Neal Singh explains why healthcare organizations are turning to this strategy

Contract Lifecycle Management

A family physician offers three case studies in virtual primary care

The New House Call?

In Our Podcast, Sundar Kamak Shares How Technology Can Help

Curing Supply Chain Woes

Hackensack Meridian Announces 2 Executive Appointments

Patricia L. Fisher, MD, was named the CEO of Hackensack Meridian‘s Ocean University Medical Center, and Kash Patel the new executive vice president and chief information and digital engagement officer for Hackensack Meridian.

Fisher is succeeding Vincent J. Vivona, DO, JD, who retired from the position after a 40-year career. Fisher is joining Hackensack Meridian from the University of Vermont Health Network – Central Vermont Medical Center, where she was chief medical officer and chief safety officer.

Patel joins Hackensack Meridian from Penn Medicine, where he served as vice president and chief digital technology officer. Patel has over 25 years of experience in technology leadership and has worked with healthcare organizations, startups and multinational corporations.

After 35-plus years in healthcare, Debbie Osteen, CEO of Acadia Healthcare, is retiring effective January 31, 2022. She will continue to serve on the board of directors and assist with the selection and transition of the new CEO. Osteen joined Acadia in December 2018, and during her tenure, Acadia acquired 14 facilities.

The board is utilizing a national recruiting firm to conduct a search for Osteens replacement. Acadia provides behavioral healthcare services across the United States and has more than 20,000 employees.

Jeff Alter is officially taking over Summit Health as CEO, effective immediately. He is succeeding Jeffrey Le Benger, MD, who is now the executive chairman on the company’s board. Alter previously worked at Anthem as executive vice president of Anthem Health Solutions and president of IngenioRx, Anthem’s pharmacy business. He has been on CityMD’s board since 2017.

The healthcare network was formed in 2019 through the merger of Summit Medical Group and CityMD and has more than 200 locations, 2000 providers, and 9000 employees in New Jersey, New York, and Central Oregon.

Davis Is Next CEO for Cincinnati Children’s

Cincinnati Children’s Hospital Medical Center announced Steve Davis, MD, will succeed Michael Fisher as president and CEO on November 22. Fisher announced in April that he was retiring as CEO after leading the healthcare system for 12 years.

Davis has been with Cincinnati Children’s since 2015 as the chief operating officer. Prior to joining Cincinnati Children’s, Davis held several roles at the Cleveland Clinic.

Interim CEO Will Be Permanent at Keck Medical Center

Marty Sargeant has served in the role of interim CEO since July 2020 but will officially be the CEO of Keck Medical Center of University of Southern California (USC), effectively immediately. Keck Medical Center is comprised of Keck Hospital of USC and USC Norris Cancer Hospital. Prior to becoming interim CEO, Sargeant was chief operating officer (COO).

Before joining Keck, he was the COO for City of Hope and held various positions over 17 years with Cleveland Clinic.

Articles

Multiple organizations named announced the appointment of new CEOs, while Acadia Healthcare announced its CEO was retiring in January 2022.

MED MOVES: Acadia’s CEO to Retire While Hackensack Meridian, Keck Medical Center and Others Name New CEOs

COVID-19 vaccines have been free and available to American adults in all states since April 2021. Despite this, as of early September 2021, 25% of adults over the age of 18 in the US remain unvaccinated. This has led to an increase in new cases, hospitalizations and deaths, according to a 

 from Peterson-KFF Health System Tracker.

This surge, which is largely preventable because the vaccines have been proven to be highly effective at preventing severe disease, hospitalization and death from COVID-19, is adding billions of dollars in preventable costs to the nation’s healthcare system.

According to the report, the average hospitalization cost of treating a patient with COVID is around $20,000. According to data from HHS and CDC, there were 32,000 preventable COVID hospitalizations in June, 68,000 in July, and an additional 187,000 in August for a total of 287,000.

Given this, new estimates of the preventable costs of treating unvaccinated patients in hospital total nearly $3.7 billion as of August, almost twice the estimates for June and July combined. From June to August, the total preventable cost reached nearly $5.7 billion.

Of note, the report points out, the monetary cost of treated unvaccinated people for COVID-19 falls not only on the patient but on society at large, including taxpayer-funded public programs and private insurance premiums paid by workers, businesses and individual purchasers.

In an analysis of privately insured patients who were hospitalized with pneumonia, the typical out-of-pocket payment was $1,300. This is, of course, relative to each individual’s insurance plan and would also depend on how COVID-19 hospitalization costs are billed. While this amount is significant for most patients to pay, it is far less than the amount covered by public and private insurance.

The report goes on to note that the Affordable Care Act and other laws prohibit insurers from charging unvaccinated people higher premiums. However, through wellness programs, employers have the ability to impose higher costs. Private insurers have begun reinstating cost-sharing for COVID-19 hospitalizations. The federal government requires insurers to cover the cost of COVID-19 tests without cost sharing for individualized diagnosis purposes, but insurers are not required to cover the cost of COVID-19 testing for employment purposes.

