In a conversation with Becker’s, COO Paul Hinchey, MD, discussed these efforts as well as other strategic moves at the organization.
Editor’s note: Responses were lightly edited for length and clarity.
Question: How does University Hospitals plan to create value through customer experience in 2025, and what strategies will be prioritized to ensure patient interactions are seamless and compassionate across all care settings?
Dr. Paul Hinchey: Knowing that patients have a lot of choice and can move between systems — at least in our market — with very low switching costs, we want to double down on changing the patient experience.
We try not to ascribe certain desires to patients without knowing in detail what they want. We aim to offer as much choice as possible. As we engage with patients, we think about it on four axes. One is time. If patients value time, we want to ensure they can access primary care or a specialist quickly and conveniently.
Second, geography. Some patients value being closer over saving time. Third, fidelity to the doctor. If I recommend a specific neurologist or neurosurgeon, some patients won’t go anywhere else. They’ll wait or drive farther to see that doctor. We want to honor that fidelity.
The fourth is modality. Do they want an in-office visit, a virtual visit or something else? We’re trying to meet consumers where they are by offering as much choice as possible.
Everyone has a consistent experience at places like Disney or Ritz-Carlton, or whatever service excellence company they admire. We need to deliver that same level of experience. We’re scripting interactions for our caregivers and doubling down on team training.
Some of it involves scripting. How do you make eye contact? How do you say hello? How do you thank patients for coming to UH? By being prescriptive, we help our front-line caregivers focus on meaningful interactions with patients.
We’re also reframing for them. There’s an inherent power imbalance when someone interacts with the gatekeeper to their doctor. We want to empower our people to solve problems. Healthcare is complex and difficult to navigate. We want our staff focused on solution-oriented design and empowered to solve problems for patients.
Q: Can you share how UH plans to manage value through risk-based strategies in 2025? Are there any innovative approaches you’re considering to balance financial sustainability with high-quality care delivery?
PH: We have invested for years in the concept of value-based care. There’s been a lot of debate on when it’s coming, if it’s coming. I personally think there are economic and environmental pressures with the new administration, employers and the government trying to get costs down. There will be more pressure to move to a value space.
We’ve invested in capabilities for years: population health management, aggressive screening and navigation. As we look at risk-bearing, whether we think we’ll need to take more downside risk, we believe we’re prepared. To capitalize on the risk-based models out there, we will need to take more downside.
I’m not saying we’ll move to a fully capitated model, but certainly more downside. In terms of innovation, some of it is managing what you can manage. Our biggest challenge in any value-based program is the uncontrolled part: patient behavior.
While patients are in our care, and we have our arms around them, we can control that environment. The challenge arises in patient behavior once they leave, and figuring out how to manage that.
We’ve focused on steering them to the right side of care or managing the complex series of things that need to happen after discharge. We’ve doubled down on helping patients in the spaces in between.
It goes to our access piece. We want timely access and as many touchpoints as possible. For example, we partnered with WellStreet to expand urgent care. We knew we couldn’t grow those fast enough, so we partnered with them.
We’ve used Epic to increase connectivity with patients, adding touchpoints and engaging them in scheduling and clinic access. The goal is to create as many touchpoints as possible.
The rationale is that if patients can access a lower-cost, familiar site of care, it reduces contact with higher-cost points like the emergency department, which risks admission and higher costs.
We focus on access in the post-acute space. When we send someone home, we spend significant effort on navigation and transitioning them safely. That’s especially important as we optimize length of stay. A robust post-acute process lowers readmission risk.
In the same navigation space, we’ve bundled tele-support services. With labor shortages, we use telemedicine to support discharge functions, like navigators or transitional care coordinators, and facilitate follow-up visits at home.
We have transitional care and chronic care management programs but are also using nontraditional providers and interventions to manage patients at home.
Hospital at home didn’t work well for us — we struggled with provider buy-in. But we’ve had great success with Healthy at Home, which includes remote patient monitoring. We identify high-risk patients, keep them in the program, ensure they adhere to medications, receive durable medical equipment and make follow-ups.
We’ve invested significantly in managing patients in the post-acute space.
Lastly, we’re exploring different providers, like health coaches or community health workers.
We also have an extensive EMS collaboration, using paramedics for home visits at lower cost points to help navigate patients safely through the system.
How will UH continue expanding its Systems of Care operational model in 2025, and what lessons have you learned from implementing it in heart, vascular and cancer care that could be applied to other service lines?
PH: We started with an institute model for cardiovascular, cancer, and women and children’s services. When we introduced Systems of Care, we went across 72 different services, specialties and subspecialties and aggregated them into systems of care.
One thing we learned was that acute care services — like hospital-based services, anesthesia, trauma, general acute care surgery, hospital medicine and emergency medicine — are unique enough that we carved them out and managed them separately, rather than leading them in a systems-of-care model.
The reasoning behind Systems of Care was two-fold. First, we wanted to move away from a site-of-service-based operating model. Like most traditional health systems, we were focused on what individual hospitals or clinics did, but that’s not how patients experience the care journey.
Patients encounter different specialties and providers along the way. The site of service is less important. We wanted to align our thinking with the patient care journey and ask service line leaders to think across the entire system — how patients enter a given path and navigate across specialties and subspecialties.
By design, we created a decision-making architecture that’s agnostic to the site of service and allows us to design processes around the patient care journey. We rolled it out across the full spectrum, so there are no new rollouts to do.
In terms of lessons learned, we had to swing the pendulum pretty far to shift our thinking and mindset. Now, we’re adding more structure around site-of-service design, rethinking what needs to be retained locally, and defining decision rights. I think we’re starting to refine the matrix — maintaining connectivity and strategic planning across all markets from a service line perspective.
We’re also creating a vehicle where all sites of service can support the strategy of the given service provider. Overall, we’re happy with how it’s rolled out.
Q: How do you ensure UH remains focused on patient-centered outcomes while navigating reimbursement models and financial pressures in the year ahead?
PH: I worry sometimes that when we frame conversations with colleagues or leaders about being mindful of finances and being cost-conscious, it’s equated with cost-cutting being the same as cutting corners.
We’re trying to reframe that. Like most health systems, we’ve been looking at costs intensively and have addressed the low-hanging fruit. We’ve optimized leadership structure and reduced overhead burden to some extent.
We’ve always been extremely patient-centered and take great pride in being both patient-centered and community-focused in delivering care.
What we’re learning is that we’re facing downward pressure on revenue from all corners: the feds, pharma, health plans and employers. To maintain margin, we don’t have much choice but to go after costs.
In medicine, there are many opportunities to address costs. I’m proud to have been an ED doctor, but we often do things out of tradition or how we were taught. Medicine is hard, and doctors and providers process a massive amount of information. The heuristics they develop become rote, which helps manage that information.
But embedded in those habits is legacy thinking or practices with little evidence-based backing that drive costs. For example, during the IV fluid shortage, I would never have identified a cost opportunity in IV fluids. Yet when supply chain issues affected IV fluid availability, everyone figured out how to use less. We cut utilization by 50% simply by shifting to evidence-based medicine, being thoughtful about who needs an IV, and using oral hydration where appropriate.
Admittedly, it’s not big dollars, but it forces you to realize we do many things in medicine because of habit. There are significant savings in physician preference items and standardizing protocols. Variation is cost.
We also need to bring technology into this. How do we create decision support, improved scheduling, and processes requiring less labor by automating mundane tasks?
Everyone’s talking about AI, but whether through AI or another technology, there are opportunities to cut costs while improving care quality and being more evidence-based.
It will take discipline and significant effort because these aren’t easy fixes. They’re much harder to achieve.
