A pair of chief physician executives talk trends with HealthLeaders at the recent AMGA Annual Conference.
The AMGA Annual Conference that concluded last week showed medical groups and health systems are rising to challenges and seizing opportunities, says John Kennedy, MD, AMGA chief medical officer and president of the AMGA Foundation.
Medical groups and health systems are facing a range of challenges, including workforce shortages, improving patient access, addressing health disparities, and adopting artificial intelligence solutions. All of these issues were front of mind during the AMGA Annual Conference.
Kennedy told HealthLeaders that he was impressed by the embrace of innovation shown at the annual conference.
"Medical groups are addressing key challenges such as physician engagement and physician resilience," he said. "I spend a lot of time with chief medical officers, and they have their workforces front-and-center. They are investing in new technology to help offload work from physicians. Chief medical officers are working to allow their physicians to spend more face-to-face time with their patients and less time in the electronic health record."
To address workforce shortages, medical groups and health systems are striving to improve the efficiency of clinicians and other healthcare workers, Kennedy said.
"There is a recognition that you cannot just continuously throw more people at the problem," he said. "Medical groups have physicians, advanced practice providers, case managers, pharmacists, dieticians, and other healthcare workers. There just are not enough healthcare workers to fill the entire need for staffing."
Kennedy said technology is at the heart of efficiency-gaining efforts at medical groups and health systems, and he gave two examples.
First, medical groups and health systems are adopting ambient transcription services in clinics to reduce clinician administrative burden and improve patient experience.
"The doctor can use their smartphone to capture all the elements of a clinic visit and immediately produce a medical note that requires only a short review for the physician," he said. "Ambient transcription services allow the clinician to engage the patient without working on a computer at the same time. The doctor is happier, and the patient has had a better experience."
Second, medical groups and health systems are adopting solutions to reduce the burden of in-box messages. "Doctors get all sorts of messages in their in-basket," Kennedy said. "It can come from a patient portal. It can come from phone messages. It can come from lab results or imaging. Those messages have gone up about 29% year-over-year since the coronavirus pandemic."
In-box solutions include artificial intelligence bots to help triage messages to the appropriate level of care and telehealth physicians who can provide remote care, he said. "What you are seeing is that messages are getting answered faster. Patients are more satisfied. And the huge volume of in-basket messages is starting to get under control."
Health equity is both a challenge and an opportunity, Kennedy said.
"The medical groups are all enabling their data systems to collect health equity data that is being required in accountable care programs," he said. "They must report on demographic information, race, gender, ethnicity, and insurance status. Medical groups' data systems are being set up to collect this data, and they are identifying underserved communities and developing programs to address underserved communities."
There are two primary areas related to patient access challenges, Kennedy said.
"One area is related to workforce. Medical groups need to strive to have fully staffed clinics—not just physicians but also nurses and the support staff. Medical groups are catching up on staffing after some difficult years during the coronavirus pandemic," he said. "Another area is related to technology. What we are finding is that patients are now able to self-schedule appointments from home. So, there can be openings in a doctor's schedule that have occurred in the previous 24 hours. Patients can fill those openings themselves, which improves access because there are fewer open visits in a doctor's schedule. In this way, clinics are getting more patients in sooner."
Chief physician executive perspectives
A pair of chief physician executives shared their views in separate interviews with HealthLeaders at the AMGA Annual Conference.
There are three keys to success in relationships between health systems and physician groups, said Bedri Yusuf, MD, MBA, chief physician executive of Northeast Georgia Physicians Group.
"The No. 1 key to success is trust," he said. "The second key to success is identifying the major challenges for the health system, then the medical group needs to consistently deliver on addressing those challenges. Third, physicians must buy-in to the health system's goals and what the health system is trying to achieve such as value-based care. When physicians are committed, you have accountability."
It can be a challenge to maximize the value of the interaction between a health system and a physician group, Yusuf said.
"There is a perception that medical groups lose money. But if you establish that a medical group is an investment in healthcare and the community, there are downstream benefits such as care efficiency, clinical outcomes, and meeting your mission," he said. "In our health system, we have pillars including safety, quality, healthcare stewardship, and healthcare delivery. If our medical group addresses those pillars point-by-point, we can generate revenue, achieve cost avoidance, make referrals to the hospitals, and attain improvements in service. By bringing new patients to the hospitals, we are adding to the bottomline and advancing the health system."
Matthew Mulder, MD, executive vice president and chief physician executive of UW Medicine's Valley Medical Center in Seattle, shared the keys to success for chief physician executives.
"First off, you must build your clinical credibility prior to taking the role," he said. "You also need to have a good relationship with the clinicians that you work with—you need to be a good listener and truly understand the needs of your clinicians. Likewise, you need to understand the needs of the administrative leaders you work with, who may not necessarily have a clinical background."
A chief physician executive must be intentional in bridging any gaps with administrative leaders, Mulder said. "Having common goals and common objectives helps," he said. "You need to understand their challenges, and they need to understand your challenges—very often, they are similar."
The physician-advanced practice provider primary care model can help address the doctor shortage.
Operating a primary care practice with one doctor and a handful of advanced practice providers was the focus of a session at the AMGA Annual Conference.
