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In Change Management, High Stakes, Quick Think

The Quick Think: The Lorax

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

2-minute read

The Big Story: Staffing overtakes financial challenges as top concern among hospital CEOs, survey finds

The workforce shortage is perhaps the biggest topic of conversation across the industry right now. While some providers and staffing agencies are offering large sign-on bonuses, others are going for retention bonuses and raises. Everyone is trying to staff up, whatever it takes. Many, especially but by no means exclusively rural hospitals, are barely hanging on.

What it Means for Our Healthcare System

Pandemic shortages accelerated the growth of temp and travel nursing, effectively changing the compensation model for RNs. That’s created a feedback loop where the shortage has become both cause and effect. Hospitals can’t maintain the tab for travel nurses – yet many can’t properly staff up without them. The jaw-dropping $40,000 signing bonuses are stopgap and not sustainable.

Dawn Carter, a veteran healthcare strategist and founding member of the Rural Healthcare Initiative, likened the situation to The Lorax, Dr. Seuss’ foray into environmentalism that describes the dangers of overusing a resource to the point that it disappears. We need nurses, and they deserve to be well-compensated. Full stop. It’s incumbent on us to design a system that allows that to happen. A system that sustains the forest.

While many are working feverishly to discern the long-term foundational changes necessary to compensate caregivers what they’re worth while keeping labor costs manageable, the land-grab nature of the current healthcare recruitment push continues. And it just might be catastrophic for smaller providers who can’t keep up.

We’re not parachuting in with 750 words to solve a very complex problem. But we do think Carter’s insight on how provider organizations, particularly rural and independent hospitals, might mitigate the damage now with their existing staff – is imminently shareable. Her suggestions cover both tactical interventions and messaging.

An extra week off. Literally, give your staff an extra week off. Maybe two. More hospitals are taking this approach because that time away may help with burnout and is a relatively low-cost benefit to the employee. Many hospitals are already offering other smart benefits – subsidizing gym memberships, meal delivery services and so on. But if we’re talking about people who are thinking about leaving, giving them extra space to recharge may be a wise step towards keeping them.

Professional development. What else can your employees do? Whatever it is, show them that. From the moment they first consider a healthcare career through their entire time with your organization, make clear the ways a team member can grow in the job or grow into another one. Many hospitals are already helping finance additional technical/educational investments. They should make those opportunities known.

Carter cited a speaker from last week’s South Carolina Hospital Association virtual meeting who suggested hospitals ensure that high school students understand the low-cost path to a high-paying job. Someone paying two years of technical college tuition and coming out of it with an RN can enter the market making $60,000, but there’s the potential for $200,000+ by pursuing a CRNA.

Clarity. Carter noted that much of the money paying for those stopgap measures like travel nurses is stopgap funding (federal stimulus and relief dollars). It’s temporary. This is an important point to make when addressing staff nurses who are justifiably frustrated seeing the compensation packages for their traveling peers while they’re receiving far lower raises/bonuses. Hard conversation, but it’s worth sitting down with staff to really talk about the current dynamics and explain why those levels of compensation aren’t sustainable as the one-time relief funds run out. Yes, you’ll still hear questions about why that one-time money is going to temps and not staff, but it will hopefully provide helpful context.

Connection with leadership. The critical message is that the core problem is a broken system, not uncaring leadership. This is no time to be defensive and complain about trying to operate a hospital in today’s brutal environment, especially with nurses who’ve been stretched beyond reason by the past two years. The point, rather, is to have deep, heartfelt conversations with staff about leadership’s position on the issues and the various imperatives they’re balancing.

To imbue those messages, Carter underscored the enduring value of leader rounding and one-on-ones. Find time to build relationships with staff, listen to their concerns and show genuine humanity. Sometimes that means telling your own story, too. We’ve heard from clients whose leadership spoke during town hall meetings about their toughest moments during the pandemic. Showing that level of vulnerability was powerful and helped dampen some of the tension that had been building.

Note that these conversations shouldn’t be used as distractions from or substitutes for practical interventions. They should be a supplement, a way to both solicit helpful information about what staff need and to demonstrate that you and the organization are working towards a collective solution.

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.

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In High Stakes, Issue Navigation, Quick Think

The Quick Think: Without Merit

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

3-minute read / 20-minute podcast

The Big Story: Brian Flores sues NFL, three teams as former Miami Dolphins coach alleges racism in hiring practices

The recently-fired head coach of the Miami Dolphins just rocked the sports world with a class action lawsuit alleging systemic racism, disparate hiring practices and incentivizing losing. The NFL came back with a near-instant response saying that Flores’ accusations were “without merit.” Dolphins owner Stephen Ross has responded with a statement that includes the very legal terminology of “false, malicious and defamatory.” Then on Saturday, the NFL sent around a memo saying the organization was bringing in outside council to review its policies.

Why We’re Writing About It

Why, indeed, is a healthcare communications firm writing about a lawsuit against the NFL?

Because this story encapsulates so much of the work we do, the advice we give and the best practices for how – or how not – to communicate in a crisis. Because sometimes it’s good to look at outside examples to shake us loose and give a fresh perspective on long-standing principles.

Principles such as…

Check your story. Remember all those times we’ve written about how hospitals need to be proactive and tell the story of the good they do for their community? Or, if faced with scrutiny, respond with a compelling story? If so, you’ll also remember the warning that comes along with it: Make sure the story you tell is consistent with what’s actually happening inside your organization. For instance, a hospital can’t brag about helping patients navigate their healthcare finances when they’re suing them for nonpayment.

In the NFL’s case, the organization’s immediate response of calling the accusations “without merit” looks rash since it came within hours of the filing. Was that really enough time to have actually gone through the dozens of pages and confirmed that they were in fact without merit? Put another way, are the NFL and three teams being sued REALLY sure that they’re not behaving as accused?

Take time. Inherent to checking the story is that it takes time to do so. The NFL probably could have afforded to wait just a breath before releasing it’s “without merit” statement. Is it a crisis? Yes. Could they have taken a little longer to review the claims and craft a better message rather than one that looks like it was copied and pasted from some sort of “In Case of Lawsuit Break Glass” document? Also, yes. If you find yourself in a crisis, don’t wait around. But don’t go so fast that you rush past a meaningful response.

On Saturday, the NFL did in fact commit to “reassess and modify” the way it goes about things. But coming days after the initial, definitive statement instead of being the first thing released by the NFL, the memo opened the door for additional skepticism.

Prepare. We’re not talking copy-paste here. But you need to have a crisis plan in place with the basic blocking and tackling components. Think general talking points, FAQ, list of potential spokespeople, overarching underlying message. Armed with that, you can use those critical first moments of a crisis to review and home in on the situation. You’re not going to recycle the same talking points for every situation. But having a plan built around the tools needed and the underlying, mission-based message that you’ll want to convey no matter what is the difference between reflexively saying, “Nothing to see here!” and “We’re committed to serving our community and want to ensure that our actions reflect that. We’ll be investigating <XYZ> thoroughly. In the meantime, here’s what we know right now.” Again, it’s the difference between the NFL’s initial statement and the Saturday memo. Better to start with the latter and not backpedal into it.

Know the limits of your credibility. In addressing a crisis, consider your community’s perception of your organization’s reputation. We all know the NFL doesn’t have the best history when it comes to responding to explosive allegations. Their handling of the concussion scandal (which also included an ugly element of racial bias) and various instances of violence and abuse by players has left the organization without much reservoir of good will. Or benefit of the doubt. That’s another reason the instantaneous “without merit” comment looks hollow. Better, perhaps, to acknowledge previous missteps and use that as a foundation to talk about what comes next.

Know the difference between the people and the organization. This is the White Coats vs Dark Suits element. People love their docs. They love their local hospitals. But they lean skeptical about the big business of healthcare. Likewise, in the NFL, people love their team and particular players on it. But then there’s the perception of the organization, the impression that it often cares more about protecting the brand than doing the right thing, its Big Business operations that burn through trust and credibility. The appreciation the public has for the people doing the work – players/caregivers – doesn’t necessarily radiate out to good feelings for the organization – NFL/hospital. If the organization behaves badly, it won’t have much cover from the individuals.

