Dennis Matheis of Sentara Healthcare: ‘Workforce flexibility for our team members is going to become more important’

How will your time as president of Sentara Health Plans inform your position as CEO of the health system?

I have 27-plus years of experience in healthcare. And I’ve worked on the provider as well as the payer side of the house. I like to think that I bring enough of a balanced perspective. One opportunity for me in this role is to continually improve the member and patient experience and to become more consumer-focused as an organization. I’m blessed that I’ve inherited an incredibly strong team here at Sentara. It speaks to the success that Sentara has had over the years in terms of our quality outcomes and our performance.

My wife was an ICU nurse for 20-plus years, so I have both a passionate and fond [sense] of what it is to be a nurse in a high-acuity setting. It makes me appreciate our team members in our 12 facilities and the work they do day in and day out.

One of the things I’ve done in previous roles is try to engage leadership deeper in the organization and push decision-making down. That’s going to be incredibly important for our continued journey as a consumer-driven organization. I and my team, quite frankly, don’t interact day-to-day with our members, with our patients, as often as our leaders in the field do. Pushing that decision-making down and putting it in the hands of people who are closer to our customers is a key element to how you start to really move an organization to become more consumer-focused.

Health system executives say that having an integrated health plan affords them unique opportunities, one of which is on the risk-based contracting side. Could you explain what opportunities being an integrated health system provides?

Having both a payer and provider under a single roof allows for trust to be built and creates more of a common dialogue between the two sides of the organization. That’s incredibly important to be able to advance payment for value as you engage with your patients as well as with other payers and ultimately employers. We have the Sentara Quality Care Network, a broad group of employed and community physicians. If you go back seven years ago, there were no other payers that were willing to contract with SQCN on a value-based perspective. Having a financing arm in Optima Health, we were able to do that. Secondly, engaging the city of Virginia Beach, the city of Norfolk and bringing doctors and employers to the table to discuss how we move the needle on both quality and affordability through SQCN was incredibly valuable. Employers stepped up and helped support the gestation of SQCN. Patients who go through SQCN with these employers typically ranked somewhere between the 75th and 90th percentile on Healthcare Efectiveness Data and Information Set measures. Tweaking benefit design to engage patients and members in a different way so that they would engage with SQCN physicians more frequently and in a trusting manner helped drive those outcomes.

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We have to do a better job of creating desire for people to jump into healthcare careers.”

Sentara recently said that it would boost pay for most of its employees. It will also offer reimbursement for adoptions and infertility care as well as increasing paid time off, parental leave and other benefits. How does this play into your recruitment and retention strategy?

We’re going to be short between 300,000 and 500,000 nurses nationally through 2028. Stack that onto a shortage of another roughly 500,000 other associated allied health professionals, and it’s a really scary thing in terms of staffing 12 hospitals and associated clinics. We’ve tried to get ahead of the curve in terms of wages, compensation and benefit design. To a degree, that’s been very successful for us in terms of stabilizing our workforce. Looking at how we create better workforce flexibility for our team members is going to become more important for us in terms of how we think about shifting and how we think about matching skill sets to nurses’ preferred areas of work. Then there’s the notion of getting people to practice at the top of license. It’s thinking of new ways to deliver care—how we leverage other team members to help in the care delivery process and free up those members to focus at their top of license. We can also leverage technology to create smoother, easier, more efficient workplaces.

We also have to do a better job of creating desire for people to jump into healthcare careers. That is going to force us to start engaging at the high school level and educating kids on the benefits of a healthcare career. We need to create the career pathing within our organization, and in partnership with others, to help people evolve their careers.

How do you facilitate practicing at the top of license?

There are several opportunities. One: How do we cultivate and continue to evolve the legislative and regulatory bodies to allow for more consistency to get us to top of license across all the different geographies that we serve? Secondly, it’s about leveraging technology. Our physicians, unfortunately, would tell you they spend two hours on average documenting the patient care and everything that they have done during their day. That’s a lot of time. The promise of the electronic health records still holds. But the way we have constructed it today is sucking a lot of administrative time out of those caregivers rather than having them put their cognitive time into taking care of patients.

How are you addressing mental health needs both among caregivers and patients?

Internally, we created safe spaces for nurses to be able to go visit behavioral health team members in our facilities. That’s a good first step. The stats are ugly: 100,000 nurses nationally under the age of 35 have left the field over the last two-and-a-half years because of the stress. There’s more work to be done there.

Externally, the COVID-19 crisis exposed long-simmering issues with access, under-diagnosis and under-treatment of behavioral health issues. You see patients in crisis showing up in our emergency departments, and there’s not a good opportunity to put those patients in appropriate settings. It creates logjams in our EDs, which are not ideal for treating behavioral health patients. We’ve remodeled some of our EDs to create designated behavioral health space that allows us to free up some staff. We’ve also started to pivot toward outreach—think virtual care and trying to get to people before they are in crisis.

In the longer term, we’re going to have to evolve to public-private partnerships. Those are going to look at how we beef up the number of behavioral health professionals in the marketplace. Virtual care has a ton of promise to create better access.

We’re also asking the question: Do we have to think differently about the care continuum regarding behavioral health, and how do we embed it more in our primary care practices? Behavioral health issues typically go hand-in-hand with chronic care issues for a lot of folks and if one goes untreated, the other is going to suffer. We see it as a responsibility of ours to figure out how we could do a better job there.

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