There is a shortage of primary care physicians nationwide, and the aging of the U.S. population is likely to make this shortage more acute in the years to come. Pairing primary care physicians with advanced practice providers such as physician assistants is one strategy to address this challenge.
"We have developed a successful interdependent team model consisting of one physician and multiple advanced practice providers (APPs), each with their own patient panel delivering high-quality and safe patient care," said Gretchen Velazquez, MD, a regional medical director at Atrium Wake Forest Baptist Health Network. She leads a primary care practice in collaboration with four physician assistants.
Valezquez said the model of her primary care practice is an effective strategy to address the physician shortage.
"There's a challenge—healthcare organizations do not have enough doctors," she said. "We need to have physicians practice at the top of their licenses while supervising and guiding advance practice providers in a way that we deliver safe and high-quality medical care."
Physicians must have qualities to be apt to successfully work with and supervise advanced practice providers, Valezquez said.
A doctor who supervises advanced practice providers should be experienced. In the first two or three years of being a primary care doctor, a physician is starting to grow their patient panel and learning how to navigate relationships with nurses and medical assistants. A more experienced physician can be a leader.
You want a physician who can be a team player. You want someone who is respected and able to bring a team together. You want someone who is available for consultation. You want someone who is available and willing to teach. There is a lot of mentoring with advanced practice providers.
You want a good communicator—someone who will tell it like it is when the time comes. When there is an issue with an APP, you want a physician who is not going to put people down and is not going to belittle people. You want the physician to be supportive. You want to have a physician who creates a relationship with APPs, so they feel comfortable coming to the physician.
There are many benefits from the physician-APP model, Valezquez said.
"You have greater access for your patients—that is really the bottomline. We must take care of a growing elderly population," she said "There is greater access for acute-care visits for patients. You have doctors working at the top of their license—you can have physician assistants handle the simpler cases such as urinary tract infections. This model is a leadership opportunity for physicians. At my practice, I am the captain of the ship. If the APPs run into a situation where they need me, they can call me any time and there is another doctor who has a similar model of practice who cross-covers for me and I cross-cover for her."
Another benefit of the physician-APP model is coverage of in-basket messages from patients, Velazquez said. "If I am out on vacation, the APPs can monitor my in-basket and respond patients."
For this model to be successful, the physician must be involved in the hiring of APPs, she said. "You can't have a physician who is disengaged. They must look through the resumes and sit down with the practice administrator to review candidates. If I cannot see a patient, I can tell the patient that it is OK to see one of the physician assistants because I hand-picked them. So, there is a level of trust there."
Interacting effectively with a multi-generational staff is foundational for retention.
Engaging and communicating with different generations of staff members is a key element of addressing the workforce challenges facing healthcare organizations, an AMGA Annual Conference speaker says.
With workforce shortages widespread in the healthcare sector, retention of staff members is crucial for organizational success. Interacting effectively with Baby Boomers, Generation X, Millennials, and Generation Z promotes retention.
A session during yesterday's AMGA Annual Conference focused on generations in the workforce. Different generations have different perspectives on job satisfaction, says panelist Elizabeth Buisker, DO, MBA, associate CMO of the Montana and Wyoming Medical Group of Intermountain Health.
"When I think about our Boomers at Intermountain Health, it is really about recognizing that they still want to have a place. They have worked hard to get to where they are at, and they want to go out on their own terms," she says. "Generation X wants to be given independence. They want to know what the goal of the organization is, but they want to get there on their own. Millennials really want to feel heard. They also need to be able to process change. You need to provide opportunities for them to have others hear their concerns."
To engage different generations of staff members effectively, it is important to recognize the different ways people like to be appreciated, Buisker says.
"Some people are mortified if you put them in front of a group and call out their good work. Other people want to be celebrated with a trophy in front of everyone," she says. "So, you need to determine whether recognition is private or public. Especially among Generation X and Millennials, they would like to get an extra day off as a form of recognition. Whereas, my Boomers are more likely to want a gift card or get a bump in salary."
Healthcare leaders need to understand what is important to their generational staff, then they must find ways to make that possible through recognition, Buisker says.
The biggest pitfall to avoid in engaging different generations of staff members is stereotyping, she says. For example, you shouldn't say, 'You're a Boomer, so you obviously do not know how to use a computer.' Or, you shouldn't say, 'You're a Millennial, so of course you are always on social media.' Putting people in buckets and not getting to know them as an individual can be detrimental.
Communicating effectively with different generations of staff members takes time and energy, Buisker says. "I wish I could just send an email, and everyone would get the message, but that is not going to happen."
Healthcare leaders should use multiple channels of communication to interact with their multi-generational staff, she says, adding these forms of communication include hard copies, email, and pop-up reminders.
From the CMO's perspective, managing different generations of staff members is pivotal for retention, Buisker says.
"You must recognize the experiences that individuals have had to get where they're at," she says. "For example, some of my older physicians consider themselves 'old school,' and they will work until they are bone tired because that's what was promoted early in their careers. But that way of working is not safe—it is not good for patient safety, and it is not good for physician well-being."
For some younger physicians, they have been tech-enabled and they can struggle to make human connections, Buisker says. "A CMO needs to be able to call this out and provide resources."
The Clinic by Cleveland Clinic provides virtual second opinions to patients, with access to more than 3,500 physicians at Cleveland Clinic.
