The most pressing issues facing health systems in 2021

The COVID-19 pandemic has presented challenges for hospitals and health systems across the country this year, and many hospital executives are planning for new challenges next year. 

The top issues facing health systems in 2021 was the main topic discussed during a session at the Becker's Healthcare CEO + CFO Virtual Event on Nov. 9. The following three healthcare executives shared their insights during the panel discussion: 

  • Ruth Williams-Brinkley, regional president for Oakland, Calif.-based Kaiser Permanente
  • Paul A. King, president and CEO of Palo Alto, Calif.-based Stanford Children's Health 
  • Stephen Rosenthal, senior vice president of population health management at New York City-based Montefiore 

Here's an excerpt from the conversation, edited for clarity. To view the full session on-demand, click here

Question: What are the most pressing issues facing health systems in 2021? 

Stephen Rosenthal: Traditionally, many organizations go through a strategic planning process very often. And what we've decided to do as an organization is to do more of a strategic action process for moving forward into the future, thinking through where are the opportunities and what have we learned from our experiences in this horrible battle that we've been going through with this virus. I think what we've learned is that we need to be creative and we need to be different. We need to be disruptive. And of course, we need to make money. In our market, the Montefiore Health System is disproportionately government programs. Government programs, as you can imagine with the dollars that we've spent through the CARES Act and other benefits that have gone to the public overall, the governments, both state and federal are not necessarily flush with the opportunity to help institutions financially on a going forward basis. So how can we be creative?

We've engaged the management of our large system to work with a well-known consulting firm to develop a process where we can identify opportunities, short-term opportunities, where we can have an impact tomorrow. Somewhat longer where it'll take a week or two, and then somewhat a lot longer than that, where it'll take a period of time beyond the few weeks. I use a week or two as a metaphor for very short, a little less than short, and then a little longer. And so we've been challenging ourselves and thinking through those key elements of what makes a delivery system important to the population that is services. And the key piece that comes out of this is that we have to focus on the patient. This is a significant change in many arenas within healthcare. We've not been the best at customer service and we're learning from other industries and we need to focus on the needs of the patient.

I think the advancement in technology platforms, particularly with telemedicine, have given us unique opportunities to reach individuals just like today, having multiple conferences in a digital format where we can meet and reach thousands of individuals quickly and inexpensively and with information that can be useful. We've been very focused on the patient. What do the patients need? Bringing things more to the patient versus making patients come to us. Thinking about those elements within a population health strategy that drive costs and challenges for the populations that we service. So dealing with issues around chronic illness, using technology for remote monitoring, bringing tools to the patients so that we can give them the benefits of our knowledge much more rapidly, much more efficiently, and begin to think about the fact that we can continue to add more and more resources from a people standpoint in our industry, but rather begin to use technology as a leveling tool to get closer to those individuals that are out there.

And then begin to actually look at the data and begin to use data to drive our decision-making so that we've got a reference point that we can measure our success against and become a little bit more didactic in that behavior that perhaps we haven't always done within the overall healthcare arena. We've become a lot more thoughtful about the process that we're going through, and beginning to think more and more about where we can interact with those individuals that can have the most benefit.

One of the last things that we're struggling with is how do you begin to interact with the payers, the insurance companies and the government, and how do we begin to help and or work with them to bridge some of the challenges that have been historically in place between providers and insurance companies, and begin to think about new ways of working together. Value-based contracting has been an important piece in the past. Going forward into the future, perhaps it needs to be a little bit more focused on opportunity versus just trying to create savings through the avoidance of certain services. And beginning to think more creatively about what we can do to segments of the population where we can have a greater impact over time.

Healthcare systems don't change, they don't move away, they stay in the communities they serve. Maybe they expand, but insurance companies and patients move in and out of products but we're always in the same place. And so we need to begin to think about how we can benefit from those relationships. And it's not been an easy connection or relationship between health systems and insurance companies in the past, and we need to think creatively about the future.

Ruth Williams-Brinkley: I thought about five issues that I think are the things that I see coming forward. First of all, you couldn't get away with not talking about the virus. It is here and it's impacted every aspect of our lives. So these are not in any particular order, but I think that would probably be number one.

Number two is health equity. We really are struggling in this country with health equity and the virus has really made it very clear that that's a struggle for us as a country, as an industry, because we find those people who are designated as essential workers, having struggled and people of color have struggled through this virus more than others. And so I would say health equity. And so we need to figure out a way to provide access to people and provide them with healthcare and with access to their social needs as well. Because many of the things that end up as health needs, start out as social needs: housing, food, safety. And because of the pandemic and really before the pandemic, I think the pandemic has exacerbated the issue. We're seeing people with not enough food, people who can't pay their rent and then landlords who can't make their mortgages in many cases, because they're not getting the rents. That's a problem and people are just fearful of basic needs and fearful of meeting their basic needs and the needs of their families.

