The Cleveland-based health system does not shy away from taking time to ensure that an AI tool is a good investment and is the right solution for its patient population.
When it comes to AI tool adoption, The MetroHealth System has a robust validation process. Health system executives are willing to take the time to review whether the tool will work regardless of its track record.
Faced with a plethora of available AI tools. executives should be cautious when adopting these solutions, according to Yasir Tarabichi, MD, chief health AI officer at MetroHealth. He is among nearly a dozen executives participating in the HealthLeaders AI in Clinical Care Mastermind program.
"How we implement our AI models is unique because we are a little slower in validating them than others and are extremely careful in validating them," Tarabichi says.
As a clinical informaticist, he focuses on the concept of the learning health system when it comes to AI tool adoption.
"You are constantly developing a huge repository of data both in terms of patients and their conditions, as well as the things we are doing in our health system," Tarabichi says. "For example, how are we communicating with patients, what are the protocols we are activating, what are the clinical pathways we are leveraging, and what are the medications we are using?"
The key is taking the learning health system concept and actualizing it, according to Tarabichi.
"There is often a gap in this area," he says. "A lot of organizations talk about being a learning health system and learning from their data. They do research. They look back and they say this worked or that did not work."
A learning health system conducts tests in real time in its patient population to identify whether a change in what they do makes a meaningful impact, Tarabichi explains.
"We need to be able to do that in an agile fashion," he says. "We need to understand whether something is working."
An example is the process that the health system used to adopt a predictive tool for sepsis.
"When we took on our AI sepsis model from a vendor, it was being used by several organizations, and everybody said it worked," Tarabichi says. "When we evaluated how others were using this AI model, we approached it with a grain of salt. We were not entirely sure that this predictive model was going to work for us."
With quality oversight and a multidisciplinary group, MetroHealth developed a quality improvement process, where patients who came into the emergency room either got to be on the AI tool's scoring system or didn't.
"We set up a response team for sepsis," Tarabichi says. "We made sure everybody knew their cues and what they needed to do in the standard practice, using clinical pharmacists as the main driver. We ran the model, and we compared the data. We wanted to know how patients who got the score did and how patients who did not get the score did."
The validation process found the AI sepsis model was effective for MetroHealth's patient population.
"By the end of the study, which was a couple of months, we found that the patients who got a score got antibiotics faster than patients who did not get a score, which is important in the treatment of sepsis," Tarabichi says. "We even showed decreased mortality in the hospital associated with that outcome."
This validation process showed that people and process are at least as important as the technology, according to Tarabichi.
"The technology was a catalyst that drove the process, but what really mattered was getting the team to think about how they would use this new information and how it would drive what they do at the point of care," he says.
The AI sepsis model is designed with clinical care teams in mind, Tarabichi says.
"Our sepsis predictive algorithm provides information about the patient's risk for sepsis in a place on the chart where emergency room providers typically look to see how a patient is doing overall," he says. "It sends an interruptive alert only to the clinical pharmacists who actually want that information. They want to be stopped in their tracks when a patient comes in who could have sepsis."
Yasir Tarabichi, MD, is chief health AI officer at The MetroHealth System. Photo courtesy of The MetroHealth System.
Understanding the AI tool life cycle
Paying attention to the life cycle of AI tool implementation is another hallmark of MetroHealth's approach to AI.
Tarabichi encourages his counterparts at other health systems and hospitals to look at the frameworks for the AI life cycle that have been set out by the Coalition for Health AI (CHAI) and the Health AI Partnership.
"Thinking about the life cycle of the solution means by the time you have launched the solution you have already figured out whether it works, whether it is biased, whether it is fair, and how you are going to use it," he says.
This includes knowing when a solution should be terminated.
"What are the criteria for success and when do you need to sunset an AI tool?" Tarabichi says. "The big thing we have found in the informatics and change management world is we have done a good job of turning things on, but we do not do a good job of turning things off."
Understanding the life cycle of an AI tool is critical, Tarabichi says.
"You need to have an offramp and to understand how you are monitoring an AI tool," he says. "Do not implement a solution if you have not thought about the life cycle."
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WellSpan Health is discontinuing the practice of asking new medical staff probing questions about their mental health status.
A primary concern in physician wellbeing is reticence among clinicians to seek help, especially when they are experiencing emotional or mental problems.
Traditionally, healthcare organizations have asked questions about mental health on credentialling and licensure documents, which raises concern about stigma for healthcare professionals.
However, WellSpan Health has been honored for removing stigmatizing questions from staff credentialling and licensure documents.
Any healthcare organization wants to know that a provider is competent and capable of providing care, but that desire should not extend to prying into people's mental health history, says Anthony Aquilina, DO, executive vice president and chief physician executive at WellSpan.
"We do not need to know your personal history, especially when it comes to mental health because that is the kind of thing that has led to stigma," Aquilina says. "It can bias people if they think you are getting mental health care."
It is inappropriate to focus on people's mental health history, according to Aquilina.
"On a credentialling document, we would not ask you whether you have ever had a heart attack," Aquilina says. "So why should we ask you whether you have had mental health problems?"
WellSpan received an award from the Wellbeing First Champion Challenge program in part for changing a particular credentialling question.
