INK
SPRING 2015
A P U B L I C A T I O N O F T H E C O R E I N S T I T U T E
Looking Back
10 Years of Keeping Life in Motion速
One on One
The CORE Institute Founding Physicians
Then and Now
The Evolution of Quality Outcome Measures
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From the Chairman
10TH ANNIVERSARY 2015
Celebrating 10 Years of Success!
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en years ago, Dr. John A. Brown, Dr. Mark D. Campbell and I, believed that we could provide best-in-class orthopedic care to Phoenix area residents. Ten years later, it is rewarding to have been able to bring that dream to fruition with 150 care providers, 700 employees, and almost half a million patients in the practice.
In addition to the hard work of our amazing staff, our phenomenal growth has been built on a
platform of evidence-based medicine and meticulous outcomes tracking managed by our proprietary IT platform. It’s very gratifying to see our innovative approach to patient care being embraced by hundreds of thousands of patients, from all 50 states and multiple countries. The one thing that has remained the same is our commitment to a proven, evidence-based, outcomes driven, standardized patient care approach. I am proud of what we have accomplished. We’re truly honored that patients and the medical community have entrusted us to care for them at The CORE Institute over the last 10 years. The CORE Institute has expanded from its early years to offer care in Orthopedics, Spine, Pain Management, Neurology, Plastic Surgery and Physical Therapy. In addition to our innovative evidencebased medicine IT platform, we continue to be a leader in payor-reform initiatives and hospital alignment strategies. Unique within the industry, The CORE Institute has agreements to co-manage the orthopedic service lines at several major hospitals, including at five Banner Health facilities in Arizona, Green Valley Hospital South of Tucson, and St. John Providence Hospitals in Southfield and Novi Michigan. In 2013, we teamed with the Cleveland Clinic, OrthoCarolina and The Rothman Institute to form the first-of-its-kind clinically integrated Orthopedic PHO (Physician Hospital Organization), operating as the National Orthopaedic & Spine Alliance LLC (NOSA). This year, we were recognized as the #1 Orthopedic Group by Ranking Arizona for the third year in a row, one of the Best Places to Work by Phoenix Business Journal the fourth year in a row, and the 2014 recipient of the IMPACT Award by the Greater Phoenix Chamber of Commerce. Over the years, numerous physicians have also been recognized by Phoenix Magazine Top Docs issue, Hour Detroit’s Top Docs issue, and several other publications. These impressive accomplishments are due to the work of an extraordinary group of people. Of today’s 700 employees, many are celebrating their 10th year of employment at The CORE Institute and we share their story on page 18. We hope you enjoy this special edition of CORE Ink and join us in celebrating our milestone. The CORE Institute is already looking towards the next ten years, with clinics planned to open in other states, as well as overseas, in the near future. We’re early in our journey as a company and I’m very excited about our future as we expand our efforts to give patients the best-in-class care, one patient at a time, every time. Keep Life in Motion!®
David J. Jacofsky, MD Chairman & CEO
Contents
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I nnovation for the Future of Healthcare
The CORE Institute Celebrates 10 Years of Excellence
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he CORE Institute Pursues Its T Dedicated Research Mission Improving Patient Care Through Using Research
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Forging Partnerships, Creating Excellence The CORE Institute is committed to Michigan Expansion
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hen and Now: The Evolution T of Quality Outcome Measures Focus on Standardization Improves Efficiency and Patient Experience
16 The CORE Institute Specialty Hospital New Hospital Provides Unique Setting for Patients 18 ‘Our Best 10 Years’ Longtime Employees Find Pride, Professional Growth and Purpose at The CORE Institute 20 Woman Gets Life Back Thanks to The CORE Institute’s Chairman David J. Jacofsky, MD
on Track
SPECIAL FOLDOUT > O ne on One With The CORE Institute Founding Physicians Meet David J. Jacofsky, MD, Mark Campbell, MD, John Brown, MD > A
Look at Our History: How a Big Idea Just Kept Getting Bigger
Q &A with Jo Adkins, Chief Strategy Officer
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Pictorial Timeline: The CORE Institute Celebrates 10 Years of Life in Motion
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Innovation for the Future of Healthcare The CORE Institute Celebrates 10 Years of Excellence By Dolores Tropiano he CORE Institute is a true success story that began with a goal of helping a hurting healthcare system. This year, the Institute turns a proud page in that story, celebrating a decade of dedication to the nation’s medical community. In that brief span of time, The CORE Institute grew from one office to 26 facilities, from a staff of three employees to more than seven hundred and from being a relatively unknown entity to becoming recognized as the number one orthopedic group in 2013, 2014, and 2015 by Ranking Arizona and one of the premiere orthopedic destinations in the world. And it all began with one innovative idea for the future of healthcare in America. Prior to 2005, Dr. David J. Jacofsky, the chairman and CEO of The CORE Institute,
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Dr. David J. Jacofsky
was a division director for the Mayo Clinic in Rochester, Minn. Dr. Jacofsky developed a clear vision of where healthcare was heading. Armed with that vision and a few other adventurous physicians, the orthopedic surgeon decided to leave one of the country’s premiere medical organizations and head west with what would become a winning prescription — the use of proven, evidence-based, outcome-driven, standardized orthopedic care. RISKY BUSINESS “It was a pretty risky, entrepreneurial move,” said Marc Jacofsky, PhD, and Chief Scientific Officer of The CORE Institute’s research and development. “They left a respectable, safe career in a top-tier institute.” Dr. Jacofsky’s vision turned healthcare on its head. Instead of prioritizing a patient’s illness, his hope was to hone in on a person’s health. He and his elite team created evidence-based standardized practices of treatment. That
