HLTH 2024 kicked off Sunday in Vegas with a pledge to go boldly forth with innovation. But in a city known for its splashy promises, it's the details that will matter.
Scalability and sustainability are two of the primary barriers to healthcare innovation. A great tool or strategy won't succeed if it can't expand past the small pilot and prove itself across a larger network or population.
As HLTH 2024 kicked off this week in Las Vegas, healthcare executives and vendors anted in on the optimism that accompanies an event focused on innovation.
But behind the glitz and glamour and the celebrities gracing the main stage, that question remains: What new idea really will take hold and change a struggling industry for the better? And what hard questions should executives be asking themselves as they evaluate each new technology and strategy?
For Kaiser Permanente Chair and CEO Greg Adams, that answer may lie in Risant Health, the company launched a year ago to drive value-based healthcare by creating a national network of high-performing health systems.
"Our healthcare system is not living up to its full potential," he said during a main stage interview to kick off HLTH. "It's time for us to lead. It's time for us to be bold. It's time for us to take risks."
But what—and how—will those risks result in sustained success?
For Risant Health, the idea is to acquire health systems and create a national network that can apply value-based concepts at scale. Risant has already gathered in Geisinger and Cone Health (in which KP plans to invest a hefty $1 billion), and Adams outlined on Sunday the company's continuing quest to pull five or six community health systems into the fold by 2026.
Adams emphasized they aren't looking to bail out a struggling network—a hint to the ongoing M&A activity that is seeing large health systems swallow up smaller hospitals, a tactic that has its successes and its Steward Health Care fiascos. Kaiser Permanente, one of the handful of healthcare organizations that includes both providers and health plans, wants to acquire health systems that are doing OK on their own and moving forward with value-based care strategies.
This, Adams, said, is about optimization, and putting into play strategies that many health networks are talking about but not really embracing.
Adams Said Risant Health has helped Geisinger realize a 1% improvement in its cost structure in six months, and he anticipates an improvement of 2% to 3% for partner health systems over a year. More importantly, he said, those in the Risant Health orbit will have access to guidelines, care pathways and other tools aimed at reducing costs, boosting outcomes and improving workflows. He noted Kaiser Permanente is getting ready to roll out more than 200 primary care guidelines to its own provider network, all aimed at giving care teams an established set of best practices.
Now that kind of optimism is common at an event like HLTH, where cool ideas like food as medicine, primary and behavioral care integration, genomic medicine, hospital at home and using AI to reduce heart attacks and identify and treat cancers at an early stage are discussed at length on stages, in the exhibit hall and in the hallways of the Venetian.
The trick is to move beyond all the talk. Many a great idea has been given the spotlight in past events, only to gradually fade away because it can't be scaled or sustained. And the concept isn't entirely new. General Catalyst launched HATCo roughly last year and earlier this year acquired Summa Health under the idea of creating a "proof of concept" for VBC. Just this month, four significant health systems announced the formation of Longitude Health, with the goal of bringing transformative ideas to scale.
Adams is coming into this with the numbers and the pledge, fortified by HLTH's theme this year of being bold, to be a front-runner in transformative thinking. The challenge will lie in understanding and implementing a value-based care strategy at a time when "value" is a debated concept.
As with anything at HLTH, the idea is great, and over the next two days there will be plenty of discussion about this and other lofty goals. The key will be to answer the hard questions that come up and define success at a time when so much of healthcare is just a struggle to move forward. That's what being bold is all about.
WVU Medicine has invested in a diploma program, says this CNE.
For years in West Virginia, nursing education has taken place within educational institutions.
Registered nurses typically complete a two-to-four-year program, then enter the workforce after earning their degrees and taking the proper exams.
However, WVU Medicine West Virginia University is investing in an alternative route.
According to Melanie Heuston, chief nurse executive at WVU Medicine and HealthLeaders Exchange member, the health system has implemented a hospital-based nursing school and registered nursing diploma program through its Center for Nursing Education.
"We're doing something that's a bit unconventional in the academic field," Heuston said. “We are developing and sponsoring our own 2-year diploma program that will serve as a pipeline of new nurses for our 24 hospitals.”
Heuston explained there are diploma programs that exist across the United States, but that this program is one of the first of its kind.
"We really wanted to be a bridge to people getting further education, so we are developing our Center for Nursing Education to offer West Virginians an alternative to the traditional path to becoming a nurse.”
