Carman Ciervo, D.O., FACOFP, is the Executive Vice President and Chief Physician Executive at Jefferson Health New Jersey (JHNJ). As a member of the senior leadership team since 2010, Carman has played a key role in Jefferson Health of New Jersey’s continued growth and transformation, working directly on hospital and health system initiatives related to the employed-physician model, population health, and clinical excellence. He has also overseen the progressive growth of the Jefferson Health New Jersey (formerly Kennedy) Health Alliance, a consumer-friendly network of primary and specialty medical practices throughout southern New Jersey.
- Healthcare providers should partner with community organizations when rolling out a new initiative to better align services with the needs of the community they serve.
- Working in collaboration with healthcare providers who would traditionally be considered competitors can reduce redundancy in the care provided to the community and lead to better value for the healthcare dollar.
- Population health initiatives that involve partnerships with non-healthcare organizations, such as major employers in the community, help create a healthy workforce.
TLD Group: How do you define JHNJ’s health ecosystem?
Ciervo: When you look at any entity and its health ecosystem, a big part of it starts with the communities you serve. When I joined JHNJ (formerly Kennedy Health), one of the first things that I was tasked to do was to better understand our medical staff, what they felt their needs were, as well as the needs of the community. This formed our strategic plan and visioning, and helped us determine how best to support the providers and the community. The way I see it, if a health system decides to roll out an initiative without partnering with community organizations, it’s going to be a very top-down approach. I believe you need to understand who comprises your community, get to know the official and unofficial leaders, and speak to them about educational opportunities around health promotion. It’s also important to work with leaders of organizations you may consider part of your competition, because otherwise there’s going to be tremendous redundancy in the care that’s provided and not the best use of the healthcare dollar.
TLD Group: What role does JHNJ play in partnering with other health sectors to improve population health?
Ciervo: We live in an area where deaths from overdose are some of the highest in the nation. Every hospital recognizes that we really don’t provide appropriate resources and access for patients with behavioral health issues. Our CEO, Joseph Devine, created a behavioral health consortium of all five health systems in our area to tackle the challenge of getting people access to behavioral health specialists, whether it be psychiatrists, psychologists, licensed counselors, etc. We came together to create a triage emergency department that all health systems in our area participate in, and we are working to place these patients into more appropriate care centers such as 28-day programs.
TLD Group: How has the consortium aligned processes and operations?
Ciervo: There is still a lot to be determined. We want to be sure to navigate the patient back to their primary care provider and the system they are affiliated with. Much of what we’re working on now has been through health information exchange. Most of the systems in this area are fortunately on EPIC electronic medical records, so that will help create movement of shared information that benefits the patient. We also have a hub of patient navigators that are primarily registered nurses (RNs), which help bring patients back to their primary care physician and others who are responsible for the majority of their care. This hub is jointly funded by all the systems, and these navigators work on behalf of the whole consortium, not just any one particular health system.
TLD Group: Can you provide an example of cross-sector collaboration?
Ciervo: The one area where we’re finally making headway is in behavioral health where we’re partnering with Horizon on a risk-based contract to 1) figure out why costs are so high for this population, 2) identify these people, and 3) provide them with improved access and care. We are working to proactively treat high risk behavioral health patients so they do not use high-cost emergency treatment that can be avoided. With the support of my CEO, Joseph Devine, we were able to hire psychiatrists, licensed counselors, and social workers to provide the right care in the right setting at the right cost structure. This investment put skin in the game and Horizon was then willing to create a risk-based contract with us.
We really believe in value-based care which drives population health initiatives, even though just about 4% of all reimbursement is value-based rather than fee-for-service. We believe it is the right thing to do. Having people that are part of JHNJ at all touchpoints is an important part of our population health strategy. We have house-call programs, nursing home facilities, primary care access points, specialist access points, hospital, tertiary, extended care facilities, case managers, and nursing hubs that are coordinating care.
TLD Group: How has JHNJ partnered with community organizations to improve population health?
Ciervo: JHNJ has a population health arm that looks at the top employers in the area, as well as other organizations where we are well-connected. For example, we’ve partnered with the Jewish Community Center in Cherry Hill, Campbell’s Soup, Lockheed Martin, among others. Our population health team conducts outreach to these major employers, and we offer to provide educational information sessions to their employees. After all, if you have a healthier employee workforce, that’s going to be better for the organization overall. The work we do is very much at a grassroots level, because we get out into the community to have an impact on population health.
As an illustrative example, one of our very successful initiatives was with ShopRite – a major supermarket in New Jersey. Their workforce is comprised of a diverse employee population with a variety of ages represented. We provided educational sessions that addressed the health needs of different ages. For example, we’d educate adults aged 40–50 about the appropriate screenings for this stage of life. Through this initiative, we learned that many of these people didn’t have a primary care provider. In addition to providing their 1,200 employees with healthcare education, we were also able to connect them with primary care providers and provide them access to healthcare. One employee we provided care to discovered she had chronic lymphocytic leukemia. It’s truly a success story because we were able to detect it and treat it. After that, she became a strong advocate for our services and spread the word. Getting into the community is how you begin to develop the trust that I feel creates the conditions for success of your organization’s population health initiatives.
TLD Group: Could you provide an example of an initiative that didn’t work as you’d hoped, and what you learned from that experience?
Ciervo: We had decided initially to go with a retail strategy, where we were going to put other primary care offices in the community. That initiative was what I’d call “primary care on steroids” because it was open every day including holidays, but the ROI on that ended up being costly. It didn’t work for us because patients didn’t necessarily gravitate to a particular venue – they were gravitating to particular areas of the community. We had to regroup and recognize that it was not a worthy investment. What we learned from this was that we needed our initiatives to align with our core strategy of understanding our community and providing primary care access points in places where the services are most likely to be utilized. You can’t just attach it to a Walmart or some other large chain and expect that people will want to get their healthcare there too. We knew we wanted to provide access points to people in the community, but the ones that bear the most fruit are the ones that are inculcated within the community.