Executives from competing hospitals and health systems shared operational information during the pandemic to better serve patients in their communities and to roll out vaccination efforts.
During the chaos and confusion early in the COVID-19 pandemic, hospitals and health systems turned to each other to share insights and information about the novel coronavirus and how to meet the needs of their patients.
HealthLeaders spoke with executive leadership from Oregon-based Legacy Health and Florida-based Tampa General Hospital, two examples of organizations that cooperated with their competitors and created partnerships to better serve their communities and roll out successful vaccination efforts.
Sharing the 'mundane'
Legacy Health, a nonprofit health system with hospitals and clinics in Oregon and Washington, is no stranger to partnering up with competing health systems to serve patients. In early 2017, Legacy Health collaborated with Adventist Health, Oregon Health & Science University (OHSU), and Kaiser Permanente Northwest (Kaiser) in creating the Unity Center for Behavioral Health, a 24-hour behavioral and mental health center in Portland, Oregon, which offers emergency services for those in a mental health crisis.
These established relationships enabled some of these competitors to team up again during the pandemic, to share non-competitive information and create a vaccine strategy.
When the pandemic hit the Northwest, with the first-ever COVID-19 case in Washington state, there was a lot of confusion, lack of resources, and panic.
"Nobody had a playbook for this situation," Trent Green, COO of Legacy Health, says.
Early in the pandemic, Green says he and other health system leaders across the state would hold weekly phone calls with the Oregon Association of Hospitals and Health Systems to discuss the virus.
This idea was modeled off of ongoing meetings the organizations' CMOs had around regional flu response, which have been happening for years. Similarly, during the pandemic, the CMOs of the different organizations broke off into "splinter groups," to share information about clinical issues and what cases they were seeing in their hospitals.
The COOs developed a weekly virtual meeting that Green describes as a "self-help group" for the leaders of Legacy Health, Providence Health & Services in Oregon (Providence), Kaiser, OHSU, and PeaceHealth.
Green says, "[We shared] non-competitive [information], in a lot of ways [it was] very mundane, but also in a lot of ways relevant given the amount of organizational energy that was [needed]." He says that none of the information shared involved trade secrets, just operational information and how to keep their patients and communities safe.
The leaders worked in concert on visitor restrictions, restricting surgical procedures, and capacity issues.
"We found that there were a number of things that we could learn from one another and draw from one another's individual decisions and information," Green says. "We would work together to come up with similar decisions or ideas on certain operational impacts."
Collaborating for community vaccination efforts
Legacy Health also partnered with Providence, Kaiser, and OHSU to jointly stand up a "high-throughput vaccination effort" for the state's metropolitan area called "All4Oregon," Green says.
"Sometime in late December, we had a discussion with the Oregon Health Authority," Green says. "It became clear to us after talking to the state that they didn't have a plan [or] a clear response from local public health as to how they might stand up vaccination efforts."
He continues, "[In mid-January], we had a meeting of all the chief operating officers with key members of our health systems who had been involved in vaccination efforts, and we made a decision in about four hours that we were going to come together and stand up a high-throughput vaccination effort."
While the organizations didn't have goals set when they first started meeting, their goal eventually became to vaccinate as many people as they could, in a timely and orderly fashion, Green says. Design models were created for vaccinating up to 15,000 patients a day. The organizations have provided 293,541 people with 549,471 vaccines, as of the morning of June 17.
The health systems created a memorandum of understanding for the vaccination effort.
"It was unlike any healthcare contract I've ever negotiated," Green says. "We did it in about 20 minutes, and it was essentially: 'We're doing this in the best interest of our community, and the partners agree that we will ultimately share in the costs, and to the extent that there are any revenues associated with our vaccination efforts, we'll share those in an equal fashion.' It's about as simple as that."
Success in launching the community vaccination effort was due to the health systems' combined effort in collaboration, communication, and teamwork. Each organization took the lead in different efforts, including the combined use of Legacy Health's Epic health records to keep track of the vaccinations. Other organizations led pharmacy efforts or medical site efforts.
"It's been a phenomenal partnership," Green says.
The health system executives also took different roles around the vaccination effort. The day Green spoke with HealthLeaders, he served as incident commander at the Oregon Convention Center, where they rolled out over 7,000 vaccinations to the community that day.
Partnership outcomes
"[As far as outcomes,] I would say one is, we still meet. We still find value in meeting even if we don't have formal things on the agenda," Green says. "We still find value in [sharing] how many COVID patients [we have], [if we're] still doing testing, [and where we are] doing testing."
Another outcome is that the vaccination throughput the four health systems implemented is now the leading vaccination effort for Oregon. The Federal Emergency Management Agency (FEMA) also told the organizations that they were one of the highest-throughput vaccination centers in the country, an achievement they are proud of, Green says.
Green says that he doesn't think the different organizations would have been able to succeed if they had not partnered and supported each other through the pandemic.
Partnering also helped the health systems gain a louder voice within the communities and states they serve for future public health decisions and considerations.
