In 2025, CNOs and other nurse leaders will have to keep track of many different trends and challenges, including the ones facing a critical part of the workforce: nurse managers.
HealthLeaders spoke to Robyn Begley, chief executive officer of the American Organization of Nursing Leadership (AONL), and senior vice president and chief nursing officer at the American Hospital Association (AHA), about AONL's nurse manager fall report and what CNOs can expect in 2025. Tune in to hear her insights.
Are consumers having an 'I'm mad as hell and I'm not going to take it any more' moment?
What’s keeping healthcare innovation executives up at night?
Many challenges. But one of the chief concerns is the potential (or perhaps the threat) of an empowered consumer, armed with their own health data and demanding AI-enabled care at the time and place of their choosing.
Health system executives like Chang, Highmark Health President and CEO David Holmberg and ChristianaCare President and CEO Janice Nevin, MD, MPH, were on hand Wednesday at the CES 2025 Digital Health Summit to gain some insight into the latest in consumer technology, but to understand how that will affect the healthcare industry. And their prime focus was on their patients’ dissatisfaction with the state of healthcare.
“We’ve got to move things forward,” said Holmberg, “and find a way to meet people to treat people where they’re at (and to) treat people as consumers.”
That’s a tough task for a healthcare industry that, Nevin pointed out, “isn’t traditionally very adventurous,” and which has taken decades just to get doctors and nurses on the same page. But the industry as a whole is in crisis, buffeted by workforce shortages, quality and cost concerns and a growing number of disruptors looking to replace the traditional care routine. Healthcare leaders need to recognize the driving forces shaping the industry and adapt to those changes.
CES offers those executives an opportunity to see where consumer technology is headed, and to understand the new ideas that are driving change. Alongside the ever-growing digital health space in the Venetian’s exhibit hall was an even-faster-growing space dedicated to the smart home. Combined, those platforms showcased a future where consumers will have more data on their environment and their health at their disposal, alongside more tools to track, analyze and improve their life journey.
Holmberg, taking note of those new technologies, said healthcare needs to “innovate its way out of” the mess it’s in. That means creating, fostering and embracing scalable tools and technologies that can take healthcare out of the hospital and doctor’s office and into the home.
Healthcare leaders are under pressure to improve the consumer experience, and they’re using tools like virtual care and digital health to improve care delivery. Those tools also aim to improve provider workflows and tackle the ongoing epidemic of stress and burnout that are contributing to declining workforces.
AI will in many cases shape that environment, and it’s being seen as a critical part of the healthcare journey as well—for both consumers and providers. Some see a future where AI could replace the doctor or nurse, while others say the technology will assist providers in making the best use of data.
Nevin, taking note of the healthcare industry’s reluctance to embrace change, said she’s worried “that we’re going to lose this moment in time.” She called on the industry to do a better job at collaborating, sharing ideas and data and knocking down the silos that create care gaps and frustrate consumers.
“We tend to point the finger at each other” she noted, rather than working with each other.
Not everyone agreed on the need for collaboration. Eli Lilly And Co. CIO Diogo Rau noted that competition might be a good thing.
“There has been a lot of collaboration in the industry that has worked against consumers rather than for consumers,” he pointed out, drawing applause from the packed audience. “I want to see more competition there to bring down the cost of medicine and the amount of healthcare.”
When asked about the future of healthcare, Rau envisioned an industry focused more on prevention and wellness that proactively treating diseases. Holberg envisioned an industry able to manage the incredible amounts of data coming in and creating care maps for consumers. And Nevin saw smaller, more focused hospitals, fewer hospital beds and an industry focused on meeting consumers where they want to be met.
But will the industry move fast enough in that direction to placate a growing consumer population—especially seniors and those with chronic care needs—that’s dissatisfied with the current state of care? Will consumers demand change?
At a separate panel on the future of AI that included Chang, Stephen Klasko, a former president and CEO at Thomas Jefferson University and Jefferson Health who’s now an executive in residence with General Catalyst, said he’s surprised that consumers haven’t yet had a “I’m mad as hell and I’m not going to take it any more” moment.
“My car gets better care than I do,” he quipped.
And that’s where AI might move the needle. But the industry has to overcome its concerns and move forward quickly.
Chang, noting the lack of healthcare providers in the audience and at CES in general, said the industry needs to embrace AI, rather than worry about the potential for mistakes or overuse.
“AI can absolutely be the equalizer,” he said. But “it pains me how much resources are being wasted because we’re [looking to solve] the wrong problems.”
