SSM Health has established "foundational building blocks" to support value-based care.
The chief clinical officer of SSM Health is passionate about value-based care.
Stephanie Duggan, MD, became chief clinical officer of SSM in November 2023. Prior to joining SSM, she was president and CEO of Ascension Michigan for five years.
"I love value-based care because value-based care means we as a health system are doing our job for those in the communities we serve," Duggan says. "When we think about value-based care, it is about being there for the patients every time they need care. With value-based care, we get credit for being able to give care in a more efficient manner."
SSM has four "foundational building blocks" to support value-based care that are paired with care management programs.
Rising labor costs are among the challenges at medical groups, survey finds.
Medical groups are continuing to feel the strain of internal and external pressures, including rising labor costs as well as increasing demand and access issues, according to the AMGA.
"With a stifled reimbursement environment and continued financial pressures, medical groups are forced to double down on operations and expense management," the AMGA said in a prepared statement.
The AMGA survey includes three key findings.
First, operating expense increases outpaced revenue gains. Median investment per physician eroded for system-affiliated medical groups from $249,000 to $256,000, excluding overhead allocations.
Second, to address physician shortages and access issues, utilization of advanced practice providers (APPs) such as nurse practitioners and physician assistants has increased sharply. APP utilization has grown from 36.8% of total providers (2020 AMGA survey) to 45.9% (2024 AMGA survey).
Third, the AMGA2024 Medical Group Compensation and Productivity Survey found provider compensation was up 5.3% from the prior year. The AMGA 2024 Medical Group Operation and Finance Survey found salary and benefits increased, while other operating expenses dropped.
"This finding indicates that the portion of the company's revenue being allocated towards compensation and benefits continues to grow (as a percentage of revenue)," the AMGA said, "while expense management in organizations is focused on management of non-salary spending."
Mark LePage, MD, MBA, FACHE, is senior vice president of medical groups and ambulatory strategy at Trinity Health. Photo courtesy of Trinity Health.
Increasing labor costs
Medical groups are experiencing higher labor costs "across the board," but physician compensation has become a major driver of increased salary expenses, says Mark LePage, MD, MBA, FACHE, senior vice president of medical groups and ambulatory strategy at Trinity Health.
"We have experienced increased labor costs on the physician side and the provider side," LePage says. "There is an inherent shortage of physicians and providers across the country."
At Trinity Health and many other health systems, special circumstances are putting upward pressure on compensation for some physician specialties, LePage explains.
"For example, we have increased the sites where we are providing anesthesia services, which has further increased demand on a limited supply of anesthesiologists," LePage says. "More and more imaging is being done throughout the healthcare enterprise, so we are experiencing shortages of radiologists in some markets."
There are several strategies to offset labor costs, according to LePage, including making sure all staff members are working at the top of their licenses.
"We want to make sure that staff are doing the things that only they can do," LePage says.
Technology is also part of the solution.
"We need to look at where we can off-load work to computers," LePage says. "We need to look at places where the electronic medical record can do more of the work for us than having people do the work."
Additionally, Trinity Health has deployed AI tools to boost the efficiency of clinicians, according to LePage. The health system has adopted DAX Copilot to decrease the documentation burden on clinicians. The ambient listening AI tool records the interaction between a clinician and a patient, then generates a clinical note for the EMR.
"It allows our physicians and other providers to spend more time with the patients," LePage says.
Expenses outpacing revenue
While expenses such as labor costs have been increasing at medical groups, revenue has been stagnant or even decreasing, according to LePage.
"We have had inflationary pressure that has impacted not only labor but also real estate and supplies," LePage says. "At the same time, when you look at the Centers for Medicare and Medicaid Services (CMS) conversion factor for professional reimbursement in healthcare, that has been decreasing year after year."
To make matters worse, commercial payers have been following CMS' lead in limiting physician reimbursement, LePage explains.
Advocacy must be part of the strategy to address the imbalance between expenses and revenue.
"First, the AMGA and others are doing a lot of advocacy work with the government about how we need to change the formula for the CMS conversion factors," LePage says. "Second, we need to work with commercial payers [to advocate] for reimbursement increases that more accurately reflect the inflationary pressures we are facing."
LePage recommends medical groups increase operational efficiencies and reduce operational expenses.
"We have to manage all of the components of our operating expenses much more closely," LePage says. "For example, there is an increasing threshold for physician productivity that we need to achieve to offset inflationary pressures."
Medical groups need to contain supply chain costs and manage real estate assets effectively to decrease operating expenses, according to LePage.
Revenue cycle is another area of focus.
"Looking at the revenue cycle, we need to make sure that we capture all of the dollars that we have actually provided in services," LePage says.
APP utilization
The increased utilization of APPs reflects significant trends in the healthcare workforce and the U.S. patient population, according to LePage.
"The healthcare needs of the population are increasing as the population ages," LePage says. "We need to incorporate APPs into the care delivery model because there are not enough physicians to provide care."
Leaders at Trinity Health believe the best model for APPs in care delivery is a team-based approach, where APPs and doctors work in cooperation as colleagues, LePage explains.
