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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.

In High Stakes, Issue Navigation, Quick Think, Strategic Positioning

Non-Profit Health Systems Fighting in an InHospitable Environment

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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: InHospitable Documentary to Launch November 13

InHospitable, according to its website, “is a documentary feature film that exposes American hospitals’ significant role in our broken healthcare system by documenting patients and activists as they band together” to go up against a large non-profit health system. We’ve only seen the trailers, but the film appears to be a full-throated attack on non-profit health systems, featuring patients allegedly harmed by the featured organizations, activists and academics known to be critical of hospitals.

What it Means for Your Health System

We consider InHospitable the latest warning shot at how our screwed-up industry delivers and funds care, and hospitals and health systems are in the crosshairs. If you’re not ready, get ready.

We’ve known for a while the film is coming, and now we have an official date for a premiere. It may not be Michael Moore or Werner Herzog, but the film is real and the trailers include compelling imagery. In one regard it’s not that big of a deal – an indie documentary with 159 Twitter followers and not a lot of traction on Google. But health system leaders should pay close attention.

InHospitable is a recent example of emotional, sharp-tongued critiques of hospitals and health systems that have gained momentum over the last few years. Some of it well deserved, we must say.

You know the issues: The crazy and inconsistent cost of care, “profits over patients,” incomprehensible financial and billing practices, strong-arming payers, insufficient and inequitable access to care, suing poor patients for a nickel, and more. In addition, we’ve written here about the increased scrutiny by the feds of health system consolidation and the chatter of whether not-for-profit providers deserve their tax-exempt status.

By focusing its fire primarily on a single organization exhibiting bad behavior (it appears to focus on UPMC), the film will be all the more effective at elevating those questions for the broader industry.

The screening at DOC NYC is likely intended to generate enough buzz to get the film a slot on a streaming service sometime next year – when the pandemic will theoretically be behind us, and it’ll be easier to ramp up attacks on providers. Even if it isn’t a major success in itself (and, who knows, it could be), it will become part of the self-referential cannon used by hospital critics in their campaign.

So whatever your gut reaction to the film, you need to be ready to push back on the pushback. Here’s how:

Inform Your Board. They may not know any of this is coming. While providers were focused on keeping COVID-19 patients alive, the critics were honing their anti-consolidation arguments and putting the final touches on illustrations portraying hospitals as assembly (or disassembly?) lines.

Make sure your board knows about the growing storm, including the existence of this documentary and where it fits into the larger conversation. Last thing you want is for them to be caught flat-footed next summer when InHospitable appears on Netflix.

The education should include specifics about the attacks. We’re seeing more and more portrayals of healthcare providers as Big Business, with all the loaded connotations that idea carries. Big Business is predatory. Big Business cares more about profits than mission. Knowing that’s the representation should help inform the response. Equip your board with messages that explain why growth is beneficial for patients and communities and employees. It’s not enough to say, “That’s not us.” You have to say, “Here’s who we really are.”

Review Your Practices. Or, Know Thyself. Don’t sue patients. Don’t do the things that would lead an entrepreneurial filmmaker to paint you as predatory. Getting bigger doesn’t just make it easier to be accused of bad behavior; it makes it easier for things to slip through the cracks. Always make sure you’re operating in the most patient-friendly way possible.

Activate Your Board. Once they know what’s going on and everyone feels confident there aren’t any dark secrets, your board needs to get out there and engage. Healthcare board members have strong networks. Use them. Push them to reach out to the influential leaders in their orbit and humanize the organization’s work – to connect back to the mission, talk about the benefits of growth, show how they’re supporting the community and employees and either get ahead of or counter the attacks. Also, push them to connect with lawmakers and build or use the relationships necessary to ensure providers have a voice in whatever happens next. This is why you have board members. Time to get them organized.

Build Your Defenses. Now. We know InHospitable will premier in November and could easily get picked up for streaming sometime next year. It focuses on one health system but may name drop others as it looks to connect the dots to the industry at large. Whatever national context is created could lead to regional and local attention, so expect calls from the media. Look through the damaging coverage hospitals have received over the past couple of years (including 2019) and develop responses to those sorts of issues. Make sure your leadership team and board have a copy, as well. Whether or not you see any likelihood that your organization will get pulled into the conversation, prepare as if you will.

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, Quick Think, Strategic Positioning

The Heart-Pumping Scoop on Stories

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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: Storytelling Makes Hearts Beat As One

Turns out Disney and Amazon were on to something with their virtual watch parties. Want to sync up with friends? You can do it without ever laying eyes on them. A group of biomedical engineers, psychologists and neuroscientists found that people’s heart rates “rise and fall in unison” when experiencing the same story, even when they’re in separate locations.

(No subscription to The Wall Street Journal? Here’s another option. Or, if you’re feeling ambitious, here’s the original study.)

What it Means for Your Health System

We know. “Storytelling” has become so much a part of the marketing and communications jargon that it’s easy to skate right past it. There’s an entire industry of speakers, consultants and tools focused on helping organizations get their message across. We’re doing it right now.

And yes, this new study itself represents the perfect story: hard data about a compelling subject, wrapped in a romantic narrative. Elegant science showing that people in distinct locations can be brought together in a profound way through something so simple. This paper simultaneously proves and embodies the point.

Funny thing is, we came across this study while working through your feedback from last week’s survey on misinformation. (See our Special Report dropping next week.) Your comments reiterated the effectiveness of storytelling when it comes to misinformation. Because what we’re seeing today are dry facts presented in absolute terms by white coats on one side, with clever, substance-free narratives (some might say, “Lies”) appealing to emotion on the other. People are dying because the clever narratives have done a better job claiming to connect dots and explain the world than the dry facts. In effect, they’ve made hearts beat together as one. As Jarrard Inc. Partner Kim Fox asked rhetorically, “What’s easier to absorb – a bold headline or a list of data points from a scientific study?”

In other cases, like many of those we’ve highlighted in this newsletter (Power to the Patients, INHOSPITABLE, the Lown Institute report on community benefits, criticism of healthcare M&A), there’s legit data backing up a deeply emotional appeal centered on individual harm at the hands of a big, unaccountable villain.

To be clear: It’s not misinformation that sells. It’s the order and emotional release provided by misinformation that gets people to buy in. Facts be damned. But if you have facts to back the story? Even better. Think of it this way: Story is the Trojan Horse that lets the data in.

So then, how do we use this for good? Narrative is an effective structure to get a point across; are you using it for what you need to accomplish?

…

Are you sure?

