By almost any measure, these are good times for Medicare Advantage (MA). Enrollment is growing, the number of insurers in the market is increasing, and gross margins are higher than in other health insurance markets. Some critics say the deck has been stacked in favor of MA and that the federal government is overpaying the insurers who offer MA plans relative to traditional Medicare. But for the legions of baby boomers who have become eligible for Medicare once they turn 65, the allure of MA plans - many with low or zero premiums, built-in Part D coverage, dental coverage, and other additional benefits - is strong. The trade-offs for beneficiaries are a narrower network of providers and managed care hoops to jump through, such as prior authorization and step therapy. 

The boom times are enticing new, smaller companies into the MA market, and some are bringing innovative offerings into the market. Meanwhile, private insurers, such as UnitedHealthcare and Humana, are working to move members over from employer-
	sponsored plans into MA plans when they hit their 65th birthday, and the federal government is making some effort to expand MA into rural and low-income populations where MA availability lags.

Mark Farrah Associates Assessed MA, Stand-Alone PDP Membership Trends

Medicare Advantage used to be called Medicare Part C, and it used to be the overlooked “middle child” of the Medicare program, sandwiched between Part A (for hospital coverage) and Part B (for physician services), and the upstart, Part D (for prescriptions), which became available in 2006. But according to data compiled by the Kaiser Family Foundation, enrollment in Medicare Advantage has been climbing steadily since 2004, when 5.3 million Medicare beneficiaries (13% of the total) were enrolled in MA plans. By 2019, that number had quadrupled to 22 million, and the proportion had grown to 34%. The Congressional Budget Office has projected that enrollment will continue to climb, so that by 2029, close to half (47%) of Medicare beneficiaries will be in MA plans. Twenty years from now, when the youngest baby boomers will be turning 76 and the oldest, 94, some projections show that 70% of Medicare beneficiaries in
	MA plans.

Provisions of the ACA that had the effect of lowering payments for MA plans were expected to reduce MA enrollment because it would make the program less attractive to insurers and beneficiaries. Quite the opposite has happened: Enrollment has doubled since 2010. Experts are still trying to figure out why. A 2019 Urban Institute report on the MA payment and enrollment question concluded that the payment cuts to the plans under the ACA weren’t as deep as expected for a variety of reasons. Indeed, the Kaiser Family Foundation’s math shows that between 2015 and 2018, the total of annual quality bonuses paid to Medicare Advantage plans has more than doubled, from $3 billion to $6.3 billion. The bonus payments are tied to quality scores, but some critics say they are flawed as indicators of the MA plan performance, instead rewarding plans for other factors, such as the relationship they have with providers and demographics of the beneficiaries. 

The overall upswing in MA enrollment does obscure some of the underlying variability. For example, geographically, enrollment is quite uneven. In six states (Florida, Hawaii, Minnesota, Oregon, Pennsylvania, and Wisconsin), more than 40% of Medicare beneficiaries are in MA plans, while in two states (Wyoming and Alaska), virtually none are. 

The Medicare Advantage market is brimming with plans today. For this plan year, over 3,000 plans were available, according to a Kaiser Family Foundation tally. CMS says that the average number of Medicare Advantage plan choices per county increased from 33 plans in 2019 to 39 plans this year. Kaiser’s numbers are lower (28 instead of 39) but still show an uptick. 

Insurance start-ups, such as Oscar and Bright Health, who were originally targeting the individual ACA exchange market, are part of the MA land rush. Oscar, based in New York City, started selling MA plan coverage in New York City and Houston this year. Bright Health, a Minneapolis company, started selling MA plans in seven additional markets. Devoted Health, in Waltham, Massachusetts, which bills itself as a “next-generation” MA plan, got started out in Florida markets and expanded into Houston for this plan year. 

Meanwhile, the large insurers continue to be the dominant players in the Medicare market, and they are adding hundreds of thousands of beneficiaries to their MA plans. UnitedHealthcare is the leader by far, with 26% of MA enrollees, followed by Humana, with 18%. Those two companies, along with CVS/Aetna and Blue Cross Blue Shield, have about 70% of MA enrollees in their plans.

The smaller companies bring innovations, while traditional healthcare companies cover the mainstream, observes Katie Guhr, president of Advantasure, a healthcare technology and information MA company in Glen Allen, Virginia. “It keeps the product from getting stagnant.”

Some of the major insurers that have been less active in MA market are recognizing the opportunity to provide coverage from the commercial market on through the MA, observes Guhr. She sees a resurgence of healthcare insurance companies recognizing that they have a place in the MA market: “There are more joint ventures than I’ve seen in a long time, leveraging subject matter expertise with unique fit in [the] marketplace.” 

Additionally, provider-insurer partnerships are popping up in the MA markets. Ascension Complete is an MA plan that is a partnership of Ascension, the large, not-for-profit Catholic health system, and Centene, which has expanded beyond its home turf, Medicaid managed care, into MA and other markets. Acquisitions are also reshaping the contours of the MA market, notes Guhr. Centene completed its acquisition of Wellcare in January. Anthem purchased a fast-growing MA plan in Florida called HealthSun in 2017; it bought another Florida plan, America’s 1st Choice, about a year later. 