"We have an outsized voice," Green says. "We've shaped a lot of the decisions around how Oregonians sign up for our vaccine, how they're communicated with, [and] all that's been driven by us, operationally."
The formal collaboration among the health systems will unwind following the high-throughput vaccination effort, Green says.
"[The vaccination effort is] an enormous amount of work that we can't continue to sustain long term. We have a mission to accomplish and get as many people vaccinated as quickly as possible, but we'll unwind that sometime in late spring, early summer is our expectation," he adds.
While the formal partnerships will phase out, Green says the relationships he's built with the other COOs will be something he enjoys forever, and they plan to communicate informally.
"The spirit of collaboration and information sharing among us as chief operating officers will be sustained," Green says. "I now get texts or phone calls not infrequently from one of my peers at the other organizations on topics that are totally unrelated to COVID."
How to work well with competition
"We still compete with these organizations," Green says. "But what we have found beneficial is [sharing] the stuff that's non-competitive. Everybody's got to have a visitation policy, everybody's going to be doing screening, these are areas that are really non-competitive, and frankly, non-differentiating."
"There's just been enormous value in moving in concert with one another," he adds. And "it does multiply the power in ideas and experience with … these significant challenges … in healthcare."
However, like any relationship, there can be downsides to partnering with direct competitors.
"We don't always fly in formation perfectly. There are different personalities … [and] we've had our share of differences of opinion," Green says. But they were always able to successfully work through those differences, he adds.
Building on established relationships
Similar to Legacy Health, Tampa General Hospital in Florida has partnered with competing hospitals and health systems in the Tampa Bay region of the state to combat the pandemic.
John Couris, CEO of Tampa General Hospital, tells HealthLeaders that the hospital and USF Health's ongoing partnerships with BayCare, AdventHealth, and HCA are going strong. The CEOs of each organization meet weekly to share non-competitive information including COVID-19 data, staffing issues or concerns, patient loads, and what's working and not working in their facilities.
The idea to collaborate came from a conversation Couris had with Ravi Chari, CEO of HCA's West Florida Division, during Florida Governor Ron DeSantis' first press conference on COVID-19 in March 2020.
"We both thought it would be incredibly beneficial for the health of our community if the major health systems came together on an ongoing basis to share information," Couris says. "So, we put a plan together and became full partners in this historic, coordinated, collaborative effort that we believe helped save lives in our region during that initial devastating wave of COVID-19 in spring of 2020."
"We share best practices, ideas, [and] coordinate efforts," Couris says. "We're typically fierce competitors, but when it has come to COVID-19, we have been good collaborators and we're continuing to do so."
Another way the healthcare organizations collaborated was when vaccines were starting to get rolled out for healthcare workers in the state, much like Legacy Health's partnerships.
"Tampa General Hospital was selected to be one of the first hospitals in the state of Florida to receive the Pfizer vaccine. We were asked by the state to not only begin vaccinating our own healthcare workers, but we were asked to support and distribute vaccines to HCA, AdventHealth, BayCare, Moffitt [Cancer Center], and Bayfront [Health St. Petersburg]," Couris says.
That first shipment of the first vaccine carried "20,000 doses of hope," Couris adds.
As of June 16, Tampa General has administered over 11,000 vaccines to team members, family, and medical staff, and over 16,000 vaccinations to patients and the community.
The hospital was able to seamlessly coordinate and work with the other organizations to distribute the vaccines to health facilities because of their established relationships.
"I'm a little biased because I know most of the CEOs and leaders of the healthcare organizations that make up the health system in the state of Florida," Couris says. "These are good people … who take seriously the idea and notion that our responsibility is to safeguard the health and wellness of the community, particularly the communities that we serve."
Although the competition among Florida healthcare systems is "fierce," there was no doubt among the organizations that they would join together to care for the 4.5 million people who live in the Tampa Bay region.
"Early on, we all agreed that when it came to treating COVID patients, and safeguarding the health and wellness of this community, that we would work together and collaborate. We would not allow competition to get in the way of doing what was right for our community," Couris says.
Because the organizations were partnering to respond to a public health crisis, and weren't sharing competitive strategies or trade secrets, there were no legal documents involved in the collaboration, much like Legacy Health.
"We didn't feel like we had concerns around legal issues about collaborating, because … this was all about clinical care and response to COVID," Couris says.
The organizations don't have plans to partner past COVID but will continue to loosely collaborate.
"We came together for a very specific reason, and we'll stay together, and we'll communicate, coordinate, and work together until COVID is no longer a problem," Couris says.
He adds, "As soon as [the pandemic] becomes something that's manageable, that we can live with, and vaccines have been proliferated to a point where we're getting close to herd immunity and COVID becomes a much more manageable infectious disease, we'll still communicate, we'll still share information, we'll still work together as it relates to COVID. But there are no plans to go beyond that."
'You have to transcend competition'
When working with competitors, Couris says to keep an open mind and be willing to learn from others, and have a willingness to be part of something larger than yourself.
"When you're dealing with a public health crisis to the magnitude that we have been dealing with, you need to come together as a team," Couris says.
