Robert Garrett, the CEO of Hackensack Meridian Health, has become a fixture at the World Economic Forum meetings in Davos, Switzerland. And he returned this year, leading and participating in discussions about different financing models for health care involving both public and private sources.

Before leaving for Davos, Garrett sat down with NJBIZ to talk about his work with the WEF, how technology is helping to improve health care outcomes and what’s going on at HMH. The latter subject involves a good deal of expansion and improvements.

“We’re seeing tremendous growth,” Garrett said. “We’re going to be investing $1.3 billion dollars into Jersey Shore [University Medical Center] for a new critical care tower, new private rooms, new operating rooms. And then at JFK University Medical Center in Edison we’re investing a lot in some of those same areas, critical care operating rooms, new emergency department, a new ambulatory cancer center that’s actually going to be opening this year. In total, over the next several years, we’re going to be investing $600 million dollars in JFK University Medical Center.”

What follows is an abridged version of that discussion. The questions and answers have been edited for length and clarity. A video of the full interview is available at NJBIZ.com/njbizconversations.

NJBIZ: I wanted to start with your annual trip to Davos, which I understand is coming up fairly soon. In years past we’ve talked a lot about artificial intelligence that’s been a big focus. Are you going to be working on the same issue this year?

Robert Garrett: This is the second year that I have the privilege of chairing the health care community at Davos, at the World Economic Forum. And you’re correct. Last year’s focus was on artificial intelligence and specifically how it can improve some of the global health care challenges, like quality, better access to care, better access to prevention and also how it potentially could help us with workforce shortages. So, we’re going to pick up on that a little bit. We’re going to talk a little bit about AI again and see the progress that we made since last year, assess that a little bit.

But we’re also going to pivot to a topic that’s related, but a little bit different. We’re going to talk about financing of health care systems from around the globe and making sure that we talk about what’s stable in order to support better access to care and better quality of care. So, you know, AI might be one thing that these financing systems invest in. But there are other technologies. There’s other means. So, we’re going to explore financing models, such as all payer systems, to fully private, privately funded health care, to maybe hybrid models. By the way – the best practice out there around the globe in terms of who’s getting the best health care outcome results are those countries that really collaborate meaning the private and public sector collaborate in terms of financing.

So, we’re going to focus a lot on the financing models and how that can impact some of those global goals I spoke about.

Q: How would a hybrid model work, I mean, obviously public and private, meaning government funding. And then what else? Are insurers involved?

A: Insurance funding, private funding, employer funding. You could even call the U.S. system a hybrid model. But I know some of the best practices out there, at least in the western world, are in Germany, in Switzerland, and places like that where there is truly a collaborative partnership between governmental funding and private funding.

So, we’re going to take a look at some of those best practices. We’re going to have the health ministers from some of those countries in Europe be there as well as in Asia and Africa.

We’re going to talk a little bit about the U.S. experience — what has worked from the financing perspective, what has not worked? And then we’re going to pivot at the end of the … session. With the new administration coming in in Washington, how can we, as a health care community, engage in these policy discussions as a new administration takes hold.

What are the health care priorities? How should we weigh in on those priorities? So, we’re going to talk a little bit about that — more of a strategic perspective of what our role should be, particularly in Washington with the new administration.

Now, obviously, there’s some new governments coming in Europe and in other places as well. So, it won’t just be about the U.S.

Q: I do want to get into that a little bit later, but I want to ask a little bit more about this question, because what occurred to me, that what you said, sounds a lot like the system we have in the United States, which I don’t think is terribly popular around the rest of the world. I’m curious whether you have a sense that there’s an openness to that kind of thing in other countries where arguably they get better outcomes at less cost?

 A: I think, where they get better outcomes at less cost, as an example in some of the European countries, is because there’s a focus on prevention. There’s a focus on primary care and preventing chronic disease. I think, in the U.S., although it is a private/public partnership, if you will, in terms of the funding of health care, the priorities may not have been the same as in Europe, and even in some Asian countries. So I think that’s really where the differences are. And we’re going to talk about that because we don’t want to just create a private-public partnership. If the dollars that are spent are not being effectively used to really improve health status and health care outcomes.

Q: OK. Now, getting back to AI – you did say that was going to be part of the discussion. What’s new this year? What are you thinking about? What are you working on in that area?

A: Well, from a global perspective, we have another year of experience with some of the AI algorithms, some of the pilots that have gone on in health systems, as an example. Not just in the U.S., but around the globe. So we’re, I think, homing in on which areas have the biggest potential. And I think it probably boils down to on the clinical side. I think predictive analytics can be very, very helpful for clinicians to identify disease states earlier on, and then therefore hopefully prevent the worst that that disease could bring on, and maybe even prevent it entirely.

Certainly, those predictive analytics tools that AI holds promise for certainly something that I think we have more experience, I think, more certainly more focus in those areas.

