Clinical AI is top of mind for CMOs and clinical leaders. Here are eight insights they shared that you need to know.
The HealthLeaders AI in Clinical Care Mastermind program reached a milestone today, with healthcare provider executives discussing key opportunities and challenges in Atlanta.
In the months leading up to today's in-person meeting in Atlanta, executives from 10 health systems and hospitals held several virtual calls and collaborated with HealthLeaders editors on stories about how their organizations are adopting and managing AI tools. The program will conclude by the end of the year, with publication of a final report.
Determining return on investment from AI tools was a pressing issue discussed during today's event.
"There are a couple of areas where there is 100% clear ROI from AI, said James Blum, MD, chief health information officer at University of Iowa Health Care. "In coding, there is clearly an ROI. With AI-based coding, I can decrease my claims denial rate. There is also an ROI with clinical documentation improvement."
Thinking about AI as infrastructure is the right play for health systems to determine ROI, according to William Sheahan, senior vice president and chief innovation officer at MedStar Health.
"For things like coding, you can find a third party and plug their tool into your data infrastructure and generate ROI," Sheahan said.
Generating an ROI from AI tools involves preparing staff members and leaders to benefit from the technology, Sheahan explained.
"There is a whole separate body of work for us that is about people and process to train clinicians, back-office staff, administrators, and leaders on how to use AI to make themselves more efficient," Sheahan said. "Ultimately, that is what is going to deliver ROI over time. We can make our business more efficient."
The impact of AI on clinicians and the role of clinicians in hospitals and health systems was a hot topic at today's event. Participants said it is highly unlikely that AI will replace clinicians.
"You are always going to need clinicians," said Hoda Asmar, MD, MBA, executive vice president and chief clinical officer at Providence. "AI will never replace clinicians, but it will affect what clinicians do and not do. AI can provide simplification and ease the way for the people who are delivering care."
The AI in Clinical Care Mastermind program was a golden opportunity for participating health systems and hospitals, executives said.
"We talked about how fast AI is changing and there is a lot of information coming out," said Roopa Foulger, vice president of digital innovation development at OSF HealthCare, "When you are collaborating with practitioners who are dealing with the same issues, you can share ideas and avoid potential pitfalls."
In addition to the difficulty of determining the ROI of AI tools, the Mastermind program focused on several other daunting challenges, including applying AI in the right clinical areas and addressing the cost, Asmar said.
"The other part is making AI benefit the people it is supposed to benefit the most," Asmar said. "We need to understand that the clinicians and the care teams on the frontline need to see some benefit from AI. They need to feel that things are changing for the better—not like the example of the struggles with the EHR."
Insights from virtual calls and HealthLeaders stories
As part of the AI in Clinical Care Mastermind program, HealthLeaders held several virtual calls with participating executives and featured each executive in a HealthLeaders online story. The following are the primary themes and findings from these virtual calls and stories:
ROI is elusive: Many small projects are showing early success, but that doesn’t translate into scalability or sustainability. There is a challenge in balancing financial ROI with clinical ROI, which can take longer to develop.
Early wins in ambient listening: Many health systems and hospitals are launching ambient listening tools to capture the clinician-patient encounter. Often these tools also capture coding opportunities. These tools are reducing clinician stress and "pajama time" conducting documentation after work hours.
Bots are becoming popular: Many health systems and hospitals are experimenting with AI agents in population health and public health programs, garnering success in engagement and increased appointments. They are exploring where else bots can be used to help doctors with clinical care.
Governance is an issue: Many health systems and hospitals are handling AI governance on their own, with dedicated committees, but they worry about stunting innovation. Challenges include determining who sits on these committees and making sure all bases are covered.
Outsourcing versus in-house: Many health systems and hospitals are outsourcing AI development because they do not have the knowledge or analysis capabilities to do the work on their own. Some are waiting on their EHR provider to develop tools for them, while others are looking at startups for innovative ideas. Those with in-house capabilities are doing what they can and partnering with vendors for the rest.
Cost concerns: AI is expensive, and it requires a lot of data and data storage, which can also be expensive. Costs are limiting innovation and AI development, particularly for small and rural health systems and hospitals.
Pressure on vendors: Many health systems and hospitals are taking extra precautions in negotiating with AI vendors. They are requiring proof of concept and ROI up front, shortening contracts to three years or less, and asking for details about how data is collected and used.
Generative and predictive AI: As AI evolves, healthcare executives will ask the technology to do more, such as predicting treatment plans and clinical outcomes. A key factor will be building clinician trust in AI tools. A pressing question is how AI will be measured against a doctor's observations and experience?
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Lifepoint Health's top clinical officer says technology and health equity will be dominant themes next year.
AI, health equity, and telehealth will be healthcare hotbeds in 2025, according to Chris Frost, MD, senior vice president, chief medical officer, and chief quality officer at Lifepoint Health.
Frost was named to his current position at 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. He is a member of the HealthLeaders CMO Exchange.
Prediction 1: Healthcare AI developments will accelerate
First and foremost, Frost believes adoption of AI tools in healthcare will proliferate in 2025, adding ambient listening technology for clinician-patient encounters will become ubiquitous next year.
"The AI works parallel to the clinician and the patient, capturing all of the information then dropping that information into the medical record," Frost says. "It takes unstructured data—the conversation—and organizes it in a structured format that is consistent with the architecture of the medical record."