MA enrollment tends to lag in rural areas. Many of the roughly 700 “low-penetration” counties, where 10% or less of Medicare beneficiaries are enrolled in MA plans, are in rural areas. Ramping up telehealth is one of the main goals of the Trump administration’s Rural Health Strategy. And starting this year, MA plans are allowed to include telehealth as part of their basic package, not just in the supplemental benefits.

In the past few years, CMS has also focused on “dual eligibles,” low-income seniors who qualify for Medicaid as well as Medicare coverage. Dual eligibles make up roughly 20% of the Medicare population. According to a 2019 report on MA by L.E.K. Consulting, enrollment in Dual Eligible Special Needs Plans, which are a kind of MA plan for dual eligibles, has been growing faster than enrollment in MA overall. 

CMS has also opened up MA rules so plans can now cover services to address the social determinants of health, including transportation, meals, and even cleaning. “We’re seeing a lot of organizations really trying to get their arms around community health,” says Guhr. And they’re recognizing the large variability in communities; a cookie-cutter approach doesn’t work for the dual eligibles. 

Both CMS and the Medicare Advantage plans understand that the senior population they serve is chronologically the same but changing in other ways. More marketing campaigns are conducted digitally and contain social media dimensions, says Guhr. The MA plans see that they need to get smarter about how they approach the consumer. “There’s recognition that a 65-year-old today is still relatively young, healthy, and active. The way 65-year-olds saw themselves in the 1990s or early 2000s is maybe in a state of relaxation - they earned their retirement,” Guhr says. MA plans have started to adjust by changing their marketing and communication strategies and adding benefits designed to prevent disease, not just treat it. 

Deborah Abrams Kaplan covers medical and practice management topics.

By almost any measure, these are good times for Medicare Advantage. Enrollment is growing, the number of insurers in the market is increasing, and gross margins are higher than in other health insurance markets.

These Are Boom Times for MA

To patients, observation status in a hospital can seem exactly like being an inpatient. Patients in observation status can be in the hospital several days just like fully admitted inpatients. They can be in a hospital bed, receiving pretty much the same kind of attention. 

But the financial implications of outpatient status are worlds apart from being an inpatient for both patients - especially for those covered by Medicare-and for hospitals. For Medicare beneficiaries, outpatient status stays are billed under Part B, which means 20% cost sharing and out-of-pocket costs for medications not directly related to the primary diagnosis. Outpatient status may also expose people to nursing home bills once they leave the hospital that would have been covered by Medicare if they had been admitted as inpatients for at least three days. For hospitals, outpatient status means reimbursement at far less than if the patient had been admitted. 

“Doctors get paid either way, but the hospitals get about half or even less for observation,” says Keith Lind, JD, MS, a senior policy adviser with AARP’s Public Policy Institute. 

Outrage over the “surprise billing” aspects of observation status and the fact that many patients didn’t realize they were classified that way led to the Medicare Outpatient Observation Notice (MOON) rule, which requires hospitals to notify patients if they are in outpatient status. Still, some physician and patient advocacy groups remain critical of outpatient status. They see loopholes in the MOON rule and cases when patients are put in observation status when, medically, they needed inpatient care. Some groups have mounted legal challenges; in late March, a federal judge ruled that some patients in the observation status could bring an appeal to CMS challenging that status. 

Effective Transitions Of Care After Discharge Process

Not everyone is a critic, though. Christopher McCann, CEO of Current Health, a Boston company that provides patient monitoring and other services, notes healthcare systems are using the shift from inpatient to observation as a strategy in their value-based contracting agreements. 

“Both private and public payers have been seeking to reduce the overall cost of healthcare delivery,” McCann says. “The hospital is the most expensive part of that delivery system, so one area of focus has been on reducing hospitalizations.” Because of the increasing reliability of remote monitoring and application of artificial intelligence, “we’ll see a reduction in both inpatient and observation stays,” he predicts, “and that observation status [care] will be delivered in the person’s own home.

Lindsey Osting, chief nursing officer and vice president of patient care at OhioHealth Doctors Hospital in Columbus, says hospitals have started to group observation patients together. 

“From a nursing perspective, while they get the same quality care you would get from being considered inpatient, if we put them together on the unit, it’s easier to develop protocols and ways of doing things in a way that is best for the patient,” Osting says.

The number of hospitals put into observation status started to increase significantly about 15 years ago. In some cases, hospitals were responding to Medicare auditors that challenged decisions to admit patients, especially for short periods. And there was some evidence that some fraction of inpatient admissions was at least questionable and perhaps motivated by a high reimbursement rate for inpatient care and the overall “heads in beds” incentives. In an effort to clarify when inpatient admissions were acceptable, CMS established the “2-midnight” rule in 2013. The rule states that if a doctor believes, with evidence to back it up, that a person needs to be hospitalized for a period that will span two midnights, then that person can be admitted as an inpatient. CMS adjusted the rule in 2016 to add back some physician judgment. 

