What healthcare will look like in 2024 | Stephen Klasko | TEDxPhiladelphia

How will healthcare change in the future? Dr. Stephen Klasko shares his insights on healthcare reform in this informative talk cleverly staged in the year 2024. As the President and CEO of Thomas Jefferson University and its affiliated Hospital, Dr. Klasko manages enormous change – both in health care and in the business of running a major college and hospital. His work focuses on merging the two, finding ways to expand medicine into the community in innovative ways.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

Well, I want to thank you all for coming,

and especially the people
that came from outside of Philadelphia

that hovered over here;

especially those of you that time-traveled
from other decades and times.

I'm Steve Klasko.

I'm the CEO of Stevie's Vinyl Emporium
and Implantable Health Chips

in South Street in Philadelphia.

(Laughter)

That's what I am today.

But for the past ten years,

I've been the presidency
of Thomas Jefferson University

in Jefferson University Hospital System

that literally was one of the pioneers
along with several others

for what is now called
the leaders of the optimistic future

in Healthcare Revolution
from 2015 to 2024.

So for those of you
who are coming from another decade,

or for those of you
who are here in the 2020s,

I'd like to talk a little bit
about how that journey happened

and maybe give you
a little bit of the personal story

about how it happened for me.

So first one of the things that we did,
is we got tired of whining,

and we decided
let's just travel to the future,

think about what we want
and then create it.

For me, that started in 1977.

Very important time for me,
I was a senior medical student.

It was important because I got asked
to give a talk for TED.

Now not the TED you're thinking of
because TED didn't exist in 1977.

It was called tomorrow's
education of doctors.

It was everything different
than the technology that exists today.

It was a little slideshow with a screen,

but they asked me to talk about
what the future of medicine looks like

from a medical student's point of view.

I remember it for it was the first time
I saw the Rolling Stones -

this is what they looked like
back then; I was a huge fan.

But what I talked about because I
was a little nervous about the first talk,

I talked about: Can you do anything
about spiraling costs?

Can you change the fee-for-service system,

so we're really rewarding
value and not volume?

And can you measure outcomes?

And I said my generation of docs is going
to solve this over the next four years.

We are not going to be dealing with this
even 20 years from now.

Well, amazingly the docs said, "No."

And that didn't happen.

Now I was also a very different
person back in 1977.

This is what I look like.

(Applause) (Cheering)

Thank you.

That's called a leisure suit.

(Laughter)

But for a brief interlude
where they tried to bring it back in 2019,

I think it's safe to say
it's out of the fashion lexicon forever,

but the car was in 1968 GTO
which was and is a very cool car.

Thank you.

So then we went through really
what some people called

the middle or dark ages,

the Managed Care Revolution,
which did not really manage anything.

It didn't really provide care;
it just promoted underutilization -

the balanced budget amendment,

which didn't balance the budget,
and didn't really amend anything.

And then the first iteration
of what has now been 17 iterations

of what was then called Obamacare.

So that brings us to 2014,
and why was 2014 important to me?

Well, I was very proud and honored
to be inaugurated and selected

as the first president and CEO

of Thomas Jefferson University
and Health System combined.

It was also a big moment for me
because it was the second time I saw them.

This is what the Rolling Stones
looked like back in 2014.

(Laughter)

And in my inauguration
I was given a script,

and what I talked about
my inauguration in 2014 is:

"Hey, can we do anything
about spiraling costs?"

Can we change the fee-for-service?

Do you think we can measure outcomes?

That was a bit of an a-ha moment for me,

I said, "Well, 37 years, that's a lot
for not to have much change."

This time though, the insurers
and government said:

"We're really going to do it."

And really what people
were actually predicting is -

because believe it or not, even at 2014

the docs said: "I really don't
want to take any risks.

I think things are fine
the way they were."

And you couldn't go a week
without people

threatening the extinction
of academic health centers.

So I'm proud to say here in Philadelphia
and at Jefferson we said yes,

and I'd love to talk to you a little bit
about what happened between 2014 and 2024.

So here we are in 2024, and by the way,

I don't know if any of you saw it
on your Facebook implantable glasses,

the Zombie Rock Tour, it was awesome.

It was awesome.

By the way, those Facebook
implantable glasses

can be bought at Stevie's Vinyl Records
and Implantable Devices.

(Laughter)

I thought the Rolling Stones,
the Rolling Stones rocked,

(Laughter) (Cheers)

they rocked the undead tour, right?

Who agrees with me?
They rocked the undead tour.

Seven decades of great Rolling Stones.

You talk about
not getting any satisfaction,

look at these guys.

(Laughter)

But more importantly, more importantly,

what happened in Philadelphia,
what happened at Jefferson was,

that we took that mode of saying -

people said that it's impossible
to change healthcare.