In our experience working with clients across the healthcare spectrum, there’s a tendency to drift to one extreme or the other. Human nature, right? Providers either showcase the Hallmark movie story or the bar chart and trendline. An effective campaign, though, lies in finding Both/And. Marry critical health information with a great narrative and deliver it through a messenger with high credibility. The result is this video from Miami Children’s Hospital. Dr. Burke gives a tour of an emotionally fraught situation while dropping in vital facts like his team’s certifications and experience so subtly you barely notice it’s happening.

We’ll challenge you to take a moment and really evaluate how your team approaches storytelling. Again, it’s easy to pay lip service because it’s so ingrained in marketing 101. Don’t let that happen. There is powerful, evidence-based practice taking place across your organization every day. Patients are leaving your facilities better off than when they arrived. Your care teams are using cutting-edge technology to care for people. Sometimes, they’re ingeniously developing new techniques on the fly because that’s what it takes to save a life. Don’t skip past that. Look down at the numbers and find the trendline. Then, look up at the people walking by who represent that trendline in real life. That’s the marriage of data and story.

Let’s simplify it even further. Maybe we’re taking this too far but think about how your hospital operates and talks about its work.

On the one hand: Is there anything going on that would lead a group of people, watching on TV, to simultaneously sit up and say, “Ohhh, that’s bad”?

On the other: Are you showcasing the good work you’re doing in a way that would lead a group of people, watching on TV, simultaneously sit up and cheer?

We always say that if you don’t tell your story, someone will do it for you. That’s the risk. And that’s the opportunity.

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

Mad Dash to Digital Turns to a Trot

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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: One big reason healthcare access is hard

“Healthcare brands invest enormous sums of money in marketing campaigns, websites, and apps that will never be effective until a consumer can overcome the data barriers to healthcare access.” And that deficit could have ripple effects as consumers get frustrated with providers.

What it Means for Your Health System

(2-minute read, 15-minute podcast)

Providers are juggling more challenges than ever… ICUs full of the unvaccinated. Media coverage of questionable billing practices. Disruptors from tech and retail growing their investments and pushing the envelope. The ongoing push-pull narrative regarding the effects of consolidation. Breaking through the perpetual avalanche of bad news to highlight the good is no easy task for marcom pros today.

The frustration builds when big-name companies without a history of delivering care get rosy headlines, while traditional providers face seemingly endless scrutiny from the media, regulators and parts of the public. Scrutiny – warranted or not – then leads people weary of traditional healthcare to look for someone else to do it better. Enter a company like Amazon, which fits the bill because it knows people, what they want and how to get it to them. Not because it “knows healthcare.”

Healthcare organizations are certainly aware of the challenge. Providers ramped up their use of digital tools last year, moving towards a more patient-friendly system out of necessity. But the advance has slowed, according to a recent study. Providers who lose momentum are not only missing out on a chance to streamline care, but also to counter some of the negative press pointing fingers at those delivering it.

So then how to flip the script? How do you leverage the current moment, building trust and telegraphing a better future? Here are six patient-friendly questions to ask your organization to help ID areas to bolster or to brag about:

  • How are you making it simpler to receive care? This covers tools to seek, schedule and manage care. It starts with the table stakes that so many patients complain about but few providers get right – basics like online scheduling tools and check-ins. It extends to back-office functions like billing processes that affect the underlying efficiency of patients’ care. Anything to cut down on the number of disparate tools and to better integrate those you need.
  • Where are you providing care? A silver lining to the pandemic? The rise of alternative models of care. However, that means programs like telehealth and ambulatory surgery centers are no longer differentiators in 2021. (Yep, back to table stakes.) You’ll need to push a lot further to show what’s unique about your version of those offerings. Now if your organization is one of the few which have ramped up “advanced” models like hospital-at-home or mobile care, talk about those. A lot.
  • How are you targeting care for your specific community? Put your marketing cap on for this. Depending on geography, infrastructure and patient demographics, the same tool could either help or hinder a patient’s trust and comfort. Telehealth can make sense for different reasons: time saved fighting traffic, ability to seek care when you don’t have access to transportation, ease in scheduling, expanded hours and more. And those reasons can vary for an urbanite, a rural dweller, a family with small children, an elderly person, a blue collar worker, etc. Your marketing should be precise in what it says and in exactly whom it is targeting. People will trust you more if they see you offering services and communicating in ways that work for them.
  • How are you making it simpler to understand care? People don’t trust what they can’t understand. Now is a good time to scrub your communications materials for simplicity and to clearly define terms. If you want to take it up a level, look at how your organization trains patient-facing staff to ensure they’re communicating clearly and simply with patients. Always be asking, “Are we talking to consumers in a way that helps them make a good decision quickly?”
  • How are you making the financial process easier? So much of the scrutiny of hospitals today comes from questionable or downright bad billing practices. Merely setting up a simple billing portal will not negate the previous damage caused by suing patients over unpaid bills. However, setting expectations early on about things like financial responsibilities and billing process, tools and options, will go a long way in avoiding situations that are traumatic to patients and reflect poorly on your organization. Work with your front office and rev cycle teams to educate patients on the finances of healthcare, offer proactive communications about what they could owe and yes, give them easy ways to pay.
  • How are you improving access and health equity? Your mission is to provide the best possible care for the people in your community, which means that in some way everything you do comes back to access and equity. People are paying more attention to the issue than ever before. So are you. So talk about it. Northwell Health, for example, highlighted the importance of its new partnership with Walgreens for health equity. Other benefits like efficiency and convenience were framed as contributors to access and equity, rather than standalone features. That’s a playbook worth copying.

Want more? Check out the 15-minute conversation with Reed Smith, Jarrard Inc.’s VP of Digital Services.

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, Kaleidoscope

DEI & Health Equity: More than Good Intentions

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Earlier this year, we at Jarrard published a special report on health equity and diversity, equity and inclusion work within healthcare providers. Separately, but roughly in parallel, a team at our parent firm, The Chartis Group, in partnership with the National Association of Health Services Executives, developed Leading While Black, a research piece on similar issues that includes a health equity maturity model for healthcare organizations.

Together, those pieces cover a huge amount of ground in some of the underlying issues, challenges, and also possible solutions for both delivering more equitable care to patients and also developing a more diverse and inclusive workforce. Now, with a bit of time having passed since publication, we wanted to revisit the topic and bring together the teams that produced them for some combined insight.

In this conversation, we spoke with LaTonya O’Neal and Mark Wenneker, MD, lead authors of the Chartis report, and James Cervantes, who helps lead our Kaleidoscope DE&I work here at Jarrard. You can listen to the podcast or read the transcript below.

(Be sure to get in touch and sign up for all of our thinking here.)