The original question was as follows: At any time in the past 10 years, have you been hospitalized or received any kind of institutional care for physical or mental problems?
The new question is worded differently: Are you currently suffering from any condition that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical, and professional manner?
"What's important is that we assess competency and capability," Aquilina says. "There are ways to do that without causing people to react in a way that makes them concerned about their livelihood."
Anthony Aquilina, DO, is executive vice president and chief physician officer at WellSpan Health. Photo courtesy of WellSpan Health.
Promoting healthcare worker wellbeing
WellSpan is making a robust and multifaceted effort to boost the wellbeing of physicians, nurses, and allied health professionals.
"At WellSpan, we have the benefit of having several physician leaders and other leaders who are dedicated to the wellbeing of our provider workforce," Aquilina says. "One of our emergency room physicians is the immediate past president of the Pennsylvania Medical Society. The theme for her presidency was all about restoring joy in the practice of medicine."
Physician wellbeing is a top concern at WellSpan. The health system has a wellness program led by a physician, who partners with a psychologist. They use a multifaceted approach to addressing physician burnout.
"We measure physician burnout, and we understand where we stand as an organization," Aquilina says. "In our most recent measurement of physician burnout, we posted a decrease in our physician burnout percentage last year."
Last year, 34% of WellSpan physicians reported experiencing some level of burnout. Nationally last year, about 50% of physicians reported experiencing some level of burnout.
WellSpan is focusing on eliminating or mitigating nonproductive work for physicians such as spending inordinate effort in the electronic health record and devoting time to insurance company requests for peer reviews.
To reduce documentation burden, the health system has adopted artificial intelligence ambient listening technology that records a conversation between a clinician and a patient, then produces a clinical note for the electronic medical record.
The health system is offloading work that physicians have been doing that other staff members can tackle. For example, advanced practice providers can provide care for minor complaints such as upper respiratory infections, uncomplicated urinary tract infections, and sore throat.
At WellSpan York Hospital, the health system has launched an initiative called Code Lavendar to help all staff members who struggle with emotional and mental distress.
"It is a response team for staff members who are feeling high levels of stress, emotional distress, or mental trauma," Aquilina says. "Code Lavendar is a private way for staff members to get help."
Emergency rooms at WellSpan's hospitals also have areas where clinicians and nurses can go if they feel stressed.
"It gets them away from work for a short period of time," Aquilina says. "We call those areas Zen Dens."
Lastly, WellSpan is trying to discourage doctors from taking work home with them.
"We are focused on reducing pajama time," Aquilina says, "[which is] when doctors are working at home on computers when they should be spending that time decompressing and enjoying life with their family."
In a biannual community survey, 80% of respondents said the Danville, Indiana-based health system is an essential care provider. Hendricks ranked 337 on the U.S. hospitals list in Newsweek's World's Best Hospitals 2025, with particularly high scores for patient satisfaction and quality metrics. The health system has received an Outstanding Patient Experience Award from Healthgrades for 17 years in a row.
In a recent interview with HealthLeaders, Ryan Van Donselaar, DO, CMO of Hendricks, shared the keys to the health system's success.
Patient engagement at Hendricks is multifaceted, according to Van Donselaar. As the community grows, the health system is prioritizing expanding access to care.
"Our primary care base has grown in the past couple of years, as have our specialists," Van Donselaar says. "We have added technology to connect with our patients through the electronic medical record. We are trying to grow virtual visits and online scheduling."
In other efforts to boost access, Hendricks has been hiring nurse practitioners and physician assistants as well as adding service lines, Van Donselaar says.
Ryan Van Donselaar, DO, is CMO of Hendricks Regional Health. Photo courtesy of Hendricks Regional Health.
Managing population health
Hendricks has invested in promoting population health.
"We are blessed to have an executive director of population health," Van Donselaar says. "When you think about managing a population of people, it is easier to do inside your own four walls when patients are getting care. We leverage our EMR to manage data."
Hendricks has invested in a third-party platform that allows the health system to track where patients are going when they are receiving care from other organizations.
"Once we get that data, we can work with our partners in the community such as skilled nursing facilities and home healthcare companies to improve the care that patients are getting even though they are not within our four walls," Van Donselaar says.
A Hendricks vice president and the health system's transitions of care team meets regularly with these community partners. To Van Donselaar, the process of establishing collaborative relationships with community partners takes years.
"If we do not have a relationship with one of the community providers, the first thing to do is to call them and talk to someone such as the nursing director about what they desire, which is usually patient referrals," Van Donselaar says. "From there, you can start to talk about patient care and grow the relationship from ground zero."
Boosting patient satisfaction and patient experience
Patient satisfaction is a byproduct of high-quality care, according to Van Donselaar.
"You cannot have patient satisfaction without great clinical care. That is the primary focus," Van Donselaar says. "Beyond great clinical care, you must empower your staff to help patients fix a problem in the moment or escalate the problem to leadership so we can take care of it."
It is a team effort.
"From the CEO down, we have worked on pulling together teams to talk about the importance of patient satisfaction, quality, and patient experience," Van Donselaar says. "In the moment, our staff can impact the patient's subjective feelings and their care."
