Latest / Becker’s Healthcare Digital Health + Health IT / Expanding Access Through Virtual Care and Innovation at Jefferson Health with Judd Hollander, MD

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Expanding Access Through Virtual Care and Innovation at Jefferson Health with Judd Hollander, MD · Becker’s Healthcare Digital Health + Health IT

• 0:00
  This is Laura Dierda with the Becker's Healthcare
• 0:02
  podcast. I'm thrilled today to be joined by
• 0:04
  Judd Hollander, senior vice president of healthcare delivery
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  innovation
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  and chief virtual care officer at Jefferson Health
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  as well as professor in the department of
• 0:12
  emergency medicine at the Sydney Kimmel Medical College.
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  Judd, it's a pleasure to have you on
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  the podcast today. Laura, great to join you
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  again.
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  Absolutely. Now I'm excited for our conversation because
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  I know Jefferson is on the forefront of
• 0:23
  a lot of innovative things happening in the
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  health care space. And, truly, you know, it's
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  always exciting to think about where you're at
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  today and then where you're headed. But before
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  we begin, can you just tell us a
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  little bit more about yourself and Jefferson?
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  Yeah. So I'll I'll I'll I'll start with
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  myself, and then I'll get into Jefferson. I
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  I sort of have a a wandering background
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  to end up in health care administration.
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  I trained in internal medicine and emergency medicine,
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  practiced emergency medicine,
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  developed, clinical research expertise,
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  and led large clinical research programs first at
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  Stony Brook, then at Penn, and then at
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  then at Jefferson.
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  So I come from a very research oriented
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  analytic background.
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  And at some point, it dawned on me
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  that if I change the spreadsheet
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  from nanograms per deciliter
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  at the end of a number to a
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  dollar sign in front of it, it was
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  a little more strategic and, you know, and
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  and it was a bigger play in terms
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  of changing health care to the community.
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  So I went back and took some courses,
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  not an MBA, but took formal courses at
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  Wharton,
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  learned the skills that I needed
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  in in order to make the leap from
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  a career researcher, emergency physician, into
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  health care administration,
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  and then transitioned at the time I left
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  Penn to go to Jefferson
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  into, you know, ultimately, this SVP and chief
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  virtual care officer role.
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  When I got to Jefferson about twelve years
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  ago,
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  it was a three hospital health system, which
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  is hard to imagine
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  now that it's 32 hospitals and four gazillion
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  outpatient ambulatory
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  practices.
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  And so I jokingly say,
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  I'm the person that's launched the most virtual
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  care programs in the world because I launched
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  them in the original three hospitals
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  and then with our first merger and then
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  with our second merger and then with our
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  third merger and then with our fourth merger
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  and then the last one. And none of
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  those first couple,
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  mergers actually had virtual care programs.
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  But, last combination with Lehigh, a very robust
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  health care system that had 14 hospitals and
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  extends through the Lehigh Valley, they had a
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  great virtual care system.
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  And and so
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  we're we're now combining the best of both
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  to develop an even better one than what
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  we had before or they had before.
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  That's amazing to hear. You know, really cool
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  that you have the opportunity
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  to start off, so many years ago with
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  Jefferson as a small three hospital system and
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  see it grow and and be part of
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  that, on the virtual care space. And I
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  I'm curious over the years, how have you
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  seen virtual care grow? I mean, obviously, you
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  know, had a great accelerator during the pandemic,
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  but where are we at today? Did you
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  imagine you'd be in this space where,
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  virtual care is is such a integrated and
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  integral part of access and communities today?
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  So it's interesting because I think you might
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  expect me to say no. It's bigger and
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  more robust than I anticipated.
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  But it it's actually across the country, it's
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  smaller and less robust
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  than I would anticipate.
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  We actually began our program in 2015.
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  And so by the time COVID hit, we
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  were reasonably well established.
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  And we went through many of the things
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  you have to do with change management. Because
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  if you think back, you know, now eleven
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  years ago into what did people think about
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  virtual care, they thought doctor Hollander was a
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  little bit nuts in why do we need
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  to do this.