Read the Transcript

David Shifrin: Let’s jump in. And Mark, tell us just about some of the high-level structural challenges that healthcare organizations are dealing with today in terms of DE&I and structural racism.

Mark Wenneker: The first answer I would give around this is that healthcare organizations, and the healthcare industry, has been aware of ethnic and racial disparities in healthcare for decades. This isn’t a new problem. In the early part of my career, I published an article demonstrating that Black patients were less likely to receive important cardiovascular procedures than white patients. That was in the 1980s. That wasn’t the first piece of research that showed that. Just last week, the Journal of the American Medical Association published an entire issue on the challenges of disparities in healthcare access for ethnic and racial minorities. So this is not a new problem. To answer your question more directly, I think there’s a greater awareness now that healthcare organizations have around the importance of addressing inequity. Most healthcare organizations have a mission to serve their communities. And if they’re not addressing the reality that there are portions of their communities that are not receiving the same kinds of care, then they’re not fulfilling their mission.

LaTonya O’Neal: When we talk about the challenges that healthcare organizations really need to overcome to move the needle on health equity, there are five things to think about. One, it takes more than just good intentions and a stated purpose.

Two, moving the needle toward health equity has to start at the top with the organization’s leadership.

Three, intentional cultural change is essential. Organizations need to expect and empower every employee to take an active role in addressing health disparities.

Four, promoting health equity needs to take place both within the healthcare organization and in the community.

And five, organizations need meaningful data to inform, measure and facilitate change.

David Shifrin: LaTonya, talk about the importance of going beyond just good intentions, right? You know I think, I hope, that everyone would agree that good intentions aren’t enough. But what does that actually mean? What qualifies as good intentions and what qualifies as the work that needs to be done?

LaTonya O’Neal: When you talk about good intentions, you can’t just take steps only because it’s the right thing to do. Just because your heart’s in the right place doesn’t mean you get credit. I think the distinction is that the actual work that has to be done should be at the foundation of the organization’s mission.

And that has to be done… the work that has to be done there is really challenging, and it’s also broad. So implementing a single, specific program to address a certain issue is great, but you can’t stop there and declare that the work is done. It’s really an ongoing, continuous process. And some of the clients I’ve worked with have struggled because they do want to do the right thing, but there’s a vast gap between wanting to do the right thing, trying to do the right thing and actually doing the right thing.

So I think having good intentions is certainly a great place to start, but you have to put the steps in place to ensure that, one, the actions are going to be meaningful; two, that they’re going to be measurable; and then three, that they’re going to be sustainable.

James Cervantes: I think too what you’re referring to, LaTonya, is really cultural change, right? So it’s not just change that happens in one department or with one program or with one person who’s leading one initiative. I think what we’re seeing, and it sounds like you are as well, is that to really move the needle on health equity and become a more diverse, inclusive organization, for many of these systems, it requires a level of cultural change that, honestly, many to this point haven’t been willing to take.

So it certainly starts at the top, but it’s also finding a way to engage every employee, every leader, to have an active role in that cultural change and that journey in becoming better—for each other and for their community.

Mark Wenneker: I would follow up what James just said. LaTonya and I recently wrote an article that was published in The Governance Institute magazine that emphasized the criticality of leadership commitment and intentionality. So, good intentions have to translate to a commitment from the top, from the board, and a set of plans that are actionable and have resources behind them. And if I’m talking to an organizational leader who’s asking me about what they do or what they should do around addressing inequities and disparities, that would be the first question: do you have your board on board and do you have a plan?

David Shifrin: Let’s talk a little bit about what you’re talking about, Mark, with the specific plans and how you build… It’s the, what is it? The SMART framework? The… Of course now I can’t think what the acronym stands for. Measurable…something: Measurable, Actionable, Timely.

What does the S… anyway… Specific! So there have to be specific goals and plans, and then also the overarching communications and mindset, and really change management that has to take place at almost a human level. And so between our organizations, I think we’ve got a lot of those bases covered in how we operate in the work that we do with clients.

But talk back and forth a little bit about how you merge those two things together, specifically as it relates to DE&I work.

LaTonya O’Neal: Change management is tremendous. It is the thing that I think, no matter the initiative in an organization, that’s required. If you don’t have a good change management process in place, you’re probably not going to be as successful as quickly in whatever that initiative is—but certainly when you’re talking about diversity, equity and inclusion, because everyone’s coming in with their own thoughts, ideas, sentiments on diversity, equity and inclusion.

You’re asking folks to align to a common idea, a common culture that speaks around the idea that you’re not going to allow inequities to occur within your organization as employees, but also that you’re going to try to resolve those inequities within direct patient care. And so I think it’s a bit of a challenge in at least some of the organizations that I’ve spoken with, it’s… even if you set up that structure, without the change management component of it, you run the risk of that idea or that initiative being abandoned because there aren’t any steps in place to make sure that you have that sustainability.

If your three highest admitters are not on board, what’s the consequence to the organization if they decide they don’t want to practice in your organization anymore. I mean, that’s an extreme example, but those are the kinds of things that I think minimize the effectiveness of some of the programs that might be out there even with well-intentioned folks, is that if these folks are not on board with it, then we must abandon it because we can’t survive without them.

James Cervantes: I think that’s a really important point; it’s having that initial buy-in, and that may take time for some organizations to build. And then beyond that, it’s really creating the awareness about what we’re doing and why, and making sure that everyone understands what our intentions are.

That we have buy-in from the board, we have buy-in from our leaders and here’s why we’re doing it. I think what makes this so challenging as well is that race and inequity is personal for many, right? We’re not talking about rolling out a new electronic medical record. We’re talking about deeply rooted issues that are very personal, very complex, very sensitive.

And so where we’ve seen some organizations struggle is just the way that we talk about it in identifying the problem. And so, one thing that we’ve done for a health system is just develop a language word bank so that we have a common definition set around how we talk about diversity, equity and inclusion across our health system and with each other so that we can all agree on something. And that, we’ve found, really built some momentum and created a more safe place for those conversations to happen.

Mark Wenneker: One area that I think healthcare organizations… after there’s been a verbal commitment made at all levels, that they really can quickly start working on is measurement. You can’t change what you haven’t measured, and healthcare organizations can readily look to see whether there’s diversity in their workforce, to have that data.

They can begin if they’re not already looking at whether there’s differences in how they treat patients. The kinds of care that they received. Their access to services. Whether there are differences by racial and ethnic background. Those are things that can be looked at. And that’s where you can start and identify those areas where there might be the greatest opportunity.