Unvaccinated workers may be required to get COVID-19 tests regularly to return to work physically, and insurers have the ability to, and may shift some or all costs for those tests to the workers. However, adults can largely avoid these out-of-pocket costs and severe illness by getting the free vaccine.

An increase in new COVID-19 cases and hospitalizations among unvaccinated individuals cost nearly $3.7 billion August, according to report from the Peterson-KFF Health System Tracker.

Hospitalizations for Unvaccinated Patients With COVID-19 Cost Billions

Vik Krishnan, MBA, is general manager of Intrado Digital Workflows, which includes HouseCalls Pro, a leading automated digital patient engagement platform.

More than half (52%) of health system chief information officers (CIOs) recently 

 ranked deploying patient engagement technology as their top priority for 2021. Driving this mandate is the need to 

 and stay connected with patients at a time of great stress and health uncertainty. Health systems are also seeking to improve care coordination while reducing costs related to patient outreach and alleviating the burden on clinicians, particularly in the wake of 

Yet, many senior decision makers at healthcare organizations still express concerns about adopting automated patient engagement technology to streamline communications related to appointments, vaccines, referrals, pre-procedure prep, follow-up and monitoring, and patient balances. Generally, the concerns are in three areas: human touch/personalization, technology costs and difficulty of implementation.

Losing the “human touch” and personalization

Healthcare organizations may feel apprehensive about losing the “human touch.” Historically, human touch has been the primary way healthcare professionals have fostered trust, strengthened the doctor-patient relationship and facilitated open communication to improve patient satisfaction and health outcomes.

As social interactions have changed, more healthcare consumers and providers are open to new ways of connecting and creating relationships that matter. One 

 found that 77% of healthcare executives identified SMS-based appointment reminder systems as the most effective tool for patient engagement, and 75% of overall respondents said that smartphones offered significant benefits for patient engagement as a whole. This reflects changes in the communications landscape and what healthcare consumers want. Patients increasingly expect 

healthcare services to mirror other industries

, delivering highly personalized services with on-demand access.

Regarding personalization, automated patient engagement technology has come a long way. With the right platform, not only can healthcare organizations connect with patients in multiple channels (text, voice, email or live one-on-one chat), they can reach patients in 

. In addition, the most sophisticated platforms use capabilities like chatbots and electronic health record (EHR) integration that enables two-way communication to create a dialogue experience that 

Automation also allows for more frequent, targeted communications. For example, one New York City primary care network with more than half million members improved compliance rates for pre-procedure instructions for colonoscopies by using just-in-time SMS messages to educate patients and provide preparation instructions. This resulted in better outcomes for patients and a reduction in the number of procedures cancelled due to lack of preparedness.

Cost is always a factor when considering technology investments, and the C-suite must weigh the benefit of adopting new technologies against the amount of resources they currently devote to patient engagement. For example, most health systems rely on call centers for routine patient engagement such as appointment scheduling and rescheduling. Yet the costs of training new medical information call center agents can reach 

 annually for each individual. Organizations that opt to outsource these functions still pay an average of 

$25 to $65 per hour for each representative

. From that perspective, adopting automated patient engagement technologies makes strong financial sense for health systems.

For example, a Level 1 trauma center and hospital in Washington, D.C., realized significant annual savings by eliminating manual phone outreach. By implementing an automated, SMS-based patient engagement platform, the healthcare organization achieved immediate cost savings in the form of full-time equivalent dollars and saw a steep reduction in no-shows.

Difficulty implementing and using yet another technology platform

Primary care providers already spend an average of 

 logged into an EHR system, so the last thing the healthcare C-suite wants to do is mandate that clinicians use an additional technology platform. And while many automated patient engagement solutions integrate with EHRs, most require users to manually initiate the connection and input data, validating concerns about difficulties of use.

What healthcare decision makers may not realize is that more advanced platform solutions now exist that “live,” or embed, directly within the EHR. This means minimal IT assistance and staff training is required to deploy and adopt an EHR-embedded patient engagement platform. And since embedded systems record all patient engagement data automatically to and from the EHR, the need for manual input by clinical staff is eliminated. When these platforms are used with widely deployed EHR systems, clinicians already know how to use them, which significantly reduces the learning curve for staff.

Patient portals are another consideration. Given the resources devoted to developing and maintaining these portals, some health executives may balk at the need for even more patient engagement technology. Yet, 

 report that they have not visited a portal during the preceding year. 

Common barriers to patient portal adoption

 include patient resistance, patient limitations and security and privacy concerns. The complexity of patient portals, unique user interfaces that entail additional learning, and requiring a distinctive login can all be challenging for numerous patient groups.

