Telehealth expanded exponentially during the coronavirus pandemic, and telehealth visits remain high compared to pre-pandemic levels. Having 24/7 telehealth services is relatively rare, but this health system is working to change that.
Hackensack Meridian Health has launched HMH 24/7, a 24/7 virtual care service, in a partnership with K Health.
"K Health, which is providing the app for HMH 24/7, is now a part of our medical group," says Daniel Varga, MD, chief physician executive for Hackensack Meridian Health. "So, HMH 24/7 is the doctors that K Health convenes, and they are part of our employed medical group."
The HMH 24/7 app includes an artificial intelligence component.
"We use an AI model in the app that allows a significant amount of information to be gleaned in a simple dialogue with the patient," Varga says. "You can use the app, get a chief complaint as well as get background and demographics from the patient, then the app populates a document for the physician."
Hackensack Meridian Health is expecting HMH 24/7 to provide "three tiers" of care for patients, according to Varga.
1. Virtual medical practice: The first tier is creating the virtual medical practice of Hackensack Meridian Health Medical Group. If needed, the health system will continue to do practice-specific telehealth visits. Moving forward, the health system will build around the HMH 24/7 platform. Anybody in the community can download the app and make an appointment to see a doctor through HMH 24/7, which is a pure virtual care model.
2. Bridge model: One of the biggest things that health systems and hospitals struggle with is emergency department discharge and readmission as well as hospital discharge and readmission. One of the obstacles to high performance in those areas is the ability to access a follow-up appointment quickly. With HMH 24/7, if there is an emergency department patient, and the ED physician would like the patient to have follow-up within 48 hours, the patient can download the HMH 24/7 app in the ED and make an appointment with HMH 24/7 before they leave the ED.
If there is a patient who has an established primary care physician, but it is going to take a week for the patient to see the PCP post-discharge, the health system can get the patient a bridge appointment by connecting them with HMH 24/7. When the patient gets in to see their PCP, the HMH 24/7 physician has documented the bridge appointment in the health system's electronic medical record. That way, the patient encounter with the HMH 24/7 physician is already in the patient workflow.
3. Wraparound services: The third tier is to build HMH 24/7 as a wraparound for the medical group that can provide 24/7 services to patients. A patient of a doctor who is a member of the Hackensack Meridian Health Medical Group can call the doctor and get connected to HMH 24/7. If the patient needs a doctor's visit, they can be immediately connected with a doctor through HMH 24/7, and the doctor can see the patient right then.
Benefits of HMH 24/7
Hackensack Meridian Health expects HMH 24/7 will improve transitions of care and limit readmissions, according to Varga.
"Where we hope HMH 24/7 will affect daily operations is particularly in transitions of care," Varga says. "When we are trying to get patients from the hospital to home or emergency department to home, HMH 24/7 can provide the appropriate medical oversight."
The around-the-clock access to care that HMH 24/7 will provide is a leap forward for Hackensack Meridian Health, Varga explains.
"We don't offer standard virtual visits after 4 p.m., and we don't offer standard virtual visits on weekends," Varga says.
Varga says HMH 24/7 should improve care for patients who visit Hackensack Meridian Health's emergency departments.
"For established patients, we are looking to provide bridge visits between the ED visits and when the patient can get in to see their primary care physician," Varga says. "For patients who do not have an established primary care physician with us, the HMH 24/7 practice can provide a primary care physician until the patients need someone to lay hands on them in an in-person visit. This enables us to provide continuity of care."
Varga provides three examples of how HMH 24/7 can connect patients to primary care through a seamless integration of virtual and in-person care.
First, there is the HMH 24/7 patient who is young and healthy and does not want to go in to get a complete physical with a primary care physician. At least 25% of New Jersey residents do not have a PCP. So, there are many patients for whom HMH 24/7 can act as the primary care doctor.
Second, for patients who already have a primary care physician through Hackensack Meridian Health, HMH 24/7 can be the after-hours and wraparound connection to their PCPs.
Third, for the patients who are discharged from the ED or the hospital, HMH 24/7 can connect those patients to a doctor then hand them off to a primary care physician.
Three of the hot topics at last week's HealthLeaders CMO Exchange were physician burnout, CMOs as liaisons, and the role of advanced practice providers.
Last week's HealthLeaders CMO Exchange focused on the top issues facing CMOs, chief clinical officers, and chief physician executives across the country.
