As Roxanna Gapstur, PhD, RN, prepares to retire as president and CEO of York, Pa.-based WellSpan Health, she points to whether to expand beyond South Central Pennsylvania as one of the most challenging strategic decisions of her tenure.
That move took shape in July 2024, when WellSpan added 131-bed Evangelical Community Hospital in Lewisburg, Pa., as its ninth hospital and established a North Region. The addition brought the previously independent hospital and its network of care in the Susquehanna River Valley into WellSpan, contributing to the system’s expansion from five counties to 12.
Since Dr. Gapstur became CEO in January 2019, WellSpan has grown from eight to 12 hospitals, increased its annual revenue from $2.5 billion to $4.7 billion and expanded its patient base from about 630,000 to more than 1 million, according to the system.
Dr. Gapstur, who announced plans to retire in April, is set to step down in January, when Laureen Driscoll, MSN, RN, currently CEO of Providence’s South Division, will succeed her. With about eight weeks left in the role, Dr. Gapstur spoke with Becker’s about the thinking behind WellSpan’s expansion and neighborhood hospitals, results from clinical AI, balancing culture with financial performance and the advice she would give healthcare CEOs in 2027.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: WellSpan grew significantly during your tenure. What was one of the most challenging strategic decisions behind that growth?
Dr. Roxanna Gapstur: A challenging strategic decision for us was whether we should move out of South Central Pennsylvania, and if we did, what would be the strategic reason for that. In the end, we decided, along with our board, that it would be a very important growth step for us, for a few reasons.
First, we thought there would be additional growth for WellSpan over the years, both in that region and potentially to the west of there. Second, we felt that the care we were providing in our communities, whether rural, semi-urban or urban, was an essential part of the fabric of Central Pennsylvania, and we believed offering that to more patients in more counties was an important part of our mission. So we established that foothold in the north, and that has been a really good decision for us. As you know, we’ve moved from five counties to 12 counties and to over a million people, and we are now touching nearly every part of Central Pennsylvania with the WellSpan care system.
Q: WellSpan has also invested in neighborhood hospitals. What have you learned about where that model works and what results stand out?
RG: The neighborhood hospitals are one example of the vast ambulatory network we’ve established across our region. At times when people weren’t even talking about ambulatory networks, we were building ours, so we have a network of ambulatory surgery centers and ambulatory sites that is very extensive for a system our size. We thought these neighborhood hospitals would be an incredible complement to the network we’d already built, as a smaller, easily accessible and more affordable way for patients to access care right in their neighborhood.
Those hospitals were very strategically placed across our footprint, both to help patients who were driving longer to get to an acute care hospital and as a way to bring patients into the specialty network we have across WellSpan’s region. I would say our neighborhood hospitals are some of the busiest in the nation by benchmark. So where we placed them were very good strategic areas with a need for additional services, and the acuity at our neighborhood hospitals is higher than at most other neighborhood hospitals. We really see a need for that kind of care, and they have done exactly what we hoped they would do: improve the patient experience, offer an easier access point for patients and families, and create a more affordable option than showing up at our level 1 trauma center, as an example. For us, it has been a gain in market share, but also a real patient satisfier in this region in terms of access.
We are ahead of pro forma by over 100% at nearly all our sites. One of the data points that speaks most to me is also the acuity. The number of transfers we’ve gotten and the growth in our other hospitals because of that neighborhood strategy has been exceptional. It’s been incredible work and a great strategy for us, in particular in this region and in these markets, and we’re really looking forward to considering how that model might play out in other parts of our region.
Q: WellSpan has scaled AI across several areas. Where are you seeing the clearest results?
RG: We will be releasing our innovation impact report this fall as another proof point. We were early adopters of technology, so the people, process, technology mantra and workflow have been really important to us. We decided more than six years ago that assisting, elevating and accelerating our strategy through the use of technology was going to be an important part of our strategy. We have done that at scale in multiple areas and probably have the longest-running ROI of several organizations.