Automated patient engagement technologies can work in concert with patient portals to increase the number of people health systems can reach on an ongoing basis. This dual approach gives patients greater choice — especially those who may prefer SMS communication given it is more accessible, easier to read and patients can respond to messages when it is most convenient for them.

Should a patient portal fail, automated SMS communication also serves as an effective backup. During a panel discussion on patient engagement and workflow management at the 

American Hospital Association Leadership Summit

, the director of Revenue Cycle Management at AdvantageCare Physicians of New York (ACPNY) recounted how demand for COVID-19 vaccines was so intense in early 2021 that their patient portal crashed. ACPNY turned to its automated patient engagement platform to fill this gap and meet patient demand for vaccinations, scheduling appointments directly via SMS.

With advances in automated engagement technologies, healthcare organizations may find the solution is a cost-effective, consistent way to connect with patients throughout the healthcare journey. Modern patient engagement solutions can address the three primary concerns noted above, allowing healthcare organizations to deliver personalized, human-like interaction, with long-term return on investment and reduced burden on staff. Ultimately, adopting an advanced automated patient engagement solution is a winning proposition for patients, providers and health system staff alike.

Vik Krishnan, MBA, is general manager of Intrado Digital Workflows, which includes 

, a leading automated digital patient engagement platform. He has 20 years of healthcare experience, including as co-founder/CEO of CipherHealth. Krishnan majored in biomedical engineering before obtaining an MBA from Harvard Business School.

Automated patient engagement technology can streamline communications without excessive costs, implementation challenges or healthcare providers losing the "human touch."

Making the Case for Automated Patient Engagement

As the pandemic continues on, there are many concerns about the nursing workforce that have surfaced. In order to dig deeper into some of the most prominent concerns, namely staffing, the UCSF Health Workforce Research Center on Long-Term Care conducted two surveys in California to assess the current and future supply and demand of registered nurses (RNs). Their findings were published in a recent 

According to the authors, California is poised to face a significant shortfall of RNs over the course of the next five years. This is primarily due to long-term trends that have worsened due to the COVID-19 pandemic. Current estimates place the shortage at around 40,567 full-time equivalent RNs, a 13.6% gap, anticipated to continue until 2026, according to a preliminary analysis from the 2020 Survey of California Registered Nurses and final data from the 2019-20 Annual RN Schools Survey.

California has more than 350,000 RNs employed in hospitals, clinics and other facilities, in addition to more than 450,000 licensed nurses. In fact, California nurses make up approximately 12% of all nurses employed nationwide. Among employed RNs in California, it is estimated that 30% are over the age of 55 years.

“The pandemic is accelerating a broad trend that has been building for some time. To address this, employers need to retain older RNs, while developing career paths for new graduates," said Joanne Spetz, PhD, co-author of the report and director of the UCSF Philip R. Lee Institute for Health Policy Studies, in a 

. "They also need to rapidly develop and implement strategies to mitigate the potential harm of nurse shortages over the next five years."

Underscoring Spetz’ recommendations are further findings from the study: Many older RNs in California have left the field and a large number plan on retiring or quitting within the next two years, while unemployment among younger RNs has increased. Specifically, in 2020, 26% of RNs between the ages of 55 and 64 reported that they plan to leave the field in the next two years, a significant increase from 12% reporting the same in 2018.

Concurrently, employers have been hesitant to hire less experienced RNs presumably because of the challenge in onboarding them amidst a pandemic. Despite this, there is record-breaking interest in the nursing profession. According to Spetz, RN education enrollments are projected to surpass pre-pandemic levels during the 2022-23 academic year.

She summarized the challenge ahead as this: “Can you address older RNs’ burnout and keep them in the workplace part-time to help onboard the new grads?”

California is poised to face a significant shortfall of registered nurses over the course of the next five years, according to 2 surveys.

Shortage of California Nurses Projected to Last Until 2026

On this week's episode of Data Book, Chief Healthcare Executive spoke with Ira Tauber, president of Triose, which works with health systems and hospitals on supply chain solutions. We discussed the supply chain issues that emerged at the beginning of the pandemic and how they were addressed, as well as potential upcoming supply chain issues at hospitals and health systems with an aging U.S. population.

Podcasts

Ira Tauber, president of Triose, discussed the supply chain issues that emerged at the beginning of the pandemic, as well as potential upcoming supply chain issues as hospitals and health systems care for an aging U.S. population.

Podcast: Setting Up a Supply Chain Strategy for Success

Peter Rasmussen, MD, is chief clinical officer, The Clinic by Cleveland Clinic, and professor of neurosurgery, Department of Neurosurgery, Cleveland Clinic and Cleveland Clinic Lerner College of Medicine, Case Western Reserve University.

Today, 81% of consumers believe the pandemic has fundamentally changed the way they receive healthcare, 

. Furthermore, 61% of parents are more willing to use telehealth than before the COVID-19 pandemic, including 29% who previously did not use telehealth, according to a 

 conducted by Nemours Children’s Health and Amwell, a national telehealth provider.