In addition to generating documentation, ambient listening technology separates the signal from the noise, Frost explains.
"If the physician and the patient are talking, and the physician takes the conversation off to a tangent that has little or nothing to do with the patient's symptoms or complaints," Frost says, "the AI will parse that out and discard that extraneous information."
In 2025, ambient listening technology will include prompts for clinicians, according to Frost.
"For example, AI is going to listen to a conversation between a clinician and a patient," Frost says, "and if the patient tells the clinician something interesting about travel history or an exotic pet that they own, the AI is going to prompt the clinician to ask the patient about environmental exposure or zoonotic infection from the pet."
Virtual sitting in the hospital setting is another AI technology that will take off in 2025, according to Frost.
"As we grapple with workforce challenges," Frost says, "any technology that we can leverage that allows our clinicians and our nursing staff to practice at the top of their licenses rather than be distracted with other tasks is going to be helpful."
AI tools that provide a virtual sitting function are most helpful in reducing fall risk, Frost explains, and if a patient is considered a fall risk, a virtual sitting AI tool can alert the nursing staff to rush to the patient's room.
"It has an algorithm that can distinguish between a patient shifting in bed to get comfortable versus movements that may signify that the patient is about to get out of bed," Frost says. "We can get a person in the room to help the patient to the restroom or to get something for the patient."
In 2025, there will be an emphasis on AI development to have tools that complement rather than conflict with clinical work streams, according to Frost.
"We have learned from the electronic health record experience what not to do," Frost says. "We learned that introducing an EHR does not win the day if you do not take the time to work with the clinicians and nurses to integrate the EHR with the clinical workflow."
Additionally, AI engineers will listen, watch, and learn before they deploy AI tools, Frost explains.
"The technology will adapt to the person rather than the person adapting to the technology," Frost says.
Chris Frost, MD, is senior vice president, chief medical officer, and chief quality officer at Lifepoint Health.
Prediction 2: Health equity reaches crossroad
In 2025, there will be a reckoning for health equity efforts, according to Frost.
"Health equity has already grabbed a foothold in healthcare, but in 2025, we will find where health equity shakes out," Frost says. "Does it stay a central focus of the Centers for Medicare & Medicaid Services as well as The Joint Commission around health disparities and social determinants of health? Or does health equity get swept up in some of the culture wars that we see in diversity, equity, and inclusion (DEI)."
Next year, Frost believes health equity is going to be caught between two competing forces.
"There is the DEI side of the tug of war on one side and anti-wokeness on the other side," Frost says. "CMS and The Joint Commission have done a thoughtful and deliberate job around using data to identify patients who may be at greatest risk for adverse health outcomes because of health disparities or social determinants of health that are not being met."
Frost explains that the industry is moving in the right direction by addressing health equity.
"For clinicians and the healthcare arena, health equity allows us to address things that we have not paid much attention to historically," Frost says. "We are moving in the right direction by focusing on health equity, and I hope it does not get caught up in culture wars. That will be a focus for 2025, and I do not know how it is going to shake out."
Prediction 3: Telehealth revolution continues
Telehealth will continue to gain momentum in 2025, whether it is telemedicine, remote patient monitoring, remote therapeutic monitoring, or expansion of wearables, according to Frost.
Frost is bullish on telehealth because there is an estimated shortfall of nearly 90,000 physicians by 2036.
"We are going to see fewer specialists in nonurban and rural communities—fewer rheumatologists, neurologists, infectious disease doctors, and endocrinologists," Frost says. "We are going to be dependent on providing access to care through telemedicine, remote patient monitoring, and remote therapeutic monitoring."
Remote patient monitoring will be supplemented by remote therapeutic monitoring in 2025, Frost explains.
Remote patient monitoring allows clinicians to gather information about a disease process to get updates on indicators of the disease. For congestive heart failure, it largely involves daily monitoring of a patient's weight. For hypertension, it involves gathering blood pressure readings multiple times per day. Based on that information, care teams can adjust diuretic doses or blood pressure medication.
Remote therapeutic monitoring takes remote care to the next level, according to Frost.
"There is a component of monitoring but there is also a component of therapeutic guidance from algorithms," Frost says. "The clinical algorithms are embedded within the monitoring process. It provides clinical decision support for clinicians and patients."
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Sepsis is the body's extreme reaction to an infection that can result in tissue damage and organ failure. Annually in the United States, there are at least 1.7 million adult hospitalizations for sepsis and at least 350,000 deaths from the condition, according to the Centers for Disease Control and Prevention.
Providence reduces sepsis deaths three years in a row
A HealthLeaders story published in July details how Providence has decreased sepsis mortality at the health system's hospitals.
"Sepsis care is a key focus for us," says Hoda Asmar, MD, MBA, executive vice president and chief clinical officer at Providence. "We have made significant strides, and we will continue to make strides. This is something we are going to be working on for years to come, and we are saving lives."
Asmar says Providence focused on two sepsis care processes in 2021 and 2022. The health system more than doubled use of a standardized order set for sepsis patients. The primary elements are blood work and tests used to diagnose sepsis, administration of antibiotics, intravenous fluid resuscitation, and management of hypotension. Providence now uses the order set for 76% of patients presenting with sepsis and hopes to raise that rate to 80%.
