In this exclusive with HealthLeaders, Quane identifies three growth strategies, how key marketplace trends highlight both competition and collaboration, and how Oscar’s "Never Build Alone" and "Make It Right" approaches create a member-centric culture and plan designs.
HealthLeaders: If you could sum up Oscar Health’s market strategy in a single statement, what would it be and how does that differentiate you from your competitors?
Alessa Quane: For 2024, Oscar is really gearing up for growth. We've been very focused over the last few years on getting the fundamentals of our business right and moving the company to profitability. We feel really good about our progress on that path, so we’ve spent our time making sure we could use that as a springboard to get back to a larger growth narrative. From 2020 to 2022, we doubled in size. And while we’re not looking to do that again, we definitely want to grow profitably and serve as many people as possible in the growing ACA market.
HealthLeaders: Can you provide details on what it means for Oscar to gear up for growth?
Quane: Oscar has implemented a significant amount of expansion. First — while we're not entering any new states in 2024 — we are expanding to 165 new counties. This includes approximately 100 that meet the definition of a rural county. Often, there is less competition and less accessibility for people in those counties, so we’re hoping to offer more affordability and more options.
[Note: Oscar Health operates Marketplace plans in 11 states. Across all lines of business, as of March 2023, the company operates in 20 states.]
Second, we are enhancing our existing diabetes care plan and are introducing a chronic care plan for individuals with asthma and COPD called Breathe Easy. This plan offers a much lower cost share for benefits directly related to these illnesses to help members manage their chronic illnesses themselves.
The last thing we're doing, for our Spanish-speaking members, is offering an experience called Hola Oscar. A large part of the growing ACA population are Spanish speakers, so this program really allows us to deliver socially and linguistically authentic experiences when they call our concierge service — like matching members to providers who speak and can provide documentation in their language.
HealthLeaders: How are traditional benefits affected in specialty health plans — what is the impact, if any?
Quane: The other benefits pretty much stay the same. What these plans try to do is provide financial incentives for members to manage their disease in a way that is more specific and more affordable overall. For example, these plans put a member’s specialist copay [e.g., a frequently seen pulmonologist] on par with their PCP copay. For patients with asthma or COPD, a specialty plan lowers the cost of oxygen services and covers nicotine replacement [to discourage smoking].
Oscar Health's EVP and CIO, Alessa Quane. Photo courtesy of Oscar Health.
HealthLeaders: What is most important about the Marketplace, in 2024 and in coming years?
Quane: The continued growth in the market is a big topic: where that growth is coming from, including Medicaid Redeterminations and beyond that for populations that were previously uninsured. We've seen smaller employer groups — not in a material way at this point ACA — turning to the individual market. I think that's a real potential tailwind over the longer term.
I also think there's more stability in the market this year. We don’t have big insurer exits like the year before. We also have new entrants that are continuing to expand their footprint in new markets or engage in strategic retrenching in other markets. What I’m really looking for in our markets is: Are they doing what they need to do? Do our products meet members’ needs? And you know, from a business perspective, is this doing what we need it to do?
And so, the rationality of the players is good. I think that bodes well for the future of the market and to reduce overall volatility.
HealthLeaders:What are your thoughts on whether expanded subsidies will continue beyond 2025?
Quane:Quane: The last thing you want to see is a mass exodus from the market from an affordability perspective. That's an important topic for the industry to be thinking about, but beyond that Congress will have to take action. The expanded subsidies will expire if no action is taken. I think the Presidential election is key. There’s really no way to know what will happen until then.
HealthLeaders: An interesting component of Oscar’s values is “Never build alone.” How does that apply to your Marketplace strategy, as well as your own leadership style?
Quane: Never build alone is a subset of one of our values, Make It Right. Do your best work. When you make a mistake, admit it, and share what you're learning — whether it's through mistakes, innovation, or just your day-to-day.
No one is super successful on their own. When I think about how to go to market, Make It Right and Never Build Alone touches on every single part of the organization. Collaboration is super important. When we bring +Oscar and our technology to others in the market, it's to make the healthcare ecosystem more efficient, more affordable, and more accessible. That’s our mission.
HealthLeaders:What else is top of mind as we close, Alessa?
