AI & Data Analytics

Business

Cybersecurity

Data + Technology

Diversity, equity and inclusion

Financial Decision Making

Health equity

Healthcare Transformation

Interoperability & EHRs

Leadership

Management

Medical Devices

Mergers and Acquisitions

Patient Experience

Point of Care Tools

Politics

Pop Health Tech

Precision Medicine

Product Solutions

Providers in Practice

Safer Hospitals

Technology

Telehealth

Virtual Care

News

Media

Medical World News

Peer Exchange

Podcasts

Videos

Webinars

Conferences

Resources

Subscribe

Chief Healthcare Executive® offers indispensable news, features and analysis for leaders to help patients, staff, and their bottom line.

About

Advertise

Editorial

Contact Us

Terms and Conditions

Privacy

Do Not Sell My Personal Information

Chief Healthcare Executive

LinkedIn

Spotlight

Topics

Mergers & Acquisitions

1rem

Authors

Michael S. Horn is a partner at Archer based in Hackensack, N.J., and New York, N.Y.

As many hospitals expand their footprint using co-management agreements, they will also be subject to greater scrutiny for anticompetitive behavior.

The shifting landscape of antitrust lawsuits in the medical field | Viewpoint

Recently, courts have been more inclined to hold that these types of agreements are unenforceable. 

The pandemic’s impact on medical non-compete clauses | Viewpoint 

By 2050, it's estimated that 139 million people worldwide will have dementia, but by today's standards, 60% will be undiagnosed. It's clear that there's a significant gap in dementia detection and care, but what can your organization do about it?

Get perspectives from clinical leaders and neuroscience experts about the underlying causes and consequences of these gaps, practical opportunities to address them, and a proven roadmap that shows how leading health systems have successfully transformed their dementia screening and care processes.

Closing the Dementia Care Gap: Expert Insights and Proven Strategies for Health Systems

In a week, the NFL Draft comes to Green Bay, Wisconsin, and HSHS St. Vincent Children’s Hospital presented its top picks.

The hospital in Green Bay celebrated its own rookies of the year: the babies in the newborn intensive care unit. The hospital staff shot pictures and videos of its promising picks, accented by tiny footballs and gridiron-themed bibs and apparel.

It’s a moment of levity with the children’s hospital getting in the spirit of one of the biggest dates on the pro football calendar, as the draft comes to one of the NFL’s most storied cities.

A Green Bay hospital sets up a football-themed photo shoot ahead of the NFL Draft.

As NFL Draft nears, Green Bay hospital celebrates its babies

But it’s also about boosting the spirit of parents whose babies are in the NICU, said Jim Burke, manager of the NICU at HSHS St. Vincent Children’s Hospital.

“For families that have a baby being cared for in our NICU, especially for extended periods of time, it can feel like they’re missing out on a lot of moments while they’re at the hospital,” Burke said in a statement provided by the hospital.

“By doing photo shoots like this, we help create some positive and fun memories for our NICU families,” Burke said. “It’s important to my team to not only offer expert care for these precious babies, but also to help lift the spirits of our moms and dads.”

Undoubtedly, the parents view their little rookies as superstars.

HSHS St. Vincent Children’s Hospital gets in the spirit with its own rookies, the infants in its NICU Unit. Hospital staff aimed to give parents a boost. 

Topic

With NFL Draft, Green Bay hospital presents its top picks

After years of planning, New Jersey’s first freestanding cancer hospital has opened its doors.

RWJBarnabas Health and Rutgers Cancer Institute teamed to build the 12-story hospital in New Brunswick. The new hospital, the Jack & Sheryl Morris Cancer Center, is connected to Robert Wood Johnson University Hospital and Rutgers Cancer Institute. Officials tout it as one of only 13 freestanding cancer hospitals in the country.

The institutions say the new hospital is part of a $1.5 billion effort to expand cancer care in New Jersey. 

They first announced plans for the hospital in 2019

The hospital includes 96 inpatient beds and surgical space, along with 80 exam rooms for outpatient care of adult and pediatric patients. The hospital’s pediatric space was designed to be more welcoming for children with a “Jersey Shore” theme.

Mark E. Manigan, president and CEO of RWJBarnabas Health, said the opening of the hospital “is true to our mission of building and sustaining a healthier New Jersey."