“One of the biggest threats that we have is misunderstanding the technology,” added Jake Leach, Dexcom’s Chief Operating Officer.
Laura Adams, RN, a senior advisor for the National Academy of Medicine, part of Kaiser Permanente’s Institute for Health Policy, said the healthcare industry is nearing a tipping point where consumers will have more experience with AI than their doctors and nurses. Healthcare providers need to keep up, she said.
“The revolution is very much underway,” she added.
A CES panel anticipates policy advances for digital health innovation, as providers and politicians look to measure the value of new ideas like AI and telehealth.
At a time when the nation is divided and combative, can digital health bridge that gap and bring both sides together? And could this help healthcare leaders plot a path forward for new ideas like AI, Hospital at Home, and wearables?
The idea was hinted at during a digital health policy panel Tuesday at CES 2025 in Las Vegas. Moderated by Catherine Pugh, the Consumer Technology Association’s Director of Digital Health, the panel tossed about the idea that digital health may have enough support on both sides of the aisle to see some good policy wins during the upcoming four years of the Trump Administration.
“This is a bipartisan issue,” said John Quinn, Legislative Director for the Office of U.S. Rep. David Schweikert (R-Arizona). And there aren’t many of them around.
Quinn, along with panelists Stephanie Fiore, director of Digital Health Policy for Elevance Health, and Susan Kirsh, MD, MPH, Deputy Assistant Under Secretary for Health for the Department of Veteran Affairs’ DEAN portfolio, listed several topics that are likely to play a prominent role in healthcare policy over the next four years, including AI, telehealth, data interoperability, consumer privacy and CMS reimbursement.
The challenge, the panelists said, will be in finding a path between innovation and cost—a key initiative for the incoming administration.
As Fiore noted, “telehealth is a big deal,” but at the same time it’s “an expensive policy.”
AI could be the driving force in this argument. Kirsh, who’s involved with most of the digital health and telehealth strategies followed by the VA—the nation’s largest telehealth network—pointed out that AI has made some significant strides in reducing administrative workflows and reducing stress on clinicians, and is just now being integrated into clinical pathways.
“There is an incredible amount of opportunity in the clinical space,” she said.
The key for health system and hospital CIOs, CTOs, Chief Digital Health Officers and others is a comprehensive policy and standards that allow healthcare leaders to use AI safely and securely, and not be bogged down by administrative details that push clinicians away from the technology.
The same goes for telehealth and digital health. Quinn spoke of the potential of wearables to help both consumers and their care providers monitor health outside the doctor’s office, and Kirsh talked of the advances in augmented and virtual reality that allow clinicians to better experience what their patients are going through and to better prepare new doctors and nurses for the workforce.
The hangup is reimbursement. Clinicians won’t use this technology if they’re not supported by payers, especially Medicare. And the Centers for Medicare & Medicaid Services (CMS) has been slow to advance new reimbursements and permissions because of the cost. Quinn noted both they and the Congressional Budget Office often have a hard time seeing the long-term benefits in health and wellness for those new technologies.
“We need to close the gap with CMS on reimbursements,” he said, “and make innovation legal.”
And for at least the next two years, he added, those agencies will be faced by a Congress controlled by one party in both the House and Senate. In the past, he said, they tend to listen more intently when that happens.
Fiore spoke of the advances in technology giving consumers access to (and more control over) their data. She sees the next four years as a pivotal time for consumer privacy and security policy, and while the federal government has struggled to pass legislation on consumer protections, more and more states are taking action on their level.
Quinn, referencing the recent spate of cybersecurity incidents, especially the Change Healthcare debacle, agreed.
“The unfortunate reality is that data is not private right now.”
And a new administration that prides itself on the strength of the private sector could make that a priority.
Unfortunately, the path ahead for digital health policy isn’t clear-cut. Nothing happening in Washington these days is easy to predict. Quinn noted that many healthcare-related provisions in the original 1,500-page end-of-year budget bill were removed, and that the final, 150-page bill that was passed by Congress contained few healthcare gains.
CNOs need to make sure that nurse managers feel supported and have the proper resources do to their jobs.
In 2025, CNOs and other nurse leaders will have to keep track of many different trends and challenges, including the ones facing a critical part of the workforce: nurse managers.
Nurse managers are vital to the success of a health system. According to the Trends and Innovations Nurse Manager Retention report that was released by the American Organization of Nursing Leadership (AONL) and Laudio in the fall of 2024, nurse manager retention is key to building a sustainable and high-performing healthcare setting.
In the report, nurse managers had four priorities that they want CNOs and other nurse leaders to focus on. Here are those priorities.