meant that the approach to a shoulder surgery in Sun City, Ariz., would be the exact same approach implemented in their Michigan clinics. Custom IT tools were created to track and manage outcome and risk and provide high value across the board. Jacofsky admits it was unorthodox business but today, The CORE Institute is a world leader in this innovative approach. Based on what the fellowshiptrained physician described as the “Holy Grail” of healthcare, Dr. Jacofsky fulfilled his vision of orthopedic excellence encompassing the entire spectrum of orthopedic sciences by limiting variation and variability in outcomes and providing consistent and predictable results. “We do things that are unique,” said Dr. David Jacofsky. “We are the only
www.thecoreinstitute.com
Talking Points
“We are the only organization in the country that manages the entire orthopedic-neurorehabilitation continuum and manages it through evidence-based patient care and IT platforms that manage
The ultimate way to predict the future is to define it. Leaders open doors to places never seen before
organization in the country that manages the entire orthopedic-neuro-rehabilitation continuum and manages it through evidence-based patient care and IT platforms that manage risks. It has not really been done before.” IN THE BEGINNING The CORE Institute started with just three doctors, Dr. David J. Jacofsky, Dr. John A. Brown and Dr. Mark D. Campbell, in a small office in Sun City West. The trio focused exclusively on orthopedics. “Our product was so welcomed by the market and patient demand was so high that we started adding physicians and grew by 12 physicians the first 18-24 months,” continued Dr. Jacofsky. The Institute was able to attract some of the country’s top talent and
now employs 150 care providers. The CORE Institute expanded from a focus on orthopedics to other areas including spine care, pain management, plastic surgery and physical therapy adding physicians, locations and support staff. In 2015, 15 neurologists joined The CORE Institute, making it the largest provider of integrated neuromuscular orthopedic care in the Southwest and enabling the organization to provide a continuum of integrated, comprehensive, musculoskeletal and neurological care. Along the way, The CORE Institute formed strategic partnerships with major hospitals including five Banner Health facilities in Arizona and entered the Michigan market in 2013 establishing affiliations with St. John Providence Hospitals.
risks. It has not really been done before.” — Dr. David Jacofsky, Chairman and CEO, The CORE Institute
EXPANDED CARE The CORE Institute now has clinics in both Arizona and Michigan and in ten years the number of patients has grown by an unprecedented 30 percent each year. The CORE Institute serves a half million patients in all 50 states and numerous countries in North America, Central America and Europe. They have even added a tail-less alligator to their treatment roster during the past decade. Plans are underway to expand into Tucson, other states and even overseas. “We were confident in our model. We have certainly grown faster than we would have anticipated but that was always our plan,” said Dr. Jacofsky.
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As the organization has grown, so has the quality of care they provide. Pioneering research and academics have fueled their passion for excellence and higher and higher standards of care. IT platforms are updated constantly and new products are released regularly. Dr. Jacofsky explained that they are in a constant evolution to improve outcomes over the prior year and maintain “best of class.” “The use of evidence-based standardized order sets improves outcomes, lowers infections, and decreases the length of hospital stays,” he explained. “We continue to be leaders in quality improvements and our goal is to continue to improve outcomes.” RESEARCH The CORE Institute’s research efforts have also evolved and grown over the last 10 years. Initially, research was driven by physician-initiated hypotheses, and took place in a small, 300 squarefoot-room in Sun City West. Only five studies were completed per year. Now,
“We are the only organization in the country that manages the entire orthopedic rehabilitation continuum and manages it through evidence-based patient care and IT platforms that manage risks. ºIt has not really been done before.”
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their team of scientists and engineers work in multiple facilities including a 5,000-square-foot, state-of-the-art center with one of the most sophisticated motion analysis and gait laboratories, state of the art biomechanics facilities and cell culture-chondrocyte facilities. Research has broadened to include supporting the medical community in developing new devices and drugs. And there is more. The CORE Institute gave birth to the MORE Foundation in 2008. As the name suggests, the foundation reflects the extra efforts of the organization. The MORE Foundation, a non-profit division of The CORE Institute, was created to support research, education and charitable assistance. AMAZING 10 YEARS It has been an amazing decade for The CORE Institute with unsurpassed growth in providing premiere healthcare. The CORE Institute is now positioned to continue on that positive path creating advances in healthcare to a wider net of patients
“We continue to be leaders in quality improvements and our goal is to continue to improve outcomes.” — Dr. David Jacofsky, Chairman and CEO, The CORE Institute who have developed confidence and comfort knowing that at the core of the Institute, is academic knowledge, quality care and the highest standards of excellence. “We hope to be involved more in the reform of insurance and the management of care throughout the healthcare continuum taking risks alongside strategic partners in hospital systems, managed care companies, the government, industry and other physician groups,” said Eric Tomlon, Chief Operating Officer of Health System Operations at The CORE Institute. “We want to pioneer new ways to improve clinical quality while reducing healthcare costs and bringing greater value to the patient.”
www.thecoreinstitute.com
Andrew Jaczynski with the shoulder controller.