HealthLeaders convened nearly two dozen CMOs, chief clinical officers, and chief physician executives from leading health systems and hospitals, including Yale New Haven Health, UW Health, OhioHealth, and RWJBarnabas Health. The event was held at the Hotel Effie Sandestin in Miramar Beach, Florida.
Physician burnout and wellness
Physician burnout was identified as one of the pressing issues facing CMOs.
"The top concerns for CMOs are maintaining the quality and safety of patient care delivery at our hospitals, while also maintaining physician integrity," says Seth Rosenbaum, MD, senior vice president and CMO of RWJBarnabas Health's Robert Wood Johnson University Hospital Hamilton. "As we know, burnout has become a concern as well as physician attrition and the rates of physicians leaving private practice."
"Physician engagement and physician burnout are high on the list of CMO concerns," says Candace Robinson, MD, CMO of Touro_LCMC Health. "I think there are ideas on how to address physician burnout, but no good clarity on what would be most effective at this point."
Physician burnout cannot be addressed in isolation from burnout in other healthcare workers, Robinson says.
"We need to have burnout programs that are for everyone, not just physicians, because we affect each other," Robinson says. "The nursing burnout is real—there is burnout across all of healthcare. COVID had a profound impact on burnout. Looking at the data from the American Medical Association, it looks like it is getting better, but it hasn't changed too much."
CMO's role as intermediary
CMOs play an essential role as the liaison between a healthcare organization's clinical staff and administrative leadership, Rosenbaum says.
"Traditionally, the CMO has been the liaison between the medical staff and the administration," Rosenbaum says. "The CMO has been the clinical person that understands both sides of care delivery. The CMO is supposed to help mediate differences between the administration, which sets policies and procedures, and the medical staff."
The intermediary role can be challenging, according to Rosenbaum.
"Sometimes, the medical staff says taking care of patients does not necessarily follow the policies and procedures that administration is establishing," Rosenbaum says. "The CMO must make both sides understand that in the interest of patient safety and patient care, both sides are working to the same goals. CMOs need to figure out a happy medium to get the job done and to make sure that we can provide the quality of care that our patients expect."
Working in a clinical role alongside their administrative duties can be helpful for CMOs to succeed as intermediaries, according to Robinson.
"I am not just sitting in a room during a meeting with clinical staff—I am working alongside them," Robinson says. "Many successful CMOs have at least a little dedicated clinical time, which is helpful in maintaining the connection between the administration and the frontline clinical team."
Role of advanced practice providers on care teams
APPs play a crucial role in today's practice of medicine, according to Rosenbaum.
"The physicians are overwhelmed with the volume of work in the timeframe allowed to do that work," Rosenbaum says. "They feel constantly pressured to see large numbers of patients in a short period of time. APPs can help mitigate that pressure."
APPs can perform clinical duties under the direction of physicians, according to Rosenbaum.
"We can have the ancillary support of qualified independently licensed practitioners such as APPs to assist physicians on clinical duties on a day-to-day basis," Rosenbaum says. "You must be able to find APPs who are able to do the work under the supervision of a physician."
APPs have an essential role to play but there are limitations, according to Rosenbaum.
"As long as everyone is on the same page, APPs will take on an expanding role in healthcare," Rosenbaum says. "We are seeing this across service lines, whether it is in the emergency department, the hospitalist medical service, or the outpatient arena."
Staffing realities make APPs crucial for care teams, according to Robinson.
"APPs are necessary to allow us to provide access to care for patients," Robinson says. "We just do not have enough physicians to take care of all of our patients."
The physician workforce is not going to be able to see enough patients without the help of APPs, according to Robinson.
"For example, if you have a large quantity of patients coming through an emergency room setting, the physicians need to be the ones taking care of the higher acuity patients, but APPs can be taking care of patients who have a lower acuity level and manage those patients, knowing physicians are there to answer any questions that arise," Robinson says.
Physicians should provide complex care, and APPs are qualified to help physicians manage patients who have complex conditions, according to Robinson.
"Given the way physicians are trained and the amount of clinical experience physicians gain during residencies, physicians should take care of the higher acuity patients. Those are the patients that physicians should be managing," Robinson says. "If an APP encounters a patient who is seriously ill, they can help manage that patient while knowing they have a physician who is available to help them with that management."
