Healthcare affordability is a growing concern, as inflation will likely continue to affect consumers' out-of-pocket costs and health insurance premiums for the long term, while advances in technology and pharmaceuticals increase the options — and the costs — for patients.
With this in mind, Becker's reached out to hospital and health system CEOs to ask: What is one specific and measurable action your organization is taking to lower the cost structure to compete more effectively in the future?
Actions ranged from new 24-hour freestanding emergency department/urgent care hybrids to a Community Cares Program.
Editor's note: Responses were lightly edited for length and clarity.
Gerard Colman. CEO of Baptist Health (Louisville, Ky.): Our new 24-hour freestanding emergency department/urgent care hybrids — which offer urgent and emergency-department care in a single location [and are a joint venture with Plano, Texas-based Intuitive Health] — are ensuring that when patients think they need immediate acute care, they receive the right level of high quality care quickly while only being charged for the level of service they need. We think that it meets the triple aim of high quality, low cost and a great patient experience while making sure that they, and potentially their employer that is providing the coverage, only pay what is appropriate for the healthcare they received.
Bill Gassen. President and CEO of Sanford Health (Sioux Falls, S.D.): One specific initiative we've been focused on that has allowed us to improve health outcomes and reduce more costly care and utilization is our care management work with health guides. Health guides serve as patient advocates and proactively help patients navigate what can sometimes be a complex healthcare system, for example, by helping them access community resources, apply for financial and/or prescription assistance and facilitate relationships and communication with their care team.
In 2021, we started working with a group of individuals identified as "rising risk" — those with one or two well-managed chronic conditions and co-occurring psychosocial risk factors. We recognized there was an opportunity to work upstream to reduce barriers, improve health outcomes and save significant costs by connecting these high-risk individuals with health guides.
Across our health system, health guide interventions have led to a 66 percent reduction in emergency department visits, 57 percent reduction in inpatient admissions, 36 percent improvement in blood pressure, 50 percent improvement in depression screening and a 76 percent Improvement in A1C. In addition, we have achieved a total annualized emergency department utilization savings of more than $875,000 and an annualized inpatient savings of more than $1.9 million. Based on these positive outcomes, we have identified opportunities to leverage health guides to support other payers with risk contracts.
Results from patient satisfaction surveys have been unparalleled. Among individuals who have worked with health guides, 90 percent report feeling heard by healthcare; 95 percent feel like a partner in their plan of care; and 92 percent report trust in healthcare.
I am deeply proud of our team's commitment to advancing rural health equity and improving healthcare affordability. By working upstream to address barriers preventing patients in rural, underserved communities from accessing healthcare, we are optimizing understanding and compliance with recommended care and replacing high-cost services with low-cost care management — creating a healthier, more sustainable future for decades to come.
David Herman, MD. CEO of Essentia Health (Duluth, Minn.): Essentia Health is committed to providing affordable, high-quality healthcare services for our patients and the communities we serve. To deliver on this commitment, Essentia Health has designed a care delivery model that transforms the traditional fee-for-service to value-based care that prioritizes improving patient outcomes and the overall quality of care while decreasing the cost of care.
At its core, our approach emphasizes prevention and wellness and:
- Improves overall patient health;
- Connects patients with the appropriate care at right time;
- Provides access to integrated care through the entire patient journey; and
- Invests in practice transformation and quality improvement.
Through this work, we have proven that delivering value-based care can both increase quality of care and drive overall cost savings. From 2018 to 2021, Essentia removed over $102 million from the cost of care across all value-based programs, while also being recognized as a top performer in quality.
Value-based care is a continuous journey as we learn, evolve, and expand our efforts across our organization. Essentia Health has achieved success in public and private value-based programs, generating healthcare savings while maintaining a high level of quality and patient satisfaction. Continuing to increase investments in value-based care and moving payers into recognizing these arrangements will help lower the cost of care while, most importantly, enhancing patients' health and well-being.
Christopher Howard. President and CEO of Sharp HealthCare (San Diego): Sharp recently launched an intensive recruitment campaign to hire more registered nurses and reduce our reliance on travelers, which at the height of the pandemic peaked to more than 500 contracted RNs at great cost to the organization. The targeted campaign was a success, and today there are fewer than 50 RNs on staff from nurse registries.
