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Roxanna Gapstur PhD, RN (Host): On this episode of Inspiring Health, we're going to take a closer look at how clinical partnerships help us advance our value based competencies in pursuit of our 2025 goal for leading the region in value. In episodes nine and 10, we had Dr. Tony Aqualina and Dr. Steven Fleck, who helped us define value as providing the safest, highest quality care at the most affordable price. We talked about ways we're measuring progress on our value based journey, how physicians and APPs are drivers in providing greater value and improving health among our patients.

And we also introduced the concept of partnership and collaboration as a key to success in our pursuit of value. So, today we're going to put a spotlight on one of our current clinical partnerships. We're going to discuss the benefits of partnering over duplicating or developing our own competencies and we'll consider what might be next for WellSpan's partnership portfolio.

Joining me today is Dr. Nikhilesh Korgaonkar. He's a Thoracic Surgeon at WellSpan, and he currently serves as the Interim Vice President and Chief Medical Officer of WellSpan's Oncology Service Line. He's also the Vice Chair of the Surgery Department and Medical Staff at WellSpan York Hospital. Welcome Dr. Korgaonkar.

Nikhilesh Korgaonkar, MD, MBA, FACS Guest): Thank you so much for having me. I'm excited to talk with you today.

Roxanna Gapstur PhD, RN (Host): In order to attract loyal patients by delivering the safest best outcomes at the most affordable price, we've pursued deeper clinical partnerships specifically to expand subspecialty services like cancer care and pediatric surgery. In fact, since June of 2017, WellSpan has collaborated with the Johns Hopkins Kimmel Cancer Center. Hopkins provides access to some clinical trials and second opinions for WellSpan patients.

And as a national leader in cancer research and innovation, there isn't a better partner than Hopkins and delivering life-saving care. As a physician and an expert in the field of thoracic surgery, you've seen this partnership and others up close. Could you share your thoughts on the advantages of a clinical partnership like the one we have with Hopkins?

Dr. Korgaonkar: Sure. You know, I want to say first that I think world-class care is being provided at WellSpan every day and you know, our physicians and their APPs and the teams are taking care of our community at a very high level, whether it's in oncology, which is obviously what I know best, or in other spaces like cardiovascular, neuroscience among others. But I think we have to understand that we can't be everything to every patient. And just like Novak Djokovic is the best men's tennis player in the world, he isn't necessarily the best squash player, even in another racket sport. So, we need to understand that there are things we do well and there are things that we can do better when we partner with others. A system like ours to succeed in our journey to value, which you've talked about so much, by taking care of the conditions we see in our community and taking care of their conditions at low cost and with great outcomes and with great patient experience. But there are conditions that obviously we see less frequently or things that require infrastructure or expertise that we don't have at WellSpan. And for those patients, care is probably best provided through a partner. I think Roxanna that from a patient perspective, this means access to the right care at the right time and the right setting, which as you know, are the very hallmarks of high value. And for physicians, this means the knowledge and satisfaction that we're providing our patients with access to the best care. It takes a certain maturity for a health system to understand that sometimes the best care for a patient is delivered through a partner.

Host: Yeah, that's a really great point, Nick. You know, I think it's a natural response for us to think why isn't WellSpan developing its own centers of excellence instead of partnering with other organizations. And I want to take a minute to consider it for our listeners. And when we align our approaches with other organizations, we have new avenues for growth. With Hopkins, for example, our partnership focuses on three areas. We're working on specialized clinical services together, which I think Dr. Korgaonkar outlined really nicely. We also have some connections with research and medical education and an area for the future is to really think about precision medicine and genomics.

So, by bringing together the expertise of both organizations WellSpan and Hopkins, we can unite around a common goal and really provide better outcomes at a lower cost while keeping care close to home in our community.

Dr. Korgaonkar: Yeah, I think that's absolutely right. There are things that academic medical centers provide more efficiently than community medical centers and even large centers like ours that have a lot of talent. And it's because those academic centers are really purpose-built. You listed some of those things like specialized services and capabilities, including personalized medicine. I have a ten-year-old son and like many, he loves video games, and he's always trying to level up. And I asked him why it's so fun to level up. And he said, because it unlocks new worlds. And I think a partnership with a place like Hopkins lets us level up and we unlock new worlds for some of our patients. I recently had a patient from my own practice, an example is a patient with a widespread paraganglioma, and he was sent to me to consider resection of a large chest mass, but his management really requires input from specialized surgeons, probably both cardiac and thoracic surgeons, specialized endocrinologists, specialized anesthesiologists, and possibly specialized oncologists. So, a patient like this is really best served by a multidisciplinary evaluation at an academic center and he is going to be seen at Hopkins. For his post-treatment surveillance and endocrine management though, he can come back home and be managed by his WellSpan team. So, I think that's a really nice example that really illustrates why partnerships like this bring better patient care.