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  And under the leadership and guidance at that
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  time of Steve Klaskow, who was our CEO,
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  we decided what I think everybody accepts now,
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  patients should get care how and when they
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  want care. And so our goal
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  was actually to make sure that the clinicians
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  in the health system or in the three
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  hospitals at that time
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  were able to deliver care that was best
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  for the patient.
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  And so our incentive programs, thinking way back
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  to then, were that you had to do
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  12 calls in a year. 12 telemedicine calls
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  in a year. And the amount of sort
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  of pushing we needed to do to get
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  clinicians to do 12 in a year
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  was insane.
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  It first year, there was an incentive on
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  the individual clinicians,
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  then that didn't work. So then we increase
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  the incentive on the chairs, and ultimately, we
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  increase the incentive on the departments
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  so that the departments would not get allocated
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  the same amount of money next year if
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  people didn't make it. And I sit in
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  make it. And I sit and think as
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  I was going around meeting with everybody,
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  I'm like, 12 calls is June 30.
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  You could meet that goal. You could do
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  it all the last day. But the goal
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  was you needed to know how to do
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  it. So if a patient wanted it and
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  needed it, you could take care of that
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  patient.
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  And,
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  you you know, people had, I would say,
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  disproportionate
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  angst about learning how to do it and
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  annoyance with doing it until COVID hit.
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  And then we actually kept this is real
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  data. Over seventy percent of our scheduled visits
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  for the first week COVID hit in Philadelphia
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  by converting people from in person visits to
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  to telemedicine visits
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  because everybody
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  knew how to do it. So we look
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  like geniuses.
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  And and people love patients love telemedicine.
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  Some do, some don't. But I think our
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  goal is we wanna take care of patients
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  the way they want to be taken care
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  of. And sometime clinicians,
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  they wanna take care of patients the way
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  they're comfortable taking care of the patients. And,
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  yeah, you can't do the same physical exam.
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  You could do a different physical exam. But
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  when a patient comes to the office, you
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  can't look in their house. And when patient's
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  on telemedicine, you can look in their house.
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  And so I think it's learning to take
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  all the information available to you
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  and do the best thing for the patients.
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  Why I think, probably a follow-up question, it's
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  not going as well as I might have
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  expected
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  is because the government refuses to make a
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  long term commitment.
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  Everybody thinks telemedicine costs less than in person
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  care. Sure. You don't need real estate, but
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  you do need to invest in products that
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  will deliver a good telemedicine experience.
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  And and with the government continually kicking the
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  can down the road and paying for it
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  for a couple months or a year through
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  continuing resolutions,
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  it's hard for health systems to really jump
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  all in.
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  Got it. That makes a lot of sense.
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  And especially on the policy side, I know
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  there's a ton, to always be considerate and
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  mindful of. So,
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  thank you so much for for digging in
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  there. And, you know, I'm curious if you
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  zero in on just the last year or
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  so. Could you tell us about an initiative
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  that you've led? What did you do, and
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  what were the results?
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  So I think the best thing we've done
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  is think about how can we improve access
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  for patients.
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  And and we've tried to do that in
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  several different ways. So one of,
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  the Hallmark program that I'll discuss
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  is our same day next day cancer care
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  program,
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  where we just fundamentally believe that that if
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  someone tells you you have cancer, you shouldn't
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  have to wait three weeks for an appointment.
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  You you know, it's psychologically devastating.
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  You're concerned about the outcome. And so we
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  made the commitment to say, we're gonna get
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  you in today or tomorrow.
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  And we just challenged our teams to come
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  up with a system to do it, and
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  we were able to do that. And at
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  this point, we have close to two thousand
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  patients
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  with new diagnoses of cancer.
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  We've been able to get in literally the
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  same day they called or or the next
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  day, start them on their journey to care,
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  connect them with chemo or surgery.
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  And we've demonstrated
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  we can get their first chemo infusion or
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  their or their surgical,
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  repair or fix
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  done sooner through this program than we did
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  the old ways. So we've worked on many,
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  many access initiatives,
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  but but that's probably the first one that
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  was, you know, super successful in that realm.
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  That's great to hear. And, you know, when
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  you think about putting a program like that
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  together and then seeing the results that you
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  got,
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  technology is one piece of it. How do
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  you make sure that,
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  the people that you're working with are really
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  jumping in, integrating it the way you want,
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  and, really, you know, running towards those outcomes
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  so you can get there as quickly as
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  possible.