LaTonya O’Neal: You’ve got to start by defining what “it” is, right? Before you even talk about putting in measurement you’ve got to know what it is you’re measuring. And I think that that’s a challenging thing to do. And I think if you don’t start with defining what it is you’re trying to solve for, and then establishing those metrics that you’re going to measure yourself up against, it’s just a lot of busy work.

David Shifrin: One more question before we get into some of the specific examples. In thinking about both the internal and external work… so, advancing this work inside the organization and developing a more diverse workforce and getting people rallied around change in diversity equity and inclusion, and then also doing things that are going to improve patient care and the relationship between the provider organization and the community that it serves.

I hope nobody would see those as two separate initiatives. But I think it can be difficult to really know how to bring them all together. So how do you all think about that as sort of a continuum under the same umbrella?

Mark Wenneker: David, while they all really fall under the umbrella of addressing disparities in care and access, they really are separate strategic initiatives in my mind. So, the activities and focus and resources that need to address social determinants of health are very different than what needs to get done to address access to a healthcare organization. And I think both are important. So, healthcare organizations need to spend time thinking about who their community partners are and what their role is in supporting the community’s efforts to address social determinants of health.

It may be purely resources. Money. Or it may be something more direct like providing staffing or support. But it’s a very different type of work.

James Cervantes: I would agree with that. I do see them as separate, but I do think they are interrelated. Especially for healthcare organizations in more small and rural communities, where oftentimes your workforce is an extension of the community. So, how you’re talking about equity, where it sits on your strategic priority plan, how it’s mentioned in your vision and values, I think speaks volumes to your workforce.

And what you’re doing proactively, externally, I think, also needs to mirror how you talk about it and how you treat your workforce internally. So I agree a hundred percent, I think they’re separate, but there are connection points because they all sort of ladder up to the same overall vision and values.

LaTonya O’Neal: Yeah, they’re separate but not mutually exclusive.

Mark Wenneker: Yeah, I think that’s a great point, James. Most healthcare organizations are the biggest employers in the communities that they serve. So you really can’t think about that completely separately. You’re absolutely right.

David Shifrin: Well, let’s talk through some specific examples. You are doing this work, you’re researching this. So let’s just kind of go around the room and talk about some of the folks that you see doing a really good job. Some of the unique things that are happening across the healthcare industry and ways that colleagues and peers can kind of take some of those lessons about the things that we’ve talked about.

LaTonya O’Neal: We did a panel. Mark referenced the paper that we wrote some months ago where we were talking about leading while black, addressing disparities in our healthcare communities. We did a panel with some esteemed senior executives from some of the largest healthcare organizations around the country.

And three things that struck me in their talking that I think is a good blueprint for how others might want to try to get at addressing the disparities and also some of the issues around, you know, just racism in general. One individual said, “The best way to know what’s happening in your community is to get out in your community and actually see for yourself what’s going on.”

Part of that could be through board representation, but the other part about that is leveraging the people that work in your organization to help you understand what’s really happening. One example that they gave was they invited one of the nurses to join a board meeting one day, just to talk about what was going on in the community.

And it really made a difference in helping the board understand what the real problems were. The other thing that they mentioned was the measurement, which we’ve spoken about already. That is putting together performance metrics that truly you can measure yourself against in order to know whether or not you’re succeeding or not.

And the third thing that really struck me, it kind of dovetails on the first one around knowing what’s going on in your community. But we had one leader talk about how they’d started creating traveling grocery stores in areas where there were food deserts, right?

So, a lot of the issues that were going on in their particular community had a simple problem of… and I say simple not in that it’s a simple problem but as straightforward a problem of… our folks are not getting the food that they need to stay healthy and to be able to thrive.

And so, they took it upon themselves to create these traveling grocery stores so that those individuals who couldn’t get out and get the food that they needed, they provided that service to the folks within that community. Other stories like that, of being creative about how do we serve our community in the way that our community needs to be served, it’s just very important in order to make sure that we’re actually addressing the root causes of the problems that we’re experiencing.

David Shifrin: LaTonya, keep going on that a little bit, if you would. Leadership recognizes the need to go out and understand what’s happening and what needs to be done. They make the commitment to go out. They go out—whether to the community or inside the organization.

What does it look like practically for a leader to step into that conversation and listen and extract the information that they can then take back and use?

LaTonya O’Neal: You know, it’s a great question. I know that at least with a couple of folks that we spoke with, they talked about how being a trusted leader in the community was one of the ways that they were able to actually even get people to share with them the needs that they were experiencing. And so, I think part of it is being present, being available, and not just coming in to be a speaking head, if you will, is the first way you do that.

And I think that listening to the teams that you have in your organization could be another way of doing that. It’s one thing to think that you’re going to be able to walk around the neighborhoods and knock door to door and have people to just share with you what’s going on. You’ve got to be creative in how you get that information, whether it be surveys, whether it be information you’re collecting when the patient is admitted into your service.

No panels… you’re really getting that real-world feedback. I guess the key point is not to assume that you know what the problem is.

Mark Wenneker: You know, it’s striking to me that a very close corollary of this importance of listening is, who is actually representing your organization to listen? And while I think we need all leaders, regardless of their background to be present—as LaTonya is saying—in the community, it is very important that organizations have leaders that reflect the backgrounds of their representative communities. And that’s not happening enough. Because I think the communities, when they see those leaders that have similar backgrounds, are going to feel more engaged. They’ll have more trust. And I also think the other piece of this around workforce diversity is if you have those opinions and experience brought into your organization, it’s important to also listen to your community and go out.

But having that representative thinking and experience within also helps you understand what needs to be done.

LaTonya O’Neal: And too, Mark, creating that safe space which we’ve talked a lot about in the past, you’ve got to create that safe space where your teams are comfortable enough to even bring those types of ideas forward.

James Cervantes: Along those lines of listening, one thing we did at Jarrard to help facilitate conversations like that—and this was for a large health system out West—is they knew that they wanted to leverage their clinicians and physicians who for the most part their workforce and even members of their communities trusted.

But some of the folks just weren’t sure how to have those conversations, what questions to be asking, how to dispel some of the myths. They have the clinical information, but it’s how you frame it. And so we created a couple of toolkits. One was really for internal ambassadors and clinicians to use within the organization, as they’re in meetings to just address some of the top topics head on and to dispel some of those myths. But more importantly, to your point, Mark and LaTonya, to just be available to answer questions. And to really hear what the concern is from some of these groups that were very reluctant to get the vaccine. And then the other toolkit was really more for community partners. So, how were they able to leverage their community partners to engage in thoughtful conversations outside of the walls of the medical center?

And I think from both of those efforts, sort of in parallel, they saw tremendous uptick in the number of folks that were coming to get the vaccine. And I think they just have a deeper sense of who their community is now in a way that a data point wasn’t able to provide before those conversations.