"We believe the best construct is a team construct in which you have physicians and APPs working together as part of a team," LePage says. "The skills of APPs and the skills of physicians as well as the experiences of both help to augment what we are trying to do in our care environments."
Duggan became chief clinical officer of SSM in November 2023. Prior to joining SSM, Duggan served as president and CEO of Ascension Michigan for five years. Her leadership experience includes serving as CMO of Ascension Sacred Heart Hospital in Pensacola, Florida.
"I love value-based care because value-based care means we as a health system are doing our job for those in the communities we serve," Duggan says. "When we think about value-based care, it is about being there for the patients every time they need care. With value-based care, we get credit for being able to give care in a more efficient manner."
To be successful in value-based care, a health system must have "foundational building blocks" that support delivering high quality care at a relatively low cost, according to Duggan, who adds SSM has four of them.
"We have our data analytics integrated, so we can see and measure the differences we are making," Duggan says. "Secondly, our value-based payer contracting is designed to manage alternative payment models. Third, we have care management programs because you cannot just suddenly expect patients to manage themselves into better healthcare. Finally, we have optimized our physician enterprise—you need doctors who are willing to go on the value-based care journey."
SSM started with seven care management programs, and recently added care management programs for congestive heart failure and diabetes care. One of the original seven is an acute transition program, where the health system has specialists who are trained to help patients when they are going from the hospital to the home or a post-acute care facility.
"Good care doesn't end when you leave the hospital or leave the emergency department," Duggan says. "Having someone guide you through care transitions has a lasting impact on how you manage to deal with the stress of an acute illness."
Data shows the care management programs are having a positive effect. In 2022, the patients who had enrolled in one of SSM's care management programs had a 17.5% lower per-member-per-month cost in 2023.
"That accounts for an annualized savings of about $16.4 million," Duggan says. "That is telling us that what we are doing is working."
Stephanie Duggan, MD, is chief clinical officer of SSM Health. Photo courtesy of SSM Health.
Attaining sufficient scale is critical to providing effective value-based care, according to Duggan, who adds that it's difficult to find success with a smaller number of patients.
"We have more than doubled the number of patients who we have attributed to our medical group that are in alternative payment models," Duggan says. "We had about 300,000 lives in 2019. At the end of 2023, we had more than 600,000 lives."
To support value-based care, SSM has also focused on annual wellness visits with patients. According to Duggan, patients who have annual wellness visits have an opportunity to talk with a provider about what's going on in their lives.
"When we are providing value-based care, we want to know what health means for the patient," Duggan says. "As clinicians, if we do not ask that question, we will do cookie-cutter medicine as opposed to individualized care."
For health systems, reimbursement is the primary challenge in providing value-based care, according to Duggan.
"Generally, when you start on the value-based care journey, you are only sharing upside risk with payers. So if you save money, you make money," Duggan says. "But as you get better and move further along the journey, you take on downside risk as well. It gets harder to capitalize on savings. What I am hoping is that as the rest of the country embraces value-based care, reimbursement will catch up."
Limiting expenses is essential in managing downside risk, Duggan explains. For SSM Health, diabetes care is one of the highest expenses.
"We are looking at how we can improve management of these patients to spend less on rescue care and more on preventative care, which not only helps the patients feel better but also keeps them out of the hospital," Duggan says. "That is how you win in value-based care programs—you must continuously be improving and helping your patients be healthier."
Texas Children's Hospital and its physician group have stepped up efforts to promote physician well-being since the coronavirus pandemic, according to this CMO.
Sapna Singh, MD, the new CMO of Texas Children's Pediatrics, has several years of experience in leading physician wellness efforts.
Singh has been a physician at Texas Children's Hospital since 2011, and she started as CMO of Texas Children's Pediatrics in October. Singh has served as medical director of physician wellness at Texas Children's Pediatrics since October 2022 and has been the chair of the Texas Children's Pediatrics Engagement and Wellness Committee since October 2021.
With 350 physicians, Texas Children's Pediatrics is one of the largest pediatric medical groups in the country.
Discussions about improving physician well-being at Texas Children's Pediatrics began in 2016, but the coronavirus pandemic galvanized the effort, according to Singh.
"Not only in our organization but also across the country burnout and moral injury increased during the pandemic," Singh says.
The Engagement and Wellness Committee was formed in 2021.
"It was comprised of physicians in the organization who had a desire to help work on improving the culture and efforts to improve wellness and engagement for our clinical teams," Singh says. "The key was not only the establishment of the committee but also partnering the committee with our leadership team."
The committee strengthened the relationship between senior leadership and the clinical staff, Singh explains.
"We moved away from what sometimes felt like a disconnected relationship between senior leadership and the clinical side of the organization," Singh says. "We tried to bring those two groups together and to work together. We have brought that partnership to fruition."
The first step to boosting physician wellness efforts was "simply asking" what physicians needed, according to Singh.
"Oftentimes when wellness initiatives are put together, there is an assumption of what is needed. Instead, we asked the physicians and the clinical teams what they needed," Singh says. "We began conducting a well-being index survey about three years ago."
Singh says she has been involved in multiple well-being initiatives over the past three years.
"A lot of what we have done in terms of our wellness programs has been off-loading work that does not directly impact patient care," Singh says, "but adds to physician burnout and adds to work physicians do outside of clinical hours."
