Where CMOs, CNOs and clinical leaders think health systems are headed

Becker's asked health system leaders: Question: What will hospitals and health systems look like in 10 years? What will be different and what will be the same?

The executives featured in this article are all speaking at the Becker's Healthcare 13th Annual Meeting April 3-6, 2023, at the Hyatt Regency in Chicago.
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 If you would like to join as a speaker, contact Mariah Muhammad at mmuhammad@beckershealthcare.com. For more information on sponsorship opportunities, contact Jessica Cole at jcole@beckershealthcare.com.

Jordan Asher, MD. Executive Vice President and Chief Physician Executive of Sentara Healthcare (Norfolk, Va.): The hospital of the future will be a location where you receive high-quality care for situations that cannot be performed in a less acute setting and in a manner that considers a person's holistic health and well-being. Health systems will extend their service offerings beyond clinical care delivered in a hospital to a variety of experiential care delivery methods that can address a person's unique situation and place within their individual health journey. A key differentiator will be the idea of treating not only a person's physiological diseases but also their "dis-eases" of life. Consumers will choose to associate themselves with a health system focused on their entire being in a life-giving and engaging manner.

Andy Anderson, MD. Chief Medical Officer and Chief Quality Officer of RWJBarnabas Health (West Orange, N.J.): In 10 years, health systems will be the best-integrated source of healthcare for patients and communities and have the highest volume of services in the healthcare marketplace. Consumers will align closely with a primary care office as their patient-centered medical home. They will have easy access to a comprehensive array of health and healthcare services ranging from prevention to urgent care, to chronic disease management with specialist care, to elective surgeries and procedures, and to sick care in the hospital setting.

Hospitals will be an integral part of the regional network of services and will be elevated to be centers of excellence for conditions such as cancer, heart disease and orthopedics. Access will be digitally driven, and everyone will have their entire medical record and entire health profile on a single app on their phone.

Paul Coyne, DNP. Senior Vice President and Chief Nurse Executive of Hospital for Special Surgery (New York City): When compared to all of the innovations in healthcare and the world, the hospital room itself has remained relatively unchanged over the last century. We have added much around the experience regarding medical treatments and documentation but have not innovated often on the care experience itself, particularly to assist the provider in having time to care for a patient.

Conversely, in many ways, more tasks, such as charting and managing the numerous new innovative devices have been added to the caregiver's responsibilities in addition to their primary purpose of caring. If the healthcare industry responds to the current challenges optimally over the next 10 years, the focus on innovation will be on the care experience between provider and patient, with administrative burdens lessened and a renewed focus on solutions that improve the care experience for both the patient and the provider.

If we do it right, the care setting will look exactly the same, with fewer wires through streamlined technology and more time to care.

Elham A. Yousef, MD. Vice President, Medical Affairs and Associate Chief Medical Officer of Tampa (Fla.) General Hospital: As I think about the future of hospitals and health systems, I believe we will see healthcare proactively centered on empowering patients and communities around prevention rather than acute care. We will see stronger emphasis on moving healthcare equity, community health, public health, social determinants of health from policies and legislations into actions.

As the vice president of medical affairs and associate chief medical officer at Tampa General Hospital, I see innovation continuing to lead on different fronts. Healthcare delivery settings will continue to grow outside of hospitals, we may see less reliance on hospitals for acute care to include new areas like surgeries. We will continue to see advances in digitized care delivery to improve access, optimize chronic disease management and proactively reaching areas that are traditionally challenging like rural areas. Self-management tools will continue to grow to support people in their health and wellness journey.

Healthcare workforce shortage will force more and more the adoption of new technologies. AI and data analytics will become more precise not just from disease prediction but most importantly disease prevention. Data analytics will enable systems to comfortably take on more risk-based contracts and build risk sharing models. We will continue to see strategic emphasis on maximizing ecosystem values through new business models, more vertical and less horizontal integration, and partnerships, either payer-provider partnership or giant tech partnership.

Electronic healthcare records will become interoperable, enabling data to move wherever the patient moves. My hope is to see systems strategically focused on the overall healthcare economic sustainability, not just the economic growth.

Michelle Winfield-Hanrahan, RN, BSN. Chief Clinical Access Officer and Assistant Vice Chancellor, Access of the University of Arkansas for Medical Services (Fayetteville): When thinking about what hospitals and health systems will look like in the next 10 years, I think of the increased usage of technology and quality driving almost 100 percent of all reimbursement. Many hospitals and health systems today are working towards or looking toward deploying technology that will have a positive impact on the patient's experience or time spent within the system.

