Becker's Hospital Review touched down in Orlando last week to ask three questions of hospital, technology and advisory firm leaders. Here, respondents share their response to question No. 1: In 2019, who are hospitals biggest threats and who are their biggest allies?
Read compilations for questions No. 2 and No. 3.
Jose Barreau, MD. CEO and Co-founder, Halo Communications: Hospitals' biggest threat is the government. If there is a big push to single payer healthcare, it's going to change a lot of things; it's going to blow up a lot of business models. It could have a major impact and it might really become a reality. I'm not saying it's bad or good, but it's definitely a threat to the existing model.
Their biggest allies should be their own internal physicians and nurses. If they listen to them and how to provide good care, everything takes care of itself. Clinicians are not always seen that way. Sometimes they are seen as employees rather than allies. I am coming from a doctor's standpoint, but i think when they buy practices, physicians are not seen as allies anymore, and I think that’s a mistake.
Keith Bigelow. General Manager and Senior Vice President, Analytics and AI, GE Healthcare: A lot of different companies are trying to consumerize healthcare, especially addressing the patient in home with remote devices, such as the Apple Watch. Combined with devices like Alexa or others, people may start trusting their physician and hospital as one voice of many in their care opposed to the voice they trust. That puts pressure on clinics and hospitals, because they don't easily have means to share and consume data from systems in the home. Only certain institutions will be able to forge the gap. For allies, I think Amazon, Microsoft, Intel — these are great partners to healthcare institutions and yet [hospitals] see them as competitors. That's an opportunity for hospitals — how do I embrace cloud, deep learning and AI? If you don't have these partnerships, how can you do that? I think many hospitals are just flat-out resisting because of concerns around security, compliance and risk. Those are great concerns that should be honored, but I don't think there are as many people concerned with security in a hospital as there are in Amazon. That's a full-time job for lots of people there. Partner with these entities versus seeing them as competitors.
Paul Black. CEO, Allscripts: I saw an article titled, "It's Time to Fire Your Doctor." That idea was blasphemy for the last 400 years because healthcare has been built upon the trust and relationship between the patient and the physician. That has been the core. But now we are starting to tease apart the question of, "At what point in time do I actually need my doc? Who is my doc, and does my doc really know me when he or she is doing seven-minute visits?" The patient-provider relationship is getting pulled further and further apart. For my children, their phone may be their trusted source to find healthcare. It's going to be, "I want to see a doctor this afternoon." Not, "When is my doctor available?"
Eric Chetwynd. General Manager of Healthcare Solutions, Everbridge: I would say coming out of last year we noticed a couple core threats, one being workplace violence — shooters, mass casualty incidents. We think about how resilient the hospital is to respond to those — they happen almost every day. Twenty percent of all nurses will be physically assaulted in the next 12 months. This problem bleeds into the whole talent conversation — think about how hard it is to recruit nursing staff, then you have a layer of workplace violence affecting them. Nurses and staff don't feel management is listening to them, and then they quit. On the IT side, we are focused on cybersecurity and protection from ransomware attacks. Where so much of hospital infrastructure is now wi-fi enabled, there is a lot of risk. There is not as much resilience in those [health system] IT systems compared to corporate America. Finally, there continues to be a struggle with how clinical teams — especially in diffused, spread-out scenarios — continue to work together. For high-acuity patients, how do those teams really collaborate and respond well. EHRs were once seen to solve the communication problems, but they haven't.
Rhonda Collins, DNP, RN. CNO, Vocera: Consistently, one of the biggest threats is the inability to completely integrate across all platforms. It continues to be a real challenge for hospitals. We were just having this conversation with UCLA. It's taken them a little while to go-live because had so many different platforms that they had to pull in. Hospitals are still so diverse in how they build their platforms, so when you do come in, it's an exceptional challenge to get it integrated.