And so here, we see a highly successful and credible voice who has worked at every level of an organization over the course of two decades. He’s making a powerful, emotional and specific accusation. However it all plays out, the NFL reminds us of the two-fold process facing an organization under scrutiny: First, of course, is actually doing the work and doing the right thing. And then it also means taking the time to communicate in a way that is consistent with the stated mission and values of the organization…or risk leaving room for the implication that those aren’t really the mission and values at all.

Listen on Apple Podcasts

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.

In Change Management, High Stakes, Quick Think

The Quick Think: Nursing Gigs and Workplace Culture

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

3-minute read

The Big Story: The gig economy is trying to solve health care’s burnout crisis

Nursing on demand? Is it shape of things to come?

Startups are building platforms to plug nurses looking for shifts into organizations with shifts to fill. Sorta like if you needed a ride and there was an app to connect you to a driver. (Someone should look into that.)

Point is, tech platforms can ostensibly help organizations staff up to the levels they need while giving nurses more control over where and when they work.

What It Means for Provider Organizations

Seeing caregivers leave for more flexible roles is one of many things putting a pit in the stomachs of healthcare executives. It’s painful for acute care providers, yet the idea of a nursing gig economy makes a lot of sense when we look at the convergence of two ongoing trends. And the ball is in organizations’ court to respond in a way that attracts, retains and supports those looking for more control.

We know nurses are burned out. Many feel disconnected from their employers. And 40 percent of healthcare workers employed within a health system don’t see that environment as their ideal. Instead, they’d prefer travel nursing, health tech, maybe even those enticing flexible gig jobs.

We also know hospitals are getting flak for being greedy Big Business. A recent New York Times video blames the deficit of hospital caregivers on hospitals’ intentional understaffing to increase their margins. These examples go right to the heart of what our research shows is a perceived gap between hospitals’ missions and their approaches to the business of healthcare. And that gap is part symptom and part source of the unsettled workforce.

When it comes to nurses, the problem is that if you can’t give these thoughtful, mission-oriented individuals an environment where they feel supported, connected or even sure that you’re prioritizing patients over money then they’ll look to leave for higher pay, a more comfortable work environment or both. Who wouldn’t?

This presents a brilliant opportunity for health services and health tech companies. If healthcare workers aren’t sure a big hospital is their ideal, then other types of providers can that professional home. Which means that today the competition between provider organizations is real and, unfortunately, there’s a zero-sum element to the whole thing.

Question is: How can we use this great reshuffling and try to get away from a zero-sum recruiting battle? Can we better support caregivers and help the right people land in the right roles, whether that’s at a huge national system or an innovative specialty clinic?

We think so, and the approach is right up Marcom’s alley:

Build personas. Consider the people you need in those nursing roles and who might want them. Younger nurses may be harder for hospitals to recruit now if they’re not tied to one place and would like to travel and make more money while doing it? Others may relish an exciting stint as a staff nurse in your level one trauma unit. Nurses with families or later in their career may be looking for the stability and consistency. Different personas are looking for different things. Know what those things are.

Learn about preferences. The best way to find out exactly what people are looking for is to ask. Yes, money may be one of the things that comes up, and it’s fair to note the discrepancy between a staff nurse’s hourly pay and that of the travel nurse filling a vacancy in the next room. But it’s not always money. We’ve heard from health systems that, based on their surveys, what employees are looking for is relatively simple. They want to be heard and recognized for the work they do. And they want to know what’s going on with the organization. Yes, financial compensation is sometimes part of it, but not all.

Show what you can offer those targeted personas. Maybe it’s the benefits and career advancement available in a large system. Or the entrepreneurial vibe and relative independence of a young health services company. Highlight how you’re unique and speak directly to those who find those characteristics compelling. Basic marketing.

Solidify your culture. Concurrent with your recruiting efforts, reinforce your good culture so current employees stay and newcomers join – and stay. You can’t fake culture. For hospitals, that means not just paying lip service to something like “having a direct relationship with our nurses.” It’s actually having a direct relationship with nurses and being able to point to exactly how you’re doing it.

A note on sustainability: Building meaningful culture requires talking and listening to employees on a regular basis. It entails aligning your recruiting and HR efforts. Organizations with success in their staffing campaigns have a chief nursing officer working closely with HR and the strategy team. With the reality of limited resources, efficiency will be a watchword in healthcare going forward. Make sure you’re aligning everyone towards the common goal of staffing.

Want more? Listen to partner Kim Fox and senior vice president Tim Stewart discuss culture and communications in our latest podcast.

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.

In High Stakes, M&A, Quick Think

FTC Goes “Modern” On Mergers

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

2-minute read

The Big Story: FTC, DOJ ask for public input in antitrust ‘overhaul’

In a move entirely consistent with the executive branch’s stated goals on M&A, the feds are ramping up an effort to “bolster merger oversight” and “modernize enforcement.” They’re particularly concerned about vertical integration which, they say, may not lead to the efficiencies often promised. Plus, they’re eyeballing scaling health systems’ smaller acquisitions, as those transactions may “skirt regulatory review.”

What it Means for Your Health System

The FTC isn’t just giving lip service to looking more closely at mergers. They’re also digging deeper during the review process. Regulators are requesting more information from health systems and healthcare companies than usual and they’re soliciting public comment. Both, of course, slow down any given transaction.

That’s sure to raise eyebrows at any health system considering a partnership. And there are many of them talking about it in their board rooms right now. Some put a deal on hold due to the pandemic and are coming back to it. Others weren’t looking to partner until pandemic pressure created the need.

All in all, the ball is rolling downhill for the antitrust crowd. They have their target in sight and they’ll be flooding the comments. It’ll be tough for healthcare organizations to push back, but we at Jarrard Inc. don’t think it’s an impossible task. The goal, for starters, should be to balance the comments in a meaningful way and point out where the critics have the narrative wrong. Here’s what that looks like:

Be ready to engage. Don’t wait for anyone to jump in on your behalf. While there’s certainly value in coordinating with associations, you have a distinct story to tell about your organization and community. Focus there and don’t assume that aggregated advocacy will suffice. And when you do appropriately engage in the public comments process, be proactive, not defensive.

Engage with real stories. The prevailing narrative is that consolidation leads to higher prices, lower quality and reduced access. But what about the real stories about mergers that saved healthcare in communities, saved access and improved patient care? Tell those stories and explain how it will work in your community. Your adversaries are using both academic studies and emotional patient narratives. Numbers backed by real faces on camera are a powerful cocktail. You should do the same.

Be specific. Price, quality and access are the areas that FTC is scrutinizing. Hospitals need to give very specific examples of how their proposed deal would address those concerns. That means avoiding platitudes like “We’re going to transform healthcare,” or “This partnership will ensure care for years to come.” Instead, say, “We are going to ensure high quality care by…” and “We will improve access through…” Similarly, where there may be changes – like L&D services leaving a low-volume rural hospital – explain exactly why it may happen and how you’re going to help expectant mothers. When they speak, your critics give specifics rather than rely on vague allusions. Take the lesson and apply it.

*A note on the cost of care: Everything in society is getting more expensive, and according to our latest consumer survey, the cost of healthcare is one of the public’s top concerns. Price is a line of attack hospital critics bring out at every opportunity. When discussing the effects of a proposed merger, be ready with necessary nuance. Talk about how and why prices won’t go up due to the partnership, why it won’t be the merger that further accelerates the increase. If you are the buyside, be ready to show (or defend) your track record of prior mergers and how cost of care played out. And if increases are going to happen, be upfront about the reasons.

Drive change and educate. Talk frequently about the innovation your organization will continue or pursue thanks to the partnership. Get into the specific things you can do to control costs or improve access. Help the public understand that healthcare overall is working toward better utilization of care. Focus on ways that your organization is investing (or will invest) in getting people the right level of care at the right time. Explain that this doesn’t always mean more services, but rather helping patients avoid overutilizing expensive or unnecessary services. The bonus: This helps people understand how they can make better choices that benefit them.

Start internally. When talking about a merger, ensure your employees and physicians truly understand what it means. Our latest survey found that healthcare workers are somewhat more skeptical of mergers than the public, so it’s critical to allay the fears of those on the inside. Provide crystal-clear messaging about how it will work and how it will and will not affect them. Speak in terms that people can understand and give them opportunities to respond and question. Then do the same publicly.

Always answer the question, “Why is this good for the patient?” Need we say more?

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.

