Care Delivery _Dr. John Chelico: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Manav Sevak:
Welcome to the Memora Health Care Delivery Podcast. Through conversations with industry leaders and innovators, we uncover ways to simplify how patients and care teams navigate complex care delivery.
Manav Sevak:
Hey, everybody, this is Manav here, founder and CEO of Memora Health. Really excited to have an interesting guest, Dr. John Chelico from CommonSpirit Health on today. John, thanks so much for taking the time.
Dr. John Chelico:
Thank you for having me. I’m John Chelico, I’m an internal medicine doctor by training, but I want to say I was, I started out way back when, as a software developer who ended up going to medical school in the nineties, worked for two health I.T. startups during that time, went on to sort of be, get formal training in internal medicine and then biomedical informatics, and really been a career chief medical information officer for a number of large health systems around the country, but currently, I am at CommonSpirit Health. I am the System Chief Medical Information Officer looking at how we are going to change care across our 22 state, 146 hospital, 1500 care setting health system. We are definitely growing, large, one of the largest health systems in the country, and we have the ability to really change the way, hopefully, we see, in how care is delivered in our footprint today.
Manav Sevak:
Yeah, absolutely, it, really, really interesting background. What was kind of the, there aren’t a lot of people who have trained as computer scientists or software developers and then ended up choosing to go into to medicine, which for what it’s worth, particularly for CMIO role is probably perfect. So what was kind of that decision-making process for you? How did you decide that you wanted to go into medicine?
Dr. John Chelico:
You know, I guess I think we shared some similar background. I have many folks in my family that are physicians over the course of time, and I think it was something I always thought about. I actually became an EMT in high school and I, as I sort of got involved in healthcare and healthcare delivery, being someone who sort of very technically oriented, I definitely saw an ability for technology to make things better and solve many of the problems in healthcare. So it was really that pursuit to sort of improve the status quo that really drove me to a career and not in health IT and clinical informatics. It’s, and really it’s not looking back, I mean, we continue to sort of use technology to improve the care we deliver, and I think the model of the first tool that a physician uses to take care of their patients is the stethoscope has really changed to, sort of the first thing they do is actually roll over to their computer and use their EHR. And I think that’s something of a care delivery tool that can’t be contended with otherwise.
Manav Sevak:
No, that’s awesome, that’s fascinating. So, you know, you’ve transitioned to now working for one of the largest health systems in the country, and it probably gives you a lot of, a very, very interesting perspective on the challenges that we face as a healthcare system in the entirety of the United States, but related to that would be helpful to maybe just hear your perspective on what are some of the unique challenges that come and start in particular has, with the patients that they see and the footprint that it has given how large of a system that they are, and how does that kind of compare to maybe prior experiences they’ve had or other systems that you’ve worked with?
Dr. John Chelico:
Well, I mean, you know, prior to CommonSpirit Health, I spent the past 11 years at Northwell Health. Combined with training, I was there for 15 years over time. Northwell Health was sort of geographically contained in and around New York City and geographically contained within an hour north and an hour east of New York City. It was geographically contained, the ability for us to sort of get care to where we want to for our communities was sort of something that I never, I really, never took for granted. Like when you think critical access to New York City, you think of a Bellevue Hospital, which is like an 800-bed hospital, or you think of a county hospital like Nassau University Medical Center, which is, behemoth of hospitals. CommonSpirit Health really wants to take care of patients where they are in all parts of the country and people that otherwise have been marginalized. For instance, a critical access hospital in the Midwest may be a ten-bed hospital. That’s critical access that no other hospital, there’s no other hospital for a 400 mile, maybe for another 400 miles. It is amazing to see that the sort of care deserts, as you kind of maybe call it, in the country, and the ability for us to sort of deliver care in the same quality of care as we do to some of our academically oriented tertiary, quaternary care centers is key. And I think it really kind of comes down to not just the delivery of care for, you know, the basic chronic care and everything else, but how do we bring clinical trials to those folks? How do we bring advanced technology to those folks? And that’s really, I think, the ability for us to harness technology to really get to those patients that otherwise don’t have easy access to care. I mean, again, going back to New York, I mean, every, if you just throw a stone, you get another Ivy League grade medical center. And, you know, we kind of take that for granted in some of the larger metropolitan areas. But I mean, the ability for that and be able to sort of look at the population of folks all across the country and in so many different markets really has abled us to see sort of in a, microcosms in the markets, but on a macro level, how we harness this, that footprint.