“It is further evidence of RWJBarnabas Health’s commitment to taking care of the communities we serve and providing patients the most advanced care possible, close to home,” he said in a statement. “I am proud to say that RWJBarnabas Health, together with Rutgers Cancer Institute, is advancing a bold vision – to beat cancer together.”

Steven K. Libutti, MD, director of Rutgers Cancer Institute and senior vice president of oncology services at RWJBarnabas Health, said the new hospital will allow more people to get cancer care without having to leave the state.

“While New Jersey has long been a nationwide leader in the delivery of outstanding, world-class cancer care, patients in the region have previously needed to visit nearby New York or Philadelphia to access comprehensive inpatient cancer treatment,” Libutti said in a statement.

The new cancer hospital includes surgical space and 88 infusion bays, along with radiation oncology.

To support cancer studies, the hospital has laboratories to support 10 research teams. Officials say the hospital will be able to house clinical trials. Officials also have said that they want the hospital to be able to connect researchers with physicians.

The hospital is named in honor of Jack Morris, the chairman of Robert Wood Johnson University Hospital, and his wife, Sheryl, in honor of their philanthropy.

Jonathan Holloway, president of Rutgers University, said that the hospital reflects a commitment to providing cancer patients with better care.

“I am excited for the future of cancer care and bench-to-bedside advances that will emerge from this vital center, leading to new treatments, redefined understanding, and ultimately, lives saved,” Holloway said in a statement.

RWJBarnabas Health and Rutgers are continuing to work on two other new outpatient cancer facilities, and they are moving closer to opening.

The Melchiorre Cancer Center at Cooperman Barnabas Medical Center in Livingston is slated to open in the fall.

Next year, the Specialty and Cancer Care Center at the Vogel Medical Campus in Tinton Falls is slated to open.

Cancer in America: Disturbing findings for women and Black Americans

RWJBarnabas Health and Rutgers Cancer Institute teamed to build the freestanding hospital. It’s part of a $1.5 billion investment in cancer services across the Garden State.


At long last, New Jersey’s first cancer hospital opens 

The maternal mortality rate in the U.S. has increased by 

, often due to factors like lack of access to care and inadequate screening for risk factors.

While it may not be the first solution to this crisis that comes to mind, birth doulas can be key to turning these numbers around and beginning to make a meaningful difference in each of the above areas.

Focused on offering comfort, advocacy, and guidance, doulas are trained to provide physical, emotional, and informational support to individuals throughout every stage of the process—before, during, and after birth. Doulas are an extension of support that improves the birthing experience for all, with their presence linked to positive outcomes, including reduced cesarean section rates and fewer preterm births.

Recognizing the benefits of doula support, Washington state’s Apple Health (Medicaid) launched a 

 in January 2025 for the first time, a milestone in addressing birth inequities.

Aiming to enhance maternal and infant health outcomes by making doula support more accessible to Medicaid recipients, the birth doula benefit will support increased access, improved maternal health, and support for doulas across the state. This innovative approach is a powerful model for other states, demonstrating how policy can create more equitable and healthier birth experiences.

More individuals can access essential doula services by reducing financial barriers for patients and widening geographic reach. This personalized support improves maternal health through better birth experiences and outcomes, enhanced postpartum support and service coordination and reduced health disparities.

For example, Medicaid members who are American Indian and Alaska Native are less likely to receive a postpartum visit after delivery (48%), but initiatives such as 

’s proactive support and education around birth doulas have helped raise this rate to 61%. The new benefit also supports doulas through increased reimbursement, with birth doulas now eligible for a $3,500 payment per delivery—the highest Medicaid reimbursement for doulas in the nation.

While the new birth doula benefit is crucial to improving maternal and child health equity, there remain significant challenges in ensuring equitable implementation. Throughout the country, workforce capacity, regional disparities, cultural representation, and public awareness remain barriers to access.

With a limited number of doulas—approximately 

, there is a deep need for increased recruitment and retention. Although the recent changes to state programs have introduced new opportunities, they also include complex certification requirements and administrative challenges, which make it difficult for doulas to enroll. 

Efforts to ensure the program is truly equitable requires that healthcare leaders acknowledge existing geographic disparities, especially for those in rural areas who face gaps in availability due to limited resources and fewer trained doulas. Transportation barriers also make it challenging to access these essential services.