Program specifics
Heuston described the program as a traditional education with a contemporary approach. The program is free of charge and students are given all necessary materials, including computers, books, and uniforms.
"We have been developing it for over a year, a very short timeline," Heuston said. "We are making an enormous investment in the new school to ensure students are immersed in a state-of-the-art facility.”
Recruiting faculty for the program has been successful, according to Heuston, and so has enrollment.
"We opened our enrollment this past summer on August 15," Heuston said. “Within a week, we had over 100 applicants, and today…we have 620 applicants [who] filled out the entire application for our inaugural class of 24."
The students will begin the program in August 2025, following a rigorous selection process that includes interviews. Enrollment is broad-based, Heuston explained, which is also known as holistic admissions.
"We’re not just looking at test scores," Heuston said. "We're actually going to interview for caring attributes to be ensured that they're the type of nurses that really want to work in a med surg clinical environment."
Program goals
The goal is to promote impatient bedside nursing as a long-standing career, according to Heuston.
"We're going to interview every candidate and we're hoping to expand very quickly," Heuston said. "The State Board of Nursing only allows us to take 24 students until we have the demonstrated outcomes."
"They have been supportive partners," Heuston said. "They want to see us succeed and have shared everything that they've done well to integrate into our environment."
Ultimately, the program is meant to be a pathway for continued education. Heuston said they have signed memorandums of understanding for local schools as well as with West Virginia University, to give the students a bridge to a bachelor's degree.
"We really want to promote the idea within our clinical ladder," Heuston said, "and give them free tuition to get their baccalaureate degree as well."
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
The annual HLTH conference kicks off next week with an array of topics and an unusual amount of star power. But what are healthcare leaders looking for?
Healthcare innovation takes the stage in Las Vegas next week with HLTH, but attendees heading to Sin City for the latest in health and wellness may be looking for something a bit more inclusive than in years past.
As the industry transitions, albeit slowly, to patient-centered care and embraces ideas like AI and virtual care, healthcare leaders are looking for comprehensive solutions, rather than new tools and programs that target certain conditions or populations.
It’s part of what Meghan Cassidy, senior director of sales and product development for market and network services at Cleveland Clinic, calls “point solution mania.”
“I understand why the industry started there, but now it seems there are hundreds of those types of solutions in the market,” she says. “So I am hopeful that this year [people] will come to try to figure out how to weave all of those solutions together.”
“They all have great ROI, they all have great patient outcomes, but they're ultra-segmented right now,” she adds.
Healthcare has long had this issue, and events with large exhibit halls are ideal places to view the expanse of vendors driving innovation. But the industry is in a tough place right now, struggling to address cost and quality issues and workforce shortages, and it needs programs and tools that can be applied across the enterprise, not bolting onto platforms but integrating with them—what Cassidy calls “the quilt that ties it together.”
HLTH is somewhat unique in that it attracts healthcare organizations and companies that are interested in whole patient care, rather than healthcare information technology or clinical care. So the reasons and the opportunities for integration are more apparent. And that’s why topics like food as medicine, women’s health, mental health, psychedelics and art and music treatments have a place in the exhibit hall and in sessions.
That’s also what draws a unique cross-section of the healthcare industry to Sin City. Cassidy, for example, is focused on programs and tools that would help Cleveland Clinic deliver healthcare services to employers. It’s an evolving field that hospitals and health systems are exploring, and one that the so-called disruptors like Amazon and Google have been targeting.
“They're not offering an app for something anymore,” she points out. “They're going in and saying, ‘Let's share risk with these primary care facilities or primary care companies and try to change the care and get more people into their primary care doctor up front. And that will of course lead to cost savings later on down the line.”
With primary care as the focal point of healthcare access, many tools and programs are aimed at reducing barriers to access and facilitating a seamless primary care visit, whether it be in person or virtual. But true innovators in this space are also expanding the definition of primary care to include more preventive health and wellness opportunities, with the idea that a consumer/patient and care provider are on a journey together.
HLTH gives healthcare executives an opportunity to expand that conversation, looking at different ways, both strategic and technological, to configure care management and coordination. And it wouldn’t be a healthcare conference if AI weren’t included in that discussion.
But HLTH also tends to draw the big names and organizations, offering solutions that those hospitals and health systems can afford to try out. Cassidy says she’d like to see more tools and strategies for smaller and more rural organizations.