Quane: The one thing that I would want to say about Oscar generally is that we're not trying to get more members by just having a lower price. We strive to offer innovative plans and go after different markets — which is really for our members and to be a very member-centric company. The member is really the North Star. We have a Net Promoter Score, or NPS, that is substantially higher in the market, and we want to continue that. [NPS measures the loyalty of a customer to a company.]
Whatever we're building, wherever we're going, however we're innovating, the way in which we partner with or use our technology to support others is really all in service of the member. That’s an important point and differentiator about Oscar. It’s what drives me as a leader and what drives the teams we have at the company.
The Washington-based health system, which spans more than 50 hospitals in seven states, tested the technology earlier this year with Premera Blue Cross, one of the largest health plans in the Pacific Northwest. Officials say it was vetted by internal teams as well as HEDIS (Healthcare Effectiveness Data and Information Set) auditors.
With the tool, Providence pushes to the head of the pack in the nationwide quest for interoperability through national FHIR standards, alongside federal efforts to develop TEFCA (Trusted Exchange Framework and Common Agreement). The goal is to create a national framework for the exchange of all data between healthcare organizations, health information exchanges, payers, consumers, and other stakeholders, eliminating silos, improving clinical and business operations, and moving the industry toward value-based care.
“Interoperability is critical within value-based care, and FHIR integration allows healthcare organizations to exchange comprehensive clinical data that enables more accurate risk assessments, enhances care coordination and captures outcomes more effectively,” Michael Westover, the health system’s vice president of population health informatics, said in a press release. “By using a national standard for contract gap closure and capturing the much-needed clinical data, we empower all stakeholders in their ecosystem to make more informed decisions, improve patient outcomes and enhance the overall quality of care to our patients – who are always at the center of all our efforts.”
The nation, as a whole, has been struggling to reach interoperability because of the lack of standards for data sets, particularly at a time when the industry is seeing a wealth of unstructured data from sources outside the health system. As a result, few organizations use the same rules to organize and share data, using everything from spreadsheets, fax machines, emails, and secure file transfer protocols (SFTP) to share information.
In an email to HealthLeaders, Westover said Providence is a “trailblazer” in developing data exchange standards that meet HEDIS quality measures.
“We had to wrestle with a new data standard, new technology, and a new data security model,” he said. “We tested for months with our health plan partners and frankly learned some hard lessons as we used a generic clinical exchange standard for a targeted business case. We are now using what we’ve learned to scale the platform with other health plans.”
At Providence, the health system’s data-as-a-service (DaaS) tool leverages the Member Attribution (ATR), Clinical Data exchange (CDex) and Bulk Implementation Guides as national data exchange standards developed through the HL7 Da Vinci Project, which is billed as an industry-led project to enhance data sharing between payers and providers to enable the industry’s transition to value-based care.
A key aspect of the project was securing participation from a payer.
“We initially targeted the clinical data elements for 15 or so clinical measures that have a big impact on patient care and payer finances,” Westover explained. “We were surprised at how excited our health plan partners were and how they immediately asked us to expand the number of included measures and the qualifying patient population in the dataset. Our partners quickly saw the impact this type of DaaS could make on their business during difficult financial times.”
“Payers currently get much of their clinical data from patient charts and from data manually keyed into clunky websites or spreadsheets,” he added. “This solution allows health plans to exchange curated patient data rapidly using a nationwide standard format. If health plans can get higher quality data faster and easier than they could before, they will outperform their competition on important HEDIS, 5-Star, value-based care metrics, and other government programs.”
According to Westover, more efficient data exchange with payers means that providers and payers will have a shared understanding of their patient populations, which in turn will help improve care management and coordination.
Providence executives plan on using the tool to partner with other payers and vendors on data exchange..
“The technological and regulatory environments are evolving so quickly that we expect to see a few different approaches to these types of healthcare interoperability challenges,” Westover said. “Some groups will ask their EMR vendors to take care of it for them. The most successful health organizations will be those that can exchange vital data more efficiently than the rest.”
We speak with James Rohrbaugh, chief financial officer and treasurer of Allegheny Health Network, about the network’s recent efforts to help patients understand healthcare costs and simplify the billing experience for patients through revenue cycle technology.
Trinity Health uses virtual care, teamwork to address workforce, clinical care issues.
