Capacity issues, staffing shortages, financial pressures, and technology overwhelm — these are just a few of the many challenges hospitals face in managing the total cost of care to meet clinical, financial, and operational expectations as the healthcare paradigm radically shifts.
To survive and thrive in the future, hospitals must concentrate on adaptability, having a strong workforce focus, building strategic partnerships, and the innovative ways to use technology, said panelists in an America’s Essential Hospitals (AEH) webinar, “How Essential Hospitals Can Reset for the Future.”
As the first in a three-part series, “Mitigating Financial and Operational Care Delivery Challenges for Essential Hospitals”, the session was hosted by Wendy McIntyre, Director of Membership and Marketing for AEH, and moderated by Guidehouse Partner Edward Abraham, MD, a former CEO of the University of Miami Health System with more than three decades of healthcare management and advisory experience. The webinar featured perspectives from Ted Day, Executive Vice President for Strategic Planning and Business Development at University Health in San Antonio, and Dr. Arturo “Art” Saavedra, Dean of the Virginia Commonwealth University (VCU) School of Medicine and Executive Vice President for Medical Affairs at VCU Health System.
Relaying a metaphor from the documentary, “My Octopus Teacher,” Day said adaptability is key for healthcare leaders at essential hospitals and elsewhere.
“The octopus is an amazingly adaptable creature: he’ll cover himself with shells to hide in plain sight, squish into the smallest place possible, and attach himself to a shark in order to avoid getting hurt by him,” said Day, a 25-year healthcare veteran who has served in diverse leadership roles in large health systems, multi-specialty physician practices, and payer organizations. “I think we as healthcare leaders can focus on making sure we’re adapting to changes around us. We have no shortage of healthcare demand, and so we need to be very creative in building capacity. We found hospital-at-home care to be a particularly helpful initiative that we built ourselves, and we’re building more physical capacity, with a new facility opening next month.”
Dr. Saavedra concurred and extended the metaphor, noting that essential hospitals must keep mission at the heart of every decision they make amidst competing priorities in this new world of disruptive healthcare.
“The octopus only has eight tentacles but is trying to juggle 10 balls in the air,” he said. “It’s not sufficient to just care FOR people; we have to care ABOUT people, and that means our patients, our workforce, our employees. We’ve noticed an incredible interest in shared decision-making, governance, and thinking about strategy and vision. We know that people have made decisions very differently than they have before, with some deciding to become one-income families, others deciding to work part-time, and others choosing different environments. So how do we learn from our own workforce and keep people here rather than continuously cycle?”
Day posited that financial pressures and staffing challenges combine to pose obstacles but can also be seen as opportunity with the right perspective.
“We have to figure out how to create savings elsewhere in order to keep the workforce in place,” said Day. “So we have the twin challenges of that, but we know that retention is much cheaper than recruiting and training a new workforce. We’ve had an interesting dialogue recently here at University Health about understanding generational differences and how we need to modify our thinking as Gen Z becomes a greater percentage of the workforce.”
Dr. Saavedra agreed that changing workforce expectations present opportunities for innovation.
“If we look at all we do every day in healthcare to meet our patients’ needs, we often think about how we staff those needs with workforce rather than how we involve the patient in some of those tasks,” said Dr. Saavedra, who has served in leadership roles at Harvard, Massachusetts General Hospital, and University of Virginia School of Medicine. “Is medical reconciliation best done at the clinical visit, or can it be done at home when you’re at your medicine cabinet? And our higher utilizing patients don’t necessarily need complexity of care; they need help navigating a complex system. How do we use these tough areas of expense to be innovative and to challenge our workforce? Workflow is really the exercise, in my opinion.”
One solution can be using patient advocates to remind patients of their appointments, facilitate communication with providers and staff, help find transportation, and complete financial forms — all of which results in greater satisfaction among patients and providers.
Another part of innovation surrounds the use of AI, augmented intelligence, and predictive analytics to reduce costs and increase quality.
“We tend to think of AI and predictive analytics almost as a futuristic item that we’re going to be incorporating into our care, but it’s already here,” said Dr. Saavedra. “Whether you’re looking at the dermatologist that’s using ELM technology to figure out if something’s melanoma, or intensive care and predictive analytics around sepsis, or transportation patterns offered by venture-backed firms that help predict outcomes — AI is already here. So the question is, how do you learn its capabilities and pilot it rather than fear it?”
Dr. Abraham asked how the panelists’ organizations are developing financial stability plans in the face of today’s brave new world of physician groups consolidating, developing new partnerships with health systems, or being bought by payers and private equity firms, as well as the growth of Medicare Advantage programs over standard fee-for-service Medicare.
Dr. Saavedra said the notion of “co-opetition” — meaning cooperating with competitors to achieve common goals — is something that all essential hospitals need to explore in the context of their respective missions and communities served.
“When a competitor closes a service, we immediately have to stand present to take care of the population that otherwise doesn’t have that service, so we live in a constant state of re-adjusting to what others are doing,” he noted. “How do we adjust to that pressure by creating new partnerships with partners we maybe didn’t think of before? How do you exist in the marketplace and be a good neighbor while thriving?”
He noted that the value proposition in identifying which primary goals these strategic partnerships will fulfill, such as improving access, quality, or information technology systems, isn’t complicated, but that understanding the details — from how partners exchange information to providing seamless patient experiences — is critical.
Day shared that his hospital gained support in the community during the pandemic, which opened up dialogue for being more involved in community decision-making — a key way to differentiate yourself from new players in the marketplace.
He said that his organization’s robust response to the pandemic proved the power of technology and of the essential hospital as a community leader, drawing interest from physicians who were more community focused. “As you become more outwardly focused and less of a self-contained system, then you can really involve yourself in community decision-making,” he added. “Asking open-ended questions to the physician community when you’ve not had that dialogue before is a winning strategy for being competitive in the marketplace.”
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