A candid conversation about current leadership priorities with health system executives
As priorities evolve in the post-COVID-19 healthcare landscape, health system leaders are developing new strategies for growth, providing care in the home, making digital health investments and addressing health equity. At Modern Healthcare’s 2022 Leadership Symposium, Sue MacInnes, chief market solutions officer at Medline, led a conversation with health system leaders to explore their most pressing priorities and their visions of success for the future.
SUE MACINNES: Can you please rank your top three strategies since COVID?
AMY PERRY: Quality, access and affordability. Number one, we’re building and investing in a great team to deliver great care because keeping our patients and employees safe is our number one priority. Number two, on access, we are leaning into our ambulatory growth, home health delivery and digital strategies. We are making it as easy as possible for people to connect with Banner in the way they want to connect — virtually and physically. And three, on affordability, we are focused on wellness, efficiency, and total cost of care to make healthcare more affordable for everyone. We are pro-actively expanding our premium-based reimbursement.
JANICE NEVIN: We just launched a new five-year plan with a new vision: creating health together so every person can flourish. (It’s about) going beyond the concept of health and wellbeing, to really thinking about the larger ecosystem that creates health, the partnerships that we need to drive health and connecting to meaning and purpose. We aspire to end disparities, radically simplify access, accelerate growth and transformation, keep people healthy at home and enable every caregiver to thrive.
MARC HARRISON: The first is listening. You can’t be effective unless you slow down and listen to people and try to understand the realities, regardless of what decisions you make. The second is equity. It’s unconscionable that (life expectancy for) Black people (decreased by) almost four years on average in the pandemic and (life expectancy for) white people (decreased by) 1.2 years. Then the final thing is ongoing transformation. The system as it’s currently designed — this volume-driven system where it’s heads in beds — proved to be remarkably un-resilient to the pandemic and post-pandemic response. Those of us that have a payer-provider model that is health-oriented have done very well, and if we’re going to have a resilient health system, that must continue.
RICHARD ISAACS: Three things: transforming care, investing in (the) people in our practice, and strengthening Permanente Medicine. There are buckets underneath each one of those. Transforming care is leveraging technology with automation that allows our people to be more effective. It brings the patient to the right place at the right time while eliminating redundancy. It’s about driving effectiveness. Investing in people is about allowing people to reconnect with our mission and making it easier for them to do their job. Finally, investing in the practice overlaps with transforming care. (In regards to) strengthening Permanente Medicine, when you have a pre-paid model of care where the focus is on creating value, it wins big. I think we have an incredible example of how value- based pre-payment models did exceedingly well during the pandemic and during recovery.
TERIKA RICHARDSON: The first is workforce. There is no greater priority for us than solidifying our workforce and thinking about what our team members need. What’s important to them? How do we attract and retain our people? We know that the nurse at the bedside in January of 2020 and the nurse today want very different things. Second is innovation. To create a great environment for our workforce, we have to innovate. We’re looking at enabling technologies that allow us to transform not only how we care for patients, but also the environment for our workforce. Lastly, but certainly not least, is access to care. Access comes in different forms and formats to meet the patient where they want to receive care. We are heavily focused on digital and outreach solutions from our provider platform and in our ambulatory settings.
MACINNES: How has your strategy regarding access changed since the pandemic?
HARRISON: I’ve been in leadership roles for a long time, and access has always been an issue. I think it’s never been more acute than it is right now, and that is for all kinds of reasons, whether it’s provider shortages, angry patients or just a system that is so clunky compared to (other consumer experiences). The disconnect is driving people nuts and making them very angry and quite disloyal to systems that they’ve been loyal to for decades. It’s going to require a reset in a lot of ways. On the one hand, you need to have a great consumer experience that stands up to other experiences that people are having. On the other hand, flexibility (at health systems) is not our middle name. But this is a time for nimbleness.
RICHARDSON: When we think about access and how we create that, it’s been an all-encompassing endeavor. We must transform ourselves to meet the patient’s needs. One of the things that the pandemic has done is really force the industry to embrace digital solutions, but it’s not sticking. We saw the consumer wanted to utilize more technology but then it waned a bit. So, we’re looking at how to make technology a part of our everyday offering.
PERRY: Banner’s mission statement is to make healthcare easier so life can be better. I’m inspired by our unique and important mission. We’re all about taking the friction away from the patient, and that is all about easy access and coordinated care — not just geographic access, which we have tremendous coverage in our markets, but it’s also about a seamless digital experience. Since the height of the pandemic, we have had a little pullback on virtual care. I’m not sure if this is driven more by provider or patient preference at this point.
NEVIN: I would put the word equitable in front of the word access, and for us it is a strategic priority. It’s about removing the friction and meeting people where they are. Fundamentally, I think the issue is that our system is built on transactions. We create the visit to get paid and with that comes a whole lot of administrative burden that can be a challenge for patients as well as for providers. We have a robust partnership with a payer. Part of the purpose of that partnership is to come together and make it easier for people to access care, and for providers to do what they want to do, take care of patients. We must think about care as a continuous relationship rather than individual transactions.
MACINNES: Is hospital at home a strategy for your organization?
RICHARDSON: Yes, absolutely. We’re thinking about everything outside of the four walls.
HARRISON: But let me ask you, what’s the daily census for (Ardent’s) hospital at home (program)?
RICHARDSON: We’re really early on and it’s very small.
HARRISON: We (Intermountain) are really big, and we’ve been doing this for a long time and (our census) is dozens, not thousands. And (Kaiser), your census is not gigantic, is it?
ISAACS: (About 300 patients a year to date just in our Northern California region), so we’re in the dozens (at any given time).