Additionally, the health system set a goal to have the first antibiotic administered within one hour of identifying a patient with sepsis. It’s currently meeting this goal for 77% of patients, with a target of 80%. Asmar says those efforts helped reduce sepsis deaths from 2021 through 2023.’
Providence’s end goal is to be at a rate better than expected mortality, Asmar explains. The health system measures sepsis mortality using the ratio between observed mortality and expected mortality.
"The expected mortality comes from a benchmark based on the acuity of the patients we see," Asmar says. "We want to be better than 1.0 on the sepsis mortality ratio of observed mortality and expected mortality."
In 2021, Providence ended the year with a sepsis mortality observed-to-expected ratio of 1.11. In 2022, that ratio was 1.04, and in 2023 the ratio was 0.90. Last year, the health system saved an estimated 1,250 lives of sepsis patients, according to Asmar.
Asmar says Providence is now focusing on four more areas to improve sepsis care.
First, the health system is looking at gaps between its care performance and the Centers for Medicare & Medicaid Services' sepsis bundle expectations, which include early antibiotic use, timing of blood cultures, fluid resuscitation, and management of hypotension.
Second, Providence is looking at sepsis care through a health equity lens. Nationally, several patient populations experience worse sepsis outcomes than white patients, including Black patients and Hispanic patients. The health system wants to solve the unique challenges of vulnerable populations and is working on educational tools in languages other than English.
Third, the health system is also focusing on early intervention. The earlier that clinicians can identify sepsis and intervene, the fewer complications and deaths. Providence is focusing on key settings such as emergency departments and urgent care centers. One strategy involves using the EHR to monitor vital signs such as blood pressure, heart rate, and respiratory rate and give clinicians an early warning when sepsis is detected.
Finally, Providence is using the EHR to manage care for patients who are admitted to a hospital for a different diagnosis but show signs of sepsis or septic shock.
Using AI to boost sepsis patient outcomes
Another HealthLeaders story from July featured a Baton Rouge, Louisiana-based hospital that has generated positive results such as reduced cost of care and lower sepsis mortality from using an artificial intelligence-driven early diagnosis tool for sepsis.
Our Lady of the Lake Regional Medical Center has adopted IntelliSep, an AI-driven sepsis diagnostic testing system developed by San Francisco-based Cytovale Inc. IntelliSep gained Food and Drug Administration approval in January 2023.
IntelliSep determines the presence or absence of sepsis by measuring the activation of a patient's immune system, says Catherine O'Neal, MD, former CMO at Our Lady of the Lake Regional Medical Center and chief academic officer at Franciscan Missionaries of Our Lady Health System.
"As a patient approaches severe sepsis and septic shock, the immune system is more activated," O'Neal says. "IntelliSep measures the range of activation from a patient who is not activated at all to a patient who has a highly activated immune system against an infection. Highly activated patients tend to be more likely to have septic shock."
IntelliSep is one of several AI-driven sepsis diagnostic tools that have been developed in recent years. Other AI-driven sepsis diagnostic tools include the following:
Steripath, which decreases blood culture contamination to increase sepsis testing accuracy
Sepsis Immunoscore, which is an AI and machine learning software that is designed for rapid diagnosis and prediction of sepsis
Targeted Real-Time Early Warning System, which is an algorithm developed at Johns Hopkins Medicine that is integrated into electronic health records and is designed for early recognition of sepsis
A study published in Academic Emergency Medicine found that IntelliSep correctly identified which patients did not have sepsis 98% of the time, making it an essential tool for clinicians to rule out sepsis and explore alternative diagnoses.
IntelliSep has decreased the number of blood cultures taken at the hospital, which has reduced cost of care, says Christopher Thomas, MD, vice president and chief quality officer at Franciscan Missionaries of Our Lady Health System.
Data shows that IntelliSep has had a positive impact on patients and operations at Our Lady of the Lake Regional Medical Center, Thomas says.
The hospital conducted 1,800 less blood cultures in six months than the facility did in a six-month span a year ago
Length of stay for sepsis patients in the ICU has been reduced by two days
Since adopting IntelliSep, the hospital has reduced sepsis mortality by 20%
Managing patients with Parkinson's disease should be viewed as part of a hospital CMO's responsibility for patient safety and quality, says this healthcare leader.
Parkinson's patients face three primary preventable complication risks in the hospital setting.
These risks are medication mismanagement such as nonadherence to time-sensitive medication administration; failure to ambulate Parkinson's patients; and failure to screen for dysphasia, which is associated with aspiration and aspiration pneumonia.
CMOs and their care teams need to take steps to avoid preventable complication risks among Parkinson's disease patients in the inpatient setting as part of their quality and patient care strategy, the lead author of a recently published journal article says.
The data on medication management missteps for Parkinson's disease patients in the inpatient setting is "stunning," according to the lead author of the recent journal article, Peter Pronovost, MD, PhD, chief quality and transformation officer at University Hospitals Cleveland Medical Center.
"Of the 300,000 patients with Parkinson's disease admitted to hospitals each year, about 75% of them will have some medication mismanagement," Pronovost says. "One-in-10 receive contraindicated medications that can make their symptoms worse."
In addition to the recent article, which was published by The Joint Commission Journal on Quality and Patient Safety, hospital CMOs and their care teams can learn about managing hospitalized Parkinson's patients at the Parkinson's Foundation's website.