Trinity Health is taking a team approach in redesigning care delivery inside the hospital, using a three-person model that includes nurses, nursing assistants, and virtual care technology.
During a session in the HealthLeaders Virtual Nursing Mastermind series, Gay Landstrom, RN, PhD, NEA-BC, FAONL, FACHE, FAAN, CNO for the Michigan-based health system with 101 hospitals in 27 states, says the model, piloted in the summer of 2022 and is now live in roughly 40 sites, addresses not only the growing shortage of skilled nurses but a need to reduce complicated workflows that negatively affect patient care and staff morale.
“We realized that we needed to create teams,” she says. “This is a fundamental change to how we [deliver] patient care.”
Health systems across the country are turning to a variety of tools and strategies, many of them centered on virtual nursing. While the emphasis is on making the most of the shrinking nursing workforce by reducing stressful workflows, these programs are also increasingly targeting clinical outcomes, ranging from reduced length of stay to improved monitoring and patient engagement. And at a time when ROI for these programs hasn’t yet been proven, the more achievable benchmarks the better.
Landstrom says the driving force behind Trinity Health Together Team Virtual Connected Care is a shortage of nurses who want to work in acute care settings. To address this, the health system “tried a lot of things,” she says, from robots to scribes, before settling on a team-based approach.
Trinity’s three-person strategy is unique. The floor team consists of a nurse and either an LPN or CNA, with the former handling the nursing duties at the bedside and the latter doing tasks that don’t require an RN. The third team member, a veteran nurse, is in the telehealth center, monitoring patients and assisting the bedside team (as well as doctors) with documentation and consults.
Landstrom says leadership did a lot of research prior to launching the program and found that 40% of the tasks done by nurses on the floor can be done by someone other than an RN. Teaming a nurse with an LPN/CNA, she says, enables the nurse to work at the top of his or her license.
The virtual nurse, meanwhile, sits in the background, offering support when needed, answering calls from patients, and keeping watch over several rooms. Their tasks include documenting, monitoring, assisting with handoffs, rounding, working with doctors during examinations, and helping patients to understand doctors’ comments.
“There’s a great deal [of task] that a virtual nurse can do,” Landstrom says. “More than we thought they could. And they function here as a team.”
Landstrom says the virtual nursing role is typically filled by veteran nurses, and that some nurses “can picture having a longer career” by working as a virtual nurse. This could help Trinity and other health systems retain nurses who are considering leaving or retiring.
Indeed, one of the challenges to creating this model, says Murielle Beene, DNP, MBA, MPH, MS, RN-BC, PMP, FAAN, FAMIA, Trinity Health’s senior vice president and chief health informatics officer, is recruiting the LPNs and CNAs. As a result, Trinity has been working on updating its nurse assistant development program and has been in touch with nursing schools to determine how to bring more people into the workforce.
As for the technology, Beene said the health system “had to buy a lot of TVs” to establish the right platform for the virtual nursing component. While some health systems use tablets or telemedicine carts, an increasing number are using TVs built specifically for the healthcare setting and providing both entertainment and clinical services, ranging from audio-visual conferencing to access to resources and education.
“Technology assessments are vital” to establishing a good base for the program, Beene says. “It’s very important that we have seamless integration, and that was a challenge.”
Beyond the technology, both Beene and Landstrom say the biggest challenge to making this program work is change management. Redesigning inpatient care management is a drastic adjustment in how things are typically done inside a hospital, and it’s safe to say not everyone will be receptive to the changes from the outset. Executives need to map out these changes and lead staff through them, identifying the pain points and the benefits.
“We’re not just teaching people new workflows but coaching them,” says Landstrom.
Skepticism “was expected,” adds Beene, though management underestimated how much resistance they encountered.
“You don’t just drop this [new program] in and then leave,” she says. “This has to be part of the culture, and it involves a transformation of the mindset.”
Beene and Landstrom also found that coming into each hospital with a one-size-fits-all program was not working, and that each hospital not only had different strengths and needs, but different methods. That meant understanding the unique workflows and talents in each hospital and leaving enough room in the program model to adjust accordingly.
Likewise, Landstrom says, the three-person model “is not a model for all clinical areas.” She says it has shown value in med-surg, telemetry, and step-down care, but doesn’t quite fit on other wings of the hospital.
“We’ll be developing other models like this,” she says.