The third thing I would look at would be what I'm going to talk about called healthcare worker safety. We have our healthcare workers, physicians, nurses, therapists, and others who work in the healthcare environment, and we certainly need to protect them. All of our providers are doing everything we can to protect our healthcare workers, physically protect them because as we've seen and read more recently in the last few days, weeks that the virus is resurging again. And so helping people with physical safety, but I would also include a psychological and emotional safety for our healthcare workers. There's tremendous stress and tremendous strain on workers as they deal with the illness, the sickness and the debts and protecting themselves. 

The fourth thing I would say is just mental health for everyone. People are isolated. They're worried about the things I mentioned earlier, the social and psychological needs of how they're going to take care of their children, especially parents who are trying to do their job and at the same time try to be homeschoolers and educate their children. Their children are old enough for school but now they're at home. If their children are going to school, they are worried if they're safe physically and psychologically. 

The other issue I would say is my fifth issue is the need to expand our technology, particularly virtual health, telehealth. It's here. We have to figure out how to use it. Not only for the pandemic, but we need to build a technology infrastructure so that we have what we need to see patients in their home, who don't need to go to a physical location. 

Paul King: When I think about the assignment we were given in terms of talking about those issues most pressing for health systems, certainly COVID overrides pretty much everything that we've talked about. I think all of the five areas of focus that Ruth just shared have an overlay of COVID sort of shadowing over them. How do we actually plan for the unknown? I think there are many things around COVID that are ripe for lessons learned, and we certainly have many of those here at Stanford.

What I had jotted down in terms of thoughts, were primarily focused on COVID. But when you think about coming up above the fray, because we could spend all day talking about the different aspects of COVID, but I think COVID is the implication for the overall economy, as well as healthcare reform. We've just come through a fairly active political season. And we know that regardless of how that settles out over time, healthcare reform is going to be something that all of us are going to have to deal with very directly. 

Getting back to COVID, some of the initial cases were reported more on the West coast, in the Seattle and in Northern California areas. So our early experience with that led us to take some actions in terms of standing up testing, as well as implementing some of the first shelter in place orders that have now become all too common across the country.

As we look at how do we keep, and to your point, Ruth, worker safety and quite frankly community safety, all of those issues remain first and foremost in our thoughts as we look at 2021. I think the fatigue that our staff is beginning to feel, and that gets to your mental health concerns, Ruth, and just their fatigue. They've been on edge for so long that it's pretty tough to keep that level of diligence just continued month after month after month. So we're trying to make sure that our staff stays safe.

We had some concerns early on in the pandemic around whether or not we had sufficient PPE. I know that's a spotty question across the country, but here, at least in our health system, we've been able to sustain our resources to not only keep our patients safe, but also our caregivers who are charged with caring for them. As we think through the implications of COVID going forward, earlier and the pandemic when we were all asked to stand down our non-urgent cases back in March and April, that had a devastating impact on us in terms of our volume, as well as our revenue. 

Now, the good news is by late May we began to see some recovery. Through the summer, we saw our volumes return to the point that where we are currently, we're back to almost pre-COVID level of activity in our inpatient and outpatient areas. The couple of areas that have been slow to return have been the emergency department as well as some of our primary care areas. But overall top line, I think we've been able to return back to some sense of our normal volumes. Now, how long that will last we don't know, as we are in the midst of what appears to be a third wave currently, as we look at the number of increasing cases in hospitalizations across the country. Those impacts are different I know in different markets, but as a country, I know that we're dealing with what appears to be another surge in activity.

Not knowing how that's going to play out, particularly in the same area as we are dealing with potential flu, we are cautious in terms of our ability to remain safe in terms for our patients and their families, but also for our staff. That's something we have to keep a close eye on.

It's been with us for 400 years, but there's more of a recognition that we have to do something around racial injustice. And I don't think that those issues are inseparable as we also try to deal with the virus, because I think those inequities that we see within healthcare also are at play there as well. I think that has impacts for how we address COVID quite frankly, and what we do with our workforce. 

From a technology standpoint, I think Ruth and Stephen both mentioned the significant uptake in terms of virtual visits. We saw that we went from pretty much zero to close to 80 percent of our visits being provided virtually. If you had told us that we had to stand up 80 percent of our outpatient visits to be virtual in less than a week, I would have told you that would be impossible. Impossible has now been redefined during this era of COVID. Things that we didn't think were possible, absolutely happened. If we were looking back over the past year just to articulate and to catalog those things that we were able to accomplish, if those were our goals in our incentive plans, I think we would be accused of being insane to assume those things. But with retrospect, I think we've been a pretty amazing industry looking back.

The other challenge that I think we're going to have in 2021 is really making the case for healthcare. I think as the country looks at the significant challenges that we're having across all industries and we know firsthand what's going on in healthcare, but it's a hard story to explain to people who are not in the industry. Predictably for our small businesses who are suffering in terms of literally being out of business, and I think as we look at the significant impacts, we've seen economically on our financial health, it's all relative, but I think that's going to be a story still yet to be told in the coming year, particularly in 2021. 

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