CEO Power Panel: Patient access is the next frontier for health systems

When it comes to innovation, there’s one overarching goal on health system CEOs’ minds: access.

That means providing patients with care where they want it, when they want it and—increasingly—before they know they need it, according to health system CEOs. And that can involve building new options for brick-and-mortar care, such as conveniently located retail clinics and urgent-care centers, or by offering care through digital means.

“Right now, the big issues are access and convenience,” said Chris Van Gorder, CEO of Scripps Health.

It seems like most health system leaders are in agreement, according to Modern Healthcare’s most recent Power Panel survey of top healthcare CEOs. Eighty-five percent of the CEOs responding to the survey ranked clinical practice among the top three healthcare areas most in need of innovation, and 62% cited consumerism.

Interestingly, for many health system CEOs, clinical doesn’t mean disease diagnosis or treatment decisions. Instead, it’s part of a broadened idea of clinical care, connecting patients with the services they need to mitigate future health issues. And while such considerations as cost and patient satisfaction remain important pieces in the shift to healthcare consumerism, a growing emphasis on care access is becoming a bigger priority for CEOs.

The proliferation of retail clinics, urgent-care centers and direct-to-consumer telemedicine options over the past few years has opened the door for patients to seek healthcare outside of the traditional hospital’s walls, and to a lesser degree outside of physician clinics. Health systems want a piece of that market.

Using technology to support convenient access to care certainly isn’t a new concept. But there’s been a marked uptick in interest recently, said Brian Kalis, Accenture’s managing director of digital health.

“That trend has accelerated significantly over the past 12 to 24 months,” Kalis said. He attributed the growth to technology getting better and cheaper, as well as patients’ increasing interest in—and preference for—nontraditional healthcare services. “There’s a couple of factors in motion there,” he said.

Scripps Health in San Diego has established a 24/7 nurse triage service for patients to call as part of its push to make it “convenient and easy” for patients to get to the appropriate care site, Van Gorder said. That includes directing patients to Scripps HealthExpress walk-in clinics, a program the health system has worked to build up during the past year.

Scripps currently operates 12 of these walk-in clinics, with another set to open next month.

“To be honest with you, it’s—to some degree—in response to not only the consumerism issue, but also new competitors coming into the marketplace,” Van Gorder said of the clinics.

Half of surveyed CEOs said tech giants such as Apple and Amazon were healthcare outsiders most likely to innovate in the industry, while others cited CVS Health, Walmart and startups yet to be created.

“Everybody wants to come in and take a piece of ambulatory care,” Van Gorder said. “We often joke around here, ‘Nobody’s coming in and trying to compete with us against building new hospitals. They’re trying to compete with everything else.’ ”

Nearly half of all patients have used a walk-in or retail clinic to receive healthcare services, according to a recent survey from Accenture. Younger patients are seemingly leading the pack here, with 24% of Gen Zers and 13% of millennials expressing dissatisfaction with the convenience of traditional healthcare services.

Providers and payers that deliver care in settings such as retail clinics, outpatient centers and through digital health services will “earn loyalty, navigate disruption and be strongly positioned as the future of healthcare consumerism unfolds,” according to Accenture’s findings.

Like Scripps, many health systems are tackling these evolving patient preferences with walk-in and same-day care clinics, while others are turning to digital services.

In fact, three-quarters of respondents to Modern Healthcare’s Power Panel survey agreed that telemedicine was a technology with great potential to drive innovation over the next year. 

“Hospital (care) is an important component of what we do, but certainly not the only part—it’s also the part that our consumers use the least,” said Jim Hinton, CEO of Dallas-based Baylor Scott & White Health. “They use the ambulatory centers, doctor’s offices and increasingly the digital tools more than they would ever use a hospital in a given year.”

One of the major ways Baylor Scott & White has tackled consumerism is by developing MyBSWHealth, an app where patients can schedule appointments, refill prescriptions and complete telemedicine visits, according to Hinton. Some 1.1 million users have downloaded the app since its 2015 launch, and more than 350,000 users access it each month.

It’s no longer enough to be there when a patient needs care. Now, health systems are seeking ways to get ahead by providing support before a patient experiences a health issue.

Health systems are “expanding the notion of health,” according to Dr. Penny Wheeler, CEO of Minneapolis-based Allina Health. That means looking at social determinants of health in an effort to address medical issues proactively. “We’re thinking about what’s really affecting people’s health in a more holistic way, from their perspective,” she said.