Most care teams should be physician-led, but there are circumstances where an APP can lead a care team, according to Robinson.
"It depends on what the team is leading. It depends on what type of initiative is involved," Robinson says. "The more medically complex initiatives probably need to be physician-led. In less complex initiatives, an APP can be an acceptable leader."
At Robert Wood Johnson University Hospital Hamilton, APPs play leadership roles in areas that do not require a high level of clinical expertise, according to Rosenbaum.
"We have our observational length of stay initiative, which has leadership roles for APPs," Rosenbaum says. "There are other initiatives that have hospitalist APPs and emergency department APPs leading on throughput issues, progress notes, and documentation."
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
OU Health's chief physician executive offers advice on how healthcare providers can promote a positive patient experience.
The new chief physician executive of OU Health is focused on recruiting physicians, leading strategic clinical initiatives, and helping care teams to generate a positive patient experience.
On Sept. 6, Cameron Mantor, MD, MHA, was named as chief physician executive at OU Health and president of OU Health Partners, which is the health system's physician practice. He had been serving in the roles on an interim basis since January. His prior leadership experience at the health system includes serving as associate chief physician executive for physician practice at OU Health Partners and CMO for OU Health's hospitals.
Lifepoint Health’s CMO shares key insights into reducing unwarranted clinical variation through a clinician-centered, analytics-driven approach.
In today’s rapidly evolving healthcare landscape, reducing unwarranted clinical variation has become a top priority for hospital and health system leaders.
At the recent HealthLeaders CMO Exchange, executives discussed innovative strategies to tackle this issue, with Chris Frost, MD, senior vice president, chief medical officer, and chief quality officer of Lifepoint Health, at the forefront.
Lifepoint’s two-and-a-half-year initiative aims to standardize care, reduce waste, and elevate clinical quality by empowering clinicians and leveraging data-driven strategies.
"Our operational definition of unwarranted clinical variation is variation in healthcare delivery that cannot be explained on the basis of illness, medical need, or evidence-based medicine," Frost says.
Lifepoint has enlisted clinicians to reduce unwarranted clinical variation, according to Frost.
"Our approach is bottom-up as opposed to a top-down approach," he says. "We have a clinician-centered process that helps engage the doctors and advanced practice providers to create standards of care and provide consistent care."
Lifepoint has been deliberate about engaging clinicians early in the process to reduce unwarranted clinical variation, according to Frost.
"We acknowledged early on in our discussions with the doctors that we understood that this effort is not just about reducing costs," he says. "There was an element of reducing waste in healthcare delivery. Ultimately, this is about elevating the quality of care—this is not about robbing clinicians of autonomy."
The initiative has been driven by a four-pronged strategy:
Quality-focused process improvement
Leveraging analytics
Care standardization based on evidence-based medicine
Deliberate focus on change management
"Overall, we improve quality by using evidence-based medicine as the standard to provide the right care to the right patient at the right time," Frost says.
Change management has been an essential part of the initiative, according to Frost.
"We recognize that if this was as easy as adherence to order sets, we would not need change management," he says. "But there is the people side of change, which is distinct from the process side of change."
Change management in the unwarranted clinical variation reduction initiative has had several components, Frost explains.
Lifepoint assessed the cost of inaction and perpetuating the status quo.
The health system was deliberate about identifying outcome measures. For example, sepsis outcome measures were length of stay and mortality, and congestive heart failure outcome measures were length of stay and readmissions.
Lifepoint also identified process measures. For sepsis and congestive heart failure, order set compliance was a key process measure.
Process measures were viewed from a team-based care perspective. The health system did not just look at physicians and advanced practice providers, but also other team members such as nurses and lab technicians.
The health system adjusted the "choice architecture" for treating medical conditions. For example, when Lifepoint clinicians pull up the sepsis order set, there is a listing of the antibiotics alphabetically, but the health system made it easy to choose the ones that have the highest efficacy and are evidence-based for that particular condition.
To maximize the impact of the unwarranted clinical variation reduction initiative, Lifepoint focused on five areas: sepsis, congestive heart failure, length of stay, optimizing blood transfusion utilization, and reducing repetitive lab testing.
There are four takeaways from the initiative so far, according to Frost.
Unwarranted clinical variation reduction can decrease healthcare waste as well as improve quality.
You need to prioritize your areas of focus.