He also says to keep the patient at the center of everything your organization does.
"We're stronger together than we are apart, when it comes to a crisis or an emergency … [and] when it comes to taking care of the health and wellness of a community," he says.
"You have to transcend competition," Couris adds. "We compete fiercely in this market. Florida is a very competitive state for healthcare … competition's good in normal times. Competition makes you better, makes you stronger, makes you sharper. But in a public health crisis, where the community looks to you to provide a safety network to care for and treat … you have to be able and willing to transcend competition, push that to the side, and focus on what's most important.
"In this case, what was most important was confronting COVID-19 together and supporting a community who relies on us to provide world-class healthcare to them, and that's exactly what we did."
Editor's note: This story was updated June 18 to reflect Tampa General's updated vaccination totals.
In a 7-2 ruling, the Court ruled that the plaintiffs do not have standing to sue over the landmark healthcare law's individual mandate.
Healthcare organization leaders, industry observers, and members of the U.S. government have released the following statements in reaction to today's ruling.
Department of Health and Human Services (HHS) Secretary Xavier Becerra issued a statement calling the ruling a "victory for all Americans" while adding that healthcare is "a right."
In his previous role as California Attorney General, Becerra led a coalition of nearly 20 states in defense of the law and filed a petition of certiorari with the Supreme Court to hear the case on an expedited basis.
"Today’s decision means that all Americans continue to have a right to access affordable care, free of discrimination," Becerra said. "More than 133 million people with pre-existing conditions, like cancer, asthma or diabetes, can have peace of mind knowing that the health protections they rely on are safe. Women who need access to birth control, life-saving maternity care and preventive care can rest easy, knowing that their care is protected and covered. Seniors and people with disabilities can breathe easy knowing their health protections will continue. Individuals who have faced discrimination can continue accessing care without fear. And people relying on Medicaid and Medicare should know these programs are stronger than ever."
The Centers for Medicare & Medicaid Administrator, Chiquita Brooks-LaSure, who has worked to implement the ACA, calls the ruling a "victory."
"From my early career on the House Ways and Means Committee, I worked on this life-saving law. And later in a leadership post at CMS, I worked to implement the ACA – and the results are clear. Tens of millions of Americans can no longer be discriminated against due to pre-existing conditions like cancer, asthma, or diabetes," Brooks-LaSure said. "[But] our work is far from finished. CMS is focused on building on the successes of ACA to further expand access to health coverage. Thanks to the ACA and President Biden's American Rescue Plan, coverage on HealthCare.gov is more affordable than ever before."
America's Essential Hospitals issued a statement celebrating the ruling, calling it a "decisive victory for patients, hospitals, and all who believe no one, especially people of limited financial means, should go without access to affordable healthcare."
"Through the ACA, our nation took a historic step toward realizing a world without barriers to a need as fundamental to living as shelter, food, and education. This ruling preserves important progress in our work to make that vision a reality," Bruce Siegel, MD, MPH, CEO of AEH said in a statement. "With this decision, we urge Congress and the administration to act to close gaps in coverage, promote health equity, and invest in hospitals that care for people who face social and financial hardships. We must put underrepresented populations and underserved communities highest on the list of priorities for next steps in the journey to equitable and accessible care for all."
Similarly, the Federation of American Hospitals (FAH) stated that the millions of Americans receiving coverage under the ACA can "breathe a sigh of relief" after the Court's decision Thursday.
"We applaud the Supreme Court for overwhelmingly upholding the ACA and hope that this latest challenge to the law will be the last," Chip Kahn, CEO of FAH, said in a statement.
The American Medical Association (AMA) was pleased with the ruling, referring to the decision as a "victory for patients and for the gains in healthcare coverage" achieved through ACA.
"With yet another court decision upholding the ACA now behind us, we remain committed to strengthening the current law and look forward to policymakers advancing solutions to improve the ACA," American Medical Association President, Gerald E. Harmon, MD, said in a statement. "The AMA will continue working to expand access to health care and ensure that all Americans have meaningful, comprehensive, and affordable health coverage to improve the health of the nation."
America's Health Insurance Plans (AHIP) applauded the decision, adding that "it is clear" that efforts should be made to build on the ACA.
"We believe the Supreme Court rightly concluded this case does not belong in court, as the challengers have not suffered any injury," Matt Eyles, CEO of AHIP, said in a statement. "The ACA remains the law of the land and a foundational component of health care and coverage for more than 300 million Americans. After a year filled with unprecedented loss when reliable comprehensive health coverage has never been more important, this decision protects the stability of health coverage for people with pre-existing conditions, hardworking families, seniors, and other Americans who need it most."
Blue Cross Blue Shield Association (BCBSA) also celebrated the news.
"We are pleased with today’s decision dismissing the challenge to the Affordable Care Act. The ACA has made health care more accessible by providing 31 million people health care coverage. Right now, 90% of Americans have health coverage through their jobs, the individual market, Medicare and Medicaid," Kim Keck, CEO of BCBSA, said in a statement. "Today’s decision now gives the nation an opportunity to meaningfully tackle the underlying cost of health care – one of the most critical challenges in the health care system."
