Erin Freeman: Welcome to Sweet Tea and Strategy, a podcast by Ackerman Marketing and PR, featuring business and community leaders throughout Tennessee talking about issues and trends of importance to our state and beyond. I’m Erin Freeman, and on behalf of Ackerman, today I’m excited to be sharing conversation and a glass of sweet tea with our guest, Mr. Joe Landsman, President and CEO of the University of Tennessee Medical Center in Knoxville. Joe, welcome to the Sweet Tea and Strategy podcast.
Joe Landsman: Good to be here.
Erin Freeman: First, I must ask you a question that I’m certain everyone wants to know the answer to. How does Joe Landsman like his sweet tea?
Joe Landsman: What’s sweet tea?
Erin Freeman: Well, in the South, it’s tea with a lot of sugar in it. Do you not like sweet tea?
Joe Landsman: So I’m from the Northeast—well, actually we’re below the Mason-Dixon line in Baltimore, but I think that’s still considered here the Northeast. And we never referred to sweetened tea as "sweet tea." It was either—it was iced tea and you either added sugar or you didn’t, or sweetener. And we always drank our tea without sugar. So, I don’t drink sweet tea.
Erin Freeman: Well, we definitely love our sweet tea here in Knoxville, but now let’s talk about business and strategy. Year after year, U.S. News & World Report ranks UT Medical Center as one of the best in the state and the best in East Tennessee. And in addition to that, Forbes recently recognized UT Medical Center as the third-best employer in the state of Tennessee, which makes the Medical Center the best healthcare employer in East Tennessee. So with that said, tell us about UT Medical Center, Joe. What’s the Medical Center best known for?
Joe Landsman: Well, the Medical Center’s been around since 1956, and we have always served the role as the region’s academic medical center. What we’re best known for in terms of services that we provide to our community is our Level 1 trauma center. We are a very, very busy Level 1 trauma center with a very high acuity of injury. In fact, 80% of our trauma victims are either falls, which is our number one mechanism of injury, motor vehicle accidents, or agricultural accidents.
Joe Landsman: So we’re—we have a very—it’s usually a multi-system blunt trauma injury that our trauma patients suffer from. But in addition to that, we also serve a unique role in our community in that not only are we the provider of patient-centered healthcare, but we also provide a number of services that are only available in this community on this campus. And we’re looking to the future in our research endeavors, looking for new cures and treatments for the diseases that our region suffers from, as well as we’re training the future healthcare professionals that will be needed to help all of us maintain our health and live healthy lifestyles and take care of the issues that we will endure over the years.
Erin Freeman: Well, with everything we hear about what’s wrong in healthcare, what do you think is right? And what’s the best way to communicate what’s right to your patients?
Joe Landsman: Well, there’s a lot that’s right, particularly given the journey we’ve been on now for about 15 years. I think that our focus on trying to work with our patients and better align the different providers that are involved in caring for a patient across an entire episode and coordinating that care, and making sure that the patient is aware of their role and what should be happening to them along that journey, as well as having our clinicians coordinate and follow a common and agreed-upon care plan is going to help improve our outcomes. It’s going to help eliminate unnecessary variation. It’s going to help our patients understand their role in that course of treatment, and I think overall will lead to a healthier population that’s more engaged in maintaining their health.
Erin Freeman: Talk to us a little bit more about what you call the quality journey and how that’s helped the Medical Center improve outcomes for patients.
Joe Landsman: So after spending 40 years in healthcare—nearly 40 years—the evolution of really being focused on the product we deliver, I think is a very important and meaningful benefit to those we serve. It is our goal to be the highest-value provider for our region. And value is defined as quality care that’s delivered safely, that is delivered in a way that those involved in that process have a good experience.
Joe Landsman: And so that means quality and safety and experience is both for our patients, but also for our team members and our physicians. And then all of that being delivered efficiently and effectively so that we would be able to become and are the highest-value partner for our patients, for our employers who actually pay for a lot of the healthcare services in our region, and for our payers.
Joe Landsman: The transparency that we’re driving in our quality metrics, I think is a very important journey that we’ve all been on for a long time. I think that we have initiated a clinically integrated structure where we’re, again, coordinating care across the entire episode with all of the clinicians and patient involvement. And I believe that this will ultimately continue to show improvements in our quality metrics and lead the state, lead the region in those improvements. As we sit today, we have very strong quality outcomes, but there is always opportunity to improve, and we’re always looking for those opportunities.
Erin Freeman: Clearly, by the recognitions you’ve received, it’s clear that your team members are engaged in the mission and the vision of the Medical Center. And so what do you think—why do you think your team members like working here?
Joe Landsman: That’s a really interesting point, and I will tell you that I couldn’t value our team members more than I do, and our physicians. That they really are a group of individuals that collectively care about the work they do, care about their patients, care about this organization. And I think that, along with the support that we hope and provide to them, makes us a good employer, but also makes the product that we deliver, which is healthcare to our region, better.