Additionally, many Medicaid recipients represent diverse cultural and linguistic communities and often face difficulties finding doulas who are culturally competent and understand their unique needs, which can hinder the effectiveness of doula care.

There are still too many lingering misconceptions regarding the role of doulas and how they can benefit from their support. With a lack of resources and education, underutilization of this valuable service could continue without intentional efforts to inform communities of the options available to them—at no cost.

Developing and expanding doula care is essential to improving maternal and infant health outcomes, particularly for underserved communities. To ensure the new doula benefit is successful, healthcare leaders must focus on increasing access to training, investing in outreach and education, and promoting cultural competency within the profession.

Healthcare providers, policymakers, and community organizations must work to advocate for the equitable reach of Apple Health’s birth doula benefit program, ensuring all birthing individuals receive safe, inclusive, and positive support.

Demetria Malloy, MD MSHS, is the chief medical officer and chief health officer of Community Health Plan of Washington.

Doulas can improve the birthing experience for all, with their presence linked to positive outcomes, including reduced cesarean section rates and fewer preterm births.


Why expanding doula care is vital for healthier communities | Viewpoint

Despite determined and even desperate efforts to save the Crozer-Chester Medical Center, the hospital is closing its doors.

Prospect Medical Holdings, the owner of Crozer Health, said 

it had no choice but to shut down the health system

 in the Philadelphia suburbs amid mounting costs and the inability to find another buyer. Crozer Health includes the Crozer-Chester Medical Center, and Taylor Hospital, which shut down last week.

Now, Crozer-Chester Medical Center is closing today. The emergency department has already been shut down, and the medical center is looking to transfer its few remaining patients. The medical center’s roots date back more than 160 years.

The hospital is based in Chester, a small city of about 33,000. Nearly one-third of the city’s residents are in poverty, and many don’t have reliable transportation.

Pennsylvania State Sen. Tim Kearney, a Democrat representing Delaware County, says he’s worried about those needing emergency care, and really any kind of medical attention. The community has very few healthcare providers.

With the medical center’s closure, “Chester is a healthcare desert,” Kearney tells Chief Healthcare Executive®.

Kearney is leading efforts to prevent similar hospital closures in Pennsylvania, as he and other lawmakers 

are pushing for changes in state law governing hospital sales

. Elected officials and lawmakers alike fault private equity owners for shuttering the system and the loss of thousands of jobs.

The closure of Crozer-Chester and Taylor Hospital follow the loss of two other hospitals in Delaware County in the past few years.

Prospect shut down Delaware County Memorial Hospital and Springfield Hospital in 2022. And Crozer Health has weathered fears of closure repeatedly.

“It’s been like a train wreck that's been happening really over the last two years,” Kearney says.

Delaware County had six hospitals a few years ago, and now only two are remaining to serve the county’s 584,000 residents: Mercy Fitzgerald Hospital, part of Trinity Health, and Riddle Memorial Hospital, part of Main Line Health.

The loss of Crozer-Chester and Taylor Hospital 

poses major problems for residents in Delaware County who need care

, but Kearney says the outlook for the small city of Chester is especially worrisome. Many in the small city don’t have reliable transportation. So even though Chester is part of the Philadelphia region, many will find it harder to get care or get to another hospital in an emergency.

“There's all these hospitals in Philadelphia, there's hospitals in Wilmington, but that's just time,” Kearney says. “It's extra time to get there.”

With Crozer Health closing, nearby hospitals prepare for more patients

A 283-bed teaching hospital, Crozer-Chester operated the only trauma center in Delaware County. Taylor Hospital had 107 beds.

Crozer-Chester also operated a highly regarded burn unit. “It had an incredible reputation as a great facility,” Kearney says.

Peggy Malone, a nurse at Crozer-Chester Medical Center, told Chief Healthcare Executive last week that 

she’s worried about lives being endangered

 due to longer trips to other hospitals for emergency care.

‘“Everybody wants to take our patients right now,” Malone says.

“But the reality is, what happens tomorrow? Next week? Next month? Which is what I have said all along. These patients can't get anywhere else. They don't have the transportation.”

Even those who own a car are facing much more time getting to one of the other hospitals, and many Delaware County roads are choked with traffic in the congested Philadelphia suburbs.