In Change Management, High Stakes, Strategic Positioning

Special Report: Aligning Needs, the Sound of Silence and Healthcare Predictions for 2022

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Try and predict the future? It’s exactly what we all do in mid-December.

This week, we checked around with friends in our network for their takes on 2022. Friends from investing, legal, a hospital association, strategy and planning and rural healthcare.

We asked them about challenges, investing, partnerships, trust, the media – and what gets them up in the morning when they think about healthcare.

Notice that we don’t quote our clients – healthcare providers. They’re impossibly covered up and looking towards another tough year, so it’s just not a great time to bring out the crystal ball.

Several clear themes emerged. Full quotes from the interviewees follow the themes section.

Staffing alarm bells are ringing. The cost of labor is going to put a crimp on provider operations, with unsustainable travel nursing rates on one side and healthcare workers leaving (due to burnout or mandates) on the other.

Behavioral health will be a point of emphasis. The pandemic laid bare what many in the mental/behavioral health space had long been saying: Our system of caring for behavioral health isn’t good enough. Several respondents market this space as one to watch in 2022.

Technology is poised for a breakthrough. More AI, more digital tools, more ways for patients to engage with providers on both their physical and mental health needs. At the same time, technologies that saw significant growth during the pandemic – most notably telehealth – will be reassessed to bring them back in line with a more natural, sustainable level. All of this came with the caveats that 1) regulation needs to keep up and 2) we need to see proof from the many digital health companies that have taken significant investment in recent years.

Value is coming (finally?). Value showed up as both a challenge and recipient of big investment. Partnerships that advance value-based arrangements also got a nod. Now that more primary care groups have waded into value and taken on more risk, expect to see the same for specialty practices.

The sound of silence. Just as interesting as what was said might be what wasn’t. While no providers were officially interviewed, we understand from our client base that following two incredibly challenging years in the trenches, no one’s really comfortable looking into the crystal ball at year three. Providers quietly tell us it’s going to be a very tough year for them, with ongoing uncertainty. That caution and concern is a theme in and of itself.

Transparency matters in all respects. Respondents who addressed “building trust” synced on this: Communicate, and do it clearly. Be open about pricing (and not just because CMS said so).

Care models must shift. We mentioned telehealth above. Hospital at home also got a shoutout. All told, a combination of better technology, patient expectations, the steady march towards value and the influx of investment for new entrants is pushing care out of hospitals and into, well, anywhere else.

Payer-Provider relationships will thaw. Multiple respondents suggested that payer-provider partnerships will be successful contributors to the move towards value. The implication seems obvious: Delivering the care and paying for it in the most efficient way will force collaboration between often antagonistic stakeholders. As Jesse Neil of Waller put it, “The traditional ‘zero-sum’ relationship has changed.”

Needs are aligning. Dawn Carter, founder and senior partner at Ascendient, summed it up well with a story about robots delivering food in a restaurant due to workforce shortages. It’s an anecdote that demonstrates how a reduced pool of labor, improved technology and the need for reduced cost and streamlined operations can flow towards a single solution.

Dawn Carter

FOUNDER & SENIOR PARTNER

Ascendient

Where do you think the biggest investments will be made?

Non-traditional sites of care, such as hospital@home and more virtual/high-tech options. I’m hearing more and more conversations about addressing behavioral health, particularly in light of how the pandemic has exacerbated what was already not working.

What will be the biggest driver of change for healthcare?

  • Workforce challenges, which should be driving innovation. There was a recent news story about a robot delivering food in a restaurant because of staff shortages…That technology has been developed in less than two years. We are woefully behind in healthcare in terms of using AI/technology to reduce our dependence on humans.
  • Payors – public and private – with a continued push to true value-based payment models, including CMS’ goal for all beneficiaries to be in value models by 2030.

What are you most excited about for our industry in 2022?

Opportunity is ripe for extreme innovation. Who will step out of a traditionally-minded industry and take advantage?

What's the biggest challenge facing healthcare providers?

Dawn Carter

FOUNDER & SENIOR PARTNER

Ascendient

 

Human resources, particularly retaining sufficient levels of direct care providers. Premium pay for a high percentage of travel clinicians is not sustainable, yet the pandemic has exhausted the workforce, particularly nurses. I recently heard of an RN in her early 30s who has worked a COVID unit at an academic medical center since the start of the pandemic. She’s leaving because she can’t do it anymore and is taking a job working from home.

Eller Kelliher

MANAGING DIRECTOR

Jumpstart Foundry

What's the biggest challenge facing healthcare providers?

No question, it’s talent recruitment and retention. Nurse and physician burnout has been an issue facing the healthcare industry for many years, however, the COVID-19 pandemic (starting to turn endemic) has put further strain on individual providers. Whether it’s doctors, nurses or administrators, this challenge is top of everyone’s mind.

Where do you think the biggest investments will be made?

  • The biggest investments will be in technology that optimizes and extends the efforts of existing personnel. There has been a massive flood of capital into digital health/healthcare IT in the last year and I believe we’ll continue to see investors fueling innovation.

What will be the biggest driver of change for healthcare?

COVID-19 changed the way that individual patients engage with their providers and in some ways empowered them to take a front seat role in their own health decisions. That said, I believe evolving payer-provider relationships and their incentive to drive utilization will be a major force for change in the industry. It will shift not only how care is delivered, but also the roles each party plays in the overall system.

Where do you think we’ll see the most / most successful partnerships?

Over time, I think we will continue to see the industry move towards stronger payer-provider relationships. However, I’m particularly excited and bullish on the idea of retail brands – who have built a lot of trust with consumers – partnering with providers to drive both access and engagement with hard to reach patient populations. Retail brands have the opportunity to impact accessibility, affordability, and possibly even adherence. (Think of how much power brands have in influencing consumer behavior!)

What’s the one thing healthcare organizations should do to build trust with patients and the public?

Be transparent with patients and treat them like consumers who have CHOICE. This is something I’m hopeful for in 2022, but know will likely take years for the industry to actually implement.

What impact, if any, has the media had on healthcare in 2021?

It’s hard not to say that the media continues to drive division and skepticism in our country. However, as it relates to healthcare, I believe the media helped facilitate the adoption of new models of care and certainly the acceptance of telemedicine as a trusted option for care.

What are you most excited about for our industry in 2022?

We all know that the healthcare industry is slow to change, but the pace of innovation has never felt faster or more urgent than it does now. I’m excited to see how the dynamic between payer, provider, and patient shifts in 2022 and how willing each party will be in the change that seems inevitable and, frankly, needed.

Pete Lawson

CEO

Lawson & Associates

What's the biggest challenge facing healthcare providers?

Staffing a facility has always been a difficult, but necessary challenge. It was surprising that some health systems were so quick to lay off workers during a shortage. This was compounded by inevitable lawsuits against the Executive Branch vaccine mandate. In 2022 and beyond I think systems will wait for the legal dust to settle before jumping the gun.

Where do you think the biggest investments will be made?

In terms of the most common investments, we’ll see IT expansion and upgrades. Relative to the most significant cost, it’ll be hospitals investing more in ambulatory care.

What will be the biggest driver of change for healthcare?

Payment expansion for telehealth along with federal legislation allowing telehealth state to state.

Where do you think we’ll see the most / most successful partnerships?

Academic health systems and community hospitals.

What’s the one thing healthcare organizations should do to build trust with patients and the public?

Communicate regularly on staffing expansion and safety.

What impact, if any, has the media had on healthcare in 2021?

Continued expansion into telehealth, especially in the rural space.

Ken Marlow

PARTNER

K&L Gates

What's the biggest challenge facing healthcare providers?

Ongoing pandemic concerns and the incredible toll that the pandemic has placed on clinicians. There is a continued threat of variants that may be resistent to vaccines that will continue to place significant stress on health systems and further erode their revenues. Coupled with that will be a workforce that is burning out due to stress, mental and emotional fatigue and politicization of healthcare in what seems like an endless war against COVID.

Where do you think the biggest investments will be made?

Over the past few years, we have seen an increase in the number of megamergers of regional/national health systems, as well as an increase in the aggregate value of the combined health systems. We expect that this trend will continue as one of the biggest investments in healthcare. In addition, expect to see a tidal wave of investments in digital health and artificial intelligence.

What will be the biggest driver of change for healthcare?

