On Monday afternoon, some innovation-minded hospital administrators gathered at Factory Six03, a trendy spot in downtown Dallas’ West End, to talk about hospital innovation. And they didn’t disappoint, offering some straightforward thoughts on topics ranging from a trend toward smaller, community hospitals, to telemedicine, to navigating a tricky transition period between fee-for-service and value-based care.
With myself asking the questions, the panelists for the Dallas Startup Week event were Matthew Chambers, chief information officer at Baylor Scott & White Health; Suresh Gunasekaran, VP and chief of operations at UT Southwestern Health System; and Julie Hall-Barrow, VP of virtual health and innovation at Children’s Health.
Here’s what they had to say:
Chambers on a trend toward opening smaller, community hospitals:
“As we’re expanding new hospitals, we’re actually going with a much smaller model that we call a health hub. It’s a 25-bed facility that does have room for expansion, and we’re putting those in places like Buda and Pflugerville, where the population is rapidly expanding. What we’re finding is that not every community—and you’re seeing this with rural hospitals—has a population base nor the clinical expertise to support tertiary, quaternary care.”
Gunasekaran on the strengths and weaknesses of UT Southwestern and on moving forward with a comprehensive approach:
“We think healthcare is in a new era. We’re looking for new thinkers that don’t talk to us about one specific technology, just telemedicine, or just community-based care. It’s: How do you redesign a system where you leverage the stuff you’re good at, whether that’s being in a community, whether that’s ambulatory care, whether that’s post-acute care. All of those capabilities become an integrated piece. Most of my day is spent on: How do you put the pieces together and really drive value for folks?
“The fact of the matter is care isn’t that convenient. The more you convenient you make care, the more disjointed it is. If Teladoc allows you to do it online, if urgent care is right down the street for you, all you can be guaranteed is that in the name of convenience, that care is even less integrated to you. I can tell you at UT Southwestern, we’re super inconvenient. We are. We’ve got all the doctors, we’ve got all the facilities—we’ve got one location. That one location is quite a bit of a hike for most people. After that quite a bit of a hike, we’re quite a bit of a wait. And then after the quite a bit of a wait, magic happens.”
Hall-Barrow on balancing pressure from higher-ups with innovations that could take money off the table in the short-term:
“For children, the value-based care model has not come as rapidly as everyone thought it would. So, how do you take all these pieces—the delivery network—and place them together like puzzle pieces so when that shift does happen, you go, ‘We’ve already got all these wonderful end points that help us create our delivery network.’
“When I’m with my leadership team, you can imagine the CFO when I’m saying, ‘Hey, I’m reducing your ER visits that you get paid fee-for-service for.’ He’s not proud of me, because that is where we continue to have our profitability. But he will be excited when we’re able to use the value-based care, and I say, ‘Hey, I actually have all the low-acuity visits that are no longer going through your ER.”
Gunasekaran on solving for the right problem:
“If you build hospitals, you’ve got to fill beds. So smarter hospitals build smaller hospitals because they’re easier to fill, and then you only offer certain services because it’s easier to make a profit on only the services that make a profit. And pretty quickly you’re solving for a different problem: Let me have a hospital capacity that the market really needs, so that we’re able to operate efficiently and make a good margin.
“I’m not interested in that question. The question I’m interested in is: How do we build a health system that an entire community really wants to get all of their care in? How do we build a proposition so that it’s worth it to get 100 percent of your care within one system? Frankly, what we found is having a really good hospital with really high patient satisfaction scores or cool TVs or a great valet isn’t enough to earn your trust, to get 100 percent of your care under our banner. The journey we’re on, that we’re trying to figure out, is: What are all the different components that you have to have under one umbrella in order to earn the complete trust of a community?”
Hall-Barrow on using telemedicine to regionalize specialty care without having to transport patients to larger hospitals:
“Many times, it’s, ‘How can I keep that patient where they are? Please don’t fire up the helicopter. Please don’t send them to me so that I can discharge them in 24 hours.’ We’ve wasted a lot of money and a lot of time when that happens.
“You can imagine when you’re a single practitioner at a very small, rural town and a two-year-old comes into your ER on a trach and a vent, you pick up the phone and say, ‘Can somebody please come get this kid?’ Well, many times we can offer that care via telemedicine, and ensure that family we wouldn’t do anything differently in Dallas. We can see their films. We can see their labs. We can talk to the patient and family. When the patient does need to come, we can do that very rapidly. The outcomes for those patients actually end up being much, much better.”
Chambers and Gunasekaran on looking toward the future of hospitals in DFW:
Chambers: “Some people say we’re over-bedded in Dallas as it is. Heaven help us, maybe Amazon HQ2 moves in and we need another couple thousand beds, but as it is we may end up with some vacant real estate.”
Gunasekaran: “The thing that Matt talked about earlier with regard to the hub model is, I think, the other answer. The physician offices of today are not good enough for tomorrow. What I mean by that is that I think that ultimately where we would go is some combination of an urgent care and physician thing. This convenience and access piece is never going to leave the demands of the healthcare enterprise. Having urgent cares in strip malls and doctor’s offices closed two blocks away is a model that’s going to go away. There’s going to be some change.”
Chambers: “I have to agree with you there. What allows us to innovate in these models is you have more and more of the per member per month fee model. If you don’t have to charge on the transaction, you have the ability to do this. You have to have the financing models to make it work.”