Similarly, the cornerstones of patient experience include access, safety, and quality, but there is another level to achieving a positive patient experience, Van Donselaar explains.
"You need to realize that anywhere the patient interacts with the health system such as phone calls and the billing office requires standardization and education on how to work with patients," Van Donselaar says. "If you provide great clinical care, then the patient is discharged and has a negative experience with the billing office, one phone call can ruin the whole experience."
To standardize interactions with patients, Hendricks has an executive responsible for systems excellence who looks across the entire health system and provides education on interacting with patients.
"We also have directors for different patient areas who educate staff members about simple things such as responding to voice mail and answering a phone call," Van Donselaar says. "That education is distributed to all office coordinators."
Successful service lines have physician alignment, operational accountability, effective communication, robust data analytics, and a grasp of quality outcomes, this chief clinical officer says.
The new chief clinical officer of the Bon Secours Richmond market has extensive experience in managing service lines.
David Hasleton, MD, became chief clinical officer of the Bon Secours Richmond market in February. Prior to joining the health system, he served as CMO of clinical shared services at Intermountain Health. The Bon Secours Richmond market is part of Bon Secours Mercy Health.
There are five components to operating a successful service line, according to Hasleton.
Strong physician alignment along with clear expectations and accountability
Clear operational accountability, with physician, advanced practice provider, and operational leaders understanding their roles
Clear and effective communication
Robust data analytics
Solid grasp of quality outcomes
When it comes to physician accountability, there must be clear leadership in a service line, Hasleton explains.
'For example, if you have a radiation oncologist who is new out of fellowship and is starting to deliver care at a hospital, there needs to be someone responsible for this doctor's outcomes," Hasleton says. "Someone needs to be responsible for mentoring, training, and teaching this doctor about the clinical pathways that are already in place."
In a service line such as oncology, there needs to be a physician leader, according to Hasleton.
"That oncology leader is a general leader," Hasleton says. "Underneath that general leader will be specific leaders for areas such as breast cancer, surgical oncology, and radiation oncology. The structure must report up to one individual such that there is accountability for one person to oversee the service line."
In terms of operational accountability, there is usually a dyad team, with a physician leader at the top of the service line along with an operational partner, Hasleton explains. In the oncology example, at the top of the leadership structure you have an oncology physician and an operational dyad partner who have clear expectations and work together seamlessly.
"The operations leader helps drive operational efficiencies along with the physician leader," Hasleton says. "The physician leader drives clinical standardization and efficiencies in conjunction with the operations leader because you cannot separate one from the other."
Communication is essential because frontline providers are involved in the process of creating clinical pathways, according to Hasleton.
"This is a co-creation between leadership and frontline providers," Hasleton says. "It is not a top-down approach."
The communication back and forth between the top physician in a service line and the frontline workers, whether they are physicians or advance practice clinicians, is a bi-directional flow, Hasleton explains.
"People must feel empowered to bring up quality issues, safety issues, organizational structure issues, and how improvement can be achieved," Hasleton says.
When a health system builds a service line, there are certain metrics that make sense, and they must be evaluated with data analytics, according to Hasleton.
"In oncology, you have metrics for outcomes for specific diseases," Hasleton says. "Using data analytics to analyze those metrics then drives care forward. You know where you are, and you know where you need to be."
For a successful service line, you need robust data that is flexible and dynamic to meet the needs of the situation, and dashboards are also essential, Hasleton explains.
"It's like driving a car—you have critical information in front of you such as speed and fuel level," Hasleton says. "You need a dashboard for every service line that people can see to know whether they are winning or not."
Service line leaders should look at quality outcomes that are specific to a disease or specific to the service line, according to Hasleton.
"In emergency medicine you look at quality care such as sepsis measures—are we meeting sepsis goals and targets?" Hasleton says. "Quality outcomes are built upon standardization so you can deliver on the quality. You also look at readmission criteria, mortality, morbidity, and length of stay. You need to have data metrics to deliver on the quality."
David Hasleton, MD, is chief clinical officer of the Bon Secours Richmond market. Photo courtesy of Bon Secours Mercy Health.
Fostering provider satisfaction
As chief clinical officer, Hasleton is charged with boosting provider satisfaction.
"When we improve the satisfaction and engagement of our physicians and advanced practice clinicians, and when they can speak their mind in a safe manner, quality and safety follow suit," Hasleton says. "In addition, the patient experience is improved."
It comes down to having dialogue and developing a culture where providers feel heard, according to Hasleton.
"I talk with providers about how I can help them feel more fulfilled at work," Hasleton says. "I talk about how we can foster a better culture, so the providers feel better supported. When providers feel better about what they are doing, patient experience goes up."
Hasleton has a process to promote engagement and satisfaction among providers.
"When I speak with the frontline physicians and advanced practice clinicians, they speak, and I listen. I act, then I follow up," Hasleton says. "It is a cycle. When providers speak, and we do nothing about the issues they raise, we destroy the ability to improve provider engagement."
Ardent Health's CMO shares how embracing technology is retaining physicians and nurses.
Health systems and hospitals have been grappling with high turnover rates for physicians and nurses since the beginning of the coronavirus pandemic in 2020. High turnover rates compromise access to care and have financial consequences for the bottom line.