Virtual second opinions offered by The Clinic by Cleveland Clinic are making a significant difference for patients and payers, data shows.
The Clinic by Cleveland Clinic is a joint venture of the Cleveland Clinic health system and telemedicine provider Amwell. The Clinic by Cleveland Clinic provides virtual second opinions to patients, with access to more than 3,500 expert physicians at Cleveland Clinic.
Case data from 2023 shows the health and financial impacts of The Clinic by Cleveland Clinic's virtual second opinions:
67% of virtual second opinions recommended a diagnosis or treatment plan change
In cases where the primary treatment plan included surgery, the virtual second opinion recommended an alternate treatment 85% of the time
Virtual second opinions recommended hospitalization 62% less often than the primary treatment plans
There was $100,911 average savings per patient for high-cost cases, where the primary treatment plan cost was above $10,000
There was $28,220 average savings per patient with a musculoskeletal condition
There was $8,036 average savings per patient with a cardiovascular condition
There was $4,306 average savings per patient with a cancer-related condition
"The kinds of recommendations that we make can have multiple benefits for the patient in terms of quality of life and a better chance of surviving disease-free or with less pain and disability. Our recommendations can also have benefits for employers and payers," says Peter Rasmussen, MD, chief clinical officer of The Clinic by Cleveland Clinic.
In general, patients request virtual second opinions directly or through their commercial insurance company. Patients who request virtual second opinions directly pay for the service out of pocket. Patients who request virtual second opinions through commercial insurance companies pay for the service through the payer.
There are several steps involved in a virtual second opinion at The Clinic by Cleveland Clinic, Rasmussen says:
Once a patient requests a virtual second opinion directly or through an insurance company, nurse care coordinators will talk with the patient to understand their clinical concerns and questions.
Within a week, The Clinic by Cleveland Clinic obtains all of the medical records of the patient that are relevant to their clinical condition including imaging. For patients facing a cancer diagnosis, pathology specimens are obtained for pathology interpretation.
A Cleveland Clinic specialty or subspecialty physician reviews the medical records.
The reviewing physician prepares a written report for the patient and their local physician. In most cases, there is a video consult with the patient and the Cleveland Clinic physician who reviewed the medical records.
"We take a fresh look at each patient," Rasmussen says.
Serving the patient's interest and lowering cost of care
Recommending a new diagnosis or change in treatment plan is "quite significant" for patients, Rasmussen says.
"For example, the local physicians could determine that a patient has rheumatoid arthritis causing joint pain and swelling. Our rheumatologists could differ and think it is a connective tissue disease," he says. "This would have a significant impact on the type of treatment that the patient receives. Obviously, if a patient gets a diagnosis that is wrong, they are going to get the wrong care."
Changes in treatment plans can benefit patients and payers, Rasmussen says.
"For example, for a patient with a prostate cancer diagnosis, we potentially would offer the patient three types of radiation treatment. Whereas, the local physicians may only recommend one type of radiation treatment," he says. "Choosing an option that takes less time benefits patients who are still working and minimizes the disruption of their lives; and from a payer's standpoint, it can be tremendously less expensive with no fall-off in cancer survival rates."
When a virtual second opinion recommends an alternative to surgery, the benefits for patients are substantial, Rasmussen says.
"Most people do not want to have surgery unless it is absolutely necessary. There can be alternatives such as physical therapy that lead to tremendous benefits for the patients. It decreases time away from work as well as avoids pain and potential disfigurement," he says. "If surgery is needed and it is the best thing for the patient, then that is what you need to do. But as our data shows, 85% of the time there are alternative treatment options available to patients."
Anything that can be done to avoid hospitalizations generally is going to be in the interest of the patient and lower the cost of care, Rasmussen says. "It reduces the patient's risk of hospital-acquired infections and other problems that can develop when a patient is in the hospital. Generally speaking, an alternative to hospitalization is going to be a lower-cost solution for the payer."
Tips for launching a virtual second opinion service
Rasmussen offered advice for other health systems that may be interested in having a virtual second opinion service.
"There definitely is a time and place for virtual second opinions, whether they are telephone visits or video visits," he says. "At a health system, a virtual second opinion program can fit into the portfolio of services they are offering. It certainly allows a health system to extend its reach beyond its standard geographic footprint."
With state regulations that do not allow physicians to practice medicine across state lines, it is important for physicians offering virtual second opinions to be licensed in multiple states, Rasmussen says.
"You need to pay careful attention to licensure and how the caregivers and physicians are delivering their opinions," he says. "We have chosen to move toward a model of broad licensure among our physicians in the vast number of U.S. states, so that we can create the most robust and meaningful interaction between the patients and our physicians."
The physicians who provide virtual second opinions at The Clinic by Cleveland Clinic each have licenses in about a dozen states, Rasmussen says.
"There is some administrative burden associated with maintaining these licenses. Over time, we have found that an individual physician with administrative assistance can maintain 12 to 15 licenses at a time," he says.
Another key to success in offering a virtual second opinion service is maintaining the "human aspect" of care delivery, Rasmussen says.
"We are using technology to assist with the care delivery for our virtual second opinion program, but there is no replacement for the human side of medicine," he says. "When patients are facing a significant diagnosis, change in their life expectancy, or treatments with side effects, they can be scared. So, we place a heavy emphasis on the human aspect of the virtual second opinion despite the fact that our interaction is delivered through technology."