After years of enrollment growth and favorable publicity, Medicare Advantage (MA) has faced a series of challenges this year, including lower contractual yields and issues with claims denials for...
RCM leaders are losing patience with barriers to patient access.
When it comes to complex, expensive procedures, "medical necessity from a payer perspective is not always in alignment with what the physician necessarily says," says Shana Tate, chief revenue officer at Ballad Health, a 20-hospital system serving four states in the Appalachian Highlands (Tennessee, Virginia, North Carolina, and Kentucky).
It "creates a lot of angst" for everyone involved. Often, "the patient really doesn't know what's going on until they get a denial and then they're confused," Tate explains. And that's a good-case scenario. When surgery needs to be rescheduled to accommodate an ongoing appeals process, the patient may need to upend their plans, such as a work leave or travel arrangements for any family coming into town to help with recovery. For their part, the provider is left with the arduous tasks of fighting the initial denial and smoothing a disrupted schedule, both of which take up "a lot of resources and time," Tate says.
It's why she's focused on optimizing her team's front-end operation, augmenting their capabilities with technology intended to streamline core aspects of patient access, including prior authorizations and scheduling. "We're really, really pushing our organization forward into the digital," she explains. The goal is to make things faster and more accessible.
But they simply cannot do it alone.
"We have to do that with the payers by our side," Tate says. They've seen some important alignment on this front: Days before a December 31, 2024, deadline, Ballad Health reached an agreement with Cigna to ensure continuing in-network access for all of their hospitals, facilities and physicians, the organization said in a December 19 press release. As part of the renewed partnership, four hospitals in the system are gaining new in-network status with the insurer's marketplace exchange product.
Ahead are some more ways RCM leaders are improving payer and administrative processes to expand patient access.
Smoothing prior authorization
Ballad Health has long partnered with a software vendor on electronic payer communications to fuel faster prior authorization approvals. Now, they're piloting EMR-based data exchange with one of their primary insurers to make the experience even "more seamless for the patient," Tate says. The results so far have been promising, even as her team continues to work out the kinks that come with new tech. "There's a lot of encryption, there's a lot of security that we have to get through," she notes.
Tate is not alone in pursuing tech-enabled prior auth solutions.
MemorialCare Health System, a four-hospital organization serving California's Orange and Los Angeles counties, has adopted robotic process automation (RPA) that allows "us to notify the health plans of hospital admissions, on average, within 14 minutes," Steve McNamara, vice president of revenue cycle, told HealthLeaders in an email. His team is also using the technology to identify any coverage alternatives to those presented at admission. Given the benefits they've seen from these early use cases, MemorialCare plans to explore additional RPA opportunities in 2025.
Success on the payer front demands intervention prior to prior authorization. Ballad Health uses technology to verify a patient's insurance upfront to reduce stress for the person seeking care, who isn't always versed in the specifics of their coverage, and to ensure the system can collect on the services they provide. "So it's not just prior auth — it's also making sure that we have the appropriate insurance for the procedure" in the first place, Tate says.
Streamlining scheduling
Shoring up scheduling has been another big access initiative for both Ballad Health and MemorialCare. "We have invested in efforts to provide our patients with a high level of satisfaction with our scheduling and registration practices," McNamara says.
"It's really important we make sure the patients can get in, and they're not on long wait lists," Tate says. Her team conducted analyses throughout 2024 to target the biggest backlog culprits.
A key takeaway from the exercise? Get to the heart of what your patient population wants. "That's a big thing," Tate says. "If you don't really understand what the community is asking for, what they need, or what's going to make you successful, and you just throw spaghetti on the wall and hopefully something sticks, that's going to make your job much harder."
To truly understand "the different pockets" of Ballad Health's population, which spans rural and urban locations, Tate's team started prioritizing referral reports and other EMR outputs that offer valuable insight into the patient experience but were previously flying under the radar. It's helped them answer vital questions about leakage, such as: "Where were our patients going? Why are they going elsewhere? What do we need to do better?" Tate explains. "How do we make sure that we're reaching out to the entire population — not just one section of it?"
One solution: Introducing new avenues for patients to handle scheduling, payment, and other administrative aspects of their care. "If they want to call, they can. If they want to do it through technology, they can. If they want to text, we're working to make sure that they can," Tate says.
Despite the possibilities RCM leaders see for digital solutions and technology, there's still no replacement for good old-fashioned human-to-human support.