The consumerization of healthcare. Patients now more than ever have a voice in their healthcare, and that is requiring providers to respond to patient demands, whether in terms of the site of care, the manner in which a patient receives care or transparency in pricing. In addition, these expectations are now bringing new and nontraditional entrants into the market, and they are further driving change.

Where do you think we’ll see the most / most successful partnerships?

Healthcare organizations should collaborate with community partners that are representative of the different constituents within the community. This will allow for advancements in combating healthcare inequities. As part of this collaboration, healthcare providers should listen and take constructive feedback from their community partners and use this information to enact positive change.

What are you most excited about for our industry in 2022?

Historically, the healthcare industry has been slow to adopt change, even when change was clearly required and long overdue. We are now in an era of change that is occurring at lightning speed, and it’s exciting to see the advancements in how care is delivered, the use of technology and AI to create better clinical outcomes and provide for a better patient experience, recognition of social determinants of health and the role it plays in an individual’s health outcomes. In the midst of incredible adversity, our industry has worked collaboratively to save lives and in the process make considerable advancements, and I’m looking forward to seeing the evolution of changes in 2022.

Jesse Neil

PARTNER

Waller

What's the biggest challenge facing healthcare providers?

The uncertainty around the demand and permissibility of telehealth services is a wildcard for 2022. It’s no secret that physicians’ use of telehealth increased dramatically during the COVID-19 pandemic in 2020—jumping from 25 percent of physicians in 2018 to almost 80 percent of physicians in 2020, according to the American Medical Association. While some heralded the trend as a new day in healthcare, a closer look shows that telehealth use may continue to flourish in some limited areas, such as mental health or chronic care management, but that overall usage rates may settle back into more normal levels. Additionally, many of the emergency telehealth rules put in place during the pandemic have expired—meaning that many states will need to make regulatory changes to allow for the continued widespread use of telehealth services.

Where do you think the biggest investments will be made?

Collaboration with other providers has become an important tool for healthcare companies across the care spectrum, and that remains the case as we approach 2022. Valuations are strong across the board, and behavioral health, telehealth, dental and healthcare IT are of particular interest for private equity firms and other investors. Sellers are commanding higher valuations as a result of increased competition between buyers. An increase in home-based services has also been an area of increased valuations and interest, as has the orthopedic space, which notably leads the way in the shift toward value-based care among physician practices.

What will be the biggest driver of change for healthcare?

Providers, operators, investors, and policymakers agree that home-based healthcare options are transforming how healthcare is delivered and the economics that drive it. Regardless of the specialty, care at home implicates a discrete set of local, state and federal legal issues. At the same time, the regulations have not fully caught up with the various business models being adopted, and CMS and states are actively experimenting with waivers, pilot programs, and new reimbursement methodologies. Anticipating this trend, we have seen increased investment by providers, payors, and private equity firms into both provider platforms and technology companies that facilitate care at home.

Where do you think we’ll see the most / most successful partnerships?

The traditional “zero-sum” relationship between providers and payers has changed and they are no longer in their own silos. Post-acute care providers are likely to find ways to leverage clinical excellence to partner with payers and assume up- and down-side risk under value-based arrangements.

What’s the one thing healthcare organizations should do to build trust with patients and the public?

Carefully-calibrated transparency across the board but in particular clinical outcomes and pricing.

What impact, if any, has the media had on healthcare in 2021?

I can’t remember a year where the media had a bigger impact on healthcare than 2021 – except perhaps 2020. I think policymakers are realizing that the media is one of the most important stakeholders when executing on public health initiatives. I don’t think any agency or media outlet has found the “secret sauce” but that responsible media coverage will be rewarded in the end.

What are you most excited about for our industry in 2022?

Providers are actively experimenting with the new value-based regulations to take advantage of the added flexibility. If our healthcare system is equipped to do anything, it is to innovate in terms of technology and, increasingly, delivery models. I’m excited to see patients reap the benefit. Getting healthcare spending on a sustainable path is one of the biggest domestic public policy challenges we have in front of us, and these new regulations are a step in the right direction.

Shawn Rossi

VICE PRESIDENT OF COMMUNICATION & MEMBER ENGAGEMENT

Mississippi Hospital Association

What's the biggest challenge facing healthcare providers?

Nursing shortages

Where do you think the biggest investments will be made?

Technology – specifically EHR APIs and telehealth

What will be the biggest driver of change for healthcare?

Workforce challenges

Where do you think we’ll see the most / most successful partnerships?

Wide-scale collaboration between payers and providers, community-based organizations and hospitals, and public health departments and hospitals.

What’s the one thing healthcare organizations should do to build trust with patients and the public?

A focus on the patient experience and health equity.

What impact, if any, has the media had on healthcare in 2021?

The media has both helped educate the public about COVID-19 and contributed to spreading misinformation. “Media” is too broad a term to consider as one these days with all of the niche news.

What are you most excited about for our industry in 2022?

A growing determination by hospitals to begin work on community health and affect social determinants of health.

 

What's the biggest challenge facing healthcare providers?

The biggest challenge facing healthcare providers in 2022 is a combination of a few factors:

  • Rapidly approaching compliance dates for rulemakings that have important implications for how hospitals do business;
  • The continued uncertainty surrounding the public health emergency; and
  • Diminishing public support for healthcare providers.

In many ways, regulators have returned to “business as usual,” with new or revised rules becoming effective in January 2022. However, healthcare providers are still experiencing waves of COVID, but this time with lower staffing rates and without the public support for healthcare heroes seen in 2020. In addition, many waivers that have been a lifeline to healthcare providers during the public health emergency (PHE) – from hospital at home services to the expansion of telehealth services – are at this time set to expire in January 2022, with little to no time built in for providers and their patients to gradually transition away from these flexibilities. While the PHE is likely to be extended, the pressure on healthcare providers – from staff nurses to the c-suite – to navigate such significant changes simultaneously while COVID measures are still very much in effect will be the biggest challenge for providers in the year ahead.

Where do you think the biggest investments will be made?

I expect to see investments in both organic and inorganic growth. With regard to organic growth, hospitals and health systems are focusing investment in services lines that have gained traction and reimbursement parity during the PHE. For example, hospital at home services, as well as digital health across practice areas – not just behavioral health, but also in areas in physical therapy and primary care. Wellness programs and wellness tools are also experiencing growth through commercial payer investment to help people take control of their own health beyond seeing their primary care providers. In general, areas that can empower patients to engage with their care and allow healthcare providers to provide much-needed care at lower costs are likely to win the year. In addition, many providers are “back on track” with regard to strategic acquisitions and affiliations in core business areas.

What will be the biggest driver of change for healthcare?

New market entrants and non-traditional players in healthcare will continue to be one of the biggest change drivers for healthcare in 2022. We’ve been following this trend for several years now and the past two years have underscored that the challenges facing healthcare and the demand for innovation are things that cannot be tackled in siloes. Perspectives from new healthcare entrants like retail and tech, the influx of funding from PE and VC investors, partnerships between traditional healthcare companies and new entrants, and collaborations between providers in different services areas or markets, are all drivers of change that will shape not just 2022, but the next several years in healthcare.

Where do you think we’ll see the most / most successful partnerships?

Some of the most successful partnerships will be ones that improve the patient care experience while seamlessly working within clinician workflows. Whether these partnerships are between “traditional” providers, or among traditional providers and parties from outside the healthcare space to launch something completely new, the successful ones will be where and the product or solution supports patients without overburdening clinicians, all while fitting within the complex healthcare regulatory landscape. It’s a tall order, but from what we’ve seen, parties are more than up to the challenge.

What are you most excited about for our industry in 2022?

Continuing to see what comes from the novel partnerships between hospitals and health systems and other market participants, as getting the best of both worlds working together on bold innovations is truly exciting.

Principal

Private Equity

What's the biggest challenge facing healthcare providers?

Increasing labor/other input costs and declining reimbursement. Providers will seek to adapt, and think this will accelerate a shift towards value-based arrangements to get paid for the value they deliver to patients and payers.

Where do you think the biggest investments will be made?

Specialty value-based care. As risk-bearing primary care groups seem to optimize their performance, there will be increasing focus on specialties and moving towards value-based care. Also much more focus on technology enabling provider groups and health systems to optimize performance and care delivery redesign.

What will be the biggest driver of change for healthcare?

A shift to value-based care over the next several years and its impact on improving patient experience and outcomes. Also expect to see more emphasis on preventative care versus reactive care.

