Online Healthcare MBA Program

Online Healthcare MBA

Faculty and Graduates Profiles

Dr. John M. Young

Assistant Professor, Clinical Research & Leadership
The George Washington University
School of Medicine & Health Sciences

The Learning Healthcare System: Data & Business Model


Dr. El Tarabishy: So, we are here with Dr. John Young. He’s an Assistant Professor of Clinical Research and Leadership in the Department of Clinical Research and Leadership and the MSHS and the Health Care Quality program at the George Washington University School of Medicine and Health Sciences. A scholar practitioner, Dr. Young, with over 18 years of health care experience in federal and state health policy development, manage care organisation leadership, and consulting.

Dr. Young is a former federal government senior advisor who was instrumental in the development and execution of key provisions of the Patient Protection and Affordable Care Act. And implementation of many other many other Medicare, Medicaid, and CHIP legislative provisions, including physician-based clinical quality measurement programs. DR. Young, thank you for coming.

Dr. Young: Thank you for having me.

Dr. El Tarabishy: Absolutely, let’s get to the question right away.

Dr. Young: Yes.

Dr. El Tarabishy: Tell me, what do you think, or what is the learning health care system?

Dr. Young: The learning health care system. So, many integrated delivery systems and hospitals and provider organisations are collected troves of data, lots of data. So, the ability or inability to be able to collect that data, analyze and curate that data, report that data, and then publish, has been sort of the mantra of these organisations. But a learning health care organisation suggests that we go much further than that.

We not just publish data, but we store knowledge, we disseminate knowledge. If you look at the Center for Medicare Medicaid Services Innovation Center, you have learning and dissemination of learning and the fusion, if you will. So, how do we take that data, turn it into knowledge, disseminate it, and use that cycle continuously within your own system, so, it’s an ability to use systems, people, culture, to collect and use data in a more “learning” or “learned” format, if you will.

Dr. El Tarabishy: So you throw a lot of key words here.

Dr. Young: Yes.

Dr. El Tarabishy: We’re in the Kiev room, and the Kiev room basically we had an interview with the curator, right? Brad, Mr. Brad Sapien, and he talked about curating knowledge.

Dr. Young: Yes.

Dr. El Tarabishy: Right, and you just use that word, curate, for the learning organisation. And I’m using the word learning organisation from the business side.

Dr. Young: Sure.

Dr. El Tarabishy: So, tell me, how is this evolved? Why is it evolving? And why is it so important as we speak?

Dr. Young: Well, I think the advent of big data is a big driver, central driver of this. So now, organisations are collecting disparate types of data, unstructured and structured types of data, having an ability to warehouse that data, curate it or collect it, and report it and use it meaningfully, is an asset to any organisation.
So when we talk about curating data in learning organisations or learning health care organisations, it’s that ability to collect it, store it, warehouse it, and use it. But continually build and learn off that data, not just let it statically sit.

Dr. El Tarabishy: So let me talk to you a little bit about electronic medical records.

Dr. Young: Yes.

Dr. El Tarabishy: And more electronic health records. Connect the dots, if you may, between EMR, electronic health records, and learning health care systems.

Dr. Young: Sure. So, the EHR or EMR is actually the conduit, our ability to collect, again, lots of data. Technology has driven this. We go back to the old days of paper records, but now, of course, in an electronic medical record or electronic health record, we’re able to capture just all types of data, structured and unstructured, that we just haven’t been able to do in the past.

Now, with that learning health care organisation, again, it’s that organisation’s ability to be able to capture that data and to use it. So again, we have the notion of inter-operability, how does that work within sort of an integrated, financially integrated delivery system? How can we begin to glean that data from systems that are enclosed or inter-operable, if you will, and use that to learn?

So again, we take our own data internally within an health organisation or health system, use that data for our own internal learning. I think, from that, we can begin to experience the value proposition of better care at lower cost, if you will.

Dr. El Tarabishy: Okay, I’m going to become tricky now.

Dr. Young: Yes.

Dr. El Tarabishy: Now it’s going to get to start the tricky part here.

Dr. Young: Okay.

Dr. El Tarabishy: Can you monetize what you just talked about? Can you put a dollar figure on a return on investment, or on a return on expenditures, if you may, from applying or creating or implementing a learning health care system?

Dr. Young: Absolutely. I believe that you can. And any value proposition, there should be a return on invest, so that data becomes an asset. The learning system, again, is the conduit to capture that data and report it, but the data becomes a commodity.

And if I use that data now in terms of clinical quality measurement or health care quality, I can go out, and now in our transparent, if you will, health care delivery system, you have lots of data that’s now transparent to consumers. We have consumers of health care. They’ll take that data and begin to make decisions on that data.

