The Arlington-based Texas Health Resources, one of the largest faith-based, nonprofit integrated healthcare systems in the U.S., encompasses 25 hospitals, 3,800 licensed beds, 18 outpatient facilities, more than 250 additional care sites; more than 21,000 employees, and more than 5,500 affiliated physicians, serving 6.2 million people across 16 counties in north central Texas.
Jeffrey Canose, M.D., who has been an executive at THR since January 2006, on Sep. 1 was named senior executive vice president and chief operating officer of for the entire health system. As explained on the organization’s website, “Dr. Canose works in a dyad relationship with Dan Varga, M.D., senior executive vice president and chief clinical officer, to align operational and clinical strategies in an ongoing plan to transform from a hospital system to an integrated health system. He is responsible for achieving full and seamless integration of all system operations, including administrative leadership of Texas Health’s three geographical zones,” as the website further notes.
Shortly after the announcement of his new position at Texas Health Resources, Dr. Canose spoke with HCI Editor-in-Chief Mark Hagland regarding his current work and his perspectives on THR’s journey forward into the future. Below are excerpts from that interview.
Jeffrey Canose, M.D.
What were you doing at THR just before accepting this new position?
I’ve been here for eight-and-a-half years so far; I came in January 2006, as the COO of our Dallas hospital. And then I had the opportunity to move to our largest hospital in the northern suburbs and served as president out there, and when we developed the zone architecture for THR, six of us—three classic physician executives and three regular executives—became zone executives.
THR serves a 16-county area including a population between 6 and 6.5 million. And when we were focused on being a hospital operating company, we had a classic architecture with a system COO responsible for hospital operations, and that was divided into east and west sides. But as soon as we made the decision to become more of an integrated health system, and started to build the infrastructure for population health, the need to cover our service area led us to divide our service area into three zones, with each one encompassing about two million people. At the same time, we consider all three zones to have permeable membranes around them, so there are no boundaries or fences; in fact, we encourage a lot of synergy and collaboration. We all office together and all meet together about things. I officially became system COO on September 1.
What are the biggest issues facing Texas Health Resources as an integrated system now?
The biggest challenge is to continue on our journey to increase our capabilities as a fully integrated health system; to develop the competency to be a high-performing system in the realm of population health management; to shift our focus from sick care to actually managing well-being; and to do that in an environment where we don’t think we need to own or build everything, but to do things through partnerships to actually accomplish our strategic vision.
Are you involved in any of the Medicare MSSPs?
Not at the current time.
Would you wish to be?
We’re always evaluating those programs, and evaluating the total cost of ownership. We initially got involved in the Pioneer ACO program, but left fairly early on [in July 2013, along with eight other organizations; THR was one of two to leave the ACO program entirely, while seven shifted from the Pioneer ACO program to the regular MSSP program—see here for HCI’s reporting of that development].
In the broadest sense, what made you choose to leave the Pioneer ACO Program?
Two primary factors were involved. One was the way the attribution model was structured; the other was that there were significant restrictions on how we could actually manage the care of the patients attributed to the ACO model. It’s sort of like having a professional football player go on the field with his hands tied behind his back.
What were the restrictions?
The essence was that CMS [the Centers for Medicare and Medicaid Services] had created the guidelines in a way so that you could not impose any gatekeeping functions on utilization of healthcare services by the beneficiaries you were responsible for managing. You could try to channel them into a narrower network of providers or affect where they received their care. So you could have patients attributed to your system who were getting their care from more expensive outside providers/health systems and there was no way or incentive to get the patients to participate in eliminating waste and redundancy.
So you participated from January 2012 through July 2013, essentially?
Do you feel that you learned anything from participation in the Pioneer program?
We continue to learn about the competencies, the analytics, the infrastructure, that we need, in order to successfully manage the health and well-being of any sub-population of patients, and there were certainly valuable lessons we learned about those specifications, and the kinds of leadership competencies we needed. It was one of our first significant efforts in shifting our focus from being acute-care-centric to being more focused on the full continuum of care. So it served as a great lab for us to learn in, per our new vision.
Do you think the folks at CMS need to change the parameters of the Pioneer program?
I don’t think I necessarily have an informed opinion about what they need to change; I think they are learning also, both from those who have chosen to participate and who have withdrawn, and those who have also stayed and achieved modest success. They’re learning how to help providers manage more efficiently.
What will the execution of your vision for THR look like in the next few years?
There are several focal points we’ll address. We have a clear focus on continuing to elaborate the infrastructure we need in order to do population health management, and we’re continuing to build those capabilities over time, and explore ways we can deploy through our employed physician groups, as well as through other partnerships in the community; we will continue to grow our partnerships with employed physicians, as well as primary care physicians. We’ll significantly continue to improve transitions of care, especially from acute care to primary care. We want to continue to reduce wasteful cost, and to reduce the utilization of the most expensive settings of care, especially in the hospital emergency room, but also in hospitals in general.
What will the strategic role of IT be in all this?
Of course, the electronic health record is a huge enabler to all this; the next challenge will be to enable things further, including through data mining, working with big data, and clinical and operational support, to figure out where the opportunities are to improve quality and patient safety, with care that is much more affordable.
What would your advice be to healthcare IT leaders nationwide, based on your experiences so far?
It’s going to sound pretty basic, but it would be around collaboration at the sharp point of redesigning patient care—that people in IT are mission-critical partners in hearing what kinds of problems we’re trying to solve, and in helping us to figure out how to drive clinical transformation and care design, and how to drive efficiency. Those of us who have either practiced medicine or managed care organizations—the idea of trying to create this kind of change without sophisticated IT and analytics and enablers—it’s sort of reminiscent of, how did we ever manage to live and function without smartphones and iPads, to help us overcome all the challenges.
What have been your and your colleagues’ biggest lessons learned so far at THR?
That’s a great question. I think especially given the environment—I’ll qualify this answer with a little prelude. We are blessed in North Texas with continued population growth and a lot of economic diversity and prosperity, which has served us extremely well here, and that is an environment that many health leaders around the country would covet. And one of the biggest lessons we’ve learned is that what we used to do when we were focused just on being a first-class hospital operating company was necessary, but not sufficient, in having an impact on the health and well-being of the people we serve—and it also wasn’t sustainable. So we knew we would require a lot of change management to make things happen; and our single biggest challenge would be getting everyone onto the same page in terms of our vision.
So I would share the comment I’ve made in a couple of national forums, and that is that people want to focus on all the disruptive change happening in healthcare and all the new challenges we face, but the one thing we always need to remember is that our mission and ministry haven’t changed and never will. We’re a faith-based organization, and we believe that the work we do allows us to express our faith. And while we’re changing the focus of our company and are broadening our focus, nothing has changed our mission and our ministry.