“A variety of analyses show that about 5% of patients account for 50% of the money we spend as a nation on healthcare. It turns out that the 5% actually need what’s called “complex care” — not just acute care, or help with a chronic illness, but complex care that includes mental health, physical health and social health. We continue to create siloes of payment and licensure between social work, mental health workers, and clinicians who focus on physical illness. People who fall into the 5% often have issues far beyond a pill or a surgery.”
As a part of my interview series with leaders in healthcare, I had the pleasure to interview Dr. Stephen K. Klasko, CEO of Jefferson Health and President of Thomas Jefferson University.
Dr. Klasko is a transformative leader and advocate for a revolution in our systems of healthcare and higher education.
As President and CEO of Philadelphia-based Thomas Jefferson University and Jefferson Health since 2013, he has steered 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 created 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.
His track record of success at creating and implementing programs that are shaping the future of health care earned him a place on Modern Healthcare’s list of the “100 Most Influential People in Healthcare” and “Most Influential Physician Executives” in 2017. That same year, his entrepreneurial leadership and success at recruiting helped Thomas Jefferson University Hospital achieve a #16 ranking — and elite Honor Roll status — on U.S.News & World Report’s Best Hospitals list.
His 2018 book is titled, Bless This Mess: A Picture Story of Healthcare in America — an account of how the USA was elected to the Intergalactic Council of Cool Health Systems by 2035.
Thank you so much for joining us Dr. Klasko. Can you tell us a story about what brought you to this specific career path?
I grew up in South Philadelphia when the coolest job was in music. Truth is, I really wanted to be a disc jockey and spin records, but my dream job as a DJ on a Philly radio station was short-lived. It helped, however, that the head of admissions when I applied to medical school was a fan. That love of music, especially Philly Soul, still reminds me that creativity is the greatest skill a doctor can have. We are undergoing a generational change in healthcare, but we still teach doctors to be risk averse. We still stifle their creativity. But it is those doctors who are confident in their creativity who will design the next future for healthcare — a future we need immediately. Sadly, healthcare in America remains stuck with Star Trek-level medicine — incredible innovation — grafted onto a Fred Flintstone delivery system.
Despite our medical accomplishments, we have a system that is fragmented, expensive and inequitable. I believe we need creative people to take a “no limits” approach to radically transform American healthcare.
Can you share the most interesting story that happened to you since you began leading your company?
Jefferson Health was the host medical system for the Democratic National Convention in 2016. It was fun to hear speakers talk about Philadelphia as such a great city, noting how it hosts six major academic health centers, marvelous universities and great hospitals. But the next month the newspapers had a story about how Philadelphia is the worst major city in America for the gap in longevity between two zip codes — 20 years. Baltimore is almost as bad. And it struck me: Simply having major health centers doesn’t make cities healthier. The idea that we are “anchor institutions” for health has failed. Our institutions must now transform how they teach and do research about the cities they live in. We need a curriculum for city health, and we need sustained research. Universities can do better.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
The story is a little long — as a medical student using the stethoscope wrong and getting called out by the patient in front of the attending. But I did learn one key thing. It doesn’t matter how nervous or tired or upset you might be at other parts of your life, when you go to see a patient, you must deliver “the performance of a lifetime.” I’m an obstetrician, so that visit may indeed affect the lifetime of a baby. Even as a president — you should try, you can fail, but you can’t show up not ready to deliver your best.
What do you think makes your company stand out? Can you share a story?
We’ve become the 195-year-old institution that acts as a startup because I believe in a “no limits” approach. We started in 2013 with one major hospital — the excellent Thomas Jefferson University Hospital — and two smaller attached hospitals. That size made it hard to imagine a new world of value-based payments. We’re now 14 hospitals, with talks that could move that number higher, and finally in a position to take care of the health of populations — as the largest provider of hospital beds in greater Philadelphia, but with hospitals throughout southeastern Pennsylvania and southern New Jersey. At the same time, we merged our historic health sciences university (including America’s fifth oldest medical school) with the former Philadelphia University, which boasted excellence in design, architecture, and the #3 fashion program in the nation. That expertise in design thinking gives us the capacity to think about creating a new future. We have, and we’re proud of, the first design thinking curriculum in a medical school, the design for a park folded into a truck and delivered to vacant lots, smart rooms in hospitals, textiles that will make your shirt the next wearable, and much more. Creative collaborations win.