Managing electronic in-box messages for physicians has been a focal point.
"We receive hundreds of thousands of in-basket messages as an organization every year, so it is an incredible amount of work, and we tried hard to off-load some of this work for our physicians," Singh says. "We had nurses triage questions. Now, we are working on AI to help us with the responses."
Clinical documentation in the Epic electronic medical record has been another area where work is being off-loaded from physicians, according to Singh.
"It takes a lot of time to check all of the boxes and complete clinical notes," Singh says. "We have initiated a pilot to use an AI virtual scribe, so some of our physicians are using AI technology that writes their clinical notes. Their documentation is largely done by the time they walk out of the exam room."
There have been training efforts to improve physicians' skillsets, Singh explains.
"For many physicians, burnout is not just a matter of the work we are doing," Singh says, "but also work that we feel helpless about."
For example, there is a training program with The REACH Institute for any physician who wants to get training in psychiatric care in the primary care setting.
"When we came out of the pandemic, many children were suffering with mental health issues," Singh says. "There was little we could do to improve resources for these patients, so we improved our own training. More than 200 of our physicians took the training, which helped us to help patients in real-time."
There have also been efforts to improve communication with physicians and other clinical team members, according to Singh, including an initiative to add anonymous feedback links in Epic.
"If you are in front of your computer and there is a 'pebble in your shoe'—a constant occurrence that keeps coming up—you can click on a link and send an anonymous message to me as the chair of the Engagement and Wellness Committee or the president of Texas Children's Pediatrics, Daniel Gollins," Singh says.
Anonymity is an important aspect of the feedback links, Singh explains.
"Clinical team members can freely express their concerns," Singh says. "They can reach people at the top of the leadership team who can address these concerns."
Sapna Singh, MD, is CMO of Texas Children's Pediatrics. Photo courtesy of Texas Children's Pediatrics.
Promoting patient safety and care quality
In addition to physician well-being, Singh's top priorities as CMO of Texas Children's Pediatrics include focusing on patient safety and care quality.
"The biggest thing I look at is making sure the teams that need to be involved in quality and safety are all talking with each other," Singh says. "When it comes to quality and safety in the clinic, we need our quality and safety teams engaged with not only the clinical staff members but also making sure that physicians know their role in ensuring quality and safety."
Physicians play a pivotal role in patient safety and care quality, according to Singh.
"When we discuss needle sticks, vaccine errors, or fall prevention, these are things that sometimes people assume will involve educating the nursing staff," Singh says, "but I take the position that physicians need to know about these things as leaders of the team to reinforce, educate, help spread awareness, and emphasize why these things matter."
To foster patient safety, clinical staff must feel safe to speak up when there are safety concerns or a medical error occurs, according to Singh.
"The focus cannot be placing blame on a person," Singh says. "Having worked in medicine for more than 20 years, I know that anyone is capable of making a mistake on any given day."
At Texas Children's Pediatrics, discussions about quality never stop.
"Quality is embedded in every conversation, and it is the hallmark of what we want people to think of when they think about Texas Children's Pediatrics," Singh says. "No matter which clinic they go to, and no matter which physician they see, the high standard of quality care is going to be the same."
The effort to form a primary care physician union is under arbitration with the National Labor Relations Board, and a decision is not expected for months. We talk with both sides.
In recent years, there has been a spike in physician unionization including seven residency programs voting to unionize in 2023, according to a research article published by the Journal of Surgical Education. The threat of physician strikes has grown significantly, according to the article.
Primary care physicians at Mass General Brigham (MGB) say they want to form a union because working conditions have become unsustainable, and the health system is resisting the unionization effort.
Primary care physicians (PCPs) employed by MGB filed their intent to unionize with the National Labor Relations Board (NLRB) in November. The PCPs are seeking to join the Doctors Council, the country’s oldest and largest union of attending physicians.
Working conditions at MGB's primary care practices are the main motivating factor for the health system's PCPs seeking to form a union, says Andrew Warren, MD, a PCP who is organizing his colleagues at Brigham Primary Physicians at Brigham and Women's Faulkner Hospital.
"We have gotten into a situation where the workload and the expectations are ever-expanding," Warren says. "The amount of support we are getting is never sufficient. This situation is hard on physicians and hard on the staff. We have gotten to a point where it is unsustainable."
Inadequate staffing is placing an unbearable load on PCPs, Warren explains, and it is affecting recruitment and retention.
"The workload is increasing, and at the same time we are losing staff, including doctors, nurses, medical assistants, and front-desk staff," Warren says. "People are feeling overworked, and when they are not compensated well or appreciated, we lose a lot of them, especially staff who are most experienced. Then we have trouble hiring new staff, and that adds to the problem."
The leadership of the health system is aware of the situation, but according to Warren, nothing ever seems to happen.
"We got to the point where unionizing was the best option," Warren says.
The benefits of unionizing include being able to work with the administration to find a way to establish a realistic workload, Warren explains.
"At least for me, it is about whether I am going to burn out," Warren says. "If something does not drastically change, I can't see myself doing this job for more than a couple more years because I cannot keep up this pace."
MGB and its PCPs have entered arbitration with the NLRB.