Manav Sevak:
Yeah, no, absolutely. And maybe related to that, clicking into a little bit of the work that you’ve done at CommonSpirit, what are some of the big areas that you’re investing in and places where you’re spending your time, particularly in the digital landscape right now?
Dr. John Chelico:
I think we are looking for places where we at the system level can improve the things for the lives of our providers and our patients in the divisions. We can do things like create connection centers that allow providers to utilize the, take work out of the provider’s hands that are in the clinics or in the office or in the hospitals. The ability to sort of do that work on a national level has the ability for us to build infrastructure that supports many different hospitals and many different clinics across the organization. We can just manage things on a global level for referrals, for instance, how a patient leaves and says, hey, you need to see your gastroenterologist and your cardiologist, and have the ability for not the office staff to be responsible, the doctor be responsible to take that burden off of the providers and let them do what they need to do to take care of patients, but not worry about the pre-authorization, the pre-visit, testing or whatever else that needs to happen prior to that next visit, but have them do the right things, make the right decisions for their patients and be able to sort of operationalize that for them and not have them burdened with worrying about getting it done. I think the ability for us to do that on a system level is really kind of where we are going to create some systemness. CommonSpirit health is just sort of forming in the sense that we really want to be a best-of-class integrated delivery network across the country, across 22 states, and unless we create that systemness and the ability to sort of harness that, we’re never going to sort of really have the ability to shift some of the costs also outside of the market, so that’s, I think that’s the dynamic. And without that footprint, we wouldn’t be able to sort of prove that out, and that’s the exciting part about what we’re doing in … size.
Manav Sevak:
Yeah, no, absolutely. And the flip side of that, though, is, you know, I’m sure that one of the biggest challenges that you have to deal with every single day is how to prioritize the reality of being a part of the C-suite for an 11-figure revenue health system is probably not easy by any means. So what’s kind of the framework that you use for figuring out how to spend your time and how to prioritize? And maybe some of the added context that I’ll share there, at least from our perspective at Memora, is that it feels as if healthcare is going through this massive transformation of moving out of the traditional healthcare setting and moving out of the walls of the hospital and out of the walls of the clinic. And related to that, there’s all of this new infrastructure that has to be put in place to be able to manage and support patients effectively. Where do you figure out where to start and how do you figure out what to put at the top of your list in the midst of probably hundreds of things that you get asked to prioritize every single day?
Dr. John Chelico:
Well, definitely in the technology arena, there’s a lot of bright, shiny objects. There are a lot of things that sound cool, could really maybe change the way we deliver healthcare, but ultimately, we need to make sure that we’re solving the problems that we are, currently have. Are we currently having problems with staffing shortages on the nursing and the physician side, or the provider side? Are we, how do we find technology to improve that? Where, are we having a hard time with making connections with our patients as they move along their care journey? And how do we kind of make that so that patients want to stay within our health system and continue to drive folks within our facilities? So when I look to sort of prioritize things, I look to sort of solve the problems that we currently have and that the board wants to sort of solve as a whole, and I think that’s really the drivers that help us prioritize what we need to do. I mean, all in all, I think there is also sort of a fiduciary responsibility to make sure that we’re doing these things that sort of continue to help us provide the revenue that helps us drive the mission of the health system, and I think those are all the drivers that help us sort of prioritize what we need to do on a global level.