Improving patient care through using research
The CORE Institute Pursues Its Dedicated Research Mission By Joan Westlake esearch has always been at the heart of The CORE Institute’s mission. They focus on its goal of providing physicians, clinicians and the research community with clinically relevant information to improve patient outcomes. The CORE Institute’s multifaceted approach to research allows the rare opportunity to study devices and drugs from the bench top to the bedside. “I like to say that the ‘R’ in our name is not a marketing tool. It is something for which we have great passion and is a service to our patients and the community,” said Marc Jacofsky, PhD, Chief Scientific Officer.
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Marc Jacofsky, PhD
IMPROVING OUTCOMES The CORE Institute research labs were founded in 2005 to answer complex treatment questions and improve outcomes after orthopedic procedures. Typically, orthopedic surgeons rely on more qualitative and anecdotal measures to determine surgical and treatment approaches. “Physicians historically would do things the way they were trained, which was, ‘This is the way the doctor who taught me did the surgical procedure but my partner trained at another facility and learned another way.’ They were both safe for patients but it was not standardized around the concept of excellence in evidence-based medicine,” he explained. All of The CORE Institute’s research is done through its non-profit affiliate, the MORE Foundation. The MORE
Foundation is dedicated to research, education, and charitable assistance in musculoskeletal health. Its research division is staffed by bioengineers and scientists with specialties in areas including musculoskeletal anatomy, gait and motion analysis and the mechanical testing of orthopedic devices.” BEST PRACTICES Dr. Jacofsky points out that one of the unique differences that makes The CORE Institute outstanding is having an internal quality department in addition to its research department. By having both, The CORE Institute is able to evaluate the evidence in conjunction with its physicians and have a team that is solely focused on guiding toward best practices.
www.thecoreinstitute.com
Talking Points
“Our physicians have this in-depth analysis ability in their toolkit, which is fundamentally what makes our practices different from others” — Marc Jacofsky,PhD
“There are times when we find a lack of knowledge in the published literature and that is when our research division can step up and help answer a question that hasn’t been answered before,” he said. One question The CORE Institute researched early on involved looking at total knee joint replacement techniques. Their doctors trained at several different world-class academic medical centers and each had their own way of putting in the same knee replacement.
The CORE Institute did a study in the motion analysis lab with 100 patients, randomized by the different replacement techniques. They studied how patients walked before surgery, then at two, four and six months, then a year and two years after the surgery. Two of the techniques were found to produce the best results long term. “Most physicians are not able to do the gait analysis of the patients in a suit with markers to see how the knee is really working as they climb steps and walk around for half an hour,” Dr. Jacofsky said. “Our physicians have this in-depth analysis ability in their toolkit, which fundamentally is what makes our practices different from others.”
HISTORY OF EXCELLENCE Over the past decade, The CORE Institute has had over a dozen, peerreviewed articles in well respected, medical journals and conducted more than 50 clinical trials and biomechanical studies. Being involved in orthopedic device trials before they were available to the general public, The CORE Institute researchers and physicians have helped the Food and Drug Administration in assessing these devices. “We have filed a number of patents on devices that our physicians have invented, primarily focused on spinal implants,” Dr. Jacofsky added. “And, we have four issued patents and six pending.” In the past year, The CORE Institute has expanded with a division of neurosciences that includes clinical drugs trials for treating epilepsy, Multiple Sclerosis and headaches. He commented, “Adding the neuroscience allows us to treat patients with an even more holistic team and conduct studies that combine orthopedic and neurological disciplines. It is always exciting to see what important new trials and research we will be doing.”
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One on One
with The CORE Institute Founding Physicians By Meghann Finn Sepulveda
It was 10 years ago when it became obvious to David Jacofsky, MD, that the future of healthcare was changing that he drafted a business plan and recruited colleagues Mark Campbell, MD, and John Brown, MD, to open The CORE Institute and fulfill a great need for advanced orthopedic care in the Valley. >>
Pioneering the vision of excellence, quality and compassionate care for patients Together, the three board certified and fellowship-trained orthopedic surgeons became the founding physicians who built a unique infrastructure, one that was centered on people, process and technology. Today, the nationally-recognized CORE Institute is comprised of more than 150 providers with 26 locations in Arizona and Michigan and is considered to be paving the way as lead innovators for orthopedics and neurological care. After 10 years, the focus remains on quality care and evidence-based outcomes. The group has developed new sub-specialties since The CORE Institute’s inception that include advanced orthopedics, spine, pain management, neurology, plastic surgery and physical therapy. In February, The CORE Institute announced the expansion of musculoskeletal healthcare in Southern Arizona, which aligns with the increased demand for orthopedic services and supports new patient growth. To mark the milestone anniversary of The CORE Institute, we sat down with all three founding physicians to learn about their professional journey over the last decade.