To foster the human aspect of care delivery, a virtual second opinion service should rely heavily on video interactions with patients, Rasmussen says. "Clearly, over the past five to 10 years, we know that video can convey empathy and compassion as well as make a human connection as opposed to telephone visits or written communication," he says.
Communication training is crucial for virtual second opinion care teams, Rasmussen says.
"Our nurse care team and our patient liaison team all go through science-based communication training to assist in creating the right language for conversations with patients," he says. "We want to create a connection between the patient and our care team. All Cleveland Clinic physicians receive similar training to assist in creating a bond between the physician and the patient."
More than 1,200 healthcare executives and frontline workers are expected to attend the event.
The AMGA Annual Conference opens tomorrow, and the event will focus on pain points and opportunities for medical groups and health systems.
The American Medical Group Association addresses four areas for its members.
First, the AMGA serves as a connector through the annual conference, leadership councils, and more than 50 in-person or virtual educational offerings throughout the year. Second, the organization helps members with innovation such as bringing members together with disruptors and conducting population health quality improvement programs. Third, the AMGA helps members to improve their performance through a benchmarking survey prepared by AMGA Consulting and a collaborative called High-Performing Physician Enterprise. Fourth, the organization advocates on behalf of its members on issues including payment reform, value-based payments, telehealth, and chronic care.
The AMGA Annual Conference will address pain points at medical groups and health systems, says AMGA President and CEO Jerry Penso, MD, MBA. "There will be sessions that address workforce, health equity, and how to lead in value-based care, which involves some of the innovations that medical groups and health systems are looking at," he says.
For example, one session features four leading health systems that are focusing on in-basket management—the messages that physicians and care teams receive from patients. During the coronavirus pandemic, those messages exploded and many of AMGA members are now experiencing three times the amount of messages that they received prior to the pandemic, Penso says. "They are figuring out with their workforce and technology how to address in-basket messages."
The conference is also going to feature disruptors, he says. "We have Marc Harrison, MD, who works with the venture capital firm General Catalyst and leads Health Assurance Transformation Corporation. He is going to be talking about the disruption that private equity is bringing into the healthcare marketplace."
The conference will also address opportunities for medical groups and health systems. For example, one of the keynote speakers, Trend Hunter CEO Jeremy Gutsche, will be talking about the healthcare opportunities related to artificial intelligence.
Another area of opportunity emphasis at the conference is the alignment of health systems and hospitals with their physician enterprises, Penso says. "We will be bringing leaders of health systems and hospitals together to discuss some of the critical issues that they face, including integrated planning, financial management, workforce, and care transitions."
About 1,200 people, including healthcare executives and frontline workers such as physicians and nurses, are expected to attend the conference, which is being held in Orlando, Florida, through Friday.
Penso says the conference is designed to be forward-looking.
"I want participants to gain fresh perspectives on the healthcare of tomorrow that they are going to be responsible for creating," he says. "As an example, our board chair, Dr. J. Stephen Jones, who is president and CEO of the Inova health system, has a powerful message he is going to deliver about the importance of healthcare leaders embracing technology such as AI."
Penso says he hopes that everyone who attends the conference will leave with at least one actionable takeaway that they will incorporate into their medical group or health system operations. "I want that takeaway to make care better for their patients, serve providers, and lower the cost of care," he says.
A HealthLeaders editor is attending the conference and expect coverage of the event later this week.
Rick Wright is relatively new to the position of CMO at Vanderbilt, but he is already full speed ahead on several department strategies.
In 2024, the top personal priority for the CMO of Vanderbilt University Medical Center is to continue to meet and interact with an increasingly broad number of people in the institution.
Rick Wright, MD, became CMO and senior vice president for clinical affairs at Vanderbilt in July 2023. Wright has been an executive at the health system since 2019, when he was named chair of the Department of Orthopaedic Surgery. Prior to joining Vanderbilt, he worked at Washington University School of Medicine in St. Louis, where he was executive vice chairman of the Department of Orthopaedic Surgery and director of the Orthopaedic Clinical Research Center.
Although Wright has been at Vanderbilt for about four years, he is focusing on getting to know people in the organization that he has not had a chance to meet because of the coronavirus pandemic and the relatively short time he has been CMO.
"I want to continue to become more comfortable with the areas of the institution that the CMO deals with that I have not dealt with as chair of orthopedic surgery," he says. "For example, there are aspects of the internal medicine and pediatric departments that I have not spent much time thinking about in the past. I want to expose myself to more of how they do business."
The effort to thoroughly acquaint himself with Vanderbilt leaders and key staff members is both organic and intentional, Wright says.
"On the organic side, I am getting to know people by working on projects and using that opportunity to get to know people better," he says. "For example, one of the general surgeons who is information technology savvy works under the adult ambulatory associate CMO. Over the past year, he and I had to work on an ambulatory project, so I have had several meetings with him, and we are now at the point where we are collaborating on other projects."
"On the intentional side, I am attending meetings that I previously was not a part of such as with ambulatory medical directors and executive medical directors for our patient care centers. I am singling out individuals in those groups that I have not previously worked with at both the adult hospitals and the children's hospital," he says. "The president and CEO of the health system has a weekly operational meeting, which includes about 30 leaders across the institution. I am making sure that I have a relationship with each of those people."
