Latest / Becker’s Healthcare Podcast / Anna Flattau, Alumni Professor and Chair of Family and Community Medicine and Enterprise Chief of Primary Care Services at Jefferson Health

Transcript

Anna Flattau, Alumni Professor and Chair of Family and Community Medicine and Enterprise Chief of Primary Care Services at Jefferson Health · Becker’s Healthcare Podcast

• 0:00
  This is Laura Dirdo with the Becker's Healthcare
• 0:02
  podcast. I'm thrilled today to be joined by
• 0:04
  doctor Anna Flateau,
• 0:05
  alumni professor and chair of family and community
• 0:08
  medicine as well as assistant chief of primary
• 0:11
  care at Jefferson Health. Doctor Flatel, it's a
• 0:14
  pleasure to have you on the podcast today.
• 0:16
  Thank you for having me.
• 0:18
  Absolutely. Now I'm excited to hear from you
• 0:20
  because I know Jefferson is very much on
• 0:21
  the forefront of a lot that's happening within
• 0:24
  health care transformation
• 0:25
  in delivery of care, expanding access, and more.
• 0:28
  And so I'm excited to hear some of
• 0:30
  the things you've been up to as well
• 0:31
  as your perspective on the future. But before
• 0:33
  we dive in, can you tell us a
• 0:34
  little bit more about yourself and Jefferson Health?
• 0:37
  Of course. So I'm a family physician. I,
• 0:40
  practice and see patients still.
• 0:42
  And as you noted, I have a dual
• 0:44
  role at Jefferson. I lead our academic department
• 0:46
  of family medicine in the university,
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  and I'm also the system chief, for our
• 0:50
  primary care system.
• 0:52
  And like many institutions, you know, Jefferson Health
• 0:54
  in its current state, which has a regional
• 0:57
  presence across Eastern Pennsylvania and Southern New Jersey,
• 1:00
  is the result of a merger of, multiple
• 1:03
  organizations
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  over recent years.
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  And I think one of the things that's
• 1:07
  really impactful is is not just our size,
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  but also the strength that comes from the
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  diversity of experience
• 1:13
  across those, different, legacy organizations.
• 1:16
  That really strengthens our ability to to come
• 1:18
  up with innovative,
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  critical, scalable solutions for the communities that we
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  serve.
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  That's amazing to hear. And, you know, certainly,
• 1:28
  such an important
• 1:29
  aspect of understanding your patient population and and
• 1:32
  what each needs in order to be successful
• 1:34
  and and better access care. Now when you're
• 1:36
  thinking of the last year or so, what
• 1:38
  was the most important initiative you led? What
• 1:40
  did you do, and what were the results?
• 1:42
  Yeah. So that's a hard question because we've
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  done a lot, you know, over the past
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  year or two. So it's hard to think
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  of just one. But when we think about
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  what's what's most important for our initiatives, it's
• 1:51
  really thinking of the scale of our organization.
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  So we're a 32 hospital system, and we
• 1:55
  have 700,
• 1:57
  ambulatory sites, and about a 150 primary care
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  sites. And in my role leading our primary
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  care system, that's approximately a million patients in
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  our in Jefferson Primary Care,
• 2:06
  whom we serve.
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  So when I think about the most important,
• 2:10
  initiatives from our past year, it's really thinking
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  about how we can further our model of
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  care, and think about
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  better, more person centered ways of creating access
• 2:19
  for our patients and communities.
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  And that's access not just in getting the
• 2:23
  appointment that people need, which certainly is critical
• 2:25
  and is a constant focus for us, but
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  in giving people access in the way that
• 2:29
  they want. Sometimes that's virtual, sometimes that's in
• 2:32
  person, sometimes that's at home to make sure
• 2:35
  also that they get the comprehensive care that
• 2:37
  they need,
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  once they make it through our doors and
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  and have connected with our system. So I'm
• 2:42
  gonna describe two initiatives that get at that
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  that we've launched in this past year.
