A Champion of Clinical & Operational Integration: Q&A with Dr. John Young

John Young, M.D., MBA, a board-certified physician in internal medicine, critical care, cardiology and interventional cardiology, started as HealthTrust’s new chief medical officer (CMO) in February. Young previously served as national medical director for LifePoint Health, where he led strategic initiatives related to quality, patient safety, service line development, performance improvement and clinical operations across the 71-hospital system.

Young has more than 20 years of clinical and healthcare management experience, has participated in more than 100 clinical trials, and authored or coauthored 90 articles, book chapters and monographs. He received medical and MBA degrees from The Ohio State University and a B.S. in chemistry and biochemistry from Wright State University.

Young spoke with The Source about his previous experience with value-based healthcare and operational improvement programs, and his goals for expanding HealthTrust’s physician engagement and integrating that feedback into contracting decision-making. He also offered some predictions on marketplace forces that are shaping healthcare.

What led to your interest in medicine?

As a child, I had severe asthma, and I was in the hospital a lot. I still remember the day a doctor handed me a bronchodilator inhaler to treat my asthma. The medication, which was still relatively new in the late 1970s, had such a dramatic impact on how I felt. Those experiences definitely triggered my interest in science, medicine and pharmacology.

Even though I was always interested in science, I made the decision to go to medical school later than most people. My undergraduate degree from Wright State University in Dayton, Ohio, was in chemistry and biochemistry. I started taking graduate classes at Wright State in biochemistry and physiology with the intention to go into pharmaceutical research and development. But as I took the same classes as the medical students, I thought, “I can do this.” So, I transferred to Ohio State University for medical school.

How do your four board certifications—in internal medicine, critical care medicine, cardiovascular disease and interventional cardiology—complement one another?

When I was choosing my specialty, I enjoyed the hand-eye coordination and technical requirements of surgery, but also liked the problem-solving and cognitive challenges of internal medicine. I happened to do a rotation with an interventional cardiologist, and his field seemed like the perfect marriage of both. Doing heart catheterizations, angioplasties and stents, he was able to combine the cognitive part of internal medicine with the technical procedure of interventional cardiology.

During eight years of residency and fellowship in pursuit of these certifications, I was fueled by the creative problem-solving aspect of these specialties and the continuous learning that is required.

What followed your medical school training?

My first job was with a 30-plus physician private practice cardiovascular group in Cincinnati, Ohio. One of my mentors ran its clinical research program, which propelled me into clinical research and data analysis. It taught me how to critically evaluate data, as well as write and present that information at national scientific meetings. It was a great beginning in the clinical research world and a primer on how the FDA approval process works for drugs and devices.

After working with that group for about six years, I did a stint on the West Coast. I worked in a program focused on technology innovation in the cardiovascular space for about two years. After exposure to some venture capital and start-up companies, I became interested in the business side of healthcare.

I came back to Ohio in 2008 and worked part-time as an interventional cardiologist while I was earning an MBA at Ohio State. I finished the degree in 2010, thinking I would transition into the healthcare industry focused on research and development. However, I wasn’t quite ready to give up the clinical part of cardiology.

I was then recruited to be the chair of the cardiovascular program at Adena Health System, a three-hospital system in southern Ohio, where we rebuilt what had been a struggling program. After six years there, I had gradually given up more and more of my clinical time to focus on administrative aspects of the business. In 2014, I had a fluke retinal injury and I lost some vision in my left eye, which made it difficult to do certain procedures. That was a true tipping point for me, and it signaled to me that it was time to move out of clinical practice and transition fully to physician executive work. In 2015, I was fortunate to find an opportunity at LifePoint Health in Brentwood, Tennessee, where I served as national medical director before joining HealthTrust in February 2018.

What were some of the things that you did to revitalize the cardiovascular program at Adena Health?

It was a rural community-based cardiovascular program in Chillicothe, Ohio. Chillicothe is a small Appalachian community, and it’s more difficult to recruit physicians to live there than an urban setting. Added to that, the program did not have the necessary leadership to define its goals or direction. I started by recruiting physicians I knew in Columbus, about 45 minutes away. I shared a vision with them of a robust community-based program representing all the specialties of cardiology. I told them that it was an opportunity to provide much better care in a community that really needed it.

We worked out a balanced system that allowed physicians to commute back and forth to Columbus, and we didn’t force anyone to move. In order to get the caliber of physician that we wanted in all the different subspecialties, we came up with a hybrid model, and it ended up working well. I had great support from the hospital’s CEO and CMO, who each gave me carte blanche to build that kind of program.

Did you find it helpful to give the physicians a choice?

Yes. The more flexible you can be, the better. My wife is a cardiologist who works part-time, and she has found getting people comfortable with somebody working part-time can be a challenge. But the more flexible you can be with these highly trained individuals, the broader the market you can pull from.

