Hackensack Meridian Health is a not-for-profit health care organization that comprises 13 hospitals, 28,000 “team members” and more than 6,000 physicians. In an exclusive NJBIZ interview, the organization's Co-CEOs, Robert C. Garrett and John K. Lloyd, open up about challenges and solutions in the healthcare space, industry innovation, and why their institution has two CEOs.
Robert C. Garrett: First, it must remain affordable. Obamacare isn’t perfect, but we’ve had concrete gains in New Jersey: 800,000 people obtained insurance, the state has received $4.4 billion annually and we have a record number of uninsured – six percent. But given the volatility in Washington, premiums are expected to rise 24 percent or higher in cases. We must keep it affordable or we will have more uninsured, which will drive up costs for all.
Second, we must ensure quality care at lower costs. We are achieving this in many ways, primarily focusing on value-based medicine, which rewards providers for keeping people healthy instead of paying them for every treatment or hospitalization.
My third point is all about innovation. As Steve Jobs said: “Innovation distinguishes between a leader and follower.’’ At Hackensack Meridian Health we have several innovations underway including an ideation center we developed with the New Jersey Innovation Institute, which brings together the best minds in science, engineering and medicine to launch the next trailblazing product or solution. Our network has funded the cause with $25 million and we expect to award one of our four finalists a grant to launch an exciting new product that could improve care and lower costs.
John K. Lloyd: Focusing on affordability, quality while lowering costs and innovation is really our only path. Consider this: We have watched health care expenditures climb from 5 percent of GDP in 1960 to one-sixth of our economy. We have to curve that spending arc to sustain and improve our system. About half of all U.S. health care spending goes to treat a small number of diseases such as diabetes and congestive heart failure. Diabetes alone costs $100 billion a year to treat. But we are putting in place more systems – hiring care coordinators and enhancing technology to better track outcomes to keep people healthy. An example: a diabetic patient in one of our Accountable Care Organizations had slurred speech Christmas Eve and instead of going to the emergency department, his care coordinator quickly contacted his doctor and arranged a visit. The net result? The man was given new medication and made it home Christmas Eve without testing and other ER interventions that could have cost up to $10,000.
Lloyd: When I came to New Jersey in the early 1980’s, my vision was to fundamentally change the way health care is delivered. I think that we have done that exceptionally well; in individual hospitals and through the formation of Hackensack Meridian Health, New Jersey’s largest comprehensive and integrated network. We accomplished this in several ways: first, by diversifying into ambulatory care so patients didn’t have to come to hospitals for non-hospital services. And second, by developing a true continuum of care, so patients can move seamlessly through our network of 13 hospitals and more than 140 ambulatory care centers, surgery centers, long-term care and urgent care centers.
Garrett: The future of health care delivery will require more data-driven care and more focus on keeping people healthy and well. We have developed entire population health teams to aid our physicians in this colossal shift toward value-based care. We are supporting them with patient coordinators, quality experts and enhanced technology, all with the goal of more personalized, cost-efficient medicine. It’s really the Holy Grail of Health Care. We are working tirelessly to support medical education in New Jersey culminating in the development of the Seton Hall–Hackensack Meridian School of Medicine. Our four-year-curriculum, which is pending accreditation, will focus on primary care and inter-professional team work when the school opens next year. Research shows that physicians are more likely to practice in the state in which they train.
Lloyd: Bob and I have known and respected each other for more than 25 years so it was a natural fit when we merged [Hackensack University Health Network and Meridian Health merged in 2016]. We each had our areas of expertise: I focus on population health and our continuum of care, which is unprecedented in New Jersey. We have more than 140 patient care locations throughout the state to offer care at convenient and affordable locations. Consider this: we have found that half of our ER patients did not need that level of care. So to save time and money, we have built more urgent care centers or partnered with other providers to deliver care closer to home at lower costs. Who wants to be in a hospital when you don’t need it? Bob’s focus has been on our 13 hospitals across our network, physician enterprise, academics and innovation. He has spent a lot of effort on building partnerships and investing in innovation. But it’s really all about our teams of physicians, nurses and leaders who share common goals and are committed to making sure our patients have the best experience.
Garrett: We have to be nimble and bold, and not wait for Washington to address our problems. We cannot be wedded to specific policies because, as we have seen, Congress remains paralyzed, unable to even agree on the rules of the game. That’s why beyond Washington, all health care leaders must embrace key principles to transform our health system: affordability, quality care at lower costs and innovation. We are doing all of that at Hackensack Meridian Health. For example, our historic partnership with Memorial Sloan Kettering Cancer Center will result in a uniform, exceptional standard of care at facilities we operate jointly in New Jersey. We will continue to focus on new paths to better care and cost savings. Here’s another example: we helped develop Cancer Outcomes Tracking and Analysis, a digital classification system that helps physicians personalize treatment and track cost. We found that by performing a test on certain breast cancer patients—one that costs $4,000—we saved on average $11,000 because the test determined not all patients would benefit from chemotherapy versus alternative therapies.
For the fourth year in a row, our Hackensack Alliance Accountable Care Organization (ACO)—a participant in the Medicare Shared Savings Program and the Track 1 Model—generated more than $50 million in shared savings in 2016. Of that estimated $50 million, the ACO will receive nearly $23 million, which participating physicians can use to continue to improve patient care. These results are evidence of the success of a major change in health care, one we are leading.
It’s on all of us to commit to providing excellent, cost-effective care. The future of our nation’s health care system depends on it.