Landstrom also says it’s too early to determine ROI for this platform. While staff support and retention is an important goal, that alone probably won’t sustain the program. By charting clinical outcomes and aiming for pain points in monitoring, charting in the medical record, and patient discharge and room turnover times, she’s hoping the benefits will materialize in better patient outcomes, a shorter length of stay, and cost savings.
“It’s really a new way of thinking how we go about taking care of our patients,” says Beene.
The HealthLeaders Mastermind seriesis a months-long series of virtual panels and an in-person event featuring hand-selected healthcare executives. This Virtual NursingMastermind panel features ideas, solutions, and insights onexceling your virtual nursing program.Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
"The pressures have just gotten overwhelming," says one health system CEO.
Healthcare in a post-COVID world has been susceptible to workforce turnover and burnout, but that reality is also hitting those at the CEO level.
For hospitals and health systems, gradually improving but still tight margins are causing organizations to alter their strategy, resulting in churning over of leadership. Meanwhile, longtime CEOs are choosing to step aside and either enter a new chapter of their career or head into retirement.
Whether it's through consolidation, elimination, replacement, or resignation, the faces at the helm of hospitals and health systems are changing.
Through the first nine months of this year, 125 CEO changes took place at hospitals, according to a report from executive coaching firm Challenger, Gray & Christmas. That mark is a 67% increase from the 75 changes that happened over the same period in 2022.
In September alone, hospitals had 24 CEO changes—the second-highest number across the 29 industries and sectors measured in the report, trailing only government/non-profit (28).
What's causing these levels of CEO turnover in healthcare? The steady stream of economic and operational hurdles, said Michael Charlton, new president and CEO of AtlantiCare Health System, on the HealthLeaderspodcast.
"I think there's intrinsic factors when it comes to the CEO level," Charlton said. "Obviously you have the regulatory burden, you have the price pressures, you have the denials and the pre-authorization… there's a multitude of challenges."
Charlton is stepping into the role vacated by Lori Herndon, who retired in June to end a 40-year career at AtlantiCare. As both an incoming CEO and one that replaced a retiring veteran, Charlton is aware of how the current stressors are affecting entrenched leaders and creating opportunities for new ones.
The Challenger, Gray & Christmas report found that 318 CEOs across all industries retired this year, which made up 22% of all exits—slightly down from the 24% of CEO retirements last year.
"Sometimes when the deck is stacked against you in such a continuous manner, it gets hard to remember the purpose of why you're doing what you're doing every day," Charlton said.
"With all the pressures that the CEO faces, if there's an opportunity to transition out because we've had a very successful career over a long period of time and you feel that somebody is in a better position to serve the organization, that's a lot of it. The pressures have just gotten overwhelming."
How hospitals can respond
Refreshing leadership can often be beneficial for organizations, but having stability and continuity, especially at a time when turnover is high, can be a steadying force.
For example, Tampa General Hospital recently agreed to a 10-year contract extension with president and CEO John Couris after six years of service. The agreement created one of the only 10-year CEO contracts in healthcare.
"What they were thinking is how do we lock down a CEO that is probably at the apex of his career?" Couris said. "How do we create consistency, continuity, and stability in the organization? How do we create as much stability for the next decade as possible, given the fact that there's a lot of movement in the industry?"
Not every hospital can necessarily offer that kind of commitment, but there’s no reason why organizations can’t have a succession plan in place, whether that’s in preparation for a planned exit or to mitigate an unexpected change.
Identifying and developing leaders early can pay dividends later when an opportunity arises to advance in-house talent. Hospitals can evaluate not just the CEO position, but the entire C-suite annually to find out which executives have the potential to step up into the CEO role if the current CEO departs.
In the case of an upcoming retirement, tab a leader and have them work closely with the outgoing CEO to ensure a similar vision and approach is maintained in the new regime. In some cases, multiple C-suite executives may be nearing retirement at the same time. To deal with that, hospitals should get ahead of a massive changeover by attempting to stagger exits.
As for the CEO turnover that hospitals choose to create, organizations should be aware that a change in strategy may require a runway and allow their CEO the time and resources to see it through. Putting a CEO in the best position to succeed by surrounding them with the right leadership team and instilling confidence can mutually benefit both the CEO and the company.