What motivated you to seek an MBA degree after 10 years in medicine?

I was doing some consulting work for both Johnson & Johnson and Abbott on the West Coast. I certainly understood the clinical and the research part, but when it came to the funding of some of these clinical activities, ROI and business strategy, there was language there that I didn’t understand. I’m glad I did the MBA program because it gave me enough of an understanding of the financial and operational side to be able to communicate in that language. It’s been a very effective way to link those two sides of an integrated healthcare system. Practicing for 10 years on the clinical side, then getting the MBA and subsequent practical experience on the operational side at LifePoint Health has allowed me to be an effective bridge between the two sides.

How might HealthTrust members benefit from your experience with value-based healthcare programs as national medical director at LifePoint Health?

At LifePoint, I had leadership responsibilities for our service line strategies, some of our supply chain initiatives and our more recent strategy for MACRA / MIPS (Merit-based Incentive Payment System).
I was tasked with leading that team and learning about all the different quality measures necessary to submit information to the Centers for Medicare & Medicaid Services (CMS) for payment. Dealing with the challenges of trying to pull data from all these disparate sources and putting it into a collective scorecard for our LifePoint practitioners taught me a lot about where things were going.
Whether it’s alternative payment models or bundled payments, we will always have to deal with some type of governmental quality-based payment program. With the data that we’re collecting here at HealthTrust, we’re in a unique position to package it and provide value back to the membership.

I have some ideas about taking my LifePoint experience and my understanding of the CMS quality payment program to help build out some of the data that we are collecting at HealthTrust into a valuable scorecard. Whatever the alternative payment model—whether related to orthopedics, cardiovascular or another specialty—HealthTrust’s clinical integration team will be able to assist members as they’re tackling the challenges related to quality-based payment initiatives.

From the perspective of a physician executive, how are challenges of five years ago different from those that lie ahead?

As a practicing interventional cardiologist five years ago, I don’t think I was that focused on cost or the data reporting that’s currently required. There’s a big burden now on clinicians and healthcare systems related to the collection and collation of various data streams, whether for the government or commercial payers.

Understandably, everyone’s much more focused on cost than we used to be. The ability to drive continuous quality improvement while at the same time being cognizant of the cost pressures is not something that was in our everyday lexicon five or six years ago.

Increasing numbers of physicians are being affected by it and want to learn more, so it is important to be transparent with the data so they understand the levers that administrators have to focus on. There’s more need for education around those areas that are going to continue to affect them day in and day out.

How has your extensive clinical research experience influenced your career path and your viewpoint on innovation in healthcare?

Ten years ago, I probably would have been more wowed by the latest, greatest widget or device. I still think it’s interesting to look at the new technologies related to procedures like TAVR [transcatheter aortic valve replacement], which have dramatically improved people’s lives. Now, I’m more cautious to recommend adoption of some of those devices until there’s more evidence behind the innovation.

When it comes to data and healthcare IT innovation, there’s a huge area of opportunity to develop common platforms to connect all the information that we’re besieged with. HealthTrust is in a great position to simplify and help members understand some of the overwhelming data coming from so many different directions.

What has been your approach to engaging physicians when working on clinical and operational improvement initiatives? What are key factors to the success of clinical integration initiatives?

With 71 hospitals across 22 states, LifePoint had various kinds of approaches to cardiovascular care, prompting the need for subject matter experts and physicians to standardize some cardiovascular initiatives. We assembled a cardiovascular physicians council with 10 physicians from facilities of various sizes and diverse geographic regions. We engaged them in an open conversation around quality data transparency, cost transparency, standardization and the need to reduce care variation, and asked them to help us develop enterprise-wide strategies.

They became key players in not only providing us feedback, but also in helping us to evangelize the message to other LifePoint hospitals as to why we were instituting these new strategies. For example, they were effective in helping us standardize different cardiovascular devices and pharmaceutical agents. At the end of the day, by reducing variation, they helped LifePoint save a significant amount of money and improve quality.

It was successful because we took the time to build those relationships. We garnered trust by sharing the information and being transparent with the data. Once they believed what we were focusing on was the right thing, they were eager to help.

What are your plans for the Physician Advisors Program moving forward?

[Previous HealthTrust CMO] Michael Schlosser did a great job starting that program. As I look to version 2.0, I want to engage physicians, encourage them to spread the clinical agenda we’re working on, and get them more involved in the HealthTrust contracting cycle so they understand the process more clearly. The more open and transparent we can be, the easier it will be to engage these physicians in some of our future initiatives.

Do you think it helps when physicians talk to other physicians? Does that underlying trust help?

