Executing Population Health Strategy: Q&A With Dr. Mike Schatzlein, CEO of Saint Thomas Health

Mike Schatzlein, MD, president and CEO of Saint Thomas Health in Nashville and ministry market leader for St. Louis-based Ascension Health, knows healthcare's status quo isn't sustainable.

That's why the former cardiothoracic and vascular surgeon with 40 years of healthcare experience is making changes at Saint Thomas to improve the quality and efficiency of care provided in his system's hospitals and other facilities. A big part of that strategy is managing the health of populations.

Here, Dr. Schatzlein discusses why and how Saint Thomas Health is working toward population health management and the leadership skills he uses to make that change happen.

Question: You've made some major changes at Saint Thomas Health. What fuels your drive to change your system and healthcare as a whole?

Dr. Mike Schatzlein: Our people deserve better. We have [as a nation] evolved into a system that is episodic in nature and we do a great job taking care of folks who need a major intervention, but then we throw them back into the pond and wait for them to get into trouble again. When we survey people, we find them frustrated with their ability to navigate the system, know what things are going to cost and know whose advice to believe. We're not serving our neighbors in helping them stay well and understand the importance of maintaining health throughout their lives. Schatzlein

Q: Population health is touted by many as being the solution to fixing healthcare. What steps has Saint Thomas taken to better manage population health?

MS: Population health is a holistic concept. When I think of population health, I think, for example, of the patient-centered medical home. For 40 years I've been saying everyone needs a personal physician. We've gotten away from that as people shop from emergency room to emergency room or specialist to specialist, but medicine is just too complicated today to navigate it without help. With the fee-for-service payment model, there is no good way for providers of any type to be reimbursed to take the time to do care navigation. The patient-centered medical home addresses those issues and it's the best way I know to help control the burgeoning cost of healthcare. We cannot continue to spend 18 percent of our GDP [gross domestic product] on healthcare in this country — that's twice what other developed countries spend, and we get outcomes that certainly are not demonstrably better.

This feels really, really right for Saint Thomas Health. We're a faith-based organization that pursues holistic care, which involves taking care of a person across the continuum and being with them where they are. Taking care of patients across space and time in a loving way is what Saint Thomas Health has done for 100-plus years. Now, the country actually really needs that, and it feels like it's our time.

In addition to all of the things we continue to do to make acute-care hospitals and outpatient centers accessible and patient-centered, we also established an ACO, MissionPoint Health Partners. MissionPoint has a board with many physicians, some hospital administrators and even a Medicare beneficiary. Beneath the board are a number of committees with physician involvement that are working on the best evidence-based care pathways to help patients get well and stay well.

If you were a MissionPoint member, one of the first things you'd get to do is go to an online marketplace and pick your medical home. In the online marketplace, patients can see which physicians have what hours and what their special interests are, things like that. Members also have access to a cadre of health partners — like nurses, social workers, pharmacy technicians or dieticians, for example. The health partners provide a kind of concierge medicine to members while also looking out for potential health pitfalls.

Underlying MissionPoint is an investment in health information technology to bring inpatient and outpatient records together and do predictive analytics to help us make sure we're achieving the results we want and that we are following best practices.

Q: On that note, what is the goal of implementing electronic medical record systems in Saint Thomas facilities, and how has it been accepted by physicians?

MS: There is no endpoint in EMR development, but we just achieved HIMSS Stage 5 and have the goal of reaching Stage 7.

There's a range of physician and caregiver acceptance of EMRs, but the only way you can have integrated records is for it to be electronic. I would be lying if I told you all of the 2,000 physicians on the medical staff and at MissionPoint are eager to see a new software program pop up. But we exert resources for implementation, optimization and provider training. Some caregivers are frustrated; and we work really hard to help with the learning curve.

The investment is clearly well worth it. There is no other way to maintain a medical record but digitally. Medicine is too complicated for us to have handwritten paper spread all over the country with no ability for the data to interact. There's also a need for more than one person to access the same record at the same time, and you can't do that with a paper chart.

Right now, a patient portal is being tested for patients presenting at one of the nine hospitals in MissionPoint, and it will be fully deployed this year. We'll keep adding functionality. It may initially be for lab test results, scheduling and bill paying, and we can continue to add on to that and we will. Our stated goal is to be the Amazon of healthcare.

Q: How will having a system clinically integrated through EMR promote population health?

MS: You can't manage the health of a population without it. If we're going to provide optimum care at optimum cost, we need to know all about the patient before we do anything to him or her. Also, if you back up and look at population, you have to have longitudinal data on its health as well.

Q: Saint Thomas is a large system — how do you lead change that affects staff and physicians at hospitals and numerous other facilities?

MS: I only have one leadership skill and that is that I hire, retain and motivate great people. When I was a transplant surgeon I could do it all myself, and I can't do that anymore. So it's mentoring, coaching and sponsoring — it comes down to trusting your team.

I've gotten better at it. Certainly, heart surgery is a solo enterprise — there are teams involved but the primary responsibility is certainly assumed by surgeons. Running a health system takes an entirely different skill set, so there had to be some evolution there.

Q: Healthcare as an industry is continually developing and growing. How do you continually develop your leadership skills to keep up?

MS: Being a ministry market leader for Ascension Health is a big boon for that. There are eight of us, and we meet with executive leadership in St. Louis in person or via telepresence. Those people all have vast experience in hospital administration, and all have responsibilities in diverse markets in which Ascension operates all over the country. They would be my first source of ongoing knowledge.

A second source, which is kind of a surprise to me actually, is that I'm sitting here at "ground zero" for healthcare in Nashville. There are so many smart healthcare people here; you can't go out to dinner without running into some at the next table. I'm also involved in the Nashville Healthcare Council. It's a function of the Chamber of Commerce, and it's unique. There's not one member of that board that I couldn't learn a lot from.

You can't help but learn about healthcare just wandering the streets of Nashville. It's the Silicon Valley of healthcare.

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