What advice would you give to other healthcare leaders to help their team to thrive?
Always have five people, who work for you, who believe they could do your job — and at least three who are right. This is not the time to coast. This is the time for people who see the future to get about the business of designing it.
Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
Let’s start with federal policy, or as I call it, the popsicle stick and glue patchwork of policies. We can’t get our act together. We can’t decide who has access, whether we can negotiate pharmaceutical prices, whether we’ll pay for value-based care, why providers cannot talk to those who are paying …it’s an endless list of major questions all shaped by constituent-based political considerations.
When I was getting my MBA at Wharton, I came to appreciate the thinking of Wharton’s William Kissick, who helped write the original Medicare/Medicaid legislation in the 1960’s, and then wrote the book: “Medicine’s Dilemmas: Infinite Needs Versus Finite Resources.” That title is still true. Kissick believed there was an “iron triangle” of quality, cost and access. If you increase any one of those, you must increase or decrease at least one of the others. Our job is to break the iron triangle, and I believe the only way to do that is to embrace a series of painful and transformational disruptions. We must embrace the consumer revolution. We must embrace “healthcare with no address,” using all the tools of wearables and telehealth to provide new access regardless of income. We must demand an end to health disparities. We must use technology to support health for individuals anytime and anywhere.
My hope is that we soon talk less about self-driving cars and more about self-healing humans.
You are a “healthcare insider.” If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
I always start with the DNA of healthcare: The providers themselves and how we select and train clinicians. We still select and train doctors based on MCAT scores and biochemistry grades. Then we’re surprised that physicians aren’t more communicative, creative and collaborative. My research at Wharton showed that compared to other professionals, doctors tend to be biased toward autonomy and hierarchy, and are taught to be risk averse. This explains a lot of burnout — if you believe you’re creative, then change in healthcare is exciting. If you’re risk averse, change feels threatening.
Hotspotting: We face a crisis in this country because we are not educating a clinical workforce able to tackle complex care. We will not solve the issue of rising costs without solving complex care.
Here’s the opportunity: A variety of analyses show that about 5% of patients account for 50% of the money we spend as a nation on healthcare. It turns out that the 5% actually need what’s called “complex care” — not just acute care, or help with a chronic illness, but complex care that includes mental health, physical health and social health. We continue to create siloes of payment and licensure between social work, mental health workers, and clinicians who focus on physical illness. People who fall into the 5% often have issues far beyond a pill or a surgery.
At Thomas Jefferson University, we launched a program to teach “hotspotting” to interdisciplinary teams of students — to identify super-utilizers, and then have the team visit them. In one case, the students simply taught a homeless patient how to change their own colostomy, eliminating the need to visit the emergency room to have it done. This helps save on cost and also provides relief for the individual.
Ok, it’s very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
I’ve called for a 9/11-style commission on healthcare — a group from all affected areas of health that would acknowledge the crisis and seek solutions across the board. As we discovered with the Affordable Care Act (ACA), it’s not enough to just increase access. ACA certainly did its job, but it also increased access to a fundamentally broken and inequitable system.
In my book, “We Can Fix Healthcare in America in 2016,” we asked individuals from all parts of the system to look in the mirror and imagine what they could do differently. If you could write the history of an optimistic future, what would you write? It was interesting where consensus happened — especially around disparities. People from all walks of life know healthcare is inequitably distributed. Everyone who benefits from the system knows there are people who do not benefit. I further believe that we’re closer to understanding that health disparities are part of other disparities — in jobs, education, housing, and community amenities. It’s time to make social determinants of health an action plan, not lip service.
This year, for the first time, my board has based a substantial portion of my incentives on reducing health disparities in Philadelphia. Sadly, even while we all tout our community missions, we reward our executives for increasing revenues over expenditures. As Upton Sinclair said, “It’s difficult to get a man to understand something, when his salary depends on his not understanding it.”
As a mental health professional myself, I am particularly interested in the interplay between the general healthcare system and the mental health system. Right now we have two parallel tracks mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?
I may have answered this when discussing hotspotting. Our goal has to be health in all its facets — physical, mental and social. Our history has separated those into different professions and different payment systems. We must build a workforce that understands “complex care.”