You need to settle on a strategic approach. In Lifepoint's case, the health system adopted a four-pronged approach.
Never underestimate the importance of change management as it relates to clinician engagement.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
Please join the community at our LinkedIn page. To inquire about attending a HealthLeaders Exchange event and becoming a member, email us at exchange@healthleadersmedia.com.
Engagement, leadership training, and building a sense of community are among the ways to limit burnout, HealthLeaders CMO Exchange members say.
Healthcare worker burnout was the primary topic of a roundtable discussion today at the HealthLeaders CMO Exchange.
Healthcare worker burnout was widespread before the coronavirus pandemic and spiked during the public health emergency. A study found that from September 2019 to January 2022, overall emotional exhaustion among healthcare workers increased from 31.8% of staff members to 40.4%.
CMOs are well-positioned to address burnout among staff members, says Gary Little, MD, MBA, a CMO at Atrium Health.
"The CMO and other physician executive leaders can lean in on burnout," he says. "The skill we bring and the expertise we bring is around identifying problems and putting teams together to find solutions. That is what we do—it is our superpower."
CMOs need to engage healthcare workers to help address burnout, several CMO Exchange members say.
"Medicine is about relationships," says Erik Summers, MD, CMO at Atrium Health Wake Forest Baptist. "We have to make time as CMOs to see our staff members. You have got to get out there. You may not solve their problems, but listening is therapeutic. Listening goes a long way toward addressing burnout. There's nothing like face-to-face communication."
Better communication addresses burnout, Little says.
"We communicate what is happening in the organization and why on a regular basis," he says. "We explain why decisions were made. We try to tie the complaints, issues, and concerns to an action or a solution, then communicate about it."
Recognition is one of the ways healthcare organizations can combat burnout, says Jared Muenzer, MD, MBA, chief physician executive at Phoenix Children's and chief operating officer of Phoenix Children's Medical Group.
"We got a lot of feedback from our providers that the marketing communications and celebrations were all about the institution, and not about the individual providers and physicians," he says. "Over the past two years, we have gone after celebrating our physicians and advanced practice providers. It's not a direct solution to burnout, but it has been a huge win."
Engagement is when a change is made and it impacts physicians, advanced practice providers, and other staff members, then they speak up about it, Little says.
"They may complain," Little says. "It is not always negative when doctors and APPs complain—that tells me they actually care."
Helplessness is a driver of burnout, and engagement can tackle the problem, says Bryana Andert, DO, medical director at New Ulm Medical Center.
"Things happen and staff members feel they are beyond their control. Learned helplessness feeds a victim mentality, which is where some of the burnout lies," she says. "You need to engage with your people better, so they can believe there is somebody who is going to stand up for them. They may not get every single thing they want, but at least there is a pathway to address helplessness."
Leadership training can help address physician burnout, says Chris Frost, MD, senior vice president, chief medical officer, and chief quality officer of Lifepoint Health.
"We have developed a physician leadership curriculum, which morphed as we were developing it to help address burnout," he says. "The curriculum now focuses on psychological safety, empathy, a culture of safety, and conflict resolution. If we can identify physician leaders, then equip them with this skill set, we can have a scalable approach for addressing burnout."
Limiting burnout can be achieved through removing "the pebble in the shoe" that can drive healthcare worker dissatisfaction, Andert says.
"For example, there was an operating room staff and the pebble in their shoe was they could not get the right-sized scrubs consistently when they showed up in the OR for their shift," she says. "The response was to make sure they could get the right-sized scrubs, which did not cost a lot of money or time. They took that pebble out of their shoe, and it was a step in the right direction."
A major driver for burnout is isolation, Andert says.
"Many years ago, physicians would go into the physicians' lounge and engage with each other. There was community and opportunities to have friends," she says. "We have to find ways to re-engage with each other and create ways to have a community of professionals. We have get-togethers once a month, where food is provided. We have a topic that spurs conversation."
OU Health's chief physician executive must overcome a relative scarcity of physicians in Oklahoma.
The new chief physician executive of OU Health is focused on recruiting physicians and leading strategic clinical initiatives.
On Sept. 6, Cameron Mantor, MD, MHA, was named as chief physician executive at OU Health and president of OU Health Partners, which is the health system's physician practice. He had been serving in the roles on an interim basis since January. His prior leadership experience at the health system includes serving as associate chief physician executive for physician practice at OU Health Partners and CMO for OU Health's hospitals.