Caring for Parkinson's patients in the hospital setting
The first thing hospital care teams need to do to limit preventable complication risks for Parkinson's patients is to identify them when they are admitted to the hospital, Pronovost explains.
"One of the main risks for patients living with Parkinson's disease when they are hospitalized is most of them are not hospitalized for Parkinson's disease," Pronovost says. "Hospitals need to be able to identify people with Parkinson's disease when they are admitted to the hospital. Most of our electronic medical records can do that."
Hospital care teams should also use alerts in the electronic health record to make sure Parkinson's patients do not get contraindicated medications, according to Pronovost.
"The electronic health record makes medication management much more feasible than having to do it manually," Pronovost says. "It just requires collaboration between the information technology team and quality team to make sure they put alerts in place."
The second thing hospital care teams can do is make sure that Parkinson's patients can get their medications on time, which can be a window as small as 15 minutes at a particular time of day, according to Pronovost.
"The average hospital patient does not get medication on a tight schedule," Pronovost says, "so there has to be a workflow for nursing, pharmacy, and physicians."
The third thing hospital care teams can do is screen Parkinson's disease patients for dysphasia, so they can identify who is at risk for aspiration, then put preventive strategies and protocols in place to make sure patients do not aspirate, Pronovost explains.
Finally, Parkinson's patients in the hospital setting must be ambulated several times a day.
"We put a mobility program in place across all 23 of our hospitals because there are benefits from mobility for all patients," Pronovost says. "Patients must be ambulated multiple times per day."
Ambulating patients requires a culture of collaboration, where roles are clarified, Pronovost explains.
"In our hospital, we decided that patients who were more ambulatory would work with nurses and patients who were less ambulatory would work with physical therapy," Pronovost says. "Then we monitor and measure who is getting ambulated."
How hospital CMOs can help manage Parkinson's patients
There are several ways hospital CMOs can ensure Parkinson's patients receive safe and effective care in the inpatient setting.
"We know that Parkinson's disease patients are at risk," Pronovost says, "so CMOs need to make sure they have a way to identify patients and make sure they get the care protocols and programs that mitigate their risk."
From a CMO leadership perspective, the best thing to do is start an interdisciplinary quality improvement team that includes staff such as neurologists, hospitalists, pharmacists, nurses, occupational therapists, and physical therapists, according to Pronovost.
"This team can look at the risks Parkinson's patients have, the protocols that should be in place, who is going to perform the protocols, and what are the workflows," Pronovost says.
CMOs should establish a culture for clinical care that is collaborative and breaks down siloes, Pronovost explains.
"If there is no clarity about who is responsible for getting the medications exactly on time or ambulating," Pronovost says, "patients are not going to get those therapies appropriately."
Pronovost recommends that CMOs also make sure there are electronic health record standards and safeguards to ensure that patients with Parkinson's disease get their medications on time.
"The same thing applies to mobility and dysphasia screens," Pronovost says. "Our electronic health records can ensure safety and ensure patients who are at risk for harm are identified."
Managing patients with Parkinson's disease should be viewed as part of a hospital CMO's responsibility for patient safety and quality, Pronovost explains.
"CMOs can assemble diverse teams to work together to do new work that has never been done before," Pronovost says. "It requires the CMO to call the teams together with a clear commitment to zero harm and optimizing care for patients with Parkinson's disease."
With physician shortages and the high cost of employing physicians, APPs have become a mainstay of care teams.
The following is an extended excerpt from a HealthLeaders story published in August. Click here to read the full story.
With health systems and hospitals across the country experiencing physician shortages, many are turning to advanced practice providers (APPs) to fill in the gaps.
But does that mean CMOs should scale back their physicians and usher in more APPs instead? There are pros and cons to considering APP-led care teams.
Thomas Balcezak, MD, MPH, chief clinical officer at Yale New Haven Health, sees the workforce benefits in pairing APPs with physicians in a care team.
"There is a long lag time to bring new physicians online because of the years of training that it takes," he says. "You can train an APP in as little as 18 months after an undergraduate degree. If we want to bring more clinical resources to healthcare settings rapidly, using APPs is an efficient way to do that."
"Relying on APPs is a strategy we can use to expand access," he adds.
The differential between physician compensation and APP compensation also makes employing APPs cost effective, Balcezak says.
While some leaders think APPs could be the answer, others are not so sure.
Although APPs have become key members of care teams, they still need to be led by physicians, says Bruce Scott, MD, an otolaryngologist from Kentucky and president of the American Medical Association.
"The American Medical Association strongly supports physician-led, team-based care, where all members of the team use their unique knowledge and skillset to enhance patient outcomes," he says. "Nurse practitioners, physician assistants, and other advanced practice healthcare professionals can all be valuable members of a physician-led care team and help to provide high-quality care, but they are not a replacement for physicians."
"Models of care that remove physicians from the care team result in higher costs and lower quality of care," he adds. "Numerous studies show that patients have better outcomes when cared for by physician-led teams."
Can APPs lead care teams?
While some studies have said no to APP-led care teams, others have shown the effectiveness of nurse practitioner-led care teams. A study published by The Journal for Nurse Practitioners found that a nurse practitioner-led interdisciplinary team reduced the median hospital readmission rate by 64%.
"It is going to be hard for physicians to accept in many circumstances, and initially it is going to take extraordinary individual APPs to serve in leadership roles," Balcezak says. "However, APPs leading care teams will become more common over time."