Ardent Health has been focusing on technological approaches to addressing staff turnover at its hospitals and clinics.
"The turnover work that we try to do is clearly predicated on what we can do to improve workflows," says FJ Campbell, MD, CMO at Ardent. "Those are the most sustainable impacts that we can create."
To Campbell, the goal at Ardent with technology should be to improve workflows.
"We believe in the notion that good workflows lead to good clinical outcomes and lead to good financial outcomes," Campbell says. "As we consider the technologies that we leverage, it always gets back to how it is improving workflows."
Three factors related to cognitive burden are driving turnover at hospitals and clinics, according to Campbell.
"No. 1, it is the patient volume," Campbell says. "No. 2, it is the patient acuity—the severe illness that we are seeing in our hospitals. No. 3, it is the rigor around the documentation, which is increasingly about what we must do to support a bill or authorization versus using documentation for communication in the record."
Addressing nurse turnover
Virtual nursing has been the primary strategy to address nurse turnover at Ardent, Campbell explains.
"In one of our markets, we put telehealth technology in 400 rooms," Campbell says. "This allowed for a new breed of nurses—virtual nurses."
Virtual nurses at Ardent are rounding on patients, and completing intakes, admissions, and discharges, and they can come into the room at any time. The work that the virtual nurses are doing is cerebral, according to Campbell.
"They are usually seasoned nurses, and they are not getting interrupted," Campbell says. "That allows the nurses that are on-site to have a greater opportunity to handle complex tasks that are taking place, have a greater opportunity to be aware of the acuity of the patients in their panel, and have greater oversight of patient care technicians."
Virtual nursing is having a positive impact at Ardent, Campbell explains.
"Where we have virtual nursing, turnover has decreased sharply, and we have seen a reduction in the cost of care," Campbell says. "What is most important to us is we are trying to create a situation where nurses want to work for us and not leave."
Automated patient monitoring that helps to identify deteriorating patients is also addressing nurse turnover. According to Campbell, Ardent is partnering with FDA-approved BioIntelliSense, which provides a sensor that can be put on the patient to monitor things such as respiratory rate, heart rate, and body temperature.
"It is creating a situation where we can identify deteriorating patients up to 16 hours sooner than we could typically identify them with vital sign monitoring and telemetry," Campbell says.
As is the case with virtual nursing, automated patient monitoring has achieved positive results, according to Campbell.
"On the units where we have automated patient monitoring, we have seen a 15% reduction in mortality," Campbell says. "For the nurses in those hospitals, we have hospitals that are watching their back. They are less afraid to be at work. That impacts burnout."
Addressing physician turnover
In recent years, documentation burden has been a primary driver of physician turnover, Campbell explains.
"Electronic medical records have not been making significant inroads in reducing documentation burden, including the most advanced EMRs," Campbell says.
To rise to this challenge, Ardent has adopted Ambience, an artificial intelligence scribe tool.
"A clinician starts an encounter with a patient by saying the conversation is going to be recorded, then they have a conversation with the patient," Campbell says. "The clinician can look at the patient the whole time. The clinician then walks out of the room, and in less than a minute a clinical note is completed."
Ambience features the latest generation of AI scribe technology, according to Campbell.
"Early generations of AI scribes were good at dictation," Campbell says. "But the newest generations of AI scribes do a much better job of summarizing and linking to key elements that are going to communicate the acuity of the patient and affect the coding and the subtleties of what is in the clinical note overall."
Adoption of an AI scribe tool has revolutionized clinician and patient experience at Ardent. In one market where the organization is piloting Ambience, Campbell says not one of the 86 clinicians has dropped out, and patient satisfaction scores have gone up one full basis point on their scale of 1 to 10.
"It has improved coding," Campbell says. "Patients are commenting that the clinicians are talking with them directly the whole time of an encounter."
Virtual attending is another technological approach to addressing physician turnover at Ardent. There are clinicians such as cardiologists, neurologists, and nephrologists who are willing to truncate their practice so long as they can have access to patients through video encounters, according to Campbell.
"They do not go into clinics or hospitals any longer," Campbell says. "In many cases, they take a lesser level of compensation. They see patients for consultations via telemedicine."
Ardent has had video consultation for stroke patients for years, but the new virtual rounding strategy is different, according to Campbell.
"You don't have a cart come into the room as you would for a stroke patient," Campbell says. "This is seeing a patient in a setting such as the emergency department, where there is audio-visual equipment in every room. Clinicians can round on many patients virtually."
For physicians, virtual rounding reduces travel time and cognitive burden, Campbell explains.
"I have cardiologists who have been rounding on patients in certain hospitals, and they have not entered those hospitals for months," Campell says. "I have neurologists in our East Texas market who will never go into those hospitals. These are individuals who are basically moving beyond the traditional confines of having an office practice and going to hospitals for consultations."
Beebe Healthcare offers a residency program for physicians as well as financial support for clinicians to pursue advanced training such as master's degrees.
Beebe Healthcare has launched several workforce development programs for physicians and advanced practice providers (APPs).
Beebe has a robust team that recruits physicians and APPs, says Paul Sierzenski, MD, senior vice president and chief physician executive at the health system.