Institutional priorities
This year, Wright also is involved in supporting institutional priorities such as growth of clinical services and recruiting physicians.
Vanderbilt is building a new 180-bed patient tower at the health system's main campus in Nashville, Tennessee, as well as expanding services at three community hospitals acquired since 2019.
"We have some service lines that we want to augment as part of the increase in our bed capacity," Wright says. "This includes the Vanderbilt Heart and Vascular Institute. So, I am helping to recruit additional cardiologists, cardiothoracic surgeons, spine surgeons, and orthopedic surgeons. We are anticipating growth over the next three to five years to fill the new beds with specialty care that we think we are well-positioned to provide in the region."
Expanding services at the three recently acquired hospitals, including Vanderbilt Wilson County Hospital, is designed to address capacity constraints at the main campus in Nashville, Wright says.
"We are looking strategically at what services make sense to offer at these three hospitals," he says. "So, I am involved in making sure the appropriate services are covered and we are expanding other services in these hospitals. We have been working on recruiting gastrointestinal doctors, cardiologists, and surgeons such as orthopedic surgeons at the three hospitals to augment what they have been doing in the past."
Competition in physician recruitment is intense nationwide. To rise to the physician recruitment challenge, Wright says he is capitalizing on the strength of the Vanderbilt brand regionally and nationally.
"Physicians appreciate the chance to work here and to be affiliated with Vanderbilt," he says.
At the recently acquired hospitals, Vanderbilt has improved services and upgraded certain aspects of the hospitals, which has attracted physicians who are seeking more of a community practice while still working under the umbrella of the Vanderbilt health system, Wright says. In these physician recruitment efforts, Vanderbilt also has leveraged the opportunity for community hospital physicians to have access to world-class specialists at the main campus.
Photo: Rick Wright, MD, is CMO and senior vice president for clinical affairs at Vanderbilt Univesity Medical Center. Photo courtesy of Vanderbilt University Medical Center.
Cincinnati Children's has again been named one of the country's Most Innovative Companies by Fortune—remaining the top-rated pediatric healthcare organization while rising in the national ranking of organizations across all industries. Of the 200 most innovative companies cited by Fortune for 2024, Cincinnati Children's ranked No. 60, which is up from No. 76 in last year's inaugural listing.
Over the past 10 years, Cincinnati Children's has posted impressive innovation statistics:
2,033 U.S. and international patent applications
658 U.S. and international patents issued
253 licenses executed
13 active start-up companies based on intellectual property from Cincinnati Children's
217 licensed products or tools
Cincinnati Children's fosters a culture of innovation, says Todd Ponsky, MD, director of clinical growth and transformation at Cincinnati Children's as well as interim vice president of Cincinnati Children's Innovation Ventures.
"No. 1, we have prioritized research and discovery for curing disease and improving child health," he says. "Because research and discovery has been prioritized, our hospital has applied incredible amounts of resources toward building our research enterprise with our research foundation."
The hospital encourages frontline workers to have the ability to come up with new ways of doing things, Ponsky says. "That is also built into the culture. So, we have a culture of innovation that is seen not only in research and discovery but also in the day-to-day practice of medicine," he says.
The organization's leadership support for innovation is crucial, Ponsky says, adding Cincinnati Children's CEO, chief strategy officer, CFO, and physician leaders are all advocates for innovation.
"They are not only committed to practicing great healthcare but also improving child health by pushing the limits on how we can improve care in the future," he says. "These leaders have broken down barriers to prioritize innovation within our organization. They are the engine that is pushing innovation."
Cincinnati Children's, which posted operating revenue of $3.1 billion for the fiscal year beginning in July 2022 and ending in June 2023, garners millions of dollars of external support for innovation on an annual basis. In 2023, the hospital received $304.7 million for innovation efforts from external sources, including $217 million from the National Institutes of Health. Last year, the hospital applied $24.8 million to innovation from philanthropic fundraising.
"Most of our research money comes from the National Institutes of Health," Ponsky says. "We have a mechanism to help our scientists apply for federal grants. We are very fortunate to be one of the largest recipients of NIH funding in the country."
Enlisting frontline healthcare workers in innovation
Cincinnati Children's has an "open door" for frontline healthcare workers to propose innovations as well as events throughout the year to encourage busy clinicians to look at problems and come up with solutions, Ponsky says.
"We can help facilitate the maturation of these ideas into a product. However, we try to go further," he says. "We want to help support our clinicians to conduct research in a way that can be challenging in the hospital setting. We have an innovation team that is inserting itself into quality improvement meetings, where we hear about challenges. If we feel that other hospitals are facing the same challenges, we want to go after the solutions."
The staff of Cincinnati Children's Innovation Ventures runs with ideas developed by frontline healthcare workers including physicians and nurse practitioners, who meet periodically with the innovation team after proposing ideas, Ponsky says.
"This is a great way to get busy clinicians to see problems, work with us to develop solutions, and have a team that is in place to help facilitate the creation of the solutions without taking up a huge amount of the clinicians' time," he says.
Innovation advice for health systems and hospitals
Health systems and hospitals must be intentional for their innovation efforts to succeed, Ponsky says.