“It's not always the easiest county to maneuver around with, with traffic, and it's putting an incredible strain on people, but it's also a huge strain on the EMS system,” Kearney says.

Crozer Health’s closure also brings real pain to the Delaware County economy, with more than 3,000 people losing their jobs.

Some doctors and nurses have already applied to other hospitals and health systems in the Philadelphia region. Clinicians may be better positioned to find work sooner since many hospitals struggle with filling all of their vacancies, but some of them may not be assured of getting a new job.

‘Even the clinicians … there is a shortage, but there's not that big a shortage,” Kearney says. “There are more people who work at Crozer who are not gonna be able to find jobs.”

Dr. Monica Taylor, chairwoman of the Delaware County Council, praised the Crozer Health staff who remained on the job even amidst threats of closure.

“They stayed true to their work,” Taylor said in an interview last week. “They stayed to the very end, and they have been there for our community. They have served our residents. And, yeah, it's just really impressive that that's what that's where they want to be, that's who they want to serve.”

Some job fairs are being set up, including one in Subaru Park, home of the Philadelphia Union, the pro soccer team.

The loss of two hospitals also is a blow to the other businesses around those hospitals. Kearney says the fallout will be widespread.

“It’s such a kind of horror story that people have difficulty trying to focus on to figure out exactly what it's going to be,” Kearney says. “But we know it's going to be severe.”

Officials and residents alike are seething at Prospect Medical Holdings. Prospect 

, with the company listing debts of more than $400 million. 

State lawmakers and Delaware County put up millions

 to keep Crozer Health operating in hopes of finding another buyer, but Prospect said it had no alternative but to shut the system down.

Leonard Green & Partners, a private equity firm, held majority ownership in Prospect Medical Holdings from 2010 through 2021. Given the experience at Crozer, Kearney and other lawmakers say they are looking to establish safeguards to prevent private equity firms from buying hospitals, neglecting them and heading out of town.

Kearney and other lawmakers are looking to pass legislation giving Pennsylvania’s attorney general the power to review hospital sales and mergers to determine if they’re in the public interest. Pennsylvania Gov. Josh Shapiro has urged lawmakers to approve such a law.

Kearney is especially interested in provisions that would bar private equity firms that own hospitals and nursing homes from selling their land and renting it back. He said that arrangement devastated Crozer.

“They were being charged $36 million in rent for property that they used to own,” Kearney said.

Under private equity ownership, Prospect didn’t adequately invest in the facilities, Kearney said. When Delaware County Memorial Hospital closed in 2022, other health systems were interested in buying the facility, but changed their mind when they saw its condition, he said.

“Every single one of them came out saying, this is a tear down,” Kearney says.

Kearney and other lawmakers have asked Pennsylvania Attorney General Dave Sunday 

to pursue possible criminal charges against Prospect

. But he acknowledges that may be a difficult case to bring.

Still, Kearney and other local officials are determined to prevent other communities from losing their hospitals. And Kearney says there’s bipartisan support for such measures in the wake of Crozer’s closure.

“Crozer has been there since the Civil War in Chester,” Kearney says. “They managed to survive all sorts of things, but it really couldn't survive private equity.”

Hospitals and private equity: Scathing Senate report shows concerns cross party lines

Prospect Medical Holdings is shutting down Crozer Health, which includes the medical center and Taylor Hospital. Taylor shut down last week, and Crozer-Chester closed Friday.

Crozer-Chester Medical Center is closing, and a city becomes a ‘healthcare desert’

Healthcare stakeholders are increasingly committed to value-based care (VBC), but many providers are still waiting to reap the financial benefits of these contracts.

Given that we are now 15 years after the passage of the Affordable Care Act—and given how many innovative value-based payment models have sprung up in its wake—hospitals and health systems are looking for the root causes of sluggish returns on VBC. 

While there are many components to successful VBC contracts, claims data may actually be one of the most underappreciated keys for health systems looking to unlock faster success.

The industry is catching on: Data integration is getting more time in the limelight as healthcare leaders reflect on VBC. After the National Association of Accountable Care Organizations (NAACOS) fall conference, 

 that data integration was top of mind: “Building a seamless data infrastructure that links claims and clinical data across payers and providers takes time and effort, but it is essential to managing patient risk effectively.”