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. So, OU Health and OU Health Partners face a challenge in terms of the number of physicians they employ.
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," Mantor 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."
The health system's collaborative culture also draws physician recruits, Mantor explains.
"It is important that the physicians who work here work in concert with other physicians, other practices, and with all members of the staff," Mantor says. "We have a collegial environment."
Additionally, the health system provides a comprehensive compensation plan that provides physicians with the financial support that they need for themselves and their families, according to Mantor.
The compensation plan has several components. Base compensation is based on metrics linked to specialties. There is an academic component tied to a physician's department, which involves metrics including education, research, and clinical care. There are also incentive plans such as productivity incentive plans and quality and patient safety incentive plans, so physicians have opportunities to earn a bonus.
Cameron Mantor, MD, MHA, is chief physician executive at OU Health and president of OU Health Partners. Photo courtesy of OU Health.
Strategic clinical initiatives
As chief physician executive at OU Health, Mantor is involved in leading strategic clinical initiatives.
"For clinical programs, we think strategically about the expertise we have that we should provide to our patients, what are the programs that we do not have expertise in, but we feel our community needs, and the needs of our patients in general," Mantor says.
Pediatrics and trauma are two of the health system's primary strategic clinical focal points, according to Mantor.
"We have the state's largest, free-standing children's hospital, Oklahoma Children's Hospital OU Health, and children's healthcare is a huge focus for us," Mantor says. "We also are the state's only Level 1 trauma center for both adult and pediatric patients. Our ability to care for trauma patients who are severely injured is a strategic focus for us."
As a diverse academic system in adult practice and pediatric practice, OU Health is fortunate to have expertise in most specialties. If the health system determines it should launch a strategic clinical initiative in an area where it lacks expertise, physician recruitment is one method to rise to the challenge, according to Mantor.
"If we are unable to recruit expertise, then we partner with a local organization or across state lines," Mantor says.
Physician engagement is an essential element for strategic clinical initiatives, Mantor explains.
"The way we get to strategic clinical initiatives is not just the administrative team at the health system, which makes decisions about bricks and mortar as well as operations and finances, but also having physician leadership involved in decisions, which is paramount in making strategic clinical initiatives successful," Mantor says.
Inclusion is a guiding principle in involving physicians in strategic clinical initiatives, according to Mantor.
"From the very beginning, the discussions on the projects we are going to pursue include physician leaders," Mantor says. "We have a strategic governance team that is led by a senior physician and a senior administrator. Then we have broad representation, both from physician leaders and from administrative leaders. That core group will make decisions on major initiatives such as pediatric care and oncology."
Physicians are involved in the planning of strategic clinical initiatives, according to Mantor.
"If we are going to expand in the neurosciences or children's care or oncology care, once those decisions are made, we put the content experts from the clinical areas such as neurologists into the room," Mantor says. "They help us decide what the strategic initiatives should be and the tactics to move us along with a particular program."
CMO priorities
"At OU Health, the CMO's key roles are managing quality, patient safety, and patient experience," Mantor says.
Quality and patient safety go hand in hand, Mantor explains.
"In quality, as an organization we need to look at what is happening with our patients from a safety perspective or quality perspective that is putting them at risk," Mantor says. "We need to understand risk and be able to measure it. Once we understand what is happening, we must put processes in place to address preventable errors from happening."
Creating a just culture that promotes the reporting of patient safety events and near misses by staff is crucial for patient safety, according to Mantor.
"We want to know about potential issues that could cause harm," Mantor says. "If we want staff members to report, we must have a just culture. The reporting structure is not punitive. We want staff members to be able to tell us about issues so we can fix the problems."
For CMOs, there are several factors that contribute to promoting a good patient experience, Mantor explains.
"To generate a positive patient experience, we need to communicate with patients, explain to them what is going on, provide care options for them, explain the risks and benefits of care plans, and offer second opinions," Mantor says. "We need to provide good care and help patients to follow through on what they need to make themselves healthier."
HealthLeaders is convening top clinical executives from across the country to address key issues facing CMOs today. Here are the four that are top of mind.
This week, two dozen CMOs, chief physician executives, and chief clinical officers are set to discuss top healthcare issues at the HealthLeaders CMO Exchange, including workforce challenges, the role of advanced practice providers, AI, and telehealth.
