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

This talk was given at a local TEDx event, produced independently of the TED Conferences. 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 2020. 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.

Dr. Stephen Klasko is the President and CEO of Thomas Jefferson University and Jefferson Health System. Jefferson is the largest freestanding academic medical center in Philadelphia, with over 12,000 employees and 3,700 students.

About TEDx, x = independently organized event In the spirit of ideas worth spreading, TEDx is a program of local, self-organized events that bring people together to share a TED-like experience. At a TEDx event, TEDTalks video and live speakers combine to spark deep discussion and connection in a small group. These local, self-organized events are branded TEDx, where x = independently organized TED event. The TED Conference provides general guidance for the TEDx program, but individual TEDx events are self-organized.* (*Subject to certain rules and regulations)

(synth music)

(audience applause)

- 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.

That's what I am today,

but for the past ten years,

I've been the Presidency of
Thomas Jefferson University

and 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 from 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 a personal story

about how it happened for me.

So first, one of the things that we did,

we got tired of whining,

and we decided let's just
travel into the future.

Let's just 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 slide show 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.

The other reason I remember it,

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 fevered service system

"so we're really rewarding volume,

"value and not volume,

"and can you measure outcomes?"

And I said, "My generation
of docs is gonna 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 looked like.
(applause and cheering)

Thank you, thank you.

That's called a leisure suit.
(audience laughing)

And 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 a 1968 GTO which was,

and is, a very cool car.
(audience light applause)

Thank you.

So there we went through really

what was what some people
call the middle or dark ages,

the Managed Care Revolution,

which did not really manage anything.

It didn't really provide care,

it just promoted under utilization.

The Balanced Budget Amendment,

which didn't really 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 bring 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 Systems combined.

It was also a big moment for me

because it was the second
time I saw the Rolling Stones,

and this is what they
looked like back in 2014.

And in my inauguration
I was given a script,

and what I talked about
in inauguration of 2014 is

"Hey, can we do anything
about spiraling costs?

"Can we change the fevered service system?

"Do you think we can measure outcomes?"

So it was a bit of an aha 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 are."

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 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

in 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.

This is, I thought the Rolling Stones,

the Rolling Stones rocked,
(audience laughter)

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.

But more importantly, more importantly,

what happened in Philadelphia,

what happened at Jefferson was,

that we took, we took that mode of,

people saying that it's
impossible to change healthcare.

And really the personal piece
for me believe it or not

did not come from Admonities
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 know
things were changing,

we weren't going to wait for a miracle.

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

Okay so, here it is, it's March 28, 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 28, 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 on

for one last Indiana Jones sequel.

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 Superbowl

since the unprecedented
four straight they won

from 2015 to 2018, the so-called
Chip Championship Years.

(audience applause and cheering)

Of course, Governor Chip
now has a very different job

than he had back then.

But more importantly, more
importantly or as importantly,

Jefferson is celebrating
it's 200th anniversary

as a state wide national,

and international hub of innovation,

with headquarters in Philadelphia

instead of just a Philadelphia
academic medical center.

We've become a destination site

for innovation 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.

Oh and by the way, I'm
getting out of my DeLorean

to accept an award from the US News

and the Interplanetary
Report, as most of you know,

in 2019 we found two other planets

with slightly disfunctional heath systems.

So they are now part of the ranking system

that the forward USNWR uses.

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 might now 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,
commutative, and creative.

(audience laughter)
As my kids would say, "Duh."

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.

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 all on, what we called in
2014, iPhones and Androids,

but really what we needed

were really 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,

a contemporary art museum,

and 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,

"That's a woman, that's a
snake, that's a family."

But when you start to look
and say what is the story?

It starts 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 worked closely

with multidisciplinary
care and 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
need 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 and 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 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
lecithin 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?
(audience 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 WHHO, stands for
Watson Hybrid Hydro-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--
(audience laughs)

By the way the first
season, the first season,

of Doctor WHHO is available

on Google Glass implantable chips,

available in Stevie's Vinyl
Records and Implantable Chips

on South Street.

So we embrace, 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.

(moaning)
- What's wrong?

- I don't feel so good.

- Then you need to go to a doctor.

(sneezing)

- Mr. Stephenson?

- Stevenson.

- 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?

Does your family have
a history of diabetes?

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

- I'm feeling a little stuffed up.

I'm experiencing some--

- Doctor your three o'clock
is early, your 2:45 is late,

from six and seven.

- Follow these instructions

and if it doesn't clear
up in a week or two

come back and we'll do
this all over again.

(moaning)

- I don't like going to the doctor.

- So in July of 2014,

we partnered with some great companies,

created an innovation driven
ecosystem for healthcare.

And starting in 2015 patients in 48 states

could access doctors via Telemedicine.

- Well now you can see a doctor

without going to a doctor's office.

With the help of your
smart phone or computer,

and American Well.

Signing up and setting up
your health profile is easy,

it only takes a minute,

and once you're 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.

- Hi Allen, I see you've been
experiencing some congestion

and some nasal blockage.

How long as this been going on?

- During the visit,

the doctor can see your
health information,

afterward you get a complete write-up

of everything the doctor says.

- Well it looks like acute sinusitis,

a sinus infection.

Now I wrote you a prescription
to help with the congestion.

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

just send me a message.

I'll be right here.

- A few minutes later
I've got my diagnosis,

and my instructions for treatment,

and my prescription is
already waiting for me

at the pharmacy.

- Of course all that now is
happens in your Google Glasses

which are available by the way

at Stevie's Vinyl Records
and Implantable Health Chips.

We also recognize 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
2024 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 and Entrepreneurship

and Scientific Solutions.

We said it really doesn't
make any sense that Nick Foles

has a better idea 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 modelling

and created a predictive analytics
of mathematical modelling

to reduce uncertainty of 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 modelling

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 extensivists.

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.

And 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 10 years?

Well were able to take the
Nanotechnology University

of Pennsylvania and Molecular
Genomics at Jefferson

and create the DNA vending machine.

For those of your from the 2010s,

it's sort of like a red box for your DNA.

We can now pick a drug for you,

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,
and 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 game 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 a few of them 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, and five year.

We measure individual professional
and personal happiness

at varying interval 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,

(audience laughter)

which would have been unheard of in 2014

when they were all
cannibalizing each other.

And we have an entrepreneurial quotient,

institutions were awarded,

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 reputational scores in the past.

Now it's based on what patients think.

For one, I'm really proud
of that we 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
and 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's Eyes factor.

And this is really exciting
because what it is,

is every patient now in 2024,

is basically when they get in the hospital

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 how
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 an casino

on the Schuylkill River.

(audience laughter)

And some things from the
past really are good,

I'm going through my third mid-life crisis

because I'm 70 and I'm,

what happens is people live to 120,

so mid-life crises have changed.

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

I was able to retrofit
(audience applause)

a GTO to hit the standards for 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
travelling in time and space,

and most importantly, stay
healthy in Philadelphia.

Thank you very much.
(audience applause)