"We have gone to arbitration and are now waiting on the NLRB, which has a six-month backlog," Warren says.
As a general proposition, MGB is opposed to having doctors unionize, according to Jessica Pastore, senior director of public affairs at the health system.
"We feel that it is important to work directly with our physicians and other clinicians without an external third party," Pastore says.
MGB is resisting the formation of a PCP union because the doctors are facing challenges that are not entirely within the health system's control and a union poses an unacceptable risk, an MGB spokesperson says.
"We know that PCPs across the commonwealth are facing unprecedented volume and stress as a result of a confluence of factors that are not unique to our organization," the spokesperson says. "We share the common goal of offering world-class, comprehensive care for our patients and believe we can achieve this best by working together in direct partnership, rather than through representatives in a process that can lead to conflict and potentially risk the continuity of patient care."
Profits over patients?
MGB is putting profits over patients, according to Warren.
"MGB is prioritizing profit over patient care. I don't think there is any argument to that fact," Warren says. "They have made it clear that they are going to put money into things where they get a return on investment, and primary care has never been one of those things."
With the way the healthcare system works, a primary care office is rarely going to be a health system’s money maker, Warren explains.
"In the best-case scenario, you might break even, but because of the logistics and staff, primary care does not make money," Warren says. "For example, we do not do lucrative procedures like the surgeons do."
However, Pastore says MGB is not fixated on profits.
"We are a nonprofit, so any so-called profit goes back into our mission," Pastore says. "For example, we invest hundreds of millions of dollars to improve health in our communities. It is important for us to be able to sustain this mission."
According to Pastore, MGB recently committed a $65 million investment in housing, mental health, economic mobility, and food insecurity, and it invested $25 million in the Massachusetts Community Health & Healthy Aging Funds.
"These grant opportunities are designed to reduce housing inequities, which is a core part of our mission in communities across the commonwealth," Pastore says. "We are also addressing other social determinants of health."
Photo: Dr. Andrew Warren, center, walks an informational picket line outside Brigham and Women’s Hospital in Boston on Dec. 13.
Coping with the challenges of mergers and acquisitions has become an essential responsibility for CMOs.
Adapting to the clinical care challenges of mergers and acquisitions is part of doing business for CMOs.
"Getting comfortable working in a shifting matrix and developing the tools needed for change management are critical to being a healthcare leader in this age of modern medicine," says Andrea Fernandez, MD, CMO of the Atrium Health-Wake Forest Baptist Market, which is part of Advocate Health.
Mergers and acquisitions in healthcare have marched forward with a constant drumbeat in recent years. Atrium Health and Wake Forest Baptist Health formed a strategic alignment in 2020.
"Historically, CMOs have been facility-based, [but] their purview has changed dramatically over the past few years," Fernandez says. "With more and more mergers and acquisitions happening, it is important that CMOs adapt to the changing environment in which they lead. To that end, CMOs and healthcare organizations can best consider what integrated care might look like by getting stakeholders at the table from the start."
CMOs play a key role in integrating clinical care after a merger or acquisition, Fernandez explains.
"By understanding best practices at the local level as well as best practices and opportunities at the larger organizational level, CMOs can optimize clinical care by using the best of both worlds while not losing some of the great work that is being done prior to a merger or acquisition," she says.
Creating a unified medical staff allows each facility within a larger entity to have reassurance that the medical staff working at their facility is delivering the same quality of care across all facilities, according to Fernandez.
"One of the great opportunities around working for a larger healthcare entity is the opportunity to create standards among the medical staff," she says. "That ensures a high quality of clinical excellence, both from a quality care and patient safety standpoint."
"When patients go to a larger health system, they want to be sure that they are going to be able to get brand quality across every point of contact," she says. "A unified medical staff allows that to happen, and it allows for efficiency for credentialling and privileging, which can be tedious when done at facilities across a larger market."
Andrea Fernandez, MD, is CMO of the Atrium Health-Wake Forest Baptist Market, which is part of Advocate Health. Photo courtesy of Advocate Health.
M&A and clinical care challenges
Within a merged healthcare organization, Fernandez says, there are enterprise-level expectations that CMOs must balance with local operations.
"When a provider delivers care to a patient, they need to consider what resources they have at their disposal as a merged organization compared to the legacy organization," she says.
EMRs, testing resources, and partnerships with consulting physicians all can change, according to Fernandez.
"Often, these changes are for the better, but sometimes there is a brief window of change management that needs to happen for providers to get to a steady state and deliver excellent clinical care," she says.
Clinicians can rise to these challenges by engaging with leadership and optimizing the tools that are offered to them, Fernandez explains.
"Clinicians are leery of anything new, especially when it involves AI," she says. "However, I can tell you from personal experience that some of the AI tools that we have been empowered with by being part of a larger organization are truly state-of-the-art and have made my ability to care for patients much easier and much more efficient. This allows me to focus on the patient rather than the electronic medical record."
For example, after the merger of Atrium Health and Wake Forest Baptist Health, leadership offered DAX Copilot to all clinicians. The ambient listening technology has been transformative for many clinicians, according to Fernandez.