And really the personal piece,
for me believe it or not,

didn't come from Maimonides or Aristotle,

or even somebody from the University
of Pennsylvania or Jefferson.

It came from a sneaker commercial.

It was an Adidas marketing campaign
back in 2014 called the Impossible.

It said "impossible" is just a big word
thrown around by small men and women

who find it easier to live the world
they've been given

rather than explore the power
they have to change it.

Impossible is not a fact; it's an opinion.

Impossible is temporary;
impossible is nothing.

So we decided, "What the heck,
let's do the impossible."

Because everybody knew
things were changing,

we weren't going to wait for a miracle.

And we said, "Let's do it."

OK, so here it is, it's March 28th, 2024.

Now I apologize for those of you
who come from this decade,

but I know some of you
probably have time travel lag,

and I just want you to know
where we're at today.

So it's March 28th, 2024,

President Jenna Bush will be debating
Democratic nominee Chelsea Clinton,

in what a lot of people think
will be a very tight race.

Harrison Ford has signed up
for one last Indiana Jones sequel,

(Laughter)

tentatively titled Indiana Jones:
the Legend of Bingo Night,

we're all excited about that one.

And the Eagles are 2-0
and trying to win their first Super Bowl

since the unprecedented fourth straight
they won from 2015 to 2018,

the so-called Chip Championship Years.

(Applause) (Cheering)

Of course, Governor Chip now has a very
different job than he had back then.

But more importantly or as importantly,

Jefferson is celebrating
its 200th anniversary

as an international hub of innovation,

with headquarters in Philadelphia,

instead of just the Philadelphia
academic medical center.

We've become a destination site
for innovative entrepreneurial health

with unprecedented economic development,

and our creative partnerships

have allowed us to become
what The Wall Street Journal called

a thriving cluster on the verge
of a chain reaction,

which has helped make Philadelphia
the epicenter of the new healthcare.

By the way, I'm getting out of my DeLorean

to accept an award from the US News
and Interplanetary Report.

As most of you know in 2019,
we found two other planets

with slightly dysfunctional
health systems,

so they are now part of the ranking system
that the former USNWR used.

So how did we get there? I'd like to ...

TEDx has asked me to talk
about three things that we did

that were very different.

First of all, we decided that we're going
to start to create docs of the future,

that it's ridiculous to have the same way
that we selected and educated physicians

that became autonomous,
competitive, and hierarchical,

and that we actually were going
to change the DNA of healthcare

literally one physician at a time.

You may not believe this,

but back in 2014, we still chose doctors
based on science GPAs, MedCaTs,

which were a multiple-choice test,
and organic chemistry performance.

And somehow we were amazed
that doctors weren't more empathetic,

communicative, and creative.

As my kids would say, "Duh."

(Laughter) (Applause)

So we changed all that.

What we recognized is that it used to be
for those of you who came from the '70s -

and I think there are actually some,

I see some people from 2014,
I see some people from the '80s.

Go Journey, yeah.

(Laughter)

I see some tie-dye out there,
some '60s and '70s. Peace!

But we decided to transform admissions.

What we realized is
that all the scientific data

is on what in 2014 we called
iPhones and Androids,

but really what we needed
were emotionally intelligent physicians.

So we now really select physicians
based on self-awareness, self-management,

and the ability to adapt,
social awareness and empathy,

relationship management, teamwork,

and the ability to really embrace change
instead of fighting it.

But not only that,

we totally changed the way that we teach
the physicians that we do accept.

Believe it or not back in 2014,

we used to spend two years
really teaching them scientific principles

in large auditoriums,
classes that a lot of them didn't come to,

when we recognized
that we could do all that,

have them learn that
at two o'clock in the morning.

Now we spend most of our time
in what we call the Art of Attending.

Teaching them to really observe,
we started back in 2014,

workshops designed to sharpen
observation skills of health students

by looking at art.

Very unusual partnership,

it was Thomas Jefferson University,
Contemporary Art Museum,

an institute for an optimistic
future in healthcare.

We took students
and had them understand art.

So if you take
this piece of art over here,

medical students originally said,

"Well, that's a woman;
that's a snake; that's a family."

But when you started to look
and say, "What is the story?",

it started to totally change the way
that they cared for patients.

And at the end of the day, we went
from silos of full-time individuals

to folks who could deliver
team-enabled and team-based care.

Doctors went from being captains
of the ship to being part of a team,

and they, believe it or not, work closely

with multidisciplinary
care-delivery teams,

including doctors of nursing practice,
nurse practitioners,

clinical pharmacists,
physician's assistants.

and at the Thomas Jefferson Institute
of Emerging Health Professions,

professions that didn't
even exist in 2014,

things like probability experts,
electronic health care ambassadors,

and telehealth professionals.

