Sutter Health in 2015 underwent a significant reorganization. The Sacramento, Calif.-based system, with 24 hospitals sprinkled across Northern California shrank from five regional divisions to two and strove to put a greater emphasis on becoming patient-centric. A year later, as part of a succession plan, Sarah Krevans took over as CEO from Patrick Fry, who led the organization for 11 years. Krevans had served as chief operating officer under Fry. As she settles into the top job, Krevans wants Sutter to push the envelope in several areas, especially when it comes to being more attuned to patient needs. She recently spoke with Modern Healthcare Managing Editor Matthew Weinstock. The following is an edited transcript.
Modern Healthcare: It's been about two years since Sutter Health went through its reorganizaton. How have things been going?
Sarah Krevans: The real focus of the reorganization was to really think strategically about what are our patients telling us about what they need, how is care delivery changing and how do those two things come together.
There are things that need to be very local, much more local than the five regions were. My 25-year-old son who works in technology has different needs than my 90-year-old mom, and he would have very different needs if he lived in Sacramento, where I live, versus living in Silicon Valley. So part of the reorganization was getting away from just thinking geographically about segmentation, to actually thinking about our patients' needs and preferences. We have a focus on human-centered design.
We have a chief innovation officer, but we're not trying to out-invest the best venture capitalist or out-design the best software engineer. It's really about understanding the human journey through the patient-care process and what do we need to change how we deliver care based on that. And that's really been the whole focus of what we've done as we've brought together system functions on patient experience, patient safety; patient innovation is starting from that core.
MH: So how does that manifest itself in a market?
Krevans: Remember, we are at the beginning of this, but here is something simple: our engagement in digital health. We use Epic, but the issue isn't necessarily what electronic health record you're on, it's what capabilities you enable within it and what your providers and care teams are doing with it. Booking appointments online was a capability that we had. That didn't mean we always made it available to our patients. It's a lot of work to make it available. You have to standardize appointment types. You have to know what kind of patients it's not appropriate for because their appointment length might vary. Lots of work goes into that and lots of discussions with physicians and you really need physician champions to get that adoption. That's a tiny example.
MH: You are surrounded by companies that make a living based on being consumer-friendly and consumer-centric. How does that impact your approach?
Krevans: We're incredibly fortunate, right? We are surrounded by people who are literally changing the world. And what an opportunity to learn from them. I'm not trying to out-design the companies at scale in our service area. I want to partner with them. Whether it's a software program or a technology provider that has a device, I want them to say, "Wow! I know a lot about this particular potential, but I don't have access to a clinician's mind. I don't have access to the diversity of the provider network."
We have both the companies at scale—the Apples and Googles of the tech world—but we also have amazing entrepreneurs. We have a real focus on partnership in our care improvement. Our chief innovation officer says, "It's really important to know what your unfair advantage is." Our unfair advantage is probably the internal talent we have plus the fact that it lives inside of this incredible ecosystem that's Northern California.
MH: Have you started to see any tangible benefits from reaching out to that ecosystem?
Krevans: Yes. It's not one big thing, although we have some bigger ideas we're working on long term, but a lot of the innovative partnerships have been very specific. For instance, why don't we deliver our drugs to you, rather than you having to go to the pharmacy after your physician's appointment?
We don't have to create something new, but maybe we take something that's working in another industry and bring it to healthcare. A great example is a pilot with Lyft in San Francisco where they have been transporting our home health nurses. Think about being a home health nurse in San Francisco and trying to find parking every time you go to visit your patients. We also have been using Lyft to take patients who are discharged home from the hospital.
During the fires, because we already had an arrangement with Lyft, we were able to get our patients from wherever they were in the Santa Rosa area. We had to bring some of them as far as San Francisco for their infusions, for their chemotherapy infusions; Lyft drives them back and forth. We also have done that for employees.
MH: How do you approach those types of partnerships when there's not a reimbursement dollar attached to it?
Krevans: Let's take the Lyft as a discharge mechanism from the hospital. One of the hardest things for a hospital is when somebody's ready for discharge, and they're waiting for a ride. Or, for the emergency room, they still feel very responsible for the patient, and the patient is simply waiting there for somebody to pick them up. And we're staffing them; we're checking on them; they're creating an environment that may seem more chaotic and busier to the other patients in the waiting room. So, in that case, there is a return.
MH: Where does that vision to pull from the outside, to create human-centered design come from?
Krevans: I am such a believer in not-for-profit healthcare. I wake up every day and I am really happy to be working where I work and to be doing what I do. But I also see so much opportunity to do more and to think differently. To me, where healthcare is behind many other kinds of service, is in that deep understanding of the entire experience.
We measure the heck out of how long you waited in the waiting room and was the exam room clean, and how your interaction with the receptionist and with the physician went? That's such a small part of your life as a patient. There are other things that we haven't paid enough attention to. Did you feel comfortable or even know who to call the first time? Did you want to call, or did you want to email, or did you want a text? Once you got an appointment, how were you feeling between the time you said, "I think something might be wrong," and when you were actually seen? What was that wait like for you? And after the appointment, what was that experience like for you? What was that experience like for your family?
One of my favorite things to talk about right now is how we celebrate the improvements we're making and still push people to think even further. We had a goal, as an organization to work on extended hours for medical offices, and to look at how can we have the availability of appointments in evenings and on weekends. I've been a working mom my whole career. If my grocery store had said to me, "Wow, are you lucky? We have extended hours now on Tuesday night and when you come in, I want you to be very grateful for those extended hours. And it's just an experiment."
We need to do those hours in a way that is not a burden on our physicians, it's not a burden on their care teams; we need to recruit for people who want to work different hours.
MH: I want to shift a little bit. Your provider-based insurance plan has suffered financially, but you've grown in membership. How committed are you to it?
Krevans: It's really important that if you decide to have a provider-sponsored plan, you do it for the right reasons and that you're also realistic about what it is or is not going to do for you. We are not trying to replace our relationship with commercial health plans. I would actually like to strengthen our relationship with commercial health plans. We have a partnership arrangement that we're just launching with Aetna that will offer a narrow network PPO product.
In general, HMOs in Northern California have not been growing. The only HMO that's been growing is Kaiser Permanente, and there are employers that want to offer an HMO. I look at our plan as the need for an additional product offering that can compete directly—in terms of an integrated offering—that is very cost-competitive and very stable. When we have a provider-sponsored plan, we have all the data, we know 100% of the medical care costs, we know 100% of the outcomes, we can be much more actively engaged earlier on in the member's experience.
MH: But does the drag on the balance sheet though impact your thinking on how much longer you'll commit to the plan?
Krevans: At this point, we are continuing to grow the plan and we just expanded into additional parts of the Bay Area. If this is something that employers are interested in purchasing, and if we can add value and we can produce the care in a way that makes sense, then that's what we want to do.