Cedars-Sinai is a nonprofit academic health system based in Los Angeles, providing specialty care, research, education and community-focused health services. Its main medical center is among the largest nonprofit academic medical centers in the U.S., with 886 licensed beds and more than 2,100 physicians.
You have led major academic medical centers on both coasts. What feels most different about the job today?
The pressures on major academic medical centers have intensified considerably. The challenge is no longer only to deliver excellent care, research and education, but to maintain financial stability as revenue growth slows and costs continue to rise.
At the same time, institutions like Mass General and Cedars-Sinai were created to address society’s biggest health care problems. One of the biggest is the rising cost of health care. As nonprofit organizations created to serve the community, we have a responsibility to find creative and innovative ways to bend the cost curve.
Academic medical centers have always been expected to advance medicine. What feels different about that mandate now?
Pushing ahead the biologic frontiers of medicine has always been a mandate for places like Mass General and Cedars-Sinai. But there is some wobble in Washington, D.C., around enthusiasm for supporting biomedical research, and we need to steady that wobble. The United States has enjoyed a leadership position in biomedical research for decades, and it would be a shame to give that away.
The other change is that a whole new dimension of research has opened up with information technology. It is no longer only about biologic innovations improving health, but digital innovations as well. Institutions like ours have faculty members who want to build careers in that space, and we need to provide opportunities for them to do so.
Cedars-Sinai has opened its first flagship outpatient clinic outside the U.S., in London. Why was London the right place to start?
Cedars-Sinai is interested in having an international profile, and that requires a presence in other parts of the world. Our staff enjoys caring for an international group of patients. It makes their work more interesting and robust. We have relationships with providers and communities around the world, and administrative offices in Mexico City, Singapore and London.
London seemed like a great place for our first clinical presence outside the United States and California. Many people spend time in both Los Angeles and London, so having Cedars-Sinai at both ends of their life is convenient. Continuity across systems is a challenge, but our strategy is always to work in partnership with local health care organizations. We do not come into a country and take on the local medical establishment. In London, we have a wonderful relationship with Guy’s and St Thomas’, and work hand in glove with them to strengthen what is already there.
Where does virtual care work best, and where does AI begin to change the clinical workflow?
Virtual care is something I have been interested in for a while. Until recently, I was on the board of Amwell and saw firsthand the impact this technology could have. In primary care, there is no doubt it can replace a lot of in-person visits. Its biggest impact has probably been in mental health care, where much of the care can be delivered virtually, including in places where there are no mental health resources available.
Almost all specialties can use it in some way, from dermatology through images to orthopedics. With AI, we are still at the early stages. Through CS Link and CS Connect, we have virtual platforms that help patients get the care they need, in some cases virtually or digitally. What is wonderful about digital health and AI is that, for the first time, we have information technology with the potential to make clinicians’ lives easier, not more difficult. We are rolling out ambient documentation for physicians, and something similar for inpatient nurses, so they can reduce documentation time and spend more time with patients.
How do you decide which areas of specialty care, research and innovation deserve the next major investment?
It is multifactorial. We want to address areas of clinical need: what the population needs and which problems are growing. Cancer care, for example, is going to be an increasing problem as our population ages, so we need the capacity and capabilities to be there. There are also areas where the scientific opportunities are so great that we want to participate in the scientific revolution and bring the latest treatments and diagnostic capabilities to patients. Cancer is almost unrecognizable from what it looked like 10 or 20 years ago.
We also have a long history of commercializing intellectual property, primarily in the biologic space. We have spun off companies and sold a company about two or three years ago. Digital health is newer for us, which is why we partnered with Redesign Health to look at areas where we could co-create companies that add value to health care and have commercial potential. Unless we move great ideas beyond the institution, they are never going to make it into the marketplace.
Los Angeles combines world-class specialty care with deep inequalities in access and outcomes. How does Cedars-Sinai understand its responsibility to the wider community?
Meeting the needs of the people of Los Angeles is our top priority. That is why Cedars-Sinai was created almost 125 years ago. Given our expertise in specialty care, we also attract people from other parts of California, the United States and the world, but that is a relatively small part of what we do every day.
We work with community agencies and government to improve the health of this very large, complicated and wonderful community. Some specialty care, transplantation for example, is extremely expensive; primary and secondary care are less so. But Cedars-Sinai was created to care for everyone, regardless of ability to pay, religion, race, sexual orientation or immigration status. There is a strong philosophy that our doors are open to everyone, and we try to live up to that every day.
When you look across health care today, what still feels harder for patients and clinicians to navigate than it should be?
Our health care system in this country is incredibly complicated, and too many people get caught up in the complexity and frustrated by it. We need to work collectively to make health care and accessing it much more effortless. The insurance system is so complicated: what your insurance covers, where it covers it, what your deductibles are and what you are going to be financially responsible for. As a consumer of health care for myself and my family, I have a hard time sorting it out.
The federal government through CMS has a lot of power, because many insurers mirror what Medicare is doing. The insurance industry itself is extremely powerful, and sometimes I think business interests override the interest in making care better for patients. There are many amazing aspects of U.S. health care; the technological expertise in American medicine probably surpasses anything in the world. But the system itself is too complicated. We have great doctors and great technology, but a very broken system.