Mark Campbell, MD
David Jacofsky, MD
David Jacofsky, MD was serving as a division chief in the department of orthopedics at the world-renowned Mayo Clinic in Rochester, Minn., when his vision for The CORE Institute came to fruition. At the time it was evident that healthcare was moving in a new direction. “I developed a business plan in which we would partner with a group of highly experienced and fellowship-trained orthopedic surgeons to efficiently track and monitor patients, therefore providing a greater value to payers and patients,” Dr. Jacofsky said. “It was considered a unique advantage in the marketplace.” Dr. Jacofsky, a board certified and fellowshiptrained orthopedic surgeon who specializes in complex hip and knee arthroplasty and orthopedic oncology, recruited former residency and fellowship colleagues Mark Campbell, MD and John Brown, MD to join him in the endeavor. “Other hospital “I knew them both personally and professionally systems began to quickly notice that and felt they would be an ideal fit,” he said. our patient outcomes The team saw their first orthopedic patient at were dramatically Boswell Hospital – now Banner Bowell Medical different.Our strategy Center – in Sun City in January 2005. with hospitals and “Other hospital systems began to quickly notice medical providers that our patient outcomes were dramatically were unique.” different,” Dr. Jacofsky said. “Our strategy with hospitals and medical providers were unique.” — Dr. David Jacofsky, Not only were hospital systems noticing Chairman and CEO, improved outcomes, but patients were paying The CORE Institute attention too. “I credit our success to the proprietary IT infrastructure which tracks patients and detects trends, our evidence-based proven order sets, the clinical pathways we have taken and the dedication of the entire team,” he said. Now with more than 150 providers on staff and over 700 employees at The CORE Institute, Dr. Jacofsky plans to focus on continued growth to expand orthopedic care not only in Arizona and Michigan but across the country and internationally. “We expect to increase our providers by 30 percent this year,” he added. “Additionally, our patient growth is steadily on the rise.”
Talking Points
John Brown, MD Mark Campbell, MD
Mark Campbell, MD, a board certified and fellowship-trained knee surgery and foot and ankle specialist, was in private practice in Washington when he and David Jacofsky, MD, began initial conversations about business opportunities. “The plan was built around people with the same interests and goals,” Dr. Campbell said. “We were more like a big family.” The physicians recognized the need for orthopedic care in the Valley. Together they shared the same thought process and goals for achieving exceptional patient care. “The vision was to provide an orthopedic experience for patients “It was so humbling. focused on excellent, quality care,” Dr. Campbell said. We were able to During the early stages the surmake it work because the only geons would visit with emergency thing important medicine and referring physicians to to us was that our demonstrate the benefits of the fellowpatients did well.” ship-trained orthopedic specialty. “It got their attention,” Dr. —Mark Campbell, MD Campbell said. While the need for orthopedic care was evident, it took time to grow the practice. “In the beginning we used milk cartons for chairs in the clinic,” Dr. Campbell remembers fondly. “We didn’t have phones and we saw patients in curtained rooms at the hospital’s emergency department.” But that didn’t matter to Dr. Campbell. “It was so humbling,” he said. “We were able to make it work because the only thing important to us was that our patients did well.” The last 10 years have been comprised of collecting data, performing research, developing metrics, analyzing outcomes and reviewing literature, all of which have proven to be top priority at The CORE Institute. “Before it was just a philosophy,” Dr. Campbell said. “Now we’ve plugged this data into a system which allows us to not only demonstrate improved patient outcomes, but clearly shows that we know how to effectively care for the orthopedic patient population.”
Talking Points
John Brown, MD, developed a close relationship with David Jacofsky, MD, during their orthopedic medical residency at Johns Hopkins University. Several years later Dr. Brown, a board certified and fellowshiptrained orthopedic surgeon who specializes in sports medicine, was contacted by Dr. Jacofsky and asked to be a partner in a new orthopedic practice in Arizona. “I thought it would be a good match,” Dr. Brown said. Together they joined forces. “We created a visionary orthopedic practice,” said Dr. Brown. “Our quality standards are focused on clinical expertise and strong research while maintaining cutting-edge technology in regard to patient care.” Ten years later Dr. Brown recognizes The CORE Institute as a unique orthopedic and neurological practice where patients are always at the forefront. “We are an academic-type institution in a private practice setting,” Dr. Brown said. “We have the ability to provide excellence in patient care.” The group at The CORE Institute has been able to successfully manage the changes in today’s evolving healthcare landscape and maintain and comply with government standards. Dr. Brown sees firsthand the positive influence of what was accomplished in Arizona and says the business model will be expanded and implemented across the country. “We are using what we have done here and taking it to a National level to be replicated across the country,” Dr. Brown added. “Growth is on the horizon.” After 10 years of caring for orthopedic patients at The CORE Institute, Dr. Brown still proudly adheres to the original vision and goals set forth by the group of the three founding physicians. His actions speak volumes. “I take superior care of my patients and drive the mission of The CORE Institute on a daily basis,” he said.
Talking Points “Our quality standards are focused on clinical expertise and strong research while maintaining cutting-edge technology in regard to patient care.” —John Brown, MD
The CORE Institute Celebrates 10 Years of Life in Motion Ten years ago, fellowshiptrained orthopedic surgeon Dr. David J. Jacofsky, along with Dr. John A. Brown and Dr. Mark D. Campbell, believed they could provide best-in-class orthopedic care to Phoenix area residents. Ten years later, it is clear that they have been able to bring that dream to fruition with 150 care providers, 700 employees and almost half a million patients in the practice.