Host: Yeah, my goodness. That is a really fantastic example about the benefit of a partnership with an academic medical center. You know, as you mentioned, as a strong community health system, we bring a lot of expertise to a significant number of problems that patients might present with. But having that extra special expertise in certain areas can certainly make the difference for patients with really complex diagnoses.

If we consider our regional competitors, most have established relationships with academic medical centers. WellSpan does not. And I think it also adds some credibility to WellSpan for our resident education, our recruitment of physicians, and also our leader development. Nick, what can be challenging about clinical partnerships from your perspective as a physician?

Dr. Korgaonkar: I think there are a couple of challenges. First many of our providers rightly feel that they have the training and skills to take care of even the most complex patients. And they're right. They do. But ultimately we get better and better at the things we do all the time. And we get less good at the things we do less frequently. As I mentioned earlier, I think it takes a certain maturity for us to understand that. I think second, you know, all of us in healthcare chose this field because we really cared deeply about our patients and it can be difficult to entrust their care to someone else. But that's exactly why a formal partnership makes sense. It's because it creates a system that allows WellSpan and Hopkins to coordinate care seamlessly and thoughtfully for patient benefit.

Host: Yeah, absolutely. That's certainly our goal. So, Nick, I'm sure our listeners are wondering what's in it for an organization like Hopkins to partner with WellSpan and at our board retreat this past spring, Kevin Sauers, who's the President of Johns Hopkins Healthcare joined us to talk about exactly this. He noted that we had aligned values between our organizations and strategies to provide higher quality care at a lower cost. It's a critical part of Hopkins Regional Strategy to ensure that care is delivered in neighboring communities and not only in Baltimore. And so we've shared goals of providing the best care that's affordable to patients in neighboring geographies. I'm curious what your thoughts might be about that.

Dr. Korgaonkar: That's a great point. I think many of us at WellSpan are very excited to have a partner like Hopkins. But I'd also like to point out that as I've been working with Hopkins, I sense a great excitement on their part to work with WellSpan and the anchor, you know, as is the case for so many of these things comes right back to patient care. We know that patients want world-class care and we know that they want it close to home. And we also know that taking care of medical needs is not an event, it's a process. And Hopkins and WellSpan mutually understand that in each other, they've got a trusted clinical partner. Another example from my own practice was a couple of years ago. I had a 74 year old patient, who for a variety of reasons could not get a standard esophageal reconstruction for his cancer. I sent him to Hopkins for what's called supercharged jejunal free flap.

And this patient required pre-op chemotherapy and radiation. Care was coordinated with Hopkins to ensure the correct timing for surgery and also to plan for post-op chemotherapy. For WellSpan that meant knowing the patient was going to get the highest level of care along the whole spectrum and for Hopkins and I think in particular for the Hopkins surgeon, it meant knowing that the patient was going to continue to get the highest level of care even after his intervention down in Baltimore.

Host: Thanks, Nick. That was a great story. And I think as we go forward in pursuit of leading the region in value, we know partnerships are key to our ability to thrive. And as we consider new partners and advancing strategies with current ones, we'll want to ask ourselves a few important questions. I think. One is, are we staying true to our own values and our culture here at WellSpan? And are we taking steps that move us toward that value based future, highest quality, best patient experience at an affordable cost? So, Nick, what other questions do you think we should be asking?

Dr. Korgaonkar: Yeah, I think the ones you identified are absolutely important, they speak to our values and goals. I would add a couple. First, I would ask what we need to do to create a culture of cooperation with them. As we have moved through this discussion, in this process, they've seen that some of our colleagues are understandably what I like to call Hopkins hesitant. And it's not unlike being vaccine hesitant, you know and understand on some level that it's the right thing to do, but you're just not quite sure what you're getting yourself into. And I think we need to ask what we need to do to everyone on this bus. The second question is really a lot more mundane.

We need to ask whether the right systems are in place to make it easy to do the right thing. And I'm talking about a clear and robust system for making and tracking referrals, for sharing notes about patients and a way to make it easy for WellSpan and Hopkins physicians to reach their colleagues at the other institution.

Host: Yeah, that's a really good point Nick. Both of those are super important. And we want this to appear seamless to our patients. So, really insightful comments. And I know our listeners are going to value hearing your perspectives on the partnership as one of our physician leaders.

So, thanks for joining me in this discussion. That's all the time we have for today. We hope you'll join us for the next episode of Inspiring Health.