"We have a team that is working diligently so that when we have clinicians who have interest in joining us, they understand our vision, what we are looking to do for our communities, and know that we are here to help them be successful in their clinical careers," he says.
Beebe looks for physician and APP candidates who share the health system's goals and mission, according to Sierzenski. The goals of the health system's strategic plan include providing access to care, being best in core clinical competencies, being the employer and partner of choice, being patient-centric for all people, and being agile and sustainable.
Workforce development for physicians
Beebe is committed to the development of its physicians, Sierzenski explains.
"An important element is how we can further develop physicians, and that may be new physicians we recruit or as we grow physicians and help train them in our residency program," he says. "We are growing our undergraduate and graduate medical education program to help develop physicians for our communities."
Beebe launched a family medicine residency program two years ago and is planning to implement other residencies.
"We have four family medicine residents per year, with a goal to grow that number to as many as eight residents," Sierzenski says. "We are in our cap-building timeline, which means that in order to get funding from the federal government we have until June 30, 2028, to grow the program to six to eight residents."
The health system plans to launch an internal medicine residency with eight residents per year, as well as a transitional year residency that will bolster physicians' experience in specialties such as anesthesia and radiology.
There are several reasons why Beebe believes offering residency and fellowship programs is important for physician workforce development, according to Sierzenski.
"First, our family medicine residency is defined as a rural medicine residency, so we have more obstetrical experience for those physicians, and we are helping them understand how to connect with communities," he says.
"Second, we believe we should be providing advanced training in a couple of key areas,” Sierzenski says. “We are looking to establish a fellowship in palliative and hospice care, a fellowship in geriatrics because we have a growing retirement community, and a fellowship in sports medicine.”
"Third, even though we may not have fellowships that cascade off our internal medicine residency program, if folks are spending three years training and living in our community then pursue a fellowship outside of our community, there is a high likelihood that they will come back and work in the community where they trained as residents," he says.
Beebe encourages physicians to seek advanced training and pursue college degrees, Sierzenski explains.
"For our employed clinicians, we have a robust benefits package that includes support for individuals to go and get advanced training," he says. "We have partnerships with other organizations for advanced training such as a Master's degree in business."
Paul Sierzenski, MD, is senior vice president and chief physician executive at Beebe Healthcare. Photo courtesy of Beebe Healthcare.
Workforce development for APPs
Beebe has contracted with ThriveAP to offer advanced training to APPs, including nurse practitioners, physician assistants, and certified registered nurse anesthetists.
"We have a three-year agreement with ThriveAP, where we have an opportunity to give evidence-based specialty training to up to 10 advanced practitioners per year," Sierzenski says. "This is a way to help support those individuals in further learning specialty-specific domains and to drive up evidence-based care."
ThriveAP training includes acute care pediatrics, cardiology, critical care, emergency medicine, general oncology, family medicine, geriatrics, hospital medicine, pediatrics, mental health, urgent care, and women's health.
Leadership development efforts for physicians and APPs
Beebe also has a formal leadership development program for physicians and APPs.
"We have a clinical leadership development program that includes aspects related to conflict resolution, stress and time management, active listening, de-escalation, finance, budgeting, and accountability," Sierzenski says. "This program is open not only to our physicians but also our advanced practitioners. A personalized coach is part of the program."
Part of the clinical leadership development program involves working with executives from across the health system, according to Sierzenski.
"The individuals that go through this program interface with several departments in our organization such as the quality department to get a deeper understanding of how work is done," he says.
Effective ambulatory clinics have strong leaders and employ tools that bolster insights and decision-making, this chief physician executive says.
The first key to success in operating ambulatory clinics is selecting the right leaders, according to the new chief physician executive of Providence.
As of February, Susan Huang, MD, now serves as the chief physician executive at Providence and chief executive of Providence Clinical Network, which features 1,100 ambulatory clinics. Prior to taking on her new role, Huang served as CMO of the health system's South Division and CEO of the payer-provider Providence Health Network in California.
"In ambulatory clinics, you need to have the right leaders in place, so it is important to recruit the right type of talent," Huang says.
Providence has several programs to develop ambulatory clinic leaders internally, according to Huang.
"What we have found is that when we are able to grow our own leaders, they understand the Providence way, culture, and mission," Huang says. "That helps a lot with continuity."
The health system wants leaders of ambulatory clinics to have exposure to the broad environment of healthcare, Huang explains.
"We try to educate people on what is happening in the global context of healthcare, which is changing a lot," Huang says. "How healthcare was delivered in the past is not how healthcare is delivered now."
Changes in the delivery of healthcare over the years include an increase in administrative burden and a shift away from a paternalistic approach to the practice of medicine. For example, patients are more involved in their care now than in the past.
"The healthcare of the past was top-down. We knew what was best, and the patient was expected to follow," Huang says.
According to Huang, the advent of the electronic medical record was positive because health systems can now collect data in one place and extract information more readily.
"But at the same time, the EMR has created burdens in documentation, not just for physicians, but also for other staff," Huang says. "While we want to realize the potential of the electronic medical record, we also want to decrease the administrative burden that comes along with the EMR."
