This is Laura Dierda with the Becker's Healthcare
podcast. I'm thrilled today to be joined by
Judd Hollander, senior vice president of healthcare delivery
innovation
and chief virtual care officer at Jefferson Health
as well as professor in the department of
emergency medicine at the Sydney Kimmel Medical College.
Judd, it's a pleasure to have you on
the podcast today. Laura, great to join you
again.
Absolutely. Now I'm excited for our conversation because
I know Jefferson is on the forefront of
a lot of innovative things happening in the
health care space. And, truly, you know, it's
always exciting to think about where you're at
today and then where you're headed. But before
we begin, can you just tell us a
little bit more about yourself and Jefferson?
Yeah. So I'll I'll I'll I'll start with
myself, and then I'll get into Jefferson. I
I sort of have a a wandering background
to end up in health care administration.
I trained in internal medicine and emergency medicine,
practiced emergency medicine,
developed, clinical research expertise,
and led large clinical research programs first at
Stony Brook, then at Penn, and then at
then at Jefferson.
So I come from a very research oriented
analytic background.
And at some point, it dawned on me
that if I change the spreadsheet
from nanograms per deciliter
at the end of a number to a
dollar sign in front of it, it was
a little more strategic and, you know, and
and it was a bigger play in terms
of changing health care to the community.
So I went back and took some courses,
not an MBA, but took formal courses at
Wharton,
learned the skills that I needed
in in order to make the leap from
a career researcher, emergency physician, into
health care administration,
and then transitioned at the time I left
Penn to go to Jefferson
into, you know, ultimately, this SVP and chief
virtual care officer role.
When I got to Jefferson about twelve years
ago,
it was a three hospital health system, which
is hard to imagine
now that it's 32 hospitals and four gazillion
outpatient ambulatory
practices.
And so I jokingly say,
I'm the person that's launched the most virtual
care programs in the world because I launched
them in the original three hospitals
and then with our first merger and then
with our second merger and then with our
third merger and then with our fourth merger
and then the last one. And none of
those first couple,
mergers actually had virtual care programs.
But, last combination with Lehigh, a very robust
health care system that had 14 hospitals and
extends through the Lehigh Valley, they had a
great virtual care system.
And and so
we're we're now combining the best of both
to develop an even better one than what
we had before or they had before.
That's amazing to hear. You know, really cool
that you have the opportunity
to start off, so many years ago with
Jefferson as a small three hospital system and
see it grow and and be part of
that, on the virtual care space. And I
I'm curious over the years, how have you
seen virtual care grow? I mean, obviously, you
know, had a great accelerator during the pandemic,
but where are we at today? Did you
imagine you'd be in this space where,
virtual care is is such a integrated and
integral part of access and communities today?
So it's interesting because I think you might
expect me to say no. It's bigger and
more robust than I anticipated.
But it it's actually across the country, it's
smaller and less robust
than I would anticipate.
We actually began our program in 2015.
And so by the time COVID hit, we
were reasonably well established.
And we went through many of the things
you have to do with change management. Because
if you think back, you know, now eleven
years ago into what did people think about
virtual care, they thought doctor Hollander was a
little bit nuts in why do we need
to do this.
And under the leadership and guidance at that
time of Steve Klaskow, who was our CEO,
we decided what I think everybody accepts now,
patients should get care how and when they
want care. And so our goal
was actually to make sure that the clinicians
in the health system or in the three
hospitals at that time
were able to deliver care that was best
for the patient.
And so our incentive programs, thinking way back
to then, were that you had to do
12 calls in a year. 12 telemedicine calls
in a year. And the amount of sort
of pushing we needed to do to get
clinicians to do 12 in a year
was insane.
It first year, there was an incentive on
the individual clinicians,
then that didn't work. So then we increase
the incentive on the chairs, and ultimately, we
increase the incentive on the departments
so that the departments would not get allocated
the same amount of money next year if
people didn't make it. And I sit in
make it. And I sit and think as
I was going around meeting with everybody,
I'm like, 12 calls is June 30.
