There are big changes happening in healthcare today, but Steven Johnson is ready to face them head on.
As president and CEO of Susquehanna Health, a four-hospital system based in Williamsport, Pa., a position he's held since 2004, Mr. Johnson is known as a "transformer" by colleagues, and for good reason: He has backed several innovative programs and partnerships at Susquehanna Health that have poised the small integrated system to be successful in the new healthcare landscape. And in January 2014, Mr. Johnson will have the chance to transform healthcare at the state level when he becomes chairman of the Hospital & Healthsystem Association of Pennsylvania.
Here, Mr. Johnson identifies three major innovation elements in healthcare and explains how he addresses them at Susquehanna Health. He also opens up about plans for his tenure as HAP chairman and how he will stay self-confident, yet humble, in 2014.
Question: You've been described as a "transformer" by colleagues. What drives you to innovate and transform Susquehanna Health?
Steven Johnson: We're serving about 300,000 people in a 9,000-square-mile area. We are an integrated health system, with home health, hospice, nursing homes, acute-care services and pre-hospital paramedic services — arguably every major inpatient component, but we're small by comparison to other health systems in the area. I like to think of ourselves as having high performance agility. We're big enough to do a lot of things, but not so big that we become like a giant behemoth that has difficulty responding to environmental changes or community needs.
We have to compete with very large, sophisticated organizations, so my motivation is to set a great example for providers that are community-oriented and faith-based and to compete successfully in an environment where we're considered a David among Goliaths. I want us to provide high quality, accessible cost effective services in a way that exceeds patients' expectations.
Q: Pennsylvania is a state with a robust healthcare provider market. How do you use innovation at Susquehanna Health to add value to the market?
SJ: When we think of innovation here, we think of three major elements: (1) partnerships, (2) application of evidence-based medicine and care coordination and (3) resource utilization.
We use a variety of partnerships to help us provide a larger profile to our community than our size would otherwise permit. We couldn't own all of the assets, resources and services directly because we're not large enough. By partnering with other organizations, we can deploy a comprehensive set of resources across the entire region. That strategy — that approach to innovation — is absolutely critical to our current performance and future success.
For example, we have a formal agreement with city of Williamsport — it's an extraordinary relationship that is very mutually beneficial. We also have a partnership arrangement with a regional YMCA that has four locations. They are currently building their newest facility on our medical center campus as a result of that partnership.
There's also a major partnership with the Pennsylvania College of Technology [in Williamsport]. They produce RNs, physician assistants, paramedics, health record techs and radiologists, and they all do their clinical rotations in one of our facilities. One of the nice things about this is that we get to select and hire the best students from each of the classes to come to work in one of our organizations.
The Commonwealth Medical College graduated its first class this summer and we have a partnership with them. The quality of the students who are applying and being accepted there is just extraordinary. It's an allopathic program that also produces MDs. We are responsible for helping educate a total of 80 students, 40 of who are full time for the third and fourth years.
We have other partnerships too, such as one with Pinnacle Health, headquartered in Harrisburg, Pa. — we partnered with them to create River Health ACO, a Medicare Shared Savings Program that's just starting. And we partner with The Penn State Hershey Medical Center for Cancer services and the Keystone Health Information Exchange to exchange patient record data across the region and between providers.
Q: What about the other two aspects of innovation?
SJ: On the evidence-based medicine and care coordination aspect, we have 200 clinical care pathways. Several of them have become national benchmarks. When we find other pathways that are good, we use those too, but we have an extensive pathway development program here.
We're different from other academic medical centers in how we develop pathways or standardized care delivery — academic medical centers tend to approach this exercise from more of an intellectual perspective. Their process is scientific and somewhat sterile and isolated. After development, their challenge is to convince their practicing physicians to use their pathways on a regular basis. Here at Susquehanna, our chief quality officer, Dr. Daniel Glunk leads the development of clinical pathways by engaging those physicians who are actually providing the services on the front line, building a pathway around what they're doing, enhancing their work with the best-practice evidence where appropriate, then standardizing and formalizing the pathway for general application. New physicians joining the team are briefed on the applicable pathways and expected to apply them on a routine basis. In their own unique way, these pathways become the Susquehanna way of delivering care.
In terms of care coordination, we focus on the integration of care delivery between specialties, service lines and business units. Some health systems are simply a collection of disparate parts that don't work well together in providing efficient and well-coordinated care. Here, we have a highly effective and efficient process for assuring patients are receiving the best care in the most appropriate setting virtually all of the time.