Manav Sevak:
Makes a lot of sense, and maybe related to that, I think one of the things sitting on the other side of the table and being a part of a digital health company is that we spend a lot of the first couple of years in Memora trying to figure out who were the right stakeholders for us in large health systems? Who were the people? Who were going to be executive champions? Who do we need to get to know on the ground? Who do we make sure we’re consistently reporting out to? Things like that. And it feels as if a lot of digital health companies go through that discovery process and go through that evolution. And it’s, one thing that I know we struggled with a lot is how to think about CMIOs, and if we should be thinking about them as technical stakeholders, if we should be thinking about them as clinical stakeholders, if we should be thinking of them as neither. What’s your perspective on that? If you’re, let’s say, advising an early-stage digital health company, or if you’re advising people outside the industry looking in, how should they be thinking about what the title CIMO really means?
Dr. John Chelico:
Yeah, I wouldn’t take it to sort of the title being the end-all sail. It really is, not all, I mean, I want to say that the title CMIO is, not all CMIOs are the same. Some have a much more technical bent and some have much more of a clinical bent, some of them have more of a bent towards the business, and over time, I think a CMIO, in general, has sort of moved from being somebody who is sort of very much into the implementation and optimization of the EHR. Obviously, the physicians, for the physicians, as we used to call it, to someone who is really acting as a player for how are we going to improve care or how are we going to help the, our senior leaders and our board deliver on what they need to do for the mission and vision of our health system. And to that end, really, how do we sort of serve all of the providers in our health system? How do we serve all the patients that come to our health system? And how do we kind of also help the business and the operations of our health system? So I think that dynamic of different things, so as to answer your question, I think it’s not a one size fits all answer. I think some CMIOs will help you significantly on the technical bend. I was a technical person. I’m always sort of that through and throughout. So I understand the technology, I understand the underpinnings of how the technology works, but as well, as I’m a practicing clinician and I kind of understand how that goes. So I’m very much sort of the translator and have the ability to sort of kind of live in those two worlds, and I think that’s something that I’ve learned over time. So I think that, same thing like, no two CMOs are the same, no two CMIOs are the same, no two CEOs are the same, or CFOs. Everyone kind of is sort of part of a larger team that makes it all happen together, and I think that’s probably my, to answer your question, I think it’s not a one size fits all approach.
Manav Sevak:
What’s kind of your breakdown of how you choose to practice versus how much of your time is more executive level?
Dr. John Chelico:
It changes over time. When I was sort of the local person and the local CMIO for the hospital and I was working within the four walls and going upstairs to see patients and sitting in the boardroom later in the afternoon. I think on a system level, I think I find myself sort of being a little bit more remote in the sense that visiting different markets and understanding what we’re doing in different markets, it really has changed sort of the dynamic. I’ve always spent about 10 to 20% in care over the course of my time as a CMIO. And I think as, sort of as I progressed, I’m sort of leaning more on my experience as a care provider and really helping that drive what I’m doing. But I think every bit of me wants to continue, kind of practice there regardless of where I am and sort of the dichotomies, I’ll still sort of hold on to that. It’s probably more from my own psyche than anything else.
Manav Sevak:
Absolutely, and as somebody who has a handful of close friends and family who all practice medicine, it only makes sense. It’s, a lot of it is, you know, people choose to go into into the field and people choose to work in healthcare because of the proximity and connectivity to patients, and it completely makes sense that’s something you’d …
Dr. John Chelico:
And in clinical care, you really kind of are distant from what’s happening at the front lines. You also sort of have a great ability that you have to sort of understanding your providers, And for me, I think that’s very much paramount. But as I see some, we can’t do it without proper management and staffing and other folks that we have in operations in the health system, and I think everyone kind of serves that a different role in sort of creating a working, functioning health system. I think that’s where I’ve sort of learned, just I’ve learned over time that everyone sort of brings something to the table, and I think whether it’s our clinicians or our staff or providers or administrators, it’s all sort of a team effort that really kind of gets to bring things to the table for our patients.