We were the second organization in the United States to adopt ambient listening, back in 2020 during the pandemic, as a way to help offload our team members, physicians and APPs. That is an area where we have more than six years of ROI. In all of our AI deployments, we have seen anywhere from 2.4 to six times ROI.
We also have our AI in radiology deployment with Aidoc. We’ve scaled all 18 modules, and it’s getting close to 2 million scans a year now. Our radiologists use it at scale in all of their workflows, and that partnership has been at least five years now. And our call center with agents has scaled to more than 3 million patient interactions. Again, that’s terrific ROI, and the workflow is smoother.
I’m sure you’ve heard from many CEOs that layering AI on top of broken processes doesn’t work, because the process is still broken. We certainly know that from working six years in deployment, and we generally don’t take that approach with our AI platforms. First, we’re looking for platforms, not point solutions. Second, we’re looking to transform the workflow end to end versus layering AI on top of it.
Q: What else would you tell peers who are looking at their own pilots or moving further into the space, including agentic AI?
RG: I would add that there are many new skill sets your team needs to understand and learn to be a good scaler of AI. The first is governance and how you make those decisions. That can include everything from IT to cybersecurity, whether it fits with your strategy and what the total cost of ownership is. Then you also have to understand how you will manage quality and safety, how you will look for drift and who is responsible. With our agents, who is the supervisor of that agent? Is it a technical supervisor? Is there a human supervisor? And when you have a team of agents and humans, how does that team work together?
We have a robotic food kitchen as well, where we’ve deployed at scale a robot that makes hot meals 24 hours a day in one of our hospitals. That’s another example of a team that has humans and robots, with AI in it. This idea that teams will become more than just human teams in the coming years is something we’ve spent a lot of time on and learned a lot about. We’ve even talked about it with some of our bigger tech partners, because everyone is trying to learn quickly how those teams can work best together.
Q: How do you balance culture with financial performance when the two may pull in different directions?
RG: We start with the why and the context and environment with our teams, sharing with them the challenges in healthcare today. What are the policy decisions that have been made? What does reimbursement look like? What does inflation look like? We give them that why and that context: why we need to care about this and why we need to focus on it.
What we’ve tried to do here is use our value of “find a better way,” and also our stewardship process, which we’ve had for six years now, to let people know this needs to be part of our daily work. How do we use our resources in the best way possible and protect our community’s assets? We do that by being diligent and conscientious about stewardship every day of the week. It’s not a special thing. We don’t just talk about stewardship once a year if we have to make a reduction somewhere.
Stewardship for us is two-pronged: driving more revenue and managing our expenses, and we’re constantly balancing those two factors. Sometimes two things can be true at the same time. We might need to invest more in, let’s say, cybersecurity, or add resources in a certain area, while another area isn’t as critical to our strategy right now, and we may decrease resources there. It’s a constant balancing act, and I hope our teams have learned over the last six years that this is how we’re going to balance the ship going forward.
Q: What advice would you give a CEO stepping into a system like WellSpan in 2027?
RG: For any CEO stepping into the role right now, I would say being a continuous learner is really important. Things are changing quickly. So make sure you’re continuously engaging with the environment and with your teams to understand those changes as they come along.
Part of our role as CEO has always been looking around corners to see what’s coming next, and I’ve taken that part of my role very seriously. I think it’s about continuing to hone your skills at looking around the corner, seeing which signals speak most to you as a CEO and understanding how you’re going to steer your team and the strategy. For me personally, one of the most challenging parts of being a CEO is making sure I’m five steps ahead of the team as they’re doing their work and I’m directing and leading in a certain direction. That has become more challenging over the last couple of years because things are changing so quickly.
Q: Looking three to five years ahead, what gives you the most hope for healthcare’s future?
RG: I have firmly believed for quite some time, probably at least the last decade, that we can do better in healthcare. To do better, we have to use all the resources at our fingertips. For the very first time in my career, I think we have some of the tools that might actually help us transform healthcare for the better. Certainly agentic AI and the new people, process and technology approaches many of us are using give us a lot of hope that we will have better access, better quality and patient safety, and in the end, better health outcomes for our country.
Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit
