With Dr. Ralph de la Torre
Steward Health Care System, Founding Chairman and CEO
In this Digital Health Wire Q&A, we sat down with the founding Chairman and CEO of Steward Health Care System, Dr. Ralph de la Torre, to discuss the challenges facing US health systems and the technologies needed to overcome them.
Prior to founding Steward, Dr. de la Torre was CEO of Caritas Christi Health Care, as well as the Chief of Cardiac Surgery at Beth Israel Deaconess, where he was widely recognized as one of the top cardiac surgeons in the nation. He’s since guided Steward’s expansion from a six-hospital system to the largest private for-profit hospital operator in the country.
Let’s start with some background on Steward. Can you share a little bit about the overall strategy and your original vision?
The premise of Steward has always been to create a truly integrated system where all of the providers, the hospitals, the care, and the patient are all completely coordinated and unified from a data perspective.
The goal is to understand the patient journey no matter where it takes place – whether at the hospital, the ASC, or the primary care office – and to have anything that comes out of those encounters captured in a central location so that everybody can use it to deliver better care.
Unifying all of that data under one roof is easier said than done. What are some of the technologies that Steward’s been using to make that vision a reality?
One of the biggest has been our enterprise data warehouse, where we collect all of our data in Massachusetts, and can then query a patient across all of their encounters. That’s a tremendous population health tool.
If you think about what payors do, more often than not they use claims data to make predictions and ascertain what needs to be done to keep a patient healthy. Our strategy involves actually using care data, which reveals problems much sooner.
By the time you get a claim, the problem’s already happened. But if you have the right stack of data coming from the providers, you can get out in front of those problems much sooner, and ideally prevent them from happening.
When you’re evaluating new digital health solutions for Steward, what separates the standout solutions from the rest?
Easy. It’s the return on investment. Whether we’re integrating a new tool or investing in one, we need to know whether it’s a 1-year, 5-year, or 10-year return. The other thing is that it needs to be real. Having a new app that relies heavily on a highly trained workforce almost defeats the purpose of the app itself.
To add to that – one of the biggest problems as hospitals are coming under cost pressure is balancing Best-in-Breed versus Best-in-Suite solutions. Many of us have a suite of applications, whether it’s Epic or MEDITECH or something else, and sometimes these applications provide an element that’s “B” grade.
You might see a new solution outside of your suite with an element that’s an “A”, but is it worth the incremental cost? As cost pressures increase, more and more of these decisions are Best-in-Breed versus Best-in-Suite. If you’re going to go with Best-in-Breed, that automatically raises the threshold of how good the tech has to be.
Are there any areas in healthcare where you think startup founders should dedicate more attention to creating new products and services?
I think as a general rule of thumb in medicine, the United States gets more excited about the latest cutting edge therapy for a small subset of patients than about ordinary care for everyone. US healthcare isn’t lacking in high technology, it’s lacking in the basics. We don’t have basic wellness, we don’t have basic nutrition, we don’t have enough primary care visits.
In America, we don’t really take care of ourselves, but we’re great at keeping ourselves alive once we get sick. I think going back to the basics and building tools that help with basic nutrition, wellness, and population health will have a larger macroeconomic effect than tailoring the latest molecule for a small cohort.
Another area I think people have forgotten a little bit about is the business intelligence tools that make hospitals and physicians more efficient. We’re keeping a close eye on products that can help us improve our efficiency. You have to realize that in the long run, hospitals are cost centers, not revenue centers – so these are the tools that are going to move the needle for value-based systems and providers.
If you could push a magic button to create the perfect business intelligence tool for Steward, what would that look like?
It would be a tool that integrates everything together. It would be able to tell me what each component of care delivery costs in detail, then help proactively guide me to minimize the cost per unit, whether it’s a device or an hour of labor.
As an example, if we have too much staff on a Friday, that’s a huge expense. The tool would need to be able to look at something like OR cases and scheduling, then predict exactly what operating room utilization will be, so that we can move OR cases around to make sure our staff and supplies are there when we need them, and not there when we don’t.
What Steward initiatives are you most excited about right now?
I’m really excited about our Medicare Advantage play, particularly everything we’re doing with CareMax. Steward has an absolutely massive amount of Medicare patients, and we decided that we want to approach them with a complete managed care platform.
We quickly realized that it would take years to build that ourselves, so we went out and looked at the different models that were already out there. We thought that CareMax had the best IT and patient platforms for Medicare Advantage, and so we ended up doing a huge partnership with them.
The way I see it is that Steward has the largest ACO in the nation, and we’re great at managing care behind the scenes. CareMax has what we think is the best Medicare Advantage patient interface, and delivers a great experience at that level. Now we’ve united the two.
I think that the market is underestimating the massive value that uniting these two components really brings, and I think this combination has the potential to be the next big thing in healthcare.