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  You know, I wish I had a great
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  answer to that, but but what we've learned
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  is it really begins with
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  identifying, you know, it's people process and technology.
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  So if you don't have the right people
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  engaged, you're gonna have a problem. So we
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  have, in the past,
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  approached departments and said, hey. We got a
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  a templated playbook for this. We're ready to
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  go. Do you wanna do this? They have
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  all said yes. But sometimes after a meeting
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  or two, the answer is, well, yeah, we
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  wanna do it, but not really because the
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  change management with all our clinicians is difficult.
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  The workflows are difficult.
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  So, you know, we have learned to go
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  where people want to
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  play nice and develop things that are novel
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  and different.
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  So I think the first thing is selecting
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  the right group of people to do it
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  with. The the second thing is being
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  both rigid and flexible at the same time.
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  Like, we know what works,
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  but that's not what everybody else wants. So
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  it's finding the right compromises
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  so people don't have to change everything they
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  know how to do. They'll change enough of
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  it that we could deliver the care and
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  open up the access
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  so that they're comfortable with it and make
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  the change over time. And then the third
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  part is the technology. In in our case,
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  the technology is easy because they've all been
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  doing telemedicine
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  visits. So they're just gonna do the same
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  type of visit they did using the same
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  technology.
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  What we're really changing is how you come
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  in the enterprise central scheduling, how you get
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  your access, who's available for the patient, will
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  clinicians add on somebody,
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  what happens if the first clinician
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  seeing somebody is a nurse practitioner
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  who's not entirely sure of the answer on
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  somebody with a super specialized cancer?
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  Rather than send them to the cancer specialist,
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  they have permission to call and disturb that
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  specialist in the middle of the day to
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  get the answer so the patient gets off
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  the phone with the answer. Those were major
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  workflow changes
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  that our our cancer service line and Sydney
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  Kimmel Cancer Center were just more than happy
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  to make, makes a big difference.
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  Not everybody else can make those changes and
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  adapt as fast.
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  Absolutely. That makes a lot of sense. It
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  just really speaks to the unique culture that
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  you have there at Jefferson and,
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  the team that you've been able to build.
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  So that's really cool to see.
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  Looking ahead, what are some of the big
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  priorities and headwinds that you're focused on for
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  2026?
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  So I tend to think of things in
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  the single biggest bucket is access.
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  I'm old enough that I have had parents
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  that have passed away and parents that have
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  spent a lot of time in the hospital
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  and, you know, friends and family that do
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  the same.
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  And the pressure point, I think, at health
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  systems all across the country is access, access,
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  and more access.
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  How do you get in? So I I
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  think we're thinking of, you know, how do
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  we get access,
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  transform, and engage as the three things we
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  talk about all the time. But
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  it begins by what you tie up people
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  doing. So although I don't lead this initiative,
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  I'm involved with it. We have Bala Yahia,
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  our health system president,
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  has a, you know, very bold initiative
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  to reclaim 10,000,000 patient care hours over the
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  next three years largely through the use of
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  AI.
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  We've grown out ambient listening
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  to thousands and thousands of our clinicians,
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  physician and APCs across the enterprise.
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  Yesterday,
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  Colleen Malozzi led a team that launched MBNAI
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  for our nurses,
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  on our first unit, which will free up
• 12:07
  nurses to be at the bedside more rather
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  than documentation.
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  So that may help create capacity. It may
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  also help us
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  recruit more people to take care of patients
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  because the job may be better, burnout may
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  be less, retention may be better.
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  Then we split people or, at least, the
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  way I think of it in the two
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  buckets. There's practices that have capacity.
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  That's easy. How do we identify the patients
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  that need to see those specialists
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  so they could take the open slots and
• 12:37
  we could provide better care to people in
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  the community?
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  So we have programs focused on where there
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  is capacity, making sure we're giving patients the
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  opportunity
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  to know we have that capacity. And then
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  there's the other side where we don't have
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  capacity.
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  And the challenge is how do we create
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  more capacity
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  without actually having to go build a multi
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  office spec or a multi specialty office building.