However, as telehealth becomes increasingly routine, healthcare providers must distinguish themselves from the pack with respect to the 

of virtual care delivery. What will this shift look like, and how can healthcare organizations solidify their telehealth value proposition?

Here are some things to keep in mind as your organization seeks to adapt to today’s healthcare landscape.

#1: Focus on Access to Expert Specialist Care, Not Just Routine Care

Chances are your organization already leverages the latest in HIPAA-compliant virtual platforms and technology to offer members the convenience that accompanies virtual visits. But today’s consumers want more: the expertise of the physician on the other side of the screen is becoming more important to them, especially with respect to specialist care and obtaining second opinions for complex conditions.

Indeed, consumers recognize there is a significant difference between consulting with a highly regarded, nationally recognized expert neurologist about their refractory seizures and speaking with a general practitioner at the local hospital. Patients with potentially life-threatening diseases, complex conditions or who are facing major surgeries desire access to the best and most appropriate experts available. For a patient with heart disease, that might mean a physician with the experience that comes with having performed thousands of heart bypass operations and valve replacements.

#2: Double Down on Providing a Comprehensive, End-to-End Patient Experience

Telemedicine services don’t count for much unless everything else surrounding the encounter, from the ease of scheduling appointments through follow-up care, also serves to improve their experience. This includes performing the behind-the-scenes work to eliminate common pain points, such as transferring test results and records of previous visits. It means supporting easier transitions to in-person or hybrid care. 

The Clinic by Cleveland Clinic and Anthem Blue Cross

, for example, developed a mechanism to quickly and efficiently transfer patient records digitally between and within facilities when members seek virtual second opinions. Contrast this with the antiquated approach of requiring patients to obtain and transport hard copies of their records.

Competitive, progressive providers are leveraging the power of virtual care to relieve patients of such tedious and time-consuming tasks, which add to the stress of dealing with their condition.

#3: Establish Next-Level Telehealth Capabilities and Offerings

Recognizing the opportunities to offer their employees better care while reducing their own costs, larger, progressive companies — including Google — are leading a push to obtain upscale telehealth benefits and convenience for their employees. Healthcare providers and health plans are stepping up to the challenge. In recent months, 

 have either begun offering or expanding member access to virtual care services through unique partnerships with providers.

For example, in addition to its virtual second opinion partnership with The Clinic by Cleveland Clinic, Anthem Blue Cross collaborates with a virtual care provider to offer concierge-level service for cancer patients. The insurer also has partnered with Boulder Care to offer individual and Medicare Advantage plan members access to a 

digital substance abuse treatment program

. Other examples include CareFirst of Maryland, which has launched a virtual care service that enables members to receive preventive care, urgent care and behavioral health services from in-network specialists through a mobile app.

These and other plans are working with providers to offer telehealth and remote monitoring of patients with chronic conditions such atrial fibrillation and diabetes. Many now enable consumers to access in- and out-of-network providers with less onerous co-pays and deductibles, particularly with respect to obtaining second opinions from recognized experts in their specific conditions.

A silver lining to the COVID-19 pandemic is the focus it has put on the value of telehealth. While most telehealth programs still focus on consultations for routine conditions like headaches, colds and the flu, progressive organizations will be sure to distinguish themselves by taking their virtual care services to the next level of patient care. It’s an approach that will benefit not only those they serve, but also their long-term success.

Owing in large part to the pandemic, telehealth is growing increasingly popular with consumers.

3 Ways to Capture the New Value Differentiator for Telehealth: Quality of Care

Gary Call, M.D., is the chief medical officer of Gainwell Technologies, a provider of technology solutions.

The concept of holistic, or whole person, care continues to gain traction as the best way to address the healthcare sector’s overall mission of improved health outcomes, lower costs and improved patient experiences. Understanding the role of social determinants of health (SDOH) has become a primary focus for providers, payers, consumers and government agencies because of their demonstrated impact on the health status of many high-risk individuals in our country.

Economic stability, and its contributing factors, are a fundamental determinant currently impacting the health and well-being of many individuals. Daily struggles around unemployment, poverty, housing instability and food insecurity all contribute to an increased risk of poor health outcomes for vulnerable groups of people. Some might argue that it is not the healthcare system’s role to solve these problems; however, it is clear that identifying and empowering individuals to overcome the barriers raised by economic instability and other SDOH is the only way that our system can meet the healthcare needs of the most vulnerable in our society.

Maintaining Employment and Socioeconomic Status

The COVID-19 pandemic has created significant economic stress in the form of unemployment, underemployment and decreased incomes. Socioeconomic status is a metric that considers an individual’s income, education level and job status. There are many factors that can affect socioeconomic status such as race, ethnicity, language and geographic location. Individuals with lower socioeconomic status have less income stability which creates social determinant barriers to positive healthcare outcomes. It has been well documented that economic stress and instability can worsen chronic mental and physical health conditions such as depression, heart disease, obesity and diabetes.

