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Event Recap: Healthcare Private Equity at HPE Miami 2022

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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: Crafting the next-generation value creation playbook in healthcare private equity

“While the pandemic has disrupted demand for certain healthcare sectors, it has accelerated innovation and provided an opportunity for investment in other areas. In particular, there’s been rapid growth in virtual and home-based care delivery, along with the adoption of technology platforms.”

What We Heard at HPE Miami 2022

(2-minute read)

The opportunities and rapid growth were big topics at HPE Miami 2022, but the conversation didn’t end there. In fact, those were just starting points. The annual event, hosted and produced by global law firm McDermott Will & Emery, attracted more than 700 attendees from corners of the industry spanning investment, banking, legal and supporting services (including at least three strategic communications pros).

If we had to pick one word to summarize the trends we heard, it would probably be “leveling.” Investors remain optimistic and active, yet there was a sense that the industry is taking a bit of a breath. Here’s what that looks like:

Global disruption = wait-and-see.

  • There was concern about possible continued or exacerbated inflation and added pressure on the healthcare workforce, but beyond that the crystal ball stayed on the shelf.
  • Why? With Russia’s horrific invasion of Ukraine casting shadows, attendees were wary of looking too far into the future. “We don’t know” isn’t a particularly compelling take, but it’s a reasonable one in the face of today’s deep human concerns and economic volatility.

Plateauing pace.

  • Across the board, 2021 was an explosive year for healthcare PE investing, with several firms noting that they made a record number of investments in promising new technologies and unheralded opportunities to improve healthcare.
  • Yes, but: The result was a rise in valuations that attendees agreed was unsustainable. A common refrain was that 2022 will be a year of “refocusing” and “rebasing,” with valuations leveling off. One attendee suggested that this year will provide a “Zen” moment for healthcare investing.

Many paths to a deal.

  • While 2022 is expected to breathe, that doesn’t mean there won’t be opportunity. Between new family offices, European firms opening offices in the US, special purpose acquisition companies (SPACs)* and a significant reservoir of capital that firms may now be ready to deploy, there are more sources of funds than ever.
  • Plus: Transactions can go through faster, thanks to an accelerated transaction process brought on by the pandemic that shows no sign of reverting. Some bankers said they closed deals last year having never met the client or the buyer in person at all.
  • *Though still a reasonably popular financing mechanism, we heard rumblings that interest in SPACs is cooling. SEC Chairman Gensler has pushed his agency to come up with new, tighter rules surrounding SPACs, and the investment community is watching closely to see where it all lands.

Patients first.

  • As for what’s considered an attractive investment, attendees are continuing to keep their eye on anything that makes patient engagement better, faster, more convenient and less costly.
  • Think: Care in the home, outpatient settings or virtually, interoperability, value-based care and physician specialty roll-ups – to name a few.

Show, don’t tell.

  • There was a level of open pragmatism as the PE community discussed moving from investments based on the art of what’s possible back to those with defined execution and practicality on their way to creating value and improving delivery of care.
  • Put another way: Investing in what companies with a clear path to delivery vs. liberal promises to deliver.

Propping up people.

  • One attendee uniquely framed it this way: The healthcare services sector is fundamentally talent management.
  • Technology, care delivery models and process efficiency may get the headlines. But at its core, it’s people providing a service – a profound and personal service – to other people. Individuals doing that work are mission-driven, financial compensation isn’t the end-all-be-all, and labor is the number one challenge for healthcare today.
  • Therefore: In 2022 and beyond, health services companies must build meaningful cultures that make employees and clinicians proud to work there.

The last word.

  • The event itself was extraordinarily well-received by attendees. Here’s Jarrard Inc. partner and chief development officer Anne Hancock Toomey:
  • “McDermott did a phenomenal job creating an environment where people got to be together for the first time in two years and did it in a safe and fun way – outside in the fresh air and sunshine. More than 700 attendees from across healthcare investing. There was buoyancy among the crowd. Just so thrilled to be in person again.”

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.

DigitaLee 4: Digitally Enhanced Healthcare, Twitter Alternatives & Execs on Social Media

Orange text that reads "The Digital Future of Healthcare" with smaller text at the bottom saying "DigitaLee with Lee Aase" on a navy blue background

Welcome to DigitaLee, the podcast for healthcare marketers, where we look at the digital news, tools, tips and tricks for effective healthcare communications. This week, David Shifrin and digital healthcare pioneer and now healthcare entrepreneur Lee Aase are looking at digital-first healthcare – haven’t we been talking about that for years, now? – whether more obscure social media sites like Parler that tend to attract subsets of wider society are worth healthcare’s time, and how healthcare leaders and execs can balance the personal nature of social media with the value of promoting their organization’s brand.

Listen and subscribe to the podcast, or read the transcript below.

Episode Links

Read the Transcript

David Shifrin: So the headline that we’re going to be talking about this week, the news story is titled, it’s from HIMSS Healthcare IT news, and it says, “Like Banks, Healthcare will become Digital-First in 2022.

And there’s a comma and the rest of the title is “Zoom Healthcare Lead Says.” So Lee, I saw this, and thought there’s a headline I have seen in some form or fashion, probably every four months for as long as I’ve been doing this, which hasn’t been that long, but it’s been more than 2022. And it even starts with digital transformation as the topic du jour in healthcare today.

So we’re all talking about it. And everybody’s talking about the digital front door and care delivery being pursued through digital means and hospital at home and all the rest. Is 2022 really the point at which healthcare goes digital first, or is this the optimistic view of a guy from Zoom who has a vested interest in that being true?

Lee Aase: Stock options and stuff, right?

David Shifrin: And stuff, trying to boost things after things have come back down to earth after the pandemic, the pandemic bounce.

Lee Aase: Well, so I think digital first is overstating it. I think digital first is, yeah, it is that thing that a Zoomer would say. I think it’s, there’s no doubt that with COVID digital has made huge strides. That’s just clear. Back when I was working at Mayo clinic, we had some goals for digital going into 2020, and then it was astonishing how quickly things moved because they had to, necessity being the mother of invention. The offspring were a whole bunch of innovations that really were, it made a difference. I think the way reimbursements have changed or did change at least during COVID to say that you didn’t have to be face-to-face to get reimbursed at a reasonable level.

And so because of that it made the telemedicine, made the virtual care much more attractive, much more viable, just economically viable for organizations. I would like to say digitally enhanced is the way of 2022 and hopefully beyond, because I think it needs to be human first.

So the analogy that was used in this article was about banks. Okay. People care about their bank. People care about their money. Not as much as their health and it’s not as personal to them. Banking is much more transactional. And for example, I just deposited a check with my mobile app and that’s perfect.