So, within a learning health care organisation or a learning health system, you want to be able to utilise that data, improve care, improve processes, and then by virtue of that, you’re improving outcomes, so to speak. So, that’s what health care consumers are looking for. That becomes the commodity or the monetisation of that data, if you will.

Dr. El Tarabishy: So, here’s the tricky part. I was driving this morning, and in the news, which kind of made me startle and actually wake up even more, a major hospital just announced that its data just got hacked.

Dr. Young: Yeah.

Dr. El Tarabishy: Right? And, which is, so which is okay, it’s not new that they got hacked. Which, I thought for the health care system, it’s kind of the first time I hear that the health care provider’s data got hacked. But what’s more shocking, that the people that hacked it has asked for money, ransom, to release the data, and they asked for the ransom in Bitcoins. In digital currency.

Dr. Young: Sure.

Dr. El Tarabishy: What are we talking about here? [laughs]

Dr. Young: [laughs]

Dr. El Tarabishy: Where are we? Are we in a whole new wild, wild west?

Dr. Young: [laughs] You know, Bitcoin, that’s not necessarily my expertise, but let’s just go back for a second. We start to look at the numerous data breaches that have happened in the health care industry over the last five years. By virtue of digitising data, health information technologists made it more accessible to folk who are after our personal data. The whole notion of cyber security within health care is an emerging phenomenon as well, too.

Health care, and again, the data that’s been sought, if you will, and held for ransom, is very private and very personal. So, I think what we have to do is to begin to increase our cyber security efforts around health care as well. But again, that data is just as valuable as any other financial data or data from other sectors as well, where it becomes, again, a monetisation or commodity, if you will, with the data.

Dr. El Tarabishy: So if you were an administrator in a hospital, running the hospital, and you just get news this morning saying you just got hacked and they want a ransom.

Dr. Young: Yeah.

Dr. El Tarabishy: You going to go hire a cyber security to company to protect the patients’ health care records? And also in the news they were saying they were going back to the paper records, and they were saying that they were kind of moving away patients, or kind of telling patients you can’t come in because we can’t accept you because our record system is down. It’s shocking. It’s a whole new world. Or is it the new normal?

Dr. Young: Well, I think it is shocking, and frankly I think that’s unacceptable because we live in an environment where of course we have lots of data, and we have sophisticated information technology systems out there that any consumer would expect reasonable protection and privacy of their data.

So, I think as health care administrators and health care leaders, we have a responsibility and a duty to protect that data. That data is an asset. It’s just like any other financial asset within an organisation. You have to protect it, so absolutely, hire cyber security professionals and provide patients and beneficiaries with a reasonable expectation of privacy and safety of their data.

Dr. El Tarabishy: So, the business model for the health care providers, for hospitals, is changing.

Dr. Young: Yes.

Dr. El Tarabishy: The whole cost structure is changing. So, we’re doing this MBA program in health care at George Washington University. So, we’re basically looking at a new coterie of experts to come out, to go apply to hospitals saying I am going to be health care, data analytics, security expert. Is that what we’re looking at?
Dr. Young: That’s exactly what we’re looking at, and in fact, when we start talking about workforce issues and trends in workforce issues within hospitals and health systems, absolutely. You’re looking at big data and data scientists, if you will. You’re looking to cyber security professionals. You’re looking at information technology professionals that really know how to operate within a clinically and financially integrated, huge health care delivery system.

And we look at now, what’s happening with our health care delivery systems where you see lots of mergers regionally; you look at the Intermountains, you look at the Geisingers, you look at the Mayo Clinics, these systems are not only capturing market share within their own regions, they’re expanding to very different regions. Here in the District or in Virginia, I think there’s a relationship with the Mayo Clinic out in Minnesota, if you will.

So again, there’s a reasonable expectation that, you know, you have to be able to protect information because these systems are growing so large. And you make a very good point, we’re coming upon this sort of new reform of alternative payment models. The payment structures are changing rapidly.

It’s all about volume — value, rather — not volume anymore, so again, for hospitals to compete and participate in this new alternative payment model world, if you will, they’ve got to be able to be responsive in terms of security and innovation around payment.

Dr. El Tarabishy: In your background, you mentioned Affordable Care Act.

Dr. Young: Yes.

Dr. El Tarabishy: And just before we’re taping, I mentioned Obamacare.

Dr. Young: Yeah.

Dr. El Tarabishy: And you smiled at me, saying two separate worlds here.