Successful ambulatory clinics also must have the right tools that lead to better insights and decision-making, Huang explains.
"You need tools that are timely," Huang says. "We have been aided by advancements in artificial intelligence's predictive abilities, including the ability to analyze large amounts of data, so that we can better understand our operations, populations, and the clinical care that we are delivering."
Susan Huang, MD, is chief physician executive at Providence and chief executive of Providence Clinical Network. Photo courtesy of Providence.
Succeeding in value-based care
Providence has posted positive results in value-based care.
"Looking at the program year for the Medicare Shared Savings Program in 2023, we generated more than $100 million in shared savings," Huang says.
Several factors dictate whether a health system can be successful in value-based care, according to Huang.
"There must be an alignment between the economic model and the clinical care and operational models," Huang says. "You need the right data and insights—you need to be able to make predictions and understand your populations."
Health systems must be aware of misaligned economic models in value-based care, Huang explains.
"With the flow of funds, they need to be aligned with the clinical activities we are expected to do. This includes incentive metrics for physicians," Huang says.
Clinicians play a significant role in delivering value-based care, according to Huang.
"They need to be attuned to evidence-based care, care pathways, best practices, and making sure there is a reduction in unwarranted variation in clinical practices," Huang says.
Providence helps clinicians to limit variation in clinical care. For example, the health system has embraced a decision-support tool called Clinpath in oncology.
"It is a tool that helps direct the chemotherapy regimens that a patient should be on based on factors including the type of tumor and pathology," Huang says. "We can establish the recommended chemotherapy and assess our compliance with evidence-based regimens."
Everyone in a health system must be involved in value-based care to achieve success, Huang explains.
"It is not just the physicians," Huang says. "It is not just the care managers. It is not just the hospitals or the clinics. Everyone must know they have a role to play in value-based care."
Flexibility and innovation are also essential in value-based care, according to Huang.
"You must be flexible, and you must innovate," Huang says. "You must think about new ways to engage your patients. This can involve technology such as remote patient monitoring to take care of a cohort of your patients."
Success in physician leadership
Providence provides opportunities for physicians to take on leadership roles.
"One of the keys to success in physician leadership roles is creating opportunities for physicians and advanced practice practitioners to understand what they could do in a leadership role," Huang says. "We also want to create a pipeline and a pathway for people to grow in their jobs."
At the health system, physicians can participate in committees and governance structures to experience leadership in different ways, according to Huang.
"Not everyone wants to take on leadership roles in the same way," Huang says. "Sometimes, it is taking a small bite of the apple, getting a little bit of exposure, and learning more about leadership."
Here's how AI tools are moving the needle in detecting colon cancer.
Artificial intelligence (AI) tools are improving the effectiveness of colonoscopies, according to the CMO of GI Alliance.
Colorectal cancer is the fourth most common form of cancer among men and women in the United States, according to the Centers for Disease Control and Prevention. It is the fourth leading cause of cancer deaths, the CDC says.
Colonoscopies are the most effective method to detect polyps in the colon that can progress into colon cancer, explains J. Casey Chapman, MD, CMO of GI Alliance, which features gastroenterology groups across the country.
"Colonoscopy is the best test we have—it is the gold standard for colorectal cancer screening as well as polyp detection," Chapman says. "There is nothing else that even comes close."
The main limitation for colonoscopies is related to the gastroenterologist workforce, according to Chapman.
"One of the limitations is that there are a lot of people who need an average-risk colonoscopy without enough people to do them," Chapman says.
With the shortage of gastroenterologists, it is imperative that colonoscopies are utilized appropriately and are done effectively, Chapman explains.
"No. 1, we have got to be sure that when we do a colonoscopy, it is sensitive to pick up polyps and colon cancer when they are present, and it is specific, meaning when colon cancer is there, we find it," Chapman says.
Polyp detection is crucial, according to Chapman.
"If you find a polyp, you want to make sure you bring that patient back for another colonoscopy at the correct interval," Chapman says. "If you don't find a polyp, you are very confident that the patient does not need to come back on a shortened interval."
J. Casey Chapman, MD, is CMO of GI Alliance. Photo courtesy of GI Alliance.
Adoption of AI tools
AI tools are making a difference in the detection of polyps in the colon, according to Chapman.
"AI has helped to start a bit of a renaissance of closing the gap for human error," Chapman says. "A gastroenterologist can miss a colon polyp. If that happens, there is an increased risk of interval colon cancer, which means you have cancer between the initial colonoscopy and the recommended second colonoscopy."
Several companies have developed computer-assisted devices that help detect colon polyps during a colonoscopy, Chapman explains.
"Basically, it is like having an extra set of eyes in the colonoscopy procedure to make sure there is fact-checking," Chapman says. "Where you see something, the AI will see it. Where you do not see something, the AI may show you there is something present."
The strength of AI in colonoscopies is going to progress as it teaches itself or as gastroenterologists teach the machine learning algorithms, according to Chapman.
"What we must do as human beings and the operator is make sure that what AI says is a colon polyp is a colon polyp, and it is getting better and better," Chapman says. "We also need to make sure when AI says there is no colon polyp there is actually no colon polyp. In other words, we still must make the ultimate decision, but AI does help to alert us that there could be danger."