Where do you think we’ll see the most / most successful partnerships?

Enablement of value-based care, with providers better enhancing payer-provider collaboration.

What’s the one thing healthcare organizations should do to build trust with patients and the public

Overcommunicate and be transparent.

What impact, if any, has the media had on healthcare in 2021?

The media has highlighted the importance of providers and the services they deliver and trust built between the public and healthcare providers. It will be important to expand on that over the next several years and elevate care delivery to meet and exceed consumer demand.

What are you most excited about for our industry in 2022?

Continued change that improves quality, reduces cost, and enhances the patient experience. Consumer expectations are increasing and we are being forced to keep up.

In High Stakes, Strategic Positioning

Healthcare’s White Glove Service

Robotic doctor holding a clipboard in front of a blurred hospital background

How two health services organizations are thinking about customized care

Just how do providers (re)build trust among their patients? And how much can technology help?

It’s not that trust has been broken. But we’re witnessing a disconcerting shift in the relationship between people and the organizations where they receive care. And indeed, even in the relationship between healthcare organizations and the individuals within them who provide that care.

The conversation within healthcare about “consumerism” is smack in the center of how providers – and the VC and PE groups funding new models of care – talk about the future of the industry.

Counter to what you might expect from a communications firm, we’re going to suggest that the language is important but just doing the work is far more so. Does it matter if providers call us “consumers” or “patients” if the product they deliver works? In fact, maybe the terminology remains a discussion point because it’s a distraction from the industry’s failure to deliver on seamless, nearly invisible delivery of care. Because designing for people is, somehow, really hard.

Neither Harvard, Oxford nor Cambridge has been able to crack the code of using the wealth of available tools and technology to create a comfortable healthcare system that patients uh, consumers uh, people can fully trust.

City

So says Regan City, the director of the national subspecialty divisions and patient safety organization at Radiology Partners. A certified quality and patient experience professional, City aligns operational imperatives with what healthcare providers and patients actually experience.

She asserts that such alignment is far more complex in healthcare than in other industries. “Product customization isn’t possible in healthcare the way it is elsewhere. Marketing is targeted, but software isn’t,” she said in a recent interview. Simply put, there are too many variables in a patient population to be able to customize everything. You could pick one or two demographic characteristics and make some assumptions, but there are so many other factors that those assumptions might not fit. “You could assume the average 40-year-old woman has a smartphone, tablet or PC and can interact with us in a way we want her to,” explained City. “but if she’s in a lower socioeconomic strata, or doesn’t have time or access to technology, she won’t. We have to recognize that every person is an individual. How do we do that with how we drive our technology? We can’t be that customized.”

That’s the bad news, and while it is bad, it’s also refreshing. Better to name the problem and find a workaround than soft-pedal it and implement solutions that don’t move the needle. So if we can’t customize for everyone, can we offer something that works pretty well for many? Yes. Call it an offshoot of the 80/20 rule. Take things as far as you can for a general user base and then step in with high-touch, possibly manual, solutions to get the rest of the way.

City made the comparison to fine art. “More than half of the people consuming healthcare, just like attending symphony orchestra performances, are well over 60,” she said. Marketing to Gen-X is largely driving ‘consumerism’ and therefore the technology choices, but they’re not the heaviest users. “My sister works in development for an orchestra in a patron-facing role, and she says there are folks who will not go electronic. They feel they are spending a good amount of money and they simply want to bring their ticket with them.” Similarly, noted City, there are many smaller or rural practices where paper and faxes remain a staple, maybe due to the cost of implementing technology, but also simply because of the difficulty in overcoming the desire for things to stay the same.

The solution is to build technology that can do the work, and then bolster it with people typing notes, sending faxes, printing tickets, answering the phone. Continuing the orchestra analogy, City said that her sister will happily answer the phone any time someone calls. “But what that patron doesn’t know is the person on the other end is entering all the information into the system on their behalf.”

But then there is the need to build a comfortable experience for those who can use and do want an experience rooted in technology. For providers, there are no excuses anymore. The tools are available, and patient preferences are clear. “A tech-savvy user is going to be really happy if he can click around and get his lab results and then message his provider. And if we have a live person answering a phone for the elderly gentleman who isn’t sure where to click on his tablet, we can make him happy too because we’ve given him white-glove service.”

Condliffe

In another realm of medicine, Diana Health is a startup aiming to smooth out the entire pregnancy journey, from prenatal to postpartum care. It offers that white-glove approach in a slightly different way. Underpinning the company’s services is a technology stack that integrates every aspect of care and simplifies both access to and input of health data.

“We’ve spent time building out a technology platform that integrates with our EHR so that if a mom is struggling or has a question about sleep, she’s engaging in our digital app at home,” said Kate Condliffe, co-founder and CEO. “That data transfers into our EHR. It shows up in the encounter note and providers can engage in an operationally efficient way.”

Mele-Algus

Everything Diana Health does, according to head of product Lexi Mele-Algus, is designed “thinking about a human-centered approach married with the evidence. It’s blending the quantitative and the qualitative elements.”

According to both City and the Diana Health team, two things that are signs of success are, simply, fewer clicks and clear next steps – for both patients and providers. In various ways, both organizations define well-designed technology as that which allows everyone to navigate the care continuum more rapidly and know what comes next at each stage. That may mean a more labor-intensive intervention like a phone call or office visit – an analog encounter, as it were. But the technology helps smooth the way while staying out of the way.

That layering can be seen in Diana Health’s graphics depicting the benefits of its platform – note the clear blend of technology and personal relationships.

Going back to that 80/20 idea, clinical decision support is another area where technology can take care far down the road, then get out of the way for clinicians to take it the last mile. At Diana Health, Condliff and Mele-Algus describe tools that allow their clinical teams to develop highly individualized care programs, with variability reduced through evidence-based clinical decision support. The team gets a pretty good idea of what might be going on because that’s what the numbers say, but the trust is built when the personalization is layered on top. Or, as City said, “we need to have nuanced conversations around an individual’s healthcare decision-making and outcomes, but we can use technology to help us learn about what happens to 80% of people with this clinical condition.”

From there, putting caregivers in the right spot is the next critical step to providing seamless care that builds trust and comfort, not creates confusion. This has been an issue in healthcare for decades, but we may be on the verge of a new wrinkle with implementation of the 21st Century CURES Act and patients’ increased access to their own health records. “Patients should have access,” said City. “But we need to make sure they can consume that information in a meaningful way. Trained healthcare providers are the interpreter.”

For radiology, that means being more proactive in noting findings to other members of the care team. City said, “There’s a saying that radiologists are the physician’s physician. We’ve got to be more forward-thinking than that. What our doctors do directly impacts patients, so we’ve created software that helps radiologists put evidence-based follow-up recommendations and timelines in their reports.” It’s synthesizing all the clinical data plus what the radiologist interprets via imaging and making it clear to the end-user.

On the patient-facing side, Diana Health uses technology for both clinical decision support and to clear the way for more meaningful conversations and smoother handoffs between various members of the care team. Mele-Algus said, “There are all these tests we’ve traditionally had for well-woman visits. But people don’t take the time to think about what the patient is coming in for. What is their agenda?” The simple solution is to ask those questions beforehand – likely through an app – so patients can understand what the visit is about and what the visit could be, including helping them think about questions they may want to ask. And then, giving that information to the provider so they can jump into meaningful conversations.

The final piece of the equation – at least for the purposes of this discussion – is a fully integrated care team. Cross-specialty collaboration has been rising in prominence over the past few years, but it needs to be implemented faster and more widely.

As alluded to above, Radiology Partners is thinking about this in terms of bringing radiologists into the main circle of the care team, rather than sitting on the periphery handing down reports. Diana Health’s model is predicated on intense collaboration among a variety of specialists – Certified Nurse Midwives, OB/GYN physicians, licensed clinical social workers, care navigators and the patient herself. “Shared decision-making is a key element in terms of taking the provider’s evidence-based assessment while involving the patient in every conversation,” said Mele-Algus.

These conversations start from the first encounter. Under the Diana Health model, the care team considers social determinants, risk factors for mental health issues, stress levels and more. That assessment allows the midwife or OB/GYN to quickly recognize that a patient may need to see an LCSW and quickly make the handoff – and that second caregiver can trust the handoff because of the well-defined processes in place.

