What will Intermountain Healthcare look like in 25 to 30 years? That’s what Brenden O’Neal from the Compliance team at Intermountain Medical Center asked Dr. Marc Harrison. Brenden also asked:

  • Will our vision of what Intermountain is and what we do change in the future?
  • How will the way we operate hospitals change?
  • Has there been any thought to expanding into new markets or neighboring states?

Dr. Marc Harrison: Good morning. Today, I'm with Brendan O'Neill from the compliance team at Intermountain Medical Center. Brenden, what's on your mind today?

Brenden O'Neal: So, I've been with Intermountain about three years now, and I love Intermountain. I would be very happy if I got to spend my entire career here.

That being said, I'll often think about the big picture for Intermountain. If I'm going to be here in 25 to 30 years, what is Intermountain going to look like then? So, I suppose that's my question for you today. Big picture, where do you see Intermountain in the future?

Dr. Marc Harrison: That's a great question, Brenden. I'll be honest. I don't know exactly because things are changing so fast, but, first of all, I hope you are here in 25 years. In 25 years, I hope to be sitting on a beach somewhere.

Actually, I hope to still be around in 25 years. Things are changing really quickly. There are a couple things that aren't going to change.

So, first of all, the commitment to our communities. That's rock solid. I think our charitable mission, dear to my heart, dear to the origins of Intermountain, I don't think that that's going to change, either.

The question is how do we still help people live the healthiest lives possible. How do we function as a model system? The question really becomes what is a model system look like, right, and how much happens in the hospital, how much happens in the out-patient arena, how much happens in the home, how much happens face-to-face, how much happens through our phones or through a telehealth kind of approach. I still think that is really quite up in the air.

On the way into work this morning, I was listening to the radio. Uber is saying that they believe there will be flying Ubers within five years in a couple of markets, and this doesn't sound like a pipe dream to me. If you had told me that five years ago, I would have said, "Who's Uber?" That's how fast, I think, industries are transforming right now.

So, what I can tell you is that the focus on health and keeping people well will be really different five years and ten years from now. I believe that precision approaches, so that we can understand what Brenden needs versus what Mark needs in terms of keeping the two of us healthy, I think is going to be much more well defined.

So, just the other day, we've actually begun to expand ... There's a nice article that talks about how we're expanding our pharmacogenomics approach. We have this very large panel, now, of drugs that we can each get evaluated for to see how our particular genotype affects how different drugs are metabolized. Five years ago, who would have thought that was in day-to-day use, right?

So, I think much more oriented towards keeping people well, much more oriented towards affordability than we are right now, much more digitally enabled, much more power to the person. In this case, the consumer/member/patient, et cetera, and then I can't imagine that more will done in hospitals. I suspect much less will be, but those hospitals will remain incredibly important because people are still going to, unfortunately, get cancer or have a heart attack or get hit by a car or fall off a cliff or something like that where we're still going to need to take great care of those people.

Brenden O'Neal: So, that being said, what do you think some of the changes might be for hospitals, then, as they become less of a focus?

Dr. Marc Harrison: Actually, I think I don't want to say less of a focus because I actually don't believe that. I think it's a different focus. I think they become places for extraordinarily ill people. I think they become more and more high-end operating rooms and ICUs for things that can only be done in hospitals, and I think the majority of surgeries will be done in much less restrictive environments and people will rarely come into hospitals unless they're really quite ill, and a lot of stuff will be able to be taken care of at home, which is great.

Brenden O'Neal: Yeah, and I think we see some of that in the total knee replacements shifting to more of an out-patient procedure, yeah.

Dr. Marc Harrison: We do. When I got here, I toured TOSH and I said, "What percentage of our drug replacements are being done as out- patients?" The answer was zero, right, and I'm just thrilled by how quickly Intermountain is getting on board with this approach, and I think we're really going to be leaders at it.

Brenden O'Neal: So, you kind of touched on it already, but as we move into the future, will our notion of what Intermountain is and what Intermountain does change as we move forward?

Dr. Marc Harrison: I think maybe operationally, it will, but I think if we define that helping people live the healthiest lives possible as keeping them healthy as opposed to doing sick care for them, I don't think really, right?

Brenden O'Neal: Yeah.

Dr. Marc Harrison: So, I think that's the thing that really needs to change, and, by the way, Intermountain is way ahead of this than virtually any other system in the US. I think Kaiser maybe is better at this a little bit, but they don't also have some of the other great capabilities that we have, and their model is constrained, but I think that's something that we are really well oriented towards already and I think that's a continuing evolution, and a lot of that is really thanks to where we've come from.

I mean, the work that Dr. Sorenson did, and how Greg Poulsen has positioned us strategically. Our board governance has supported us in taking this orientation. I think we're in a great spot, but, no, I think it's really going to be ... The only notion is, in some ways, we almost look at it as a failure when somebody gets admitted to the hospital, right?

Brenden O'Neal: Yeah.

Dr. Marc Harrison: Something didn't work right. Maybe we didn't take care of their chronic disease well enough, or maybe we should have educated them better about how to wear their seat belts. Maybe we failed them by not providing them with great food to eat and a great exercise plan. Changing our thinking in that way will be a little bit of stretch, but I think we're on that path. At least, it feels like it to me.

Brenden O'Neal: Yeah. Since we do things so well, has there been any thought given to maybe expanding into new markets or other neighboring states?

Dr. Marc Harrison: Sure. The answer is yes, but I think mostly what I'm calling an asset-lite approach ... As we see the de-emphasis of hospitals except for the really sick over time, I think it's going to be important to be really thoughtful about the bricks and mortar that we have, and invest in distance solutions and physician groups who are good at managing populations, but, absolutely, and this isn't about building an empire.

It's about if we have real competence in keeping people well and managing populations and doing good in those communities, shouldn't we share that if we can? Because I think that's a very Intermountain way of thinking about it, and then the other is it would be great to have those populations to help support our beautiful physical infrastructure that we have because it's going to take more patients to support that infrastructure going forward if more stuff is getting done on an out-patient basis than we currently have. Does that make sense to you, Brenden?

Brenden O'Neal: Yeah, it does.

Dr. Marc Harrison: So, can I ask you a quick question?

Brenden O'Neal: Yeah.

Dr. Marc Harrison: How does this make you feel? Does it make you feel scared? Does it make you feel optimistic? I mean, because things will change just like so many other industries have, but our values really stay the same. So, how does that make you feel?

Brenden O'Neal: It makes me feel excited. I think that we both agreed, we do things pretty well.

Dr. Marc Harrison: Really well. We're a great system.

Brenden O'Neal: So, I think the more people that we can help, the better, and if that means maybe expanding into new areas or sharing our knowledge on how we do things in other ways, the better off more people will be.

Dr. Marc Harrison: What do you think you'll be doing in 25 years?

Brenden O'Neal: I have no idea, but I just hope to be here.

Dr. Marc Harrison: Yeah, me too. I hope you will be, too, and I think that we're going to be in really good shape. Do you have any other questions for me?

Brenden O'Neal: No, I don't. Thank you. This has been great.

Dr. Marc Harrison: Good. I really enjoy this and I hope you have a great summer.

Brenden O'Neal: Thanks. You too.

Dr. Marc Harrison: Yeah.