I do think that really deep partnerships with companies hospitals have invested with — whether it's their EHR, or a communications strategy like Vocera, or if it's even consulting parties who help manage operational issues in the hospital — those are the people who know and understand the landscape of healthcare. We all are struggling because it's so unstable. We're not exactly sure how it's going to turn out, but I do think when we work together, we do create a pretty powerful force.
Pete Durlach. Senior Vice President, Healthcare Strategy and New Business Development, Nuance Communications: Hospitals' biggest threat is actually a what — not a who — and should come as no surprise: it's physician burnout. If those on the frontline of care are in pain, the trickle-down impact will run deep in terms of patient experience, patient and care team retention, organizational quality and revenue over time, and ultimately access to care. Secondary threats are outside disruptors. From the likes of "big brands" that are potentially entering the space (Amazon, Google, Apple, CVS, etc.) and non-hospital players (urgent care centers, ambulatory care centers and growing specialist-oriented centers of excellence). The biggest allies are health IT and digital health players; those ranging from EHR vendors to patient monitoring to telehealth. Any innovator who can help hospitals achieve their mission and bring technologies to help deliver the quadruple aim of quality, cost, and both physician and patient satisfaction.
Garri Garrison, RN. Vice President of Performance Management, 3M Health Information Systems: The payers are their allies. I don't think they recognize it. In past years, the relationship between payer and provider has been adversarial at best, but that's really changing. I worked on the provider side for years. Three years ago, I took over our payer market. What I found with the payers is they are very reasonable. They want cost down, quality up as much as the provider does. The provider looks at it and says, they are here to make sure I get paid less. That is not my experience with the payers. What the payer wants to pay for is quality of care, and if their members are getting quality of care, they're not going to drive your prices down. Are they going to drive prices down to make you change your behavior? That's the only way you've been able to get traction to get people to change behavior is to follow the money. If I'm spending more for complications, I am going to penalize you if you can't get a handle on that.
I'm in a unique position to sit between the payer and provider, and I find they are both looking for the same thing, so my perspective is if you as a provider really reach out to the payer and acknowledge that you want to find a win-win for both of you they are going to be your biggest ally.
Alan Hughes. President, NTT Data: Their biggest allies are the consumer, believe it or not. It's the consumer and what the consumer is looking for from an engagement perspective that will inform and allow hospitals and providers to become better at what they do. Traditionally, when you draw a diagram of a health system, the hospital was in the middle of it. Now when you draw a diagram it's all about the consumer being in the middle and everyone around the consumer. We all have to learn how to take input from the consumer about what it is they are looking for and turn that into capabilities and offerings.
Hospitals biggest threats are themselves. Externalizing their view of themselves in the marketplace is something that is still very difficult for them to do. Every industry is a machine, but when you are on the hospital side, you tend to get sucked into the machine and having that external view is very difficult.
Greg Kuhen. Senior Director, Research, Advisory Board: The verticals we are seeing composed of an ambulatory setting with a PBM and insurer have a very significant ability to draw volume out of traditional health systems. That will make the large fixed cost structure of those systems unsustainable. These verticals are able to deliver commodity services at lower costs amid an overall shift of payers and CMS driving more and more procedures to ambulatory settings. All of that is eating away at traditional health system volumes. When it comes to allies, it's data. When hospitals can become truly data fluent organizations, they are very much positioned to meet the triple aim of better care quality, better patient satisfaction and lower cost. I think we will see that in digital therapeutics, which I think was a little bit before its time. I think we will see hospitals acting as information hubs for some of their patients wearing wearables. Health systems will also need to tackle the cultural challenge that comes with data — can they go where data is telling them to go? Can they change their practice based on quantifiable outcomes? If so, then they have a future. Otherwise they are going to become high acuity procedural centers, and that's not a good place to be.
