Taking care of Hopkins Stobo: Since 1993, Dr. John Stobo has put Johns Hopkins into position to cope with a changing medical market.

September 19, 1997|By M. William Salganik | M. William Salganik,SUN STAFF

John D. Stobo loves to solve problems.

As a researcher in California, he solved problems in immunology and cell biology. Then, starting in 1985, he began solving a different set of problems as chief of medicine at Johns Hopkins.

And for the past four years, he's been solving a doozy -- moving Hopkins, oriented toward research, teaching and specialty care, into position to cope with a medical market that suddenly put a premium on primary care and cost-efficiency.

Today is his last day as chairman and chief executive officer of Johns Hopkins HealthCare -- an enterprise he has headed since its creation in 1993. He leaves to assume the presidency of the University of Texas medical campus at Galveston, where he will get a new set of problems to solve as he oversees four schools, two institutes and seven hospitals.

Stobo was "a pioneer -- there aren't very many people doing what we're doing," said Dr. Robert A. Barish, chief executive officer of UniversityCare, an organization at University of Maryland Medicine very similar to the one Stobo ran at Hopkins.

"Jack did a wonderful job of helping build the infrastructure," says Dr. Edward D. Miller, dean of the Hopkins medical school and chief executive officer of Johns Hopkins Medicine. "Jack was a wonderful spokesman about why we had to develop an integrated delivery system. He has the ability to talk to the trustees and to the faculty and to say, 'Here's what's going on in the outside world.' "

What was going on in the outside world was the managed care revolution. Instead of insurers paying for care people got from doctors they chose, insurers began taking an active role in deciding how patients got treated, contracting with providers for set fees and looking for cost savings.

In response, medical schools and the hospitals began to build "integrated delivery systems," involving nearly every type of care provider -- doctors, clinics, labs, nursing homes, community hospitals, home health nurses.

"The vast majority of academic medical centers are expanding their clinical enterprise in any number of ways, most of which are similar to the initiatives at Hopkins," said Dr. Paul Griner, a vice president of the Association of American Medical Colleges, who heads a research group at the AAMC called Center for the Assessment and Measurement of Change in Academic Medicine.

Since Stobo began at Johns Hopkins HealthCare four years ago, the enterprise has:

Built a network of some 1,300 doctors throughout the state and reaching into Pennsylvania, Washington, D.C., and Virginia. While some hospitals have been buying physician practices, Hopkins assembled its network primarily through contract arrangements.

Created the Employee Health Plan, which functions somewhat like an HMO. Only self-insured employers can participate; their employees get access to the Hopkins network of doctors and hospitals.

Launched another HMO-like organization to care for low-income patients under the Medicaid program. Called Priority Partners, it is owned half by Hopkins and half by a network of 11 community health centers. It hopes to enroll 30,000 to 35,000 members this year.

Reached loose agreements with Suburban Hospital in Bethesda and Kent & Queen Anne's Hospital in Chestertown. Hopkins helps the community hospitals with training and clinical support and receives specialty referrals.

Became an investor in Patient First, a chain of urgent care centers.

With Howard County General Hospital, opened an outpatient cardiac catheterization center on the campus of Howard County General.

Merged its off-campus radiology network into American

Radiology Services Inc., a group with more than 70 doctors, 25 outpatient locations, 13 hospital contracts and $40 million to $50 million in annual revenue. Hopkins has a minority ownership stake in the operation.

The result is a Hopkins that works with other institutions in a way it never did before.

"We need to be friendly to community physicians," Stobo said. "We don't have to run everything, and we don't have to own everything.

Part of Stobo's mission has been not only to connect Hopkins with doctors, clinics and other off-campus parts of the medical world but to get different parts of Hopkins working together.

Johns Hopkins HealthCare was created as a joint venture of two major pieces of the Hopkins medical empire -- the medical school and the health system. (The health system, created in 1986, includes Hopkins Hospital, Johns Hopkins Bayview Medical Center and the Johns Hopkins Medical Services Corp., which provides medical care at 17 off-campus sites.)

The joint operation was designed, Stobo related, "because neither corporation was willing to cede total control to the other."

"Those two sides were not talking in the most collegial way," Miller said. "Johns Hopkins HealthCare was instrumental in showing the ability of Hopkins to talk with one voice."

In that sense, Johns Hopkins HealthCare was the forerunner of ** Johns Hopkins Medicine, created a year ago to preside over both the medical school and the health system, and headed by Miller in a post sometimes called "medical czar."

Stobo said he took the job in part because he understood the need to preserve the teaching and research mission at the medical school, while at some other institutions, "the tail has started to wag the dog."

Though hospitals seek affiliations and build networks to get patients to fill beds, Stobo said, "The whole reason for doing this is not simply to have patients come to East Baltimore. One reason is so we can go to the payer, and they'll say, 'You've got a very attractive network in terms of access and price.' "

Pub Date: 9/19/97

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