How RWJBarnabas Health is Using Innovation to Transform to a Value-Based World

Transformation executive Joseph Scott offers behind the scenes look at a unique approach to change, with employee training at the forefront and a related gaming app in development.

How does a health system transition from a fee-for-service environment to value-based care? RWJBarnabas Health is taking an interesting path by combining strategic planning with population health and innovation under the leadership of Joseph F. Scott, FACHE, executive vice president of health care transformation.

"We're on the cusp of seeing significant transformation in healthcare," says Scott. "We're figuring out how we begin to gain experience in what this new transformational healthcare world looks like."

Part of the formula for New Jersey’s largest integrated health care delivery system involves managing its own employee health plan, a comprehensive training program that teaches every employee how to be part of a High Reliable Organization (HRO). Scott's approach also involves a heavy dose of innovation, investing in ventures that include developing a gaming app for employee training to enhance retention, as well as a startup that saves physicians time by scrubbing the electronic medical record for specialists to present only the most meaningful information for their needs.

Previously, from 2008 to 2018, Scott served as president and CEO of Jersey City Medical, which received more than 35 awards and recognition for quality services, patient safety, and community outreach under his leadership. He joined Barnabas Health in 2014 after a successful merger between Liberty Health and the Barnabas system. He continued serving as the president and CEO at Jersey City Medical Center while beginning work at the system level to formalize the strategic planning process.

Following are excerpts from a recent conversation between HealthLeaders and Scott:

HealthLeaders: What are your strategic responsibilities?

Joseph Scott: I have responsibility for strategic planning, so as we look at transformation, [I'm focused on looking at] what key strategic initiatives will transform our organization as we move forward. I'm also responsible for population health; I don't think there's anything more transformational then a move to value. Tying our strategic plan and population health under my leadership is a good connection. And, third, I'm responsible for innovation—looking for new ways to do things in our organization. The biggest issue around transformation … revolves around engaging everyone in what it means to prepare the organization to move into a value-based world.

HL: Can you share more details?

JS: We're largely in a fee-for-service world today, and yet there are pockets of moving to value that are beginning to put pressure on the organization. For example, many of our managed care companies would like us to move to more risk-based contracting [to manage] a particular patient population. {In addition] of our advanced medical groups might have primary care medical home models where they're in some type of risk arrangement. There's pressure from those groups who are now saying, "Maybe I don't want to use hospital-based services. Maybe I don't want to admit patients as much as I did in the past. I'm being incentivized now to move to value, and we're going to do that independent of the hospital." So that becomes a big challenge. At the same time, what's driving the majority of our revenue is that fee-for-service model. That's where the challenge is, trying to explain to people why we need to get ready for a move to value, what the benefits are, and engaging our entire organization around that move to value.

HL: How are you meeting those challenges?

JS:                                                                                 

1. Communication is key. That's got to be a key strategy going forward, and it's got to be succinct and in a way that's understandable for people.  
    
2. We're looking at ways that we can move to value and really focus on how we might be able get experience in a value-based world. We have over 32,000 employees, and with their dependents, we're self-insured for about 40,000 people. [In November 2018] we took over managing our own employee health plans because essentially, we're at risk for those 40,000 people. One way we're gaining experience and talking about challenging the status quo is to begin to gain care management data analytics—essentially population health experience—in our employee population base where we're at full risk. That's one strategy that we were using to put our toe in the water of a value- based world, and it should have exponential benefit if we can really manage our own employee population to the highest level.
    
3. The other thing that we're really truly focused on from a transformational perspective is the ability for us to provide the highest level of safe and quality care, which we believe will eventually result in reduction in overall cost of care. We have a large initiative around high reliability training, [helping] every employee understand what it means to be a High Reliable Organization (HRO). We believe that that will drive a singular patient experience at each one of our facilities and is key to improving the overall efficiency of our inpatient model at this point in time and it extends to all of our ambulatory sites.
    

HL: How does the innovation factor into your process?

JS: We've got a slightly different approach [than other organizations]. We have invested in some venture partner firms and we're working with them to identify gaps in facilitating and making things easier for our patients, physicians and employees. One of the partners is called Newark Venture Partners. We shared our strategic plan with them, and they started looking for startups who might provide opportunities to make things better.

HL: How have these startups impacted the way you do things at your health system?

JS: One company they ended up funding and housing in their facility is called Wellsheet. Essentially, they scrub the medical record by specialty. We started with cardiology. Instead of seeing the entire medical record, its scrubs it for specific issues relative to the cardiologist. It's a really innovative way for us to take all of the data in the medical record, put it into a summary format, and save the cardiologist time from looking through the entire record for the information they need. It [also] will identify if someone had a diagnostic test, and by using artificial intelligence, indicates [whether] that the patient might be a candidate for [another procedure, such as] a TAVR (transcatheter aortic valve replacement). It was a collaboration between Wellsheet, Cerner, and us, and I think it's fully implemented at two of our facilities right now.

HL: Any other significant innovations?

JS: Last year we trained 32,000 employees in a four-hour session around high reliability. Our commitment was to get every single employee up to speed [on this initiative]. As you can imagine, that's a big undertaking. We also spend a lot of time doing compliance and HIPAA training.

[We're now working with a company] called 1Huddle. They take the content of your training and put it into a video [gaming] format that can be accessed on a [smartphone]. Employees can then have contests learning about different topics. Each module takes about three minutes. [Compared to traditional classroom training, 1Huddle's studies indicate that] after 90 days, people using [this method] retain 90% more than people who attended class. We gave them all of our HRO training, and they put it into various modules. We're getting ready to do a study to determine the difference between using 1Huddle versus training in a classroom and see what employees' retention rates are after a period of time.

It also tracks the scores for individual employees. When Joint Commission visits, you can pull up a report and show exactly how your employees scored on [each topic]. I'm really excited about it because we do so much training, and this will make things easier for our employees. I 'm going to know we're successful when one of our employees says to me, "Hey, you know, that HIPAA training was so much fun!"

HL: What advice do you have for other healthcare systems that need to jumpstart their transformation initiatives?

JS: Transformation is about your entire organization being engaged. I can't stress enough how important that engagement piece is and to communicate in a way that's meaningful for frontline staff. Commit to high reliability and explain that this is a transformative process that's going to make things safer for employees, for patients, and for everyone who comes in contact with the organization.

In terms of value, we focus on social determinants of health. I believe that the only way we are truly going to focus on social determinants of health is when we're fully at risk in a value-based contract because that's when it will become important for us to settle issues like transportation, housing, and food insecurity because that will drive the overall cost of care. Until we're in a full-risk contract it will be more difficult. But having people understand why those social determinants are so important as we move to value also becomes a great way of engaging our employees around what we're trying to accomplish. So I would say employee engagement would be the key issue.