Erin Freeman: Well, the saying is that leadership starts at the top and trickles down. So what’s the most important aspect of leadership to you?
Joe Landsman: Well, I give full credit to the team and to the physicians. I take no credit for this. But I do believe that being—having a collaborative spirit, being open to ideas and concerns, and being attentive to trying to address those ideas and concerns is critically important to the values of the organization and the team that lives those values every day.
Erin Freeman: There are several negative misconceptions about healthcare. What is the biggest misconception that you feel patients hear about our healthcare system?
Joe Landsman: I think one of the areas that we struggle with as a community, and that makes it difficult on all of us, including and particularly our patients, is that I think at times when we have needs, we forget about the lifestyle of those that are delivering and satisfying our needs. And being a healthcare provider—and I don’t care what specialty you’re in, whether you’re a physician or a nurse or a certified nursing assistant—it’s a hard lifestyle. And it’s a commitment to serve.
Joe Landsman: And we have to make sure that not only are we taking great care of our patients, but we also have to make sure we’re taking care of ourselves in that process. And I think at times the patients don’t feel like they’re getting the attention they need, when in fact it’s some of our healthcare professionals really trying to be attentive to making sure that they can do the work they’re doing over an extended period of time and addressing their own needs as well, and their own health and well-being. And I think that’s going to become even more of a challenge, particularly as we continue to face predicted shortages of healthcare professionals, be it nurses or physicians.
Erin Freeman: So in your 40 years of working in healthcare, and you have a background of coming from finance, what is the biggest change you’ve seen in the healthcare industry?
Joe Landsman: That’s a great question, and I would say there’s a few observations. Number one is that—and I can be very critical of the provider sector of our industry, and that’s what we’re responsible for is the provider sector—but I can criticize all sectors of the industry, whether it’s the payer sector or the manufacturer sector. But let’s focus on the providers for a second, and I think going back 40 years ago, we were not very good stewards of our sector of our industry. And I would say that the product we delivered probably could have been a lot better.
Joe Landsman: So when I refer to being a good steward of our sector of the industry, what I’m really speaking to is making sure that the quality of the product we’re delivering is a valuable product. And I defined that earlier being quality, safe care that has a great experience for those involved in that process and doing that all efficiently and effectively. And as we look at our industry, we have been resistant to using techniques that other industries have used to drive quality or drive value.
Joe Landsman: And we are now embracing that, and we are now being more transparent with our quality metrics, and I think that is good for everyone involved. It’s good for patients obviously, but it’s also good for the folks that are involved in delivering the care. And it gives them a better understanding of how they’re performing and where the opportunities to improve are. And I know that just about every healthcare provider that I know is focused on improving their outcomes and improving the value that they deliver to their patients. I believe that we’re doing great work in our clinical integration journey in trying to coordinate the care across an entire episode so that all the providers are working on a common and agreed-upon care plan that’s evidence-based and patient-centric, and that our patients are engaged in their process as well.
Erin Freeman: When you look at other healthcare systems in our nation, is there one that stands out to you that does it right?
Joe Landsman: Well, there’s many that stand out as doing it right. You know, Kaiser—they were early on in this journey. I think that they’re—they’re probably more advanced than most and have done a great job with their patients, and I read a lot of their publications. And there’s others. And but we’re all in various stages of—and clinical integration has become the term that’s commonly used, but to really understand and be able to define clinical integration and then move towards fully implementing clinical integration, there’s probably fewer organizations that have actually moved very far down that road, but I believe that we’ll all be moving down that road over time.
Erin Freeman: You’ve mentioned the phrase "clinical integration" several times, so what is clinical integration? Define that for our listeners.
Joe Landsman: Okay, so in order to define that, I need to level set on a couple statistics. First off, let’s understand that the literature will tell you that it takes about 17 years in the United States to fully adopt evidence-based medicine. Secondly, we have been lacking real patient engagement in their care processes. And it’s because they don’t understand—I’m not being critical of the patients, they just, you know, they’re not healthcare professionals, so they’re not going to understand, and I’m not sure we’ve done a good job explaining to them their role in their care process and their recovery process.
Joe Landsman: And I think that the other thing that I worry about is the efficiency of the work that we do, and facing the future where right now about 10,000 people are turning 62, which means they’re going to be better—bigger utilizers of the—or bigger—they’re going to access more of the healthcare services. I worry about our capacity going forward.
Joe Landsman: So clinical integration in our—on our campus really is defined this way. First off, we believe that an episode of care should be delivered based on an evidence-based, patient-centric plan of care that spans the entire episode, and that every clinician or every care provider that’s providing care throughout that episode to the patient is following that same plan. And that plan of care is measured and evaluated to make sure it’s driving high-quality, safe care with a great experience for those involved in that, and all of that being done efficiently and effectively.