And like the whole thing about not… just before we were on today, ATMs used to be the big thing. Wow, you don’t even have to stand in line at the teller. I mean, so that the convenience of that, and that’s what it really has to be all about, ‘Is it for the patient’s convenience?’

Is it for the good of the patient or is it just to drive profitability and make it more efficient for providers? So I think from my perspective, I know in a future episode we’ll talk about the other little venture that I’m working on right now personally, but really with that, we’re wanting to establish that human relationship and then use digital where it makes sense for the patients.

If it makes sense to do a phone call or a video visit, because it would be inconvenient to bring the kids in for…to be seen, then yeah. But we don’t want to say if you want your lab results, you need to log into the portal and here are the instructions as to how to do that. No, you can actually talk to a nurse. We’re glad to talk, or your doctor who’ll talk to you.

So I think digital can be a, can and will be a huge enabler and can create some huge efficient…in fact, a lot of the stuff that we’re doing with this new clinic that I’m helping my good friend start, my physician friend start, a lot of what we’re doing wouldn’t have been possible without digital, just in terms of being able to get this going. Having electronic medical record that is cloud-based and that we like, don’t have to have the huge IT expenses; it’s pretty astonishing what digital can make happen. But if that becomes first, digital first is a buzzword, and that’s what the HIMSS guys and the Zoom guys are gonna go for.

But if we lose sight of the human relationship then, and if it becomes not just, not a means to the end of more satisfied patients then we’ll be missing the mark.

David Shifrin: Let’s take a look at the platform or the platforms of the week and in the notes I sent over, it’s Parler, but as you’ve pointed out before, there’s a bunch of these, and we’ve some folks ask about quote unquote, that Twitter alternative, which we assume to be Parler, but that could just be a catch all for things that aren’t the Instagram, Facebook, Twitter.

Lee Aase: Yep.

David Shifrin: With a lot of these, and we talked about this in the previous episode, these are coming about because people feel like they don’t have a place to talk about issues that matter to them. So they are highly politicized, and Parler in particular, tend to cater to specific political segments.

And that also does feed into, I think, to an extent into more of a mistrust of institutions of healthcare. I don’t know if you want a say an establishment, but that potentially that’s there too. So, you know, as you look at all, all these upstart platforms, because at one point Twitter was an upstart and Facebook was and everything else – RIP MySpace – do you see any indication that these are places that healthcare providers should be getting involved in? Is it flash in the pan? What are you thinking about?

Lee Aase: I would suggest this is a – to use the medical term – it’s as a watchful waiting approach that you would apply here. But also I’d start by listening. you can create an account personally if you’re a healthcare marketer or communicator. Get familiar with what’s happening there.

You don’t have to speak, you can be one of the lurkers and just see what people are saying. And maybe try some experiments if you think it makes sense, but I think not paying attention to them at all as the wrong approach.

But I also think given the tenor that will likely be there in most of these platforms, running out there with a whole bunch of establishment kind of messages you’re probably getting the equivalent of a ratio there.

David Shifrin: Yeah.

Lee Aase: On those platforms too. But I do think it’s like, you know, in politics you have to get 50% plus one. Marketers are all about tenths of a percent of market share at the lower end of things and making a big difference in their bottom line by how well they’re reaching people. And so, unless you want to say that this segment of the population is just, we just shouldn’t, don’t even want to treat their kind, you know, then you should be paying attention.

You should at least be hearing what they’re saying and seeing if there’s a way that you could effectively communicate there. But I wouldn’t, I wouldn’t rush into it and say okay, everybody has to have a Rumble page, a Rumble channel and put all their videos on Rumble too.

But I think not at least listening is you know, making the problem worse.

David Shifrin: All right. Last one. The tip let’s…we’ve talked about social media policies, and let’s talk here more specifically about good ways for leadership as individuals to use social media. How do folks in leadership positions in the executive suite build trust and credibility and come across as real people while also presenting valuable information about the brand or the organization as they need to?

And I mentioned before we started recording that I’d love to continue on this thread at some point about how almost the flip side of that is how brands can leverage the corporate voice versus the individual voice.

But let’s start sort of if you’re a healthcare leader how do you balance that and come across as a real person?

Lee Aase: Yeah well, I mean I think healthcare leaders who are going to be or have personal accounts on social media need to be engaged with them, need to be paying attention to them. There are certainly…any public figure who has a social media account is having other people help manage the account just because there’s such a volume of messages.

David Shifrin: Sure.

Lee Aase: But it needs to come across as authentic and that there needs to be some level of the person himself or herself speaking and engaging. And that if it’s all, if it’s all managed and not an individual being involved at all, it’s not going to be genuine. It’s not going to feel genuine and real.

And I think that’s part of what people are thirsting for, is that there would be that ability to, that this is a real person who personifies the brand who personifies the values of the organization. So I think one way, I mean, a lot of that can be accomplished through video by having just the CEO or other leader talking about things but I would say much more like a livestream and “ask me anything kind of thing” versus a highly produced thing with the drone footage, you know, where they’re, they’re coming

David Shifrin: Swooping into the CEO suite.

Lee Aase: Swooping into a CEO suite. It’s like, I mean, I understand there, are different brands that have the different fields and for some that might be just the, like maybe for Elon Musk.

Well, I mean, just let’s think like Elon Musk, okay. I mean, another good example of someone who you’re pretty sure that that’s authentic to who he is and he’s done okay for himself mostly.

David Shifrin: Yeah, it would be hard to ghost write for Elon Musk, he has his own style. That’s a good example because it does show and he does say some things that you can really “Wow, bro.” But he, as you say, he is incredibly successful and he has built real products and he has advanced his brand.

So it does show that people are interested in the human behind the brand. And in some cases they might be inextricable, but it’s not necessarily a bad thing.

Lee Aase: Yep.

David Shifrin: Okay.

Lee Aase: So that’s what I have to say about that.

David Shifrin: All right. Thanks, Lee.

DigitaLee 3: Spanish Misinformation, Meta’s Dive & Apple’s Privacy Rule

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Welcome to DigitaLee, the podcast for healthcare marketers, where we look at the digital news, tools, tips and tricks for effective healthcare communications. This week, David Shifrin and digital healthcare pioneer and now healthcare entrepreneur Lee Aase are looking at the Spanish language misinformation crisis, Meta / Facebook’s recent dive and Apple privacy rules.

Listen and subscribe to the podcast, or read the transcript below.

Episode Links

Read the Transcript

David Shifrin: Welcome to DigitaLee, the podcast for healthcare marketers, where we look at the digital news, tools, tips and tricks for effective healthcare communications. I’m David Shifrin with Jarrard Phillips Cate & Hancock, and I’m with Lee Aase, digital healthcare pioneer and now healthcare entrepreneur. Today, we’re looking at the Spanish language misinformation crisis, Meta / Facebook’s recent dive and Apple privacy rules.