"DAX Copilot is an AI-enabled solution that partners with our Epic EMR to record my conversation with a patient, then assist me in creating my note within the medical record," she says. "By not having to worry about taking notes while talking with a patient, I am much more able to focus on what the patient is saying, the patient's physical condition, and any body language the patient may be demonstrating during a physical exam."
Simplifying clinician and patient experience after a merger or acquisition
Clinicians have a personal role to play in the simplification effort, according to Fernandez.
"In order to simplify the experience of clinicians in mergers and acquisitions, clinicians need to keep up to date with the changes that are occurring as part of the process," she says. "By keeping up to date with changes, clinicians will not be caught off guard or forced to double up on work."
Clinicians are also essential in simplifying the patient experience after a merger or acquisition, Fernandez explains.
"Understanding the context of how changes are happening is also helpful for clinicians so they can relay these changes to patients and help patients to have a better experience," she says. "Patients rely on their clinicians for guidance as they navigate health systems. If clinicians are up to date and understand the context of any changes, they are going to be better navigators for their patients."
A perfect example of this is the rebranding of patient portals, according to Fernandez.
"If the providers understand the change from one patient portal to another, they can help patients to log in to the new patient portal and help patients to understand the benefits of the new portal compared to the old one," she says.
Fernandez is a member of the HealthLeaders CMO Exchange.
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UMass Memorial Health has multiple avenues for physicians to stay informed and to participate in decision-making.
The new top clinical executive at UMass Memorial Health has been involved in physician engagement at the health system for more than six years.
Andrew Karson, MD, was named as system chief physician officer and CMO in October. Prior to his new role, he was interim president of the UMass Memorial Medical Group, and he had been CMO and senior vice president at UMass Memorial Medical Center from May 2018 to April 2023.
One of the keys to success in physician engagement is to have organizational priorities line up well with physicians' priorities, according to Karson.
"At UMass Memorial Health, we put patients and their families first," he says. "Patient-centered care engages physicians—that is why they have typically gone into medicine."
An organizational commitment to high-quality care is another important element of physician engagement.
"Physicians want to be engaged in a place that values the care that is provided," he says.
Physicians should have formal pathways to engage with a health system and contribute to decision-making, according to Karson. For example, there are two meetings every week at UMass Memorial Health with the 18 clinical department chairs.
"One meeting is with all of the leaders in the organization, and the second meeting is more intimate, with myself, the interim president of our medical group, and our chief operating officer," Karson says. "We hear directly from the department chairs about their priorities and concerns."
Karson also attends individual department meetings.
"Most department chairs have weekly or monthly staff meetings," he says. "I hear directly from clinicians, which is critically important."
The health system also has regular electronic town hall meetings.
"Our medical group covers five hospitals and over a dozen campuses as well as more than 80 practice locations," Karson says. "We share our current plans and strategies. We get input from physicians and other staff during those town halls."
Finally, the health system publishes a biweekly newsletter, called Group Talk.
"We have articles and information series about new clinical guidelines, changes to the staff benefits, and opportunities for physicians to participate in community service activities," Karson says. "Every time we publish one of these newsletters, I get about a half dozen questions about the content or ideas from the faculty."
Physician engagement is essential to the effective functioning of a health system, Karson explains.
"We have 2,000 clinicians spread across central Massachusetts," he says. "We give them multiple avenues and ways to share their thoughts and get back to us. We want them to know what we think is important and to be able to hear back from them about how they would like us to adjust and alter our thinking."
Andrew Karson, MD, is system chief physician executive and CMO at UMass Memorial Health. Photo courtesy of UMass Memorial Health.
Integrating medical services
One of Karson's top priorities is integrating medical services.
"First, you must set goals for integration and define why the organization is integrating," he says. "For us, we are integrating medical services to generate better access for patients. If we are not integrating our medical enterprise, we might not have the right resources in the right places."
One example is in cardiovascular services.
"We don't need a cardiology catheterization lab at each site," Karson says. "We have one at the academic medical center, where we need cardiologists and echocardiologists. We are trying to be intentional on where we put the resources to take the best care of patients. We want to give them access to care in the right place at the right time."
One of the goals of integrating medical services is boosting efficiency, Karson explains.
"We do not want to duplicate services at all sites of care," he says. "Not having a cath lab at every hospital is an example. By not having redundant services, we can invest in other parts of our mission. For example, we have one campus handling complicated traumas—you don't need a hospital a mile down the road to also have a trauma center. You are better off consolidating your resources to make sure you can give the best care possible without being redundant."
Standards of clinical care
A big element of Karson's job is promoting standards of clinical care.
"You need to share the 'why' behind standards of clinical care, and if everyone agrees to the why of a clinical standard, then we can all get behind the work," he says. "Part of our mission is to improve the care of the people in our diverse communities. We can improve that care by promoting the standard way we do our work."
One of those standards is ensuring that patients have access to high-quality care.
"We want to make sure that patients can be seen in a timely way by the right provider in the right place at the right time," he says. "As we design standards of care, we want to craft them in a way that provides better access to patients."
Standardizing care is based on an intentional process, Karson explains.
"We want to provide the highest quality of care based on published clinical guidelines," he says. "Medicine should be evidence-based, and where there are clinical guidelines, we want to infuse them into our work. We also want to provide care in the safest way possible."