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  One is, that we've really expanded our virtual
• 2:49
  primary care, service, and, that's a service that
• 2:52
  many organizations,
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  have been growing and we're no exception to
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  that.
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  What I think has been very special about
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  the way we've
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  structured, built, and, scaled our virtual primary care
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  services
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  is that we really made an effort to
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  connect it with the deep roots of what
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  primary care is,
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  relationship centered,
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  comprehensive,
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  focused on continuity over time, really meeting the
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  entire set of patients' needs,
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  in collaboration with specialists and other colleagues, as
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  needed.
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  So when we set up our our primary
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  care service, we were very careful to delineate
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  it from our also very important virtual urgent
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  care offerings
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  and really talk to patients as they schedule
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  about becoming part of a panel with a
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  personal physician or advanced practice
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  practitioner,
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  in order to,
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  to to to really root in the in
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  that in that important aspect of primary care,
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  which we know is the driver of individual
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  and human and community health.
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  So we've,
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  actually routed that service into all of our
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  access points.
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  When people call Jefferson, when they look at
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  our website,
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  when there's a referral,
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  internally for primary care, every single patient, gets
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  an explanation of what virtual primary care is,
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  a traditional primary care practice, but all virtual.
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  Same scope of practice, same commitment to their
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  health. And we found that that's extraordinarily
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  popular,
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  with patients,
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  who are seeking primary care at Jefferson.
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  What's been very interesting also is, you know,
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  initially, we thought that maybe this would appeal
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  more to
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  healthier, or maybe higher income people or people
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  who are more tech
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  savvy. It turns out that all sorts of
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  patients are voting with their feet to join
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  our virtual primary care services.
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  So people,
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  of all sorts of different, ages, we have
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  a patient who's a 102 years old who
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  joined our virtual primary care service,
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  patients of a wide range of disease complexity,
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  many, many patients with previously uncontrolled chronic diseases
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  like hypertension or diabetes
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  who were just not getting to a a
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  clinician,
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  who have joined our virtual primary care practice
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  and whom we're now able to manage without
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  them having to take a day off from
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  work or leave their children,
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  or otherwise,
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  overcome the obstacles to an in person appointment.
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  And even some highly complex patients who come
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  out of our hospital and are at home,
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  we found that we've been able to effectively
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  manage, through our highly experienced virtual primary care
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  clinicians.
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  And we've also noticed that people from all
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  different socioeconomic backgrounds have signed up. We've, matched
• 5:23
  people's addresses to the area deprivation index, which
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  is an indication of how rich or poor
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  the neighborhood is where you live. And we
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  found that people from across the entire socioeconomic
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  spectrum,
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  are signing up for virtual primary care.
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  So,
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  just from our,
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  our, kind of,
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  standard scheduling processes, we're, gaining about 500
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  new patients a month, who did not previously
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  have primary care, who are joining virtual primary
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  care. And I think that will only accelerate
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  over time as we hardwire some pipeline from
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  our emergency rooms and other areas where we
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  know that there's, unmet demand and offer this,
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  really, important option that we found to be
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  very effective in meeting people's needs.
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  The other program I'd like to mention, which
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  actually launched today,
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  is our lifestyle program.
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  And I'm gonna go back to what I
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  said originally about access being not just getting
• 6:15
  your appointment, but getting everything you need. We're
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  very committed to whole person primary care. We've
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  had long standing,
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  services, for example, for integrated behavioral health,
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  and our lifestyle program is a structured year
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  long program to help people make the behavior
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  changes that as human beings we all struggle
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  to make, but that are actually
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  extraordinarily
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  impactful for both preventive health and management of
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  chronic disease. So that's a program that over
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  the course of a year in telehealth based
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  group visits co led by a registered dietitian
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  and a nurse practitioner
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  will address the six pillars of lifestyle medicine,
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  diet,
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  exercise,
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  restful sleep,
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  social connection, stress management, and avoidance of risky
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  substances.
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  And we're really excited. We're committed to enrolling
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  at least 5,000 people over the next, three
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  years in in this year long program, which
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  I think will be transformational
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  for how we provide care.