Joe Landsman: So as we sit today, about 95% of our inpatients are covered by the care plans that I’ve described. Those care plans have now moved into the post-acute care arena—rehab facilities, nursing homes, long-term acute care hospitals, skilled nursing facilities. We also have moved those pathways into the physician outpatient practices to a degree. That’s still work in process, but we have a lot already embedded in those practices so that no matter where the care starts throughout an episode—could be an EMS transport, could be the emergency room, could be a physician’s office, could be just a direct admit to the hospital, and then could end either with a home health visit or a rehab stay or back in the physician’s office—that care plan covers that spectrum.
Joe Landsman: The last iteration of the care plans is one we’re working on now, and that is actually taking the plan of care and converting it to patient education material and highlighting the things the patient should be experiencing and at what point in that episode they should be experiencing that care, and what their role is in ensuring that they’re getting the care and what their role is in their recovery.
Joe Landsman: Now, wrapping around that pathway, that care plan, we believe that we need two additional components of our delivery system. One is chronic illness management programs that are centralized and staffed by passionate, knowledgeable experts that can engage with the patients in a multitude of different ways. Meaning electronically, telephonically, in person, whatever it is that the patient responds to the best and the patient’s desires. So we have built three chronic illness management programs around this structure to help with the chronic illnesses that our patients struggle with. And the whole goal there is to educate and encourage and help the patients maintain their health, who are dealing with chronic illnesses.
Joe Landsman: And then the last piece is, and this is an interesting concept, and that is we really need to have a better medication management plan for our patients. And when you think about Tennessee, I’ve read articles that claim that there are as many as nine prescriptions written for every individual that lives in Tennessee on average. So that means there are some that are on many more than nine.
Joe Landsman: And when you think about it, to understand the meds they’re on, to be able to afford the meds they’re on, making sure they’re taking the right meds is very difficult for some of our patients. So we’ve built—we have a full-time pharmacist and we actually need more to handle the number of patients—but we’ve built a medication management program around the patients that support our clinical integration structure.
Joe Landsman: They are looking at patients that are on X number of prescriptions or more (right now we’re using nine, I think that needs to go lower) and they’re going through an algorithm that says, are there any meds that should have been discontinued? Are there any meds that are causing negative drug interactions? Are there any meds that they should be on that they’re not on?
Joe Landsman: Then they get all of the clinicians that have written those prescriptions on the phone, and they agree on what the medication program for that patient should be, and then the primary care physician is the owner of that conversation with the patient. And the other thing that we found is for some patients that can’t afford all their co-pays on all the meds they’re supposed to be on, we’ve been able to work with the pharmaceutical companies that have programs that will provide meds free of cost to these patients, so we’ve been able to get them the meds they need if they can’t afford them. And I think that more than anything is going to drive better health in our community.
Erin Freeman: So what does clinical integration mean to the patient?
Joe Landsman: I think from the patient’s perspective, it means that there is a lot better coordination of care throughout the entire episode, because one of the things that we struggle with in healthcare is the fragmentation. You know, what happens in a physician’s office is not necessarily transparent to what happens in the inpatient setting, which is not necessarily transparent to what happens in a post-acute care setting like a rehab facility. So I think from the patient’s perspective, having that care process aligned, with everybody communicating and sharing information across the episode, will improve the outcomes for the patient and the additional benefit is the patient understands the process. So there’s a patient education component of this that’s going to be incredibly impactful over time for our patients.
Erin Freeman: One final question before we let you go. What’s next for UT Medical Center?
Joe Landsman: Well, as an academic medical center and with the responsibility that that comes with, there are a number of services that we are looking at adding to our campus that will be enhancements to what’s available in our community. We are looking at additional growth—actually in mid-August we should be adding another inpatient unit, 32-bed unit, to help with the additional volumes that we’re seeing.
Joe Landsman: The additional research programs that are being built as we speak should help enhance our ability to find new cures and treatments for the illnesses that our region suffers from. And then lastly, we’re looking at adding some academic programs, particularly in the post-residency fellowship arena, that will again enhance the ability to have the number of qualified healthcare professionals that this community needs going into the future.
Erin Freeman: Joe, thank you so much for your strategic leadership. We admire what you and your team members at UT Medical Center do for your patients and our community. We appreciate you chatting with us.
Joe Landsman: Erin, it’s been my pleasure and thank you for the opportunity.
Erin Freeman: We hope you’ve enjoyed today’s Sweet Tea and Strategy podcast. To hear more conversation about business strategy and communications, visit https://www.google.com/search?q=thinkackerman.com. We appreciate you listening. Cheers to the next edition of Sweet Tea and Strategy.