Expanded locations to service patients in Sun City on the Banner Boswell Medical Center campus and Phoenix on the John C. Lincoln Deer Valley Hospital campus.
Opened The CORE Institute in Sun City West, Arizona
2005
2006
“Our phenomenal growth has been built on a platform of evidence-based medicine and meticulous outcomes tracking managed by our proprietary IT platform.” —Dr. David Jacofsky, MD
Granite Valley groundbreaking
Launched CORE Ink publication Expanded subspecialties to include hand and upper extremity care
Peoria open house
Expanded locations to service patients in Gilbert, Arizona on the Mercy Gilbert Medical Center Campus. Launched non-profit foundation, the MORE Foundation
2007
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2009 2010
Launched first co-management agreement with Banner Del E. Webb Medical Center in Sun City West, Arizona.
2011
Mr. Stubbs
CORE Cycling Team
Best Places to Work celebration
Expanded into Michigan, first clinic expansion outside of Arizona Launched CORE Cycling Team to include a 50-member cyclist team
Expanded co-management relationship with Banner Health to provide world-class orthopedic care at Banner Desert Medical Center and Banner Thunderbird Medical Center.
2012
The CORE Institute, is joined by Cleveland Clinic, OrthoCarolina and Rothman Institute to form the first-of-its-kind clinically integrated Orthopedic PHO (Physician Hospital Organization), operating as the National Orthopaedic & Spine Alliance LLC (NOSA). Built prosthetic tail for alligator, Mr. Stubbs
2013
Expanded locations to service patients in Mesa, Arizona on the Banner Desert Medical Campus Expanded co-management relationship with Banner Health to provide world-class orthopedic care at Banner Good Samaritan Medical Center Recognized as one of the Best Places to Work in the Valley by Phoenix Business Journal Received #1 Orthopedic Group Recognition by Ranking Arizona
Volleyball Fiesta Classic
Michigan expansion
Michigan expansion
The CORE Institute is now largest provider of integrated musculoskeletal and neurological care in the Southwest.
Open House
Opened 70,000 sq. ft. headquarters facility and clinic opens in Phoenix, Arizona
Received #1 Orthopedic Group Recognition by Ranking Arizona for second year in a row
Expanded specialties to include Neurology and Plastic Surgery
Recognized as one of the Best Places to Work in the Valley by Phoenix Business Journal
Signed Orthopedic Co-Management Agreement at Green Valley Hospital in South of Tucson
2014
Recognized for the IMPACT Awards for Entrepreneurial Excellence by the Greater Phoenix Chamber of Commerce
Expanded Michigan Market to Grand Blanc, Michigan Received #1 Orthopedic Group Recognition by Ranking Arizona for third year in a row Â
2015
A Look at Our History How a Big Idea Just Kept Getting Bigger Q: When did you realize you were really part of something special?
Q & A with Jo Adkins, The CORE Institute’s Chief Strategy Officer
Probably before The CORE Institute ever actually started practice. Dr. Jacofsky talked about his vision for the future and what he wanted to build; it was always about the patients first, an evidence-based practice, quality and research. Once he was here, he was in my office daily telling me: “We need to develop a plan. Here’s what we need to do.” I recognized that his vision was one for the long term.
By Brian Sodoma She held Executive positions at large hospital systems in the Midwest before making her way to Arizona. By the mid-2000s, Jo Adkins was helping to create an enterprise that is continuously reshaping best practices in healthcare today. Adkins recently took some time to talk about the early days of The CORE Institute.
Q: How big of a role did research play at The CORE Institute early on?
Q: Tell us about your work prior to The CORE Institute.
In 2002, I served as the CEO of Banner Del E. Webb Medical Center (formerly Sun Health Del E. Webb) just at a time when the Northwest Valley was starting to grow. I likened that growth to a mushroom cloud. In 2002, the hospital had 8,500 discharges and by 2005 we had 19,000. … At the time, there were long ER waits for surgical evaluation and patients reported experiencing sixmonth waits for many elective orthopedic surgeries. The hospital began to look at how to grow our surgical specialties. We needed to recruit at least three orthopedic surgeons into the market. … We ran an ad in an orthopedic journal that said “How would you like to practice with your two closest friends?”
Q: So that’s how The CORE Institute began?
Yes, we had two physicians that were interested in practicing orthopedic medicine at our hospital. Dr. Arash Araghi, Orthopedic Shoulder Surgeon, was finishing up his fellowship and wanted to relocate to Arizona and
Dr. John Thompson was an Arizona Native and grew up in the Northwest Valley. But things changed when I received a call from Dr. David Jacofsky. He was at the Mayo Clinic in Rochester and was head of the trauma program. He was looking for a place across the country to develop and grow an innovative orthopedic practice. On January 17, 2005, Dr. Jacofsky, Dr. Brown and Dr. Campbell established The CORE Institute. Drs. Araghi and Thompson joined The CORE Institute shortly after. From the beginning The CORE Institute’s philosophy was very patient focused. Physicians would respond to the emergency room quickly, they participated in training staff and developing clinical protocols. Referring physicians could quickly get their patients seen. And as a result, there was a lot of support for The CORE Institute’s growth and word of the practice spread quickly in the community.