"Innovation is a rapidly moving target," he says. "It is incredibly challenging for a busy health system or hospital to get involved in innovation in a meaningful way. The needle is moving so quickly now—there are so many elements of innovation that were not on the forefront even five or 10 years ago."
Health systems and hospitals should look for partners to drive innovation forward, Ponsky says.
"If you look at innovation, it is very hard to stay up-to-date with what is new without having teams and partners across the country to keep you aware of developing technologies," he says. "New patents are developing exponentially now, and you need to have a collaborative and forward-leaning approach to stay on the forefront of cutting-edge technology."
For example, Cincinnati Children's is part of the International Society for Pediatric Innovation. "We collaborate with many other children's hospitals," Ponsky says. "This is an example of collaboratives that help us advance innovation."
Wellness and well-being efforts at RUSH include a wellness office, wellness resources, and group and individualized coaching.
The wellness and well-being of staff members is among the top 2024 priorities of Paul Casey, MD, MBA, chief medical officer of RUSH University Medical Center.
Casey has been CMO of RUSH since June 2019. Before becoming CMO, he served in multiple roles at RUSH, including associate chief medical officer, senior patient safety officer, associate chief medical informatics officer, and chairperson for emergency department operations.
Staff members are a critically important asset and foundation for success, Casey says.
"They will always be our highest priority," he says. "When you take a step back, healthcare has been under assault over the past couple of years on multiple fronts not only related to the coronavirus pandemic but also with payers, dealing with inflationary pressures, and rising to the challenge of a tight labor market. The only way to successfully combat these challenges is to invest in our people and our teams, making sure they are empowered to help lead us forward."
Efforts at RUSH to address the wellness and well-being of staff members include having a wellness office and wellness resources, but the organization also reaches out to staff members through "listening campaigns" to understand the stressors that are impacting them, Casey says.
"We have done a lot of work to listen to the voices of our staff and to understand the biggest pain points and how we can help to resolve pain points whether it is workflows or other areas," he says.
One initiative that RUSH has launched to address physician burnout is helping to manage email, texts, and MyChart messages to clinicians from patients. RUSH physicians receive hundreds of these messages every week, Casey says.
"We make sure we have support for our physicians, so that only things that need to go to the physicians are escalated to the physicians," he says. "We also want to make sure that mundane tasks such as prescription refills are automated as much as possible through technology such as generative artificial intelligence."
RUSH has a robust coaching program in place to help promote staff member wellness and well-being, Casey says. There is group coaching to talk about how the organization views the challenges ahead and how staff members can deal with stressors. In addition, there is individualized coaching that is paired with the group sessions.
"The group coaching curriculum is focused on how we perceive some of the challenges in the workplace and different perspectives on how to deal with stress," he says. "The individualized coaching focuses on what individuals are facing whether it is work-life balance or how they are scheduling their time. We want our staff members to be scheduling their time to be as effective and efficient as possible. The individualized coaching also looks at how we are finding joy in our work life and our home life."
Paul Casey, MD, MBA, is chief medical officer of RUSH University Medical Center. Photo courtesy of RUSH University Medical Center.
Digital patient engagement
Another 2024 priority for Casey is supporting efforts to expand digital patient engagement at RUSH.
Like many other healthcare organizations, RUSH took a step back over the past couple of years to consider how the organization could provide more personalized and accessible care, Casey says, adding some of this effort has been related pressure from new entrants into healthcare such as Amazon.
RUSH recently rolled out personalized reminders for services such as screening and wellness visits.
"These are important things that we know are not often prioritized because of patients' busy lives," he says. "For example, we are connecting digitally through our primary care clinics to tell patients they are overdue for mammography screening and suggesting available times for that screening."
RUSH is also making it easier for patients to schedule appointments digitally, Casey says.
"We want patients to be able to make appointments with three clicks or less through our reminder system," he says. "We know that patients often get bogged down, and it quickly becomes more cumbersome to make appointments. We want to create a good experience in as few clicks as possible."
Supporting growth
This year, Casey also is involved in efforts to forge partnerships and grow ambulatory services.
"We are not only thinking about the ambulatory space in the traditional bricks-and-mortar sense of building new clinics and regional sites of care, even though that is part of our plan," he says. "What is going to be key to increasing accessibility for our patients is both the digital work we are doing and growth through partnerships. We are always looking at new opportunities to partner and expand our existing footprint, whether that is in the form of additional clinics or online presence."
Last month, RUSH opened a new rehab hospital in partnership with a large national rehab organization, Select Medical.
"We have found that our growth through partnerships is effective when we find the right partner that has the same goals in mind," Casey says. "Relatively quickly, we have been able to expand our services at the same level of quality that we expect because we are an organization that is recognized for the high quality of our care."
RUSH recently opened a new ambulatory care facility in the western Chicago suburb Hinsdale. "This is an expansion of our primary care as well as our first concierge offering," he says. "This is an example of how we are expanding our offerings for patients who want to access RUSH in different ways."
Advancing health equity
In the area of health equity, Casey and fellow executives are building on the work of a prior RUSH CMO, David Ansell.