Income instability can cause a SDOH domino effect — creating unhealthy outcomes, excess costs and poor patient experiences. Unstable incomes can lead to unreliable transportation, substandard housing (overcrowded, pest infested, poor heating/cooling, lead or asbestos problems, etc.), poorly located housing (high crime area, food deserts, long distance to care, no available public transportation, etc.) and food insecurity. Food insecurity is an often-overlooked health problem in the United States. According to the United States Department of Agriculture, food insecurity may range from “reduced quality, variety or desirability of diet,” to “disrupted eating patterns and reduced food intake.” The latest estimates from Feeding America are that 1 in 8 Americans will experience food insecurity in 2021.

All of these SDOH factors create healthcare issues including poor availability and access to healthcare providers and medications, inability to adhere to care plans, increased exposure to communicable diseases and the health consequences of poor nutrition.

There is now widespread recognition of the negative impact that income instability can have on multiple SDOH that affect an individual’s health. However, addressing the problems can be very challenging. Important tools for healthcare payers include enhanced care management, population health programs and outreach. These types of programs require time and scarce resources — technology is critical to using these resources efficiently and maximizing the impact across populations.

Advanced predictive analytics can identify individuals most at risk of poor outcomes including both hidden risk (people with unidentified chronic conditions) and rising risk (those who will develop chronic conditions without intervention). Analytics can be used to help prioritize and guide the work of care managers and population health program directors. Analytics also can help monitor which programs, payers and providers are most effective in addressing SDOH factors and achieving desired outcomes. Sophisticated care management software platforms can make the assessment and development of care plans for patients more effective and individualized. These platforms can enhance information sharing among all caregivers for an individual. Effective patient engagement and outreach through multi-modal messaging and mobile digital platforms can educate patients and empower them to overcome barriers to good health.

Income instability creates daunting SDOH challenges for many individuals in the United States. While healthcare payers can’t solve income stability problems directly, they can blunt the negative impact on health by using technology enabled care management, population health and outreach programs.

Gary Call, M.D., is the chief medical officer at 

Economic stability, and its contributing factors, are a fundamental determinant currently impacting the health and well-being of many individuals.

Acknowledging Economic Stability as a Primary Social Determinant of Health

Melissa Lukasick has been named regional chief financial officer (CFO) at Loyola Medicine. Lukasick has been with Loyola since 2004, and in July 2021, she was named the interim regional CFO. Prior to the interim role, Lukasick was the regional president of financial operations at Loyola.

During her tenure at Loyola, Lukasick has led financial system implementations, process improvement initiatives and regionalization exercises. In addition, Lukasick is active in Loyola Medicine's Diversity & Inclusion steering and action committees.

Mayo Clinic’s New Chief Development Officer

Mayo Clinic has named Jennifer Arnett as chief development officer, effective Dec. 1, 2021. As chief development officer, Arnett will lead fundraising efforts at Mayo Clinic, the top ranked hospital among the country’s healthcare institutions.

Currently, Arnett is the vice chancellor of University Development and Alumni Relations at the University of California, San Francisco (UCSF). Her last day with the university will be Oct. 22, 2021. Arnett has been with UCSF for 12 years in a variety of positions with the development team.

Caroline Chung, M.D., has been named the first chief data officer in a newly created role at The University of Texas MD Anderson Cancer Center. Chung is associate professor of Radiation Oncology and Diagnostic Radiology and her new role as vice president and chief data officer is effective Oct. 1, 2021.

In the new role, Chung is responsible for MD Anderson’s data strategy and leading the implementation. She will also oversee the Data Governance and Provenance Office and institutional data offices. Chung joined MD Anderson in 2016.

Intermountain Names Dr. Krakovitz to President Role

Paul Krakovitz, M.D., has been named president for Intermountain Nevada after beginning the role in the interim earlier in 2021. Krakovitz previously served as Intermountain’s vice president & chief medical officer for Specialty-Based Care in Utah and Idaho.

Previously, Krakovitz was chief medical officer for specialty-based care at Intermountain and section head of pediatric otolaryngology and vice chairman of surgical operations at Cleveland Clinic.

Wellstar Announces New Diversity, Equity and Inclusion Position

Le Joyce Naylor has been named the first chief diversity, equity and inclusion officer at Wellstar, as well as a senior vice president. Naylor started in the role August 2. Naylor nearly 20 years of experience in diversity and inclusion work.

Previously, she was the executive director of diversity and inclusion at the Cleveland Clinic.

Wellstar announces Le Joyce Naylor in the new diversity, equity and inclusion role; MD Anderson names Caroline Chung, M.D., the first chief data officer; and more executive moves.