Everyone is working on the digital front door, moving more patient-facing encounters virtually or at the patient's fingertips. We are all looking at ways to decrease the dependence on human capital through the use of technology. The thought has been technology helps organizations do more with less, the age-old mantra, and I believe this rings true, but we need to make sure our processes and pathways to care are just as robust as our technology. I anticipate the use of technology will continue to augment or provide care to the patient over the next 10 years, while I envision fewer hospital beds as more healthcare systems move toward non-traditional healthcare models such as hospital at-home and virtual nursing.

As many of us know, healthcare, at times, can be slow to change or adopt processes or procedures to meet the ever-changing healthcare environment, so when I think about what will be different and what will remain the same, my thoughts are that all reimbursement, 100 percent will be based on quality and outcomes, even more so than it is today, prior authorizations will unfortunately still exist and bedside nurses will be able to bill for their time outside of the global hospital fee.

Throughout the pandemic, hospitals, providers, nurses and all ancillary teams were challenged in ways that no one thought possible and we rose to the occasion with really positive outcomes such as greater adoption of virtual care, thinking outside of the box to ensure patients and families were cared for and I challenge all of us to continue to do the same as we embrace the future of care delivery within health systems.

Michele Szkolnicki, MEd, RN, BSN. Senior Vice President and Chief Nursing Officer of Milton S. Hershey (Pa.) Medical Center, Penn State Health: The 'hospital of the future' will be right in our own homes. Several studies show that safe hospital-at-home programs can be delivered if the provider establishes appropriate support structures. These types of services can improve health equity, spotlight patient experience and outcomes, address gaps in staffing and be more cost-effective. In fact, this futuristic model may be closer than we think, given the innovative steps our hospitals already took during the pandemic, such as digital communications and video calls.

For example, this year, Penn State Health expanded its at-home care through a virtual ICU, refining the delivery of virtual nursing and physician services to some of our most critical patients. Data also shows that, unfortunately, many patients leave hospitals more disabled than when they arrived due to a lack of mobility. Most hospital rooms are set up to make a patient become more infirm, with their bed being the central feature around which care revolves. At-home care is more comfortable for the patient. They are surrounded and supported by family and friends. In addition, they are more involved in their own care. These factors impact morale, emotional well-being and independence, which all promote healing.

While brick-and-mortar hospitals will continue to exist, they will be dedicated to high-level services (critical care or surgery) and wellness (hospital-at-home administrative teams and programs that help keep people healthy). At-home care efforts will free up physical space and reduce bed shortages.

Stephen Hoang, MD. Pediatric Anesthesiologist, Medication Safety Officer of Children's Health System of Texas (Dallas): In 10 years, healthcare will continue to be a complex and dynamic environment, but with some evident trends in hospitals and health systems. There will be more patients; more innovation is driven by competition and increasing costs, as well as the number of uninsured. There will be more advanced technology, particularly in the areas of automation, artificial intelligence, and data intelligence. These advances will be applied in areas such as patient monitoring, imaging, the medication use system, and the patient experience.

Other applications include clinical staffing algorithms, management of drugs and medical supplies inventory/shortages, and bed control. There will be more mergers and acquisitions and continued development of centers of excellence in clinical specialization and more centralized research hubs.

On the other hand, there will still be challenges in the retention of practitioners and staff as personal well-being, competitive compensation/benefits, and work-life balance continue to be top priorities for care team members. Finally, as different care delivery models evolve and become more refined, central to their success will still be value-based care, with the patient as the ultimate consumer.

Christopher McLarty. Associate Vice President and Chief Nursing Officer of the University of Texas Southwestern Medical Center (Dallas): We are seeing today and I expect we will see even more in the future, the evolution and expansion of the integrated ambulatory practice as an increasingly critical component to care delivery. This includes coordinated fundamental elements such as primary and specialty care, as well as more accessible health system entry points and embedded ancillary services, all closer to the patient and their families within the community. I also expect we'll see increasing opportunity for outpatient management of acute illness and recovery, as new technology and care innovation creates broader opportunity for disseminated care and shorter acute inpatient stays.