You could meet that goal. You could do
it all the last day. But the goal
was you needed to know how to do
it. So if a patient wanted it and
needed it, you could take care of that
patient.
And,
you you know, people had, I would say,
disproportionate
angst about learning how to do it and
annoyance with doing it until COVID hit.
And then we actually kept this is real
data. Over seventy percent of our scheduled visits
for the first week COVID hit in Philadelphia
by converting people from in person visits to
to telemedicine visits
because everybody
knew how to do it. So we look
like geniuses.
And and people love patients love telemedicine.
Some do, some don't. But I think our
goal is we wanna take care of patients
the way they want to be taken care
of. And sometime clinicians,
they wanna take care of patients the way
they're comfortable taking care of the patients. And,
yeah, you can't do the same physical exam.
You could do a different physical exam. But
when a patient comes to the office, you
can't look in their house. And when patient's
on telemedicine, you can look in their house.
And so I think it's learning to take
all the information available to you
and do the best thing for the patients.
Why I think, probably a follow-up question, it's
not going as well as I might have
expected
is because the government refuses to make a
long term commitment.
Everybody thinks telemedicine costs less than in person
care. Sure. You don't need real estate, but
you do need to invest in products that
will deliver a good telemedicine experience.
And and with the government continually kicking the
can down the road and paying for it
for a couple months or a year through
continuing resolutions,
it's hard for health systems to really jump
all in.
Got it. That makes a lot of sense.
And especially on the policy side, I know
there's a ton, to always be considerate and
mindful of. So,
thank you so much for for digging in
there. And, you know, I'm curious if you
zero in on just the last year or
so. Could you tell us about an initiative
that you've led? What did you do, and
what were the results?
So I think the best thing we've done
is think about how can we improve access
for patients.
And and we've tried to do that in
several different ways. So one of,
the Hallmark program that I'll discuss
is our same day next day cancer care
program,
where we just fundamentally believe that that if
someone tells you you have cancer, you shouldn't
have to wait three weeks for an appointment.
You you know, it's psychologically devastating.
You're concerned about the outcome. And so we
made the commitment to say, we're gonna get
you in today or tomorrow.
And we just challenged our teams to come
up with a system to do it, and
we were able to do that. And at
this point, we have close to two thousand
patients
with new diagnoses of cancer.
We've been able to get in literally the
same day they called or or the next
day, start them on their journey to care,
connect them with chemo or surgery.
And we've demonstrated
we can get their first chemo infusion or
their or their surgical,
repair or fix
done sooner through this program than we did
the old ways. So we've worked on many,
many access initiatives,
but but that's probably the first one that
was, you know, super successful in that realm.
That's great to hear. And, you know, when
you think about putting a program like that
together and then seeing the results that you
got,
technology is one piece of it. How do
you make sure that,
the people that you're working with are really
jumping in, integrating it the way you want,
and, really, you know, running towards those outcomes
so you can get there as quickly as
possible.
You know, I wish I had a great
answer to that, but but what we've learned
is it really begins with
identifying, you know, it's people process and technology.
So if you don't have the right people
engaged, you're gonna have a problem. So we
have, in the past,
approached departments and said, hey. We got a
a templated playbook for this. We're ready to
go. Do you wanna do this? They have
all said yes. But sometimes after a meeting
or two, the answer is, well, yeah, we
wanna do it, but not really because the
change management with all our clinicians is difficult.
The workflows are difficult.
So, you know, we have learned to go
where people want to
play nice and develop things that are novel
and different.
So I think the first thing is selecting
the right group of people to do it
with. The the second thing is being
both rigid and flexible at the same time.
Like, we know what works,
but that's not what everybody else wants. So
it's finding the right compromises
so people don't have to change everything they
know how to do. They'll change enough of
it that we could deliver the care and
open up the access
so that they're comfortable with it and make
the change over time. And then the third
part is the technology. In in our case,
the technology is easy because they've all been
doing telemedicine
visits. So they're just gonna do the same
type of visit they did using the same
technology.
