William R. Brody was well into his tenure as president of The Johns Hopkins University (1996–2009) when David Hellmann approached him in the mid 2000s with a growing concern – and an idea for addressing it.
A physician widely admired for his patient-centered approach to providing care, Hellmann was worried by the path that medicine was taking. He proposed an initiative that would promote medicine as a public trust – one that would “be compelling and make a positive difference in the lives of patients and physicians,” Brody recalls.
But how best to make it a reality, Hellmann wondered?
“I encouraged him to think big,” says Brody, who served for seven years as the Martin Donner Professor and director of the Department of Radiology at Johns Hopkins before assuming the university presidency. “I remember saying, ‘You have so many grateful patients who appreciate the time you spend listening to their stories and providing exceptional care. I’m sure you will be able to attract a lot of support for this mission.’”
Hellmann took that advice, and he did “think big.” In 2005, the Center for Innovative Medicine was born at Johns Hopkins Bayview Medical Center, with Hellmann as director.
“When David started the Center for Innovative Medicine, I don’t think he could have known just how much the world of medicine would wind up needing it,” says Brody, who left Johns Hopkins in 2009 to assume the presidency of the Salk Institute for Biological Studies, a leading scientific research institute in La Jolla, California. During his six-year tenure there, Brody led the institute’s first fundraising campaign, the highly successful $300 million Campaign for Salk, which put the institute on solid footing and enabled the recruitment of a number of highly sought-after faculty members.
During his time at the Salk Institute, and in the years since, Brody says it’s been “fun to watch” the Center for Innovative Medicine serve as an incubator for so many patient-centered initiatives, including the Miller Coulson Academy for Clinical Excellence, the Aliki Initiative, the online learning community CLOSLER and much more.
Though officially retired, Brody has maintained a very active presence in the worlds of higher education and medicine. He currently serves on the boards of Stanford Health Care and the W.M. Keck Foundation in Los Angeles, a charitable foundation that supports scientific, engineering and medical research. After so many years spent serving as chief fundraiser, first for Johns Hopkins and then Salk, he says, chuckling, “It’s great to be on the side of giving money away.”
A talented pianist (he performed “Rhapsody in Blue” with the San Diego Symphony for a Salk Institute fundraiser), Brody also serves now as a trustee of the Curtis Institute of Music in Philadelphia. “I wanted to get involved in something I was passionate about that wasn’t health care related,” he says, “and the experience has been just amazing.”
“What David created with the Center for Innovative Medicine is actually much more relevant today than when it launched.
He and others at CIM are working tirelessly to bring the ‘care’ back to health care.”
After years of living on the West Coast, Brody recently remarried and relocated back to Baltimore to be closer to the extended family of his wife, Hyunah Yu. The couple now makes their home just a few blocks away from the Homewood campus.
From that vantage point, it’s easy for him to stay tuned in to the Center for Innovative Medicine’s ever-widening impact. “What David created with the Center for Innovative Medicine is actually much more relevant today than when it launched,” says Brody. “He and others at CIM are working tirelessly to bring the ‘care’ back to health care.”
Don Willett November 9th, 2019
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When radiologist Pamela Johnson first began leading the charge to advance “high-value” medical care, the concept was barely on the radar of many clinicians. Today, some four years later, she finds herself as a national leader on this issue as hospitals and health care systems have embraced the movement with urgency.
“It’s been an exciting ride,” says Johnson, who is co-chair of the Johns Hopkins Health System High Value Care Committee, and was recently named a Center for Innovative Medicine (CIM) Stanley Levenson Scholar.
So what exactly is high-value care? Within the world of health care, value is defined as the ratio of quality over price, just as with any consumer product. If, for example, you can get a great car for a cheap price, you have a high-value car. The U.S. health care system has been critiqued for its low value. Though Americans spend twice as much on health care as some other advanced countries, the resulting quality (i.e., health outcomes) is not better – and sometimes is worse.
And it is patients who are paying the price, says Johnson. As she points out in a recent paper published in Academic Medicine, medical debt is the leading contributor to U.S. personal bankruptcy, and patients are choosing to avoid necessary care because of its cost. “[This] is a call to action for the profession to transition to a high-value model – one that delivers the highest health care quality and safety at the lowest personal and financial cost to patients,” wrote Johnson.
In 2016, Johnson and Vice Dean for Education Roy Ziegelstein recognized the need to escalate the work nationally and believed that collaboration across medical centers could deliver large-scale improvements in value. With the assistance of Dean/CEO Paul Rothman, they established the High Value Practice Academic Alliance, an organization that now includes 100 academic partner institutions. In November, the alliance hosted its third national conference here in Baltimore, sponsored by the Johns Hopkins University School of Medicine.
Johnson points out that a leading cause of low-value care is unnecessary medical testing, including blood-work, MRI scans and CT scans. From the beginning of her work in this area, she has championed the importance of engaging medical students and residents in the research and performance improvement necessary to ensure that potentially unnecessary tests can be safely reduced in practice. Toward that end, in 2015, she joined forces with Susan Peterson to create and co-direct the High Value Practice Alliance at Johns Hopkins.
Residency program directors from multiple specialties joined the committee to tackle problems that are largely multidisciplinary. “I’m a radiologist, but if I observe areas where patients are not benefiting from imaging and want to reduce utilization, I can’t do it myself,” says Johnson. “It has to be a team effort.”
The work quickly advanced beyond the graduate medical education arena, she says, owing to the creation of the Johns Hopkins Health System High-Value Care Committee by Redonda Miller and Renee Demski in 2016, followed in 2018 by the appointment of a high-value faculty lead in each department at The Johns Hopkins Hospital. Johnson has subsequently observed systemwide growth of these types of initiatives.
