What worries hospital CEOs at night? 4 chiefs tell us

A number of questions keep hospital and health system executives up at night. While they strive to manage the health of larger populations, they also drive the culture that makes their organization a positive workplace for individual physicians and employees. This is just one dual demand that can make a CEO toss and turn.

At the Becker's Hospital Review 4th Annual CEO + CFO/CIO Roundtable, four healthcare leaders discussed a few of these challenges and opportunities.

How to execute a population health strategy
Taking care of patients is no longer enough for health systems. Executives now must also focus on the health of the population.

"Population health involves managing a challenging population," said Larry Kaiser, MD, dean, CEO and senior executive vice president of Philadelphia-based Temple University Health System. For his organization, working on population health means working in the largest city without a public healthcare system. To meet this challenge, Temple is setting up urgent care centers in the community to keep people out of the emergency room.

Memphis, Tenn.-based Methodist South Hospital is confronting population health in a different way: by focusing on behavioral health. "If you're not doing behavioral health, you can't be doing population health," said CEO James Robinson III, PsyD. Methodist South Hospital has created a behavioral health service line and is deliberately focusing on patients' individual needs to direct them to the correct services. Though it's still in the formative stages and growing, the hospital also has an ACO.

Other executives are not as keen on population health management. "I've been a skeptic of population health for a decade," said Emad Rizk, MD, president and CEO of Chicago-based Accretive Health. Instead, Dr. Rizk likes the medical home model, which he believes takes on a more structured, team-focused approach. "As we're putting doctors in leadership positions, we also put teams around the medical home and give them retrospective data from payers," he said.

How to support a stable, positive physician culture
It's difficult to craft the ideal culture at a hospital. Keeping employees in the loop and dealing with competing forces are just a few of the issues health systems face when confronted with managing culture.

Physician alignment is key to creating an improved hospital culture. "The alignment between hospitals and physicians will become extremely important," said Dr. Kaiser, especially with the rise of bundled payments and programs like CMS' Comprehensive Care for Joint Replacement Model. "In terms of employed doctors, 40 percent are fully employed and 80 percent have a relationship where they receive some type of compensation. I think we're going to see more and more physicians becoming aligned, whether it's fully employed or another model." Physician leadership opportunities can then help confront the challenge of physician alignment.

But employment isn't a silver bullet. "Employment doesn't necessarily equal alignment," said Dennis Swan, president and CEO of East Lansing, Mich.-based Sparrow Health System.

On paper, a system may have a robust team of employed physicians, but cultural alignment is not as simple to quantify. Perhaps there is a lack of confidence and trust between physicians and hospital administration, or too many changes and decisions are made without physician input. Physicians may not receive meaningful feedback or recognition. Physician champions are also incredibly important. Without physician advocates leading initiatives, apathy can quickly take hold. These are all problems executives are working to prevent.

"We really want to have physicians leading physicians," he said. Dr. Robinson said, citing Methodist South Hospital's model of a physician leadership academy, in addition to nursing and management academies.

Other late-night worries
No matter how many opportunities are met, hospital and health system executives still face challenges that feel insurmountable.

"Numerous things keep me up at night," said Dr. Robinson. Of his many concerns, Dr. Robinson highlighted one key factor: people issues. "I worry that the staff will not do what's expected of them and make good decisions when no one's looking," he says.

Dr. Rizk agreed. "People are obviously a very important component of what keeps me up," he said. "But what I'm mostly concerned about is capabilities of providers taking on this risk." Although providers are moving toward value-based payment models, Dr. Rizk is concerned about the infrastructure needed to thrive under a new finance model as well as the competencies of payers.

For Dr. Kaiser, it's not people issues that keep him up at night; it's his English Springer Spaniel, he joked. Healthcare-wise, however, he worries about the future of academic medicine. Especially in the Philadelphia market, determining whether it's wise to consolidate plays a key role in the future of AMCs. "With the evolution of healthcare and how it's financed, the role of the AMC is going to change," he said. "In my own market, consolidation is something that is huge. It's important to consider whether or not we should form a larger system and how large it should be."

Mr. Swan's late night worries regard the culture of his organization and the industry. Specifically, he worries about talent acquisition, retention and development. "We constantly work on the cultural aspect of what's going on," Mr. Swan said. "It's a never-ending journey."

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