So for the first section, I wanted to talk about, we’re back to talking about misinformation in the news. This one is a little bit different. A story on Axios about Spanish language misinformation crisis, and I think everybody’s pretty aware of what’s going on. As far as misinformation, it’s not quite as hot of a topic as it was a few months ago at the peak of the vaccine push, but certainly is still an issue.

And I thought that sort of the core point, the thing that really stood out to me in this article, was between the lines and says where platforms are quick to remove misinformation posts in English, some identical posts in Spanish remain online. And just something that I hadn’t really considered is the multi-lingual nature of everything that’s going on and the need to reach out to so many different communities.

What’s your gut when you see this article?

Lee Aase: I have a little bit of a different take and I thought it was actually a good launching pad to be able to talk about some of this. So I think there is a crisis. I don’t think it’s a Spanish language information crisis, and I think it’s a different one. And we’ll get to that in a little bit.

When I started advocating for social media use by hospitals about 15 years ago now, there were definitely a lot of people interested and then I got a lot of objections because people are saying “what about all the bad information on the internet?”

And my response was, there will always be bad information on the internet. That’s just the way it is. If you have a free and open internet, you’re going to have people publishing bad information. So my answer was then if responsible medical professionals don’t engage, we’re ceding the territory to the snake oil salesman and to the people, the charlatans, the people who are putting out bad information.

And so that’s why I was arguing that health professionals had a moral responsibility to put out good information. I have a good friend of mine that a lot of folks listening to this will probably know. Andy was the founder of the Word of Mouth Marketing Association, or was the president of that.

Anyway, he founded a group called the Blog Council—now that’s socialmedia.org what it later became—anyway, he had a saying that he said he learned in high school chemistry that the solution to pollution is dilution. You know, that if there’s bad stuff out there, you need to overwhelm it with the good, okay. You need to put out reliable, trustworthy information. And the way that we have thought about it for 15 years in social media is that the good information will drive out the bad, the good information that people like it, they’ll comment it, it’ll get up-ranked. There’s a thing on Twitter called the ratio. The ratio is comments versus retweets or likes, and if your comments are much higher, that’s meaning that people are taking issue with what you’re saying versus what, versus liking it or passing it along.

There’s a quote that’s been attributed to Voltaire: “I may disagree with what you’re saying, but I’ll defend to the death your right to do it.” We’re a long way from that right now. You know, we’re saying, yeah, we need to tamp down, we need to drive out this information.

I think that’s a big part of the problem for the polarization that we have now, is that it is viewpoint discrimination and that opinions that align with the governmental or large entity positions are…are those that are aligned are promoted and others are suppressed.

So, over the last several months, users have been banned from Twitter for messages that today we know are true. Cloth masks don’t work. Posting that previously would get you, could get you banned from Twitter. And if the goal is to prevent respiratory infections, they don’t work.

Okay. Cloth masks don’t work. And they’re saying, ‘No, yeah you got to wear N-95s or KN-95s.’ You know, some messages that previously came from government or medical authorities have been shown not to be true. Okay, Israel has a vaccination rate of about 95% for those who are over 50 and about 85% have gotten the booster, and as of February 3rd COVID deaths were at an all-time high in Israel, okay.

The president of the United States, the current one, not the previous one, the head of the CDC and a whole bunch of others have previously said, and the tweets are still up, if you get vaccinated, you won’t catch COVID and you won’t spread COVID. And there aren’t any warning labels on those. There aren’t any things saying this may contain misinformation.

So I think those messages are still up, and I think another issue in addition to this alleged Spanish misinformation crisis is if you can’t be heard on the normal platforms where everybody’s speaking, well, if you park your truck on a bridge and don’t move it, and it’s a bridge between two countries, people are gonna pay attention. They’re gonna listen.

David Shifrin: Going to get noticed.

Lee Aase: Yeah.

So I think the fact that things are being suppressed, pushing down on that is kind of why we get, and I know in another…in a future segment, we’ll get into talking about some of these other platforms, GETTR or Parlor and others, but the reason those spring up is because the more mainstream platforms are suppressing it. And I think it’s…so that’s where the problem that I see is the credibility. You know, even if you think it’s harmful, then you should speak out against it instead of banning it, instead of banning individuals and banning and putting labels on that feel like they’re putting the finger on the scale.

So that probably wasn’t what you were expecting when you proposed the top.

David Shifrin: But it’s a good note too, that we have to engage. And to do… and this is something that I’ve been really concerned about for a long time, I’m a scientist by training and we need to do a better job of communicating how science works and how the data is collected and how we analyze it, because it does change.

And that doesn’t mean anybody’s being disingenuous or trying to play rope-a-dope or whatever, but it’s just, this is how science works. It’s complicated and it’s hard. And so the guidance will change. And that should be the message. And that gets to your point about diluting the bad information and just being more clear and straightforward about, ‘Here’s where we are today and here’s how we arrived there and this may change tomorrow.’

Lee Aase: Yeah, science, isn’t a person and it isn’t a noun. The science is a process, it’s a verb, and we need to, yeah, and educating people on the scientific method and what we know because of studies and what they can tell us, and then what the limitations of the studies are. And I realize that you get into a pandemic and people say we gotta get some communication out here because there’s all this bad stuff happening and we gotta give them some clear messages, and they want to give a clear message. And I think the risk of that, and I think what has borne out because of it is that we have people that have much less trust in public health than they would previously.

David Shifrin: Yeah. I love it. Thanks, Lee. Let’s look at the platform of the week. Meta, the artist formerly known as Facebook, the artist formerly known as Mark Zuckerberg’s dorm room. A lot of stories going around recently about how the number of active users has dropped for the first time ever, and as a percentage of total users it’s pretty minuscule, but it did drop.

It’s never happened before. Their earnings are down. Their market cap took a hit largely, or at least in part, because of Apple’s privacy rules, which I think a lot of folks listening as marketers are going to be aware of.

It’s something we’re watching here. So is this a big New York Times headline story that’s a big story because it’s a massive company or is this something that digital marketers in healthcare need to be paying close attention to for potential issues?

Lee Aase: Well, I think marketers should always be paying attention to things like that and be looking at performance. So they need to be looking at what’s really happening in terms of click-throughs and business results that they’re trying to accomplish through it. I think being cognizant, at least of the fact that the user base is diminishing a little bit, or at least the active user base, that paying attention to where the attention of users is going is something that just is basic work that marketers should be doing. Marketers, communicators of all types.

