Tom Sullivan | January 13, 2020
Health Evolution interviewed top-tier provider, payer and life sciences CEOs to delve into their most pressing agenda items for 2020 and beyond.
Snapshot: Change quickly or risk failing.
“If I don’t move 180 degrees I’m going to be part of a dying breed,” says Steve Klasko, MD, CEO of Thomas Jefferson University and Thomas Jefferson Health. Marshfield Clinic CEO Susan Turney echoed that sentiment. “We know if we don’t do things differently, our competitors will — and they’re not just our competitors of the past,” Turney says.
Whereas some of the undertakings are not entirely new, that striking sense of urgency is prevalent among chief executives. Let’s take a look at what CEOs told Health Evolution about their top priorities.
Value-based payment: Still not coming quickly enough
BCBS Rhode Island CEO Kim Keck cuts to the chase: “The way health care is delivered and paid for needs to come together, literally under the same roof, and it’s happening, but not fast enough.”
Klasko points out that for all the talk about value-based care, fewer than 10 percent of actual income is based on it, while Iora Health CEO Rushika Fernandopulle, MD adds that in such a complex industry sweeping transformation won’t happen overnight.
“We’re starting to see the wave changing, and for a lot of reasons: CMS driving change, employers driving change, new entrants, a lot of those are pointing in the same direction: value-based care,” Fernandopulle says.
He also evokes the once-unforeseen disruption Netflix inflicted on the video store industry and then again to movie theaters and network television as examples of how the shift to value might pick up momentum in the future and accelerate the pace of change.
“I think that what is easy to forget when you look at, say, Netflix, is that things were changing slowly until they weren’t,” Fernandopulle explains. “We’re not there yet with value-based care but we’re starting to approach a critical time of change.”
Carilion Clinic CEO Nancy Howell Agee says that her system has been working toward value-based care for more than a decade. The provider even created the infrastructure to achieve better care for patients with multiple chronic conditions, but agrees with those that say the transition is not happening fast enough.
“We’ll go farther into this and partner with payers but it’s truly an evolutionary journey,” Agee adds. “Not a revolutionary one.”
Highly efficient care models: Improving care can payoff
It’s no surprise that CEOs are rooting out inefficiencies. This trend will likely continue well into the future as cost becomes even more of a focal point.
Premier CEO Susan DeVore says her organization is thinking in terms of “a total cost management approach” that is judicious when it comes to everything.
“We call it holding every penny prisoner,” DeVore explained. “Going after every source of waste and inefficiency and weeding it out, cutting any and all duplication, streamlining administration, using the most efficacious and cost-effective supplies, not providing care that has no demonstrable positive outcomes, to name a few. It’s a tall order, but necessary for long-term sustainability.”
Agee explains that Carilion’s long-term strategy to change its care delivery model, which included transforming several primary care practices across 200 miles into medical homes and implementing widespread case management, is starting to yield results.
“We’ve demonstrated we can change care and provide excellent care — we can also tell you it’s costly to do,” Agee says. “But we’re beginning to see the financial benefit.”
Social determinants: For the community, and your own, sake
Iroquois Memorial Hospital CEO Don Williams lists his main priorities in the next 3-to-5 years as maintaining a focus on the community and evolving that strategy to establish Iroquois as a “conduit for holistic community health” by empowering its people to take chances because they understand that “leaders in the C-Suite are willing to take the brunt of mistakes.”
“We tell our people all the time, ‘Go do something good. If it doesn’t work out, it’s [the CEO’s] fault. If it works out, you get the praise,’” Williams says. “In the next three to five years, I want to have an organization that embraces that mentality such that we are fully immersed in our community.”
ChristianaCare CEO Janice Nevin, MD, says the system is also rethinking how it works with social determinants, including building a layer of mental health access and establishing a community investment portfolio. “We are explicitly saying ‘we’ll invest in housing, in food insecurity, in violence prevention,’ as examples,” Nevin says. “We’re going to track those investments to see how they’re doing.”
Affordability and coverage: Critical to sustainability and growth
“The health care ecosystem is incredibly broken,” Klasko says. “Just giving more people access to an inequitable and sometimes unsafe system is not the answer.”
Thomas Jefferson, to that end, is prioritizing what Klasko describes as a fundamental transformation from hospital care to “health care with no address.” The goal is to deliver patients care how and where they consume everything else: at home or close to home via digital technologies.
Taking a similar view, Nevin says affordability and coverage are critical to growth and success moving forward.
“We have to create the kind of experience around access that creates value for people, allows them to achieve health goals they set for themselves and to do it in a way that is affordable to them,” Nevin says.
As part of its efforts to broaden coverage and make care more affordable, AdventHealth is putting priority on a care navigation process, according to CEO Terry Shaw.
This process is designed to eliminate gaps in care, enable synchronous and asynchronous access to deliver care, answer questions from consumers and family members, make care services available within a 15-minute radius of its population’s home 95 percent of the time, and offer a price guarantee on its top 500 offerings, Shaw explains.
Carilion Clinic’s Agee adds that her health system is deploying “technology to improve access, such as telehealth and telemedicine, as well as mobile devices and wearables.”