Here's an example: We have a really extraordinary mother baby program. Team caregivers partner with young moms beginning at 28 weeks of their baby's gestation. They work together through the delivery until the baby is two years old then hand off the mom and baby to other caregiver services as needed. [The program] connects pre-hospital care, acute-care during the hospital stay and home follow-up. That coordination and care quality is outstanding.
Another example of care coordination is end-of-life care. We have an active palliative care program, inpatient and outpatient hospice programs, and a large home health operation that covers the entire footprint of our 11-county region. We have organizations coming from all over the country to see how we integrate these services across the care continuum. Interestingly, some health systems have divested of their home health and nursing home operations, but here we see them as integral parts of our organization.
The third innovation category is resource utilization. We've been a "most wired" health system for the bulk of the last decade, and place a very high value on the effective use of information technology. We have been a Siemens One business partner for the bulk of this time and are now working with them to develop the appropriate population management resources. The Siemens team, along with their full range of technology and software, has been a critically important resource.
We also applied a green building approach to major building reconstruction and modernization work. Our most recent hospital addition of nearly 250,000 square feet is the first hospital to receive Gold LEED status under their very rigorous current requirements. It has an extraordinarily efficient energy system — it produces its own electricity, which captures residual heat from the generators power source and can run on natural gas or fuel oil, whatever is most efficient or cost effective at the time.
Q: I understand you're planning to open a Health Innovation Center — what can you tell me about that project?
SJ: We have a family practice residency program with obstetrical training that is available to both DOs and MDs. This residency will literally be on the same floor and share space with the Commonwealth Medical College students. It's a unique approach. Medical students, studying to becoming physicians, will be working in tandem with [medical school] graduates who are now in residency.
In addition we're working with the Cleveland Clinic on a heart and vascular institute and developing unique services which will be also be located in the Innovation Center.
The space is laid out in a unique, patient-centered fashion; it's not a traditional collection of office and exam rooms. Layout is designed to accomplish team-oriented services. Usually you have surgeons in one corner, noninvasive physician specialist in another corner, invasive cardiologists in another corner, etc. Here, teams will work in pods across the facility. This innovative approach is actually placing the patient rather than the provider at the center of the facility design.
The primary purpose of the innovation center is to concentrate on developing and deploying more outpatient intensive services. Our aim is to create outpatient services that are more intensive, more patient friendly and more economical to operate.
Q: You will become chairman of the Hospital & Healthsystem Association of Pennsylvania in 2014. What are some goals you have for your tenure?
SJ: One of the things that's become obvious to us is there will be a lot of organizations that look different than hospitals delivering various types of patient care in the future. Companies like Walgreens are opening up services that have traditionally been provided by hospitals or health systems. One priority is to get our arms around this evolution to assure our association's ability to be relevant to them while continuing to provide value to our more traditional health care provider systems.
Another major priority is working effectively with physicians. In Pennsylvania we have historically had a separate hospital association and separate physician associations. It occurs to us we need to find a way to work together. Having separate associations is somewhat counterproductive and dilutes total efforts relevant to helping assure the most appropriate national and state healthcare policy.
A third priority is taking a different approach to working with consumers. Hospital associations historically look at major provider organizations as their customer-members. We think today's consumers want to have more say in their care. With the revolution of mobile-based information technology and a growing number of healthcare-related mobile applications, patients are much better informed than ever before. As an association, we have to get our arms around how we can help members be more relevant to this highly participative and rapidly evolving customer patient base.
The other piece of working with today's healthcare consumer is that more patients are responsible for a higher percentage of the cost of their care. Employers are moving from "defined benefit" healthcare coverage to "defined contribution" coverage. This means we have many more consumers using our services who have a lot more interest in what services are going to cost. This will contribute significantly to dramatic changes in the historic patient-provider relationships.
Q: Any New Years' resolutions you can share as we look ahead to 2014?
SJ: Candidly, my primary focus is to assure that during this period of tremendous transformational change, our health system maintains a pure conviction to our three core values. For us, that is to carefully place patients and families first in whatever we do — be it redesigning pathways or building new buildings, patients and their families must always come first, they must be the center of all we do. Secondly, to collaboratively share ownership of everything we do with our business partners, employees and physician partners. And third is to gratefully lead with a servant's heart. Maintaining the right leadership attitude is really important. We must maintain a proper balance of self-confidence and humility as we work through this period of tremendous changes. So my New Years' resolution is to be even more committed to these same core values.