The HealthLeaders Exchange program is the organization's premier thought leadership and peer-to-peer learning opportunity for healthcare executives. In addition to the CMO Exchange, HealthLeaders holds Exchange events for a range of healthcare leaders, including CEOs, CFOs, CNOs, and revenue cycle executives.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
Please join the community at our LinkedIn page. To inquire about attending a HealthLeaders Exchange event and becoming a member, email us at exchange@healthleadersmedia.com.
HealthLeaders is convening top clinical executives from across the country to address key issues facing CMOs today.
This week, two dozen CMOs, chief physician executives, and chief clinical officers are set to discuss top healthcare issues at the HealthLeaders CMO Exchange, including workforce challenges, the role of advanced practice providers, AI, and telehealth.
The HealthLeaders Exchange program is the organization's premier thought leadership and peer-to-peer learning opportunity for healthcare executives. In addition to the CMO Exchange, HealthLeaders holds Exchange events for a range of healthcare leaders, including CEOs, CFOs, CNOs, and revenue cycle executives.
CMO Exchange member Thomas Balcezak, MD, MPH, executive vice president and chief clinical officer at Yale New Haven Health, talked with HealthLeaders recently to highlight four critical concerns for CMOs at this week's event.
Recruitment and retention of healthcare workers
When it comes to the recruitment and retention of physicians, they have similar desires as other professionals, according to Balcezak.
"They want to know that they are getting a fair deal," Balcezak says. "They want to know that their work is rewarding and enriching to their personal lives. They want to feel like they are making a difference. They want to work for an organization that shares their values. And they want to work with other individuals who are similar to them and treat them fairly."
At Yale New Haven Health, there are several shared values between physicians and the organization, Balcezak explains.
"We put patients first," Balcezak says. "We treat patients and staff with respect. We make sure that we live the values of the organization, including integrity."
According to Balcezak, retaining healthcare workers is informed by an adage: People take a position for the job, but they leave a position because of their manager and the environment that the manager creates.
Balcezak recommends that healthcare leaders pay attention to both aspects of that adage to retain staff.
"We need to make sure that salary and benefits are competitive," Balcezak says. "We also need to make sure that how healthcare professionals are treated is positive and that their leadership is trying to make the working environment continuously better."
Thomas Balcezak, MD, MPH, is executive vice president and chief clinical officer at Yale New Haven Health.Photo courtesy of Yale New Haven Health.
Role of the advanced practice provider
The role of advanced practice providers (APPs) has not expanded clinically at Yale New Haven Health, but the health system is committed to maximizing their impact, according to Balcezak.
"We talk about working at top of license—not just for APPs but for all kinds of caregivers such as respiratory therapists, nurses, and physicians," Balcezak says. "We want to make sure that all of our practitioners are working at top of license."
At Yale New Haven Health, APPs work under the direction and supervision of physicians, and they take on tasks that free up physicians to work at the top of their licenses, according to Balcezak. The tasks assigned to APPs vary in the inpatient and outpatient settings.
In the inpatient setting, physicians admit patients, set care plans, and discharge patients. This leaves several tasks that APPs can perform, Balcezak explains.
"In between admission and discharge, there is follow-up care, daily progress notes, and other aspects of care that an APP can do extremely well under the direction of a physician," Balcezak says. "APPs can also perform functions such as screening, history, and physical exams preceding surgery and other procedures."
In the outpatient setting, APPs can perform functions such as routine office visits and checking on care progression under the supervision of a physician. These are the primary roles for APPs at Yale New Haven Health, Balcezak explains.
"While working at the top of their license, the efforts of APPs allow physicians to see more new patients, to create treatment plans, and to do surgeries and other procedures," Balcezak says. "The ideal role of APPs on care teams is to extend the expertise and time of physicians."
Adoption of artificial intelligence
Yale New Haven Health is in the early stage of adopting AI technology. Balcezak gave three examples of where AI is impacting care delivery at the health system.
Ambient listening: The health system uses ambient listening to capture encounters between clinicians and patients. The technology creates a template note for the clinician to review, edit, and authenticate.
"AI is going to allow us to streamline documentation and allow the clinician to spend more face-to-face time with the patient," Balcezak says. "This is going to free the clinician from endless typing."
Radiologic procedures: The health system has an AI tool that does preliminary reads for some radiologic procedures.
