, come back; we’ll do this all over again.
(Moaning) S: I don’t like going to a doctor. SK: So in July of 2014, we partnered with some great companies, created an innovation-driven ecosystem for healthcare. Starting in 2015, patients in 48 states could access Jefferson doctors via telemedicine. S:
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’ve 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. D: Hi Allen. I see you’ve been experiencing some congestion and some nasal blockage. How long has this been going on? S: During the visit, the doctor can see your health information, afterward, you get a complete write-up of everything the doctor says.
D: It looks like acute sinusitis, a sinus infection. Now I wrote you a prescription to help with congestion. If things don’t clear up in, say, a week or so, just send me a message, I’ll be right here. S: A few mins later, I’ve got my diagnosis and my instructions for treatment and my prescription is already waiting for me at the pharmacy. SK:
Of course, all that now happens in your Google Glasses which are available by the way at Stevie’s Vinyl Records and Implantable Health Chips. We also recognized 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 2014 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, Entrepreneurship and Scientific Solutions.
We said, “It really doesn’t make any sense that Nick Foles has a better idea of 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 modeling and created a predictive analytics and mathematical modeling to reduce uncertainty in 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 modeling 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 extensiveness, 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. 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 ten years? 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, and 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; 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-gain 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 also 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, or five year. We measure individuals’ professional and personal happiness at varying intervals 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, (Laughter) (Applause) which would have been unheard of in 2014 when they were all cannibalizing each other.
And we have an entrepreneurial quotient where institutions are rewarded 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 the reputational score in the past. Now it’s based on what patients think. The one I’m really proud of that we got 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 in 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-eyes factor.
And this is really exciting because what it is, is every patient now, in 2024, basically when they get in the hospital is 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 whether 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 & Casino on the Schuylkill River. (Laughter) And some things from the past really are good.
I’m going through my third midlife crisis because I’m 70 and what happens is people live to 120, so midlife crises have changed. And I’m proud to say this is what I got myself, I was able to retrofit a GTO to hit the standards for a 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 traveling in time and space, and most importantly, stay healthy in Philadelphia. Thank you very much. (Applause) (Cheering)