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  That's amazing to hear. I think both of
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  those options, the virtual primary care as well
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  as the lifestyle program, and congratulations on the
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  launch. You know, it seems like it covers
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  huge needs for patients and and really puts
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  them in a position to be healthier overall.
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  I'm curious when you look at the growth
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  and popularity of the virtual primary care program,
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  have,
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  the clinicians that are are working and meeting
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  with patients had to do,
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  much differently or adjust to,
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  I guess, any of the things that come
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  along with virtual care,
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  visits? Is there anything you've been surprised by
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  as the program has grown and developed?
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  So I think they've been done an incredible
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  job at finding solutions to problems that present
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  themselves.
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  And that's perhaps the definition of primary care.
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  Right? We we look at the those the
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  the, issues that patients bring to us when
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  we find solutions.
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  And they've been very creative, not not just
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  the physicians and the advanced practice clinicians, but
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  also our administrative leadership,
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  of that program has really done an extraordinary
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  job in being,
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  solutions oriented.
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  So they've become excellent at ensuring that everyone
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  can get a blood pressure cuff, when they
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  need it so that we're able to manage
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  hypertension
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  remotely.
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  We've become excellent at ensuring that, we can
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  get sometimes vital signs including weights, at a
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  laboratory facility, which many of them will do.
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  We've become, very creative about getting the testing
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  supplies, for self testing,
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  for certain types of tests,
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  to patients, so that they can,
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  for example, get, the, STD testing, in their
• 8:38
  homes,
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  and then bring those results back to the
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  lab. So I I there haven't actually been
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  a whole lot of, problems that we've been
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  unable to solve. I think it really comes
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  to having focused administrative and clinical dedication,
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  to,
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  helping patients to get what they need. When
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  patients do need an in person appointment, we
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  can bring them into any of our 150
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  sites, in order to, to have an in
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  person exam. When we started the program, I
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  think we all expected that that would happen
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  somewhat often, but it's actually been pretty rare
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  that that's been necessary. We found that we've
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  been able to, to the large extent, really
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  manage comprehensively,
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  through,
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  virtual means.
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  That's amazing. Thank you so much for sharing
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  a bit more about that program. And now
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  when you look ahead, what are some of
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  the big priorities and headwinds you're focused on
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  for 2026?
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  So for 2026,
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  as for 2025, we've really been looking at
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  what our commitment is to the population that
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  we serve. So that's the million people who
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  are in our primary care system, but also
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  the people who come into our hospitals who
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  may not have,
• 9:41
  access to high quality primary care. So we've
• 9:44
  been giving a lot of thought for 2026
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  on how to improve
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  transitions programs, not just for the transition the
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  day you leave the hospital or that week
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  or those fourteen days, but how to build
• 9:53
  out those programs to ensure people are connected
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  to ongoing care that, again, is whole person
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  and comprehensive.
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  So we've we're expanding,
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  dramatically
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  our telehealth transitions of care program to make
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  sure everybody leaving the hospital can, get that,
• 10:09
  appointment if not with their primary care, physician,
• 10:11
  which is always plan a, then with a,
• 10:14
  transitions
• 10:15
  physician or APC,
• 10:17
  who can ensure that they have a smooth,
• 10:19
  experience leaving the hospital and transitioning back to
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  their home.
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  But once we bring people into that transitions
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  program, we are going to make sure that
• 10:27
  they're connected with primary care. And those who
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  are not,
• 10:30
  the the virtual primary care option allows us
• 10:32
  to expand access very rapidly
• 10:34
  to ensure that patients have a safe landing
• 10:36
  place. So we will offer them, as we
• 10:38
  do to all of our patients, an option
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  between the traditional in person, primary care or
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  the virtual primary care and ensure that we
• 10:45
  have our arms around those patients,
• 10:47
  for their long term care. And then, of
• 10:49
  course, once they're enrolled, they have access to
• 10:51
  behavioral health options, lifestyle options,
• 10:54
  social service,
• 10:55
  supports, and so on, as part of that
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  or, foundational,
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  layer.