Condliffe explained, “The way we build collaborative care teams results in certified nurse midwives managing the bulk of routine care and with time to provide that level of engagement women want prenatally, intrapartum and post-partum. And it allows OBs to then make the best use of their time and come in when they’re needed to identify or manage complications, to do surgery. It drives efficiency in the clinical model and creates a level of work-life balance that matters to providers.”

That last point is key because of course provider experience also affects patient experience. With everyone practicing at the top of their license and using well-designed technology that reduces clicks, makes the next steps clear and “takes pixels on a screen to make something eloquent and beautiful,” as City put it, the clinicians themselves will be more comfortable and satisfied. They can focus more on building relationships with their colleagues and patients, maybe even feeling better physically and mentally because they’re no longer dealing with thousands of mouse clicks and endless alerts. They can simply deliver care.

Corum

Jim Corum, co-founder and COO of Diana Health, summed it up well in reflecting on his colleague’s comments: “Kate talks often about the desire of patients to be heard. And so it’s about setting up an environment and a framework and making the time. Because then you have the right clinician, the right support person there at the right time, and it’s all underpinned by this technology that gives that opportunity. Good things happen when that’s the case.

In Change Management, High Stakes, Issue Navigation, Quick Think

Bite Your Tongue or Speak Up?

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

The Big Story: The CEO “Talking Trap”

CEOs, you might want to bite your tongues.

A new survey from the Brunswick Group says you’re overestimating the necessity and effectiveness of your organization’s communication on social issues. Yes, there’s enormous pressure on organizations to respond to everything that’s happening. But doing so without careful consideration can come off to the public as inauthentic. “The effort may come from a place of earnest engagement, but it is not being perceived that way,” the report observes. So if you choose to talk the talk, your organization needs to walk the walk.

What it Means for Your Health System

For leaders, the decision to speak is fraught. The Brunswick Group refers to it as “the talking trap.”

Basically, while corporate intentions around speaking up on hot social issues may be well-intentioned, audiences are disregarding these efforts due to “the broad alienation that most Americans (Democrats and Republicans) feel toward people and institutions of power.” If communications about an issue are poorly received, there’s the potential for them to be reputationally harmful.

Yet at the same time, we know there are times when leaders do need to speak. That’s part of being a leader, isn’t it? And with everything going on in the world, the range of topics on which they might be asked to weigh in is wider than ever.

So then how to do it effectively? The Brunswick Group report closes with excellent general recommendations to avoid the talking trap. Read them all – after you finish this note with ideas tailored for healthcare leaders and marcom officials.

It all boils down to integrated communications, similar to integrated care teams. The core structural issue is to know who’s in what lane and to coordinate appropriately. When clinicians aren’t aligned, they step on each other’s toes, information gets lost and patient care suffers. Similarly, communications efforts can be derailed by too many people trying to offer their own version of the message or offer it at the wrong time. When dealing with sensitive topics like social issues, the results can be damaging.

Consider these steps to ensure your message is received with the authenticity intended.

  1. Speak well – within your lane. You and your organization are experts on healthcare, and the public does want to hear from you on the things you know. Previous Jarrard Inc. surveys have shown that the public expects providers to speak up on healthcare topics. So before getting deeply involved in a range of issues, ensure that you are clear and consistent, firm yet humble, on the topics directly related to your work. 
  2. Do well – within your lane. Back up your message with actions. Better yet, back up your actions with your message. The Brunswick Group emphasizes the importance of tangible and significant investment (financial or otherwise) in causes related to the issue. For hospitals, that’s likely community partnerships and charity care. It’s also your work to support employees, professional development opportunities, and defined, financially-backed programs to help close racial disparities within the organization. Your mission is strong, so make sure the work you do reflects it.
  3. Recognize that there is more than one lane. “Health” encompasses so many issues, and we’re seeing a growing conversation about how social issues are health issues. Granted, we just suggested building credibility by staying in your lane. But that’s a lot harder when your lane is very wide – or when there are multiple lanes. Basically, your team needs to define the terms and come to some internal consensus on how you view the continuum of health and the myriad factors that contribute to it.
  4. Define who can and should be speaking out in each lane. One way to handle the complexity and the expectations is pretty standard: Break the work up into manageable bites. Within your organization you have nurses, administrators, physicians, social workers, care navigators and so many others. Find the right individuals within these roles to talk about the issues most closely aligned with their work. Social workers can talk about mental health or homelessness. Leadership can talk about the delivery of care to different communities. With people in the right spot, there’s minimal stepping on toes.
  5. Coordinate, prepare and activate. Whether it’s one person who will be speaking or five, define the expectations. For example, what’s appropriate for people to say as representatives of your organization – versus on their own time? As always, bring in outside voices like community leaders to help inform your thinking on the issue and your approach. Set up mechanisms for feedback – even if it’s uncomfortable. That in itself goes a long way towards demonstrating your authenticity and commitment. Finally, go out and speak – humbly, kindly, quietly but firmly – acknowledging what you know to be true and what you’re still learning, as well as how you and your organization are responding.

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.

In Change Management, High Stakes, Quick Think

One-to-One: Building Community & Pursuing Equity

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

The Big Read: Together – The Healing Power of Human Connection in a Sometimes Lonely World

We usually link to a quick article. But hey, we’re going into a holiday week so of course you have time to read a whole book, right? Surgeon General Vivek Murthy’s work, which was published last April, caught our attention as we’ve been thinking a lot about myriad issues that rise to the surface during the holidays – relationships and connection, equity, community and gratitude.

What it Means for Us

(a two-minute read)

Today we’re leaving the boardroom, C-suite and exam rooms.

Health and community belong to all of us. We frequently talk about social determinants and what can be done at the institutional level. Moving into the holiday season, we’re reminded of the power of our individual, one-on-one actions to support others and our ability to directly impact – for better or worse – their health.

On paper, many of the issues facing healthcare seem disparate. But looking closer, the common thread is a need for human connection. Take the health system whose employees are burnt out and threatening to quit. Or the community hospital where marginalized populations have higher readmission rates – if they were able to access care in the first place. And then there’s the metro facility where food services employees feel left behind and look toward unionization. In each, a fundamental problem is that the people involved don’t feel seen or heard. So, the solution starts with the same first step: Listening in personal, thoughtful settings.

Healthcare inequity takes many forms: gender gaps, racial inequity, mental health stigma, socioeconomics, access to care and so much more. As we think about our personal role in solving inequities, we must first ask, “What’s the win?” How do I define progress? How do I build this human connection to understand the needs? Here’s a place to start:

  • Approach people with an authentic desire to build connection. What’s their story? What do they value, and what do they need from us to feel valued? We listen to understand, and we listen so others will feel seen and heard.
  • Elevate marginalized voices. Take what you learn from your conversations and bring it to those who have the agency and tools to drive change, whether it’s the CEO or employee supervisor or neighborhood group. Help them create structures that open two-way communications, dismantle communications barriers and empower the marginalized to be heard by those decision makers.
  • Partner with those affected by our decisions. People are more accepting of a decision or change when they feel heard, even if the change isn’t what they wanted. Moreover, without the input of those who are directly affected, there’s never a complete solution. Of course, no decision will satisfy everyone. But we can listen to every voice and let everyone feel heard and seen.
  • Remember that giving someone a voice doesn’t mean taking it away from others. We’re adding to the conversation and creating richer experiences for all. We’re widening our personal and institutional perspective so that we can find better solutions that benefit everyone.

Human-to-human connections have been devastated by almost two years of physical separation and growing polarization. We as individuals and as representatives of our various organizations need to be cultivating relationships between people, both for our sake and theirs. It’s a way to repair some of the damage of the past and the burnout many are feeling now.

We can’t solve every problem, the solutions to get better aren’t simple and we won’t please everyone. But we can make progress with people who are willing and eager to partner with us – if we give them the opportunity and are willing to partner with them. And that’s a win.

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.

In Change Management, High Stakes, Quick Think, Strategic Positioning

Health, Not Healthcare

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

The Big Story: CVS Health Launches $25 Million Ad Campaign Focused on ‘Healthy’

The idea of “health” is too complicated, too fragmented. That isn’t going to work in an environment where expectations for simple, convenient and integrated experiences continue to grow. CVS is one example of a provider organization working to make health – and, by extension, the healthcare they provide – more accessible to patients consumers.

What it Means for Your Health System

“People often feel overwhelmed by the concept of ‘healthy.’”