What we're really changing is how you come
in the enterprise central scheduling, how you get
your access, who's available for the patient, will
clinicians add on somebody,
what happens if the first clinician
seeing somebody is a nurse practitioner
who's not entirely sure of the answer on
somebody with a super specialized cancer?
Rather than send them to the cancer specialist,
they have permission to call and disturb that
specialist in the middle of the day to
get the answer so the patient gets off
the phone with the answer. Those were major
workflow changes
that our our cancer service line and Sydney
Kimmel Cancer Center were just more than happy
to make, makes a big difference.
Not everybody else can make those changes and
adapt as fast.
Absolutely. That makes a lot of sense. It
just really speaks to the unique culture that
you have there at Jefferson and,
the team that you've been able to build.
So that's really cool to see.
Looking ahead, what are some of the big
priorities and headwinds that you're focused on for
2026?
So I tend to think of things in
the single biggest bucket is access.
I'm old enough that I have had parents
that have passed away and parents that have
spent a lot of time in the hospital
and, you know, friends and family that do
the same.
And the pressure point, I think, at health
systems all across the country is access, access,
and more access.
How do you get in? So I I
think we're thinking of, you know, how do
we get access,
transform, and engage as the three things we
talk about all the time. But
it begins by what you tie up people
doing. So although I don't lead this initiative,
I'm involved with it. We have Bala Yahia,
our health system president,
has a, you know, very bold initiative
to reclaim 10,000,000 patient care hours over the
next three years largely through the use of
AI.
We've grown out ambient listening
to thousands and thousands of our clinicians,
physician and APCs across the enterprise.
Yesterday,
Colleen Malozzi led a team that launched MBNAI
for our nurses,
on our first unit, which will free up
nurses to be at the bedside more rather
than documentation.
So that may help create capacity. It may
also help us
recruit more people to take care of patients
because the job may be better, burnout may
be less, retention may be better.
Then we split people or, at least, the
way I think of it in the two
buckets. There's practices that have capacity.
That's easy. How do we identify the patients
that need to see those specialists
so they could take the open slots and
we could provide better care to people in
the community?
So we have programs focused on where there
is capacity, making sure we're giving patients the
opportunity
to know we have that capacity. And then
there's the other side where we don't have
capacity.
And the challenge is how do we create
more capacity
without actually having to go build a multi
office spec or a multi specialty office building.
And so transitioning some people that work in
the office
to work at home,
backfilling the office space with a new clinician
creates more capacity
without us having to wait ten years to
build a building and find real estate. So
I think it's making us more efficient at
what we do, filling capacity where we need
it, and creating capacity where we don't have
it as the major strategies that I'm working
on.
That makes a lot of sense, and I
appreciate the specifics that you talk through there.
I mean, I think it's having those creative
ideas to expand access in ways that are
also,
financially
viable right now. I think every dollar and
every minute of health care resources is so
precious, and and so to find those, unique
opportunities to continue to,
evolve the system, it just seems to make
a lot of sense, and I can imagine
is, you know, really where there's a lot
of attention and focus today. Yeah. Thanks,
Laura. Perfect. Well, I think, you know, there's
been a lot of changes in health care
too, coming rapidly in in,
you know, consistently. So what do you think
the hardest thing you'll have to do in
the next year will be? Oh, that's an
easy one. Change management.
It's it's all about change management. Too often,
we think about,
you you you know, the end result,
but it's really about how do we get
the people that are in the process
to accept the fact that health care is
changing, and it's not the same health care
you might have trained in fifteen years ago.
Like, if we have clinicians
that haven't figured out how to use AI,
where AI can be used, if we have
clinicians that haven't figured out how to engage
their patients in virtual care,
then patients are gonna go somewhere else, and
those clinicians aren't gonna be able to do
their job well.
