As the new COO of Yale New Haven Health System, what do you see as the current challenges?
I've joined YNHHS at a very exciting time. We are facing tremendous external pressures right now — the Governor's state budget cuts and the impact of national sequestration, which is setting caps on government spending that will dramatically affect hospitals, Medicare and Medicaid, and medical education. Things are changing all around us, and this is a good time to be part of a strong system. How we got here and where do we want to go are two very important questions.
Where are we, as a health system?
We are the largest health system in Connecticut — comprised of several organizations with shared vision and values — our hospitals, medical staffs, NEMG and others. We have a common interest in being successful, but we need to harness our synergies. We do that through a process of cultural integration among our three system hospitals.
What do you mean by cultural integration?
Cultural integration is a process of coming together and blending the best from each of us, with a common purpose — and our purpose is to deliver better care more efficiently to our communities. Our communities are in different towns and cities and our patients are all along the continuum of care, from outpatient to inpatient, from acute to rehabilitative to preventive care. This is what is meant by accountable care.
Could you describe accountable care?
Accountable care means taking overall responsibility for keeping patients healthy and ensuring they get appropriate care at the right time — not just focusing on an episode of illness or a hospitalization. We are accountable not only to patients but to others who pay for health care — insurance companies and the government which pay us through Medicare and Medicaid. So we are responsible for the cost as well as the care. This is part of what people call Obamacare — the Patient Protection and Affordable Care Act of 2010, enacted to decrease the number of uninsured Americans and reduce overall healthcare costs.
Is healthcare reform part of what you mean when you say, "Where do we want to go as a health system?"
Absolutely. We need to grow and strengthen this system if we want to survive and thrive, but our ultimate goal is always improving patient care and making it more efficient and affordable. We do that by sharing best practices within the system, by managing the health of our population and by offering value. We think and act more as a system than as individual providers. We share a common vision.
What is the vision of Yale New Haven Health System?
Our vision is to provide clinically superior appropriate care in collaboration with other providers and payors that improves value for patients and enhances the health population we serve. We can do that better as a unified system than as separate hospitals. We don't have to do everything exactly the same, but we need to find and develop our similarities.
Can you give an example of how we have developed our similarities?
Epic is a perfect example. We purchased, customized and are implementing it together, so we will have a single electronic medical record linking our institutions, our physicians and our patients — both inpatients and outpatients. Another example is the Smilow Cancer Hospital Patient Care Centers, which are at YNHH, Greenwich and throughout the state. Standardizing by adopting more and more of the best practices already in use in our own system will make us more cost-efficient but more importantly, will raise the quality standards of the care we provide. This is what the phrase "cost and value" means.
Haven't we already standardized and reduced costs in many areas?
We have done a good job with many of our nonclinical services like billing, registration, information technology, purchasing, pharmacy formularies. We are now beginning to look at clinical redesign. We will continue to identify the best ways to do things across the system — such as decreasing hospital-acquired infections, removing gall bladders or replacing joints. Yale New Haven Health will never be the lowest cost provider because of who we are. We offer services and have additional expenses, such as physician training, that not all hospitals have. Which is all the more reason why