Kenneth L. Davis, MD, president and CEO of The Mount Sinai Medical Center in New York City and the Gustave L. Levy distinguished professor, has jumped boldly into the future of healthcare at Mount Sinai and isn't looking back. For instance, he has embraced team-based
training in education at the Icahn School of Medicine at Mount Sinai, accountable care organizations and investment in biomedical research.
On April 16, during a talk at the Aspen Ideas Festival preview event in New York City, Dr. Davis shared some of his views on where healthcare is heading. During the half hour dialogue at the Festival event, Dr. Davis addressed everything from bundled payments to supporting immunotherapy research to robotic surgery and how they all fit into the industry's future.
Here, Dr. Davis expands on the views he expressed during the Aspen Ideas Festival preview event. For a transcript of the Aspen discussion, click here.
Question: How do you see payment reform advancing away from fee-for-service in the future? What approach has Mount Sinai taken in this regard?
Dr. Kenneth Davis: Accountable care organizations, which many hospitals have become a part of, are the first step. ACOs are attractive to hospitals because they offer shared savings with no downside for the hospitals. Providers can learn how to manage populations in a way that doesn't put them at risk. As hospitals become more comfortable with programs like ACOs, and payors begin to see the benefits of aligning the best interests of payors, providers and patients, there will be gravitational pull away from fee-for-service and toward population health management.
We see increasing acceptance of bundled payments as a way to move away from the fee-for-service system.
Mount Sinai has an ACO with 25,000 members. We are generating significant savings derived from decreased readmissions and use of the emergency department for common diseases. We've been able to facilitate that with a more coordinated care program that has, as its backbone, case managers that are intimately involved in patient care. They are supported by a robust IT platform that reminds us everyday what patients need to do and that helps case managers identify problems early, before they become the kind of problem that leads to a readmission.
We're also focused very intensely on areas that we believe would prepare our organization to manage populations that are not just Medicare beneficiaries. We're focused like lasers on the quality metrics, efficiency metrics and resource utilization that we think would put us downstream into a good position to negotiate contracts with commercial payors that would include shared savings. As we start to renegotiate contracts with insurers, we're asking ourselves what we can do in behavioral health to manage the very large population we take care of and what kind of programs we can put there to decrease readmissions. Our nation's frayed social service network leaves a hole in the community that our patients can fall through. We have to partner with community programs that can provide housing and some level of supervision so that a chronically and persistent mentally ill population can avoid readmission. I think that's essential.
Q: How can implementing new medical school teaching strategies help build and improve team-based care?
KD: Traditionally, medical education has been about teaching the individual student how to be a great practitioner, and often that was without reference to the team he or she might be embedded in when they enter practice. We began to realize that our best physicians were team members and we had to teach skills that allowed physicians to understand what it meant to lead or be embedded and work in a team.
At Mount Sinai, we start teaching those skills [on the] first day of medical school. We put our students in groups of four and give them a list of places they have to go to. We also give them money and they must figure out collectively where they want to eat dinner. They come back to us at the end of the day and explain the process of decision-making — whether it was collaborative, collegial or hierarchal — and what worked to make them effectively manage the steps. That's used as a springboard throughout school. We make them work in groups and judge their performance based on the accomplishments of the whole team. Their performance is not only a reflection of what they know but what they communicate to each other. It produces a different dynamic.
Teaching this way is important because medical care today is delivered in teams. Physicians must trust and respect everyone around them to make sure they don't make mistakes. Primary care physicians, for example, deal with disease prevention. To do so, they have to work with a team of people embedded in community. Specialists need to understand they too need other specialists and primary care physicians to work with. In our healthcare environment, people have to work to the highest level of their license, and they have to respect and trust the nurse practitioners, physician assistants and lots of other people that are engaged in the care model, otherwise we can't be efficient.
Q: What led you to embrace biomedical research at Mount Sinai, and how is the organization supporting that research?