"That allows the physician to have preliminary ideas about the findings of radiologic exams, then independently confirm or deny them," Balcezak says. "This can save physicians time and improve their diagnostic acumen."
Patient monitoring: The health system is using an AI tool called eCART to monitor patients in the inpatient setting. eCART continuously evaluates the patient's electronic medical record, looking for evidence of clinical deterioration. It measures and monitors data, including nurse notes, clinician notes, laboratory results, radiology results, and vital signs.
"It can flag to a nurse or any other caregiver to make sure patients are evaluated clinically in person if it looks like the patients are deteriorating," Balcezak says.
Pictured: CMO Exchange members enjoy the reception cruise at the 2022 event.
Telehealth trends
The volume of telehealth visits at Yale New Haven Health has decreased significantly since the height of the coronavirus pandemic, but telehealth has become an established care delivery modality at the health system, according to Balcezak.
"The pandemic taught us that telehealth is highly effective, and it is a satisfier for both clinicians and patients," Balcezak says. "While we are not using telehealth as frequently as we did during the pandemic, we know that it has an important role to play. My prediction is that we will be using telehealth more for routine visits and follow-up visits, especially in primary care."
Balcezak expects specialty consultations via telehealth will increase across the country.
"We have a shortage of clinicians in certain specialties in the United States that disproportionally impacts rural areas," Balcezak says. "As we become more comfortable and facile in using telehealth, we can better serve rural communities and other communities that lack specialty clinicians."
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
Please join the community at our LinkedIn page. To inquire about attending a HealthLeaders Exchange event and becoming a member, email us at exchange@healthleadersmedia.com.
Health systems, hospitals, and physician groups should take steps to address the prostate cancer health disparity among Black men, according to this CMO.
Socioeconomic and genetic factors are the primary reasons for a health disparity in prostate cancer among Black men, according to the CMO of Envita Medical Centers.
September is Prostate Cancer Awareness Month. About 1 in 8 men will be diagnosed with prostate cancer during their lifetime, according to the American Cancer Society. Prostate cancer is the second-leading cause of cancer death in American men, behind only lung cancer, the cancer society says.
"With Black men and prostate cancer, Black men are more likely to be diagnosed with the disease and two times more likely to die from prostate cancer compared to other men," says John Oertle, NMD, CMO of Envita Medical Centers in Scottsdale, Ariz. "They also have a higher likelihood of having a more aggressive form of prostate cancer."
Socioeconomic factors play a role in the health disparity, according to Oertle.
"Black men do not screen as regularly for prostate cancer than other men, and there is a financial component to this screening disparity—they don't have the resources to access screening," Oertle says.
Genetics also impact the health disparity, Oertle explains.
"Black men have a higher likelihood of having the genetic predisposition of BRCA1, which has been associated with a higher risk of breast and ovarian cancer in women and prostate cancer in men," Oertle says. "Black men have a general higher risk of having BRCA1, which puts them at higher risk of having prostate cancer."
Health systems, hospitals, physician groups and CMOs should take steps to address the prostate cancer health disparity among Black men, according to Oertle.
"We need to have better advocacy and education in Black communities," Oertle says. "We also need to screen Black men sooner. Black men should start screening for prostate cancer at 40 years old. The screening should include a physical exam and blood work including Prostate-Specific Antigen testing."
Healthcare providers must also tackle the relatively high mortality rate among Black men with prostate cancer, Oertle explains.
"Healthcare providers such as health systems, primary care doctors, and urologists that do screening for prostate cancer also need to understand the increased risk of aggressive prostate cancer among Black men," Oertle says. "That message needs to be understood more frequently."
For most men with prostate cancer, they will die from another disease such as cardiovascular disease before they die of prostate cancer. Most prostate cancers are slow-growing, and they do not readily metastasize to different sites in the body.
However, the experience of Black men with prostate cancer is different, according to Oertle.
"It can go from Stage 1 and quickly advance to metastasis," Oertle says. "When it metastasizes, you have an out-of-control disease, which leads to mortality. We need to be aware, and we need to treat Black men more aggressively when prostate cancer is diagnosed."
An element of clinician engagement is giving them meaningful ways to influence a healthcare organization, a new CMO says.
To be successful in clinician engagement, healthcare organizations must give clinicians ways to influence the institution, says the new CMO of Medical City Denton and Medical City Argyle.