I think that, getting back to the previous issue, we talked about when you have the…I think one of the reasons behind, I mean this is a hypothesis, okay? This is a guess even, you know, that 50%ish, maybe it’s 48% of people and maybe 40% that are pretty strongly feeling that way are saying, you know, this is a platform that’s not friendly to me. Or, that is, this is going to put a label on things that I agree with that says this might be misinformation. I think people then maybe hold back and just say, ‘Okay well, I’ll share my family, kid pictures and watch the grandkids.’

But maybe you’re less likely to…it just takes a little bit of the luster off, I think.

David Shifrin: Yeah. And so then if they’re backing away from their engagement, it’s even harder to reach them, obviously, by definition, with good information. So you’re…

Lee Aase: Right. Yeah. And when you’re…I mean the answer isn’t to turn up the volume, okay. It isn’t to turn up the volume and turn down the screws, it’s to engage and to discuss. And I recognize that having been worked in the healthcare system and where you’re posting the messages that you’re, you know, being given to post, and there are definitely, there are unpleasant conversations that are happening there. The way it is right now, for sure.

David Shifrin: Okay, so let’s keep an eye on it and watch the numbers and see what happens next time Zuckerberg testifies before Congress.

For the last piece here Lee, the tip that I want to focus on is Apple’s privacy rules, which I just mentioned. I think, again, I think a lot of folks are aware of this, but the native iOS Apple mail app, which accounts for a huge chunk of email management, somewhere between 40 and 50-plus percent, it now is pre-loading tracking pixels to obscure human opens and geolocation data.

It’s a privacy push. It reduces the ability for us marketers to track engagement and target across different platforms. And again, this bit into Facebook’s revenue. So it’s potentially a problem for pure marketers selling whatever, clothes or widgets. How much do you think this could matter for the types of campaigns that hospitals and other healthcare providers are running?

Lee Aase: Yeah, well, I mean I think the upshot that HubSpot talked about in that article that we, that I think you referenced and you probably put it in the show notes, is just that marketers need to focus on the harder metrics and the ones that are more business-oriented, like click-throughs, like actual, go to the other one we were talking about here, replies. Yeah.

So, I mean, that’s the thing is when people are actually taking some step, you know, I look at shares for instance as well, shares on social, A share is…I used to call it the mother of all metrics, because it’s not just “I like it,” it’s “I want my friends to see it,” and so those are the things that I am typically going to be paying a bunch more attention to.

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Special Report: Recruitment Starts with Retention

“Mom, today I found out how I can own my own store.”

Was that the first thing you said as a teenager coming home after your first day of your first job slinging guacamole at a fast-food restaurant? Nope? Wasn’t for us either.

But that did happen to a teen whose orientation at Chipotle included a pathway to go from line crew to store manager to franchisee. And what a profound lesson for healthcare organizations struggling with staffing, said Dan Collard, co-founder of Healthcare Plus Solutions Group, who recently shared the story with us.

As Collard sees it: Recruitment starts with retention when companies give employees a reason to stay and grow.

Healthcare’s persistent workforce shortage is one of the industry’s most daunting issues right now. Everything’s on the table: large sign-on bonuses, retention bonuses, raises as everyone competes to staff up, whatever it takes. Many, especially rural hospitals, are barely hanging on. A few numbers to illustrate the point:

BY THE NUMBERS

96

Rural hospitals having difficulty filling nursing roles

11

Increase in salaries and benefits reported by HCA in 2021

54%

Rural hospitals significantly increased reliance on travel nurses

75

Nurse leaders citing employee emotional health as key concern

We all know the problem illustrated by those numbers. But how did it get so complicated?

Social context. The great resignation is affecting every facet of the workforce, with retention of hourly employees particularly tenuous.

Damsky

Expectations for greater pay, better benefits, improved work-life balance, career development opportunities and a desire for a better connection with employers are leading employees to push for change and/or leave their position in pursuit of it. Nurses, techs and shared services employees are expressing those same expectations but with the added layer of the intensity of their work.

Different process. “How people are going about getting talent has evolved as nursing recruitment has been empowered by technology. That’s making it more costly and more competitive,” said Pamela Damsky, director and Performance Practice co-lead at Chartis.

Jung

Jeffrey Jung, engagement manager at Chartis, pointed to the rapid rise of placement firms and “matchmaking technologies” that help connect provider organizations with talent. Jung said the matchmaking software can increase the speed at which a nurse can be placed and make better matches on the front end to boost retention. “It’s cheaper than just using placement firms because of the technology, but the overall cost is increasing because there are so many more applicants being hired,” he said.

Jennifer O’Meara, senior digital strategist at digital marketing firm Eruptr,

O’Meara

said the recruitment campaigns her firm ran online before COVID-19 tended to be “as needed” and focused on RN recruitment. Now though, Eruptr is involved in comprehensive recruitment campaigns that run constantly across platforms. Budgets, she said, “are double and triple what we were running previously, and it’s not just SEM, it’s Facebook, it’s Instagram, it’s display ads, it’s YouTube… it’s everything.”

More competition. Atop increased cost due to shifting talent acquisition processes is the pressure to raise compensation through bonuses and higher salaries to compete with other organizations in the market for a smaller and, perhaps, more selective talent pool. Hospitals are vying for the same nurses and trying to fend off the travel firms. At the same time, nurses and other staff have far more options, with outpatient clinics and health services companies delivering outstanding care and offering attractive careers.

Frayed relationships. The pandemic has accelerated a breakdown between title bands. Leaders are working to keep the whole operation running, staff are keeping things clean and caring for patients, managers are liaising between the two. Nurses aren’t happy. They’re being asked to do more with less. The LinkedIn post from nurse Kelly Fassold illustrates it well. Fassold compellingly expresses the anger many nurses feel towards administration, regulators, hospital groups and anyone else trying to codify salary caps – or even just discuss nurse compensation. The relationship between administration and staff is broken, and nurses feel like they are – or actually are – on the outside looking in as discussions about their value take place. It understandably leads to the sentiment of being both disrespected and undervalued. “You’ve left us out of the conversation and you don’t understand what we do so how can you tell us what we’re worth?”

Surviving then solving the nursing shortage

The healthcare staffing crisis isn’t intractable, but it’s not going to be solved in the short term. Right now, healthcare execs and HR teams are doing whatever is necessary to have just enough staff on shift to deliver care. Whatever it takes. That only adds to the unsustainable feedback loop and the feeling that we’re in the middle of a land grab, making it that much harder to plan for the long term. But plan we must. In fact, we must redesign the whole thing.

To do that, we have to establish the environment for long-term change to take root. First, a few thoughts on the tactics hospitals and health systems can employ.