Tushar Mehrotra. Senior Vice President, Analytics, Optum: If you think about the adoption of analytics in health systems, the biggest threat or competitor is almost the culture within the health system itself and being able to drive that change and adopt and accept that new technology. Hospitals have generally been slow to adopt to new tech anywhere. For them to actually get value from it, it's about top-down adoption by the executive team and experimenting pretty regularly. I also think hospitals aren’t going to be able to build all these capabilities in-house. A thoughtful partner can help them and provide talent and resources. A health system needs to be thoughtful about not picking 20 different vendors and getting overwhelmed by how to work with them.
Dan Michelson. CEO, Strata Decision Technology: Their biggest threat is inertia and their biggest ally is physicians. Competitively speaking, if you have a multibillion dollar health system, the fact that someone is opening a small retain clinic isn't going to cut into your business as much as you might think. From a federal government perspective, people are worried about Medicare-for-All. It's out of their control. We need to shift what strategies senior executives are focused on. It's inertia. They've got to be able to break away from looking at things through a fee-for-service lens.
I don't think people have viewed physicians as allies, and they are. They are the ones who ultimately deliver the care. Hospital revenue is driven by decisions of physicians. That is their biggest ally.
Bob Monteverdi, MD. Global Healthcare Solutions Leader, Lenovo Health: It's just this sea change that's causing more of the care, more than ever before, to be done outside the four walls. I think the more they can broaden their attitude to think beyond their four walls the better off they will be. The push is more and more in that direction, to value-based care. We don't talk about it as much as we used to, but it's still the driver. The ally is those executives who get that as quickly as possible and don't try to keep 110 percent capacity in beds and who try to think broadly beyond that.
Karen Murphy, PhD, RN. Executive Vice President, Chief Innovation Officer and Founding Director of the Steele Institute for Health Innovation at Geisinger: I think the biggest threat is that the industry doesn't respond quickly enough, in general, to what patients are requesting of healthcare today. How do we be responsive to meet the changing needs of our patients? The demographic makeup is changing. The complexity is changing. I think the biggest threat to being effective is not figuring out how we change and evolve quickly enough. The biggest ally we have is data. We can leverage data to make those improvements to mitigate the threat of us not understanding patients. The industry, as a whole, has accumulated data in a way that we can turn it into actionable information.
Andy Nieto. Global Healthcare Solutions Manager, Lenovo Health: I think the biggest threat to hospitals is internal. Their biggest threat is rigidity to change. I think their ally is actually the patient — if they are delivering quality care, if they are checking the box on 'I feel better after visiting your hospital and I'm getting well.' Listening to the patient about what the patient wants, what the patient is looking for, engaging the patient as to what the future looks like for them, that's your ally.
Carey Officer. Operational Vice President, Nemours Care Connect, Center for Health Deliver Innovation, Nemours Children's Health System: I see partnerships becoming a bigger play. I almost think payers are going to become a bigger ally in the future than they have in the past necessarily. From a threats standpoint, you start to look at the big organizations who are starting move into healthcare like your Amazons. I think those are the players that we haven't seen as a threat in the past but they are really going to be a disruptor of the future.
Michael Peluso. Chief Technology Officer, Rectangle Health: Hospitals' biggest allies are anything that is going to make that healthcare experience better. Uber Health is a good example. It's a way to physically get more patients into the hospital — that's somebody you want to be allied with. Your biggest threat would be these companies that think they can do healthcare better than hospitals. Certainly telemedicine [companies], if the hospital doesn't take on its own telemedicine department, or any company that's saying, 'Hey patient, don't go to the health system. Come to this emergency clinic or try to stay home and call in to get care.'
Joe Polaris. Senior Vice President, Product and Technology, R1 RCM: One threat is inertia, meaning there is a slow pace in healthcare. If organizations keep making slow incremental moves — problem, solution, problem, solution — I think that is a killer in organizations. Inertia keeps organizations from meeting financial commitments given the rapid pace of pressures and headwinds. It kills innovation, engagement, morale and excitement. And point solutions are a manifestation of that threat. You see hundreds of companies that can solve one little problem. Each one has a compelling value proposition and great story, but the inertia organizations face when they are not doing big moves is a threat. I think allies are enablers of platforms for health. Organizations are going to have to become digital platforms of health; they can't just be brick and mortar. The ally to the health system is the organization that builds everything around the patient from the convenience perspective, value perspective and security perspective.