It was one of our first critical initiatives, along with formalizing our orthopedic service line approach. I recall working with Dr. Jacofsky to negotiate a lease for clinical research space and designing a gate and motion analysis lab. Research is a cornerstone of who we are. … If we have a question about load bearing on a shoulder implant we can actually test those shoulder implants within our lab. That’s what makes The CORE Institute unique; we look at published evidence as well as what we learn with our own studies. We’re not only using evidence, we’re creating it too.
Q: What are you most proud of when you reflect on those Sun City years?
Definitely managing the speed of the growth, and being able to keep up with that growth through some high quality physician recruitment. The growth helped attract other high quality surgeons and physicians to the area. A lot of people who know me would say my legacy is The CORE Institute and bringing it to our community, and I am definitely proud of that legacy and hold it with high regard.
Forging Partnerships. Creating Excellence. The CORE Institute is committed to Michigan expansion By Michael Ferraresi he CORE Institute’s expansion into Michigan began more than two years ago with the vision of an eight-person orthopedic group from the St. John Providence Health System that sought to expand their practice. As Dr. David Markel and other top orthopedic surgeons from the Detroit area sought ways to branch out on their own, they soon discovered that a group of colleagues in Arizona shared their ideals on caring for patients — and had their own vision to expand beyond the Valley of the Sun. Dr. Markel had spoken with colleagues in North Carolina and Indianapolis about successful orthopedic networks where groups of doctors forged relationships to link their private practices with large healthcare companies and hospitals. But when he spoke with The CORE Institute doctors like Dr. David Jacofsky, it was clear that the Arizona dynamic was the best fit, both for the Michigan group, and for the Phoenix group seeking a “CORE North” concept.
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‘CORE NORTH’ The resulting partnership led to The CORE Institute’s support for a Michigan site that rapidly developed into three additional sites. Clinics in Novi and Southfield were followed by the opening Dr. David Markel
of a location in Grand Blanc and Brighton in 2015. The network gives The CORE Institute a presence in both the Greater Detroit and Flint areas. “At this point, things are looking quite good for the direction we’re going, but it would be unfair to tell anyone starting a similar national venture that it was without obstacles or hurdles,” said Dr. Markel, who recalled the early days where dictation software might have a glitch or other long-distance growing pain. “Some of it was good parenting, and some of it was tough love,” Dr. Markel said. “But relative to commitment, I couldn’t ask anything more from the Arizona side.” CULTURE OF CARE The Michigan team got through it, though, and quickly adopted The CORE Institute culture that has driven Arizona market success. The CORE Institute’s relationship with the Banner Health network, which includes a management of the orthopedic service lines within five Banner hospitals, was the standard the Michigan market aimed to emulate with St. John
Providence Health System. Today, The CORE Institute Michigan Market has a team of more than 20 doctors, physical therapists and other healthcare professionals. Dr. William Higginbotham, a founding member of The CORE Institute Michigan Market, said it was natural for their practice to gravitate to The CORE Institute based on its doctors’ reputations for maximizing physician alignment, data-driven analysis, research and patient care. A FORCE IN MICHIGAN “We knew we needed to be part of a larger group, where we can control some of the factors with patient outcomes and how we measure those outcomes using data and information,” Dr. Higginbotham said. “The CORE Institute in Arizona has strong relationships with its hospital partners, but they also have a strong EMR system and control of their data.” With that model in play, The CORE Institute has become a force in Michigan and proven that Arizona’s success can be duplicated elsewhere in the U.S.
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Then and Now: The Evolution of Quality Outcome Measures Focus on standardization improves efficiency and patient experience
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new technology also allows orthopedic surgeons to achieve those goals. “For example, through computer navigation and robotic-assisted surgery, we are able to more accurately align knee implants with greater precision,” Dr. Araghi said. “These techniques give patients the opportunity to achieve mobility and get back to their normal daily life sooner.”
STANDARDIZATION PROCESS Implementing standardization practices at The CORE Institute involved coordinating clinical pathways, physicians, nursing staff, physical therapy and post-operative care to decrease the chances of complications. “We evaluate things like our order sets and rely on research to gain valuable knowledge about areas that will have a huge impact on outcomes,” said Sarah Muller, PA-C, Executive Vice President of Quality and Clinical Care at The CORE Institute. “We look at our known clinical metrics in areas such as medication, length of stay, blood loss and the mobility of each patient after surgery so that we can determine what works best.” Standardization helps patients, physicians and hospitals know what to expect. “We are transparent with each of our physicians by communicating regularly about strengths and areas of improvement,” Muller added.
PATIENT EXPERIENCE The CORE Institute has implemented patient reported outcomes, a national initiative that gives patients the opportunity to provide feedback about their procedure and experience. “Through this metric, patients are able to tell us about things like their level of pain, functionality and if they have resumed daily activities,” said Muller. “We want to know their opinion on the success of the surgery.” Quality experts at The CORE Institute have been actively gathering data, evaluating patient reported outcomes and making adjustments as needed. “We review the results and tailor our standardization measures if we feel that extra care, more therapy or additional appointments with the surgeon will lead to better outcomes for our patient population,” Muller said. Research indicates that knee replacement patients at The CORE Institute can walk, climb stairs and use full extension of their limbs sooner. These benefits allow patients to return home faster and increases overall satisfaction. “We are a patient-centric organization,” said Dr. Araghi. “We want our patients to know that when they come to The CORE Institute they will be respected and feel confident that the best possible care is being received.”