MemorialCare Health System has earned industry recognition for their concierge program, which, McNamara says, features "a team of trained individuals who identify patients in need of financial counseling to ensure they are aware of their out-of-pocket liabilities prior to the service date."
Nurse managers are the 'CEOs' of their patient care area, and it's the CNO's job to support them, according to this nurse leader.
It's a new year, and people all around the world are setting new goals and resolutions for themselves, including CNOs.
In 2025, CNOs and other nurse leaders will have to keep track of many different trends and challenges, including the ones facing a critical part of the workforce: nurse managers.
Nurse managers are vital to the success of a health system. According to the Trends and Innovations Nurse Manager Retention report that was released by the American Organization of Nursing Leadership (AONL) and Laudio in the fall of 2024, nurse manager retention is key to building a sustainable and high-performing healthcare setting.
However, the report says that nurse manager turnover is highest within the first four years of leadership, and according to Robyn Begley, chief executive officer of AONL, and senior vice president and chief nursing officer at the American Hospital Association (AHA), this is due to very high levels of stress and burnout.
"As a former nurse manager earlier in my career," Begley said, "I can tell you it was the most challenging role that I've had in nursing leadership in my entire career."
Nurse manager challenges
Nurse managers are responsible for patient care, their nurses, 24/7 staffing for their units, budgeting, and compliance with regulations. Begley explained that it's not easy for nurses to move to a nurse manager role, and it should require formal training in leadership, management, and administrative skills.
"They are really the CEOs of their patient care area," Begley said. "Transitioning from a clinical role to a managerial role requires different competencies."
Nurse managers work long hours and have to constantly be available in case something goes wrong, and this can have a large impact on their personal lives and wellbeing.
“Hospitals and healthcare settings are very frequently 24/7 operations," Begley said. "Work-life balance gets a lot of attention, and this really is one of those areas [where] it's challenging for a nurse manager, and this can strain their wellbeing."
Organizational culture also has a large impact on nurse managers, and, according to Begley, it can influence a nurse manager's job satisfaction. CNOs need to make sure that support systems are available.
"Some new managers may feel isolated or perhaps unsupported," Begley said, "finding it difficult to navigate their new responsibilities and feel confident in their roles, especially in those first few years."
The nurse manager's role may also be ambiguous, so Begley recommends clarifying their responsibilities as best as possible to avoid confusion and lack of direction.
"Many times, if a new initiative comes into play, who is left to actually make sure that it gets implemented and outcomes are monitored and measured?" Begley said, "it's the nurse manager."
Nurse manager turnover also greatly affects the rest of the staff. Begley explained that strong, effective communication and trust takes time to build, and frequent turnover disrupts that process and makes it difficult for staff to develop meaningful relationships with their managers.
"Frequent changes in management can create a sense of uncertainty and instability among those units that have frequent turnover," Begley said. "This can lead to decreased morale and job satisfactions, as employees, the nurses, the nursing assistants, and the clerical support on those units may feel that their work environment is unpredictable."
Improving nurse manager retention
Begley had several tips for CNOs who want to improve their nurse manager retention. As CNOs continue to build an engaging and psychologically safe environment for nurses, they must also think about nurse managers and how they can feel safe speaking up, surfacing concerns, and potentially disagreeing without negative repercussions.
"They understand what it's like on the front line and they have to feel free to be able to communicate that back to executive nursing leadership," Begley said. "They have to feel like they can tell it like it is and not sugarcoat some of the messaging that they really do need to communicate to their leadership team."
Additionally, Begley suggested that CNOs allocate resources and advocate for the funding to provide formal training to their nurses who are aspiring to become managers or leaders.
"It takes continuing leadership development and education because we know there's always something new to learn and things are changing in healthcare very rapidly," Begley said.
CNOs also need to be showing up for their nurse managers in tangible ways.
"Nurse managers told us how important it is to actually see their leadership and to have communication and conversations with them," Begley said. "Not just fly by rounds where leaders will stroll through a unit, say hi, try to check in with the staff quickly, but really scheduled time for managers to be able to engage in dialogue is what is required."
Meeting nurse manager expectations
In the report, nurse managers had four priorities that they want CNOs and other nurse leaders to focus on: ensuring a healthy work environment, promoting leadership development, identifying new leaders early, and addressing role complexity.
Begley emphasized the necessity of succession planning for upper management and for executive management, and that there needs to be planning for every level of leadership.
"That involves a formal plan, a succession planning framework, that includes purpose, level, assessment, and nurturing," Begley said. "We know with the baby boomer retirements that we are creating space in leadership in nursing, as well as in many other professions."