Bernie Rice. Enterprise Vice President, CIO, Nemours Children's Health System: Threats will be those disruptive forces, like your Walmarts and your CVS's. I was just reading about a CVS shop that they just opened that's more healthcare than the traditional storefront. They're coming. Amazon bought PillPack. You know they're driving that at the consumer level, and that's going to change traditionally how medications are delivered and monitored and tracked. That's good, especially in the adult world if we're able to monitor if someone is taking their medications at the right intervals so they're not returning to the ER. It's true in pediatrics too. There could be a lot of advancements that will help the patients, but threaten the traditional delivery systems.
I would say other hospitals are allies. At the Children's Hospital Association meetings, it's been about how can we share data more and be less in competition. It's really about the data and how do we make the care better. Especially if we're sharing with Rady Children's Hospital on the West Coast, where we don't compete in the same market, but we can share data and operations and lift all boats.
Lisa Romano, MSN, RN. CNO, Vice President Clinical Services, CipherHealth: The biggest threat to hospitals is in this traditional model of care delivery, where you come into the hospital, you have this set length of stay and you're discharged, and maybe we're going to make a follow-up phone call and check on you. It can't just be limited to that. Hospitals' have to think about efficient, safe care in areas other than the hospital and really following that patient across the continuum and meeting them where they are in that journey of care, rather than thinking the patient is just going to come to them.
Andrew Schall. Director of User Experience, Modernizing Medicine: Telehealth. There are companies that focus on complete telehealth solutions, and I think doctors don't want to lose that connection with their patients. While they see the advantage of something like that, they realize the convenience it offers the patient, it might not provide the same quality of care. As that technology starts to gradually make it easy to do a virtual visit with any doctor, it opens up competition on a much larger scale than providers are used to.
Roy Schoenberg, MD, MPH. President and CEO, American Well: Other hospitals are their biggest threats because hospitals are reimagining their footprint, specifically embracing technologies that allow them to spread their wings and be more available and more involved in geographies around them. Hospitals that factor technology into operations beyond the EHR are going to the be the ones that create a threat to other hospital systems around them. The other thing I would say is that this is a perfect storm because with that comes changes in reimbursement and changes in physician licensure that allow physicians in one location to care for patients in other states. As you can imagine, those health systems that take advantage of that are really going to be in a position to reimagine their footprint. It's not a threat – it's an evolution. Telehealth is their biggest ally.
Zach Silverzweig. Co-founder, CipherHealth: As someone who does a lot of work with security — we treat our patient data very seriously and take our obligations there very seriously — I think the whole threat around cybersecurity this year definitely is top of mind. It's the same kind of innovations that have made it easier to develop applications and to launch businesses have also made it a lot easier to hack and create malware, spyware and different types of attacks.
Don Soucy. Executive Vice President, Global Sales, Spok: Consumers have choice, especially as it comes to consumer experience, cost and ease of access. It's ambulatory surgery centers, it's the MinuteClinics of the world, it's concierge physicians. It's anybody that can figure out a way to provide a better experience, at a reduced cost and save people time. That includes anybody that can do self scheduling. Organizations have to partner. If they don't partner with ASCs, then they lose a lot of business. Let's face it, they build these ASCs almost like tourism destinations. You get valet parking, the rooms are beautiful, but you don't have to deal with nursing overnight, you don't have to deal with the typical chaos of the hospital. You are in a hotel-like setting. It's the Ritz. You're checking in, you have great technology, marble flooring. Get your procedure done that morning and you are discharged that night. It's tough to get that type of experience in a hospital, so organizations are really trying to partner with those folks because they are a threat.
