Sajid Ahmed, Chief Information & Innovation Officer, MLK Community Hospital, Chapter 1

For Sajid Ahmed, the chance to build a new hospital and provide care to more than a million underserved patients was too good to pass up. But it wasn’t going to be easy. In order to succeed where the previous facility was (very publicly) shut down, MLK Community Hospital would have to do two things: expand care outside the four walls and leverage technology to improve outcomes. In this interview, Ahmed talks about what it will take to achieve those goals, why he believe culture is the most important innovation, and the challenge of going big bang with an EHR before workflows were established. He also discusses his “no fax machine” policy, the trap many hospitals fall into, and the one thing he would’ve done differently.

Chapter 1

• MLK Hospital’s complex history
• Forming MLK-LA Healthcare Corporation
• New hospital, new funding model — “We’re in charge of the bottom line.”
• Treating “the sickest of the sick”
• 3 components of health IT — “The lines between them are beginning to blur.”
• “Telehealth has arrived.”
• Plans to expand to PCPs and specialists
• Discharge app

Bold Statements

Our number 1 goal is to provide more access to care, and not just wait until patients come to our ED. We treat the sickest of the sick.

How often do you get to be part of a startup organization where you can build a brand new hospital — not just building it physically and hiring new doctors and nurses, but trying to balance term reimbursements and the need to keep the hospital going?

Now that the technology is more ubiquitous through mobile devices where access to high-speed broadband is readily available to almost everybody, I think that telehealth has arrived, and it can play a critical role moving forward.

The lines between the three are slowly beginning to blur, in part because communicating, sharing data, documenting that information, and putting consumer information into that is what makes health IT serve its purpose, which is to supporting the delivery of care.

We’re doing something very unique by using these technologies to not only fill in the gaps with specialty care from UCLA and other facilities, but also to communicate with patients at a very basic level to support their care after they leave the hospital.

Gamble: Hi Sajid, thanks so much for taking the time to speak with us. Let’s get started with some background information. Can you talk about the history of Martin Luther King, Jr. Community Hospital?

Ahmed:  Sure. I’m part of the new Martin Luther King Community Hospital, a community hospital located in South Los Angeles. I say ‘new’ to differentiate it from the old hospital, which was opened in 1972 and closed down in 2007. There was a lot of history there; suffice to say, it was closed down by CMS due to lack of quality and a number of other factors. It was a hospital run by the county, and to the county’s credit, they went to the state and said this area represents about 1.35 million people who need acute care services. So the state invited the University of California system and facilitated a cooperative agreement back in 2008-2009 to restart the hospital — not only building four new buildings and renovating one of the seismically-safe towers, but to putting in the money to help start it up.

The county created a startup that put together an independent committee of current and retired healthcare executives — most of whom are former or existing CEOs of health systems, and what they quickly realized was no one wanted to do this. No operator wanted to take on that responsibility. And so after two years of searching, the seven board members decided to form their own company: Martin Luther King Los Angeles Healthcare Corporation (MLK-LA).

That was four years ago. Shortly after that, we helped build and launch a 131-bed acute care inpatient hospital, with 20 ED beds, including eight fast-track beds. Within a year, we were at capacity. Compared to the old hospital, which had more than 400 beds, it’s small, but the county wanted to make sure it was built to serve the community, and it is. There are plans for a 185-bed tower as part of the master plan.

What’s interesting is that it is operated and run as an independent private nonprofit but in a public private partnership with the county, on a 40-plus acre campus that includes an outpatient center run by the county Department of Health Services. That also includes inpatient/outpatient mental health, urgent care, a public health facility, and a medical school. We have a brand new, state-of-the-art hospital facility and a brand new outpatient center, and our goal is to renovate the entire campus over the next several years, with a complete redesign focused on the wellness of the community. The hospital’s primary focus is on delivering the highest quality of care; we want the community to see this as their primary resource.

Also of note is the fact that the demographics have changed since the old hospital. Instead of being a largely African-American population, we’re now about 75 percent Hispanic. What hasn’t changed is the socioeconomic status. Two-thirds are still at or below the poverty line, and along with older, chronic care patients, we have younger patients to care for. We’re providing care in an area that’s designated as medically underserved and professionally underserved. We had a consultant who told us we could hire 1,800 physicians in the service area and just barely meet capacity.

 

Gamble:  Okay, so definitely a huge need for care in the area. Is the hospital still being run by the county, and how is it doing financially?

Ahmed:  Yes. We opened in July of 2015, on time and on budget. We consider the county and the people of Los Angeles our venture capitalists — they gave us a specific amount of money and they gave us a mandate to deliver a product by a certain time. We’ve done that, and now we’re doing more. Now that we’re on our own in charge of the bottom line — and the top line, we’re taking the funds we get from the state, the county, and the feds in the form of reimbursements to provide care to a (mostly) safety net population. We’re looking to open an outpatient adult office by the end of this year and another by the end of next year or early 2018. It’s a medical office building that we’re going to be anchoring and leasing out to other physicians to provide outpatient and specialty care.