The career trajectory of many nurses nowadays is also vastly different than what it used to be, Begley explained.
"There are some young up-and-comers who are very willing and able to take on more, to learn and aspire to be leaders," Begley said, "so these organizations need to do a deep dive and do that assessment and really figure out what their staff nurses desire to do in the future."
Health systems need to provide exposure to what nurses at different levels do, and provide formal education and leadership development, according to Begley.
"It's wonderful if nurses decide to stay on the clinical track and become more proficient in a specialty area, or go into a clinical track for advanced education," Begley said, "but there are also nurses that want to pursue nursing leadership as their specialty, and they also require a career plan."
In terms of role complexity, Begley said AONL is focusing not only on span of control, but also on what leaders can do to take some of the burden away from the nurse manager.
"Clerical work could be done by an assistant, by someone who is perhaps not a nursing leader or a nurse manager, but can do things like scheduling, managing logistics of their unit, [or] supplies," Begley said. "It's so complicated when we look at what [nurse managers] are actually accountable for."
Begley also emphasized the issue of having four generations in the workforce. One solution is technology and innovation, and having nurse leaders at all levels embracing technology and learning how to use it.
"These are skills that perhaps a decade ago or more, nurses weren't innately exposed to in their education," Begley said, "but we know now that technology and innovation is truly the key to the future of transforming healthcare and helping our communities become healthier."
To read more about AONL's previous spring report on nurse manager span of control, click here.
Researchers found that most health systems following the CMS Acute Hospital Care at Home model are large urban hospitals, and said the current model may not be sustainable for small or rural hospitals.
A new study of the Hospital at Home strategy questions whether it can stand up in rural areas and small hospitals, key markets for the innovative program’s growth and sustainability.
In a December 23 study posted in JAMA, researchers from UCLA and the University of Pennsylvania say almost all of the healthcare organizations participating in the Centers for Medicare & Medicaid Services (CMS) Acute Hospital Care at Home (AHCAH) program are large, urban, not-for-profit and academic hospitals.
As of December 2024, 373 hospitals across 139 health systems in 39 states are following that CMS model, which includes a waiver enacted in 2020 to help participating hospitals receive Medicare reimbursement. The waiver was recently extended to March 31, 2025, and with CMS hinting that it will no longer grant extensions, supporters are lobbying Congress to make it permanent.
The implications of this latest study are that only large, well-resourced health systems can sustain a Hospital at Home program, leaving a significant percentage of the nation’s health systems and hospitals out in the cold. Yet advocates say this strategy, while complex, can save money and resources and improve clinical outcomes, all key metrics for any type of hospital.
“If CMS’ goal is to continue to expand hospital-at-home, these findings suggest that different incentives or outreach may be needed for smaller, rural, and non-teaching hospitals,” Hasham Zikry, MD, MS, an emergency medicine physician and clinical research fellow at UCLA Health and lead author of the study, said in a press release.
(One notable exception is Sanford Health, which launched its CMS-approved AHCAH program in November 2024 targeting patients in rural communities around Fargo, North Dakota. The health system is currently targeting an annual daily census of five patients and hopes to bring that number up to 12 soon.)
Zikry and his fellow researchers, David Schriger, MD, of UCLA Health and Austin Kilaru, MD, MSHP, of the University of Pennsylvania’s Perelman School of Medicine, also cite two familiar criticisms of the Hospital at Home movement: That these programs haven’t yet proven their value, and that they don’t take into account the pressure put on patients and their caregivers at home.
“Are family members of these patients acting as unpaid caregivers during these admissions?” Zikry asked in the press release. “Could these patients do just as well in other care settings? Do patients actually prefer to be at home? And are health systems leveraging this program equitably?”
In addition, he said: “Resources are being poured into these programs around the country, yet we still don’t have a comprehensive understanding of how the programs are functioning on the ground.”
Many expect the Hospital at Home strategy to take a hit if Congress declines to extend the CMS waiver or make it permanent. Without Medicare reimbursement and a relaxation of certain telehealth rules, some health systems may end or cut back their programs.
That said, supporters are arguing for at least another extension so that participating health systems can gather the data needed to prove the concept’s value. The prevailing opinion among both supporters and critics is that the strategy needs more time to gather data to prove value.
Virtual nursing must be additive, not a replacement, according to this nurse leader.
HealthLeaders spoke to Katie Boston-Leary, senior vice president of equity and engagement at the American Nurses Association (ANA), about several pressing concerns for CNOs, as well as nursing trends, like virtual nursing, that will continue into the new year. Tune in to hear her insights.
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