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  When we think about transitions, there are a
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  couple of special populations in there, and we're
• 11:04
  working very hard for 2026
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  to ensure that we design the right programs
• 11:08
  for them. That includes, people who may benefit
• 11:12
  from palliative care. So we are, expanding,
• 11:15
  our community based palliative care services to new
• 11:17
  regions under that transitions of care umbrella.
• 11:21
  We're also looking at how some of our,
• 11:23
  national model,
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  programs here for people with severe substance use
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  disorder,
• 11:29
  can be, expanded so that from all of
• 11:31
  our hospitals, patients who, are suffering from a
• 11:34
  severe substance use disorder, which often leads to
• 11:37
  recurrent emergency
• 11:39
  medicine visits or recurrent hospitalizations,
• 11:41
  trans can transition into a complex primary care
• 11:44
  model, the Sheller Bridge program that we've established
• 11:46
  that we've proven can help people,
• 11:49
  get into recovery,
• 11:51
  and also,
• 11:51
  manage their,
• 11:53
  comprehensive primary care needs as well as conditions
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  they may have, like hepatitis c, or the
• 11:58
  need for injectable PrEP that can also be
• 12:00
  administered in that setting.
• 12:02
  And finally, we're thinking in terms of transitions
• 12:04
  not just for those telehealth visits, but how
• 12:06
  to expand our home based primary care offerings
• 12:09
  to ensure
• 12:10
  as needed, visits for that transitions population. So
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  those are some of our ambitions for, 2026
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  as we think about the sort of global
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  needs, not just,
• 12:19
  event oriented needs, but global needs for that
• 12:22
  population and those communities that we serve.
• 12:25
  That's amazing to hear. And, you know, it
• 12:27
  makes a lot of sense to have that
• 12:28
  type of focus and energy in looking at
• 12:30
  where people
• 12:31
  can really benefit the most from additional services
• 12:34
  and opportunities,
• 12:36
  to have their more comprehensive needs met in
• 12:39
  the primary care setting or primary care model.
• 12:41
  What do you think the hardest thing you'll
• 12:43
  have to do next year will be?
• 12:45
  No. There there's plenty of headwinds in in,
• 12:48
  health care. No shortage of them. I think
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  what I worry most about, is, the changes
• 12:53
  to Medicaid,
• 12:55
  including those that will require,
• 12:58
  reenrollment,
• 12:58
  very frequently,
• 12:59
  because I, you know, having worked
• 13:02
  in safe net organizations for most of my
• 13:04
  career, in FQHCs for many, many years, I
• 13:06
  know how burdensome that paperwork is, and it
• 13:09
  will create
• 13:10
  an enhanced,
• 13:11
  social determinant of health barrier,
• 13:14
  to receiving care for many of our patients.
• 13:16
  So we're going to organize ourselves to help
• 13:18
  them go through that,
• 13:20
  bureaucratic process, much more frequently than was previously
• 13:23
  the case,
• 13:24
  due to, the changes in the rules around
• 13:26
  Medicaid. So that's that's certainly top of mind
• 13:29
  of for me. Also concerns around people just
• 13:31
  losing their insurance, which some with some of
• 13:33
  the, the, changes in, insurance eligibility across Medicaid
• 13:37
  and and ACA.
• 13:38
  I think everyone is worrying about those.
• 13:41
  As soon as I can get my patients
• 13:43
  in the walls and we have them, you
• 13:45
  know,
• 13:46
  cared for by our team, I know that
• 13:48
  we can do,
• 13:49
  everything to meet their needs and build the
• 13:51
  programs that they need, but ensuring that they
• 13:54
  have that coverage up to date and and
• 13:56
  that their enrollment, is in place, is something
• 13:58
  that is concerning.