KD: We embrace it because these are the most extraordinary opportunities to understand the physiology of disease. So much of disease, we know, has heritability, but we don't know how that interacts with environment to produce disease.
A revolution in technology has made gene sequencing more efficient and inexpensive. We want to be ahead of the curve in investing in genomics and big data. We're hiring not just geneticists and biologists but informatics experts and mathematicians to help us with a very substantial effort in genomics. Initially, that effort is funded by some very foresighted philanthropists who have long been associated with Mount Sinai who have provided the resources that allow us to recruit people and the cutting-edge equipment that they need.
Q: During the talk, you addressed the da Vinci robot and popularity of robotic surgery. Many tout minimally invasive surgery as "the future of healthcare." Do you think this is the case?
KD: The future is doing whatever we can do to produce better results in a shorter period of time with lower cost. Laparoscopic surgery is undoubtedly an advance in surgery. The question is how often is the robot an advance on laparoscopic surgery? It is undoubtedly an advance for some surgeries in the hands of some experts, but there is also no advance for some surgeries in the hands of some surgeons. Less expensive to the healthcare system is even more difficult to prove for many procedures. Gynecology is the poster child for whether laparoscopic or robotic surgery is better. As I read it, there is no advantage in robotic surgery over laparoscopic surgery in gynecology, but I do see it costs more money to use the robot.
I am absolutely convinced in hands of experienced surgeons, robotic surgery can be more effective with better outcomes for some surgeries, like prostatectomies and complex head and neck surgeries. You have to pick the right surgeries and right surgeons. Physicians shouldn't be convincing patients that robotic is better. Physicians aren't going to wither on the vine if they don't have a robot.
Dr. Davis will be sharing more thoughts on healthcare's future at the 2013 Aspen Ideas Festival held in Aspen, Colo., from June 26 to July 2. Mount Sinai is a sponsor of this year's festival.
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| At the Aspen Ideas Festival preview talk at the Studio Museum in Harlem From left to right: Leonard Achan, Chief Communications Officer, The Mount Sinai Medical Center; Kenneth L. Davis, president and CEO, The Mount Sinai Medical Center; Thelma Golden, director, The Studio Museum in Harlem; Corby Kummer, senior editor, The Atlantic; Kitty Boone, vice president of public programs and program director of the Aspen Ideas Festival, the Aspen Institute; Anna Deavere Smith, actress/playwright and board member, the Aspen Institute; Elizabeth Baker Keffer, senior vice president and group publisher , The Atlantic |
| Photo credit: Ben Gancsos for Mount Sinai |
On April 16, during a talk at the Aspen Ideas Festival preview event in New York City, Dr. Davis shared some of his views on where healthcare is heading. During the half hour dialogue at the Festival event, Dr. Davis addressed everything from bundled payments to supporting immunotherapy research to robotic surgery and how they all fit into the industry's future.
Here, Dr. Davis expands on the views he expressed during the Aspen Ideas Festival preview event. For a transcript of the Aspen discussion, click here.
Question: How do you see payment reform advancing away from fee-for-service in the future? What approach has Mount Sinai taken in this regard?
Dr. Kenneth Davis: Accountable care organizations, which many hospitals have become a part of, are the first step. ACOs are attractive to hospitals because they offer shared savings with no downside for the hospitals. Providers can learn how to manage populations in a way that doesn't put them at risk. As hospitals become more comfortable with programs like ACOs, and payors begin to see the benefits of aligning the best interests of payors, providers and patients, there will be gravitational pull away from fee-for-service and toward population health management.
We see increasing acceptance of bundled payments as a way to move away from the fee-for-service system.
Mount Sinai has an ACO with 25,000 members. We are generating significant savings derived from decreased readmissions and use of the emergency department for common diseases. We've been able to facilitate that with a more coordinated care program that has, as its backbone, case managers that are intimately involved in patient care. They are supported by a robust IT platform that reminds us everyday what patients need to do and that helps case managers identify problems early, before they become the kind of problem that leads to a readmission.