"He was a pioneer in thinking about health equity long before it became an in-vogue topic for discussion," Casey says. "We have been focusing on our West Side of Chicago community in making sure we are sourcing both our opportunities to hire staff and our vendor agreements through our local economy to help lift the economy in the area. We are making an investment in the communities that we serve."
RUSH is also focused on providing equitable care, he says.
"We keep an eye on health equity quality metrics and how we are doing among different races and ethnicities to make sure we are providing equitable care," Casey says. "We look for trends that we can identify and correct. We have begun to do this work for all quality metrics to trend the data and understand where opportunities to improve health equity exist."
From a health equity perspective, the primary quality metrics RUSH is tracking include patient experience on both the inpatient side and the ambulatory side, hospital readmission rates, and mortality rates, he says.
Yale New Haven Health is stepping up efforts to be a high-reliability organization.
For 2024, a top priority for the chief clinical officer of Yale New Haven Health is improving patient safety and care quality.
Thomas Balcezak, MD, MPH, has served as chief clinical officer of the health system since 2020. He previously held several positions at Yale New Haven Hospital, including chief medical officer, chief quality officer, director of performance management, and medical chief resident.
This year, Balcezak is focused on re-evaluating and retooling patient safety and care quality programs. Yale New Haven Health is doubling down on efforts to be a high-reliability organization that began a decade ago, he says.
"During the coronavirus pandemic and with the influx of new staff, we have seen an opportunity to recommit to the principles of high reliability," Balcezak says.
The effort involves the aspiration if not the actual achievement of zero harm for patients, he says. "It involves education. It involves making sure that we do a thorough evaluation of every serious safety event and near-miss event. It involves engaging staff members who can re-engineer processes and practices given the recognition that very few safety events are the fault of an individual. It is more often the fault of the system."
In the area of care quality, the health system has launched an initiative called Care Signature. The foundation of Care Signature is that patients should have the expectation that no matter where they go in the health system, they are given the same care based on their clinical condition, Balcezak says.
"You get the same therapeutic evaluation, the same access to cutting-edge therapeutics, and achieve the same outcomes no matter where you go," he says.
Care Signature involves operational standardization, according to Balcezak. For example, each hospital in the health system has the same radiologic protocols, the same laboratory protocols, and the same pharmaceutical formulary.
The initiative also seeks to influence physician behavior, he says.
"We want to reduce to the lowest possible denominator physician variation and how they approach diagnostic workups and therapeutic plan development," Balcezak says. "We are creating clinical care pathways, which include links to order sets within our electronic medical record for what tests should be ordered, what tests should be avoided, and what is the correct approach therapeutically for a patient with a given clinical condition."
Thomas Balcezak, MD, MPH, is chief clinical officer of Yale New Haven Health. Photo courtesy of Yale New Haven Health.
Financial turnaround
Balcezak is also focused on helping Yale New Haven Health improve its financial standing.
"Like many institutions, we had negative operating margins during and immediately after the pandemic for a variety of reasons such as inflation, labor tightness, and a lack of elective procedures," he says. "This will be the first year in which we break even on operations or even turn a small profit since the pandemic."
Clinical care efforts tied to financial performance at the health system include managing hospital length of stay and patient throughput as well as clinical stewardship, Balcezak says. Yale New Haven Health saw an increase in length of stay during the pandemic, and returning to a pre-pandemic length of stay has been a multifaceted body of work, he says.
These efforts include key drivers on hospital units such as setting an anticipated date of discharge, working with the patients and the care management team to get the patient ready for discharge, bringing the family into the discussion with the expectation about date of discharge, then holding all members of the care team accountable to hitting goals, Balcezak says. "For example, the physicians, the nurses, the care management team, and the social workers have to be held accountable."
Managing hospital length of stay and patient throughput is a top concern for clinical officers because it not only impacts cost of care but also is tied to the quality of patient experience and bed capacity.
Embracing clinical stewardship makes care delivery more efficient and cost effective, he says.
"In clinical stewardship, there was a time several years ago when we had an open pharmacy formulary, and you could get virtually any drug at the hospital. You could also order virtually any test," Balcezak says. "That was a time when physician autonomy as well as a lack of clear clinical guidance ruled. Clinical care guidance has become much clearer. How we do utilization review on the inpatient and the outpatient services has changed. Determining appropriate workups, appropriate testing strategies, and appropriate therapeutic regimens has become much clearer."
Clinical stewardship achieves more efficient medical care, which gets patients treatment faster, so it is more efficient financially and timewise for the patient, he says.
"We use the literature to help us guide us on care pathways, which gets us to better outcomes in a more efficient way," Balcezak says.
Coping with growth
Another priority for Balcezak this year is dealing with population growth in Connecticut.
"In the past, both outpatient and inpatient growth stalled. In our Connecticut communities in the late twenty-teens, growth in our population stalled," he says. "There was a net out-migration in Connecticut for at least a couple of years. The pandemic changed that trend. Since the pandemic, we have seen a net increase of particularly younger people seeking to live in Connecticut. We also have seen a growing elderly population."
Growth in the patient population over 65 is a concern for clinical officers nationwide.
Yale New Haven Health is experiencing growth in outpatient and inpatient services, Balcezak says.
"We have had growth across virtually all service lines," he says. "The growth has been between 2% and 4%."