Current Tactics for Recruitment & Retention

Hospitals and health systems are activating a variety of strategies to staunch the bleeding of the workforce crisis. We’ve curated a list of short and long-term interventions in force today and arranged them by feasibility for different types of provider organizations. After all, very few health systems have the financial wherewithal to buy a nursing school the way HCA did with Galen College of Nursing nearly three years ago.

Remember that nursing challenges arise indirectly as well when other areas of the organization break down. Take environmental services. When that department is understaffed, nurses end up with additional responsibilities because who else will change the linens? It’s more rocks in the nurses’ backpack.

Collard referenced a health system that was struggling with retention among environmental services and other support staff. Leadership changed the employee onboarding process so that, instead of following up with new techs after 30 and 90 days, those conversations happened on days one and two. That kept new hires engaged and allowed managers to uncover questions and problems instantly rather than letting them fester, improving the likelihood that the individual would stick around.

Again, wise to stay vigilant on the indirect disruptions that spill over onto nurses and address them promptly.

Building a culture of retention

Our experts agree there’s no easy solution, and the hard, sustainable solutions involve completely rethinking how we deliver care. But then they cite something that absolutely can be accomplished: building a culture that makes people want to stay. And when people stick around, you save on acquisition and training costs, maintain workforce stability and naturally gain advocates who may recruit others.

But O’Meara cautioned: “If you have to talk so much about culture and sell people on it when recruiting, do you really have a good culture to begin with? Is that culture reflected once you get past the advertising and the recruiters who make you feel so great about everything? Is it reflected once a new hire gets into the clinical setting?”

When you look up “employee retention” on stock photography sites, this is a lot of what you’ll find. But this represents a “what not to do” approach.

Professional development

Collard

Back to guacamole. After telling the story of the young man’s first day at Chipotle, Collard drew the contrast with healthcare organizations. “On Day One, we’re more interested in getting people set up with their password for the electronic medical record and showing them which gloves to wear,” he said.

In the push to get people working on their floor as quickly as possible, there are so many priorities to check off the orientation list that nothing is a priority. In contrast, Collard asked rhetorically, what if hospitals were more like Chipotle? “What would it be like if we began to engage our clinical staff on the day they started?” He mentioned research findings that indicate nearly four of five millennials will take a job with lower pay if it’s a job they feel connected with and that provides them a clear career path. It’s not always about the money. (Although yes, the Chipotle post below does feature the money along with the career trajectory.)

Jung emphasized this point, too, but with less avocado and red onion. Before COVID-19 there was less enthusiasm for bringing in a new graduate “because they require so much hands-on involvement,” as he put it. That hesitancy to hire novice nurses and techs is changing, and what’s becoming important now for retention in a smaller labor pool is giving people a clear pathway to move and grow.

Carter

A specific example of this in healthcare comes from Dawn Carter, a veteran healthcare strategist and founding member of the Rural Healthcare Initiative. She said that from the moment they initially consider a healthcare career throughout their time with an organization, people need to see how they can grow in their job or grow into another one. Hospitals that are already helping finance additional technical/educational investments have a massive leg up – they should do everything to make those opportunities known.

Carter cited a speaker from the 2022 South Carolina Hospital Association meeting who suggested hospitals ensure that high school students understand the low-cost path to a high-paying job. Someone paying two years of technical college tuition and coming out of it with an RN can enter the market making $60,000, but there’s the potential for $200,000+ by pursuing a CRNA.

Another example? Take the entry-level hospital employees working in “central sterile” cleaning surgical equipment. The skill level is such that they could work at an Amazon warehouse for more money and skip the dirty equipment. Hospitals, Jung said, can and should create a defined career ladder for techs. Many techs are in nursing school, and if you create those relationships and provide the opportunities, they’ll eventually want to come back or continue employment when they graduate, he said. “It’s the difference between a very transactional, ‘We need you here’ and a relational, ‘We’re going to invest in you – and we’d love for you to go back to school,’” he said.

Nurse-manager relationships

Go back to that LinkedIn post above. The post, and several comments below it, are built on the idea that unless someone has done the job they can’t know what it’s worth. It’s a push against salary caps, but it also reveals the significant gap between the suits and the scrubs. And it’s a fair point. The system is broken, staff see their census and patient acuity steadily increasing and the message many hear from managers and administration is a combination of, “Keep going,” and, “We can’t give you what you want.”

But again, sometimes what people want isn’t necessarily money. “We need to be sure we have salaries that match the market, but it’s more than dollars,” Damsky said. “It’s also treating nurses with respect and meeting their needs and creating an environment where they want to be.”

Carter highlighted the desperate need for leaders to spend time with staff, having heartfelt conversations about what they’re experiencing and humbly – not defensively – discussing leadership’s position on the issues and the various imperatives they’re balancing.

Sometimes it’s effective for managers and executives to share their own stories. We’ve heard from clients whose leadership spoke during town hall meetings about their toughest moments during the pandemic. Showing that level of vulnerability was powerful and helped dampen some of the tension that had been building.

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

Leadership development

Over the past couple of years, particularly during the omicron surge, we’ve seen an increase in non-clinical staff stepping in to help fill gaps. There are stories of managers running to get blankets, leaders helping empty trash. It’s certainly not happening everywhere or all the time, but more frequently than ever before.

That’s all well and good…but interestingly, our experts noted that it’s not necessarily the best thing. Plugging holes is an important crisis response and it’s great for showing staff that leadership is engaged, willing to do whatever it takes. Even so, there are drawbacks. “Leaders have been rolling up their sleeves and diving in,” Collard noted. “If I’m in that position, it means I’m spending less time leading and more time doing on the unit.”

Reconsidering Compensation

NOT EVERYONE WANTS TO BE A TRAVEL NURSE

— Nurse A 🖤🩺 (@Nurse_Lyss) February 5, 2022

We reference compensation throughout this piece and noted that it’s not always about the money. Two reasons for that:

  • First, the key thing organizations should be providing people with is an environment that attracts them and keeps them engaged. Which, again, isn’t to say that our industry shouldn’t be taking a long hard look at financial compensation.
  • Second, the current money isn’t sustainable – for anyone, but especially rural and independent facilities. The key is remembering that different people want different things, and any given organization can highlight the things it offers that will be attractive to someone, if not everyone.

 

According to Eruptr’s Jennifer O’Meara, hospitals in bigger cities with more competitive markets are relying more on bonuses and the financial incentives, while rural facilities and systems lacking competition but without the financial wherewithal are focusing on the intangibles. Think quality and cost of living. She said that in many recruitment campaigns there’s less emphasis on the standard “great culture” line and “a big push in online campaigns and in discussions about how making this move can be better for your quality of life.”