“[This] is a call to action for the profession to transition to a high-value model – one that delivers the highest health care quality and safety at the lowest personal and financial cost to patients.”
She points to Agile MD as one example of an important tool that started as the brainchild of Johns Hopkins Hospital Emergency Department providers and will soon be improving care across the Johns Hopkins Health System. An evidence-based decision support tool, Agile MD works within the Epic electronic medical record system to place relevant best-practice guidance and information within easy reach of clinicians as they make decisions about testing and treatment. The content is created by Johns Hopkins physicians, advanced practice providers, nurses, pharmacists and residents, who synthesize the literature with their own clinical experience.
“We want clinicians to make decisions according to the evidence in a way that is at the same time tailored to the patient and their clinical acumen,” says Johnson. “We don’t want to completely standardize care, but we do want to reduce variability that does not improve outcomes, especially when it involves overuse or underuse of tests and treatments.”
Johnson’s tireless leadership in high-value care aligns beautifully with the mission of the Center for Innovative Medicine, says Hellmann. “An important part of pursuing medicine as a public trust involves being good stewards of society’s resources,” he says. “The CIM is very proud of Dr. Pam Johnson’s efforts to get all of us higher quality for less cost.”
For her part, Johnson says, “Being named the CIM Levenson Scholar is the greatest honor of my medical career.” The funding, she says, “will enable me to escalate our effectiveness and deliver measurable improvements in health care quality and affordability at Johns Hopkins and across the country. Of equal importance, by demonstrating accountability for the improvements that we need to make within health systems, we will safeguard patients’ trust in physicians and medical institutions.”
Don Willett November 9th, 2019
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A onetime federal prosecutor in the U.S. Attorney’s Office for the District of Maryland, Charlie Scheeler went on to a highly successful 37-year career as a defense attorney with DLA Piper. Now a retired partner with the law firm, Scheeler remains very active in the community, serving as chair of the board of Rosedale Federal Savings & Loan Association, and on the boards of The Johns Hopkins University and Johns Hopkins Medicine. In those roles, and as chair of the board of Johns Hopkins Bayview Medical Center, Scheeler has come to know well the work of David Hellmann and the Center for Innovative Medicine (CIM), and to champion CIM’s efforts to promote healthy aging. In the conversation that follows, Scheeler tells why Johns Hopkins is “the perfect fit” for an Institute for a Long and Healthy Life.
Q. Your ties to the Baltimore community and to Johns Hopkins run deep, don’t they?
A. Yes. I’m fairly certain my dad, Charles Scheeler, was born at what today is Johns Hopkins Bayview Medical Center. His family moved from Butchers Hill to Rosedale after the 1904 Baltimore fire. My dad’s grandfather formed the Rosedale Permanent Building and Loan Association with $71 in assets in 1908 to pool their money and help others buy homes. My dad followed his own father at what became Rosedale Federal Savings & Loan Association. He sat on its board for 64 years and spent 26 years as chair. When he joined the board in 1952, Rosedale had about $3.8 million in assets. When he stepped down, it had $800 million.
“As native Baltimoreans, we saw firsthand how incredibly important Johns Hopkins is to the greater Baltimore community.”
My own ties to Johns Hopkins go back more than 20 years, when our youngest daughter, who was 4 at the time, was struggling with obsessive-compulsive disorder. My wife, Mary Ellen, and I came to Johns Hopkins to search for solutions for Cecelia. Once we found those solutions, we stayed closely connected with Johns Hopkins and got involved as volunteers. As native Baltimoreans, we saw firsthand how incredibly important Johns Hopkins is to the greater Baltimore community.
Q. In remarks you made in August at CIM’s annual retreat, you talked about the need for the U.S. to confront the health issues of our rapidly graying population. Why is that so critical?
A. Taking action is vitally important, not just to address the physical health of our country’s seniors but also to address the financial health of our nation. As a country, we are currently spending more than$3 trillion on health care, and $1 trillion of that is dedicated to providing health care for those over age 65. And our nation is only getting older. By 2020, for example, one-quarter of residents in Baltimore County will be over 65. Each year, we are seeing a climbing curve in health care costs for the aged as a percentage of the gross domestic product. We must figure out a way to care for our elderly population in a less expensive manner.
Fortunately, that lines up with what elderly people want. By providing an entire ecosystem that allows for more independence in our later years, for healthier and more enriched lives, we can also save money on health care. The goals are completely congruent.
As a society, we need to pursue this. We owe it to our parents to provide as dignified an old age as possible. Economically, it’s imperative that we address this so we don’t starve our children of future resources.
“We owe it to our parents to provide as dignified an old age as possible. Economically, it’s imperative that we address this so we don’t starve our children of future resources.”
Q. That brings us to plans within the Center for Innovative Medicine to establish an Institute for a Long and Healthy Life…
A. Yes! So, if we agree that we need to take action, then the question becomes, where? And to that, I respond: What better place to establish a national institute on healthy aging than at Johns Hopkins –a place that consistently ranks No. 1 in geriatrics, a place that has such strong programs in psychiatry, neurology, rheumatology. The Johns Hopkins Hospital and Johns Hopkins Bayview have long housed centers of excellence for all of the specialties that collectively support healthy aging. We’re a perfect fit.
“What better place to establish a national institute on healthy aging than at Johns Hopkins – a place that consistently ranks No. 1 in geriatrics, a place that has such strong programs in psychiatry, neurology, rheumatology.”
I think that creating an Institute for a Long and Healthy Life here could be a real game changer. Here in Baltimore, we can develop and road-test models for innovative programs – entirely new ways for individuals and for groups of people to have healthier and more productive later lives – and then export these models to the rest of the world, which matches perfectly with Johns Hopkins’ mission. Every day that I get older, the more excited I become about the prospect for this institute!
Don Willett November 9th, 2019
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