“There's a lot of marquee names that are out there that are saying what they do, but they represent very large companies and have large pockets,” she says. “With the small employers who are struggling, like the mom and pop shops on the corner, thinking about more ways to intervene and help them would be very, very interesting and effective.”
And while this event in particular carries the glitz and glamor that Las Vegas attracts, there are a few more celebrities than in past years—evidence, perhaps, of the energy brought to bear on issues like maternal health, mental health and chronic conditions. First Lady Jill Biden will talk about women’s health research during a Main Stage session on Wednesday, while entertainers John Legend, Halle Berry, Maria Shriver, Lennie Kravitz and Lance Bass are scheduled to appear as well.
Regardless of the star power, HLTH offers healthcare leaders an intriguing look at how the industry is evolving beyond episodic care, and how new ideas and technologies can shape their organizations to deliver what patients not only need by want.
This unique nurse identifier follows nurses for their entire career, says the NCSBN.
HealthLeaders spoke to Jason Schwartz, director of member outreach at the National Council of State Boards of Nursing (NCSBN), and Matt Sterzinger, director of information technology, about the NCSBN ID and its applications. Tune in to hear their insights.
A CFO's job is evolving and its mission impossible. What will it take to survive as a modern CFO as isolated decision-making isn't a part of the future?
Welcome to our October 2024 cover story. Each month, our editors will be taking a deep dive into the topics that matter most to you in our cover story series. From ways to win the payer/provider war to the new era of the APP, we've been working hard this year.
So, what did our team look into this month? Well, the role of the healthcare CFO has reached a breaking point. No longer just the financial gatekeepers, today's CFOs are thrust into an unforgiving landscape where the stakes couldn’t be higher. With the entire fiscal health of their organization resting on their shoulders, they must make critical decisions in the face of economic turmoil, shrinking margins, and escalating labor costs.
Every misstep risks not just the bottom line but the clinical outcomes that patients depend on. In this high-pressure environment, failure is an option. In the rare cases when hospitals do fail, the CFO will be in the conversation about why.
This begs the question: is this responsibility too immense for one individual? Many healthcare CFOs are burning out, crushed by the weight of these ever-expanding expectations. On top of this, CEOs are now asking themselves if it’s too risky for the entire financial wellbeing of a healthcare organization to hinge on one person?
As the job description continues to grow, CFOs are now required to oversee everything from operational strategy to technology investments—all while navigating the daily pressures of shrinking margins, labor shortages, and payer disputes.
In this high-stakes environment, where every misstep can be costly, is the modern CFO’s role becoming unmanageable? Our finance editor Marie Defreitas found out.
Allegheny Health, a member of the HealthLeaders Mastermind program on AI in revenue cycle managemet and finance operations, is using the technology to help executives understand the data and make better decisions.
Healthcare has a people problem, especially in revenue cycle management and finance operations. There just aren’t enough people filling those roles, and the competition with other industries is fierce.
This is where AI fits in.
Whereas the human touch is a critical part of clinical care, when numbers are concerned, the fewer hands the better. Revenue cycle and finance managers are looking for AI tools to reduce human interaction in areas like coding, claims, denials and prior authorizations.
“We’re all trying to remove touches from the claims process,” says Brian Ice, vice president of clinical revenue cycle for the Allegheny Health Network. “We’re all trying to come up with ways to make that process more efficient.”
“We look at AI for any workflow that's high volume [and] requires a lot of analysis,” he adds. “If it requires looking through clinical documentation or large data sets to respond. We're trying to use AI to help drive and make those workflows more efficient.”
Ice, a participant in the HealthLeaders Mastermind program on AI in revenue cycle and financial operations, says RCM and finance executives have been working with automation for years, and they’re leery of the flood of vendors coming into the space with so-called AI tools that really don’t use AI.
“Vendors that say they can do what we're looking for are a dime a dozen,” he says. “There's a lot of them out there that say they can do different things. Finding a vendor that's a good fit for your organization, that integrates well with your electronic health record, that has the right price tag associated with it,” is an elusive goal.
And what Ice is looking for now is AI that can learn the complex algorithms involved in rev cycle and finance operations and generate pathways to efficiency. Apart from transcribing documents and analyzing utilization workflows, that might mean identifying the right codes, smoothing out the prior authorization process, even predicting when a payer might issue a denial and working toward a quicker resolution.