So we recognized that we needed
to evolve doctoring.

We also recognized that the patient
experience was really pretty lousy.

Back in 2014, you could actually
do anything you needed to do in travel,

anything you needed
to do in shopping on a device,

but could you get an appointment
with a physician? No.

Could you interact
with a doctor or nurse? No.

So we decided that healthcare needed
in 2014 to get into the E&I mode.

If you even look at how people
viewed us from TV shows -

how many of you are here from the '70s?
There you go, okay.

So the big tip television show
in the '70s was Marcus Welby.

Now here's what Marcus Welby was.

He was a family physician.

He would get up in the morning,

he would go to the homeless shelter,
take care of people for free.

On the way home to lunch, a cow would
be having trouble delivering a calf,

he'd deliver it.

He'd then go to his family medicine
office in the afternoon,

and then at night he'd do
left ventricular neurosurgery.

We were Gods, we could do everything,
that's how people viewed us.

In the 2010s this is what we had.
Anybody remember this guy?

(Laughter)

He was a drug-addicted,
sex-addicted, really smart guy

that couldn't communicate or see patients.

That's what people viewed us.

The number one TV show of 2023?

Was Doctor WHO, which
stands for Watson Hybrid Organo Doc,

who basically fell in love
with his robotic-bionic counterpart

who does all the scientific stuff
while he does the emotional stuff.

And as you can imagine, hilarity ensues.

By the way ...

(Laughter)

By the way the first season of Doctor WHO

is available on Google Glass
implantable chips,

available at Stevie's Vinyl Records
and Implantable Chips on South Street.

(Laughter)

So the other thing we embraced
was entrepreneurship.

We recognized that being academic
and entrepreneurial

just were not mutually exclusive,

and we also recognized that we had
to enhance the consumer experience.

It really was lousy going to a physician.

This is what it looked like back in 2014.

Female: What's wrong?
Stevenson: I don't feel so good.

F: Then you need to go to a doctor.

Female nurse: Mr. Stephenson?
S: Stevenson.

FN: Do you have any allergies?

How would you describe your symptoms?
What is the general area of pain?

Does your family have a history
of heart disease or diabetes?

Doctor: And what seems
to be the problem today, Mr. Stevenson?

S: I'm feeling a little stuffed up.
I'm experiencing some ...

FN: Doctor, your 3 o'clock is early,
your 2:45 is late from 6 and 7.

D: Follow these instructions;

if it doesn't clear up in a week or two,
come back; we'll do this all over again.

(Moaning)

S: I don't like going to a doctor.

SK: So in July of 2014, we partnered
with some great companies,

created an innovation-driven
ecosystem for healthcare.

Starting in 2015, patients in 48 states

could access Jefferson doctors
via telemedicine.

S: Well, now you can see a doctor
without going to a doctor's office

with the help of your smartphone,
or computer, and American Well.

Signing up and setting up
your health profile is easy;

it only takes a minute,

and once you've done it,
it's stored safely and securely.

Then you can log in or use the App
to see doctors who're available,

and connect by video phone or chat.

D: Hi Allen.

I see you've been experiencing
some congestion and some nasal blockage.

How long has this been going on?

S: During the visit, the doctor
can see your health information,

afterward, you get a complete
write-up of everything the doctor says.

D: It looks like acute sinusitis,
a sinus infection.

Now I wrote you a prescription
to help with congestion.

If things don't clear up
in, say, a week or so,

just send me a message,
I'll be right here.

S: A few mins later, I've got my diagnosis
and my instructions for treatment

and my prescription is already
waiting for me at the pharmacy.

SK: Of course, all that now happens
in your Google Glasses

which are available by the way

at Stevie's Vinyl Records
and Implantable Health Chips.

We also recognized
that information was everything.

As Yogi Berra would say,
it comes down to one word, big data.

And believe it or not, believe it or not,

we used to do everything
based on experience and anecdote.

Evidence-based medicine in 2014
was actually a novel idea.

And now we recognize that we can
take things from other industries.

So at Jefferson, for example,
in 2014, we started

the Center for Healthcare,
Entrepreneurship and Scientific Solutions.

We said, "It really doesn't make any sense
that Nick Foles has a better idea

of whether or not a screen pass
will work in the third quarter

than I do of whether or not
a cancer drug will work."

So we took some of the best people
doing mathematical modeling

and created a predictive analytics
and mathematical modeling

to reduce uncertainty in medicine.

Believe it or not, in 2014, 28% of people
that went to the hospital in this country

got readmitted within 90 days.

Now, through our mathematical modeling

we're able to see exactly
what intervention

will keep people from coming back.