We're also focused very intensely on areas that we believe would prepare our organization to manage populations that are not just Medicare beneficiaries. We're focused like lasers on the quality metrics, efficiency metrics and resource utilization that we think would put us downstream into a good position to negotiate contracts with commercial payors that would include shared savings. As we start to renegotiate contracts with insurers, we're asking ourselves what we can do in behavioral health to manage the very large population we take care of and what kind of programs we can put there to decrease readmissions. Our nation's frayed social service network leaves a hole in the community that our patients can fall through. We have to partner with community programs that can provide housing and some level of supervision so that a chronically and persistent mentally ill population can avoid readmission. I think that's essential.
Q: How can implementing new medical school teaching strategies help build and improve team-based care?
KD: Traditionally, medical education has been about teaching the individual student how to be a great practitioner, and often that was without reference to the team he or she might be embedded in when they enter practice. We began to realize that our best physicians were team members and we had to teach skills that allowed physicians to understand what it meant to lead or be embedded and work in a team.
At Mount Sinai, we start teaching those skills [on the] first day of medical school. We put our students in groups of four and give them a list of places they have to go to. We also give them money and they must figure out collectively where they want to eat dinner. They come back to us at the end of the day and explain the process of decision-making — whether it was collaborative, collegial or hierarchal — and what worked to make them effectively manage the steps. That's used as a springboard throughout school. We make them work in groups and judge their performance based on the accomplishments of the whole team. Their performance is not only a reflection of what they know but what they communicate to each other. It produces a different dynamic.
Teaching this way is important because medical care today is delivered in teams. Physicians must trust and respect everyone around them to make sure they don't make mistakes. Primary care physicians, for example, deal with disease prevention. To do so, they have to work with a team of people embedded in community. Specialists need to understand they too need other specialists and primary care physicians to work with. In our healthcare environment, people have to work to the highest level of their license, and they have to respect and trust the nurse practitioners, physician assistants and lots of other people that are engaged in the care model, otherwise we can't be efficient.
Q: What led you to embrace biomedical research at Mount Sinai, and how is the organization supporting that research?
KD: We embrace it because these are the most extraordinary opportunities to understand the physiology of disease. So much of disease, we know, has heritability, but we don't know how that interacts with environment to produce disease.
A revolution in technology has made gene sequencing more efficient and inexpensive. We want to be ahead of the curve in investing in genomics and big data. We're hiring not just geneticists and biologists but informatics experts and mathematicians to help us with a very substantial effort in genomics. Initially, that effort is funded by some very foresighted philanthropists who have long been associated with Mount Sinai who have provided the resources that allow us to recruit people and the cutting-edge equipment that they need.
Q: During the talk, you addressed the da Vinci robot and popularity of robotic surgery. Many tout minimally invasive surgery as "the future of healthcare." Do you think this is the case?
KD: The future is doing whatever we can do to produce better results in a shorter period of time with lower cost. Laparoscopic surgery is undoubtedly an advance in surgery. The question is how often is the robot an advance on laparoscopic surgery? It is undoubtedly an advance for some surgeries in the hands of some experts, but there is also no advance for some surgeries in the hands of some surgeons. Less expensive to the healthcare system is even more difficult to prove for many procedures. Gynecology is the poster child for whether laparoscopic or robotic surgery is better. As I read it, there is no advantage in robotic surgery over laparoscopic surgery in gynecology, but I do see it costs more money to use the robot.
I am absolutely convinced in hands of experienced surgeons, robotic surgery can be more effective with better outcomes for some surgeries, like prostatectomies and complex head and neck surgeries. You have to pick the right surgeries and right surgeons. Physicians shouldn't be convincing patients that robotic is better. Physicians aren't going to wither on the vine if they don't have a robot.
Dr. Davis will be sharing more thoughts on healthcare's future at the 2013 Aspen Ideas Festival held in Aspen, Colo., from June 26 to July 2. Mount Sinai is a sponsor of this year's festival.