Pause on that quote from the linked article, just for a moment.

Seriously. What the hell are we doing? We’ve overcomplicated healthcare to the point that people are “overwhelmed” by the idea of eating a salad and taking walking breaks. And they’re frustrated by it.

According to the latest American Consumer Satisfaction Index, healthcare – including ambulatory care, hospitals and insurance – retains the trust of the public but lags other industries in customer satisfaction. In fact, healthcare and hospitals reached their lowest index score in nearly two decades, per the study. (Health economist Jane Sarasohn-Kahn covered the study in a recent blog post worth reading.)

We all know consumers are frustrated by the fragmentation. Good news is that forward-thinking health enterprises are already bringing everything under one roof. That includes risk, care delivery, education, tech and health-related consumer goods.

And that’s why companies like CVS-Aetna are doing so well. They’re pushing hard on giving the public a reframed, integrated perspective on health while also finding the service lines and payment models to make it profitable. A retail chain buys a health insurance giant and now offers everything from urgent care to mental health services to renal care. And they’re marketing those services in a way that fits the customer journey.

Clever startups and health services companies are building technology platforms and care delivery models that are based on collaboration, interoperability and user experience.

On the business side, money and planning is going into integration so that control of the entire care continuum stays under that one roof. On Tuesday, Fierce Healthcare covered a recent survey from HFMA that found three-fifths of health systems are looking to bring more risk management in house by diving into Medicare Advantage. This approach, the article points out, parallels payers who have stepped into care delivery.

And finally, private equity has been – and looks ready to continue – pouring record money into healthcare in 2021. It’s a trend Paul Keckley reviews in his latest newsletter.

Time, energy and money are being deployed to integrate health(care). Each category of player has advantages in that work:

  • PE has money, operational acumen and enthusiasm – they don’t have to drive change, they get to.
  • Traditional providers have public trust based on proven expertise in care delivery and the medical acumen.
  • Startups and health services are quick, flexible and have fresh thinking on technology and patient experience.
  • Retail has consumer perspective and data, along with technological power. Moreover, people are already spending time in retail settings so it’s easy and familiar. And you can find a parking space at CVS.

There’s another fundamental difference that underpins the CVS ad campaign. Traditional healthcare providers see people as patients, whereas the new entrants and retail-based providers view them as consumer. Though hospitals are expanding beyond just offering sick care, the historical approach has been, “We know medicine. Come to us when you have a problem, we’ll take care of you.”

On the other hand, the underlying philosophy behind the CVS ad campaign is that a consumer-centric mindset puts more responsibility on people to care for themselves.

Whatever angle a provider organization is coming from, that patient-as-consumer must be the destination. Integrating the business and technology and risk management is the operational mechanism to do so, but the work must be built on a culture that prioritizes integration and experience.

Investor-backed providers have the flexibility of starting from scratch but lack the institutional knowledge; traditional providers have the institutional knowledge but have to retrofit the tools.

As you work to triangulate on the right solutions to streamline care and redefine “health,” here are some questions to ask about your organization’s culture in terms of innovation and integration to get the conversation rolling. These questions can lead to solutions that can help you render “health” an accessible concept, not one to fear.

  • Do you think about things like “integration” and “transparency” in the context of CMS or other regulation? Or in the context of patient and provider experience?
  • Do conversations about other categories of providers focus on how to defend against their encroachment or what can be learned from them?
  • Similarly, does your approach lend itself to collaboration and partnership? Or does it insulate your organization?
  • Do you check in regularly with clinical and back-office staff to learn about bottlenecks and hear their ideas?
  • Practically, are you integrating processes and software?
  • How long does it take you to test and evaluate a new system? Can you shorten that timeline?
  • As a health service company or startup, do you have a clear story to tell traditional providers about how you can support existing systems? Do you understand the constraints they’re under?
  • As a traditional provider, do you listen to the new entrants with an open mind rather than a concern about what can’t be done?
  • Do you have educational and marketing materials that simplify and humanize you to your patients and that put them at the center of the story?
  • Do you have people testing the experience patients and employees have when they interact with you?

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.

In High Stakes, Issue Navigation

Special Report: Rising Above Health Misinformation

Cartoon image of an overflowing laundry bin full of hospital uniforms and nametags in a room where someone is departing through an open door

Introduction

“No go, unfortunately.”

That was the text from a friend saying her spouse, a physician, wouldn’t talk to us for this piece.

As a critical care physician who spent the last 18 months treating COVID-19 patients, he’s now taking an extended sabbatical to recover. He had the perfect perspective for an article looking at the current state of the healthcare workforce – the accelerated burnout, the frustration, the fear and the sheer exhaustion.

We had questions lined up: What do doctors and nurses need today? How much does monetary compensation play into the equation versus other types of support? Do the rumblings about an exodus from healthcare represent a real threat? Where do you hope to be after your time away?

But no, we would not be asking those questions. And maybe, that makes the story more powerful.

That this elite physician couldn’t talk to us wasn’t a matter of scheduling. It was because he has given everything to save as many people from COVID-19 as possible and has nothing left.

“He just shuts down when we talk about COVID,” the spouse said. That exhaustion encapsulates the problem our entire healthcare system is facing today. It clarifies both the human cost and the operational challenges facing provider organizations.

As an industry, we’ve been talking about the burnout of our nurses and physicians for years, to the point of cliché and numbness. Then: COVID. And now? The headlines are everywhere:

On top of that, President Biden’s new mandate for large employers will force even more people to make a choice – including some healthcare workers who may join peers who have already decided their career isn’t worth the vaccine.

All told, addressing the exhaustion and resignation of our clinicians has become an urgent business imperative for every organization who employs physicians and nurses. The issue’s been building for years. Maybe you can momentarily stanch the bleeding with pay raises and travel nurses, but that won’t heal the wound.

What to do now? This report, based on interviews throughout the Jarrard Inc. network of clients and experts, triangulates the trends, draws conclusions about the future and offers thinking on how to manage an issue that’s gone past the boiling point.

BY THE NUMBERS

6,800

Employees lost by Southern hospitals

49

Healthcare workers experiencing burnout

29

Healthcare workers considering leaving the industry

38

Healthcare workers self-reporting anxiety or depression

Back to the Beginning

Graepel

Burnout and the growing shortage of healthcare workers are well-documented. National surveys from a couple of years ago revealed burnout rates approaching 50 percent for a variety of reasons, per Kirk Brower, MD, chief wellness officer at Michigan Medicine. Long hours, burdensome administrative requirements, mediocre technology all contributed. Kevin Graepel, MD, PhD, a pediatric resident at St. Louis Children’s Hospital, observed that the buildup starts early. “A lot of the challenges my colleagues and I are facing in terms of burnout are driven in large part by the way resident training occurs in the U.S.,” he said.

Those stressors intensified over the past year and a half, evolving somewhat differently for physicians and nurses, according to Dean Browell, a digital ethnographer and principal at Feedback, who has been tracking the issue of burnout online for years.

Browell

Throughout the pandemic, we’ve seen clinicians of all stripes joining the conversation online. That’s not new, but it has taken on a different flavor, per Browell. Nurses, he said, have long used digital platforms to discuss work-related issues amongst themselves. Early in the pandemic, those conversations expressed frustration with somewhat amorphous ideas of “hospital administration,” and the virus. Exhausted nurses were checking around for jobs that might give a bit of relief.

More recently, the anger has moved towards a more direct target in “the patients,” specifically the unvaccinated. That shift has led to more public activity among nurses, and the persona of long-suffering, patient caregiver is being replaced by that of the exasperated professional fed up with the parade of patients making dangerous choices.

Screenshot of a Twitter thread highlighting several points on COVID-19
Screenshot of a Reddit post from an exhausted hospital worker during the pandemic
Screenshot of a Facebook post from a displeased nurse during the pandemic

Trauma is Changing the Equation (Permanently?)

Essentially, healthcare is facing a potential and troubling shift in the way caregivers see their roles.

Clinicians and their families have shared with us this refrain about their calling: “I’m putting those around me at risk to care for countless people who made choices that are creating the danger.” Dedicated nurses and physicians are having to decide how far that mission goes. And that tension is creating moral injury – possibly even recalibrating the moral and psychological standard.