Ruchi Garg, MD. National Program Director, Gynecologic Oncology, Comprehensive Care and Research Center of Cancer Treatment Centers of America (Boca Raton, Fla.): Ten years from now, I hope for a move towards utopia in the healthcare system — an understanding on the part of practitioners and the system as to what the patient is going through and, in reverse, an understanding from the patients that the providers and the system are made up of human beings who have their own life ongoing as well. To accomplish that, I believe much of the care will shift from in-house to outpatient in the community/workplace and at individual homes. Much will be done through artificial intelligence and automation and remote monitoring. Value-based care would be prominent due to automation and algorithms. Further discussion and plans need to be made for health insurance and litigations. I hope the practitioners will actually take over the administrative aspect of medicine as well, and of course, more are doing so already.

Kenneth Altman, MD, PhD, FACS, Chair, Department of Otolaryngology, Head and Neck Surgery of Geisinger (Danville, Pa.): It's exciting to envision the future. Still, events over the last three years certainly emphasize its pitfalls. We all dream about the amorphous AI along with associated controversies, but a more practical vision is the transformation of the EHR from a documentation, billing and data repository tool to a primary role in decision support emphasizing clinical best practice.

Care pathways are still in their infancy as linear order sets, and these will develop into complex decision trees with nodes that address the relative risk and effectiveness of medical interventions. Greater integration between health systems is likely to follow, which we're already starting to see with Epic's Care Everywhere. Recognizing the importance of human capital will be another milestone, developing the workforce to take advantage of staffing for growth, innovation and team building.

I also believe that as we're moving some services outside the hospital, the bricks and mortar medical centers will still be critical pieces of the care delivery continuum, given forces like our recent pandemics, the growing needs of the aging population, and continued technological advances enabling more complex care interventions. Although we're living with unusual financial constraints, the time to invest in the inevitable future is now.

David Kalainov, MD. Clinical Professor of Orthopedic Surgery of of Northwestern University Feinberg School of Medicine (Evanston, Ill.): The U.S. healthcare system pushes toward value-based care and away from fee-for-service care to improve quality and control costs will lead to further consolidation and integration of hospitals (and clinicians) in 10 years. Large organizations will permit improved economies of scale in staffing, purchasing, and payer contracting. Quality measures for hospital accreditation, ratings, and value-based payment models will continue to evolve and the payment systems and payment programs defined by Medicare will simplify. As costs continue to rise, hospitals and healthcare systems will employ more advanced practice providers, further consolidate administrative functions, and pursue new technologies to help with patient monitoring and care both in the hospital and at home. The human qualities of compassion and service to others will not change.

Chad M. Teven, MD. Plastic Surgeon, Microsurgeon of Northwestern Medicine (Chicago); Clinical Assistant Professor of Surgery of Northwestern University Feinberg School of Medicine (Chicago): While the precision and accuracy with which we can forecast diminish the farther into the future we go, one thing for certain is that hospitals and health systems will look significantly different in many ways than they do currently. First, while hospitals will still be necessary for the delivery of complex care (e.g., organ transplantation), a greater proportion of health management will occur outside the hospital (e.g., prevention and management of chronic conditions).

Health systems will need to innovate and incorporate smart ecosystems, technology, and digital infrastructures to do this effectively. In addition, greater emphasis will be placed on the patient experience, both within hospital walls and outside of them. Human-centric care that aims to improve the wellness of both patients and staff, for example, will receive increasing attention moving forward.

Trishul Kapoor, MD. Fellow, Department of Anesthesiology of University of Michigan Medicine (Ann Arbor): In 10 years, hospitals and health systems will evolve tremendously. First, there will be a drastic shift in digital health integration with disruptive and innovative care delivery mechanisms. Although I am confident in a shift in the mindset of hospital leadership, I am hopeful there will also be a greater appetite for collaborative partnerships outside of a hospital and health system. Our greatest potential for impactful and transformative change will arise from lessons outside of our immediate environment.

Second, I believe hospitals and health systems will invest more aggressively in innovation through venture capital constructs or in-house accelerator programs. It will be necessary for hospitals and health systems to create additional opportunities for revenue in efforts to pursue enterprise growth outside of a capitation model, especially considering the impending implementation of evolving risk-adjusted payment programs focused on unclear concepts of value and performance.

Third, in the setting of generational shifts in patient populations, patients will expect a greater degree of communication and transparency than ever before. Hospitals and health systems must adapt to this cultural shift within the clinical ecosystem.


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