Of course, even as the CEO position experiences change, other areas of the healthcare workforce remain in flux and that's something Charlton doesn't want to lose sight of.
Nurses and other clinicians continue to be vulnerable, which is why CEOs have had to manage the effects on their workforce while also dealing with it personally.
"We're all facing it," Charlton said. "It's just more magnified at the CEO level."
The Boston-based health system is the third to collaborate with the retailer on programs that shift care from the hospital to the home.
Mass General Brigham has announced a partnership with Best Buy Health to reinforce its acute care at home and remote patient monitoring (RPM) programs.
The Boston-based health system, one of the first to develop a hospital at home program and post studies proving positive clinical outcomes, joins Geisinger and Atrium Health in partnering with the retail giant, which jumped into the healthcare space with its purchase of Current Health in 2021. The collaboration gives the health systems a consumer-facing platform through which selected patients will be supplied with the appropriate medical equipment and have access to technical support.
“At Mass General Brigham, we are building the integrated healthcare system of the future across the entire continuum of patient care needs,” Heather O’Sullivan, MS, RN, A-GNP, president of Mass general Brigham’s Healthcare at Home program, said in a press release. “As a recognized leader of Home Hospital services, we understand that consumers are increasingly choosing the comfort of care at home as an alternative to traditional, facility-based delivery settings. By enabling our world-class provider services with technology that matters, we are elevating system capabilities and, most importantly, improving clinical outcomes for the communities we serve today while preparing for the future delivery of care more broadly.”
Massachusetts General Hospital and Brigham and Women’s Hospital were two of the first hospitals to launch acute care at home programs in 2016, before merging in 2020. The health system has treated more than 3,000 patients in its Home Hospital program, including nearly 1,000 this year, and recently received federal and state approval to expand the platform to treat patients from three more hospitals.
Acute care at home programs, which combine digital health and telehealth with daily in-person care visits, have grown in popularity since the pandemic, as health systems look to shift more services out of the hospital and into the home. The program enables health systems to reduce costly and staff-intensive in-patient services, while giving patients the opportunity to recover in their own homes, which studies have shown to improve clinical outcomes. The Centers for Medical & Medicaid Services has its own version of the platform, which requires hospitals to follow strict guidelines for Medicare reimbursement.
Through the Best Buy partnership, patients have access to the Current Health platform, including Geek Squad services, in which a team from the retailer is dispatched to the patient’s home to assess the home environment, install the right equipment and train patients on how to use the devices.
"We're fundamentally changing healthcare," Chris McGhee, Current Health’s founder and CEO, said during an interview at this year’s HIMSS conference in Chicago, noting the Best Buy can pick and choose the technology needed to make the best and most reliable connections between a patient in the homes and his or her care team at a hospital. "Hospitals value that curation."
Mass General Brigham officials say the partnership will not only bolster their existing programs but help develop new ones.
The Health and Human Services Department recently updated TEFCA to what it calls “version 1.1,” with specific tweaks and clarifications. Officials said the updates to the QHIN (Qualified Health Information Network) Technical Framework, FHIR (HL7 Fast Healthcare Interoperability Resources), and standard operating procedures will be unveiled during the Office of the National Coordinator for Health IT (ONC) annual meeting on December 14-15.
Of particular interest is the news that TEFCA will support FHIR-based transactions. Supporters say this is a key element to the industry’s acceptance of TEFCA as a roadmap to interoperability, while critics argue that many organizations aren’t yet ready to embrace FHIR.
“We have … committed to having TEFCA support FHIR-based exchange because API scalability needs TEFCA, and we are pleased to report that this will soon be a reality as well,” Mark Knee, an ONC deputy division director, and Jawana Henry, an interoperability systems branch chief and health coach at the ONC, wrote in an ONC blog last week. “The Common Agreement Version 2.0 is actively under development with a publication goal of no later than the end of Spring 2024. This version will include participation enhancements and technical updates to require support for Health Level Seven (HL7) FHIR-based transactions within 2024.”
"We're thrilled to see FHIR-based exchange make it into Version 2.0 of the Common Agreement,” Steven Lane, chief medical officer for Health Gorilla, one of the seven HHS-designated candidate QHINs, said in an e-mail to HealthLeaders. “ONC's FHIR roadmap for TEFCA exchange pointed us in this direction long ago, and it’s great to see we’re moving down the path. There was a lot of debate around TEFCA without FHIR, so we're glad to see the issue finally put to rest."