Dr. Young: [laughs]

Dr. El Tarabishy: So, tell us exactly what you were doing with the Affordable Care Act, and kind of how do people equate it to Obamacare, or they don’t.

Dr. Young: Yeah, you know, that’s been a really interesting topic, I think, since the advent of the Affordable Care Act back in 2010. So, having been at CMS as the Patient Protection and Affordable Care Act, or the ACA, as the Affordable Care Act was being drafted, I was in a really interesting position where I worked for Medicaid quality and what I call CMS proper, before the Innovation Center.

And as a technical director, I had the opportunity to work on legislation that included medical homes or health homes, never events and patient safety, collection of standardised racial and ethnicity data. Really interesting topics that made its way into the Affordable Care Act. Then I was recruited to actually work in the Innovation Center, that is an ACA mandated center at the Centers for Medicare and Medicaid services, so.

I was a senior advisor there, and when I hear the differences between the Affordable Care Act and Obamacare, it almost just makes the little hairs on my neck stand up. But again, I could write a book about Obamacare, and the very different tone and tenor that the Affordable Care Act has now. With that being said, am I saying or suggesting that the Affordable Care Act is perfect? No, there’s still work to be done. But it’s absolutely on the right track.

But don’t I hear Obamacare really has become contentious, it becomes political, it becomes not in sort of the spirit of what the Affordable Care Act was meant. So I see those as being two very different tracks. Although the President sort of adopted Obamacare and said that that’s fine. Those of us who were in the trenches who helped develop it and execute it, I like to call it by what the legislation was intended to be called, and that’s the Affordable Care Act.

Dr. El Tarabishy: Again, in the news, they were talking about Blue Cross Blue Shield being predominantly the main provider for the Affordable Care Act, for most of the premium for the people subscribing in. But using data analytics, they just announced that most of the people that were joining recently were more expensive or had more expenses than the other ones that were in the system, so they increased their premiums.

Now, for me, driving, I kind of said, well, from a business perspective, it makes sense. But there might be something wrong with this, that they have identified one group versus the other group, even though from a perspective saying that once you’re in this pool, you know, standard deviations at the end will allow for averaging out. So why are they singling out one group versus the other, or maybe it was misinformation, but the point is that big data allows you to start doing this mining.

Dr. Young: Yeah.

Dr. El Tarabishy: And is it correct? Are we not having an ethical issue here based on this data saying trying to identify groups versus other groups which cost more or less?

Dr. Young: I fully agree and I think it really does center around an ethical issue. Now, many will argue that it is a business model and a financial issue as well, too, because in any community rating on premiums, you want to make sure that you have a representative population to average out those premiums, but with that being said, of course when you bring in 16, 18 million new beneficiaries into health care, you’re going to get some of the sickest of the sick.

So I think in our payment methodologies, our quality programs as well, we’ve got to figure out how to make that care equitable and accessible if you will. And organisations are making a business to say we’re going to pull back because we don’t have a representative population to begin to smooth out our patient panels, if you will, for more equity and risk-adjusted rates, so to speak.

So, I think big data, that’s — I don’t want to call it an unintended consequence, because the data’s going to give you exactly what you’re going to get as long as it’s being interpreted and is reliable and valid. But I think it really requires more leadership and strategic action on behalf of those organisations to figure out how to write policies that really allow care to be given to this new, these new beneficiaries in a more equitable and cost effective way.

Dr. El Tarabishy: And you just recently joined GW.

Dr. Young: I did.

Dr. El Tarabishy: Tell us a little bit why you came to GW, what you’re hoping to do here, and kind of what you’re working on right now.

Dr. Young: Sure. So, everyone in health care thinks that they’re a natural educator, so one of the things that I really want to do at this point in my career is to bring together all of my experiences in public health, in academic medicine, and policy and manage care, and be part of this sort of new teaching cadre online, if you will, that allows me to share those experiences and teach it in a meaningful way.

My expertise is in health care quality or clinical quality measurement, which is really at the core of health care reform. So, George Washington University School of Medicine and Health Sciences has a rigorous program in Health Care Quality, which just really fit my background and really what I’m about as a scholar practitioner.

So, I thought I had something to contribute, so. Since I’ve been here now for about three months teaching my first couple of courses in the health care enterprise, which I would recommend any health care professional take, I’m really looking forward to upcoming semesters where I’ll be teaching pretty much some of the core courses in the Health Care Quality program.

Dr. El Tarabishy: Excellent. Maybe you can write that book. [laughs]

Dr. Young: [laughs]

Dr. El Tarabishy: Right?

Dr. Young: That would be great. I would love to. Yeah.