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A Few Questions with Daryl Tol

PL JETER

The worldview held by Daryl Tol began in the small town of Dunlap, Tennessee, and by kindergarten age, he had spent most of his life halfway around the world in Borneo, Indonesia surrounded by role models who approached life with a servant's heart.

By the time he reached school age, his missionary parents Bill, a pastor and mother Darla had returned the family to the United States to live in the picturesque Northern California coastline city of Eureka where he began to witness a life of caring for others.

"(Mom) was a home health nurse for years and would become very close to her patients," he recalled. "I remember visiting many of them as she would develop a personal connection with each. I appreciated the emphasis my parents put on meaningful work versus work for a paycheck. Both worked hard, but had very satisfying careers that made a difference to the people they worked with. I remember my folks routinely sending me on my way each day with the reminder to 'make it a good day,' rather than the more passive 'have a good day.' That important difference has stuck with me."

Tol earned a business administration degree with a focus in accounting and finance from Walla Walla University in College Place, Wash., where he was elected president of the American College of Healthcare Executives (ACHE) chapter. He then earned a master's degree in healthcare administration from Loma Linda University in Loma Linda, Calif.

After leaving the California coast, Tol headed to Portland, Ore., where he began his healthcare administrator service at Portland Adventist Medical Center in 1998. In 2000, he began serving in progressive leadership positions with Florida Hospital Memorial Systems, Florida Hospital Flagler, Florida Hospital DeLand and ultimately Florida Hospital System's Central Florida Region, which includes eight Florida Hospital campuses in metro-Orlando, and Florida Hospital Waterman in Lake County.

With more than 2,600 beds, Florida Hospital admits more patients annually than any other hospital in the United States, and is the largest provider of Medicare services in the country.

As president and CEO of the Central Florida Region, Tol oversees more than 19,500 employees.

Tol was kind enough to take a few minutes to address with Orlando Medical News some of the issues he faces as leader of one of the country's major healthcare systems.

The State Legislature is considering a controversial issue for hospitals specifically related to CON repeal. How do you see the debate shaping future care delivery in the State of Florida?

With a CON requirement in place, those proposing new hospitals generally have to place a hospital in a community where there is need, and they must commit to caring for all individuals in those communities, regardless of ability to pay. In the absence of CON, markets start to see high-income areas become overbuilt and low-income areas underserved. Niche hospitals are built to provide services only to segments of the population who can pay, rather than to all residents of a community. We know that there are many interests that would like to see CON go away for business reasons. And if it does go away eventually, we will be ready to compete in that environment. But we should not assume this will serve the public interest.

It's also important to note that the chief argument for removing the CON - that it will increase competition, thus lowering costs - has not been borne out in other states that have done away with CON requirements.

There has been a significant amount of consolidation in health care over the past decade but it seems to have waned a little bit most recently, how do you see physician practice acquisition by health systems and health plans evolving over the coming year?

The health care system we know today has been designed around providers, not patients. Health care must become more connected. That lack of connection is a driver of much dysfunction in the system. But connection doesn't require acquisition of practices by health systems. Hospitals and physicians can come together in well-designed networks to provide well-coordinated, well-connected care even though members of the network are independent of one another. We feel this model has great promise, and we have partnered with more than 1,800 physicians to form Florida Hospital Physician Network, a Clinically Integrated Network, as a result. We also have a large, multispecialty group called Florida Hospital Medical Group that is becoming a pre-eminent medical group for those physicians who prefer to practice in that setting.

In the discussion of stand-alone clinics being significantly cheaper than hospital facilities, what's the strategic plan for FH moving forward?

Affordability and access are important. Many of our services today are too expensive. Too confusing. Too disjointed. We are working hard to create care options close to where our community lives, works and plays. Those care options must be affordable and we don't expect our health system will own them all. We are working to create a network of connected options that meet access, affordability, connectivity and excellence requirements. Places members of our community can rely on. Places that don't require significant self-navigation, that don't leave yawning gaps between settings of care. Some of the greatest shortages of care in Central Florida are at the foundational level - adequate primary care and low-cost ambulatory care settings. We want to be part of changing this story side by side with a connected medical community.

What are the short-range plans for improvements/changes over the next 5 years and what about long range plans?

We are serious about affordable, connected and exceptional care. This means planning health care access carefully, placing locations within 10 minutes of 90 percent of our population. It means considering health care needs of communities more broadly than acute care, designing for a lifetime of hand-in-hand relationships with consumers. It means knowing our consumers, making it easy, holding hands and providing great care every time. It means leveraging technology for instant access and communication. It means doing all of this side by side with physician leaders who want to build health care centered around the consumer.

In the next five years we will open two new hospitals, several new free-standing Emergency Rooms, numerous Health Parks and Ambulatory Care locations. We will invest heavily in care management and connecting technology that allow us to stay very close to those with high risk and chronic conditions as well as being a source of information and helpful connectivity to those who are healthy. We will eliminate the idea of discharging patients from our vocabulary. We will build and strengthen our physician-led Clinically Integrated Network and work hard to connect providers as seamlessly as possible in the interest of the consumer. We will design our care to address the whole person: emotional, physical and spiritual, recognizing that this creates total health. We will address total cost of care and work to improve affordability across the spectrum. We are enthusiastic about being part of the transformation of healthcare and being deeply part of the legacy of healthcare in Central Florida.

With payment reform ideas being at the forefront for CMS in Washington, what challenges has Florida Hospital seen in regards to implementation of new programs such as bundled payments and Accountable Care Organizations. How is your institution responding to these challenges?

Health care is a team sport. Seamless connectivity is required to provide the best care for patients every time. This is why we spend so much time focused on building an exceptional Clinically Integrated Network with leading physicians. Success will start with a strong primary care leadership team. Physicians who have a vision for what can be in healthcare and an energy to build it. An early challenge centers around technologic connectivity. There are over 140 Electronic Medical Records in use just across the Central Florida Community. Sharing information and designing for simplicity is difficult in this kind of scattered technologic landscape. There is no silver bullet...yet. Perhaps it is time for a healthcare "X-prize!" Fortunately, there is much we can do with the technology we do have: smart clinicians, ample data, compassion and excellent communication are already driving us forward. We have also invested heavily in a Population Health Services Organization that is providing tools and people on the ground to improve care across a lifetime.



 
 
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