“Last week’s announcement is an indication we are getting close to a critical step in the launch of TEFCA,” Paul Wilder, executive director of the CommonWell Health Alliance, a non-profit trade association and a candidate QHIN, said in an e-mail to HealthLeaders. “We expect to have live production QHINs next month. It also acknowledges TEFCA is a living, learning framework that embraces iterative improvement with a scaled approach to FHIR being next. The rapid advancement of TEFCA and an explicit mention of FHIR indicates a desire to put FHIR at scale on the TEFCA speed ramp with significant steps expected in 2024.”
Also part of the process is the recent release of proposed disincentives for healthcare organizations engaged in information blocking. Health system leaders are particularly interested in this hotly-debated issue and will likely make their feelings know to ONC as this moves forward.
“The hard work of aligning the 21st Century Cures Act’s key priorities in API adoption, nationwide network interoperability, and Information Blocking is now being realized,” Knee and Henry wrote in their blog. “The launch of TEFCA this year, support for FHIR next year, and the recent release of draft rules to close remaining gaps in enforcement of Information Blocking are mutually reinforcing initiatives that will significantly advance interoperability in the coming years.”
The health system announced its dedicated space for innovation during the HLTH conference, with plans to support and develop new technologies and ideas to address healthcare’s biggest pain points.
Sutter Health is joining the ranks of health systems with built-in innovation incubators.
The Sacramento-based 24-hospital health system is opening an innovation center “aimed at fostering creative solutions to some of today’s biggest healthcare challenges.” Warner Thomas, Sutter Health’s president and CEO, unveiled the plan at last month’s HLTH conference and said the center should be up and running in San Francisco in early 2024.
The health system is one of at least a dozen major health systems, including UPMC, Houston Methodist, the Mayo Clinic, the Cleveland Clinic, and OSF Healthcare, who are looking to develop new technologies and ideas from within, with the goal of using their networks of hospitals and healthcare sites to test out and validate—and then potentially market—those products.
Speaking on the main stage at HLTH, Thomas said Sutter Health’s goal is to create an integrated network that enables consumers and patients to address all their healthcare needs in one place.
“Patients don’t want to go to 20 different [locations] to get healthcare,” he said. ‘They want an integrated health system.”
“We need to create an integrated experience, not a one-off experience,” he added.
Under Chief Innovation Officer Chris Waugh and chief health innovation officer Albert Chan, MD, MS, Sutter Health has built a reputation for focusing on human-centered design in healthcare. The health system recently beefed up Waugh’s team by luring two top executives from Ochsner Health: Richard Milani, MD, who was Ochsner’s chief clinical transformation officer and had led the health system’s Innovation Ochsner program for more than 11 years, is now Sutter’s chief clinical innovation officer, and Laura Wilt, who was Ochsner’s chief information officer for roughly a decade, has taken on the role of chief digital officer.
“Digital innovation is propelling healthcare into the future, and integrated systems like Sutter Health are leading the way,” Wilt said in a press release accompanying Thomas’ announcement at HLTH. “Establishing an intentional space for innovation sends a clear signal that Sutter, alongside our partners, is more committed than ever to deliver on our mission of making healthcare simpler, more engaging and deeply human.”
“We believe healthcare is at an inflection point,” added Waugh. “Sutter’s history is etched with groundbreaking innovations and partnerships that have elevated the patient experience. With the innovation center, we’re propelling our mission to new heights – igniting innovation through an unapologetically human-centric lens and ensuring a dynamic transformation that enhances the experience for both patients and providers alike.”
Thomas, who noted Sutter Health would also expand its investment strategy, said health systems are under pressure during a tight economy to be “more connected to our patients all the time.” That means investing in and supporting connected health tools and concepts that enable care management and coordination at the best time and place for both patients and their care teams.
That also means working together with other organizations to connect those care paths.
“Innovation thrives when we collaborate,” he said in the press release. “Together with innovation industry leaders, we are charting a new course to revolutionize the way care is delivered. Whether it’s in how we manage chronic diseases or provide care at home, our commitment to pushing the boundaries of what’s possible in healthcare has never been stronger. We want the work done here to have a ripple effect, transforming the entire healthcare ecosystem by benefiting both clinicians and patients. We invite visionaries who share our passion for innovation and improving the lives of patients to join us on this journey.”