To serve diverse communities in central Massachusetts, UMass Memorial Health needs to provide culturally sensitive clinical care, according to Karson.
"This includes medical services, teaching, and research," he says. "This means providing care that is free of bias. By having clinical standards, we can improve care broadly."
Having proven their value in administrative uses, the Pennsylvania health system is now applying the cutting edge technology to clinical care.
With more than 80 AI bots deployed since 2020, Geisinger Health is ready to push the envelope and use the technology in patient care.
Narayana Murali, MD, CMO of medicine services at Geisinger, says health systems should take an intentional approach to AI bot adoption.
"It depends on how you view the solutions you are looking for," he says. "You want to understand the present state, and you should not start off with the solution on the front end. You try to look at the issues that need to be addressed or solved, then you start the process of the AI bot application."
The first issue is to understand the problem you want to solve, Murali explains.
"The second piece is not to focus on the solution—you need to understand the gaps or barriers in the workflow," he says. "Then you can start to design the necessary applications to address those gaps or barriers."
Murali gave several examples of areas where AI bots have been deployed at Geisinger.
AI bots are being used for patient outreach such as scheduling laboratory testing or office visits.
AI bots are promulgating policy changes mainly in the administrative sphere. They are not being used for policy changes related to patient safety or care quality.
AI bots are being used for compliance such as program audits.
AI bots are boosting productivity in patient communication such as helping clinicians manage electronic in-box messages.
AI bots are being used in the emergency department such as the timely generation of notices of admission to reduce the number of claims denials.
"You need to understand AI bots from the standpoint of the entire workflow and where you need to address your challenges," Murali says. "Otherwise, you will come up with point solutions that are not capable of increasing efficiency."
AI bots have value from the perspective of the CMO, according to Murali.
"If I can achieve dramatic improvements in efficiency, it allows me to do things that reduce mundane work for physicians and frontline staff," he says. "AI bots can address pain points for the organization. You can reduce burnout among frontline staff by using AI bots."
Narayana Murali, MD, is CMO of medicine services at Geisinger Health. Photo courtesy of Geisinger Health.
Taking a careful approach to AI deployment
Health systems should take great care in AI bot adoption, according to James Blum, MD, chief health information officer at The University of Iowa.
"We have concerns about the nature of AI bots and the potential responses patients are going to get from them," he says. "One of the concerns is whether the responses from AI bots are going to be accurate and are going to provide the right information."
At this point, AI bots have the greatest potential in administrative functions, Blum explains.
"There is less concern in these cases, particularly if the tool is trying triage administrative issues," he says. "If there is a billing issue and the patient wants to set up a payment plan, that can be a good application. There is a place for AI bots in these areas, where the consequences are lower, and the risk is lower."
AI bots are more problematic in areas that affect patient outcomes, according to Blum.
"If you have anything that is potentially diagnostic or triage-based that impacts patient care, validating the quality of the response and making sure that is going to provide accurate assessment and triage of a patient is paramount," he says. "Many of these tools are doing symptom checking, then they are trying to figure out whether to send the patient to urgent care, the emergency department, or an office visit. We have real concerns about not having a human in the loop."
Customer experience is another area of concern regarding AI bots, Blum explains.
"You need to make sure that you have a patient population that wants to interact with an AI bot versus wanting to interact with a human," he says. "The question is whether you are providing a high-quality interaction that people desire or are you giving them lesser service at lower cost."
AI bots have the potential to support value-based care, according to Blum.
"We have looked at AI bot products in this domain, where the bots act as a coach for the patient," he says. "An AI bot can contact the patient to set up an annual physical and set that appointment. This communication can be conducted through text, and this presents an opportunity."
In the future, AI bots will be more appropriate in areas that impact patient care, Blum explains.
"In the coming years, there will be opportunities for AI bots to be far more triage-focused, to be doing diagnostics, and to eventually moving into ordering authority," he says.
Today, the focus of AI bots is on value-based arrangements such as following up with patients and administratively getting patients to the right place inside a health system to take care of administrative issues, according to Blum, who adds AI bots will eventually be appropriate for more advanced healthcare applications.
"With diagnostics, at some point the time will be right to provide triage services with AI bots—we will probably see that in the next five years," he says.
Physician burnout is tied to key performance indicators such as patient safety and care quality.
Four HealthLeaders CMO stories in 2024 looked at ways to promote physician well-being.
Physician burnout remains a concern across the country, and it spiked during the coronavirus pandemic. In a 2021 survey of physicians conducted by the American Medical Association, Mayo Clinic, Stanford University School of Medicine, and the University of Colorado School of Medicine, 62.8% of physicians reported experiencing burnout symptoms, which was up from 38.2% the previous year.
UW Health stepped up efforts to promote physician and advanced practice provider well-being in 2017, when the health system conducted its first physician and APP well-being survey as part of Stanford Medicine's Physician Wellness Academic Consortium. UW Health has repeated the survey every two years since 2017, says Aimee Becker, MD, chief clinical officer at the health system.
"It is challenging to make meaningful change without having data and metrics," she says.