Change is difficult. And I think for us,
we need to have programs, and we do
have programs with our leadership
about how we can get the people we
work with, the people we work under, and
the people we supervise,
how to embrace change and and to move
forward into the next, decade.
Absolutely. I I love that. And I think,
you know, it's so true being able to
have those folks,
that really are able to take on, you
know, new technologies as things are moving so
quickly and change with whatever is needed,
for that moment, I think is critical.
When you look at AI in particular in
bringing that into and integrating that into the
broader organization,
what are some of the ways that you've
been able to, you know, whether it's roll
it out or or communicate about it with
the team to,
ideally reach that spot where they're starting to
integrate, especially for those who are on the
more skeptical side, what's possible,
to bring them along a bit more quickly
and get them up to speed.
So I think, you know, AI is fascinating
because the right AI tools,
people beg for.
So
it it's when we rolled out Ambient, and,
again, not my program, Bracken Babula gets the
credit for this in in our
clinician practice.
We got they describe it as love letters.
It saved 84% of the documentation time was
the actual data. You know, we talk about
pajama time. No one wants to go home
and document, but
we're able to decrease the amount of doing
that. And the original clinicians that piloted it,
they took care of the change management because
they just loved it so much. They spread
the word to the person standing next to
them, and it spread like wildfire.
The the growth curve we have in our
organization and the number of clinicians adopting it,
it was hard to keep for us to
keep up with the training.
So I think if if we listen, and
that's critical, if we listen to the pressure
points for the people who work in our
system and we solve the problem
for those people that wanna be first movers
in that space,
they will spread the word. If we find
a solution that doesn't work and we give
it to those first movers and it stinks,
it's very hard to come back and do
the same thing again. So it it it
again comes back to listening,
solving the problem, and finding the right people
to take the bull and run with it.
I love that. I mean, it's just so
simple, but at the same time, I know
it's so much easier said than done. And
to have something like Ambient two, you know,
is that perfect use case where you can
get love letters where you do, you know,
make things so much easier for clinicians,
that, you know, having that foot in the
door to then think through, you know, what
else can AI do for me is really
powerful.
Yeah. And I I think you you're right.
It is way easier to say it than
to do it. There are plenty of sleepless
nights in trying to make these things go
forward.
But, you know, I think it's the mission.
At the end of the day, I mean,
the advantage of being an ER doc is
you get to see what's broken in the
health system, and there's so much to solve.
So it's easy to stay really passionate
and try and fix these things.
Absolutely. And, you know, to that point, I
wanted to talk about growth as well. Where
do you see some of the best opportunities
for organizational growth going forward?
You know, that's a much more difficult question.
I I I think that a lot of
health systems are really thinking about diversification.
Right? We have a university.
We have a venture fund. We have a
health plan.
And it's if we're gonna take great care
of patients,
we can't be on the receiving end of
everybody else's policies
and not influence
it. So much easier for us to give
really good cost effective care
if if we're control you know, people talk
about controlling the whole premium dollar, but really,
I prefer to think of it as controlling
the whole patient journey while working with the
patient to deliver an optimal journey.
And if we could use the university to
create staff
and train in the right programs,
and we could use the health plan to
help the patients in our community pay for
their care, and then we could deliver a
cost effective care.
Well, that's a great way to grow. But
you you think about the the policy headwinds
to everything.
Well, this is now a lot of policy
headwinds in a lot of different directions
that we need to be prepared for.
But I think growth is gonna be about
making the best patient journey for the patient.
And if we could do that, then
we're gonna be the place patients want to
come to.
I love it. Judd, thank you so much
for joining us on the podcast today. This
has been such a fun conversation, very informative
as well as the passion for what you
do comes through in everything that you're talking
about. So I appreciate your time today and
look forward to seeing you in April. I
know you'll be speaking on a panel at
one of our annual meeting sessions coming up,
and and so it'll be great to dig
a little bit deeper as well as see
you in person. So looking forward to it.
Laura, thank you. I I I love the
podcast, and I love the meeting in April.
I look forward to seeing you there.