• 14:00
  That's helpful for to understand. And I think,
• 14:02
  you know, so many organizations out there in
• 14:04
  health systems, big and small, are having similar
• 14:06
  issues that they're trying to troubleshoot in terms
• 14:08
  of, you know, figuring out what the barriers
• 14:10
  are and then understanding what some of the
• 14:12
  changes coming down the pipe will be from
• 14:13
  the federal government and state level in in
• 14:16
  looking at insurance and access to care. And
• 14:18
  so, it seems that you're building out a
• 14:20
  network in a smart way with a variety
• 14:22
  of different contingencies. No matter, you know, where
• 14:24
  things evolve over the next several months, you'll
• 14:26
  be able to know who's out there and
• 14:28
  and and provide services,
• 14:31
  that they're needing.
• 14:33
  Absolutely. Yeah. And and, you know,
• 14:35
  we talk about social needs a lot. Insurance
• 14:37
  eligibility is a social need, and a very
• 14:39
  important one, of course, in in health care.
• 14:41
  So something that we need to have front
• 14:43
  of mind and also not to underestimate the
• 14:45
  complexity of those processes and the the amount
• 14:47
  of support that, our patients are going to
• 14:50
  need to navigate them.
• 14:52
  Absolutely. Are you, thinking of making any new
• 14:54
  hires to cover some of those areas, or
• 14:56
  is it primarily looking at how do your
• 14:59
  current teams just think one bit differently,
• 15:01
  to make sure that they're getting that space
• 15:03
  covered and that patients know what their options
• 15:05
  are.
• 15:06
  We're definitely, looking at,
• 15:09
  ensuring that we have,
• 15:10
  our care managers, our community health workers, our
• 15:13
  social workers,
• 15:14
  trained to be able to, manage some of
• 15:16
  those demands, absolutely,
• 15:18
  in in in conjunction with community partnerships.
• 15:21
  That's great to hear. Now before we wrap
• 15:23
  up, I wanted to talk about growth as
• 15:25
  well. Where do you see some of the
• 15:26
  best opportunities for growth at Jefferson Health in
• 15:28
  the next two to three years?
• 15:31
  So I I think the demand for health
• 15:32
  care is always there. It's really a matter
• 15:34
  of meeting patients, in the way that they
• 15:36
  need.
• 15:37
  Our business model is changing. Right? It's, you
• 15:39
  know, with, more virtual care, with more,
• 15:42
  consumer driven,
• 15:44
  you know, health initiatives, including the support by
• 15:47
  by AI.
• 15:48
  Health care is gonna change, and I think
• 15:50
  the way to grow is to embrace that
• 15:52
  and to build according to what people and
• 15:54
  communities want.
• 15:56
  So, you know, as I think about, growth,
• 15:58
  we I think virtual is gonna continue to
• 16:00
  be a really strong focus for us.
• 16:03
  I think that the the sort of experiential
• 16:05
  and relationship relational,
• 16:08
  aspects of health care, that are demonstrated through
• 16:11
  primary care, but also through programs like our
• 16:12
  lifestyle program will be increasingly important.
• 16:16
  I think that a lot of the, artificial
• 16:18
  intelligence technology will allow us to free time
• 16:21
  to to have better access and more comprehensive
• 16:23
  access,
• 16:24
  for our patients.
• 16:26
  So I I think there's a lot lots
• 16:27
  of ways that we will need to grow,
• 16:29
  not just in quantity, but in a way
• 16:30
  that evolves the way services are provided along
• 16:33
  those lines.
• 16:35
  That's helpful for understand to understand. Doctor Flatel,
• 16:38
  thank you so much for joining us on
• 16:39
  the podcast today. This has been such a
• 16:41
  fun conversation. You know, I learned a lot,
• 16:43
  and it seems like you've got truly some
• 16:45
  amazing things happening there at Jefferson Health. And
• 16:47
  I look forward to seeing you at our
• 16:49
  annual meeting too in April. I know you'll
• 16:51
  be speaking on a panel and really bringing
• 16:53
  some of this great expertise and insights into
• 16:55
  some of the broader strategic things happening in
• 16:57
  the health care space. So, looking forward to
• 16:59
  seeing you then.
• 17:00
  Thank you so much for having me. I
• 17:02
  look forward to it as well.