MED MOVES: MD Anderson and Wellstar Fill Newly Created Roles; Loyola Medicine Names Regional CFO; and More Moves

After a near lack of a 2020-2021 flu season, the 2021-2022 flu season is expected to be more severe than average. Children are expected to be particularly hard hit this flu season.

Scientists from the University of Pittsburgh Graduate School of Public Health published 2 studies that suggest flu-related hospitalizations and deaths may be mitigated with vaccination rates that are 20% to 50% higher than in previous flu seasons.

“As COVID-19 containment measures—such as masking, distancing and school closures—are relaxed around the world, we’re seeing a fierce resurgence of other respiratory viruses, which does not bode well for the coming flu season,” Mark Roberts, MD, MPP, director of the Public Health Dynamics Laboratory at Pitt Public Health and senior author on both studies, 

. “In a worst-case situation with a highly transmissible flu strain dominating and low influenza vaccination uptake, our predictive models indicate the potential for up to nearly half a million more flu hospitalizations this winter, compared to a normal flu season.”

The Framework for Reconstructing Epidemiologic Dynamics simulation platform found that there could be 20% more flu cases during the 2021-2022 flu season than normal. About half of Americans were vaccinated against the flu during the 2019-2020flu season, and the simulation showed that increasing vaccinations by about 10% resulted in hospitalizations decreasing by 6% to 46% depending how transmissible the dominant flu virus is.

The Susceptible-Exposed-Infected-Recovered model found that there will be 600,000 hospitalizations this upcoming flu season, which is at least 100,000 more than a normal flu season. If vaccine uptake is low, there could be 400,000 more hospitalizations than usual. The model found that 75% of Americans need to be vaccinated against the flu compared with the typical 50%.

The mild flu season in 2020-2021 resulted in waning population-level immunity to influenza, and continued COVID-19 precautions could result in another blunted flu season, which would further erode natural immunity against the flu. In the future, there could be an even larger flu outbreak with higher hospitalizations as social activity returns to normal.

“The ‘twindemic’—a coinciding flu and COVID-19 epidemic—overwhelming our hospitals was thankfully avoided last year. But that does not mean it is no longer possible,” Roberts said. “If anything, our models show that we should be more concerned this year about the possibility of a surge in COVID-19 hitting at the same time as a massive flu outbreak in areas of the country with low vaccination rates against both diseases.”

Scientists warn against a severe upcoming flu season and a continued possibility of a twindemic, in which COVID-19 and flu epidemics overwhelm hospitals.

Severe Flu Season Predicted With Higher Hospitalizations 

As a result of the COVID-19 pandemic, hospitals and health systems are treating sicker patients, as well as paying more for labor, drugs and supplies, according to a new report prepared by Kaufman, Hall & Associates, LLC for the American Hospital Association (AHA).

The patients being treated by hospitals and health systems are sicker due to COVID-19 or from delaying care as a result of the pandemic. These patients require longer lengths of stay and more services. From June 19 to September 14, the seven-day average of new hospital admissions of patients with COVID-19 increased 488%.

“America’s hospitals and health systems continue to face significant, ongoing instability and strain as the COVID-19 pandemic endures and spreads,” Rick Pollack, AHA president and CEO, 

. “With cases and hospitalizations at elevated levels again due to the rapid spread of the Delta variant, physicians, nurses and other hospital caregivers and personnel are working tirelessly to care for COVID-19 patients and all others who need care. At the same time, hospitals are experiencing profound headwinds that will continue throughout the rest of 2021.”

The report projects that hospitals will lose an estimated $54 billion in net income throughout 2021, even after taking into account 2020’s federal Coronavirus Aid, Relief, and Economic Security (CARES) Act.

In addition, more than one-third of hospitals will maintain negative operating margins through year’s end. Median hospital margins are projected to be 11% below pre-pandemic levels by the end of 2021. While 35% of hospitals are expected to have negative operating margins by the end of the fourth quarter, it’s an improvement from the first quarter, when 47% of hospitals had negative operating margins.

“Even as overall hospital revenues are improving, they are offset by mounting expenses in caring for greater numbers of sicker, high‑acuity patients who require longer hospital stays, more supplies and staff time, and more resources overall,” according to the report.

In addition to dealing with sicker patients and higher expenses, hospitals have fewer outpatient visits, which tend to have lower expenses and higher margins. While outpatient visits grew, they remained below 2019 levels and have not fully recovered after shutdowns and other efforts to slow the spread of COVID-19 during the early months of the pandemic.

“While many hospital leaders hoped 2021 would provide an opportunity to return their organizations to greater financial stability after the severe losses seen in 2020, those hopes are dimming as the virus continues to circulate throughout the population,” the report concludes.

More expensive patients and higher expenses as a result of the COVID-19 pandemic will continue to drive hospital and health system losses in 2021.