Cessna

Joel Cessna, Eruptr’s vice president of sales pointed out another example of alternative compensation for rural locations and those that can’t compete financially: creative benefits packages. For example, five weeks of vacation vs. three. “That’s a critical thing nurses are looking for, especially when you think about the exhaustion and burnout today,” he said.

Organizations need to find ways to get leadership out of staffing and back into leading, while equipping them to lead effectively. It’s the management version of practicing at the top of one’s license. It doesn’t mean someone never steps in to do something that isn’t in their job description. It means they’re doing their best so that they can help those in their care and on their team do their best.

“Leadership development becomes really important,” said Damsky. “It’s the thing that falls by the wayside because who has time for it?” There’s a cost when leadership development is put on the back burner and, conversely, a clear benefit when it’s maintained. Damsky mentioned a client who tracks employee engagement against their organizational development work. “They ask questions like, ‘Does my manager make me feel valued?’ and track that against staff turnover. They’re looking for negative correlation,” she said.

Helping staff feel valued involves moving leader rounding beyond checklists and perfunctory appearances. Collard said that it’s training leaders and giving them the space to have relationship-centric conversations. He said, “So when a leader says, ‘How are you doing?’ it means, ‘I’m not just asking, I’m really interested. It’s just me and you right now. How are you? What do you need?’” Collard cited a large medical center where a high-caliber ER nurse quit suddenly. When the team did some digging, they found out she hadn’t left for an agency to make more money. Instead, there were things at home affecting her ability to stay at the hospitals. Per Collard, the nurse executive said, “Oh my gosh, if we’d only known, we could have done something to help her!”

Eventually, healthcare provider organizations will be able to shift some of the focus from the crisis of filling shifts to the long-term structural change that will make staffing far easier. Many had laid such groundwork pre-COVID. And there is an array of remarkable health services companies rolling out software and innovative care models to solve the problem. Artificial intelligence, remote nursing, hospital at home, standardizing meal prep across a system, automated revenue cycle – everything that will put nurses and staff in a position to do what they do best and offload much of the rest.

We’re not there yet, but the foundation is in place and the frame is starting to take shape. In the meantime, provider organizations must step back to ensure that even as they continue the necessary scramble to fill shifts, they’re laying the groundwork. That means giving everyone in the organization permission and practical support to keep going. Starting on Day One.

A Note on Nursing Labor

Nurses unions have been talking about staffing levels and compensation for years. Now, the conversation has come to them. Hospital advocacy groups could push back saying that it didn’t make sense to implement rigid staffing requirements; organizations of different types and sizes and locations needed flexibility. But on the heels of the pandemic, staffing has become a core concern, both among the public and healthcare workers – a point proven by the most recent Jarrard Inc. national survey.

47

The public citing staffing shortages as a top concern

64

Healthcare workers citing staffing shortages as a top concern

In addition, the business side has come to the forefront, and with it a rising skepticism among nurses and staff about the intentions of their employers. Some feel organizations are holding patient care over nurses’ heads while, in the background, pushing the business forward. The response is essentially: “We can’t be the only ones carrying the weight of our mission. If you expect us to be the only mission-driven people, we’ll go travel or organize and strike.” In addition, the employee-manager relationship is starting to ring hollow. Historically, a core argument against organizing is that a union only adds complexity, getting in the way of those direct conversations. But more and more nurses are feeling – or recognizing – that they don’t actually have that relationship and their voice isn’t valued. In that case, they’re not giving anything up by bringing in a third party.

There’s no easy fix for provider organizations. The solution is long term – doing the slow, hard work of engaging employees, giving them a real voice in conversations and training leadership to lead effectively. Before making any statement about valuing nurses’ input or taking any action to ostensibly boost engagement, ask whether the move represents a true, long-term commitment or is simply lip service, an attempt at a quick fix. Worried about organized labor? Give people a way to not need that third party.

Questions about employee engagement? We can help.

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DigitaLee 2: YouTube for Healthcare and Social Media Polls on Twitter and LinkedIn

Orange text that reads "The Digital Future of Healthcare" with smaller text at the bottom saying "DigitaLee with Lee Aase" on a navy blue background

Welcome to DigitaLee: The home of digital and social media for healthcare.

We’ve partnered with Lee Aase, formerly of the Mayo Clinic and Mayo Clinic Social Media Network. He’s joining us every other week to look at the role of digital and social media in healthcare. Each week we’ll look at a news story related to healthcare social media, a digital platform healthcare providers should (or shouldn’t) consider, and a digital tip of the week.

Today we’ve got a story on how doctors use YouTube to connect with patients and work towards health equity, the value of YouTube as a platform for healthcare providers, and for our tip of the day it’s whether hospitals and physician practices should consider using Twitter and LinkedIn polls.

Listen and subscribe to the podcast or read the transcript below.

Read the Transcript

David Shifrin: This is DigitaLee from Jarrard, Phillips, Cate & Hancock. I’m David Shifrin.

Twice a month, we highlight the headlines, platforms and best practices in digital and social media that healthcare organizations need to keep up and –better yet – get ahead. Today, we’ve got a story on using YouTube to connect with patients to work towards health equity, the value of YouTube as a platform for healthcare providers, and for our tip of the day it’s Twitter and LinkedIn polls.

The news theme of the day is from an article in Business Insider. The title was, “This Doctor Says YouTube Is a Crucial Way That She Connects with Patients, Here Is Why.” So, with that clickbait headline, the point is that Dr. Lisa Fitzpatrick works in underserved communities trying to improve access and health equity and has found that YouTube is a powerful tool for approaching that work.

So, Lee, what was your take when you saw YouTube being considered as a platform for health equity?

Lee Aase: Yeah, I think YouTube is a platform for health equity and just general health information for people, because we’re talking about doctors who are the well-respected voice due to the fact that it says MD behind their name. People are trying to sort out: “What should I believe? What should I know?” What I found in my career at Mayo Clinic was that sometimes even the longer videos that were going into more depth on a topic could be among the most valuable ones because they’re really reaching people at their moment of need. They’re giving them that in-depth information that they really need about their condition. Being able to address commonly held questions and beliefs and being able to address them authoritatively is a great, scalable way to reach a lot more people who maybe wouldn’t even come into the doctor’s office regularly. But they find someone with whom they identify, with whom they resonate and can build up some trust. It’s a great way to get some good health messages to people who maybe otherwise wouldn’t darken the door of a medical office.

DS: Let’s keep going with something that you mentioned: The value of in-depth medical information, because that runs a little bit counter to so much of the marketing, communications, social media and digital principles where everybody’s talking about how attention spans are shorter than ever.

Normally, you have to keep it tight. What are you seeing when it comes to “in-depth?” How far can you go with that before you start to lose people?