LaTonya O’Neal: Just to add onto that, we created a maturity model as part of the work that we did earlier in the year as a way to help hospitals take a hard look at themselves. To look in the mirror and say, “Where are we along this continuum of where we want to be to address these disparities and make sure that we are really serving our communities holistically?”

And there are lots of other tools out there that we’ve seen. Actually, through the work that we did with the National Association of Health Services Executives, they’ve got other resources as well. But, I think that’s really important. You’ve got to take a look in the mirror and understand where you are, ask yourself those questions, and be honest about where you really are. And then put a program in place to drive toward where it is you’re really trying to head. I think without that, it again is well-intentioned, but it’s certainly not going to move the needle in a way that’s going to be measurable and impactful.

David Shifrin: Okay. LaTonya, Mark, James, what did we miss? What do you want to chat about?

Mark Wenneker: You know, there’s… the only other thing I was thinking about in terms of topics, was this issue around, is there a business case to be made?

So, in our report, that we did in collaboration with NAHSE, we talked about one of the challenges that healthcare organizations are facing, which is the question about, “How do we invest in these important areas, given the challenges we’re facing financially—most acutely with the pandemic, but certainly in the long term?” And yes, those are real. Those are real issues. However, it’s important to understand that the societal impact of healthcare disparities from a financial standpoint is significant. A Kaiser Family Foundation report estimated that disparities contribute almost $100 billion dollars in excess medical costs to our society and $42 billion in lost productivity.

Now that’s not to say that healthcare organizations can always capture those savings by making investments, but I think it’s important that they in their planning think through how can they benefit financially in addition to morally, their moral commitments, as they proceed with this planning work.

LaTonya O’Neal: You know, Mark, that’s a great point demonstrating the return on the investment. So, even in our consulting work, there are a lot of things that are the right thing to do that are good for the organization but might not have a return on investment. When you think about health disparities, the readmission rates that happen with patients who are not able to care for themselves at home, or when you think about extra admissions just because patients are not able to make their regular physician visits and things like that.

I mean, there is not enough data yet. I think that this is again back to where we need to really create some good measurement vehicles. But the return on the investment of making these programs part of your organization’s internal fabric and culture is significant. And in my mind, at least in working in the revenue cycle space like I do, you think about admissions, hospital care and then the billing that happens on the back end. I’m sure that there could be a direct correlation between these programs and patients do in your organizations on a regular basis.

James Cervantes: I would add, too, going back to our point earlier about your workforce, the labor market is as tight as it ever has been. And so, how are you honoring your commitment to health equity and retaining the talent and bringing in top talent? And I think more people, especially younger generations, are driven by and inspired by organizations that do what they’re going to say that they do and fulfill those commitments to their community and to solving for health equity. So, I think there’s sort of the workforce element as well, from a business imperative.

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

A Win for Patients…and Rural Providers

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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: New study finds consolidation lowered mortality in rural hospitals

“Rural hospitals that merged with or were acquired into larger health systems are associated with greater reductions in mortality for conditions like heart failure, stroke and pneumonia compared to facilities that remained independent, according to a new study.

What it Means for Your Health System

(2-minute read, 13-minute podcast)

Some good news for those trying to make the case in favor of rural hospital M&A. For too long, insurance companies, policymakers and some parts of the media have been filling the “cons” column with negative consequences – real, alleged and everything in-between – of rural providers joining up with former competitors and larger systems alike. Now, this study, published in one of the reputable journals within the JAMA constellation, offers a solid datapoint for the “pro” column.

We’ve been encouraging providers pursuing partnerships to tell their story by explaining the value that partnership will create. We’ve also advocated for finding data that can undergird those arguments. And so for many reasons it was encouraging to see lives saved – mortality from heart attacks was cut nearly in half following an acquisition, mortality due to stroke decreased by about a third.

Whether your organization is looking to acquire, be acquired or simply help change the narrative around consolidation, add this study to your stack of materials. Here are some considerations as you do.

Be motivated. Nothing in the data guarantees an outcome, but rather shows what’s possible. That possibility can serve as a goal for everyone involved. “They cut mortality by half? It can be done – and let’s take it further!” It’s a way to connect back to your mission and give your people hope through the promise of making healthcare better.

Learn from the results. Use the overall data as the impetus to look at how other providers have succeeded. It’s the action to follow the motivation. That means spending time to reverse engineer the improved outcomes following an acquisition, then working to apply and explain those lessons for your specific situation. Who knows? Even hospitals who aren’t in the middle of a deal might find some valuable ideas.

Go on offense. A risk with positive data such is that it can become fetishized, something that advocates for a deal instinctively point to every time criticism comes their way. Don’t give in to the temptation. For one thing, you run the risk of muddying the waters by getting into a tit-for-tat argument. “They showed that costs went up? Well, we showed that mortality went down!” Technically accurate, maybe, but not helpful. In addition, if you use data defensively you are, by definition, reacting to the opposition. Instead, be positive and proactive by using the numbers to explain why you’re moving towards a deal and what you plan to accomplish.

Don’t expect a magic bullet. First, what does it tell us? That done well, a merger or acquisition can lead to meaningful improvements. What does it not tell us? That a partnership will lead to meaningful improvement. Be very careful to not overstate results. Getting to better outcomes will take a lot more than just partnering up and letting things run their course. It’s years of careful, mission-driven work to get the desired outcome.

Be patient. The Modern Healthcare article about the paper noted that many of the improvements “were not seen until after three to five years post-merger.” That’s a tough pill to swallow in an instant-gratification society, especially for something as acute and personal as medical care. As you proceed through a deal, it’s critical to set expectations about what is and isn’t possible, including when people can reasonably expect to see the results. But at the same time, explain to people the meaningful benchmarks along the way so they can track your progress towards the goal.

Rural hospitals are struggling and need a path forward. Recognizing those difficulties and mapping the way is the impetus for groups like Rural Healthcare Initiative. Here we have a bit of light, showing that there is a way to improve care for these communities through strong relationships. It takes time and energy to find that right partner, but here we have strong, reliable data that it can be done.

Want to learn more about the study and what it means for rural M&A? Check out the 13-minute conversation with Jarrard Inc. Partner Isaac Squyres.

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, Quick Think

Tired of Being Your Hero

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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.

Healthcare workers are leaving.

They’re citing burnout, stress, safety, moral harm – and in some cases a desire for “personal freedom” over all else. They’re answering the question, “Is it worth it?” with a decisive, “No.”