Additionally, in April, Sharp opened the Sharp Prebys Innovation and Education Center, which will help us identify, develop and practice safer, more cost-effective ways in which to deliver health care to the San Diego community. Highlights of the Innovation Center include a simulation center to enhance caregiver knowledge and skills with four simulation spaces representing a variety of care areas; The Caster Institute of Nursing Excellence to advance nursing education, innovation, practice and research; Technology Immersion Lab, where Sharp researchers, clinicians, technologists, and industry partners will gather to explore a variety of advanced technologies including artificial intelligence, software development, machine learning, advanced analytics and more; and a technology demonstration room, where existing and potential vendors and partners can showcase tools and products available today and in the future for Sharp to evaluate for potential integration across our system and beyond.
Also this year, Sharp launched its new Office of Transformation. Building upon our commitment to continuous process improvement and the work of our Six Sigma team, the department partners with groups and departments within our organization to support and accelerate improvement projects through coordination, monitoring, mentoring, training, project management and facilitation. The aim of the department is to drive systemwide improvements in patient care, operations, finance, and growth. It is designed to identify and expedite projects which can improve systemwide performance by applying an enhanced discipline to project identification, facilitating collaboration, breaking down barriers, and applying drivers of transformation. The ultimate goals include cost reduction; improved clinical care delivery; enhanced employee, physician and patient satisfaction; and growth.
Maulik Joshi, DrPH. President and CEO of Meritus Health (Hagerstown, Md.): Meritus Health has five bold goals to achieve by the year 2030, one of which is to be the lowest total cost of care provider in the state of Maryland. The other 2030 bold goals are to lose 1 million pounds in the community, have zero patient harm, be a nationally ranked employer of choice and provide world-class medical education through a new medical school.
One specific way to make care more affordable has been a project we launched to reduce the provision of low-value care. We call it "Doing Wisely." By working with our providers, reviewing the evidence and providing feedback of ordering data, Meritus Medical Center has reduced over 30,000 routine labs over the last two years. Work continues to reduce unnecessary imaging as well. This results in better care and lower cost for patients.
Alan Kaplan, MD. CEO of UW Health (Madison, Wis.): UW Health is committed to affordability through value-based care. We demonstrated success by earning $2.8 million in shared savings in 2021, bringing our total shared savings to $29.7 million since 2017. Value-based payment models are accelerating our investments in innovative care models, high-quality patient care, and health equity. We reinvested ACO shared savings to launch home-based hospital care in July and plan to serve up to 500 patients per year with hospital-level care at home. Shared savings have also been reinvested in social workers for a program to address Black infant mortality and low birthweight, COVID vaccine educators, and integrating behavioral health in primary care.
Airica Steed, EdD, RN. President and CEO of the MetroHealth System (Cleveland): We have taken specific and concrete steps to widen the front door and increase access to ambulatory and preventive care across our service region. This includes opening additional "brick and mortar" neighborhood-based clinics, offering mobile medical services across the city and expanding our school health program to provide additional screenings and clinical support to children and their families. These efforts directly reduce costs by decreasing the need for expensive emergency room visits and inpatient hospitalizations, while improving the overall health, and the wealth, of all of our communities.
Mark Wallace. President and CEO of Texas Children's Hospital (Houston): Efficient, effective and economical healthcare begins with seamless access to a healthcare delivery system when and where patients need us. An organization can commit to consolidations and scaling back financially but without appropriate, convenient and affordable access to care for the millions of patients who need us, these decisions truly mean nothing.
One specific action Texas Children's has taken to ensure access and lower the cost structure for our patient families — and one that I'm especially proud of — was creating and continuously expanding access through our Texas Children's Pediatrics network, specifically our Community Cares Program. Texas Children's Pediatrics is a network of more than 333 physicians across 69 practices throughout Texas, with 50 across the greater Houston community and 19 serving the Austin and Central Texas region. Eight of those practices are a part of the Community Cares Program — a model where we provide free, safe and high-quality healthcare to children and women and also serve our families by connecting them with social workers and helping them sign up for health insurance, government assistance and other programs they may qualify for.
Since Texas does not have Medicaid expansion, we swiftly ran toward that problem and created this unique program to support the unmet needs of our underserved communities. Additionally, without programs like Community Cares, patients may end up in much more highly resourced hospital areas, which can easily become a much more expensive care option for families.
Simply put, Texas Children's firmly believes that all children and women deserve access to safe, high-quality healthcare, regardless of where they live or their ability to pay. We recognized this need and decided that providing the very best care to our patients and their families means much more than treating an illness. It is our responsibility to fill the gap and create a path to consistent and dependable access for all.