We want to “take some of the back and forth out of it,” Ice says, adding that payers are also interested in using Ai to improve collaboration with providers.
The key, Ice says, is to have AI do the number-crunching and analysis and give RCM and finance executives the data they need to make those collaborations meaningful, whether it’s in plotting the right pathway for patients to pay their bills or working with health plans to align care management with coverage.
Ice says AI is still a new technology, and one that needs careful monitoring as it learns the workflows. Every outcome generated by an AI program still needs to be checked by the “human in the loop.”
“When you automate something, you're trying to do something at a high volume to produce a significant amount of output without human intervention,” he says. “So if you have quality issues in that space, you can create a pretty significant mess for yourself in a hurry.”
That may not always be the case, however. The hope is that AI tools in RCM and finance eventually become reliable enough to run in the background, enabling those humans in the loop to focus on other tasks.
For now, Ice says, Allegheny Health has an expansive governance team in place, representing a wide range of departments within the health system. Their tasks range from reviewing vendors and products to monitoring the development and installation of all AI programs to continuous quality control.
“There's still an extreme amount of investigation and research that goes into approving these technologies before they would ever be … deployed within our system,” he says.
The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This AI in Finance Mastermind series features ideas, solutions, and insights on excelling your AI programs.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com
The NCSBN ID can be used as a unique nurse identifier, according to the organization.
Health systems are feeling the effects off the nursing shortages as they try recruit and retain qualified nurses who want to continue being a part of the industry.
As more innovative staffing solutions arise, it's up to CNOs and other nurse leadership to take advantage of the systems and tools that are already in place to build a strong workforce.
According to Jason Schwartz, director of member outreach at the National Council of State Boards of Nursing (NCSBN), and Matt Sterzinger, director of information technology, one of those tools could be the NCSBN ID number.
The on-demand staffing model breeds loyalty and longevity, according to this CNO.
On this episode of HL Shorts, we hear from Jennifer Garnica, vice president of nursing and CNO at SSM Health St. Mary's Hospital, St. Louis, about how the W-2 on-demand staffing model is addressing staffing concerns. Tune in to hear her insights.
The NCSBN ID can be used in a central database to keep track of nurses and build the workforce, according to the NCSBN.
Amid the nursing shortage, health systems are struggling to recruit and retain qualified nurses who want to continue being a part of the industry.
Part of this equation is ensuring that nurses have career opportunities available to them and options to advance their education. While health systems can work on giving them these resources, it's also up to CNOs and other nurse leadership to take advantage of the systems and tools that are already in place to build a strong workforce.
According to Jason Schwartz, director of member outreach at the National Council of State Boards of Nursing (NCSBN), and Matt Sterzinger, director of information technology, one of those tools could be the NCSBN ID number.
What is it?
The NCSBN ID is a unique nurse identifier, according to Sterzinger, and is used exclusively in nursing. The number is issued automatically by NCSBN during the NCLEX examination process, and it follows the nurse for their entire career.
"Typically, a nurse will go to a nursing education program," Sterzinger said. "They’ll take the NCLEX exam, and then after the exam, they're licensed by a state board of nursing, and then they can begin their career as a nurse."
The information attached to the ID number has to do with the nurse that it's assigned to. According to Schwartz, nurses might have licenses in single or multiple states, and they might have different kinds of licenses. The ID is associated with all of a nurse's licensure history and disciplinary history through the state boards.
"Through our work with the state boards, all of their different nursing licenses across jurisdictions and across license types are automatically linked to the NCSBN ID from their educational institutions, employers, etc.," Schwartz said. "If they're using the NCSBN ID, they have the power then to attach even more."
The data can be found through Nursys, a national database run by NCSBN that contains all of the nurse license and disciplinary information. According to Sterzinger, NCSBN has data sharing agreements through their membership with the state boards of nursing, and they all contribute their license and disciplinary information.
"As a result, we are able to take all that license information and tie it together with one individual," Sterzinger said, "and assign that unique nurse identifier."
In terms of privacy, the NCSBN ID itself is public. Sterzinger explained that there is a subset of license and disciplinary information which is considered to be public record, and users can go to the Nursys database to find that information. Sterzinger compared the NCSBN ID to a vehicle identification number, or VIN number, on a car.
"That identifier is tied to that car, and it is connecting all these different datasets and systems around the life of that car, and it's publicly available," Sterzinger said. "You can walk up to any car, and you can look through the front windshield and down in the dashboard and you can see that VIN."
