Creative approaches to the staffing crisis, artificial intelligence's early results and worries about cybersecurity were among the issues healthcare leaders examined last week at Modern Healthcare's Leadership Symposium.
Here are five topics executives shared their thoughts on during the day-long event in Washington, D.C.
Staffing
Recruiting employees for all levels of an organization, and keeping them, is requiring the development of pipelines with schools and programs internally to better address career advancement and employee mental health.
Kathleen Sanford, chief nursing officer of CommonSpirit, said everyone is hoping for a silver bullet, but a magic solution to staffing doesn't exist. It takes a lot of smaller, creative steps to shore up a workforce, Sanford said.
Organizations need to ensure they themselves are not the institutional impediment to diversifying and maintaining their workforces, said Dr. David Lubarsky, vice chancellor for human health sciences and CEO at University of California Davis Health.
Hospital systems can deny themselves good, loyal employees if they insist on advanced degrees for jobs that don't really require them, Lubarsky said. UC Davis widened the pool of potential applicants by changing the qualifications to include degrees from community colleges.
Artificial intelligence
Artificial intelligence gets high marks as a tool to improve productivity and the patient experience — but executives said adoption by clinicians will depend on how intuitive its use feels. They also expressed a need for doctors, nurses and others to act as a human backstop for the technology.
Dan Liljenquist, chief strategy officer at Intermountain Health, said if clinicians must be convinced to use technology, it's already too late. “The ones who love it tell their friends,” Liljenquist said.
Nallan Sriraman, chief technology officer at Mass General Brigham, argued that while some practitioners are wary of legal liability for using AI, before too long the technology will advance to the point where the liability would be greater if AI isn't used, a point echoed by Liljenquist.
Liljenquist noted there’s room for the government to collaborate with the industry on AI use and development, but cautioned that repercussions for poorly performing AI tend to come internally and from other parts of the industry. The government runs the risk of stifling creativity if it over-regulates the space, he said.
Cybersecurity
Seven months after the Change Healthcare cyberattack, organizations seem resigned to the fact that they can’t thwart all potential attacks on their internal systems.
Executive-level conversations become about determining risk tolerance, said Ben Schwering, chief information security officer at Premier, Inc., who noted he reports to the CFO, not the CIO.
Greg Garcia, executive director of the Health Sector Coordinating Council Cybersecurity Working Group, said the costs of improving cybersecurity can help avoid the higher costs — reputational and financial — of being vulnerable.
American Hospital Association President and CEO Rick Pollack called for a "whole of government" approach. CMS Deputy Administrator and Chief Operating Officer Jonathan Blum signaled the agency is working on oversight policies for third-party vendors.
Value-based care
Moving clinicians toward value-based care is showing signs of progress, but executives said speeding up the process requires clear signals from CMS that staying in fee-for-service pay arrangements won't be productive or profitable.
"CMS controls the fee-for-service side and the [alternative pay model] side. And I think it really has to be that we have to allow it to be uncomfortable staying in fee-for-service," said Dr. Farzad Mostashari, CEO of Aledade.
Executives agreed value-based care is better for clinicians and could allow them more freedom to practice medicine and help relieve burnout — but said the necessary upfront investment and lack of transparency around some value-based care models are challenging. The payment model also stands in the way, said Dr. Mohamed Diab, CEO of CVS Accountable Care.
“It's shocking to me that in this day and age, especially after COVID-19 exposed us as a society, that CMS payment for many of the primary care physicians is 2% of the total cost,” Diab said.
Dr. Andrew Bindman, executive vice president and chief medical officer at Kaiser Permanente, said the system is all-in on value-based care as exemplified by its formation of Risant Health, which has acquired Geisinger Health and seeks to acquire Cone Health.
"We're completely convinced this is the way to improve health in this country," he said.
A post-Chevron world
Healthcare is still digesting the impact of the Supreme Court overturning the Chevron deference in the Loper Bright case. The ruling threw out the 40-year precedent that said judges should defer to agency experts, and shifted greater responsibility to judges themselves.
Executives said the ruling will result in greater uncertainty, a likely slowdown in regulation and a probable spike in litigation.
Ceci Connolly, president and CEO of the Alliance of Community Health Plans, voiced concerns that well-funded industry players have the deep benches to write legislation that will benefit them, while smaller companies don’t have the depth of talent to advocate for their own interests.