Not only that, we've changed
the way we do things.

In 2014, family medicine physicians
would actually be out of the hospital.

Hospitalists would never
leave the hospital,

and then there was no real communication.

Now we have what's called extensiveness,

hospitalists that actually
follow those patients for 90 days

so they don't get readmitted.

We actually pay for performance now

because we can actually
measure performance.

And we can actually
give you predictable answers

as to what you're paying for
and what you're getting back.

Accountable care organizations
for the first time really are accountable

because we have math to back it up.

One of the great things
that happened in Philadelphia,

believe it or not, again in 2014,

with decreasing NIH funding,

Penn, Jefferson, Temple, Drexel,
would all fight for NIH funds.

What we did, and one
of the greatest things we did,

we created the Philadelphia
Clinical Research Super Site

where we said really what's important
is to take all of our resources,

both in education and research,
and make Philadelphia an epicenter.

What did that do for us
over the last ten years?

We were able to take the
Nanotechnology University of Pennsylvania

and Molecular Genomics at Jefferson

and create the DNA vending machine.

For those of you from the 2010s,
it's sort of like a red box for your DNA.

We can now pick a drug for you,

and instead of saying it's
for 200 people that look like you,

we can take exactly
the drug that fits your genome

and have it available for you.

We can also put your genome on a chip,

so that God forbid,

if you need a new organ,
we can make that for you

based on work that's been done
in Philadelphia.

And we finally decided
to work with patients

to really make them
shareholders in their health,

and this is what it means.

It means that in a community
like Philadelphia,

if we're able to make you healthier,

we do better as physicians; you do better.

And we actually partnered
with great companies

from again outside Philadelphia

to look at a different way
of making sure that everyone matters,

that we can look at not only drugs,
but holistic remedies

to look at personalized
performance-gain plans

integrating a proven system
to drive health outcomes.

Whether it's mindset, or nutrition,
or movement, or recovery,

we were able to do many more things
that didn't require pharmaceuticals.

So that brings us to 2024, and as I said,

I'm here to accept our number one ranking
from the US News and Interplanetary Report

and what's really cool is

that some of the ranking parameters
didn't even exist in 2014,

and I'll give you an example
of a few of them on the academic side

and also on the clinical side.

On the academic side,
we actually, imagine this,

get ranked based on how our students do
at one year, three year, or five year.

We measure individuals' professional
and personal happiness

at varying intervals after graduation.

Because after all, that's why
they came to our university.

And if we don't do really well,

then they actually
get some of their money back.

We have a collaborative quotient.

Academic entities are incentivized
to actually get over themselves

and work well with others,

(Laughter) (Applause)

which would have been unheard of in 2014

when they were all
cannibalizing each other.

And we have an entrepreneurial quotient
where institutions are rewarded

that invent and envision
new ways of doing things

that generate alternate revenue
and develop new student opportunities.

But probably nothing's changed
the most than health quotients.

I mean, it used to be back
in 2014 and before

that parameters were based
on the reputational score in the past.

Now it's based on what patients think.

The one I'm really proud of
that we got a very high score on

is called the BUB Quotient.

It stands for the
Believable Understandable Bill,

that we actually have enough
respect for patients

that we provide understandable bills,

so they can understand
what they got and what they're paying for.

We have the say-what-you-mean
and mean-what-you-say quality parameter.

We actually take marketing professionals
to read all the billboards

in the marketing we do,

and see if they have any semblance
to reality of what really happens

in the hospital,

and you get points
if there is some semblance to reality.

And then finally we have
the through-the-patient-eyes factor.

And this is really exciting
because what it is,

is every patient now, in 2024,

basically when they get in the hospital
is given a Google Glasses,

and they basically can record
what's happening through their eyes,

how the doctors and nurses
are treating them,

and then we have CEOs of other hospitals
look at that video for a day

and grade on 1 to 10 whether they'd like
to spend a day in that hospital.

And again that's a great parameter for us.

So a lot has happened since 2024,

and I'm really excited to be here.

We're about to accept an award
in the new Convention Center & Casino

on the Schuylkill River.

(Laughter)

And some things
from the past really are good.

I'm going through my third midlife crisis

because I'm 70 and what happens
is people live to 120,

so midlife crises have changed.

And I'm proud to say
this is what I got myself,

I was able to retrofit a GTO
to hit the standards for a hovercraft.

Excuse me for a second, Google Glass out,
could you get the GTO to get ready

to go to the Convention Center?
Great. Thank you.

Listen, I want to really
thank you for being here,

I want to thank you
for traveling in time and space,

and most importantly,
stay healthy in Philadelphia.

Thank you very much.

(Applause) (Cheering)