By Meghann Finn Sepulveda ince its inception 10 years ago, leaders at The CORE Institute have placed strong emphasis on quality of care and the impact it has on patient outcomes. Through standardization practices and process improvement techniques, along with data collection and research, quality outcome measures have been refined, which has led to improved efficiency and patient satisfaction.
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Arash Araghi, DO
The CORE Institute is aligning with value based healthcare to create a platform where it can be competitive in the new medical environment by reducing risks, lowering readmission rates, and creating better outcomes which lessens the impact from a cost perspective. CLINICAL OUTCOMES Through evidence-based medicine, the board certified and fellowship-trained orthopedic surgeons at The CORE Institute take the same path of care and tailor it to each individual patient. Their shared knowledge allows them to know when to start antibiotics, how soon to get patients out of bed following surgery and when to coordinate physical therapy. “Standardizing our practices provides better quality, faster recovery and improved outcomes,” said Arash Araghi, DO, Arthroscopic and Reconstructive Shoulder Orthopedic Surgeon at The CORE Institute. “We try to manage all areas of subspecialties in orthopedics.” Adopting advanced methods and techniques combined with incorporating
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The CORE Institute Specialty Hospital New hospital provides unique setting for patients, offering high-end, specialty specific, quality care By Allison Vasconcellos Vice President, Marketing, Branding and Communications
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he CORE Institute has partnered with Surgical Care Affiliates (“SCA”, NASDAQ: SCAI), a prominent surgical solutions and specialty surgical services provider, to open The CORE Institute Specialty Hospital in Phoenix, Ariz. The CORE Institute Specialty Hospital will be staffed with the Valley’s top orthopedic surgeons specializing in hip and knee replacement, spine, pain management, podiatry and other orthopedic surgical specialties. The CORE Institute’s partnership with SCA will create a national model of specialty centers for the future by tapping collective strengths and competencies of both companies to enhance the quality of patient care, improve accountable care models, and reduce costs to consumers. Through its hospital alignment strategies, The CORE Institute Specialty Hospital (formerly Specialty Hospital of Phoenix), will offer evidence-based approaches to medical care and integrated orthopedic service lines to improve the experience for patients in the local community. As consumers, employers and third party payers look for higher value options in the
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Allison Vasconcellos
delivery of surgical services, The CORE Institute Specialty Hospital will offer a unique setting for patients to receive high-end, specialty specific, quality care — validated through The CORE Institute’s well-proven improved surgical outcomes. The CORE Institute’s partnership with SCA will include future local and national expansion. “The CORE Institute is pleased to join forces with SCA to continue to transform the delivery of healthcare”, said Chairman and CEO David J. Jacofsky, MD. “Both organizations have outcomes with data that speaks for itself and through this strategic partnership, we are able to expand our standardized care approach, proprietary quality and IT platforms, and replicate these proven outcomes nationally.” The CORE Institute will deploy proven pathways and protocols, create efficiencies in an inpatient setting, and provide optimal patient outcomes all while focusing on a specialty patient-centered approach. “The CORE Institute has built a national reputation for performing routine and complex orthopedic surgeries, while providing excellent patient care and clinical outcomes,” said Goran Dragolovic, Senior Vice President of Operations at SCA. “With their experience and expertise in co-management with Banner
Health and St. John Providence Health Systems, The CORE Institute is the ideal partner to support SCA in furthering our mission to improve healthcare and achieve our shared goal of establishing a system of accountable care, where quality outcomes drive reimbursement.” Eric Tomlon will serve as the Interim Chief Executive Officer of the hospital. Currently, Eric serves as Chief Operating Officer of The CORE Institute’s National Hospital and Service Line Management Division. He brings 20 years of experience in health administration, including twelve years of hospital administration in forprofit, not-for-profit, Catholic, university, pediatric, independent and large health systems. “The CORE Institute Specialty Hospital will be a place where patients, physicians and employees can expect the very best in top tier, orthopedic services,” commented Mr. Tomlon. “The community will benefit tremendously from this partnership between The CORE Institute, SCA and local physicians, and the incredible patient care our physicians and employees will proudly deliver.” The hospital is currently open operating under its new governance and ownership. One of the first objectives for hospital to achieve in 2015 will be a new master facility plan and upgrade. Please look forward to a new look and improved patient experiences!
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By Joan Westlake
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aking the Valley’s Best Place to Work and Best Employer lists year after year is certainly a notable achievement. But, the real story is best told by some of the many employees who have worked at The CORE Institute since its very beginnings. Pride in being at such a renowned organization, opportunities for professional growth, great colleagues and the chance to make a difference in the world are among the reasons they give for devoting a decade of working at The CORE Institute.
‘Our Best 18
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JODY RYKHUS Senior Director of Operations Research & Development Jody Rykhus says that over the past 10 years, so many people within the organization have mentored and inspired her. “I think the best thing about my job is the challenges I am presented with on a daily basis,” she said. “All of the dynamics within The CORE Institute that you do not see in other private medical practices allow me to experience new things. There are things I learn while performing my job that I would never learn in a classroom or from a textbook. The CORE Institute has defined the standard of musculoskeletal care.”