On the workforce front, I think we found over the last year that there’s a lot of potential for AI and AI-assisted technologies to really help us augment the workforce, whether that’s through remote access, as an example; virtual programs like virtual nursing that could be powered through AI; or making or enabling the health care workers that are on the front lines more apt to do direct, patient care. In these times, where there are workforce shortages, using AI, as an example, to help doctors summarize their notes to help nurses with discharge summaries and admissions processes which are very, very time consuming. So, when you’re short staffed, you want the workforce that you have to focus as much attention as they can directly on patients. We’re finding that that’s a big area for AI focus. So, I think there have been some good lessons learned over the last year, I think.

Last year was a little more of a broad spectrum. We threw everything out there, and I would say the two most promising areas, in my view, are the AI applications that will help us with the workforce and, by the way, by doing so, we’ll also help on the affordability issue. Reducing health care costs. And the the second piece, of course, is really on the clinical side and on the predictive analytics side.

Q: What I’m hearing, what I’m seeing anecdotally, is a lot of the early resistance to AI is really breaking down. There’s a lot more openness to it. I’m wondering if you’re hearing the same thing in your work, particularly with folks around the world and at the World Economic Forum?

A: Definitely a lot of that resistance is breaking down. I think there’s still concerns about governance and making sure that data is accurate, that patient privacy is protected through these processes. But I think, it’s becoming more well known, more accepted.

We have as an example at Hackensack Meridian a real significant interest from our clinicians, from our doctors, our nurses who want to see more AI pilots develop to really assist them in their day-to-day functions.

Definitely a lot of that resistance [to AI] is breaking down. I think there’s still concerns about governance and making sure that data is accurate, that patient privacy is protected through these processes. But I think, it’s becoming more well known, more accepted.
– Robert Garrett, CEO, Hackensack Meridian Health

And we’re seeing more acceptance with patients, too. As long as patients are educated and families are educated that it doesn’t mean that a human is still not going to make your final diagnosis or sign off on treatment plans and develop treatment plans — which they are. As long as it’s explained that way; that this is like another pair of eyes for a radiologist to view a scan and maybe identify a breast cancer earlier on. I think patients, when they understand it in that context, are much more supportive.

So there is definitely much more support from a variety of constituents for AI to move forward. At HMH, we’re definitely embracing the technology in a big way. And we beefed up our team that has AI capabilities, AI expertise. We have a broader group of folks who are prioritizing AI pilots. That’s happening not just at HMH, but that’s happening really in health systems all over the U.S. and around the globe.

Q: And the human involvement, from what I hear, is what really helps to get people comfortable with this idea — that it’s not just going to be a machine that’s actually making decisions. There are going to be human beings behind it. In your discussions, is that part of what you’re hearing from the folks you’re talking with at the World Economic Forum and elsewhere around the world?

A: I think it’s an important component. I mean, having the human component involved every step along the way, and actually overseeing it, particularly in health care, is really important for folks. That just gives it gives a lot more credibility. And from a safety perspective, people are embracing a lot more with that understanding. It’s like the analogy of pilotless planes and cars that drive themselves. People still have some reluctance there. They want to make sure there’s still some human intervention in those activities. And certainly in health care and making health care decisions and diagnoses and treatment, it’s important that AI is used as a tool that helps and enhances human beings’ ability to do the right thing.

Q: So, given all of that, what do you hope will come out of the discussions in Davos on the financing model with the AI component?

A: It probably won’t be one model, per se. But I think what we will be able to do is endorse several models – maybe all under the umbrella of this hybrid, public/private type of partnership – and identify some best practices out there that maybe we can go to policymakers and they will be part of this discussion as well.

So we’ll have health ministers from different parts of the world there. But we would like to then have an action plan that would go out and say to policymakers, in order to improve access, in order to improve quality outcomes around the globe, we need more stable financing processes and systems. And here are our ideas for best practices.

Q: Now, you mentioned the new administration in Washington. I’m curious as to how receptive you think those folks are going to be to these sorts of things. Are you concerned at all about the direction that he seems to be taking, or are you just going to wait and see what happens?

A: Well, I certainly want to give the new administration a benefit of the doubt. … We want to see exactly what’s going to happen … or what direction they’re going in. And like any new administration, there are things that you worry about, and there are things that you’re encouraged about.

So, as an example, putting the personalities aside, in terms of policy, if one of the priorities is going to be to attack chronic disease in the U.S., that’s a good thing. I think our rate of chronic disease compared to other Western democracies is a lot worse. And maybe it’s because we haven’t put our attention on prevention and primary care. So, if that’s going to be the focus, really attacking the drug issues and the food issues and the exercise issues, I think that’s a good thing. That’s certainly part of our mission at HMH — to transform health care. We can’t do that without really attacking chronic disease.

But where I get concerned is if we are going to put policies in effect, or even in attacking chronic disease that are not science-based and are not based on good scientific principles and good data, that’s where I would get concerned. Because then we could be making some decisions that are going to be counterintuitive.

And I do worry about vaccinations, about things of that nature, because, we’re – and especially being on the world stage at Davos –  you hear in some countries that don’t have ready access to basic vaccinations there are epidemics, particularly with children that can be prevented. So, we want to make sure that decision-making in any administration— in this administration in particular, is based on good science and good data. That’s really where my concerns are.

But if the focus is going to be on improving health status in the U.S. by reducing or eliminating some of the chronic diseases that we have out there, that I would encourage. I think that’s a positive development.