What are the benefits?
There are several use cases for the NCSBN ID, including use in education programs. According to Schwartz, the University of Alabama in Huntsville is using the ID to ensure that graduate students are maintaining active, current, and valid nursing licenses and tracking their success and their career pathways after they leave.
"With the NCSBN ID, it's possible for an education program to know what percentage of RN grads are going on to become APRNs, or what areas of the workforce they are ending up in," Schwartz said.
The ID can also be used to address workforce shortages and quantify the value of nursing. Nurses are involved in many different aspects of care delivery, Schwartz explained, but the data is captured in different systems, with no convenient way of sharing information.
"With the NCSBN ID, multiple systems can talk to each other, multiple data sets can be exchanged," Schwartz said, "but there's no personally identifying information that needs to travel."
For health systems, the NCSBN ID can help with screening and verification processes, and to make sure that nurses are keeping their licenses up to date. For CNOs specifically, Schwartz explained that the ID can be used to improve quality and training over time.
"If you're able to link the care provided by a specific nurse to a particular outcome over time, what you may find is [that] nurse is having more success than others," Schwartz said. "Are there things that that nurse is doing where we can provide training to other nurses, or perhaps if the outcomes are worse than average, is remediation or professional development needed to bring things on par with expectations?"
The NCSBN ID also provides value to the patient, according to Schwartz. Patients are able to look up their nurses and see their licenses and career history.
"Through Nursys and through the NCSBN ID, we improve upon the transparency of nursing care to the public, [and] to consumers as well," Schwartz said.
"There's a lot of studying going on regarding the nursing workforce, and aging, and where they’re coming from," Sterzinger said. "The NCSBN ID can be used to help researchers tie together different data sets and get those results so that we can make sure that we have a solid nursing workforce in the future."
Four large health systems have joined forces to launch Longitude Health. They're hoping that economy of size can overcome the barriers to innovation and actually implement value-based care.
Collaboration has become a key strategy in healthcare innovation.
The partnership aims to combine the resources of the four health systems to invest in strategies and technology that look to improve care management and coordination, health and wellness, and system improvement. A press release issued by Providence says the new group intends to make "multiple strategic investments" within two years and will invite other health systems to join them.
"Longitude Health will scale the next generation of capabilities faster and more effectively than if individual health systems attempted to do so themselves," Pete McCanna, CEO of Baylor Scott & White Health, said in the press release. "We aim to set a new standard, demonstrating that new approaches can optimize organizations performance and quality and drive positive systemic change to benefit patients."
While the announcement is short on details, it points to the idea of developing programs or deploying new technology—perhaps even spinning out new business lines--that can scale out quicker and more effectively, improving the chances of sustainability. The press release lists the organization's three main initiatives as transforming business models, improving health system performance and empowering healthier futures.
The collaboration also creates a sizable organization to work with payers on value-based care.
"Healthcare requires new approaches," David Callender, MD, Memorial Hermann's president and CEO, said in the release. "Health systems must expand their core focus areas beyond care delivery and into new business creation and services that will drive high-value care. Through this collaborative approach, we aim to take the lead in designing solutions that drive operational transformation and translate into tangible benefits for the patients and communities that we serve."
While partnerships aren't entirely new in healthcare, the idea of getting disparate health systems to work together has usually come in the form of M&A deals. Kaiser Permanente launched Risant Health in 2023 to create a value-based care network, has so far acquired Geisinger and Cone Health and plans to add another three or four health systems in the next five years. Meanwhile, Transcarent, a digital health company launched in 2020 by Glen Tullman, unveiled its "National Independent Provider Ecosystem" in 2023 with 10 health systems (including Memorial Hermann and Baylor Scott & White).
The new group's CEO is Paul Mango, a former executive at the U.S. Department of Health and Human Services (HHS) and the Center for Medicare & Medicaid Services (CMS), as well as a former partner at McKinsey and a gubernatorial candidate in Pennsylvania. The CFO is Brett Moraski, who held VP roles at Highmark Health and Wellpoint and was a founding managing partner at SEMCAP Health and operating partner at Frazier Healthcare Partners.
The CEOs of the founding health systems—McCanna, Callender, Carl Amato at Novant Health and Rod Hochman, MD, at Providence—will serve on the board of directors, with McCann as chair.