Circumstances that are well-suited for APPs to serve in leadership roles include when the leadership expectations are around organization, delivery, and scheduling, he says.
"When those are the leadership requirements, the APPs can be outstanding leaders," he says. "APPs who have a clinical background and a mindset that is focused on management can lead care teams."
Where APPs can and cannot take the lead
Yale New Haven Health is moving toward more consistency in its primary care teams, with two APPs supporting each primary care physician along with the nurses, Balcezak says.
"We think this APP model is a much more efficient use of physicians' time and will open up more patient access," he says. "The division of labor in this model is still being worked out, but an experienced APP can do most of what a physician does in the primary care setting. There are some complex patients and diagnostic dilemmas that are better handled in the physician's hands, but most routine screening, health promotion, symptom management, and the urgent care that established patients require such as colds and strep throat can be handled by the APPs."
At Davis Health System, the most common primary care team model consists of one physician with a cadre of nurse practitioners, medical assistants, and nurses working to the top of their licenses, says former CMO Catherine Chua, DO, MS.
"The team approach has been advocated by the American Hospital Association and the American Academy of Family Physicians in order to stretch the ability of a physician to serve patients," she says. "Studies have shown that having the physician as the lead care provider at a primary care practice is the best approach in terms of cost savings, patient experience, and quality. One of the studies that I have seen said that about 72% of patients prefer to see a physician at some point in their care."
Chua says a physician-led primary care team should be designed with specific parameters around decision-making.
"One physician does the primary intake of the patient, then follow-up appointments are handled by APPs," she says. "There are other things like follow-up calls, renewals of prescriptions, and prior authorizations that can be done by the nursing staff. In addition, the nursing staff can prep the patient's visit, so that the nurses get to know the patient and can help the physician field questions from the patient."
The main challenge of this model is when patients present with complex conditions or difficult diagnoses during follow-up appointments. CMOs should ensure that physicians get involved in care when these circumstances arise, Chua says.
To address obesity, CMOs must promote intensive therapies in clinical settings to make a difference on the individual patient level and think globally.
Obesity is a worsening crisis in the United States, according to a recent journal article and the president-elect of the American Academy of Family Physicians (AAFP).
According to the journal article, which was published by The Lancet, nearly three-quarters of the U.S. population aged 25 and older were overweight or obese in 2021. "Without immediate action," 80% of the adult U.S. population will be overweight or obese by 2050, the journal article's co-authors wrote.
"Existing policies have failed to address overweight and obesity," the co-authors wrote. "Without major reform, the forecasted trends will be devastating at the individual and population level, and the associated disease burden and economic costs will continue to escalate."
There is no question that obesity has reached a crisis point in the United States, according to Sarah Nosal, MD, president-elect of the AAFP and vice president for innovation and optimization as well as chief medical information officer at The Institute for Family Health.
"We need to say that this is a crisis, so we can mobilize the resources that we need," Nosal says. "Unless we acknowledge this is a crisis across all communities, we will not mobilize resources, and we will not see a change."
Obesity is associated with several serious medical conditions, particularly diabetes, Nosal explains.
"We are worried about diabetes because it is associated with many other medical problems and diabetes is a chronic disease that can be a burden on its own," Nosal says. "Once you have diabetes, your likelihood is higher of having stroke, heart attack, vascular complications, amputations, and infections."
Other serious medical conditions associated with obesity include high cholesterol, cardiovascular disease, sleep apnea, arthritis, and joint pain, according to Nosal.
"Our bodies are built to carry a certain amount of pounds," Nosal says. "When the amount of pounds that are on our structural system such as our knees is too great, it leads to problems. Many adults are carrying around an extra hundred pounds that joints were not designed to carry."
How CMOs should address obesity
CMOs of health systems and hospitals need to think about obesity beyond the context of an individual patient in a clinic or hospital setting, according to Nosal.
"You need to think about patients as part of a larger community, and CMOs and others running a hospital system need to think about what health is and the interventions to improve health," Nosal says. "That may be promoting that fruits and vegetables are available in the community. That may be promoting funding for more walkable communities or more parks access for kids in communities."
In addition to promoting intensive therapies in clinical settings to make a difference on the individual patient level, CMOs need to think globally about addressing obesity, Nosal explains.
"CMOs need to think about making global changes in the community that can make a difference on the entire population," Nosal says.
How physicians should address obesity
Nosal, who is a practicing family physician, works with overweight and obese patients on what they want to prioritize.
"Their mother may have diabetes, and they are worried about what they should do," Nosal says. "I break down what they should do in steps and help them do longitudinal, intensive work."
Physicians need to help patients manage daily caloric intake and promote consumption of nutritious foods, according to Nosal.
"When you look at the United States and you look around the world," Nosal says, "all of the countries that have calorie-dense and nutrient-poor foods and a shift to those foods being processed rather than resourced locally have a dramatic shift to overweight and obesity."
Research has shown that short-term diets are ineffective at addressing overweight and obesity, Nosal explains.
"People need to make long-term changes for the rest of their lives," Nosal says. "I talk about juice and soda with my patients. Anything that is a liquid calorie is of poor nutritional value."
A single meal in a restaurant is often more calories than a person should eat in an entire day, according to Nosal.