LA: Yeah. I mean, attention spans are shorter when it’s something like a public health message because it’s something that’s intended for a mass audience. But, when you get a particular kind of sick, that’s all you care about. It’s something that you’d really like to hear about from someone who knows about it. Say, “How do I deal with acne?” or, “How do I deal with some other condition that’s affecting me?” So, the beauty of YouTube is that is the place where people can have essentially unlimited time to follow a bunny trail of information that relates to what they’re interested in, since YouTube also serves up related videos on those topics.

One of the better videos that we had in my Mayo Clinic days was 10 minutes, it was on a particular kind of cancer, a blood cancer, and it got tens of thousands of views. It wasn’t millions of views – it wasn’t funny cat video territory – but it was the right kind of patients or their family members who really had that as an interest to help them to better understand the condition.

DS: So that’s a perfect segue into the second part of this, which is looking at YouTube as a search engine. It’s about not just thinking about YouTube and kind of the news and trends, but also as the platform that we want to focus on here. YouTube is owned by Google, of course, and it is a massive, massive search engine – I believe it’s the second largest in the world.

So, when you’re in it, Lee, you just mentioned the ability to serve up related videos and content to whatever you happen to have pulled up in your initial search. Because it’s such a powerful place for people to go and look for information, what should providers be thinking about in terms of their strategy around using video and YouTube in particular, to make sure that they’re serving up the content that people need where they’re looking for it?

LA: I think one of the keys with YouTube is to be sure that you’re effectively using your titles and your descriptions, putting in captioning as you can, both for accessibility with ADA compliance, but also because it makes it easier. Doing so gives more terms to be found within search – so, titles and tags and descriptions.

It’s important to recognize that it’s the number two search engine owned by the number one search engine. When you’re searching on Google, one of the tabs is “Videos,” and for some things, the first thing that’s going to show up is a video.

It’s often geographically contextualized as well. So, some of the things that may be nearby would show up – there’s some geographic preference with it. I think you just need to be sure that you are not only communicating to humans in the video, but communicating to the algorithm by how you tag, describe and title the videos.

DS: Cool. Okay, thanks. Let’s move on to the tip of the day.

We’re going to switch platforms here and look at LinkedIn and Twitter polls. I’ve been seeing more and more of this. I think maybe it’s died off a little bit over the last couple of months – kind of tail end of the summer of 2021 – but lots of organizations and lots of people have been posting quick polls on LinkedIn and Twitter.

Anecdotally, I’ve seen this coming more from the marketing and businesspeople in my network than from the healthcare provider folks. But that said, I think we all have seen those, and we’ve all probably responded to them. Some of them are goofy, some of them are a little bit more serious.

I guess the simple question is, “Is that a useful tool for healthcare providers to be considering, or is it just yet another social media, digital fad that’s going to be gone in six minutes and we’ll all forget about it?”

LA: It all depends on what you’re trying to accomplish. I’ve seen some people use them for education. For example, where there is actually a right answer to the question and they’ll put up a quiz and then they’ll do a follow-up with the right answer, and then they can use it. That’s the educational perspective.

Now, Twitter does not represent the world, okay? It’s a subset of…

DS: Hold on, hang on, hang on. Whoa. Back up.

LA: Twitter is opinions. It’s especially the opinions of those who are posting. There is a distinct minority of people who do so much of the posting that they aren’t necessarily reflecting the rest of the user base and Twitter users in and of themselves. It’s a distinct subset of the country, of the world. And so, Twitter polls are certainly not a scientific representation of what people really think.

However, probably, you get more engagement among the regular lurkers on social media and on Twitter in a Twitter poll. Because it’s anonymous, people can vote what they really think versus what they are supposed to think. If you reply to a comment, your name can be traced to what you’re saying versus on Twitter the poll, where the responses are anonymous.

I think depending on what you’re trying to accomplish, it can be helpful. I also think that LinkedIn polls are probably more reliable because they’re less susceptible to some kind of an organized, “Okay, somebody put up a poll and I’m gonna torture them with the answer that they didn’t want.”

That has been known to happen definitely on Twitter, for sure.

DS: Alright, I think we’ll call it good there.

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DigitaLee 1: Finding Health Information on Social Media, Clubhouse and Effective Healthcare Social Media Policies

Orange text that reads "The Digital Future of Healthcare" with smaller text at the bottom saying "DigitaLee with Lee Aase" on a navy blue background

Welcome to DigitaLee: The home of digital and social media for healthcare.

We’ve partnered with Lee Aase, formerly of the Mayo Clinic and Mayo Clinic Social Media Network. He’s joining us every other week to look at the role of digital and social media in healthcare. Each week we’ll look at a news story related to healthcare social media, a digital platform healthcare providers should (or shouldn’t) consider, and a digital tip of the week.

Today we’re covering a story about the use of social media for finding health information, an overview of the audio platform Clubhouse, and considerations for how hospitals, health systems, doctor’s offices and health services companies can build a good social media policy.

Listen and subscribe to the podcast or read the transcript below.

Read the Transcript

David Shifrin: This is DigitaLee from Jarrard, Phillips, Cate & Hancock. I’m David Shifrin. This is our first real episode. So, if you stumbled in here and are wondering what it’s about, please check out the intro, episode zero, on whatever platform you’re listening on now. In short, we’ve got Lee Aase, a pioneer in digital and social media for healthcare who just retired from more than two decades at the Mayo Clinic, among other positions. Every other week, Lee and I will review three things: a trend or headline related to digital healthcare, a social media platform, and then a quick tip for healthcare Marcom and digital teams. Today, we’re covering a story about the use of social media for finding health information, an overview of the audio platform, Clubhouse, and considerations for building a good social media policy.

All right. So let’s kick this thing off with our first news story, an article from Forbes saying that one in ten Americans turn to social media for health information. I’m going to bias the conversation a little bit before I kick it over to you, Lee, by saying that I was really surprised that the number was only one in ten, only about 10%. I would have guessed, I don’t know, 40% maybe? But what’s your reaction to the rise of social media as a health information platform?

Lee Aase: Yeah, well, I think you need to put it in context that in the survey of a thousand patients like me, they found only 16% went to traditional news.

So, if you’re only at 16% for traditional news, the fact that you’re at 11% for social media isn’t that far behind. They did see that Google and disease and condition sites like WebMD and Mayoclinic.org, were kind of in that 30%-ish range, 30, 35%.

So, I think the reality is that people don’t go to social media, they go to their friends. It isn’t like social media in general, but they’re looking at what did the people that they connect with on social media have to say? So I think that’s the question: Who do they really trust?

And I think we’ve seen a declining trust in some of the various news outlets that has probably brought that down. I probably would have been predisposed to think it would, that number would be for social media going in, but I think what we’ve kind of just generally seen in society is kind of a breakdown in who your trusted source is.