Absolutely. I think a peer-to-peer connection is more effective than if it seems like it’s being dictated to them from the administrative side. People who have practiced clinically for a long time want to talk to someone else who has done the same. There’s an inherent trust when I know you’ve experienced what I have.

There’s no doubt that it’s critical to engage physicians, especially physicians who have leadership roles within their institution, to help move any kind of clinical agenda that’s tied to physician behavior. The culture of these health systems varies, and nobody knows that better than the local team. They become critically important in trying to move things forward.

For those supply chain leaders who don’t have a clinical background, what are your recommendations for successful physician engagement?

I have come across some supply chain folks who are intimidated by physicians or just don’t have experience interacting with them. For those individuals, I’d say, step one, don’t be afraid—simply talk to them. They’re just people.

Step two, physicians are scientists by background. They tend to be data-driven and evidence-based, so be as transparent as you can with data and information.

Step three, ask them for help. Engage them so they feel like they’re co-creators of the chosen strategy. Approach a group of physicians and say, “Look, here’s the problem that we’re having, and here’s why we need your help,” and then enlist their inherent problem-solving abilities to assist.

When we approach physician engagement that way—asking for help and using their problem-solving ability—we get much more buy-in. We’re much more likely to be successful than if we try do it all ourselves, package it up and bring it to them and say, “Here’s the finished product; will you do this?” It’s better to engage them further upstream, so they can help create the outcome.

What are your top priorities in 2018 as CMO?

One of my priorities is to expand the HealthTrust Physician Advisors Program. We have talked about creating specialty groups or councils that can focus on the physicians’ individual specialties. As we’re diving deeper into some of the specialties, we’re realizing we need to spend more time with each of these groups so they can get further educated about HealthTrust’s contracting processes and, as a result, provide the best feedback.

We also want to get the physicians more closely connected to HealthTrust’s contracting cycle so that they can see how it works. So far, we have asked physician advisors to weigh in on certain products or pharmaceuticals, but I’d also like to see them act in a proactive way and pitch ideas to us. So, if there happen to be pharmaceuticals or device opportunities that fall outside the contracting cycle, they can alert us and we can perhaps consider expanding a category to think about additional opportunities.

The second priority involves the clinical data teams. We have three different clinical data teams that all provide significant value to HealthTrust, but at the moment, they are operating somewhat independently. The overarching vision is to take those three offerings and meld them into a clinically integrated offering. They all have unique competencies and skill sets, so if we can find the right organizational structure in which to align them, we’ll have a more cohesive value proposition.

What marketplace forces do you think will most dramatically impact healthcare providers in the next three to five years?

There are a number of them: The trend toward consumerism; the growing emphasis on patient satisfaction; the increasing costs of care, particularly with prescription medications; the trend toward cost sharing, seen in patients paying much higher deductibles; how information technology is going to transform data analysis; and then finally, all the unknowns around governmental healthcare policy. There are a fair amount of external forces leaning on healthcare systems and providers, but at the end of the day, the only thing that we can really control is what happens within the health system and patient outcomes. Really, that’s what patients and their families want—the highest quality outcome a provider can deliver. So, despite all those external forces, the focus on quality outcomes should be the same.

Most of those external forces can be mitigated through appropriate strategies. The real unknown is how the governmental policy piece plays out and how the government and commercial payers are going to respond to some of the dynamic changes in the market.

What excited you the most about joining the HealthTrust team?

It was CEO Ed Jones’ commitment to and focus on a clinical agenda. He strongly believes, and I agree, that HealthTrust offers something unique—above and beyond the typical GPO. The opportunity to organize clinical teams and track quality outcomes, tied to cost efficiency and demonstrate that value-add is exciting. I can tell you from having been in clinical practice previously, it is needed.

Healthcare systems and physicians are asking for help because there’s no way they can build the necessary infrastructure in every single health system—it’s too much. So, if we can help them by providing information that can change the culture at those institutions, that is going to translate into better quality care, which is the ultimate motivation of the entire clinical integration team. That’s what really attracted me to HealthTrust.

I was pleasantly surprised with the depth of resources that we already have within HealthTrust. There is a great opportunity to collaborate and bring these experts together to develop the best strategy to accomplish that value-add for our members.

What is one of your talents that might surprise people?

I’m a musician; I’ve played the drums since I was a kid. Before I went into medicine, my first career in the mid-80s was as a professional drummer. Yes, I had long hair and a cheesy mustache—the whole thing. I have played in a number of bands focused on various kinds of music, including rock, country, country/rock, jazz and even a Greek wedding band. I still play and have a drum set in a studio in my basement. It’s a great decompression activity and escape from all the left-brain work I do during the day. I can go home and bang on the drums and live in that right-brain world for a little while.

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