CareFirst is "pleased that the key provisions of the ACA remain in effect."
"[CareFirst] will continue to promote access to affordable health insurance for the individuals we serve and all Americans," President and CEO of CareFirst BlueCross BlueShield, Brian D. Pieninck, said in a statement. "CareFirst looks forward to continuing our work with Federal and state policymakers to maintain and improve access to healthcare throughout our region."
The Association for Community Affiliated Plans (ACAP) called the ruling a "victory for all Americans."
“In ten years, the ACA has been subjected to constant threats. Consumers have too long paid the price for the uncertainty these attacks bring about," ACAP CEO, Margaret A. Murray said in a statement. “Enough is enough. It’s time to stop attacking our health care system and time instead to repair, reform, and reinforce it so every American has access to quality, affordable, comprehensive coverage.”
The American Hospital Association (AHA) said that while "more than 30 million Americans who secured health insurance under the ACA can again breathe a sigh of relief ... our work is far from over."
"We need to redouble our efforts to close coverage gaps and make care affordable and accessible for everyone, all while continuing to fight COVID-19 and encouraging more Americans to get vaccinated," AHA CEO, Rick Pollack said. "The AHA is eager to partner with Congress and the Biden administration to make sure all Americans can achieve their highest potential for health."
The American College of Physicians (ACP) stated that was "glad" to see the ACA remain in place.
"Eliminating the coverage, benefits and protections provided by this law would have thrown our health care system into chaos, and placed health care for millions of Americans in jeopardy," George M. Abraham, MD, MPH, FACP, FIDSA, president of ACP, said in a statement. "We are glad that the justices saw the need for the law to remain in place."
The Association of American Medical Colleges (AAMC) was encouraged by the ruling and urged the Biden administration to increase the accessibility of coverage options for Americans.
"The AAMC applauds the Supreme Court’s decision today to uphold the Affordable Care Act (ACA), which will help safeguard access to high-quality and affordable health care for millions across the country," David J. Skorton, MD, CEO of AAMC, said in a statement. "This decision is instrumental in ensuring that all people can access care and more confidently face health threats, such as cancer, Alzheimer’s disease, heart disease, diabetes, and mental health disorders, among other conditions.
The United States of Care (USC) released a statement describing the ruling as bringing "peace of mind to those who feared having their healthcare torn away by the courts."
"It is time — especially in the wake of a pandemic — that we put a permanent stop to wielding people’s health care as a political tool or bargaining chip," Natalie Davis, co-founder and acting executive director of USC, said. "Yet another Supreme Court decision in support of the law means that it is time to move beyond these battles and work to create a more affordable, reliable, and more equitable health care system."
The Robert Wood Johnson Foundation (RWJF) said now is the time "for our nation to resume its path toward achieving universal healthcare coverage."
"States that have expanded their Medicaid programs under the ACA have provided health coverage to millions, leading to improved health outcomes and stronger state economies," Richard Besser, MD, CEO of RWJF, said in a statement. "Now we must finish the job to ensure that every person in the United States—no matter their skin color, income level, or zip code—has health insurance and a fair and just opportunity to live the healthiest life possible."
While many stakeholders are celebrating the decision, the Texas Public Policy Foundation (TPPF) feel differently about the Court's decision.
“A decade after the passage of the Affordable Care Act, Americans are still unhappy with the high cost of care, a lack of affordable options, and a system that puts the interests of insurance companies over patients," Director of TPPF's Right on Healthcare, David Balat, said in a statement, "Millions of Americans are eligible for low- or no-cost insurance yet decline to enroll because the system does not deliver the care they need. While supporters of the ACA might cheer today’s decision, the reality is that our system is still in need of repair."
"The good news is states like Texas are beginning to forge their own path and develop new models that provide better help to the uninsured, require pricing information up front, and put patients in charge," Balat continues. "Texas is not waiting around for the Supreme Court to finally recognize the legal problems with the ACA. The failed policy has been evident for more than a decade and Texas is responding with solutions that result in better health outcomes for patients."
Lawmakers weigh in
White House Chief of Staff Ronald Klain tweeted "more Americans are covered under the ACA than at any time since its passage." Additionally, he tweeted "It's still a BFD."
Speaker of the House Nancy Pelosi, (D-Calif.), tweeted her approval, stating that the ACA "endures as a pillar of American health and economic security alongside Medicare, Medicaid, and Social Security."
Former HHS Secretary Donna Shalala tweeted that after the Court's ruling, "Millions of Americans … can breathe a sigh of relief."
New York Attorney General Letitia James, who worked with a coalition including 20 states and the District of Columbia to defend the ACA, said that it is "here to stay."
"For more than a decade, the Affordable Care Act has been the law of the land, providing health coverage and a multitude of protections to tens of millions of Americans across the nation, and today’s decision solidifies those protections for generations to come," James said. "While Republicans have repeatedly tried to take us backwards in time and strip health coverage away from millions, we have now beaten those efforts over and over again and, specifically, three times at the Supreme Court."