Glenn Hardesty, DO, was named CMO of the Denton, Texas hospital and its Argyle campus in August. He previously served as assistant CMO at Medical City Dallas.
Medical City Denton is an acute-care hospital and Level 2 trauma center that has 232 licensed beds; Medical City Argyle has 12 licensed beds. Both are part of Medical City Healthcare, a division of the HCA Healthcare health system.
Hardesty says clinician engagement is more of a philosophy than a series of interactions.
"Just because you have a medical staff golf tournament doesn't mean that you are engaging the physicians," Hardesty says. "You want to make sure that they have real input into the organization. You want to build structures so that they have meaningful ways to contribute to the health system and to make clinical decisions."
Medical City Healthcare has medical staff structures at each of its hospitals, according to Hardesty.
"How you utilize those structures can vary from facility to facility and health system to health system," he says. "We use the medical staff structures to hear the voice of the clinicians and to drive change. We also do an annual physician engagement survey to identify things that are top-of-mind among our physicians."
CMOs need to meet physicians where they are and actively listen, Hardesty explains.
"You don't want to pay lip service," he says. "You want to make sure that when physicians tell you something important, you take action when possible. If you can't take action, you need to tell the physicians why."
CMOs need to establish trust with their clinicians to engage them successfully, according to Hardesty.
"Without trust, engagement does not work," he says. "You build trust by experience over time. You can't come in on Day 1 and engage clinicians. It takes time to build trust. Trust is something that you must earn. You must have multiple encounters, and those encounters must be seen to have integrity."
Glenn Hardesty, DO, is CMO of Medical City Denton and Medical City Argyle. Photo courtesy of Medical City Healthcare.
Promoting quality care
There are two primary factors to promoting quality care in the hospital setting, according to Hardesty.
First, nursing is crucial to promoting quality.
"You must have nursing onboard in a quality plan and quality efforts to be successful," Hardesty says. "If you do not have the nurses on your side, if they do not have the bandwidth, if they do not have the understanding, your quality efforts are for naught."
The second factor is leadership visibility.
"Visibility as a leader goes a long way in promoting quality," Hardesty says. "When I left Medical City Dallas and came to Medical City Denton, the nurses gave me some advice. They said I was very visible, and I needed to keep that up, particularly with the nursing staff."
A major quality initiative that Hardesty helped lead at Medical City Dallas was limiting C. diff infections.
"With a quality initiative such as C. diff reduction, we found it takes everyone to be successful," Hardesty says. "It involved nursing and environmental services, for example. If the rooms are not cleaned properly, you can contaminate one patient to the next."
Part of the initiative involved targeting patients who were at high risk of infection.
"At Medical City Dallas, C. diff reduction was a challenge because there were specialized service lines such as bone marrow transplant that had high-risk patients," Hardesty says. "Those patients are extremely immunocompromised, and C. diff is easily passed in those kinds of units."
Key elements of the C. diff reduction initiative included training nurses on infection prevention, ensuring environmental service staff cleaned patient rooms effectively, and bolstering testing for C. diff.
"We wanted to know when C. diff tests were ordered and to make sure tests were ordered appropriately—that was a big part of what we did," Hardesty says. "We tested patients on arrival at the hospital if we suspected they had C. diff to identify patients early on, so those patients could be isolated and not expose other patients."
The C. diff reduction initiative generated positive results.
"When we started the initiative, we were having several cases per month at Medical City Dallas, and when I left the hospital, we were down to a small handful of cases per month," Hardesty says.
Risk management
In the hospital setting, risk exists everywhere, according to Hardesty.
"The key to risk management is to avoid engaging in unnecessary risk," Hardesty says. "You need to keep the preoccupation with failure front-and-center when dealing with risky situations."
Care teams should compare the alternatives before moving forward to avoid risk, Hardesty explains.
"For example, in the emergency department, you don't want to make moves until you are ready," he says. "You want to move appropriately and deliberately. You want to avoid rushing to judgment. You should pull back, use the resources you have at your disposal, make a decision as a team, then move forward."
Risk management and patient safety have a common theme, according to Hardesty.
"In risk management, you want to identify scenarios before they escalate," he says. "When it comes to mitigating risk, it helps to recognize risk early and address it sooner rather than later."
Pictured: CMO Exchange members enjoy the reception cruise at the 2022 event.
