SouthCoast Health Administrator John Marrero has been with the practice since its inception 20 years ago, when a number of physicians who met regularly to discuss the state of their industry decided that they would have greater success moving forward if they combined forces. Marrero, living in Denver at the time, was brought in initially as a consultant to help facilitate those discussions. With 20 physicians, most of them general practitioners, SouthCoast Health was born. Those original physicians, based on their foresight, invested their own money to purchase and renovate a vacant grocery store building on Eisenhower Drive in Savannah that has become a thriving medical campus. Today, the practice has 80 physicians with offices in eighteen locations and an ever-expanding list of specialists throughout the Coastal Empire and Low Country. On the anniversary of SouthCoast Health’s coming into being, Marrero addressed a variety of topics about its past, present and future.

Question: What was the impetus to create SouthCoast Health?

John Marrero: The initial group was made of up five or six physicians who used to meet every Tuesday morning. It started as a conversation about how they could collectively think about the things that physicians needed to do to remain competitive in a changing healthcare economy. At this point, there were no HMOs and very limited managed care in Savannah. Ultimately, they made the decision that in order to remain competitive, they needed to create an organization that would allow physicians to work more collaboratively and collectively.

Q: How was the decision made to locate the group in a building that was once a grocery store?

JM: At the time in Savannah, there were no large medical groups. In bringing in all these doctors together, one of the things we saw that we needed was to create a sense of common purpose and of working together and that meant really trying to consolidate our services into one location. There were no existing medical facilities that met our need. Surprisingly, there was a supermarket that sat empty for several years that had a really large parking lot and we realized that it would provide us with an opportunity to build out part of it. We could consolidate the operation and leave room to expand and add an additional building onto the campus and serve as our home base for the organization. We bought it and renovated part of it and consolidated a number of smaller practices into that location.

Q: How has the initial investment to purchase that property paid dividends?

JM: I think that in medicine, property and facilities are really there to serve the purpose of the patients who come and receive our services. From that standpoint, it was a great investment because it gave us space to grow our practice and when other physicians expressed an interest to join, we had the space to expand. The initial investment was wonderful because it led to things like having an Imaging Center and it led to us being able to bring in additional physicians and it really transformed us from a primary-care organization to a multi-specialty organization.

This concept of having a medical campus that made it convenient for the patients to come get their primary-care services and their laboratory services and their imaging and possibly seeing a specialist — all at one location — ultimately made it more convenient for the patients and the doctors. It makes it easier for doctors to collaborate and work together when they share patients. So, in many ways, the investment paid enormous dividends in our culture and our ability to provide services to the patient. A secondary benefit was, as medicine evolved, it also gave us the ability to roll out technologies and innovations like Electronic Medical Records, 3-D mammography and our High Risk Breast Cancer Clinic in a much more efficient and focused matter.

Q: Was it difficult to manage the growth of the practice from 20 physicians at the outset to 80 today?

JM: In the early days it was more of a challenge because in our infancy we were a lot more prone to add to the group just on the basis of opportunity. What we’ve learned since then is that our growth has to be focused around a strategic plan and long-term thoughts about medical specialties that our patients need and that improve the practice. Over time, we also have become a much more structured organization, an organization that spends much more time on planning and not just executing. I would tell you that we are now a lot more deliberate and purposed about our growth.

Q: How did the decision to adopt Electronic Medical Records come about?

JM: In 2003, we started thinking about transitioning to Electronic Medical Records. As we grew we recognized that in order to provide the best care for the patient, we could not do that in a paper world. We had offices in multiple locations and had separate records from specialists and primary care physicians. It was impacting our ability to provide comprehensive care to our patients and impacting physicians’ ability to communicate with each other.

We made the decision that the only way to provide uniform medical treatment was to move to Electronic Medical Records and we knew that would take several years. It was something that was very much a conscious decision that we were going to move everyone onto a single medical record platform so that if a patient showed up anywhere within any SouthCoast practice and saw a provider, the doctor would have the full access to that patient’s medical records and history. In doing that, of course, we were a little bit ahead of the curve and it is very much a transformative thing. In a medical organization, to move from paper to Electronic Medical Records, it touches on every aspect of what you do in healthcare. It involves multiple departments. It touched every one of our employees. It was a huge undertaking but at the end of the day we’re ultimately happy we did it.

Q: How has the transition to Electronic Medical Records improved the level of care for patients?

JM: What is now delivered to us — and this is what we’ve been focusing on the past couple of years by capturing all of this information in one central repository — is the opportunity to really, honestly look at the quality of medical care and look at ways we can improve that. It’s also allowing us to see where patients may not be receiving the care they need and allowing us to outreach to those patients. It’s really been the tool that’s allowed us to get National Committee for Quality Assurance recognition for diabetic care and heart stroke and allowed us to get Patient-Centered Medical Home Standard 3 certification and, of course, we qualify for Meaningful Use (under federal government guidelines). Moving forward, we think that for all of the value-based healthcare programs that are going to come down the pike — we really believe that were it not for our transition to Electronic Medical Records and our ability to mine our data and quantify the work we’re doing — we would be lost. Again, it might not have started for that purpose but we think it’s a tool that’s going to let us do a better job for the patient.

Q: What is in store for SouthCoast in the future?

JM: First and foremost as an organization, we are very focused on evolving our organization to a value-based healthcare system. One of the things that all of this data has done now is allowed physicians to truly understand and truly see how healthcare services are being provided.  Armed with this information, we can improve the quality of care for the patient while either maintaining or even lowering the actual cost of care. One of the big things our organization is embracing is this twin concept of the Patient-Centered Medical Home model of healthcare as well as embracing as the value-based healthcare model to make sure we’re providing the best outcome for the patient in as cost-effective a manner as we can.

What that will look like is working much more collaboratively with other physicians in the community, other healthcare organizations in the community — even those outside SouthCoast. I think it also will mean we will continue to expand our services around what I call primary care in so far as we have to move to a healthcare model that provides patients easier access or timely access — access that is convenient to them as an alternative to going to the emergency room or going to the hospital. We need to make sure that we’re breaking down any barriers we can for patients to see a provider and get the services that they need. What that will look like in all likelihood is that we will expand after-hours care. We will broaden services we provide on the weekend to patients to a broader geographic area. But it will probably also mean that we will expand our services to things like telemedicine so that patients will be able to access a provider over a secure video service. That way, a mother who is worried about her child can get a hold of a provider using her smart phone or tablet. They will at least be able to have a consultation with a provider to make a decision about what’s the best course of action for that child. Should they come in to one of our evening clinics? Should they go to the emergency room? We’ve got to get away from the traditional way medicine has always done things, which is come to the office between 8 a.m. and 5 p.m. and we’ll see you when it’s convenient to the doctor. We’ve got to really rethink that and move to an arena that says we need to provide access to the patient when it’s convenient to them and in a way that provides high quality care. We’re not going to do it if it doesn’t meet that first need of quality healthcare, but we certainly need to broaden our perspective from that traditional 8-5, Monday through Friday model.