"That is stunning for most of my patients," Nosal says. "The assumption is we should be eating multiple meals in a day, but eating out can put us high in caloric intake. I work with my patients to help them understand how much they should be consuming in a day."
Exercise is an important component of a broad strategy to address overweight and obesity, but it is insufficient on its own, Nosal explains.
"Research shows people can exercise a few days a week and it can make a difference," Nosal says. "But exercise by itself has a limited impact on your weight. It is really about the types of calories we are putting in our bodies and how many calories. We should be eating nutrient-rich rather than calorie-rich foods."
At HealthLeaders, the top CMO trend stories of this year focused on care team composition, deprescribing, 'medspeak,' physician onboarding, and physician leadership development.
As part of our CMO coverage, HealthLeaders has published more than two dozen trend articles this year. The following are the Top 5 CMO trend stories of 2024 (click on the headline link to read the full story):
It's time for physician leaders to say the unspoken part out loud: There will never be enough physicians. And even if you can find them and keep them, it is difficult to pay all of them.
The Association of American Medical Colleges estimates that in the next 12 years, the U.S. will be short 86,000 physicians, with more than half of those being primary care physicians. The future is a zero-sum game, where the clinical need of an aging population runs up against falling numbers of physicians.
To fill those gaps, health systems and hospitals are elevating advanced practice providers and giving them more responsibilities. The resulting change in care team design is forcing CMOs and other executives to think about how they manage their physicians to ensure a productive workplace and positive clinical outcomes.
Since this shift, CMOs have begun to wonder whether they need as many physicians as they thought, especially since the APPs are sometimes carrying out the majority of the tasks.
This begs the question, is it time for CMOs to scale back their physicians and usher in more APPs instead? While the question is in part written in jest, it doesn’t mean there aren't pros and cons to considering APP-lead teams.
For patients on multiple medications, deprescribing is a key strategy to promote patient safety and care quality.
The primary risk with multiple medications is medication interactions. This risk can lead to an increase or decrease in the effects of medications as well as undesired effects and side effects.
Cost and waste are other considerations, according to Karna Patel, MD, MPH, vice president at Tampa General Hospital and president of Tampa General Medical Group.
"As you add more medications, there is more cost to pay for those medicines," Patel says. "Globally, prescribing multiple medications can lead to waste of pharmaceuticals."
When assessing patients on multiple medications, clinic visits and visits in other healthcare settings are an opportunity to go over a patient's medication list, according to Patel.
"At that time, we want to make sure all the medications the patient is taking are appropriate for their conditions," Patel says. "We also check for interactions. That is a great time to try to deprescribe or consolidate medications."
"Medspeak" is characterized as medical terminology used by clinicians that leads to communication gaps with patients. Medspeak gets in the way of effective shared decision-making for clinicians and patients.
There are several steps clinicians can take to make sure they communicate medical terminology and procedures effectively, and it's the CMO's job to make sure their clinicians are aware of medspeak and how to avoid it.
"The jargon, the abbreviations, and the terms we use in medicine seem natural to clinicians, but patients often do not understand these terms," says Donald Whiting, MD, CMO of Allegheny Health Network and president of Allegheny Clinic. "Clinicians can fly through an explanation without getting the patient engaged, then leave them behind."
Onboarding is about more than helping clinicians navigate the hiring process.
According to the Physician and Clinician Onboarding Research Report by the Association for Advancing Physician and Provider Recruitment (AAPPR), successful onboarding programs integrate clinicians into an organization, acquaint clinicians with an organization's culture, and provide clinicians with resources and support to help them excel in their new role. AAPPR compiled this data from a survey conducted in collaboration with Jackson Physician Search and LocumTenens.com.
Providing effective clinician onboarding is pivotal in a health system's success, according to Pranav Mehta, MD, MBA, CMO of HCA Healthcare American and Atlantic Groups. HCA Healthcare, which features more than 180 hospitals, has more than 45,000 employed and affiliated physicians.
"It is critically important that we orient those physicians in a systematic way and approach," Mehta says. "We spend time onboarding them as they come from outside of our organization into our practices. That gives us the ability to make sure they are successful in clinical practice."
Physician leadership development is pivotal for the U.S. healthcare system because many of the top-performing hospitals are physician-led.
Research shows there is a gap between physician interest in leadership development and opportunities to gain this experience.
A report from Jackson Physician Search and the Medical Group Management Association found that 67% of physicians surveyed were interested in leadership development opportunities, but only 18% had been exposed to nonclinical leadership development through their education or experience in clinical practice.
It is essential for health systems and hospitals to offer leadership development opportunities, says Kristin Mascotti, MD, MS-HQSM, CPE, CMO of Penrose Hospital, which is part of CommonSpirit Health's Mountain Region.
At CommonSpirit, there are formal and informal leadership development opportunities for early career and mid-career physicians who have shown influence in their department or on committees, according to Mascotti.
"It is vital to provide physicians with leadership development opportunities," Mascotti says. "Some of the best-performing healthcare centers and hospitals in the nation are physician-led."
Chief clinical executives such as CMOs are focused on a range of issues, including quality, patient capacity, care variation, and high reliability.
This year, HealthLeaders interviewed more than a dozen new CMOs, chief physician executives, and chief clinical officers. Here are seven executives that are poised to make an impact in 2025:
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. Frost is a member of the HealthLeaders CMO Exchange.