JENNIFER BRAVO Senior Director of Facilities and Project Management Her department’s office suite was still under construction when Jennifer Bravo started just weeks after The CORE Institute opened its doors. Today, she leads facility expansions of the organization. “One of my greatest feelings of accomplishment is each time we open a new location,” she said. “We work really hard and really long hours in the days leading up to the opening. It is always a great feeling when the providers, staff and patients step into the office opening day and love their new work environment. I get to support CORE staff each day so they can run their departments the most efficiently and take the very best care of our patients.”
TANYA BURKE Director Quality Assurance The opportunities to discover her strengths and gratitude for being invested in as a professional are some of the reasons Tanya Burke gives for describing The CORE Institute as “amazing!” She explained, “Whether we are looking at patient feedback, compliance, risk management, internal audits, quality reporting programs or patient outcomes, the possibilities for improving the patient experience are endless.” The competitive runner and fiddle player added, “I enjoy pushing myself to continue learning. The more I learn, the more efficient I can be. The more efficient I can be, the more patients I can help.”
10 Years!’ Longtime employees find pride, professional growth and purpose at The CORE Institute
MELANIE UITTO Coding Supervisor As Melanie Uitto looks forward to celebrating her 10 year anniversary with The CORE Institute on May 1, she said, “When I started, I could count the total number of employees including the providers on two hands. To be a part of the growth and watch what The CORE Institute has become today makes me very proud to say that I have been a part of this organization for so long.” She added, “I am a medical coder and most of us admit that we are ‘nerds’ about it and are a department that is very much behind the scenes. Coding compliance has always been a priority to our organization, so for a coder there is no better environment than to work where you know you are supported by management and also by the providers you are coding for.” She concluded with a statement that many longtime employees echoed, “I do believe I will be working at The CORE Institute for years to come because I love the work that I do, the people that I work with and a management team that has confidence in me and encourages me to grow and take on new responsibilities.”
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Woman Gets Life Back On Track 20
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Thanks to the CORE Chairman David J. Jacofsky, MD By Gremlyn Bradley-Waddell t’s been four years since Louann Hirsch had her knee replaced, but the 77-yearold Sun City West woman is still full of praise for the procedure – and the doctor who performed it. “I haven’t had pain since I went in for the operation,” said Hirsch, whose 2011 surgery was carried out by David J. Jacofsky, M.D., chairman, CEO and co-founder of The CORE Institute. “I work out five days a week, I play cards three times a week, and I’m very active. Dr. Jacofsky gave me my life back. He’s just brilliant, and his staff is also marvelous. I don’t know what I’d do without his team who were with me every step of the way.”
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EXPERIENCED SEVERE PAIN Having been healthy all her life and having never previously taken a prescription medicine, Hirsch was dismayed several years ago after she began experiencing severe pain from arthritis in her right knee. She received cortisone injections for a few years and was still able to continue exercising, but the pain eventually got so intense that she went back in for a checkup. An exam revealed bone-on-bone contact in her knee, which led Dr. Jacofsky to recommend a minimally invasive, computer-navigated knee replacement in 2011. Advancements in technology are exciting and computer navigation now can literally guide the surgeon through the implantation of a total knee replacement. A recent publication of national registry data from Australia proved that the use of navigation decreases the future risk of revision surgery in younger and more active patients. “Through infrared sensing of the patient’s
Musculoskeletal and neurological conditions, affecting everything from shoulders and hips, spines and knees, and nervous system including the brain and spinal cord are a leading cause of disability and chronic pain for patients around the world.
At the Musculoskeletal Orthopedic Research and Education Foundation
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anatomy, the computer can precisely advise the surgeon as to the exact location in which a new knee implant should be positioned,” Dr. Jacofsky said. “This technology carries the promise of improving the precision of total knee replacement surgery, thus improving the short- and long-term performance of the knee replacement.” MIMIMALLY INVASIVE APPROACH Indeed, the technique results in less postoperative pain for patients, as well as shorter and smaller scars, he noted. In addition, the minimally invasive approach combined with newer pain and therapy protocols, has been found to result in shorter hospital stays for patients, a reduction in the amount of time that patients need to use a walker, and a speedier return to their normal routines. Hirsch stayed a few nights in the hospital after her surgery, and then was released to go home. After one brief stop elsewhere, that is.
Talking Points “The minute they released me, they had me go across the street for rehabilitation,” she said. “We set up the program the day I left the hospital, and I started my rehab the very next day.” Hirsch said she stuck closely to her rehab regimen, attending several times a week to work with a physical therapist, and she thinks that kind of determination helped her achieve such a successful recovery. “They told me to do exercises in the water, so I did that up until last year, 40 minutes each time,” said Hirsch, who was diagnosed last October with colon cancer and recently completed chemotherapy.Coincidentally, she isn’t the only one at her house who thinks The CORE Institute and Dr. Jacofsky are tops. Jules Becker, her companion whom she met through friends, also had a knee replacement performed by the surgeon and has been exceedingly pleased with how his knee feels as well. “He said it’s 101 percent perfect,” Hirch quipped.
“I haven’t had pain since I went in for the operation. I work out five days a week, I play cards three times a week, and I’m very active. Dr. Jacofsky gave me my life back.” Louann Hirsch