Additionally, Sen. Mark Warner, (D-Va.), tweeted: "For the third time, SCOTUS has ruled to leave the Affordable Care Act in place. Without the ACA, 20 million Americans could lose their health care coverage. I plan to continue to work in the Senate to protect our health care."
Julián Castro, mayor of San Antonio was also in favor of the ruling, stating in a tweet that "nearly 1.5 Million Texans have care through the ACA. We should be working to expand, not cut, their coverage."
Additionally, HealthCareInsider.com developed an ACA sentiment tracker to monitor the public's sentiment around healthcare reform. The tracker utilizes Twitter's API once a day and analyzes sentiment value from 100 unique tweets.
This is a developing story that will be updated as more information becomes available.
A new Manatt and Robert Wood Johnson Foundation white paper details how healthcare systems can increase price transparency by using cost growth benchmarking models.
States can increase price transparency by using cost growth benchmarking models and developing strategies to contain costs, according to a white paper released by Manatt and Robert Wood Johnson Foundation Thursday morning.
States that have already enacted benchmarking models include Massachusetts, Delaware, Rhode Island, and Oregon. Since 2020, Connecticut, Washington, New Jersey, and Nevada have taken the initial steps to establish benchmarking programs in their states.
This trend comes as state governments and consumers have grown increasingly concerned over the rise in healthcare costs.
Each state that has implemented cost growth benchmarking models have employed a strategic angle when it comes to engaging stakeholders, which is an "essential ingredient" for program development and setting goals, according to the white paper.
Beyond the effort to improve healthcare cost transparency, states are also interested in investing in primary care, identifying trends in patient cost-sharing, and advancing alternative payment models.
Additionally, the white paper highlights five common features among cost growth benchmarking programs which include:
Authority to collect and use data to monitor health system spending trends
Growth target against which to measure spending trends
Spending measurement to collect and track healthcare expenditures
Data and analytic capacity to support data analysis, reporting, and use cases
Data use strategy to advance state use cases
The report also indicated that standardization could benefit benchmarking programs in certain circumstances by supporting continued growth and creating coordination between states. Areas for the potential of standardization include:
Creating model language for legislation and executive order text
Creating instruction guides to detail how to set a cost growth target
Creating a standard methodology for benchmark data collection
Creating strategies to ensure data accuracy and completeness
Utilizing detailed case studies to "inform practice"
Creating interstate working groups to "shape practices and understanding of emerging issue"
The white paper concludes that while benchmark programs are not a cure-all, these initiatives can help states “identify cost drivers and make data-driven decisions with the full spectrum of stakeholders at the table."
"With eight states on board and others looking closely at cost growth benchmarking, these programs are destined to become a critical data resource for states seeking to understand healthcare cost growth trends and what can be done to contain costs and direct spending toward efficient and equitable investments," according to the white paper.
The acquisition marks another step in Humana's strategic initiative to further develop the organization's value-based home healthcare offerings.
Humana announced Monday morning that it has signed a definitive agreement to acquire One Homecare Solutions (onehome) from WayPoint Capital Partners.
The acquisition of onehome, based in Miramar, Florida, marks another step in Humana's strategic initiative to further develop the organization's value-based home healthcare offerings.
In April, the Louisville-based insurer announced it would acquire the remaining 60% interest in Kindred at Home, a home healthcare and hospice provider.
Onehome's value-based, full-risk model aims to improve patient outcomes and quality of care while lowering health plan costs. Currently, the organization manages "a range of post-acute needs" including nursing, occupational therapy, physical therapy, infusion care, in-home durable medical equipment services, and site of care placement.
The acquisition is slated to close during Q2 2021, subject to state and federal regulatory approvals. No financial terms were disclosed.
According to a company press release, onehome will enable Humana to "deliver value-based home health at a national scale" through:
Its experience in risk-based contracting and its "fully capitated models in place in Florida and Texas" which can be used to expand contracting in other states.
The organization's "fully-dedicated network management and utilization management systems" can be utilized for more efficient administration of in-home visits.
Its ownership and management of home-based durable medical equipment and infusion services, which can be expanded to other markets outside of members in its core geographies.
Its ownership of durable medical equipment can also help deliver better outcomes at a greater value, through "reduced waste and more consistent equipment utilization."
"The acquisition of onehome is a key component of [our] strategy. It complements our recent announcement to fully acquire and integrate Kindred at Home and brings together additional capabilities that will allow Humana to deliver value-based home health at a national scale," Susan Diamond, segment president for Humana's home business and Humana's interim CFO, said in a statement. "By combining onehome’s value-based approach with Kindred's home health services and Humana's analytical capabilities and clinical expertise, we believe we can create a transformational value-based offering to serve more people, including non-Humana plan members, nationwide."
Healthcare stakeholders said that increasing procurement efficiency is the top priority for the industry this year.
More than one-third of healthcare respondents plan on making more than 50% of purchases online in 2021, according to an Amazon Business report released Monday morning.