Newly appointed president and CEO of AtlantiCare, Michael Charlton, joins HealthLeaders strategy editor Jay Asser to share his view of the healthcare landscape at the helm of the New Jersey-based health system. Charlton singles out workforce challenges as his main focus and offers insight on responding to disruptors, consolidation, and more.
At Valley Children’s Hospital, Jeremy Woods is digging into a patient’s genes and developing databases that uncover how diseases are created. “We’re no longer thinking one treatment per disease state,” he says.
Genetic testing is a relatively new and exciting concept in healthcare, giving doctors an intricate look at how diseases are created. And Jeremy Woods, MD, is developing rapid genetic tests and building databases that are changing how children are diagnosed and treated.
“We’re using data to get the patient’s best diagnosis and treatment based on their individual biology,” says the director of precision medicine at Valley Children’s Hospital in Madera, California. “We’re no longer thinking one treatment per disease state. We’re … getting real answers and providing precise treatments.”
Woods, who worked at UCLA Health before coming to Valley Children’s in 2020, is at the forefront of an innovative time in healthcare, with new and improved technology and strategies that are allowing researchers to get at the roots of disease diagnosis and treatment. Genetic testing and DNA analysis on newborns, for example, could help doctors identify and treat diseases early, saving millions of dollars in downhill healthcare costs and improving clinical outcomes—perhaps even curing patients.
Valley Children’s is part of Project Baby Bear, a consortium of California children’s hospitals launched in 2018 and funded by the state of California to develop rapid whole genome sequencing (rWGS) for ICU infants. In the first 18 months of the program, the genetic codes of 178 critically ill babies at five hospitals were sequenced, with some 43% receiving a diagnosis of their condition within three days and about a third receiving changes in treatment.
“This was a watershed moment in genomic medicine,” says Woods. “There are more than 3 billion pieces of information in the human genome, and it used to cost millions [of dollars] to sequence it. Now it costs about $200 and we can [provide results] in about a week, sometimes a day. The rate of innovation over the past three to five years has been stupendous.”
Jeremy Woods, MD, director of precision medicine, Valley Children's Hospital. Photo courtesy Valley Children's.
Woods says he treats about 2,000 patients per year, many with rare diseases.
“I deal with a disease that I had probably never heard of every day,” he says. “There are so many genetic variants that we don’t understand properly. That’s why collecting and analyzing all this data is important.”
And that has produced results. Using a database of genetic sequences that he developed, Woods was able to identify a rare genetic disorder, called Zellweger Syndrome, and trace its roots back to indigenous farmers from central Mexico. Although currently uncurable, Woods and his colleagues were able to send detailed information back to OB-GYNs in Mexico so that they could begin early screening to catch and treat the condition more quickly.
While this is an example of how data can be analyzed to produce meaningful, value-based outcomes, Woods says there’s not enough analyzing being done right now. Health systems need the technology, including AI, to take all that data coming in and curate it. And they need EHR platforms that can integrate that data.
“Many people [undergo genetic screening] and get their results in a PDF, which they forget about,” Woods says. “That’s why it’s so important” that the data is embedded into the EHR, where it can prompt doctors to take a closer look and have discussion with their patients.”
With that data, he says, healthcare providers can also identify populations that exhibit a prevalence of a specific disorder, then design community outreach programs that support screening, identification, and early treatment. And it can be used by genetic counselors to support—or rule out—expensive lab tests and new treatments.
On another level, Woods sees the continued development of pharmacogenomics, or programs that study how a person’s genetic makeup reacts to medications. This, in turn, would help the pharma industry develop more effective medications, while giving clinicians more insight into what drugs will and won’t work for specific patients.
Woods says support for precision medicine and genetic testing is slowly gaining steam. Payers, including some Medicare and Medicaid programs, are now covering genetic testing when it’s recommended by a patient’s doctor. And the technology will someday be refined so that genetic tests can be sequenced at the patient’s bedside, in less than an hour, and inputted directly into the EHR.
Precision medicine “is still a somewhat nebulous concept,” he says. “The biggest challenge right now might be education.”