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  And so transitioning some people that work in
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  the office
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  to work at home,
• 13:06
  backfilling the office space with a new clinician
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  creates more capacity
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  without us having to wait ten years to
• 13:13
  build a building and find real estate. So
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  I think it's making us more efficient at
• 13:18
  what we do, filling capacity where we need
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  it, and creating capacity where we don't have
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  it as the major strategies that I'm working
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  on.
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  That makes a lot of sense, and I
• 13:29
  appreciate the specifics that you talk through there.
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  I mean, I think it's having those creative
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  ideas to expand access in ways that are
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  also,
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  financially
• 13:37
  viable right now. I think every dollar and
• 13:39
  every minute of health care resources is so
• 13:41
  precious, and and so to find those, unique
• 13:44
  opportunities to continue to,
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  evolve the system, it just seems to make
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  a lot of sense, and I can imagine
• 13:50
  is, you know, really where there's a lot
• 13:51
  of attention and focus today. Yeah. Thanks,
• 13:54
  Laura. Perfect. Well, I think, you know, there's
• 13:57
  been a lot of changes in health care
• 13:59
  too, coming rapidly in in,
• 14:02
  you know, consistently. So what do you think
• 14:03
  the hardest thing you'll have to do in
• 14:05
  the next year will be? Oh, that's an
• 14:07
  easy one. Change management.
• 14:09
  It's it's all about change management. Too often,
• 14:12
  we think about,
• 14:13
  you you you know, the end result,
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  but it's really about how do we get
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  the people that are in the process
• 14:20
  to accept the fact that health care is
• 14:22
  changing, and it's not the same health care
• 14:24
  you might have trained in fifteen years ago.
• 14:27
  Like, if we have clinicians
• 14:30
  that haven't figured out how to use AI,
• 14:32
  where AI can be used, if we have
• 14:35
  clinicians that haven't figured out how to engage
• 14:37
  their patients in virtual care,
• 14:40
  then patients are gonna go somewhere else, and
• 14:42
  those clinicians aren't gonna be able to do
• 14:45
  their job well.
• 14:46
  Change is difficult. And I think for us,
• 14:49
  we need to have programs, and we do
• 14:50
  have programs with our leadership
• 14:53
  about how we can get the people we
• 14:55
  work with, the people we work under, and
• 14:57
  the people we supervise,
• 14:59
  how to embrace change and and to move
• 15:01
  forward into the next, decade.
• 15:05
  Absolutely. I I love that. And I think,
• 15:06
  you know, it's so true being able to
• 15:08
  have those folks,
• 15:09
  that really are able to take on, you
• 15:12
  know, new technologies as things are moving so
• 15:14
  quickly and change with whatever is needed,
• 15:17
  for that moment, I think is critical.
• 15:20
  When you look at AI in particular in
• 15:22
  bringing that into and integrating that into the
• 15:24
  broader organization,
• 15:25
  what are some of the ways that you've
• 15:27
  been able to, you know, whether it's roll
• 15:30
  it out or or communicate about it with
• 15:32
  the team to,
• 15:34
  ideally reach that spot where they're starting to
• 15:36
  integrate, especially for those who are on the
• 15:38
  more skeptical side, what's possible,
• 15:41
  to bring them along a bit more quickly
• 15:43
  and get them up to speed.
• 15:45
  So I think, you know, AI is fascinating
• 15:48
  because the right AI tools,
• 15:51
  people beg for.
• 15:53
  So
• 15:53
  it it's when we rolled out Ambient, and,
• 15:56
  again, not my program, Bracken Babula gets the
• 15:58
  credit for this in in our
• 16:01
  clinician practice.
• 16:03
  We got they describe it as love letters.
• 16:06
  It saved 84% of the documentation time was
• 16:09
  the actual data. You know, we talk about
• 16:11
  pajama time. No one wants to go home
• 16:13
  and document, but
• 16:15
  we're able to decrease the amount of doing
• 16:17
  that. And the original clinicians that piloted it,
• 16:20
  they took care of the change management because
• 16:22
  they just loved it so much. They spread
• 16:24
  the word to the person standing next to
• 16:26
  them, and it spread like wildfire.
• 16:28
  The the growth curve we have in our
• 16:30
  organization and the number of clinicians adopting it,
• 16:33
  it was hard to keep for us to
• 16:34
  keep up with the training.