Our number one goal is to provide more access to care, and not just wait until patients come to our ED. We treat the sickest of the sick, and we have people that use our ED as their primary care. We’re reinvesting in the community, opening these adult care primary offices or clinics and hoping to provide care.

 

Gamble: By on opening physician offices and clinics, is the goal to address one of the biggest issues with the hospital that closed as far as providing care to patients outside the hospital?

Ahmed:  Absolutely. Our assessment, and the reality that we experience every day in working with this population, is that they don’t have convenient access to primary care. Many of them are not part of a medical home. Remember, these are Medi-Cal patients; a lot of them are insured through the Medicaid extension program, and California supports the marketplace by providing insurance. It’s great that many people now have insurance, but some still don’t, and of course a lot of our population falls into the presumptive eligibility space. So there’s still episodic access to care that’s done mostly through the ED. Even though a lot of these are county patients that have access to the outpatient center, there is so much need and not enough capacity, and so we feel that opening these adult care medical offices and outpatient ambulatory care sites is one of the ways we can help the population become healthier. And so instead of waiting until the condition becomes more acute, if we can provide access to an outpatient setting, we can not only save costs, but catch conditions earlier to provide better care.

One of the most unique aspects of our mission is that we don’t just want to be a regular hospital. I mean, how often do you get to be part of a startup organization where you can build a brand new hospital — not just building it physically and hiring new doctors and nurses, but trying to balance terms reimbursements and the need to keep the hospital going, with the idea that maybe we can move toward value-based care? And a lot of that starts with providing primary care and outpatient care, first and foremost, and catching conditions before they get worse.

I think we’re following the trends that are happening across the nation. A lot of the merger and acquisition movement we’re seeing is focused on investing in outpatient centers and medical group practices. DaVita bought HealthCare Partners, and many others are looking into buying IPAs and expanding into independent physician groups. It’s a testament to where everyone’s going. So from a basic level, it’s to provide care in the outpatient setting and treat patient before their conditions get worse.

Also, we want to make sure we’re ready for the value-based care that’s coming down the line. Right now it’s mostly focused on Medicare, but we’ve spoken to CMS and said, ‘We’d like to see you give a little more thought to working with the state to do value-based reimbursement on the Medicaid side, for us and Medi-Cal.’ I think it’s a no-brainer.

 

Gamble: So a lot of focus on chronic care patients. What kind of role do you see telehealth playing in the future?

Ahmed:  I’m biased here, as I’ve been a big fan of telehealth for 25-plus years. Now that the technology is more ubiquitous through mobile devices where access to high-speed broadband is readily available to almost everybody, I think that telehealth has arrived, and telehealth can play a critical role moving forward.

I believe health information technology is made up of three key approaches. One is the electronic health record, the second is health information exchange — both the noun and the verb, the act of being able to share data, and telehealth. The lines between the three are now slowly beginning to blur, in part because communicating, sharing data, documenting that information, and putting consumer information into that is what makes health IT serve its purpose, which is to supporting the delivery of care.

For example, in launching our hospital, we had telehealth in mind. Even though we’re an urban hospital located less than 15 minutes from downtown Los Angeles, because there is a lack of providers, we’re using telehealth at the hospital just to get call coverage. We’re using tele-radiology with UCLA, we’re using tele-neurology, and we’re expanding into other telehealth areas to get to specialty consults for our patients. We implemented telehealth right at the beginning, and we’re expanding it.

We’re also looking at telehealth locally, working with the eight FQHCs and other providers in South LA through the independent practice associations (IPAs) to say, if you have a patient in your office and you’re about to refer them to the Martin Luther King Emergency Department because of an acute care issue, please contact us. Please talk to our hospitalists. So we’ve put in telehealth, but we’ve also put in people to support telehealth. We have 24/7 hospitalists, we have 24/7 intensivists, and we have more than 60 care managers and coordinators that support care coordination for every patient that comes into hospital. We haven’t done the telehealth from the primary care or referring physicians yet, but that’s exactly what we’re working on.

We’re also working on an app that would allow patients and their family members to not only download discharge instructions, but have the opportunity to contact our care managers and hospitalists as part of their follow-up care. If they want to come back to the ED, there’s a button that they can push, and our care managers or hospitalists will intervene and say, ‘Tell us what happened. How’s your care? Do you need to come in?’ I think we’re doing something very unique by using these technologies to not only fill in the gaps with specialty care from UCLA and other facilities, but also to communicate with patients at a very basic level to support their care after they leave the hospital. Hopefully we can turn that around so that they contact us directly before they even come to the hospital, and maybe they go to the outpatient center instead. I think that’s part of the new model of care.

It’s the opposite of how it is at most hospitals, which tend to look at heads in beds — that’s how they get reimbursed. We’re really not interested in that. Of course, we have to manage our census and our current reimbursement model, but our mission is the health of the community, which is counter to how the reimbursement model works. We’re willing to work with the patients to keep them out of the hospital and keep them home; by using telehealth technology and remote monitoring, we want them to contact us before they receive care. So we’re really embracing telehealth — not only as a technology, but as a ubiquitous way to manage a health program for the community.

Chapter 2