COVER STORY
the Medicare Shared Savings Program (MSSP) and Next Generation Program, others collaborating only with private health insurers, and still others working with both public and private payers. Summit Medical Group participates in both federal and private programs, while Brown & Toland participates only in programs sponsored by private health insurers at the moment.
Hospital system leaders dig into the challenges While every patient care organization has unique challenges and opportuni- ties, there’s no question that the nation’s children’s hospitals face strong head- winds, as they remain heavily depen- dent on revenues from care delivery to patients that come from the Medicaid program, even as more and more American families fall into poverty, swelling the numbers of Medicaid recipients. That’s certainly true at Nemours
Children’s Health, the multi-hospital system based in Wilmington, Del., and with a major hospital in Orlando, Fla., and dozens of clinics across the Delaware River Valley and in cen- tral Florida. T h e r e , R .
Lawrence Moss, M.D., the health system’s
CEO,
sees leadership as essential to clini- cal, operational, and fi nancial suc- cess going forward. What will it take for the leaders of patient care organizations to be suc- cessful going forward in the emerging healthcare system? “Courage and get- ting comfortable with ambiguity will be essential,” Moss says. “With respect to courage, this is a pivotal moment for our country’s healthcare system. And it’s people with jobs like mine who have the opportunity” to lead their organizations forward through change, he stresses. “Neither government nor private industry will tell us what to do. It’s a moment where we could let go of a system where we’ve done reasonably well and developed a comfort level; but is so far from where we could go,” Moss says, referring to fee-for-service pay- ment systems. “I like to use the analogy that you’ve got to let go of one side of the pool to get to the other side. There is no clear path from pure fee-for-service,
where we incentivize volume, to where we incentivize health. It’s all ambiguity. And it’s incumbent on people like me to enter into that ambiguity and uncer- tainty and know we’ll come out better on the other side. It would be easy to fall back to the old ways, to business as usual. It would be an absolute crime if we allowed that to happen.” With regard to how he and his
colleagues are creating the future at Nemours, Moss says that when mov- ing organizations of people forward, “It’s about the why; it’s about making a clear vision of what the future can be, and that ultimately inspires people to change, and is a call to action. It’s not about wading into the details on a spe- cifi c plan. It’s saying, here’s where kids are today, here’s where they could be tomorrow; we’re the ones who will get them there. And we’re about 85 percent complete with our strategic planning process,” he reports. “We were well into it before COVID, and kept going. And I could sum it up by saying [that it
a bar chart that shows the $3.5 trillion budget and 7 percent of that is kids— the future should involve a healthcare budget half [of that] size where we’re getting more health. So the issue for me is how to redo this.”
“I like to use the analogy that you’ve got to let go of one side of the pool to get to the other side. There is no clear path from pure fee-for-service, where we incentivize volume, to where we incentivize health. It’s all ambiguity. And it’s incumbent on people like me to enter into that ambiguity and uncer-
tainty and know we’ll come out better on the other side.” —R. Lawrence Moss, M.D.
involves] a common vision for the future that is inspiring for better for children.” And, while children’s hospitals face
headwinds even beyond those of adult hospitals, Moss says this: “Children’s hospitals are fi nancially challenged, true, that’s a challenge every day. But that’s a consequence of the way health- care is structured in the U.S.—we have a fee-for-service system constructed around volume and complexity of care. And children’s care is 7 percent of
the system. Most children don’t
have much money, and are supported by parents, and that’s why roughly 50 percent of our patients are supported by Medicaid. It’s a systemic issue. But when we incentivize health, that will be a boon for children’s hospitals, because there’s no more economically effective way to make those investments. I have
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What CIOs must do What are the implications of all of this, for CIOs and other senior healthcare IT leaders in patient care organizations nationwide? They are very profound, say leading CIOs; indeed, they speak to the role of the CIO itself. “I think the new role of the healthcare CIO is very different from that of the pre- COVID pandemic era,” says John M. Kravitz, CIO at the Danville, Pa.-based Geisinger Health System, an organiza- tion renowned for its culture of care delivery innovation. “The work the CIO needs to perform is strategic in a number of areas,” he says. With regard to organizational leadership, Kravitz says that “The push is to move to a digital strategy for the focus on our customer, and how we make it easier for the customer to get services from Geisinger the
versus compet it ion.
That means the CIO must work closely with
the specific
business area to look for digital solutions or develop digital solutions.” Bobbie Byrne,
M.D., CIO of the Advocate Aurora Health Care sys- tem, based in the Chicago suburb of Downers Grove and
in Milwaukee, agrees. In the wake of much urgent work that has needed to be done to support health system operations during the COVID-19 pan- demic, Byrne says that “Beyond that necessary work, CIOs need to achieve very tight alignment with operations on the very few other projects that can be completed. The original 2020 plan is in the garbage can, and we have a much more narrow list of priorities. If it is not on the approved priority list, we do not even talk about it. This can be hard because some people will go around the process and directly to the IT team members that they know to try to get movement on their particular project. IT people like to serve their customers. I am very focused on assuring that we are all rowing in the same direction,” she says.
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