• 16:36
  So I think if if we listen, and
• 16:38
  that's critical, if we listen to the pressure
• 16:40
  points for the people who work in our
• 16:43
  system and we solve the problem
• 16:46
  for those people that wanna be first movers
• 16:48
  in that space,
• 16:50
  they will spread the word. If we find
• 16:52
  a solution that doesn't work and we give
• 16:55
  it to those first movers and it stinks,
• 16:57
  it's very hard to come back and do
• 16:59
  the same thing again. So it it it
• 17:01
  again comes back to listening,
• 17:04
  solving the problem, and finding the right people
• 17:07
  to take the bull and run with it.
• 17:10
  I love that. I mean, it's just so
• 17:11
  simple, but at the same time, I know
• 17:13
  it's so much easier said than done. And
• 17:14
  to have something like Ambient two, you know,
• 17:16
  is that perfect use case where you can
• 17:18
  get love letters where you do, you know,
• 17:19
  make things so much easier for clinicians,
• 17:22
  that, you know, having that foot in the
• 17:24
  door to then think through, you know, what
• 17:26
  else can AI do for me is really
• 17:27
  powerful.
• 17:29
  Yeah. And I I think you you're right.
• 17:30
  It is way easier to say it than
• 17:32
  to do it. There are plenty of sleepless
• 17:35
  nights in trying to make these things go
• 17:37
  forward.
• 17:38
  But, you know, I think it's the mission.
• 17:40
  At the end of the day, I mean,
• 17:42
  the advantage of being an ER doc is
• 17:45
  you get to see what's broken in the
• 17:46
  health system, and there's so much to solve.
• 17:50
  So it's easy to stay really passionate
• 17:52
  and try and fix these things.
• 17:55
  Absolutely. And, you know, to that point, I
• 17:57
  wanted to talk about growth as well. Where
• 17:59
  do you see some of the best opportunities
• 18:00
  for organizational growth going forward?
• 18:03
  You know, that's a much more difficult question.
• 18:05
  I I I think that a lot of
• 18:07
  health systems are really thinking about diversification.
• 18:10
  Right? We have a university.
• 18:12
  We have a venture fund. We have a
• 18:14
  health plan.
• 18:15
  And it's if we're gonna take great care
• 18:17
  of patients,
• 18:18
  we can't be on the receiving end of
• 18:20
  everybody else's policies
• 18:22
  and not influence
• 18:24
  it. So much easier for us to give
• 18:26
  really good cost effective care
• 18:28
  if if we're control you know, people talk
• 18:30
  about controlling the whole premium dollar, but really,
• 18:33
  I prefer to think of it as controlling
• 18:34
  the whole patient journey while working with the
• 18:37
  patient to deliver an optimal journey.
• 18:39
  And if we could use the university to
• 18:42
  create staff
• 18:43
  and train in the right programs,
• 18:45
  and we could use the health plan to
• 18:47
  help the patients in our community pay for
• 18:49
  their care, and then we could deliver a
• 18:52
  cost effective care.
• 18:53
  Well, that's a great way to grow. But
• 18:56
  you you think about the the policy headwinds
• 18:59
  to everything.
• 19:00
  Well, this is now a lot of policy
• 19:01
  headwinds in a lot of different directions
• 19:04
  that we need to be prepared for.
• 19:06
  But I think growth is gonna be about
• 19:09
  making the best patient journey for the patient.
• 19:12
  And if we could do that, then
• 19:14
  we're gonna be the place patients want to
• 19:16
  come to.
• 19:18
  I love it. Judd, thank you so much
• 19:19
  for joining us on the podcast today. This
• 19:21
  has been such a fun conversation, very informative
• 19:24
  as well as the passion for what you
• 19:25
  do comes through in everything that you're talking
• 19:27
  about. So I appreciate your time today and
• 19:29
  look forward to seeing you in April. I
• 19:31
  know you'll be speaking on a panel at
• 19:32
  one of our annual meeting sessions coming up,
• 19:35
  and and so it'll be great to dig
• 19:37
  a little bit deeper as well as see
• 19:39
  you in person. So looking forward to it.
• 19:41
  Laura, thank you. I I I love the
• 19:43
  podcast, and I love the meeting in April.
• 19:44
  I look forward to seeing you there.