In addition, I’m intrigued by technology as a way to intervene in two major issues for mental health — teen depression and suicide, as well as loneliness among the elderly. The companies who learn how to predict a depressive episode, and then respond with texting or other digital connections, are opening new possibilities for teens who often refuse to divulge their suicidal thoughts in traditional ways. And it’s heartwarming to see older adults use robots or even just voice recognition devices as partners in getting things done.
How would you define an “excellent healthcare provider?”
I believe the future of health is “healthcare with no address.” In fact, I want the alien who lands in 2025 and asks, “Where is Jefferson?” to find no answer. You mean Jefferson in my shirt, on my phone, on my TV, in my neighborhood? Or do you mean the hospital where really sick people go?
To get there, we need a revolution in the education of clinicians. We should be selecting for emotional maturity, we should be teaching empathy, and we should be breaking down walls between disciplines. In fact, I’d love to see a “Center for Inter-Sentient Education,” where we teach clinicians to work seamlessly with a new generation of augmented intelligence.
Can you please give us your favorite “Life Lesson Quote?” Can you share how that was relevant to you in your life?
It’s a quote that appeared in an Adidas advertisement that my wife shared with me. It’s absolutely true, especially in health: “Impossible is just a big word thrown around by small men who find it easier to live in the world they have been given, rather than to explore the power they have to change it.”
Are you working on any exciting new projects now? How do you think that will help people?
I’ve become increasingly interested in the work on the ethics of artificial intelligence (AI) and robotics. Bottom line: A robot will never be moral. It cannot be. Nor can a machine be ethical while it inherits the biases of data and programming to take actions we cannot understand — deep learning. Ethics must come in the design phase. We should be teaching the ethics of AI, we should be examining biases hidden in data, and we should be willing to ask, “What is moral?”
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
I just finished “AI Superpowers,” the book by Kai-Fu Lee. It dovetails with work I’m doing with Aimee van Wynsberghe, in the Netherlands, an expert in the ethics of robotics. Check out her work!
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
Why do doctors still have banker’s hours, when even bankers are available 24/7? We need healthcare with no address, based on the idea that technology can help us create self-healing humans. Why does a car have an OnStar-style system to warn of a problem, but we don’t? I’m aware that humans are more complex than cars, and healthcare is more complex than banking, but we’re not embracing the changes we could make right now. When I write the history of an optimistic future, I ask: What will be obvious ten years from now, and why can’t we do it today?
Thank you very much for your time! How can our readers follow you on social media?
@sklasko on Twitter
About the Author:
Originally from Israel, Limor Weinstein has been anorexic and bulimic, a “nanny spy” to the rich and famous and a Commander in the Israeli Army. Her personal recovery from an eating disorder led her to commit herself to a life of helping others, and along the way she picked up two Master’s Degrees in Psychology from Columbia University and City College as well as a Post-Graduate Certificate in Eating Disorder Treatment from the Institute for Contemporary Psychotherapy.
Upon settling in New York, Limor quickly became known as the “go to” person for families struggling with mental health issues, in part because her openness about her own mental health challenges paved the way for open exchanges. She understood the difficulties many have in finding the right treatment, as well as the stigma that remains so prevalent towards those who are struggling with mental health issues. She realized that most families are quietly struggling with a problem they’re not comfortable talking about, and that discomfort makes it much less likely that they will get the help they need for their loved ones. She discovered that being open and honest about her own mental health challenges took the fear out of the conversations. Her mission became to research and guide those families to the highest-quality treatment available. Helping others became part of her DNA, as has a commitment to supporting and assisting organizations that perform research and treatment in the mental health arena.
After years of helping families by helping connect them to the right treatment and wellness services, Limor realized that the only way to ensure that they are receiving appropriate, coordinated and evidence-based care would be to stay in control of the entire treatment process. That realization led her to create Bespoke Wellness Partners, which employs over 100 of the best clinicians and wellness providers in New York and provides confidential treatment and wellness services throughout the city. Bespoke has built its reputation on strong relationships, personalized, confidential service and a commitment to ensuring that all clients find the right treatment for their particular issues.
In addition to her role at Bespoke Wellness Partners, Limor is the Co-Chair of the Academy of Eating Disorders. She lives with her husband, three daughters and their dog Rex in Manhattan.
To sign up for our newsletter, or learn more about custom mental health, click here.