Frost says the core elements of promoting quality care include a leadership component, a process improvement component, and a culture of safety.
The leadership component includes the recognition of the importance of leadership in every aspect of the organization, according to Frost. It also includes engagement of all the quality stakeholders and an accountability process.
Frost says Lifepoint has a checklist of 10 critical components for performance improvement, including huddles that clinical care teams use to focus on clinical workflows, whiteboards at every clinical care unit to identify opportunities for improvement, and tracking data that demonstrate progress or regression.
The culture of safety at Lifepoint includes the engagement of patients and their families as well as fostering an environment where all team members experience psychological safety and have a voice in the safety process, according to Frost.
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.
Addressing patient capacity is one of his top challenges.
A unique element of the medical center's patient capacity crunch has been California's seismic compliance requirements, which prompted the closing of many beds, according to Galante.
"We have had to close 70 beds over the past year," he says. "By closing those beds, we had to find 70 new beds to open in different locations throughout the hospital."
UC Davis Medical Center has had to do more than open beds to address the facility's capacity challenge, Galante explains.
"You must apply the operations and workflows to be able to move patients more seamlessly and get them discharged," he says.
3. Cameron Mantor, MD, MHA, 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.
OU Health Partners is positioned for growth, and one of Mantor's primary responsibilities is to help manage the recruitment of new physicians. Oklahoma ranks low for the number of physicians per capita in the country for almost every primary care area as well as specialties.
One recruiting advantage for OU Health and OU Health Partners is the tripartite mission of the organization: education, research, and clinical care, according to Mantor.
"Our goal is to show physician recruits what we are looking to create, so they see what our vision is and hopefully that aligns with them," he says. "That tends to attract recruits. We have a great academic health center, with seven colleges on our campus, so we can attract physician recruits both from an education standpoint and a research standpoint."
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.
McGinn says he is passionate about reducing clinical care variation to boost patient safety and quality.
"My background is in evidence-based medicine and looking at clinical standards," he says. "We have a national program that sets clinical standards."
According to McGinn, the key to success in setting clinical standards is to have clinicians drive the process.
"It is not a top-down approach," he says. "We put the standards in front of the clinicians, we give them some options, we have multiple group meetings, then the clinicians come to a consensus about the clinical standards."
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.
This year, UC Health launched an initiative to become a high reliability organization.
"Many healthcare organizations across the country have taken on the concept of high reliability," Pancioli says. "It is a well-studied science that is a methodology of improvement of an entire organization. We have just entered an engagement with a consultancy, and we are starting our journey to high reliability."
The first step in this process, he says, is assessment.
"The first thing you do is determine your current state and opportunities for improvement in high reliability, which is the pursuit of zero harm in a highly complex organization," Pancioli says.
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.
To address health equity concerns, a health system or hospital must be inquisitive, according to Puri.
"It starts with asking questions about health equity," he says.
The next step is harnessing data, Puri explains.
"You need to have data that you can act on," he says. "Our data and analytics team has done a good job of creating an equity lens that we can use when we look at any of our data and break data down along multiple patient demographics, including race, gender, and Zip codes."
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.
Like Pancioli, Schissel is focusing on high reliability, which he also pursued in Boston.
"We had a system of just culture, where patient care was examined from the perspective of systems improvement and accountability that goes beyond individual human error," he says.
Staff from all disciplines at the Boston-based hospital shared a vision of high reliability and worked collaboratively on care and quality goals, Schissel says.
"In addition, every decision we made in healthcare leadership placed the patient's best interest and safety at the center," he says. "Creating and maintaining this kind of culture is hard work, and it is a continuous process."
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Since November 2020, health systems and hospitals have been providing acute care in the home setting through the Acute Hospital Care at Home (AHCAH) program under a waiver from the Centers for Medicare & Medicaid Services (CMS). Ochsner's Acute Care at Home program, which was launched in March, does not receive reimbursement from CMS and serves patients who are participants in value-based contracts.
"With the Acute Hospital Care at Home program, under the regulations you are providing inpatient care at somebody's home, and there are restrictions such as number of visits as well as continuous monitoring," says Sidney "Beau" Raymond, MD, CMO of Ochsner Health Network.
"In addition, Acute Hospital Care at Home billing is done as an inpatient visit," Raymond says. "With our Acute Care at Home program, there is not 24/7 remote patient monitoring, and we are not billing to insurers as you would with an inpatient visit."
Billing is a key difference between AHCAH and the Acute Care at Home program, according to Raymond.
"This is a pilot, and we are serving our value-based lives now," Raymond says. "In this pilot with about 400 patients, we are getting about a two-and-a-half times return on investment for the access that we are opening up."
In the Acute Care at Home program, patients participate in a 15-day episode of care at home, with virtual care provided by a physician, nurse, and care manager staffed by myLaurel, according to Logan Davies, MD, medical director of hospital access and throughput at Ochsner Medical Center—New Orleans. The virtual visits by a physician are accompanied by a paramedic in-person visit.
"Over the 15-day episode of care, myLaurel is managing acute care, the clinical plan, and transitional care services," Davies says, "where we have virtual nursing and virtual care management doing everything from medication reconciliations, to fall risk assessments, to education for patients and their caregivers."
Clinicians employed by myLaurel conduct the home care, but they are Ochsner-credentialled providers, Davies explains, which allows them to have full access to the health system's electronic medical record.