Allina offers patients covered by Medicare or Medicaid the ability to participate in screenings for health determinants, such as food insecurity, transportation access and concerns related to interpersonal safety. The health system’s care teams then provide patients with a list of relevant community-based resources such as food pantries and financial-assistance organizations.

And health system leaders are increasingly turning to advanced data practices—whether in the form of predictive analytics, machine learning or full-blown artificial intelligence—to help do this work. That’s part of why AI ranked as the No. 1 technology CEOs cited as having the potential to drive innovation over the next year.

Nearly 80% of surveyed CEOs indicated that AI was likely to drive innovation during the next year, with most saying they are seeing AI innovation in clinical practice and consumerism.

But most health systems aren’t using “true artificial intelligence” yet, said Catherine Jacobson, CEO of Milwaukee-based Froedtert Health, although she believes they’re on the way there. “There are algorithms and things that use historic data, like predictive analytics, and that’s really what most of us are using right now,” she said.

As an example, she described clinical decision-support tools that use algorithms to predict when a patient’s care is on the verge of deteriorating, so that staff members know to intervene.

Randy Oostra, CEO of Toledo, Ohio-based ProMedica, said the health system is building its own analytics tool to screen patients for issues related to social determinants of health, as well.

Using predictive analytics paired with data from patient surveys and medical claims, the tool will help “drive much more informed decisions for clinicians,” he said. That can mean directing a diabetes patient in need of support to a dietitian or food pantry, which may subsequently reduce that patient’s risk of an avoidable hospital admission.

Of course, there are some more direct clinical use cases for AI. But they’re few and far between.

“We’re experimenting with a lot of that technology—all of it, at this point in time, is supervised by our physicians,” Scripps’ Van Gorder said, referencing dermatology and imaging as two medical areas that could be aided by AI. “There may come a time where we’ll use AI far more broadly than we do today. … We’re just now really scratching the surface.”

Efforts to use AI to help clinicians provide medical care are still in the early stages of adoption across the board, according to Accenture’s Kalis.

“Where we see the highest level of adoption today is actually in back-office and administrative processes to get more efficiency,” he said, as well as in using AI to improve patient experience. That might involve AI applications that flag patients at risk for missing their next appointment or that help patients navigate their care with symptom checkers.

While the technology is enticing, there are a few barriers holding AI back in clinical practice. One of these barriers is technical—developers need an enormous amount of data to train AI systems how to deliver insights before these tools can offer trustworthy and accurate diagnosis or treatment suggestions.

For example, Hinton at Baylor Scott & White said one of the applications he anticipates for AI would involve helping a physician analyze a patient’s symptoms, and guiding the physician through possible treatment plans. “Never replacing the clinical judgment of the physician, but really as an adjunct to that,” he said.

The benefit of this type of AI program would be to provide physicians with an additional perspective based on thousands of patients’ previous outcomes. But that means developers would need a way to bring together patient data to train these AI tools, and health systems would need a way to seamlessly feed a patient’s data into the system for analysis—and that requires some serious improvements in interoperability.

A key barrier standing in the way of innovation as a whole—beyond just AI—is “culture,” according to 73% of surveyed CEOs.

“People struggle with changing their processes to adapt to what new technologies can give you,” Froedtert’s Jacobson said. One way her system is considering addressing this challenge is by investing additional resources into its existing change-management program next year, such as by adding more at-the-elbow support when new technologies or practices are deployed.

Dr. John Pigott, chief innovation officer at ProMedica, said he’s found success in supporting the health system’s front-line staff and clinicians as they develop their own new processes. As part of the health system’s innovation arm, ProMedica Innovations, Pigott said he encourages employees to approach him with suggestions about how to improve hospital workflow or patient care, and his team helps to build those ideas into commercial companies. Pigott was not part of the survey panel.

There’s also room for upstream interventions ahead of the deployment of new technology. Emerging technologies often require employees to learn new skills and adapt to changing components of their jobs—or might even necessitate a change in workforce. That’s part of what drives resistance to change.

To address these types of concerns, Wheeler said Allina has emphasized involving clinical staff in innovation from the get-go. “To the best of your ability, have people be part of the change,” she said. “As we’re making these changes, it’s pulling people who are closest to whatever process we’re affecting to actually help redesign it.”

RELATED STORY: Innovation is a value-based care investment, health system CEOs say