Manav Sevak:
Yeah, absolutely. So you obviously have experience on the technology side and have a technical background, and have now spent a lot of time in healthcare. As you think a little bit about the moment that healthcare is having as an industry, what are some of the other industries that you look to for inspiration? Or are there particular types of organizations that you really admire that you think give healthcare a really good model for understanding how it should be, navigating all the change that’s happening regulatory-wise, technology-wise, care-delivery-wise?
Dr. John Chelico:
I think if you can open up your smartphone and look at the top six, top used, best-used apps that you have, you know, the Amazons, the Ubers, the, you know, whatever your banking apps, your banking industry, I mean, a lot of the even social media, I think we have a lot to learn in healthcare from how people are getting used to interacting with everything else that they do in their lives. Your expectation is to have a fully functioning interaction with your driver, your supermarket, your package, your Amazon vendor, or even your interaction with your banking is all done sort of in your hands and you’re in your thing at any time of day, and I think that is really a goal, is the ability for you to sort of feel in touch with your healthcare provider as you are with many of these other entities without ever interacting with a person, even though there are people behind the scenes sort of getting a lot of that done. And I think that is a place where I think I look to say, hey, why can’t we deliver the same way some other industries are delivering? Now, healthcare is a lot different than a lot of these other things, and we’re not delivering packages, we’re delivering care, and it’s obviously a lot more high touch than some of these other things. But there’s a lot of work to be done to improve the lives and the care that we deliver for our patients when they’re not in front of us, and I think that’s, the ability to do that while they’re not in front of us is key.
Manav Sevak:
Yeah, 100%. Cool, just last question I’ll ask you is, related to that, there’s so much that has to happen and at times that’s super energizing, and at other times it’s daunting to think about how much change needs to happen in healthcare. What kind of keeps you going? What excites you the most about where the industry is at right now? What excites you the most about just being six months in this role at CommonSpirit? What excites you the most about how much has changed in terms of just technology adoption over the past several years in healthcare?
Dr. John Chelico:
I think we’re sort of at just at the precipice of really seeing how we’re going to change care in this in this country. I think we’re getting to a tipping point where COVID has proven to us that we have the ability to do some of the things that we always wanted to do. You know, payers are getting a lot more aligned for us to sort of support these care models, and the ability for us to work together with the rest of the sort of the healthcare ecosystem to provide the best care for our patients is something that keeps me up and gets me excited every day. I mean, the ability, again, to do this across such a large footprint in CommonSpirit health allows us to sort of prove it out in some markets and where it totally makes sense today, and from a relationship with our payers and other things, and the ability for us to sort of translate that and look at it in some of the other markets is going to be very exciting. And that’s really, I definitely, when I say I started to do this because I want to make healthcare better, I think this is sort of now, we have the foundational things in place like ubiquitous EHRs, access to our data, all of the rudiments of technology and standardization between our vendors, all of these things have kind of come to a perfect storm for us to sort of really kind of act on all of the foundational things that have been put in place in health IT informatics over the course of the past 20 years.
Manav Sevak:
Yeah, no, absolutely, and I think one of the things for me is that the past two and a half, three years, in particular, they have very much changed the tone in how much pressure is applied to leaders in healthcare to understand how much actually needs to change if we’re going to turn around our healthcare systems, and it feels as if now compared to at any point in time that I’ve been running Memora, or any point of time that I’ve had proximity to the healthcare system, that that very, very much is starting to show in how people choose to make decisions and people being very invested in figuring out how do we take these businesses that are incredibly, incredibly challenging to run and historically have had unfavorable economics, and figure out ways to really modernize and entirely change the experience of what healthcare looks and feels like. So it’s wonderful to hear your perspective, John, really, really appreciate you coming on, and excited to see all of the wonderful things that you’re able to do in the new role at CommonSpirit.
Dr. John Chelico:
Thank you very much for having me, look forward to future conversations.
Manav Sevak:
Thanks for listening to the Memora Health Care Delivery Podcast. For more ideas on simplifying complex care for care teams and patients, visit MemoraHealth.com.
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