DS: The participation versus trust gets to another finding in there, where they found only 2% of people actually trust social media. Nine or eleven, depending on which number you’re looking at, go to social media for information, but only 2% trust it. So, that implies that it’s exploratory.

All right. Let’s turn our attention to the platform of the week or whatever we want to call this thing. There’s a new-ish, I guess it’s really not that new at this point, but still, a relatively obscure platform called Clubhouse, which is essentially live audio rooms. And I think it’s become more popular among business types over the last year or so, it’s a different way for folks to engage.

But because we are starting to see more folks bring up the idea of this interactive audio approach rather than either live chats or text-based social media. Should healthcare providers be paying attention to Clubhouse? And if so, why?

LA: Yeah, Clubhouse is a really neat platform. Twitter Spaces is an analogous platform within the Twitter universe. The whole idea behind it is it’s live interactive audio chats that instead of just listening to a recording (for the most part), you’re able to interact directly with people. Compared to regular, old-fashioned Twitter chats where people are texting, where anybody can run into the conversation, they’re much more moderated and orderly. I think there’s been a lot of growth. I think Clubhouse had a good strategy when they made the platform invitation-only at first to give it a more consistent user experience and make it feel somewhat exclusive.

That way, people had to get an invitation to be able to join, and so they perhaps valued it more.

DS: So, my first Gmail address.

LA: Like that! Or, The Facebook back in the day, you know? Because it was somewhat exclusive, it was kind of a cool thing to get an invitation, to be able to participate in it.

I have found for a lot of the same reasons that people use podcasts, and where there’s been this resurgence in podcasts as led by Joe Rogan and then so many others after that, where the fact that you can multi-task by listening and driving is a great advantage. Also, you can listen to a podcast on something of very personal interest and go into it in great depth. Likewise, some of these Clubhouse chats can go on for half an hour, forty-five minutes, maybe even an hour where you’re having a conversation and it’s moderated by leaders who are inviting people in to share their perspective.

So, it isn’t as noisy. It’s got audio, but it’s not as noisy as a Twitter chat where anybody can use the hashtag and jump in with a point.

DS: Should providers be considering using this for, a weekly health chat and getting their physicians out in the world? Or is there relevance for Marcom teams?

LA: I think there’s something to be explored there to at least test it, to see how it works in your particular context. One of the beauties of it is that, unlike Zoom, Facebook Live, or some of the other platforms that include video, there just isn’t as much production.

It can be much more informal. You can just do it with a smartphone because that’s the only way you can do it. You don’t have to be worried about hair and makeup and lighting; you can be focusing much more on the nature of the content of the conversation without having to worry about some of the aesthetics. It’s kind of like video killed the radio star, you know, back in the day.

This is sort of like the radio stars’ revenge.

DS: All right, let’s move on to the final section. We’ll get better titles for each of these sections. Tip of the day. With so much happening around nurses and doctors getting more involved in talking about their field, work, and what they’re seeing within the four walls of their facility, there is much more noise and, frankly, anger on social media, on all sides.

Consequently, it’s a really good time to be evaluating your social media policy.

What are one or two key tips for a good, strong social media policy for a healthcare provider when they’re looking to ensure that their employees are staying in line without stifling the conversation?

LA: I definitely agree with wanting to facilitate it and make it encouraging, and putting up guardrails instead of roadblocks. I think the other one of the other elements is just to make sure that you’re legal with it. A lot of times people will want to put in a policy that says, you can’t say anything bad about our organization online that reflects poorly on us. The National Labor Relations Board has said that concerted efforts and discussions around wages, hours, and working conditions are protected speech and you need to guard people’s ability to do that. So, you have to realize that there will be the good with the bad, but that you can have standards for professionalism and for mutual respect.

That rule applies whether people are on duty or off. I think the other part of it is effective communication of the policy, and that the idea isn’t to be a “Gotcha!” thing. It isn’t, “Oh, good, we can fire you.” It’s, “How do we keep people out of the ditch. How do we keep people from doing things that will reflect poorly on the organization?”

It just isn’t good practice – they get into a heated discussion and they kind of spout off on something. It’s important just to be in front of people, to be giving them guidance with examples of the kinds of things that they can do and should do, then the things that they would be best to avoid. Training and education, I think, are the really key elements.

DS: Alright, well, thanks. First episode, first conversation, in the books.

LA: Magically edited to sound super smart!

DS: You know, that’s what I do.

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

The numbers "2022" in front of a blue background, with the "0" being a magnifying glass with the words "healthcare predictions" in the circle

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dawn Carter

FOUNDER & SENIOR PARTNER

Ascendient

Where do you think the biggest investments will be made?

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

What will be the biggest driver of change for healthcare?

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

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

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

What's the biggest challenge facing healthcare providers?

Dawn Carter

FOUNDER & SENIOR PARTNER

Ascendient

 

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

Eller Kelliher

MANAGING DIRECTOR

Jumpstart Foundry

What's the biggest challenge facing healthcare providers?

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

Where do you think the biggest investments will be made?

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

What will be the biggest driver of change for healthcare?

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

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

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

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

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

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

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

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

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

What's the biggest challenge facing healthcare providers?

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

Where do you think the biggest investments will be made?

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

What will be the biggest driver of change for healthcare?

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

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

Academic health systems and community hospitals.

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

Continued expansion into telehealth, especially in the rural space.

What's the biggest challenge facing healthcare providers?

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

Where do you think the biggest investments will be made?

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

What will be the biggest driver of change for healthcare?

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

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

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

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

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

Jesse Neil

PARTNER

Waller

What's the biggest challenge facing healthcare providers?

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

Where do you think the biggest investments will be made?

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

What will be the biggest driver of change for healthcare?

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

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

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

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

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

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

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

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

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

Shawn Rossi

VICE PRESIDENT OF COMMUNICATION & MEMBER ENGAGEMENT

Mississippi Hospital Association

Where do you think the biggest investments will be made?

Technology – specifically EHR APIs and telehealth

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

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

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

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

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

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

What's the biggest challenge facing healthcare providers?

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

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

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

Where do you think the biggest investments will be made?

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

What will be the biggest driver of change for healthcare?

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

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

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

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

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

Principal

Private Equity

What's the biggest challenge facing healthcare providers?

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

Where do you think the biggest investments will be made?

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

What will be the biggest driver of change for healthcare?

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

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

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

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

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

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

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

Healthcare’s White Glove Service

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How two health services organizations are thinking about customized care

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

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

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

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

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

City

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

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

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

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

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

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

Condliffe

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

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

Mele-Algus

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

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

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

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

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

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

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

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

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

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

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

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

Corum

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

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.

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.