After UW Health started conducting the well-being survey, the health system committed to not only measuring wellness among physicians and APPs but also to acting on the measurements. UW Health developed a well-being committee that included physician and APP representation from all clinical departments.
"They were tasked with helping us as an organization to identify initiatives to improve physician and APP well-being," Becker says.
Most of UW Health's well-being improvement initiatives for physicians and APPs have been consistent with the Stanford Medicine Model of Professional Fulfillment, Becker says. The model has three domains: culture of wellness, efficiency of practice, and personal resilience.
Connie Savor Price, MD, MBA, is CMO at Denver Health. Photo courtesy of Denver Health.
Addressing physician burnout is fundamental to promoting patient safety and care quality, says Connie Savor Price, MD, MBA, CMO at Denver Health.
Denver Health has been working intentionally to reduce physician burnout for the past eight years. There is no silver bullet to address the problem, Savor Price says.
"There is not a singular solution to the problem, but we know we must work on it regardless of the challenges," she says. "We must try different things and make continued efforts to move the needle because provider burnout has a big impact on patient safety and quality."
A primary effort has been to address excessive workload and administrative burdens such as documenting clinical care in the electronic medical record, Savor Price says.
"One of our most successful clinician burnout initiatives that was launched about three years ago has been at-the-elbow support in using the electronic medical record, which is Epic," she says. "We have had Epic 'super users' who are very knowledgeable in how to use the EMR to make themselves more efficient work with other clinicians. These super users have been working with their peers to show them how to efficiently document clinical care."
After selecting a well-being measurement tool, Allegheny Health Network picked an established strategy for its wellness program. As was the case with UW Health, the health system picked the Standford Model of Professional Fulfillment.
Culture of wellness: The first step involves making sure that providers have multiple ways to reach out for help, says Thomas Campbell, MD, MPH, chief wellness officer at AHN.
Survey data showed that physicians are reluctant to reach out to AHN's employee assistance program (EAP) because they are concerned about confidentiality.
"We created a help line so physicians could reach out to internal behavioral health providers 24/7," Campbell says. "We now have an EAP program that does not use internal reporting tools if people are uncomfortable with our internal behavioral health resources. We also established external resources, where people could get help through our county medical society."
AHN also conducted leadership education to create a culture that included psychological safety, so that physicians could feel comfortable sitting down one-on-one with their leaders, according to Campbell.
"The primary focus of the leadership training was how to lead your physicians with wellness in mind," he says.
Efficiency of practice is an essential element of promoting physician well-being, Campbell says.
"When you have a workday where everything is working well, you are less likely to get burned out," he says. "You are likely to get out of work on time, to be more fulfilled in your day, and to make yourself a better person physically and mentally outside of work."
AHN's effort to improve efficiency has focused on the health system's Epic electronic health record.
"We have been trying to limit the amount of time physicians are on a computer to make their work more patient-centered," Campbell says. "We want physicians to spend less time at night—we call it pajama time—charting because they could not get to it during the workday."
To address this, AHN has formed teams of proficient Epic users to help physicians use the EHR more effectively.
"We call members of these teams IT officers, and these officers show physicians how to be more efficient in the EHR," Campbell says.
The health system has also adopted AI-driven ambient listening technology, which automates documentation during physician encounters with patients.
"We are trying to find ways to make the EHR work for the physician to promote a more efficient workday, create better documentation, and create tools that support better care," Campbell says.
Personal resilience: For physicians, teamwork is also tied to personal resilience and a commitment to wellness, Campbell says.
"We have found that resiliency is tied to the team around physicians, but physicians do need to keep an eye on their health and well-being," he says.
It is important to understand that personal resilience is individualized, Campbell says.
"What one person might need in terms of diet, sleep, hydration, and mental healthcare is often different than what another person might need to keep healthy," he says.
Campbell has found that his human resources colleagues and AHN's benefits offerings are crucial to supporting personal resilience.
"I have been looking at what programs that we have and what benefits that we have for those who may need help with issues such as weight management and addiction, including smoking cessation," he says. "We want to provide multiple ways for people to get the things that they need."
Schaal has also been focusing on the core approaches of the Standford Model of Professional Fulfillment.
"We want to create a culture of wellness for physicians at Houston Methodist," she says. "We do not want a culture where physicians feel pressured to see as many patients as possible as fast as they can."
“The second thing we are focusing on for physician well-being is the efficiency of practice," she says. "There are many things in the modern practice of medicine that take up a physician's time, and we want to redesign our processes to make sure our physicians are practicing at the top of their licenses, and they have support to do things such as coding, billing, and answering messages."
"The third thing is personal resilience," Schaal adds. "We know there are ways that we can help physicians increase their personal resilience, which is related to a culture of wellness and efficiency of practice."
The stories explored new CMOs appointed in 2024, anesthesia staff shortages, patient experience versus customer experience, value-based contracts, and the need for APP executive leadership.
These five stories from HealthLeaders touched upon the top executives and pivotal issues of the year.
Chris Frost, MD, is senior vice president, CMO, and chief quality officer of Lifepoint Health. Frost was named senior vice president, CMO, and chief quality officer of Lifepoint in July. He has served in two other leadership roles at the Brentwood, Tennessee-based health system: chief medical officer of Lifepoint Communities and national medical director of hospital-based services.
