The rules of healthcare are changing: the tools transforming, the resources shifting — even the definition of success isn't firm.
As health systems grow and ownership concentrates, both C-suiters and physicians can feel the growing pains. Population health and value-based care initiatives are changing the way providers approach their work. New technologies present new opportunities, but also new risks and challenges. If one thing is definite in healthcare right now, it's that nothing is definite.
On Nov. 5, at the Becker's Hospital Review Annual CEO Strategy Roundtable, a dozen industry leaders came together in Chicago to discuss how they are navigating the dramatically changing landscape.
In a panel-style discussion, the leaders addressed their priorities and challenges, the effects of the Patient Protection and Affordable Care Act, the physician workforce, population health, C-suite size and bandwidth, independence and the outlook ahead.
Note: The following excerpts have been edited for clarity. This is part one of a two-part series.
Participants
- Dianne Anderson, RN, President and CEO of Lawrence (Mass.) General Hospital.
- Terry Akin. CEO of Cone Health (Greensboro, N.C.).
- John Brennan, MD, MPH, CEO of Newark (N.J.) Beth Israel Medical Center and Children's Hospital of New Jersey.
- Alan Channing. Former CEO of Sinai Health System (Chicago).
- Phil Kambic. President and CEO of Riverside Health Care (Kankakee, Ill.).
- Luke Lambert. CEO of Ambulatory Surgical Centers of America (Hanover, Mass.).
- Chuck Lauer. Former Publisher of Modern Healthcare (Chicago).
- Tom Mallon. Founder and CEO of Regent Surgical Health (Westchester, Ill.).
- Julie Manas. President and CEO of Sacred Heart Hospital (Eau Claire, Wis.).
- Ora Pescovitz, MD. Former CEO of University of Michigan Health System (Ann Arbor).
- Jim Rohan. Vice President and Managing Director of SullivanCotter and Associates (Chicago).
- John Jay Shannon, MD. CEO for Cook County Health & Hospital System (Chicago).
On priorities and challenges
Terry Akin. CEO of Cone Health (Greensboro, N.C.).
Physician partnership. There's a place for independent and employed physicians. We had nearly 1,000 physicians opt into our accountable care organization, and the majority are independent and our ACO is physician-led.
John Jay Shannon, MD. CEO for Cook County Health & Hospital System (Chicago).
The biggest challenge for us is monumental culture change. I work in an environment where people come in and they plug in for career service. We're an organization that has done wonderful but that hasn't had patient experience being a big part of that. We have to get people to understand that we need to compete for patients. We need employees to be responsive.
Dianne Anderson, RN, President and CEO of Lawrence (Mass.) General Hospital.
I believe the most important thing for me to focus on is to create a system to bring the physicians and community partners together and be successful at population health. It is really daunting. It takes adding resources to the organization to manage patients outside the walls of the hospital.
John Brennan, MD, MPH, CEO of Newark (N.J.) Beth Israel Medical Center and Children's Hospital of New Jersey.
There are three things I need to do. 1) Obtain alignment with payers, physicians and the community, 2) achieve cost reduction and managing off of Medicare costs and 3) create the infrastructure for population health management, which means adding a whole new skill set of providers who are going to be working a whole different set of skills for the community.
Tom Mallon. Founder and CEO of Regent Surgical Health (Westchester, Ill.).
Our mission is to help our health system partners execute their ambulatory strategy partnerships with physicians. We think our mission will evolve into setting up community-based retail-like ambulatory facilities for our health system partners over the next five years.
Julie Manas. President and CEO of Sacred Heart Hospital (Eau Claire, Wis.).
For me, I try not to play fireman, running around putting out fires. I wear three hats: I am CEO of 350-bed hospital, I am regional CEO and I also serve on the team for the health system. I try to split my time from strategic to operational initiatives. We have metrics and balanced scorecards — that helps drive the operational focus — and then three- to five-year strategic planning. Day to day, it's about communication and visibility.
Luke Lambert. CEO of Ambulatory Surgical Centers of America (Hanover, Mass.).
In my organization, I probably spend about two-thirds of my time interacting with health systems and other companies in my industry who I am looking to sell a center to or merge a center with. The other third of my time is spent working with various leaders within my company to help align our initiatives and efforts to ensure we're coordinated together.
Jim Rohan. Vice President and Managing Director of SullivanCotter and Associates (Chicago).
I'm in board level compensation meetings three to four days a week. When I look at [CEOs], I don't know how you stand up because it seems to be 24/7 job. Peter Drucker said the hospital is the most complex organization ever devised. That was in 2000, before healthcare reform, networks, medical homes and accountable care. On top of all of those things, you are getting bigger and getting more complex. You also have to get ready for shift in reimbursement and payments based on value and population health. When it comes to boards, these people have never worked harder or longer. They have to be much more creative and they are developing new skill sets because they know all the rules have changed.
On the Patient Protection and Affordable Care Act
Chuck Lauer. Former Publisher of Modern Healthcare (Chicago).
It has gone fairly well because the industry has cooperated with some of the basic tenants of the ACA. The industry is remarkable in how it can adjust to dramatic change. It really is quite amazing. I had the opportunity of moderating a 50-CEO panel at Claremont College that Peter Drucker was on, and I got to listen to him speak for three hours straight. He was extolling the virtues of the great American healthcare system. He was a great advocate for the way we did things. I think this is a great time to be in this industry.
Terry Akin. CEO of Cone Health (Greensboro, N.C.).
[The PPACA] was the product of such a politicized process that it only has a vague resemblance of how it was initially intended. There are various ways of gauging its impact. [Cone Health has] chosen to try and distill the principles that are inherent in the PPACA. No one is going to be able to run away and hide from value.
Tom Mallon. Founder and CEO of Regent Surgical Health (Westchester, Ill.).
If I look at it selfishly, it's been very good for us and our business. It has scared the health systems straight. We don't know what the ACA is yet, because so many provisions have been delayed or haven't started yet. So we won't know what this looks like, but it scared all of us straight. We started doing things better, faster and more affordably. Even the major academic medical centers, which had been so insular, are looking to reach out to new partners. So, overall, the PPACA has been good.
John Brennan, MD, MPH, CEO of Newark (N.J.) Beth Israel Medical Center and Children's Hospital of New Jersey.
I think [the PPACA] has done a lot of good for us as a safety-net hospital. There has been a lot of innovation and alignment as a result. We have better alignment with physicians and a strategic alignment with our major payer. We're aligned at the premium level with the payer which allows us to incentivize the physicians in financial pools. The physicians are becoming very innovative in how to keep patients healthy.
On the physician workforce
John Jay Shannon, MD. CEO for Cook County Health & Hospital System (Chicago).
I think the challenge we have in our organization is we will, for the foreseeable future, be an employed-physician model.
Terry Akin. CEO of Cone Health (Greensboro, N.C.).
A little less than a third of our physicians are employed by us, and I don't think it's a one size fits all. We are careful to say we're not trying to compel anyone. We think there is a place for independent and employed physicians. I expect the number of employed to grow, and I think a part of that is being a growing business.
Dianne Anderson, RN, President and CEO of Lawrence (Mass.) General Hospital.
Right now, our employed physicians are hospitalists and emergency department physicians, but that will rapidly change. We're beginning to employ primary care physicians and we have been approached by specialists and surgeons who want to be employed as well. We have some physicians who I know will continue to stay independent until they retire, but next wave of physicians will be employed.