To be enrolled in the Acute Care at Home program, patients must be stable and able to be treated safely in the home, according to Davies.
"A cornerstone of the program is appropriate acuity," Davies says.
Patients are transferred to the Acute Care at Home program from the emergency department, hospital observation units, and inpatient units.
Acute Care at Home patients are being treated for several medical conditions, Davies explains.
"For the conditions we are managing, the most common are infections, including urinary tract infections," Davies says. "The second most common condition is congestive heart failure. After CHF, we are treating pulmonary conditions such as chronic obstructive pulmonary disease as well as upper respiratory infections. We also treat patients for electrolyte issues and renal issues."
Benefits of the Acute Care at Home program
The main benefit of the Acute Care at Home program is that patients get to receive care in the home, which is an appropriate care setting for these patients, according to Raymond.
"People are eligible because they are stable enough to not be hospitalized, but they do need more than just intermittent care that would require travel to and from a clinic or other care setting on multiple visits," Raymond says. "It's the right care in the right place. These patients get to be home, where they and their caregivers are more comfortable."
Secondarily, the Acute Care at Home program is beneficial because it meets an acute need for a patient at a lower cost than hospital inpatient care, Raymond explains.
"This program is currently available to patients that we share in the total cost of care in some way," Raymond says. "This allows us the freedom to try different models of care while always keeping the patients first. Another benefit is that it frees up beds inside the hospital for those that need that level of care or intervention, and it avoids delaying that care by having better access."
The Acute Care at Home program exemplifies value-based care, according to Raymond.
"The goal of value-based care is to provide high quality care at a lower cost with a great experience," Raymond says. "This checks all of those boxes. People are getting great care at an appropriate cost in their home. Value-based reimbursement allows us to do this."
The Acute Care at Home program is reducing total cost of care by avoiding hospital admissions and readmissions, Raymond explains.
"Hospitalizations are some of the costliest events in healthcare for not only the payer, but also the patient through deductibles and coinsurance," Raymond says. "Reducing hospitalizations has a direct and noticeable impact on the total cost of care."
This HealthLeaders podcast focuses on several infection prevention topics, including respiratory virus season, emerging pathogen considerations, and healthcare-acquired conditions.
Health systems and hospitals are entering the respiratory virus season with little guidance from local and federal public health agencies, according to the executive medical director of infection prevention and control at UChicago Medicine.
Infection prevention and control staff are the first line of defense for infectious diseases and infections at health systems and hospitals. They help health systems and hospitals manage interventions such as masking and promote best practices in areas such as healthcare-acquired conditions.
Coming out of the COVID pandemic, there are a lot of questions about the role of masking and other interventions for respiratory viruses such as restricting visitors in hospitals, says Emily Landon, MD, executive medical director of infection prevention and control at UChicago Medicine.
"For a long time, we had a lot of rules that we had to follow from our local public health agencies and the Centers for Disease Control and Prevention," Landon says. "Most of those rules sunset before this year's respiratory virus season."
In the absence of guidance from public health agencies, it is challenging to know when to require masks at healthcare settings, but it is clear that masking helps prevent transmission of respiratory viruses, Landon explains.
"What type of mask you wear helps determine whether or not you are going to be protected," Landon says. "If you want to be protected from a sick person near you, then you need to wear a tight-fitting, N95 mask. If you want to help prevent yourself from giving someone else COVID or influenza, you can do that safely by wearing a surgical mask."
Emily Landon, MD, is executive medical director of infection prevention and control at UChicago Medicine. Photo courtesy of UChicago Medicine.
UChicago Medicine has created a "masking ladder" to manage the wearing of masks during this respiratory virus season.
"We have a team of people including ambulatory staff, people from occupational medicine, people from pharmacy, and people from infection control, and we huddle every Thursday for about 15 minutes," Landon says. "We use a set of metrics to determine how we move up and down the masking ladder."
The bottom rung of the masking ladder is when staff wear masks when they are sick. The next rung of the masking ladder is called the yellow level, according to Landon.
"At the yellow level, we know something is coming such as seeing a new variant or seeing more cases of influenza," Landon says. "At the yellow level, staff still wear masks when they are sick, but we also tell people that respiratory virus season is heating up and they should be more careful, they should stay home if they are sick, and they should get tested if they feel sick."
The next rung on the ladder is the orange level.
"When we start seeing higher respiratory virus numbers in our community and among staff at our care settings, we switch to the orange level," Landon says, "which requires all staff members to wear masks when they are in direct patient care."
The top rung on the ladder requires universal masking, including for patients.
"If we see widespread problems such as lots of people being admitted to the hospital with respiratory viruses or lots of staff sick in multiple areas of the hospital," Landon says, "then we would consider universal masking, including for patients."
So far during the early days of this year's respiratory virus season, UChicago Medicine has been able to limit infections in healthcare settings, according to Landon.
"We track hospital-acquired COVID, influenza, and RSV at the University of Chicago, and we have been successful in preventing patients from getting sick in the hospital just by requiring masks for staff members when we see infections in healthcare workers," Landon says. "You can get by using fewer masks than you did during the COVID pandemic, but masking has the benefit of patients not getting sick from healthcare workers."
Chris Frost, MD, is senior vice president, chief medical officer, and chief quality officer at Lifepoint Health.