Dan Trencher. Senior Vice President, Product and Strategy, Teladoc: The honest answer is a little cheeky, but I think their biggest threats are themselves. In many places, competition is greater within hospital systems for the patient experience and for mindshare in the market. Beyond that, I'd say their competition is healthcare moving outside the walls of the hospital, whether to urgent care, a walk-in clinic or other sites of care. I see virtual care as more of a tool and ally to basically enable the hospital to follow through on their strategies. Some hospital systems are focused on competition against the hospital across the road for patient flow and mind share. Those systems may have telehealth to support that strategy by bringing new patients in and familiarizing them with their brand. Others are more concerned with cost of care and avoiding readmission penalties, and telehealth is also a big tool for achieving those goals too.
Randy Tomlin. Chairman and CEO, Mobile Smith Health: It's the self-insured companies that take care of 80 percent of Americans. Hospitals can either be a real friend of them, or if they stay the course, they will become irrelevant because the people paying for healthcare are self-insured companies. They haven't had a large voice in healthcare. They are going to start using their dollars —they are spending about $10,000 per employee for healthcare — they are going to start making requirements for healthcare to become more efficient. If hospitals begin to consumerize healthcare, move away from these large brick and mortar hospitals, move more toward the day care things and mobile services that can take care of employees, then the self-insured companies will be the best friends of hospitals. If the hospitals don't move to that, then these companies are going to come up with answers and they are going to standalone alternatives to hospitals, and it's going to be the hospitals' biggest threat.
Tom Utech. Vice President of Marketing and Strategic Innovation, BD: In 2019, probably the biggest threat is nontraditional entrants into the healthcare environment. It's not so much going to be challenging the hospital model, I think it's going to be more challenging the nonacute care model, which continues to draw patients out of the hospital. Naturally overtime we are going to see that anyways — we've already been seeing it. Patients are going to the outpatient side for procedures. Some of the nontraditional people in this space are even going to pull that harder out of the hospital space. Opportunities [for hospitals] are for them to partner. We're getting into this whole new level of consumerism, and people are very digital. Then partnering with some of these players can be the opportunity for the things they know how to provide. Hospitals and health systems know how to provide care, so how can they pull that into the consumer market and the digital market?
Wes Wright. Chief Technology Officer, Imprivata: From a financial perspective, the biggest threat to hospitals is the pulling out or stripping of lucrative services such as plastic surgery and dialysis, both of which used to be done in a hospital but are now opening in outpatient clinics. The low-hanging fruit has been pulled from hospitals. From a security and cybersecurity perspective, the biggest threat is the hospital's employees — not from a malicious context, but because of successful social engineering and all the stuff employees accidentally do. Lots of people click on phishing emails, for example. Then there's malware and network penetration. There is a lack of security awareness in most of healthcare. That's why the healthcare employee is the biggest threat from a cybersecurity perspective — and they're not doing it on purpose.
Megan Callahan. Vice President of Healthcare, Lyft: Hospitals have a great opportunity to collaborate with technology companies to improve the patient experience and drive patient satisfaction and loyalty — including digital health organizations who provide new models to navigate the clinical and financial patient journey.
One of the ways we're doing this at Lyft is improving patient access through partnerships with companies like Allscripts or with Medicare Advantage, which allow providers to call NEMT for patients and expand transportation access for seniors, respectively.
Jason Considine. Senior Vice President, Patient Collections and Engagement, Experian Health: Hospitals have competition more and more from local urgent care imaging clinics. People like options. Hospitals have typically been a place you can get great care, but they are normally the higher cost option. They face continued pressure from those types of urgent care, smaller facilities. I also think payers create an interesting dynamic. Payers are buying physician practices. I haven't seen a payer buy a hospital yet.
Hospitals biggest allies are companies helping hospitals have better relationships with patients and navigate the problems they have. I also think the patient is an ally. Patients don't like to switch doctors. If hospitals transform their businesses, have a better and more transparent relationship with providers they know in their communities, patients will be their allies.
This article was updated Feb. 25 at 10:10 a.m. CST.