Many are leaving because they cannot spend another day watching patient after patient die unnecessarily. Others have decided their career isn’t worth the vaccine. Logs on that particular fire? President Biden’s new mandate for large employers that will force even more people to make a choice. All told, the consequences for healthcare are severe – moral injury for healthcare workers, frightening staff shortages for providers and the public and long-term questions that will likely affect how all of us receive care.

Our latest Special Report homes in on the massively complex problem of clinician burnout. It’s a big read with some strong takeaways – definitely worth taking 15 minutes to digest.

Meanwhile, for a fascinating behind-the-curtain look at how doctors and nurses are expressing their burnout online, check out our Q&A below with Dean Browell. He’s a digital ethnographer and principal at Feedback, a social listening firm that digs into how what we say in the digital realm translates into how we behave in the physical world. And, he’s been tracking the issue of burnout among the healthcare workforce for years.

The Genie’s Out of the Bottle: What Clinicians Are Really Saying Online

(Five-minute read)

Jarrard Inc.: You’ve been tracking burnout in the healthcare workforce for years. Give us a bit of the back story.

Dean Browell: There’s been two different arcs with nurses and physicians, which have developed a little differently over the past 18 months.

Browell

Starting with nurses, about this time last year there was a larger burnout effect that in some ways was getting stoked by the heroes messaging that was finally starting to get a little stale. The pushback started with nurses, who are the most vocal group in healthcare, maybe even more than patients. They have their own message boards and have for years. They had some of the first Facebook groups because they all had .edu email addresses.

This time last year there was this perception that all of healthcare was being treated the same publicly, but in those groups, nurses were asking whether it really was the same to work in one organization or the other. For providers this meant that nurses considering a move represented an opportunity to attract and retain or a threat that the grass might be greener somewhere else.

Jarrard: What are the nurses expressing today?

DB: There’s more outright discussion that, “Maybe this entire industry isn’t for me.” What was first anger towards a larger or more nebulous idea – like administrators or how people are handling things on a macro level – is now towards the patient. Before, it was being angry at the virus and potentially how your hospital handled something. Today people are wondering if they can continue and serve a public that is, in their mind, willingly putting themselves at risk and creating this situation. It’s a very different burnout. And it’s a much harder equation from a retention and a recruitment standpoint for providers.

Jarrard: How are nurses talking about those concerns?

DB: In the beginning, nurses often had two distinct online personalities. There’s the online personality of “capital N” Nurse in front of everyone on Facebook versus on the American Nurses Association message board where they’re talking amongst themselves. Last year, those two faces began to collide. What we saw for the first time last fall was nurses on Facebook talking about union meetings. Typically, that would be relegated to the nurse message boards or discreet groups. We saw nurses not just take the platitudes about heroes and say, “Thank you. It’s been a lot. We have to push through this” like they did last summer. Instead, suddenly, you had them openly criticizing things they normally never would have discussed with their public-facing persona.

Jarrard: What’s the background on physicians?

DB: Usually what we saw is that physicians would pop up every now and then during a career change asking about the schools or nightlife in a particular city they were considering. “Hey, I’m thinking about moving to the city, what’s the orthopedic scene like?”

In August of last year, though, we saw physicians poking their heads up for the first time with the general public. They were offering their own statements and being a bit more forward with their own name at stake. That was different. And we saw this happening in some unusual places like threads of Reddit – that almost never happened before.

Jarrard: Same question – where are physicians today?

DB: They stepped out last August and they’ve stayed out in the public square since then. Now, like nurses, we’re seeing that they’re not just saying, “Hey, I have a stake in this, and I’m trying to help you navigate misinformation.” It’s not just a benign educational leadership approach like it would have been a year ago. Now it’s taken on an angrier or more exasperated tone that we haven’t heard out loud.

Jarrard: Nurses and doctors are coming from different professional and financial statuses. Does that affect how they’re able to respond?

DB: It manifests in the freedom to talk in a certain way. The physician discussion we’ve seen has still been very high level. “Here’s my take on what’s happening” as if they’re giving a comprehensive analysis of the moment. Contrast that with the nurse that says, “I just took my first break in eight hours.” Physicians take more of a punditry angle, whereas the nurses’ perspective is more in the moment.

Jarrard: Is this shift in tone and the level of engagement permanent or will it recede?

DB: For the most part I expect the physicians-as-pundits to eventually fade. Their level of connection online may stay, they may reappear when there’s something big they want to speak their mind about. But from a day-to-day perspective I’d expect that genie to go back into the bottle.

On the nurse side, I doubt the genie that will go back in the bottle – because of how open nurses are being today – is this idea of the two personas. There’s the happy-go-lucky, “I love that I’m in healthcare!” and “Here’s why I’m a nurse,” that is presented to family and friends, versus what they were saying in private among peers. You can’t unwind that clock now that they’ve been this exasperated publicly.

Jarrard: What does it all mean for the healthcare workforce going forward?

DB: This will have a freezing effect of some sort. It’ll be fascinating to watch enrollment in nursing programs. It was on a fast track for the last three years in order to meet the demands. We do a lot in higher education and there are some robust nursing programs having trouble meeting their enrollment numbers.

The question is turning into, “Who do you want to do this for?” And the feelings of betrayal and burnout change that conversation. I think it’ll have a freezing effect on the creation of a new nurse population.

Jarrard: We’re also seeing indications that people at the other end of their career are getting out. What does the situation you’ve described mean for them?

DB: It’s how many people leave the industry completely and how many leave the center of the industry. It’s people saying, “I’m going to find a nice, quiet CVS somewhere.” There’s this idea of decentralization of demand for healthcare services where it’s coming out of the hospitals and moving to those outer rings. It’s dangerous for hospitals because there was already attrition due to these alternative models. But now and over the next 18 months the threat is greater with people looking to leave completely or say, “How about I just not stand in the center of the storm?”

Jarrard: How can healthcare providers respond to this shift?

DB: Health systems have an opportunity to do better because of their sheer size. They can talk about what it’s like to work for the system in different roles. People will gripe about robbing Peter to pay Paul, but showcasing lateral movements that improve quality of life is one way that systems can cope.

Jarrard: What about smaller hospitals?

DB: Community hospitals will be the hardest hit because there’s almost no lateral movement available. For them, it will be about improving the situation. Maybe it’s investment in telehealth or to try and not be so ER-focused to remove some of that constant pressure. But it’s not an easy solution.

Jarrard: Last category: What’s the approach for those non-traditional or health services providers that aren’t in the center of the storm?

DB: We just finished a study for an orthopedic group that’s branching out towards a major metro area where they’ll be competing with some big systems. They’re going to have a fantastic story because they can recruit nurses who are desperate to get out of the ER by showing them what it’s like in an ortho urgent care by comparison. For these specialty practices it’s saying, “Hey, stay in nursing but come out of the storm.”