The Seattle-based tech giant’s e-commerce survey was created to better understand the transformation of business-to-business e-procurement because of the COVID-19 pandemic.
Nearly one-third of respondents said that "accessing suppliers that meet the needs of their business" was the top pain point of 2020.
According to the study’s authors, e-procurement is evolving to better meet the needs of the healthcare industry by providing access to a "much broader range of suppliers" compared to traditional procurement methods.
"Diversification of supply is the focus now and is a huge priority. We are slowly watching the tide rise," Petra Schindler-Carter, general manager and director for Amazon Business, said in the report. "Now we are in a position where healthcare customers care most about whether we have the products that meet their specifications, which can be a matter of life or death."
As part of the study findings, more than half (52%) of the healthcare industry respondents said that increasing procurement efficiency is the top priority for the healthcare industry for 2021.
Other top procurement priorities for the healthcare industry in 2021 include:
University Hospital CEO Shereef Elnahal, MD shares his takeaways from a recent U.S. Senate Committee hearing about the national supply chain, University Hospital's pandemic response, and the Newark-based hospital's efforts to get its Black and Brown communities vaccinated.
The COVID-19 pandemic presented the provider sector with a plethora of challenges and learning opportunities, including the importance of maintaining a robust supply chain. Hospitals and health systems faced shortages of critical supplies while trying to navigate caring for patients who had contracted the novel coronavirus.
In mid-May, the U.S. Senate Committee on Homeland Security and Governmental Affairs held a hearing to address the medical supply chain and what changes are needed to successfully operate during the next pandemic or health crisis.
Among those who testified before members of the Committee was Shereef Elnahal, MD, CEO of University Hospital, New Jersey's only public hospital. In his testimony, Elnahal described what the Newark-based hospital experienced during the COVID-19 pandemic, including facing shortages of critical supplies such as PPE and medication.
This pandemic has highlighted just how vulnerable and integral the hospital supply chain is in the healthcare industry. To cover the pain points, lessons learned, and solutions for sustaining the supply chain, HealthLeaders is launching a monthly Supply Chain eNewsletter. Get your free subscription.
"As the number of COVID cases in our emergency rooms and intensive care units doubled, tripled, and quadrupled, we found ourselves at risk of running out of supplies for which we have never seen shortages before," Elnahal said during the hearing. "This includes protective equipment for our staff and ventilators for the patients with the most severe cases of COVID-19."
Prior to his role at University Hospital, Elnahal served as Commissioner of the New Jersey Department of Health and as a White House Fellow to the Secretary of Veterans Affairs during the Obama administration. Following the hearing, Elnahal spoke with HealthLeaders about his takeaways from the hearing, University Hospital's pandemic response, and the hospital's efforts to get its Black and Brown communities vaccinated.
This transcript has been edited for clarity and brevity.
HealthLeaders: What are your biggest takeaways from the hearing?
Shereef Elnahal: [The hearing] was a productive bipartisan inquiry into what we can do to better shore up the supply chain in the event of a pandemic. It's a bright spot in the overall environment in Washington right now, the fact that leaders from both parties in Congress want to come to solutions on this issue because nobody wants a repeat of what we saw last year.
To not have the essential supplies and medications to care for patients in the most desperate of times in the richest country on Earth is a problem that we just cannot ignore. There was agreement on that and a broad consensus that we need to find solutions.
I learned a lot about how the domestic manufacturing capacity for PPE was not adequate, to begin with, and over time, there has been offshoring of too many of these assets and productive capacity. I had the front-line view of that last year when we were on the phone with suppliers, mostly abroad, who were telling us “No" because they had nationalized their supply chain for their own pandemic response.
To boot, we received shipments from suppliers from abroad that were defective equipment, and essentially examples of fraud. We did the best that we could in real-time to vet some of the suppliers, and even after all our exhaustive efforts, some shipments slipped through the cracks that were simply not acceptable for patient care.
HL: What steps are required to ensure the supply chain is ready for the next pandemic?
Elnahal: Making sure that the Defense Production Act is ready to deploy in the event of a public health crisis. The Biden administration is making significant strides in that.
[There are] representatives from the textile industry who are reorienting their operations at the request of the federal government, who are saying that they're happy to help in this, but we need to make sure that textile manufacturers are protected in this country.
[Implementing] incentives for domestic manufacturing of critical drugs. We were days away from running out of some critical medications that we've never seen depleted before, including basic drugs like fentanyl and propofol that keep people sedated on a ventilator. It's an unacceptable outcome to have people wake up while they have a breathing tube down their throat.
Finally, having more of these suppliers domestically will improve oversight and add another layer of protection against fraud, not to mention the benefits on American jobs, and building the productive capacity of the future.
All the policies to achieve those ends will be determined by folks who are experts on these issues. I was [at the hearing] to highlight our experience as an end-user and purchaser of these critical items on behalf of our patients and our community, and I was grateful to provide our perspective.