To say that linking claims and clinical data across payers and providers requires “time and effort” is likely understating the issue: Ingesting claims data on the provider side is incredibly difficult, yet also foundational to nearly every work stream in value-based care.

First of all, ingesting claims data is new for providers. They are used to sending 

claims data in the context of documenting services and sending bills to health plans for payment. That puts health plans in the more privileged position of being experts at ingesting claims data and analyzing it for business purposes.

Meanwhile, providers—who are just now starting to ingest aggregate claims feeds to gain a more holistic view of the patient and move the needle on quality metrics—are playing catch-up. This asymmetry of experience means that health plans have more information at their disposal when it comes to VBC contracts. Understandably, it’s an imbalance that provider organizations are eager to correct.

Second, data layouts from payers are not at all standardized.

There is little consistency in the way payers deal with simple issues including basic variable definitions. But more importantly, there is even less consistency in significant areas that impact downstream analysis, including the way payers reflect: adjustment, reversal, and denied claims; multiple claims for a single event; definitions of financial fields; eligibility spans; initial and final claims; masked diagnoses; and whether the data is a full refresh or an incremental update. 

No two payers are the same, and small misunderstandings in how different payers present their claims and eligibility information can have big impacts on the accuracy of downstream analytic output.

Additionally, these layouts change frequently. Some of these layout changes are small, but when a hospital is managing contracts across multiple payers and each data set includes anywhere from three to 15 files, a series of small changes can throw a meaningful wrench in operations.

Managing these data sets requires a combination of technical expertise and industry knowledge, and these staff are difficult to recruit and retain. Providers may staff these functions with existing IT or analytic resources, and often find out that the specific skill sets, knowledge and experience to integrate the claims data do not exist in these internal resources.

Third, the logistics and operations required to manage all these incoming datasets is a complex task, even before anyone actually works with the data they contain. Providers with one or two VBC contracts may be able to cope, but those who have multiple contracts will soon find managing the incoming files onerous.

Managing the flow of incoming data files requires a system to identify received files, late files, missing files, duplicate files and a way to track operational activities around this function. Managing the content of the incoming data requires a system to dissect and analyze the incoming files to validate the content of the files, specifically related to the population included in the data, the dates of services provided and the consistency of the content of the data files.

Any change in content requires attention and validation before the data can be passed through the ingest process. Small changes that may be difficult to detect may end up significantly impacting downstream analysis, so the ingest process has to be thorough and complete to ensure confidence in the data being passed through for analysis. 

Working with data across multiple payers requires a combination of technical expertise and industry knowledge; finding staff with these skills is no small feat.

So, given these challenges, what is the upside of overcoming these barriers? In almost all cases, hospitals and health systems can expect higher confidence in their VBC operations—and here’s why.

Better decisions await the organizations who have complete and accurate claims data. It’s difficult to close a care gap when you don’t know the gap exists in the first place. It’s nearly impossible to understand how providers are performing against population health contracts if the aggregate data for that patient population is incomplete.

Many hospitals and health systems have invested, rightfully so, in analytics teams that are capable of running sophisticated analyses across multiple key VBC areas: HEDIS reporting, care gap closure, network analysis, cost and utilization tracking, population health management, and managing downside risk, among others.

But these reporting areas are only as useful as the underlying claims data—if there are holes, or if a new layout renders it unloadable, then the analysis that departments and C-suites rely on can be misleading. Provider organizations risk making business or care delivery decisions based on faulty data, which undermines the goals of value-based care in the first place.

Claims data is hardly new and shiny in the healthcare industry. But the way claims data are used, and by whom, has shifted significantly with the rise of value-based care. Providers are realizing the difficulty of maintaining in-house expertise given the constantly changing data streams.

Before spending significant time and effort refining their programs and contracts, health systems should make sure that the underlying data is sound. The wrong decisions can be costly, not only for data teams, but for all VBC priorities.

The hospitals and health systems that figure out the data piece of the puzzle will stay ahead of the pack in a competitive environment.

Jonathan Kaye is founder and president of Health Data Innovations.

Better decisions await the organizations who have complete and accurate claims data. It’s difficult to close a care gap when you don’t know the gap exists in the first place. 

Michael S. Horn

Articles

Latest Updated Articles