The application of AI tools in colonoscopies is just beginning and exciting advances are on the horizon, Chapman explains.
"We are going to be able to utilize not only two-dimensional polyp detection as it exists today, but also move into three-dimensional spatial computing," Chapman says. "Not only are you going to see the polyp, but you are also going to be able to see it at a high image rate and in a three-dimensional fashion."
While AI has the potential to revolutionize colonoscopies, it is unlikely that AI will ever be able to conduct the procedure independently of a gastroenterologist, according to Chapman.
"The hard part would be patient buy-in. Patients probably would not want a machine doing their colonoscopy," Chapman says. "In addition, it takes about 10,000 colonoscopies to be really good at it because every colon is unique. If you are going to train AI to do colonoscopies, it is going to take hundreds of thousands of colonoscopies to train it."
Replacing the human touch in colonoscopies would be extremely difficult, Chapman explains.
"It is impossible to teach a machine trust and empathy," Chapman says. "When you are dealing with a person who might have colorectal cancer or colon polyps, the most important part of the entire process is the human-to-human relationship."
After screening for health-related social needs, health systems and hospitals can connect patients with community-based resources.
CMOs should be concerned that the health-related social needs of their patients are being met, according to a pair of experts.
Social determinants of health (SDOH) impact 80% of health outcomes, according to research. SDOH includes food insecurity, education level, transportation access, and economic standing.
There are several reasons why CMOs should be focused on making sure the health-related social needs of their patients are screened and addressed, according to Nebeyou Abebe, senior vice president of social determinants of health at Highmark, and Sally Kraft, MD, population health officer at Dartmouth Health.
"When people think about social determinants of health, they think about community programs and supplemental benefits. A third component that a lot of people do not pay attention to is medical cost reduction," Abebe says. "CMOs are tasked with medical cost reduction."
SDOH impacts patient engagement, Abebe explains.
"You need to be able to understand and identify when a patient has health-related social needs because they are a barrier for that individual from fully engaging in their care plan," Abebe says. "This is an opportunity for us to remove barriers to enable patients to fully engage in their health and well-being."
Regulatory compliance and payer contracts are related to screening and addressing SDOH, according to Kraft.
"Increasingly, we are seeing payers and regulators require screening for health-related social needs," Kraft says. "We can predict that soon there is going to be a requirement that you were able to meet your patients' identified health-related social needs. There are contracts that require that this work be done."
Addressing SDOH is also linked to the well-being of healthcare providers, Kraft explains.
"It is distressing professionally to have a patient before you and you cannot address the needs that are impacting their health," Kraft says. "Understanding social care needs and putting systems in place to respond to those needs will decrease the moral depression and moral injury that occurs for frontline staff."
Screening for SDOH
Screening for health-related social needs is the first step to addressing SDOH.
In 2019, Highmark and its health system, Allegheny Health Network (AHN), developed an evidence-based SDOH assessment tool for the payer's members and the health system's patients.
"We leveraged clinically validated screening questions to create a 13-question assessment covering social needs across several domains," Abebe says. "Through this assessment, we screen patients to identify their needs, then help to make connections to address these challenges."
There are several ways for AHN patients to complete the SDOH assessment, according to Abebe.
"The SDOH assessment may be completed through our AHN MyChart app before a visit, on a tablet in the waiting room, or a one-on-one interaction during an appointment," Abebe says. "We find that some patients enjoy the opportunity to complete the assessment on their own digitally, while others may not utilize technology the same way and may feel more at ease with someone asking them the questions."
Dartmouth Health started collecting information from patients about their health-related social needs in 2017, beginning in adult primary care clinics. The screening effort has since been implemented in other outpatient clinics and the inpatient setting.
At Dartmouth Health's outpatient clinics, which conducted 108,000 SDOH screens last year, patients complete the assessment tool through the health system's patient portal before an appointment or through a tablet when they come to a clinic.
"Patients' responses are secure, private, and voluntary," Kraft says.
In the inpatient setting at Dartmouth Health, SDOH screening is conducted by nurses or care managers.
"The care managers see patients to help organize care and understand whether there are needs that need to be met before the patient is discharged," Kraft says.
Addressing SDOH
Highmark and AHN use a community-support platform powered by findhelp to connect patients with community resources.
"The platform has a database of community-based organizations with resources that patients and members can access for free or at a reduced cost," Abebe says. "They can access resources such as food, housing, transportation, and utility assistance."
In addition, AHN has Healthy Food Centers and food prescription programs at six of the health system's 14 hospitals.
"A doctor can write a food script for the patient, and the patient can take the script to one of our Healthy Food Centers and access healthy food and additional resources to support both their food insecurity needs as well as their chronic condition needs," Abebe says.
Patients who have used the Healthy Food Centers have posted positive health outcomes, Abebe explains.
"Patients who have had a positive health outcome as it relates to our prescription food program include a drop in A1C of 1.28%, an average drop in body mass index of 2.04%, and an average drop in cholesterol of 44.7%," Abebe says.
In the inpatient setting at Dartmouth Health, care managers assist patients with making connections to resources in the communities where they live after they are discharged from the hospital.