Hospitals, Health Systems Will Lose $54 Billion in Net Income in 2021

Hospitals and health systems are largely not equipped to handle all the patient data they could receive and turn it into actionable information, explained Edmondo Robinson, MD, MBA, MS, FACP, senior vice president and chief digital officer at Moffitt Cancer Center.

Oh, absolutely not they have they don't know what to do with those data. Especially we start talking about wearables, right? So, you think about it, a patient says, "Hey, I, I'm averaging 10 more steps this week than I was last week." What does that mean? You know, other than saying, "Yes, keep going. That's wonderful," it's hard to know what that means.

And so I think there's a process around structuring your approach to understanding, in this case, remote patient monitoring, wearable types of data, to say, are there criteria whereby a certain change — because it because some of those data are even continuous, right, continuous monitoring — so are the criteria whereby a change would trigger an intervention of some sort? Are there summaries? You know, a weekly summary, a monthly summary, whereby understanding those data at that level across over time is important for many intervention perspective. It depends by the data. And that's not even including all the research you want to do, which is going to ask the questions differently and attack them differently, depending on the  hypothesis being built in that particular research study.

So, you know, it could be everything from "I have a patient on a particular chemotherapeutic intervention; they're now at home after getting their infusion in the infusion center, and I want to monitor adverse drug reactions or events." Well, I could use wearables for that. But what does it mean, if the heart rate went up a little bit? Or if the heart rate went down a little bit? Is that a 88 [heart rate]? Or is that just normal variation in a heart rate?

You've got to set those parameters and you've got to understand what it means to have those data; but just looking at it constantly, it's not gonna be helpful. So, again, you really got to be disciplined about your approach to those data.

Will health systems and hospitals need to implement things they don't currently have, like artificial intelligence (AI) or different algorithms?

It could. That could absolutely accelerate your ability to sift through those data and get to...separate the signal from the noise, right? You absolutely could leverage machine learning to do that. You need a ton of data to train those models really well. But, ultimately, I think that's where it's going to go, whereby what happens is, the AI surfaces up, "hey, this, look at that, that's important."

But even short of that, you can just set some hard parameters around some of these things, right? Where, you know, they're not always perfect, but they at least signal that you should pay attention. So, for example, if your heart rates over 100 [bpm], I'm going to pay attention. Now, it could just be that you were out for a run — not a big deal. Or it could be that you are having some kind of reaction. And I'm thinking about even for patients who are on the inpatient side. It could be that I caused that high heart rate or I know the reason for their high heart rate. Or it could be that I don't know the reason. And I better go figure out what the reason is, right? So though that's just a hard, it's not even AI driven. That's just a hard line, that 100 right. So, there's some of that.

The reason why machine learning might be really critical is often it can pull signal from noise that we can't see normally. Right? And it might do it sooner. And that's actually really important.

Videos

Dr. Edmondo Robinson Outlines Hospital Readiness to Receive Large Amounts of Patient Data

John Figueroa is the chairman and chief executive officer of CarepathRx, a company providing innovative pharmacy solutions to hospital health systems. He also serves on the Pepperdine Graziadio Business School board.

“A gem cannot be polished without friction, nor a man perfected without trials.” This proverb from ancient Roman philosopher Lucius Seneca is a profound reminder for senior executives that excellence is born out of tribulation.

In a similar way, the COVID-19 pandemic has proven healthcare organizations, even in a crisis, need to tirelessly forge ahead with innovation to be successful. For CEO-level healthcare professionals and the organizations they serve, the current era of disruption is pushing healthcare into the future at a blistering pace.

Industry experts and healthcare futurists agree the pandemic has accelerated the need for organizations to innovate and adapt. Recently, management consulting firm 

., surveyed more than 100 healthcare leaders, from pharmaceutical and medical technology companies to health systems and payers. An astounding 90% responded that the pandemic will fundamentally change the way they do business, requiring new products, services, processes and business models.

At the heart of transformation are new technologies and innovative applications. While senior-level executives should not be expected to know every new application or upgrade, they need to follow the macro-trends. Here are five that will drive the industry forward:

Already healthcare executives are planning for a day in which care is based on specific, personal, genetic information versus physical exams, patient complaints or symptoms alone. Researchers are hard at work identifying ways to collect data that will one day enable highly tailored healthcare.

A catalytic event will take place in 2028, when the National Institutes of Health completes its 

research program, a historic effort to collect and study data from 1 million or more people living in the United States. As this research emerges, senior healthcare executives must be prepared to leverage its insights for maximum gain.

 The innovations and technology brought on by managing the COVID-19 pandemic has accelerated virtual care. The practice of telemedicine — once limited primarily to individual online consultations — has broadened to include coordinated and comprehensive virtual care. This convergence will continue to evolve to include data capture through wearables, video environments and post-acute monitoring. Senior-level executives should understand new capabilities, especially those powered by augmented information and artificial intelligence.