Jarrard: One of the consistent themes in our interviews is that it’s not about the money, but money is a major factor. Where does compensation come into all of this?

DB: Something that hasn’t come to healthcare is the concept of hazard pay. Of all industries you’d think it would be there for healthcare. That may start to happen, especially in systems that can only offer so much lateral movement. Maybe it comes into play between telehealth and in-person care in the ER or trauma.

Jarrard: Anything else? What are we missing?

DB: We may see an effect on M&A, too. If a system is looking at three different hospitals with similar profiles but one is an absolute powder keg in terms of its workforce, that would probably make it very easy to choose a different acquisition. It’s a different metric than most systems have looked at in the past. The focus has been on heads in beds. But looking at the distressed asset from the workforce standpoint will change the game a bit. The question will be, “What can our system sustain in terms of volatility, whether it’s attitude or behavior? Can we repair the culture or, even though it makes sense on paper, should we walk away because it will never fit?”

In High Stakes, Issue Navigation, Strategic Positioning

Special Report: Clinician Burnout and Managing the Unsolvable

“No go, unfortunately.”

That was the text from a contact saying her spouse wouldn’t be able to talk to us for this piece. As a critical care physician who’s spent the last year and a half treating COVID-19 patients and is now taking an extended sabbatical to recover, he was the perfect source 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. Because the reason that this elite physician couldn’t talk to us wasn’t a matter of practicalities and 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 absolute exhaustion encapsulates the problem our entire healthcare system is facing today. It clarifies both the human cost and the operational challenges facing provider organizations.

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.

That’s the public side, though. How much do the headlines reflect what’s happening behind closed doors? And, how much of an impact are we seeing from the visible PR battle combined with the results of closed-door negotiations? What’s the public perception of providers and payers? Does it even matter?

To determine whether payer-provider relationships are under more strain than usual, we spoke to experts in our network, checked in with our team and polled the public.

What we summarized: The cold war is heating up. There’s pressure on and from both sides, and a growing feeling of “Us” vs “Them.” Publicly, the balance of the PR is weighted towards payers, thanks to the campaigns mentioned above. But the insurance industry has a way to go to convince the public of its good intentions.

What We’re Hearing

Overall, payers and providers are getting more aggressive. Historically, negotiations tend to follow a set arc, with long, tense conversations bumping up against the expiration date only for a deal to be struck at the eleventh-and-a-half hour. While that remains largely true, the tone of more negotiations is getting hotter, the demands bigger. And in some cases, according to sources, the conversations nastier and more personal – with some individuals pointing fingers at the people across the table, not the organizations represented. That’s a problem.

As both providers and payers get bigger, it makes sense that the stakes would get higher. Each side is looking for leverage, and size is leverage. There are many reasons why hospitals pursue mergers and partnerships. Strength to push back against payers is certainly one of them.

An Elephant in the Room

Or, ahem, at the negotiating table.

Last year, as the CMS price transparency rule loomed, a big question was how the posted data would be used. Providers were concerned the data would  be of marginal value to consumers – but a gold mine to competitors and other industry stakeholders. Eight months on, that’s looking more likely.

Sources tell us those numbers are beginning to come into the national discussions around price. While the data are far from perfect – in some cases they’re not even that great – they could begin to affect payer-provider negotiations.

M&A skeptics (including the White House) like to note that “The top 10 health systems now control 24 percent market share,” according to Deloitte. Yes, and, the five biggest health insurance companies control 44 percent of the market. Half as many players controlling almost twice as much relative territory. So, joining forces with a larger system that can help balance the weight makes a lot of sense for a smaller provider.

Document with the White House signet with text that reads "FACT SHEET: Executive Order on Promoting Competition in the American Economy"

Still, it’s not all brass knuckles. “I’m seeing more candid discussions and true attempts to find middle ground,” said James Kennedy, a Tampa-based shareholder and chair of the healthcare practice at Carlton Fields. Greg Maddrey, director at Chartis and president of Chartis Consulting, said he’s seeing a mix of discussions:

“We see very collaborative discussions in some parts of the country and contentious discussions in other regions. It depends on the payer and market. One system just negotiated a significant value-based program, and they are exploring additional opportunities for JVs/collaborations. In other areas, the negotiations seem like traditional zero-sum game models.”

Things Usually Work Out, But…

We’ve also seen recent examples of things falling apart, eleventh hour or not. As the players get bigger, so do the numbers of patients who will suddenly find themselves walking into an out-of-network facility. Then comes the finger pointing as both sides try to pin the blame on the other. “They’re too expensive!” says the payer. “They’re raking in profits and want us to take less!” says the provider. “We’re trying to find a solution for our patients,” both exclaim. Meanwhile, patients are left scrambling, confused and footing the out-of-network bill.

Fortunately* for providers, the public is on their side. Or at least, more on their side than on the side of payers. We recently fielded a survey of American adults to get past the noisy headlines and figure out what the public actually thinks.

Do You Think Healthcare in the US Costs too Much?

Pie chart showing 85% "Yes" and 15% "No"

Who is Primarily Responsible for the Cost of Care?

Pie chart showing 12% "The System," 15% "Doctors," 13% "Hospitals," 30% "Insurance Companies," 16% "Government," and 10% "My Choices"

Most everyone (85 percent) agrees that healthcare is too expensive, and 30 percent of consumers believe the insurance industry is to blame. Only 13 percent blame hospitals for the high cost of care. Makes sense, then, that insurance would want to reposition itself in softer, friendlier light. It also follows that health insurance advocates would want to shift some of the blame to hospitals.

*About that asterisk: Hospitals should be pleased that they retain more of the public trust than other healthcare stakeholders. But they shouldn’t take that trust for granted. While the headline-grabbing ongoing campaign against hospitals doesn’t seem to have taken hold in the public’s mind yet, nothing says that it won’t.

What Happens Next

On paper it looks like providers are facing a multi-front battle, with skirmishes breaking out in places and tensions rising in others. How do you, as a provider, prepare for the impending charge? By going on the offensive.

Publicly

Explain your value. Repeatedly. Specificity is the antidote to speculation. Be aggressive in presenting data that shows how your organization contributes to the community it serves. Patient visits, lives saved, babies delivered, cancers caught early, people employed, economic impact. If your hospital reflects the local demographics, if you have a career development program to help improve diversity at the upper ranks, if you have a unique recruiting program to bring in more diverse physicians – talk about it. (If you don’t, start working in that direction). Talk about what you do with the revenue that comes in. Explain where that four percent margin you make is reinvested.