"A resource that is used often is called 211, which is a centralized social care resource in New Hampshire," Kraft says.
In the outpatient setting at Dartmouth Health, such as primary care clinics, the health system employs community health workers and resource specialists to work with patients who have health-related social needs.
"They offer to meet with the patients to provide assistance with social needs," Kraft says. "They will meet with the patient, ask clarifying questions about the patient's social needs, then help patients identify goals, set goals, and meet those goals."
The community health workers and resource specialists try to equip patients with the skills necessary to address health-related social needs.
"The goal is to help patients meet their needs but not necessarily to do it for them," Kraft says. "We coach patients and help them learn problem-solving skills."
These community health workers are having an impact.
“In our most recent report, where we provided information on how well we did in 2024, we found that for community health workers that were working with patients and started an action plan to meet social needs, about 72% were completed," Kraft says.
Essential elements of physician leadership include listening skills, goal setting, the ability to make outcomes better, and providing good feedback, according to this CMO.
Physician leaders play a crucial role in the success of health systems and hospitals. They occupy key positions, including work as CMOs, department chiefs, and service line leaders.
RWJBarnabas Health takes an intentional approach to physician leadership development. Physician leaders have several essential qualities and characteristics, according to Andy Anderson, MD, MBA, CMO and chief quality officer at RWJBarnabas.
"Good physician leaders are excellent listeners, and they understand the key issues that their stakeholders are going through, including their physician colleagues, nurse colleagues, patients, and families," Anderson says. "They are listening, and they understand what the issues are and think about how they can make improvements."
A good physician leader tries to make outcomes better for patients and families as well as for their colleagues who work with them in health systems and hospitals, Anderson explains.
Effective physician leaders also are adept at goal setting in critical areas such as safety, quality, and patient experience, according to Anderson. They must be able to hold others accountable to achieve goals.
"They need to be able to influence their colleagues who work with them in health systems and hospitals to generate good outcomes," Anderson says. "Part of that is using data to demonstrate baseline performance and to track progress."
Strong physician leaders must also be able to get good feedback and provide guidance to help their physician colleagues improve performance at the frontlines, Anderson explains.
[SUBHED] Identifying physician leaders
RWJBarnabas energizes physicians to step up and self-select for leadership roles, according to Anderson.
"When a physician is interested in leadership, we would love to hear from them and encourage them," Anderson says.
The health system also monitors physicians to see how they behave in meetings and how they interact with their colleagues to identify future physician leaders, Anderson explains.
"When physicians show leadership potential, we ask them whether they are interested in taking on additional responsibility," Anderson says. "That can be progressive responsibility in terms of leading a committee or leading a particular initiative, then it can progress to leading a department or program."
Andy Anderson, MD, MBA, is CMO and chief quality officer at RWJBarnabas Health. Photo courtesy of RWJBarnabas Health.
Physician leadership development efforts
RWJBarnabas has several physician leadership development efforts in place.
The most formal physician leadership development program, which was developed by senior leadership including Anderson, is an all-day session designed to impart leadership skills for emerging physician leaders.
"We walk through things such as what does physician leadership look like—what are the behaviors physician leaders exhibit," Anderson says. "We talk about areas such as recruitment, performance management, how to give effective feedback, how to maintain wellness for yourself and your colleagues, and change management."
Mentoring and coaching are essential elements of physician leadership development at RWJBarnabas, Anderson explains.
"It is important for senior physician leaders to be great mentors, great coaches, and great role models," Anderson says, "so others can observe the things we do and in turn do those things themselves."
A crucial element of mentoring and coaching physicians who aspire to being leaders is giving good feedback.
"A coach or mentor must understand a physician leadership candidate's strengths and weaknesses," Anderson says. "If there are behaviors that are not the right behaviors, a coach or mentor should make sure that feedback is given in a timely and effective manner."
As the health system's CMO, Anderson provides mentorship and coaching to RWJBarnabas' 12 hospital CMOs.
"Each of those chief medical officers report to me, and I mentor and coach them to be more effective leaders," Anderson says. "In turn, they have department chairs, program directors, and other physician leaders within their hospitals that they mentor and coach."
In addition to knowing the strengths and weaknesses of his hospital CMOs, Anderson strives to be transparent with the executives in his role as a mentor and a coach.
"I like to focus on the outcomes at a hospital, see how things are going, and offer help if there are opportunities for me to coach based on the things I am hearing," Anderson says. "I am transparent and have open conversations."
Anthony Aquilina, DO, is executive vice president and chief physician officer at WellSpan Health. Photo courtesy of WellSpan Health.
Ryan Van Donselaar, DO, is CMO of Hendricks Regional Health. Photo courtesy of Hendricks Regional Health.
Paul Sierzenski, MD, is senior vice president and chief physician executive at Beebe Healthcare. Photo courtesy of Beebe Healthcare.
Susan Huang, MD, is chief physician executive at Providence and chief executive of Providence Clinical Network. Photo courtesy of Providence. 
J. Casey Chapman, MD, is CMO of GI Alliance. Photo courtesy of GI Alliance.
Andy Anderson, MD, MBA, is CMO and chief quality officer at RWJBarnabas Health. Photo courtesy of RWJBarnabas Health.