Here we are in “World A,” President and CEO of Emory Healthcare says as he describes patient “Mary Jo” as one of the frequent flyers of healthcare, who suffers from multiple chronic conditions. John T. Fox said to the Dunwoody Chamber of Commerce Dec. 4 that he wants to help get to “World B,” where a connected healthcare system alleviates common stresses on patients and reduces overall costs of healthcare.
When patients with multiple chronic conditions are stabilized and discharged, they often leaves the hospital with a stack of prescriptions and a list of doctors to follow up with in addition to the followup appointment for whatever they were just in the hospital for, Fox said.
“When the Mary Jo’s get out [of the hospital] and they have all this stuff to do, their lives take over,” Fox said. She will pick and choose which doctors to follow up with based on her schedule, and she will decide which medications to fill based on their price, he added, saying he’s witnessed this happening with patients throughout the 30 years he’s worked in healthcare.
“None of her providers know what she’s doing at that counter,” Fox said, describing a woman picking and choosing which prescriptions to fill.
The pharmacist doesn’t have access to her doctors, and the doctors aren’t connected, he said.
“The nephrologist doesn’t know what the cardiologist is doing,” Fox said. “They’re not connected in IT systems, and they may do duplicate testing. That’s constantly going on with redundant lab work and imaging.”
When she doesn’t follow the doctor’s recommendations and fails to take the right medications, Mary Jo finds herself back in the hospital, Fox said.
In World B, Mary Jo would be discharged with a week’s worth of the medications she needs to fill, and she would benefit from an embedded care coordinator who would help set up followup appointments and referrals to specialists, Fox said.
“If you’re in our network, you must be connected to our information health exchange,” Fox said. So private physicians are connected. “They can see what each other is doing and that’s a big deal when you’re trying to manage these types of patients,” Fox said, noting that all records are already connected through a common IT platform. If a patient goes to a primary care physician in the morning and is admitted to Saint Joseph’s in the afternoon, the records are available.
The Emory Healthcare system is the largest network in Georgia, Fox said. It includes seven hospitals, staffed by about 16,000 employees and 1,300 physicians. Fox said the network is a product offered to insurance companies, and he said the future of healthcare may involve choosing not only an insurance provider but also a network.
A goal for Fox involves changing from a fee-based service industry to one that values quality and performance, he said. “Performance-based contracting is becoming dominant,” he said. The business sense lies in ensuring patients are treated well, not just “good enough” or “surviving,” he said, and that “avoidable costs” are reduced. The cost of healthcare involves everything from the redundant lab test to the equipment needed in hospitals, and Fox said that things like “space suits” for nurses treating Ebola patients won’t be cut, but the common IT platform will reduce redundant lab tests.
During the rest of his keynote speech, Fox listed three “life-changing solutions” at Emory Healthcare. Deep-brain stimulation involves treating patients with severe depression, Parkinson’s or epilepsy. Fox described “flu-microneedle patches” as “Band-Aids” that work to distribute flu vaccines. A third life-changing solution Fox mentioned involves using bone marrow stem cells to treat heart attack victims and help regenerate lost heart tissue.
Fox spoke proudly of the work done to get two of the system’s hospitals Magnet recognized, a benchmark measuring the quality of care patients can expect to receive. He added that his goal is to get all seven hospitals in the Emory Healthcare system recognized, which has never been done in any healthcare system Fox said. He also spoke about the decision-making process to accept the first two Ebola patients in July, saying 75 percent of the decision involved ensuring the staff and surrounding community would be able to help the patients safely.
Elected officials Senator Fran Miller and Dunwoody Councilman Denny Shortal sat in the audience of about 25 members of the chamber of commerce,and they each asked Fox a question after his key note speech. Shortal expressed concern for the marines who “don’t know anything about Ebola,” and ensuring their safety in west Africa. Fox said the need for special housing and precautions only exist for those treating patients, not building infrastructure. Miller asked about the effect of performance-based contracting on doctors, and Fox said “In World B we still have to compensate everyone,” but Fox said that physicians who work to avoid unnecessary costs and provide great quality care will receive incentives for making the whole system better.