Ellen Feinstein, RD, MHA, FACHE serves as Vice President of Cancer Services for The University of Chicago Medicine.
On April 12th, Ellen Feinstein will speak on a panel at Becker's Hospital Review 9th Annual Meeting. As part of an ongoing series, Becker's is talking to healthcare leaders who plan to speak at the conference, which will take place April 11-14, 2018 in Chicago.
To learn more about the conference and Ellen's session, click here.
Question: Who or what are the disruptors that have your attention? Why?
Ellen Feinstein: Market consolidation continues to be a major opportunity and potentially disruptive force that all providers — private practices, hospitals and payers — need to heed, as former competitors join forces to leverage influence and compete for greater market share. The technology advancements in information, biomedical devices, diagnostics, genetics and genomics, and new approaches to disease prevention are positively impacting the ways care is provided. It's also changing how our patients' individual needs and genomics impact if, and what, care they receive. The changing workforce is also a significant disrupter, as baby boomers with work-life balance challenges are leaving the workforce. Early careerists in healthcare management are emerging, seeking quality of life, accelerated career advancement and user-friendly tools and processes they are accustomed to in their personal lives, such as access to on-demand mobile services. Through digital health and telemedicine, the way providers interact with patients is changing and will continue to evolve as the market continues to move towards value-based models and the needs and wants of consumers.
Q: Describe one of your best colleagues. What it is that person does/brings that makes them indispensable to your organization?
EF: There are many role models in my years as a healthcare administrator who come to mind. The attributes I recall most vividly are those who are terrific listeners, and who are not necessarily at the top of the pecking order, but serve as informal leaders. They are accessible, affable and highly capable, yet comfortable enough in their own skin to not need to appear to be the smartest person in the room. Those who are able to establish and sustain positive relationships with everyone they work with, across many stakeholders, are most successful. If they do so with a sense of humor and humility, they attract many within their orbit. They also go out of their way to recognize and thank those who support their work, and do so sincerely, and often.
Q: What did you notice about your healthcare experience the last time you were at the receiving end as a patient?
EF: Depending on where the care was provided — private office versus outpatient hospital setting — I've noticed appointment confirmation texts to prevent no-shows are more prevalent than ever, and private offices more often run on-time compared to hospital settings. As a first-time patient, I still marvel at the dependence on paper for patient self-reported histories, and the need to make appointments by phone, versus online — a la Open Table for restaurants. Care coordination is a goal of most hospitals, yet they often struggle in how to deliver it. Though everyone's time is precious, I'm still surprised early morning, evening or weekend appointments are not always available. The use and acceptance of advanced practice providers (i.e., nurse practitioners and physician assistants) is definitely on the rise, which positively impacts access and service.
Q: All healthcare is local. What about your market influences your organization's business or operations most?
EF: For ""routine"" care, patients and their families prefer to stay local, as convenience is paramount. And it's a level playing field in terms of quality and expertise for those services. For life-limiting diagnoses, specialty pediatrics and tertiary or quaternary care, patients are relying somewhat less so on the recommendations of their primary care providers, and increasingly doing their own extensive research on the web. They're looking to find specialists who are the best in their field or who are the most experienced experts for their specific diagnosis. That's all positive. But given the barriers that insurance contracts can pose, patients are sometimes caught unaware of their limited choices. They often desperately depend on out-of-network providers to help them obtain authorizations, which may not be forthcoming, at least not at affordable out-of-pocket expense. They, and the specialty referral centers, are sometimes caught in the middle.
Q: Please share a new consumer-centric capability your organization has built or tapped into within the past 18 months.
EF: I'll give you three of many examples. We recently started working with a vendor who makes ""lab house calls"" to our cancer patients who need to have blood drawn the day prior to their chemotherapy. The benefits of convenience are obvious to the patient, but it also benefits the cancer center in that it saves precious waiting time for lab results to be reported when drawn on the day of the chemotherapy visit, and it helps with overall efficiency and throughput in our busy infusion center, while not sacrificing the revenue our hospital receives for the diagnostic testing.
From an access perspective, opening community-based specialty care centers that allow patients seeking academic medical care closer to home has been well-received, particularly due to our convenient hours and user-friendly appointments and check-in features.
Our pharmacy implemented a ""meds to beds"" program last year that's been a big crowd pleaser. When a patient has outpatient surgery and will be leaving with a prescription for pain control medications, the order goes electronically to our retail pharmacy, and the meds are delivered to the patient prior to discharge. The same is available to our inpatients who are being discharged with home medications, which not only is a significant convenience to our patients, but also helps us retain revenue that could have been lost to a competing retail pharmacy.
Q: When was the last time your organization responded to concerns or needs expressed by physicians? What unfolded?
EF: As an academic medical center, we work closely with our faculty in all planning, process improvements, new facilities, programs and improving quality and safety, to name a few. As an example, we are building a new, expanded emergency department, which will also house a new adult Level I trauma center. Our physicians and staff are in lock step with every aspect of that project, since they are the ultimate operators of those facilities. They are informing everything, from the layout design, workflows, communications, technology systems and care delivery from intake to discharge or admission.
Q: What change in reimbursement is your organization feeling most acutely and how is it affecting your 2-5-year strategic plan?
EF: AMCs have higher expenses and different cost structures from community settings, and we are focusing on the value equation of cost and quality more than ever. We have entered the world of value-based contracting with several payers, and there's now a shift from a long-standing culture of volume to value. This is no longer an option or experiment, but a necessary adaptation, as we move the cost curve to provide the right care in the right setting at the right price.
Q: How do you define patient engagement?
EF: There are many definitions, but we look at it quite simply as making all decisions by determining patients' and their families' goals early in the care journey. We want to make sure we're helping them make informed care decisions based on their individual preferences, physical and psycho-social needs, and that we're continuing to honor their wishes and needs throughout their experience. One example is the formation of patient and family advisory councils, where they inform us of the patient perspective as we improve processes, build new facilities and create new tools to make it better for the next patient.
Q: As a leader, what is the best investment you made in your own professional development in the past five years?
EF: As a newly relocated executive from a city where I had worked for over 30 years and where I had an extensive professional network, my best investment has been to tap into the local chapter of the American College of Healthcare Executives. I am cultivating a new professional network, getting involved in mentoring, career development and advancement. It's also a chance to give back to help those who are just starting out, as I was three decades ago. This investment is truly rewarding, and gives me a sense of belonging within a new market where I truly didn't know anyone in my profession.
Q: How do you see the barrier between competitors and collaborators changing?
EF: Referring back to current environment of increasing market consolidation, it sometimes feels like a case of strange bedfellows. Those who were competitors yesterday are now merging, acquiring, collaborating or affiliating today. The emergence of ACOs are perfect examples of these innovative collaborations, where the best of all worlds are coming together as partners to create models that bring value and greater access to patients, employers and payers seeking to reduce costs, while not sacrificing quality and safety. I often tell early careerists to be mindful of who and how they interact with competitors and colleagues. We never know who we may be working for, or with, in this dynamic environment.