I made sure that I emphasized that the safety net institutions in this country who care for the most vulnerable and tended to care for higher proportions of minority residents, were the ones that were worst off. Whether it was us here in Newark, or critical access hospitals that treat Native Americans and other groups across the country, we were facing the worst situation when it came to the supply chain because we just don't have the purchasing power to exert leverage on suppliers in times of crisis unless their supplies are shored up with effective policy.
All those dynamics point to the worst situation for standalone hospitals and safety-net hospitals when it comes to this issue around the supply chain. Making sure that the strategic national stockpile is enhanced and produces what's needed for standalone and safety institutions as a first stopgap, and also reforms that make these supplies more available, will help us make sure we have the critical items we need in the next crisis.
HL:During the hearing, you spoke about how University Hospital handled 83,122 emergency department visitors, 15,572 inpatient admissions, and 199,804 outpatient clinic visits. Can you further describe what the pandemic looked like at University Hospital?
Elnahal: Within days in early March of last year, we saw the number of patients with COVID-19 increase exponentially in our hospital. By the time April rolled around, we were getting between 20 and 30 admissions per night almost exclusively for COVID-19. We had patients with a disease that we knew little about.
This is not an academic issue for us; this is a lived experience of what it's like to proceed through a crisis like this. You couldn't help but notice that in our hospital almost every patient in our rooms was a person of color. It's not just the public health emergency, it's the glaring health equity issues that stem from generations of systemic racism that have created disparities and chronic disease, which make folks in this community more susceptible to COVID-19.
These reforms, if they're enacted at the federal level, will help us meet better equity goals and care for Black and Brown communities more effectively.
HL: How has the pandemic affected your leadership style?
Elnahal: Crisis leadership became my entire agenda last year. That involves excessive communication. You can never under-communicate during a crisis, and you can never under-communicate the truth during a crisis.
We had town halls every week with staff where I would tell them the good and bad news about our supplies and imparted everything we were doing to try to fix that issue. We also had daily e-mails updating folks of things and we had [smaller] forums of people when needed to address issues.
Finally, to not explicitly recognize and mourn for folks who died during this pandemic on our workforce would have been a giant mistake, and I recognized that from the beginning. So, we didn't hide the fact that folks were dying from COVID-19 in our hospital. We were transparent about that and mourned collectively with their colleagues on the frontline. That brought us together in solidarity.
HL:How has University Hospital worked to get over 20,000 people in the community vaccinated, including those who are underserved or who are hesitant?
Elnahal: We vaccinated the first person in New Jersey outside of a clinical trial. We also conducted a Moderna vaccine trial here on our campus and was one of the few hospitals across the country serving a community predominantly of color.
Enrolling people of color in the trials was essential. There's a lot of hesitancy that's well-rooted in the history of systemic racism and racism at the hands of the medical establishment, and also concerns around the current experiences of folks who experience implicit bias at the point of care. We knew there were going to be hurdles and a long way to go to earn the trust of the community, but we approached the community humbly starting around the time that we launched the trial, and that prepared us to get going the vaccination.
As a hospital, we've vaccinated more people than any other hospital in Newark, and we are rerouting our vaccination strategy to move away from our campus and more into the community. [We're] not only doing town halls, talking about the vaccine and why folks should try to accept it but also addressing the most critical barrier now which is access. We now have three mobile vans that we plan to deploy here and elsewhere, to get closer to where people are. We're also conducting walk-in clinics to reduce the barriers upfront to folks who are ready to be vaccinated. Making it as easy as possible is a public health imperative, and we've taken that seriously.
Jay M. Anderson will execute the organization's vision and strategy across all clinical enterprise operations.
The Ohio State University Wexner Medical Center named its new COO Monday afternoon.
Beginning July 1, Jay M. Anderson will take up the role and execute the organization's vision and strategy across all clinical enterprise operations at seven hospitals and its ambulatory services division.
In addition to overseeing operations and ensuring alignment across the medical center, Anderson will help work on growing a new comprehensive health platform, which will include telehealth services, home-based and remote health offerings, and a range of acute and specialty bedside care for patients.
"We welcome Jay’s remarkable experience in performance improvement, quality and operations to Ohio State," Harold Paz, MD, CEO of Ohio State Wexner Medical Center and executive vice president and chancellor for health affairs at OSU, said in a statement. "Undoubtedly, his deep roots in Columbus and affinity for Ohio State, combined with his exceptional experience and leadership, will continue to accelerate the achievement of our strategic goals."
Over the past two decades, Anderson has served in multiple executive leadership roles at Northwestern Medicine, most recently as president of Kishwaukee and Valley West Hospitals.
He also served as Northwestern Medicine's senior vice president of pandemic operations during the COVID-19 pandemic, where he was responsible for coordinating COVID-19 testing efforts and allocating resources.
The national employer organization and the regional coalition will work to improve “affordability and employee health outcomes" for employers in Colorado.
TCPA, a regional coalition and affiliate of the Colorado Business Group on Health, will work with PBGH, a national employer organization, to create an alliance that brings public and private healthcare purchasers together to "improve affordability and employee health outcomes.”