Joseph Galante, MD, is CMO of UC Davis Medical Center. Galante was named CMO of the Sacramento, California-based academic medical center in July. He had served as interim CMO for a year and was the hospital’s trauma medical director for many years.
Cameron Mantor, MD, MHA, is chief physician executive at OU Health and president of OU Health Partners. In September, Mantor was named chief physician executive at the Oklahoma City, Oklahoma-based academic health system and president of OU Health Partners, the health system's physician practice. He had been serving in the roles on an interim basis since January.
Thomas McGinn, MD, MPH, is senior executive vice president and chief physician executive officer of CommonSpirit Health. McGinn was appointed senior executive vice president and chief physician executive officer of the Chicago-based health system in September. He joined the health system in 2021 as executive vice president for physician enterprise.
Arthur Pancioli, MD, is senior vice president and chief clinical officer of UC Health. Pancioli assumed the role of senior vice president and chief clinical officer at the Cincinnati-based academic health system in August. Prior to taking on his new position, he was chief transformation officer of the health system.
Tipu Puri, MD, PhD, is CMO of University of Chicago Medical Center. Puri was appointed CMO of the Chicago-based academic medical center in September. He joined UChicago Medicine as an internal medicine resident in 1999 and has held several physician leadership roles, most recently associate CMO.
Scott Schissel, MD, PhD, is CMO of Newark Beth Israel Medical Center. Schissel became CMO of the 665-bed academic medical center, which is operated by RWJBarnabas Health, in August. He had been CMO and vice president of medical affairs at Brigham and Women's Faulkner Hospital in Boston, where he also served as associate CMO and chief of medicine.
The country is grappling with a critical shortage of anesthesia staff, and several steps need to be taken to address the problem.
An article published in the journal Anesthesiology detailed the extent of the anesthesia staff shortage and offered solutions to rise to the challenge. According to the article, before the coronavirus pandemic, 35% of healthcare facilities reported an anesthesia staff shortage. Two years after the pandemic, the percentage of healthcare facilities reporting an anesthesia staff shortage rose to 78%, the article says.
"For me, the biggest challenge of the anesthesiologist shortage is patient safety," says Gulshan Sharma, MD, MPH, senior vice president and chief medical and innovation officer at The University of Texas Medical Branch at Galveston. "It's a different ballgame when you are putting a patient under anesthesia. You want to make sure you have a talented team of anesthesia professionals who can help manage the patient."
Healthcare organizations need to focus on both the patient experience and the customer experience. And yes, there are important differences.
The contrast between patient experience and customer experience is largely a difference in perspective, says Sarah Way, MD, JD, chief quality and medical officer at Texas Health Dallas, a hospital operated by Texas Health Resources.
Patient experience is related to when someone receives medical care in the moment, says Way, an emergency medicine physician. For example, receiving treatment from an emergency room clinician is a patient experience.
"A customer experience is when you look at an interaction more broadly, when somebody is engaging with the healthcare system, but it is not the provision of medical care in the moment," Way says. "In the emergency department, customer experience includes how somebody is checked in at the front desk and how they are discharged."
Research conducted at the Providence health system shows primary care physicians are overwhelmed with quality measures in value-based contracts.
One of the primary criticisms of payers' value-based contracts is that there is little to no coordination of quality measures for which clinicians are held accountable. In addition, value-based contracts have been adopted for quality improvement in primary care despite mixed evidence of their positive impact.
A research letter published by JAMA Health Forum found that primary care providers at Providence have been saddled with an overwhelming number of quality measures in value-based contracts. The research features data collected from more than 800 primary care providers from 2020 to 2022.
The senior author of the research letter told HealthLeaders that the study's findings were unexpected.
"We were shocked by what we found," said Ari Robicsek, MD, chief analytics and research officer at Providence. "Effectively, the level of industry disorganization leads to a situation where individual physicians have way more quality metrics than they can possibly be expected to manage."
A growing number of health systems and hospitals have been creating APP executive positions, including Vanderbilt University Hospital, CommonSpirit Health, and Corewell Health. The new executive positions recognize the crucial role that APPs are playing in healthcare.
Cleveland Clinic has been using APPs, such as nurse practitioners and physician assistants for decades. Over the past 25 years, the number of APPs has grown significantly from about 400 to nearly 4,000.
The health system decided to create an executive position to improve the management of APPs at the health system, says Melissa Stoudmire, MSN, who became Cleveland Clinic’s first vice president of APPs in August.
"The organization identified the need to create a dedicated enterprise APP role to manage continued growth in APPs, maintain consistency in APP practice, and streamline the leadership structure," she says. "The health system wanted to give the APP group an executive presence."
Stephanie Duggan, MD, is chief clinical officer of SSM Health. Photo courtesy of SSM Health.
Sapna Singh, MD, is CMO of Texas Children's Pediatrics. Photo courtesy of Texas Children's Pediatrics.
Andrew Karson, MD, is system chief physician executive and CMO at UMass Memorial Health. Photo courtesy of UMass Memorial Health.
Connie Savor Price, MD, MBA, is CMO at Denver Health. Photo courtesy of Denver Health.