AI, machine learning and predictive analytics: A new era
AI and analytics are widely believed to be ushering in a new age wherein organizations consider data a raw material they can transform into information that is a strategic asset.
“We’re growing data analytics, artificial intelligence and machine learning,” ChristianaCare’s Nevin said. “We’ve been asking ourselves if in 2025, will we be a data company that happens to deliver health?”
ChristianaCare is not alone in that thinking. Machine learning, predictive analytics and AI are still over-hyped, of course, but they are showing signs of considerable promise and leading CEOs are already seeing changes to key areas of their business, notably in Klasko’s case the c-suite, growth strategies and partnerships.
“I believe a good part of health care will be at home and involve artificial intelligence and machine learning,” Klasko says.
Likewise, Agee says Carilion is employing a similar mindset and is continuing its care transformation journey with AI, machine learning and analytics. Carilion’s nurses use AI, for example, to put information from charts and vital signs together and to augment caregiver knowledge in ways that have already helped reduce patient falls.
Steve Udvarhelyi, MD, CEO of Blue Cross Blue Shield Louisiana, points to early AI wins in dermatology and retinal screening for diabetic retinopathy as interesting examples of the technology in certain instances achieving fewer errors than human clinicians.
Consumer tools for engagement: It’s the ‘entire experience’
CEOs said the need to more effectively reach and engage the people their organizations serve is both coming and sorely needed.
To that end, payers such as BCBS Rhode Island are concentrating efforts on creating a better patient experience.
“Over the years we’ve heard the phrase patient-centric and that’s fine but it’s also more basic. It’s getting care and insurance when you need it and want it,” BCBS Rhode Island’s Keck says. “It’s building the kind of experience people have in all other aspects of their life. Just getting a ride now with Uber or Lyft, you can rate the driver, map the route, take that through an entire day, or the same thing for shoes you bought. We have nothing like that in health care.”
On the life sciences front, Edwards Lifesciences is focused on what CEO Mike Mussallem described as cutting-edge technologies that enable groundbreaking standards of care.
“Innovation can and will transform care for patients around the world,” Mussallem adds. “It’s our responsibility to provide compelling evidence and education so that patients can get access to the best, most advanced therapy, at the right time and the right place.”
Ochsner Health System is among the providers also working to improve the experience it delivers.
“We think about how people will consume health care in the future, how we can use information to provide a better experience, how we use data to take care of patients in a better fashion,” says Warner Thomas, CEO of Ochsner. “For the last 10-15 years, health care has gone to EHRs, the real power is now we have to figure out how to put that data to work to be more proactive and predictive.”
Marshfield’s Turney also ranks experience high on the priority list and she says it’s not just about patients. “It’s really the entire experience of those who seek care, provide care, partner with public health — it’s about making it easier for people to navigate the system, expanding access to care and having the whole experience be friendly,” Turney says. “That sounds sort of simple but it’s true. Care is daunting.”
New entrants: Threat or promise?
The phrase “new entrants” suggests the likes of Apple, Amazon, Google, Microsoft and other vendors brimming with potential to disrupt the industry, whether via new insurance models, emerging technologies or cutting-edge care delivery. And there are more players looking to make a greater impact on health care.
“It’s all the disruptors, the national payer strategies, national pharmaceutical strategies,” Turney says. “We have to be vigilant and very smart about how we change.”
Taken together, the class of new entrants either pose a formidable threat, open new partnership possibilities or both, depending on one’s perspective.
“We view what they bring to the table as potential for partnership,” says Cedars-Sinai CEO Tom Priselac. “Candidly, the people successful in the future are the ones who figure out how to partner — and there is no doubt in my mind that what they bring to the table will be part of making health care a better experience for everybody.”
Talent pipelines and culture
Talent and culture in health care, like every industry, are always major issues. Nearly every CEO we interviewed ranks them as top priorities for the next three to five years (if not forever).
“Talent has become such an important component in the changing world we’re in today,” Ochsner’s Thomas says, adding that Ochsner is prioritizing building its talent pool across clinical practice as well as its administrative and technology workforces.
Nevin says ChristianaCare is investing in workforce pipeline programs with higher education and high schools to attract people who might otherwise not be aware of the opportunities in health care.
“The talent we’re going to need five years from now is being created very differently than I always thought about how to train people and the role they play,” Nevin says. “The job you’re going to have five years from now doesn’t even exist today.”
Health care organizations are going to have to adjust, if not overhaul, their culture for that future workforce within and outside their own walls.
Takeda Pharmaceuticals U.S.A. President Ramona Sequiera, for instance, said the company has an algorithm for creating the culture its employees and consumers deserve: patient, trust, reputation and business.
“How do we support the patient? How do we build trust with society? How do we enhance the reputation of the company? How do we build our business through that lens?” she adds. “How do we combine our culture and our values of patient, trust, reputation and business?”
From there, Takeda’s focus is on improving as a company in the way it serves patients, engages the community, and is a place where people feel that their voices are heard and they are empowered to achieve their goals and help patients.
“We want to continue to make progress on diversity and inclusion altogether. We pride ourselves on our culture,” Sequiera adds. “We want to always take the long view of what our business is.”
Gabriel Perna, Senior Manager of Digital Content, contributed to this article.