Part of the health system's response to growth has been to launch a healthcare access initiative, Balcezak says. "The access initiative is in conjunction with the Yale School of Medicine to try to improve outpatient access for workups, diagnostics, and therapeutic treatments," he says.
On the inpatient side, Yale New Haven Health has been operating at record capacity, which makes length of stay work and throughput important beyond their impact on cost of care, Balcezak says.
"We cannot create new beds in an instant and we do not have any shuttered units that we can open and operate," he says. "So, the most important things we can do to accommodate inpatient growth is to lower length of stay and improve patient throughput."
The United States has the highest maternal mortality rate among high-income countries.
For chief medical officers seeking to boost maternal care, a top priority should be care coordination between the inpatient and outpatient settings, the CMO of Ob Hospitalist Group says.
The United States has the highest maternal mortality rate among high-income countries, according to statistics from the National Center for Health Statistics and the Organization for Economic Co-operation and Development. U.S. maternal mortality rates have been rising, with the rate pegged at 32.9 deaths per 100,000 live births in 2021, compared with a rate of 23.8 in 2020 and 20.1 in 2019, according to the Centers for Disease Control and Prevention.
CMOs should be focused on care coordination to achieve good maternal health outcomes, says Mark Simon, MD, CMO at Greenville, South Carolina-based Ob Hospitalist Group.
"Chief medical officers should focus on the continuum of obstetrical care from conception into the postpartum period," he says. "Especially at health systems, CMOs should be focused on how the outpatient setting is connecting to the inpatient experience that the patient has as well as care in the outpatient setting after the patient leaves the hospital. CMOs need to focus on how the outpatient setting and the inpatient setting are working together to ensure that the care is consistent across those locations. Good maternal care is about ensuring that connections are happening in the outpatient and inpatient settings, and those connections are happening consistently across a health system."
Good communication between care teams in the inpatient and outpatient settings is crucial, Simon says.
"Even if there is not a true admission, does the information that is gathered in the hospital setting such as an emergency room visit or an OB triage visit connect to the outpatient setting, where the patient is going to follow-up?" he says. "Is there a process by which that patient can have follow-up in a timely manner for whatever condition was seen in the hospital? Good communication is also required when patients are seen in the outpatient setting. Does the information that the patient has created during their visits in the prenatal experience get to the hospital? Does the physician and the team that is going to take care of the patient in the hospital know what has happened in the pregnancy before hospital admission? They should not be starting with a 'blank canvas.'"
In the hospital setting, care providers need to know where their patients are coming from and have relationships with community-based care providers, Simon says.
"Most patients we see at Ob Hospitalist Group have prenatal care to some extent," he says. "So, you must build relationships with the people providing the care, whether it is community physicians who are obstetricians, or it is midwives in the community. If hospitalists do not have relationships with these other care providers, it can create a very difficult situation."
Evidence-based care
CMOs should be involved in ensuring that maternal health patients receive evidence-based care, Simon says.
"There is evidence on clinical pathways and protocols that should be followed and adhered to," he says. "There are protocols on conditions that affect pregnancy. The key is to make sure those best practices are implemented in your clinical settings, whether they are outpatient settings or inpatient settings. With best practices, you need to implement them, you need to measure them, you need to analyze the data to see how you are performing, and you need to implement changes if things are not going as well as you want them to."
Simon says two key protocols in maternal health are a patient care bundle on hemorrhage and the management of hemorrhage in pregnancy as well as a protocol for hypertensive pregnancies. "Making sure patients are on the path with these protocols is the right thing to do because they can prevent poor outcomes," he says.
There are several maternal health metrics that CMOs should ensure are followed at health systems, hospitals, and outpatient clinics, Simon says.
Mode of delivery such as C-section rate
Hemorrhage metrics such as blood product use
Hypertensive management such as how quickly anti-hypertensive medications are given to a patient after an abnormal blood pressure reading
How quickly patients receive follow-up care for adverse conditions
Screening for mental health disorders such as postpartum depression
Addressing workforce shortages
CMOs are well-positioned to address workforce shortages in maternal care such as a dearth of physician obstetricians, Simon says.
"What a CMO should be doing is thinking about how they are utilizing their obstetrical clinicians to the best of their ability," he says. "The CMO should be thinking about how they can have their physician obstetricians doing top-of-license work such as caring for high-risk patients and doing C-sections. These physicians should be involved in care pathways that require the highest level of medical support for patients. Then the CMO should be thinking about how they can supplement physician obstetricians with other clinicians such as certified nurse midwives and women's health nurse practitioners, who can manage the low- and moderate-risk patients."
CMOs should work on team building in maternal care, Simon says.
"If you think in siloes, with separate obstetrician practices and separate midwife practices, you will run out of clinicians," he says. "CMOs need to re-think how we do obstetrical care in this country. Most prenatal care does not need a physician obstetrician. Most prenatal care is relatively low risk or moderate risk, which is well-suited to the skill sets of certified nurse midwives or women's health nurse practitioners. CMOs should want physicians seeing high-risk patients or working in the hospital setting."
Paul Casey, MD, MBA, is chief medical officer of RUSH University Medical Center. Photo courtesy of RUSH University Medical Center.
Thomas Balcezak, MD, MPH, is chief clinical officer of Yale New Haven Health. Photo courtesy of Yale New Haven Health.