But don’t get mired in the data. Personalize it. Use stories to illustrate the numbers. Need a sign that stories are effective? Look no further than the “other side” of this debate. Hospital critics have been far more effective using stories to illustrate purported patient harm. They’re masters at personalizing the numbers they’re attacking. The public can see and hear patients and the pain they’re suffering. In contrast, providers, so far, tend to speak in numbers and vague platitudes. It’s no contest.

Explain how healthcare finance works. Did you cringe? Fair. Explaining the complexities of healthcare is brutal and daunting. But it’s on you to simplify the complex (or call in the experts to help you with that). Clear is kind, right? The more absurdly dense something is, the harder you need to work to explain it clearly, and dispel any sense of covering up, hiding facts and being opaque. Your patients and the public will appreciate you for that.

More Smart Strategies

Keep these tips in mind to navigate public disputes with payers

Advance preparation is key

Strike first to frame the issue

Clear, patient-centric messaging is most powerful

The messenger matters most: Clinical spokesperson is key

Establish a single source of truth online early on

Tactics & tone must match culture

Marcom obviously plays a lead role here. It’s time to develop educational materials to explain how insurance and billing works, and what patients’ options are. Not the inscrutable, low-quality papers that look like they came off a 90s copier, but attractive resources that explain in simple language what the terminology means, where people should look for information and how to interpret what they find. Video is helpful, or even social media posts to talk through the basics. Finally, work with your rev cycle team to ensure that anyone who might interact with patients on billing is trained to answer questions…in a friendly way.

One more thing here. While you’re translating the basics healthcare finance to your patients, think about going public. Seek out opportunities to talk in public forums. Use the media. Be a resource for reporters who are covering these issues. Don’t wait until they call you with tough questions. Position yourself proactively as the one offering information.

Privately

Get networking – now. Weak or nonexistent relationships sit at the center of problems around the negotiating table, according to experts who provided insight for this article. As noted above, some negotiations include personal attacks – an odd, dispiriting development. Without relationships, there’s no built-in trust, no ability to read the other side’s actions or words – typical buffers that prevent conversations from turning nasty. In the legal world we hear of plaintiff and defense attorneys having lunch together, meeting for drinks after court. On the surface, it feels strange to be dining with the enemy. But the outcome is often far more amicable and productive in legal proceedings. Healthcare could use the same approach. It’s time to network and meet with counterparts regularly so that the personal relationships can help soften the rough edges of negotiation.

The need for better relationships extends to employers and brokers, as well. As providers struggle to match up with payers, the employers who are effectively paying for care and whose employees make up the patient base can be strong allies. In our experience, this doesn’t happen nearly enough. Same thing for insurance brokers, who are often so key to connecting the various pieces of the how-do-we-pay-for-care puzzle.

In all of these networking conversations, providers must always take the high road. Everything should be about improving the health, access, experience and comfort for those receiving care. It’s all too easy for patients to get lost in the skirmish, but providers must intentionally make them the focal point.

Profanely

This is a no brainer. Just @%!# do it.

Providers save lives. They drive innovation. They employ millions. The provider side of the industry is not without its faults, and we should not hesitate to call out problems and bad actors. Ultimately, though, it is the providers who deliver care. Make that point in public and in private. Step up efforts to ensure every aspect of your organization is aligned with its mission. Make the case with data and stories, and don’t behave in ways that could give critics fresh ammunition.

As insurance companies increase the pressure, consolidate and integrate with providers of their own, delivering on their mission and showcasing how they’re doing it is the best way for hospitals and health systems to maintain trust take the financial steps necessary to keep the doors open.

In Firm News

Leading Healthcare Consultancies Launch Organization to Chart Path Forward for Rural Healthcare Providers

Firm News
Rural Healthcare Initiative

Unique social enterprise approach needed as rural hospitals face record closures, unprecedented pandemic stress

RALEIGH, NC, September 9, 2021 – A consortium of national healthcare consulting firms with a long history of serving rural healthcare providers today announced the launch of a collaborative organization built on the common mission of shoring up healthcare delivery for the 20 percent of Americans living in non-urbanized areas.

The Rural Healthcare Initiative (RHI) will offer a single point of contact where the leaders of struggling hospitals and health systems can tap into more than 150 years of combined experience in strategy and planning, physician alignment, practice management, facilities, operations, finance, law and regulation and communications and share experience and knowledge.

According to the Center for Healthcare Quality and Payment Reform, more than two in five rural hospitals could be facing closure, on top of the more than 130 that have closed in the past 10 years. “Rural hospitals don’t have the staff to keep on top of every industry trend, so they end up cobbling together an assortment of consultants who provide niche expertise,” said Dawn Carter, founder and senior partner at Chapel Hill, NC-based Ascendient, a top-ranked strategy and planning firm devoted to community-based healthcare providers. “Unfortunately, that siloed approach to consulting support is costly, slow and management-intensive – three things that a rural hospital can least afford in a moment when so many are at risk for near-term closure.”

To broaden its impact, RHI includes a 501(c)(6) nonprofit educational arm that will provide practical training and tools to rural healthcare leaders as a means to learn from and deploy best practices. Founding consultancies have committed a portion of their own resources to launch this nonprofit educational program. In addition to the 501(c)(6), the collaborative will offer consulting services aimed at delivering efficient, cost-effective management solutions.

“We started with the mission of strengthening rural healthcare providers and then asked ourselves how we could deliver on that mission with maximum reach and sustainability,” said Robert Wilson, Raleigh-based partner at national law firm Nelson Mullins. “By structuring RHI as a consulting collaborative with a nonprofit arm, we see the opportunity to provide a much more cost-effective solution for rural clients while creating a funding stream to advance our core aim of providing education and best practices for these healthcare organizations. It’s this approach that makes RHI unique, with our group the only one in healthcare consulting using the social enterprise model at this scale.”

Other founding members of the RHI collaborative are Charlotte, NC-based Criterion Healthcare, which offers facility development and financing consulting, and Richmond, VA-based Health Management Resources, which focuses on physician practice and network management services. The group also receives support from Nashville, TN-based strategic communications firm Jarrard Phillips Cate & Hancock.

About Rural Healthcare Initiative:

WIth a mission to secure the future of rural healthcare in the United States, RHI is a consulting collaborative formed by professionals at Ascendient Healthcare Advisors, Criterion Healthcare, Health Management Resources and Nelson Mullins, with support from Jarrard Phillips Cate & Hancock. Nonprofit educational programs are carried out under the auspices of a registered 501(c)(6) organization based in North Carolina. For more information, please contact RHI online or email info@ruralhealthcareinitiative.org