Through the joint venture, PBGH and TCPA will establish provider relationships with facilities and their associated physicians who meet national quality standards at competitive prices. The organizations will also jointly identify centers of excellence across several procedure disciplines and condition categories and directly contract with them to ensure a proper care continuum for patients.
"We’ve seen a readiness on the part of large employers, who pay the lion’s share of health care costs in this country, to partner directly with providers who can deliver high-value services that improve the care and well-being of employees," Elizabeth Mitchell, CEO of PBGH, said in a statement. "This initiative builds on PBGH’s experience running one of the country’s most successful centers of excellence programs, which eliminated unnecessary care, improved patient outcomes and experience, and produced significant cost savings."
The new venture will also create a common set of standards to evaluate healthcare organizations that leverage local relationships, according to a press release, establishing a framework that can then be scaled nationally.
"After decades of health care price increases that hurt Colorado families and communities, the time has come to re-think the basic structure of a dysfunctional health care market," Robert Smith, president of The Colorado Purchasing Alliance, said in a statement. "By working with PBGH, a national employer organization that has experience purchasing care based on value, we can create a health care market in which employers purchase healthcare services with the same due-diligence as other goods and services in the market."
Eleven employers have signed letters of intent to participate, including the State of Colorado, the City and County of Denver, the Boards of Education Self-Funded Trust, and the Colorado Employers Benefit Trust.
"The arrangement between The Colorado Purchasing Alliance and the Purchaser Business Group on Health is an excellent opportunity for Colorado's health care market to not only demonstrate its ability to perform at a national level, but, having done so, to gain business from national employers," Colorado Governor Jared Polis said in a statement. "My administration is proud to support this effort and it is another clear example of how we can work together to save people money on health care.”
Effective immediately, Warren E. Moore, FACHE, will serve as executive vice president and COO of the New Jersey-based health system.
Inspira Health announced the appointment of Warren E. Moore, FACHE, as executive vice president and COO Wednesday afternoon.
Effective immediately, Moore will lead the New Jersey-based system's strategic growth strategy and will oversee the hospitals, health centers, and outpatient services operations, under the leadership of CEO Amy Mansue.
Moore has more than 25 years of experience in the healthcare sector and most recently served as CEO of Children's Specialized Hospital and senior vice president of pediatric services for New Jersey-based RWJBarnabas Health. During his 21-year tenure at RWJBarnabas, he also served as executive vice president and COO of Children's Specialized Hospital.
"Moore is a highly respected executive leader in the healthcare industry whose experience will be invaluable to the growth of Inspira," Mansue said in a statement. "He has a strong background in utilizing his insights to improve hospital operations. In joining our leadership team and our network overall, he will bring immeasurable knowledge and experience to fuel our growth as a health care leader in the South Jersey region."
Prior to his time at RWJBarnabas, Moore served as chief administrative officer at Bristol-Myers Squibb Children's Hospital, a part of Robert Wood Johnson University Hospital.
"I am grateful for this opportunity, and I am looking forward to taking on this leadership role at Inspira and utilizing my previous experiences to maximize the impact Inspira can have on their patients," Moore said in a statement. "Alongside the leadership team, we will continually elevate the high quality, safe and compassionate care that we provide to those in our community."
The regional health systems mutually decided the best approach to supporting their respective communities was by remaining independent.
Sentara Healthcare and Cone Health announced Wednesday afternoon that their affiliation plans have ended. The regional health systems mutually decided the best approach to supporting their respective communities was by remaining independent.
The announcement comes a few months after the public was asked to weigh in on the merger, which was first announced in August 2020, when Sentara, based in Norfolk, Virginia, and Cone, based in Greensboro, North Carolina, signed a letter of intent.
In March, North Carolina Attorney General Josh Stein asked residents to voice their opinions on the proposed merger, and in April, the North Carolina Department of Justice extended the deadline for two additional weeks.
"Recently, in the final analysis, we mutually decided that we can best serve our communities by remaining independent organizations," Terry Akin, CEO of Cone, said in a statement. "We have developed a high regard for the excellent services and outcomes Sentara delivers, and we expect both our organizations to continue to advance our common goals of providing outstanding care for our respective communities."
Additionally, Howard P. Kern, CEO of Sentara, said in a statement that both systems are “high performing, well respected, community-focused organizations.”
“Those similarities served as the basis for efforts toward an affiliation,” he added. “I am confident that this mutual decision will not alter either organization’s ongoing commitment to meet the needs of our respective communities."
In an interview with HealthLeaders in August, Kern said that during a board retreat, he and Akin shared their ideas, and it became clear the two organizations were aligned on vision, strategy, and direction, including a shared vision on value-based care. That's when formal discussions about a merger began.
HealthLeaders reached out to Cone Health about the two organizations' future plans to collaborate, but no further statements were given.
Earlier this year, Akin and Jeff Jones, CFO of Cone, announced their departures once the health system merger was complete. On Thursday, Cone Health announced that Akin will be stepping down as planned. Mary Jo Cagle, MD will assume the role of CEO on June 15, becoming the first woman and physician to lead the Cone Health Network.