 Instead of making medications for diseases, drug makers will make treatments that work for the individual patient, taking specific needs into account. Data will also play a critical role in areas like clinical trials, in which several treatments are tested simultaneously and take place at home. This also extends to pharmacies where, according to pharmaceutical distributor 

, patients will benefit from smart drug packaging to improve adherence, digiceuticals to help patients with their drug therapies, point-of-care testing medical supplies and advances in equipment. In fact, services like these already exist at 

, for more than 80,000 chronically ill patients living at home.

COVID-19 dramatically increased the rate at which healthcare organizations moved information ecosystems to the cloud. In order to improve care, increase agility and protect data, healthcare providers shifted data centers to the cloud in droves — and there are no signs of that trend slowing. According to consulting firm Accenture, 

 say they will be operating within the cloud within the next year and 96% within three years. Senior healthcare executives don’t need to know the intricacies of cloud computing, but they do need to have trusted partners who can aid in adopting a cloud approach without compromising data.

 In the future, biotech companies will not be one organization, but a sum of multiple parts (like technology company Alphabet, the parent company of Google). Each company will operate separate units using a unified technology platform and mission. Innovative biotech companies will grow companies from scratch while making long-term investments in innovations and technology that enhances the entire organization. Senior executives will need to understand this new business model and how to fit in as a division, partner, or supplier.

To be sure, public health crises like COVID-19 are not the only frictions in healthcare. The push for expanded access to care, an escalating nationwide physician and nurse shortage and the unending call to bend the cost curve will continue to test the traditional limits of the U.S. healthcare system.

Disruptive technologies and innovation are already brightening the path to better medical outcomes. Indeed, the trend toward rapid innovation and transformation surges ahead. According to the Accenture study, 81% of senior healthcare executives say the pace of digital transformation for their organization is accelerating and 93% report their organization is innovating with an urgency and call to action this year.

As all these variables rub together with increasing force, the rough corners and faults will be polished out. A shimmering future lies ahead for those willing to keep pace with innovation.

John Figueroa is the chairman and chief executive officer of CarepathRx, a company providing innovative pharmacy solutions to hospital health systems. He also serves on the Pepperdine Graziadio Business School board and will moderate the 

The COVID-19 pandemic has proven healthcare organizations, even in a crisis, need to tirelessly forge ahead with innovation to be successful. Senior-level healthcare executives need to follow the macro-trends driving the industry forward.

Polishing the Stone: Healthcare Innovation and Technology

Despite the massive undertaking, both financially and structurally, that the US federal government took on to digitize the healthcare system by creating and nationally adopting electronic health records (EHRs), the promise of EHRs to significantly improve quality has remained tenuous.

One mechanism by which EHRs were expected to improve quality in particular was the implementation of computerized provider order entry (CPOE), coupled with clinical decision support (CDS) tools. CPOE enables healthcare providers to write orders for patients electronically, as opposed to verbal or written communication. CDS coupled with CPOE then uses EHR data specific to the patient as well as medication reference databases to supplement clinician decision-making and prevent potential adverse drug events, such as ordering a drug a patient may be allergic to or a drug with a potential contraindication.

While CDS tools intervene at the point of care, performance outcomes have been mixed and a significant amount of customization happens at the organization level which results in differences even within hospitals using the same technology.

A potential policy mechanism to incentivize quality improvement is public reporting of performance. However, recent evidence has cast doubt on whether national programs are useful tools in identifying high quality and it remains unclear if public reporting is an effective way to encourage improvement.

In order to determine whether publicly reported feedback was associated with hospital improvement in an evaluation of medication-related CDS safety performance, 

 authors conducted a nonrandomized controlled trial that included U.S. hospitals that participated in the CPOE Evaluation Tool in the Leapfrog Hospital Survey. This tool is a is a national quality reporting program that evaluates safety and performance of CDS using simulated orders and patients from 2017 to 2018.

A total of 1183 hospitals were included in the study with a mean CPOE score of 59.3% (16.3%) at baseline. Hospitals receiving negative feedback improved 8.44 percentage points more in the subsequent year compared with hospitals that received positive feedback on the same evaluation. This change was driven by differences in improvement in basic CDS capabilities rather than advanced CDS.

Overall, the authors found that publicly reported feedback was associated with quality improvement, which suggests that targeted measurement and reporting of process quality may be an effective policy that encourages improvement in specific areas.

Hospitals receiving publicly reported negative feedback improved their electronic health record medication safety.

Dr. Edmondo Robinson Outlines Hospital Readiness to Receive Large Amounts of Patient Data

Polishing the Stone: Healthcare Innovation and Technology

Public Quality Reporting Associated With Quality Improvement in Hospitals

Podcast: Moving Healthier With the OneStep App

Hospitals Are Ill-Equipped to Handle an Increase in Patients With Addiction in EDs

Featured Content

Contract Lifecycle Management

The New House Call?

Curing Supply Chain Woes