An example one person offered: An ED team can treat the single gunman who’s harmed others, successfully managing their emotions and maintaining their oaths to care for every patient. Yet when a notable percentage of the population – healthcare worker and public alike – refuse to get vaccinated, it becomes like an accumulation of mini active shooters coming through the ED doors every day. And with that, a mental shift could happen that unconsciously allows the level of care slip.

Others maintain that the levels of care won’t suffer, but that there will be greater distance between clinician and patient. Those who make it through will become more aloof.

Holding on to “Heroes”

It’s time to stop using the language of “healthcare heroes.” It rings hollow and feels discordant with what’s happening inside ICUs today and the way a big chunk of the public is acting towards healthcare workers.

“About a year ago, this larger burnout effect started being stoked by the hero messaging that was finally starting to get a little stale. It was this idea that, ‘Hey, I’m tired of being a hero right now.”
– Dean Browell, Feedback

“Healthcare workers got at least an emotional boost by being the ‘healthcare heroes.’ That’s just not happening anymore. They are back out in their communities, and they see people walking around without masks. It’s disheartening. Same thing with treating anti-vax patients – it’s creating a lot of anger.”
– Lisa Bielamowicz, MD, Gist Healthcare

“The core issue today is staffing. It’s time to point out the problem, which goes beyond healthcare. It’s also a problem in any type of service job where society pays low wages to people who we call heroes on a daily basis.”
– Erika Matallana, Jarrard Inc.

Leaking from Both Sides of the Pipeline

Roades

The result of all this could be an exodus. It may play out in lower enrollment in nursing schools, as more early retirements or leaving healthcare mid-career. (While the American Association of Colleges and Nursing noted an increase in enrollment last year, Browell said he’s hearing from top-tier schools that are struggling to fill seats.)

“People have changed their calculus about where they want to be spending their time. Younger people have alternatives,” said Chas Roades, CEO and co-founder of strategic advisory firm Gist Healthcare. He pointed out, only somewhat tongue-in-cheek, that given the level of pay at entry levels in healthcare, some people may view warehouse or gig economy jobs as viable, safer alternatives. Lisa Bielamowicz, MD, president and co-founder at Gist, brought up the education debt issue for clinicians. “It’s hard to talk about aligning compensation and incentives if people have to take out a second mortgage for 20 years to pay for student loans,” she said.

Bielamowicz

Clinicians Have Options

Between the rise of telehealth and the resurgence of concierge care, there are lots of career options today enabling clinicians to practice without having to deal with some of the mess. Physicians in particular have the financial resources to look around and find other revenue streams. For nurses, travel jobs have always paid well. Now, privately owned groups are offering massive pay jumps and impressive per diems for those inclined to take contracts – sometimes not far down the street from their current employer.

“They’re understaffed and their people feel at risk because the ratios are so high,” said Aaron Campbell, a Jarrard Inc. associate vice president keenly focused on patient and employee engagement work. “There’s a sense, too that the short-term solution – ‘I’m going to bring in people who’ll be paid far more than you and aren’t invested in our culture and will be gone in 12 weeks,’ – is going to create even more strife.”

Mississippi nursing ad with a red background containing job description

Browell explained it by positioning traditional providers at the center of the industry and new models of care on the outer rings. It’s about how many people leave the center of it for “a nice, quiet CVS somewhere,” he said. There was already attrition for hospitals because of the rise of those new models. In the next 18 months the threat to traditional providers may increase because people don’t want to stand in the center of the storm.

Of course, the flip side of that is significant opportunity for health services organizations. Referring to an orthopedic group client, Browell observed, “Their story is going to be a fantastic one they can ride for a while because they can recruit a nurse who is desperate to get out of an ER by showing them what it’s like in an ortho urgent care by comparison.”

What’s the Answer to Burnout?

In our interviews, a near-universal sentiment is that this won’t be quickly fixed, only managed. We can only do so much to help clinicians and other employees who are at the end of their rope. The days of quick fixes ended years ago (though we do offer a few ideas for immediate intervention in the sidebar.)

Operationally, providers need to look ahead to long-term transformation. That could mean evaluating technology across your enterprise. Or creating a Wellness Office, which Michigan Medicine did before the pandemic. Or even going truly massive – how about HCA owning a nursing school? In contrast, some Communications strategies can be brought to bear immediately.

Glenn
We don’t want to wait until people are in a crisis. We’re trying to understand the factors that are contributing and do something before it gets to that point.

Rose Glenn, Senior Vice President, Chief Marketing Officer, Michigan Medicine
Glenn

Operations

PURSUE STRUCTURAL CHANGE

First and foremost, don’t expect to paper over the shifts in healthcare.  “Change can’t just be a rebranding exercise,” said Jarrard’s Campbell. He pointed to K-Mart’s promise to evolve several decades ago. They asked their employees to stick around and buy-in to that vision. Many did, literally. The company used pension funds to buy company stock, leading to huge losses and a lawsuit in the early 2000s. “People are trusting you,” said Campbell. “You have to pursue deep change to follow through on that.” We all know what happens to organizations that try to skip past the hard work and fail to adapt. (There are 33 K-Marts left, in case you were wondering.)

OFFER SHELTER FROM THE STORM

Clinicians are considering their career options. Many who want to stay in healthcare may look to move away from the center of the storm. When possible, Bowell says, providers should offer that.

Admittedly, this is easier for larger systems with opportunities for lateral moves within the enterprise, and frequently, larger coffers for salary increase and other investments. Health services companies like the orthopedic group mentioned above often can provide calmer environments. The challenge is greatest for smaller systems and independent hospitals. “For smaller hospitals, it may be about investment in telehealth and generally finding ways to be less reliant on ER/trauma,” said Browell.

OPEN YOUR WALLET

Which brings us to financial compensation for physicians and nurses. Money can’t solve all the problems for a mission-driven workforce, but financial incentives do need to better reflect the realities both nurses and doctors are dealing with. Some thinking:

  • Imagine the tension in organizations where staff ICU nurses are working alongside travel nurses hired with huge stipends. Dollars should be wisely allocated for retention as well.
  • Surprisingly, hazard pay hasn’t really hit the healthcare industry in a major way, but could be a solution as this plays out, noted Browell.
  • Graepel, the early-career physician-scientist, put it bluntly: “Financial issues are a huge strain for many of my colleagues. Increased financial compensation would go a long way to lifting some of these major stresses. People are looking at a quarter million dollars in debt while getting paid $60,000 a year… It can be hard to imagine what that future looks like.”

So where does the money come from to fund this? After all, labor is already the largest cost for hospitals and health systems. Gist’s Roades suggested “looking at trade-offs with other expenditures like capital projects.”

Making Appreciation Apparent

Some of these can kick off tomorrow, others require a bit more time and investment. But all will give your team small yet meaningful doses of hope. As always, ask your team what they need – and what they don’t want to see. They’ll tell you.

Visual reminders of mission and appreciation

Hand-written letters to employees’ loved ones to express appreciation

Local media coverage highlighting employee service

Discounts/gifts from local businesses

Free subscriptions to wellness/mental health apps

Membership to services connecting people to daycare, pet care, handyman, etc.

Cover meal/grocery delivery service fees

Subsidized gym memberships or, better…

…Build/update a top tier on-site gym

Revised PTO to offer extra time off or create “PTO banks” for specific situations.

SUBSTITUTE, STRATEGICALLY

Technology can also help free up money for better compensation – along with saving time and reducing stress. First, more user-friendly EHRs are directly correlated with lower workload and, by extension, burnout. Second, is “strategic substitution” and job design – finally realizing the long-promised revolution where technology can augment the human touch and allow clinicians to practice at the top of their license. Bielamowicz and Roades were adamant that strategic substitution and streamlining operations from back office to clinical decision-making will reduce stress on the healthcare workforce and make more efficient use of limited dollars. Leaders should be asking if there are places to reduce dependence on labor by using AI or restructuring their teams so patients can do more self-service.

It’s always critical, our experts maintained, to evaluate human capital, asking if the right people are doing the right things and identifying gaps that need to be filled. “Everyone wants more data-driven, personalized care,” Bielamowicz said. “Every health system wants to take data from devices and use it for remote monitoring. But right now, we don’t have people to take that information and turn it into actionable information. We need medical technologists trained to do that work.”

Lastly, finding ways to accomplish back-office work related to revenue cycle and HR is not a new discussion. Those tasks are prime candidates for automation and AI to free up resources.