HARRISON: So, (Intermountain and Kaiser) are two of the biggest systems — and its dozens. Now, I (know a colleague) who’s in India and she runs a giant system there. They’re converting 11,000 hotel rooms to hospital rooms. that they could be, which is the acute care environment. So, I think it will evolve. We’ve been working our way back to staffing the full capacity of our hospitals and that’s been our priority.
PERRY: I’d probably put (Hospital at Home) as a total cost of care opportunity. How do we make healthcare more affordable for our patients? And one of those things is keeping them out of the most expensive place that they could be, which is the acute care enviornment. So, I think it will evolve. We've been working our way back to staffing the full capacity of our hospitals and that's been our priority.
MACINNES: In terms of a digital strategy, what didn’t work and what does your organization need?
PERRY: Digital is a hugely successful strategy for care, coordination and communication, but we are in an industry that has a hard time moving forward without taking a couple steps back. The provider community was all-in (on telemedicine and digital) during the pandemic, and then post-pandemic, providers wanted to see their patients in person again. So, I think we may have artificially pulled back our digital interactions a little bit, and we’re seeing it come back now. Banner’s digital front door and web presence drives about 60 million visits to Bannerhealth.com a year.
ISAACS: I think we’re in a transition period right now, and payment reform is required to really see the value of digital. In 2020, about 85% of our visits were (completed over) video in the middle of March. It was unbelievable. But it’s not the end all; you must have a hybrid situation. So, the onus is on leadership working with empowered chiefs and office-based physicians to identify where the value add is. In a pre-paid model like (that of) Kaiser Permanente, there are huge benefits to video, because a dermatologist can do their work largely on video and identify the patients they need to see. But in a fee-for- service model, there isn’t a dermatologist that would want to do that because there’s no revenue.
NEVIN: We’ve learned digital-first doesn’t work for everyone. So, part of the challenge is creating the experience that the person desires and needs, and then leading them to what I see as the future, where the majority of their interactions are on their time, at their request.
HARRISON: What you need to be wary of for all these digital and tele-solutions, is ... so many of them are point solutions, they’re not part of the system. When you need medication management, when you need to be admitted, when you need family therapy, you’re not part of a system (which leads to a poor patient experience). Healthcare’s still incredibly parochial, and it needs to be nimble like other industries have become nimble. We still suffer from a “not-invented-here” kind of mentality.
MACINNES: Shifting gears, what is your organization’s growth strategy and where do mergers and acquisitions fit in?
RICHARDSON: I think you’re going to continue to see consolidation because our industry is in a state where we must prop each other up. There are a lot of beds and a lot of need, but there are also a lot of organizations that, unfortunately, are not able to make the payroll at the end of the day. Ardent has been very fortunate to weather the storm. We’ve all had our challenges across the board. We all know the contract labor scenario that happened over Q1 and Q2 of this year.
PERRY: (Our strategy is) geographic expansion, in terms of more ambulatory sites and physician access. In the last three years, we’ve grown our primary care services to more than 500 providers. The Phoenix market is unique with significant population growth. So, although uncommon in healthcare now, we’re planning to add new acute care facilities to serve our growing neighborhoods.
ISAACS: Kaiser Permanente is on a mission to become much more national. We have eight regions in different time zones, and we support each other.
HARRISON: Intermountain grew from $6 billion in revenue to $15 billion in revenue in the six years that I was there. We went from one state to seven states. We believe in growth, but we only believe in good growth, so growth that drives population health and value. I think the criticism of most health system growth is largely justified — that it tends not to improve quality and it tends to drive up costs. If you really peel back the onion on why people grow, they are growing for the wrong reasons. They’re doing it to leverage payers, and that’s not good. We don’t do that. I do think that Intermountain has more growth ahead of it, but it will be in that same model of driving population health and value.
NEVIN: When we think about growth, we look at the number of lives that we will be accountable for in terms of their health outcomes and costs. So, we have an ambitious goal of doubling the number of lives with whom we have a meaningful interaction over the next five years. We believe that growth will come from a variety of ways. Expanding ambulatory services into new geographies is certainly one way. More engagement with health plans is another way. We are also looking at opportunities to use our virtual platform to grow outside of our local region. (We can) maybe even provide some services across a broader geography.
MACINNES: What is your vision for the future of healthcare?
RICHARDSON: We’re pushing to make sure our ambulatory platform is strong because we recognize — and COVID really solidified this for us — that in the future, the hospital is going to be a tertiary care space. We’re going to need ambulatory assets to be able to meet the patient where they are in a more convenient environment.
ISAACS: There are too many centers of excellence in this country. As I look from Sacramento to the coast, there are far more cardiac centers than we need. Some of these centers don’t have the volumes to have the highest quality. So, at a macro level, we have to consolidate nationally. The hospital of the future is going to probably be the most effective way that we provide care. When I was at Memorial Sloan Kettering as a resident, we used to admit patients the night before surgery, and we would keep them for a week. Now, a lot of the elective surgeries are same day (discharge), so there’s been a movement to alternative venues for recovery. I think we’re in a position now where that will continue. We’re just at the tip of the iceberg. I think in the future hospital, you’re going to see emergency rooms with an operating room attached to, perhaps, an ICU and step down (unit), with the majority of care being managed in an alternative venue, either a hotel that’s supported or at home.
PERRY: We want to be able to understand our patients in a way that helps us wrap services around them and give them what they need, whether it’s making sure they’re getting their annual health checks or that they have the right tertiary and quaternary referrals within a system. We want to be able to take care of them for their entire lifetime — building a trusting relationship instead of a purely transactional approach.