The decision to unite into an integrated system was only a first step in the recipe for Penn Medicine’s success. “If you look at the top hospitals in the country today, most are part of integrated systems,” said UPHS CEO Ralph W. Muller. “But integration alone is not what makes us great.” Muller and other Penn Medicine leaders point to a few key ingredients that have made the organization successful.
Uniting around Quality
Penn Medicine’s growth in clinical care has been intimately linked to its strategic emphasis on continuously improving the quality and safety of that care. In the mid-2000s, under the leadership of Chief Medical Officer Patrick J. Brennan, MD, that effort coalesced into Penn Medicine’s first “Blueprint for Quality and Patient Safety,” as a guide, a roadmap, and a shared language for all of Penn Medicine’s clinicians and other staff to focus on system-wide priority areas of quality improvement. Reducing healthcare-acquired infections was one early priority, and other initiatives have attacked ventilator-associated and aspiration pneumonias. Co-led by both the chief medical officers and chief nursing officers from across Penn Medicine’s entities, the Blueprint is revised every four years to adapt to changing needs. An emphasis on reducing readmissions has included an innovative partnership with the region’s largest private insurer, Independence Blue Cross (IBC). Launched in 2017 with IBC and Penn Medicine’s new five-year contract, the effort has been a key driver of an unprecedented 7 percent reduction in 30-day preventable readmissions. Among patients insured by IBC, preventable readmissions dropped more than 25 percent, with improvements for key patient groups such as those with cancer and heart failure.
Building for the Future
Penn Medicine’s growth from a single owned teaching hospital to a region-wide system of six acute-care hospitals and numerous outpatient sites is self-evident. Less evident is the strategic investment in strengthening each facility to flex unique strengths as part of a larger whole. Penn Presbyterian Medical Center (PPMC) is one case in point: “When I took over as CEO, Presbyterian needed a rebirth,” said Michele Volpe, who has led PPMC for 18 years. PPMC first recruited Penn-trained physicians, then over a span of years built up clinical strengths in Medicine, Radiology, Anesthesiology, Surgery, and other departments. “The next, very large change, was just three years ago: the transition of our Level One Trauma Center from HUP to Presby and then the Pavilion for Advanced Care,” Volpe said. “I can honestly say, and I think most people in the system will say this, the journey has just been magical. It has absolutely changed the perception of Presby, within and outside the health system.” Pennsylvania Hospital similarly transformed into a mighty force in cancer care, orthopaedics, and neurosciences, among other areas—and Penn Medicine has made significant investments in the growth of its newer regional hospitals including Chester County Hospital and Lancaster General Health while building on unique strengths to deliver care close to patients’ homes.
In the late 1990s, Penn’s health system was in financial turmoil, as the system’s income failed to keep pace with the expenses incurred by its burgeoning research enterprise and its purchases of independent outpatient practices. The multiyear turnaround effort culminated in an innovative fiscal model implemented under CEO Ralph W. Muller, called “Funds Flow.” The model channels resources from successful areas of the clinical enterprise to support Penn Medicine’s holistic success across its research and education missions, as well as in underfunded areas of clinical practice. Under the leadership of UPHS Chief Financial Officer Keith Kasper and Beth Johnston, executive director of the Clinical Practices of the University of Pennsylvania, the model decentralizes decision making and rewards clinical units for building up their own financial strength. “One noteworthy aspect of Funds Flow,” Muller said, “is that in addition to driving patient satisfaction, it incentivizes cost control at a time when there is a growing need across the health care world to keep costs down.” The financial stability that Funds Flow engendered has been essential to investments in Penn Medicine’s sustainable growth in this century.
Investing in People
“Penn Medicine Academy is the differentiator between having great strategies and being able to successfully implement those strategies for the outcomes we all desire,” Muller said. As the learning and change management arm of the health system, PMA’s core mission is to sustain an agile environment by investing in people, developing strong leaders, building a skilled workforce, igniting engaged teams, and managing change. In the last year, PMA facilitated over 57,000 learning hours for over 7,700 participants with topics focused on developing leadership, customer service, project management, and other essential skills. It has built libraries of just-in-time online, mobile-friendly learning modules that VP for Learning and Organization Development Cindy Morgan calls “a friendly booster shot of new skills” for staff at all levels, from the front line of care to the executive suite. Since its establishment more than a decade ago under former VP for Organization Development and Human Resources Judy Schueler, PMA’s imprint on the health system has continually grown and strengthened the organization’s agility in the face of change. PMA has orchestrated the use of simulation and stakeholder engagement that substantially reshaped the design of Penn Medicine’s new inpatient Pavilionin addition to supporting hundreds of other change initiatives.
“People don’t get sick and come to a pathology department or a radiology department,” said Peter D. Quinn, DMD, MD, senior vice president for the Clinical Practices of the University of Pennsylvania. “They just get sick, so there needs to be coordinated and integrated care among all the departments, or physician groups in our community-based settings, to properly treat the patient.” Penn Medicine delivers that complex care to patients through a model of integrated disease-based service lines. Multidisciplinary teams focus collaboratively on services for cancer, heart and vascular disease, neurological and neurosurgical conditions, musculoskeletal issues, women’s health, transplant, metabolic conditions, digestive diseases, and others. “We also know that costs are very concentrated in a small proportion of the patient population: Five percent of patients account for 50 percent of health care spending,” said Phil Okala, chief operating officer of UPHS. “The service-line approach helps our clinicians to work in teams that address these high-acuity and chronic-care needs with care that is coordinated across inpatient, ambulatory, and post-acute settings, all connected through a single electronic health record across our region. Ultimately this leads to better patient outcomes and lower costs.”