“If a doctor thinks the patient is going to stay at least two days, they can admit them, and that claim will not get close scrutiny,” says Lind at the AARP. “If the patient is only there for one day, that claim is likely to be denied.” 

Many see the 2-midnight rule as giving hospitals even more of a reason to put patients into observation status, notwithstanding the lower reimbursement (better a smaller claim is paid than a larger claim denied). Hospitals may also use observation status because it may help with their readmission rates. 

Eric Burch, principal at Vizient, a member-owned healthcare services company in Irving, Texas, says with the rollout of the 2-midnight rule, hospitals began placing patients in observation status to avoid denial of payment. Commercial payers followed suit and, in some instances, downgraded patients from inpatient to observation status when calculating reimbursement.  

“Hospitals now leverage utilization review committees and have dedicated care teams and observation units to ensure they follow CMS and payer guidelines to provide the appropriate care for all patients,” he says. 

Grouping patients into observation status or inpatient as well as the push for quicker discharges has led to an improvement in the transitions of care, say some healthcare executives, according to many in the industry. There are now guidelines in place so that medication reconciliations and hospital treatment summaries are supposed to be provided to primary care physicians.

Maria Vila, DO, a family medicine specialist in New Jersey, says healthcare systems have adapted by creating observation units with hospitals, emphasizing case management and hiring physician advisers to determine the appropriate status. “Physician advisers can review the assigned status by the treating physicians and provide guidance if needed or challenge the assigned status of either inpatient or observation,” she says.

Teryl K. Nuckols, MD, director, division of general internal medicine at Cedars-Sinai Medical Center in Los Angeles, says it is still hard for clinicians because they are expected to make guesses about whether patients may stay longer than two midnights “often at a point when they are still sorting out the diagnosis.”  

“In some cases, it’s the luck of the draw whether the observation patients end up on the ‘observation units’ or on regular hospital nursing floors,” Nuckols says. “The literature also talks about hospitals creating protocols for certain categories of observed patients, such as those with chest pain, but now observation status applies to any patient with an anticipated short stay, so protocols seem to not play as large a role.”

Vila notes the main challenge includes unforeseen circumstances such as an inability to predict if a patient will truly improve and be able to be discharged within the appropriate time frame once determined as observation status.  

“Another challenge is that by discharging patients quickly, we need to ensure that they have proper follow-up with their primary care physicians and sometimes other services,” Vila says. “These issues must be handled by the case management team prior to discharge.” 

Keith Loria is an award-winning journalist who has been writing for major newspapers and magazines for close to 20 years.

How are healthcare systems addressing the shift from inpatient to observation?

Patients in Observation Status

You’ve just been offered a promotion. Congrats! This should be great or you - and your career.

But hang on. Not every promotion is the right fit. The wrong one can kink a career path instead paving the way forward.  

David Wildebrandt, a managing director at the Berkeley Research Group’s healthcare practice, notes that promotions and leadership are earned privileges and not given rights. If most of the following are applicable, then you should think “go” and not “no” about this promotion.

· The promotion is aligned with your capabilities and not occurring just because someone left the organization so now there’s a void to fill. For people who should be already working at this level, the promotion is an acknowledgment of their abilities.

· It is matched with your skill set and allows you to showcase your hard and soft skills.

· It’s not a high-risk venture in general, meaning you can feel safe taking this next step. This should be a calculated risk to push yourself, but you also need to be realistic.

· You can actually see and understand what success looks like in this next role. Clarity is everything.

· You don’t have to do a lot of soul-searching or think about reinventing yourself because the promotion means a role that seems to require totally new or unpredictable skill sets.

· You have a clear understanding of what your team looks like and a feeling of how they will work with you. You shouldn’t have to use a lot of “I” statements because your job will be less about you,and more about successfully developing the people under you.

· Your future hiring philosophy will be to replace yourself, and you’ll have the bandwidth and scope to do just that. You have the support of the organization to assemble the team and resources you need instead of having to be a superstar every day to get it done yourself.

· If you are switching employers, is the new employer keeping up? Does your new employer make sure the customer is at the center of everything and offers customers the technology and access they are used to in other facets of their lives? 

“Anyone in the post-ACA era of operational efficiency and reimbursement degradation must understand how to deliver high-quality care and services while receiving less,” says Kevin Groves, PhD, an associate professor of management at the Pepperdine Graziadio Business School in Malibu, California, and president of Groves Consulting Group, a succession-planning and leadership talent development firm.

Here are some of the attributes of a job or an employer that he advises clients to be on the lookout for: 

· The organization is cognizant of the mass consolidation taking place in healthcare and is reacting appropriately with a well-aligned, integrated delivery model.  

· The top management team has stability and longevity in defining the strategic direction of the organization. Research shows that when a CEO departs, half of the top team will also leave. 

· Succession planning and the talent development process are robust. Management is methodical and thoughtful about both.

· You sense that your own career interests and needs are being weighed and valued as you’re being considered for the promotion.

· If it’s a smaller organization, you will have opportunities to exert a broader influence and engagement in different functions and business units as you seek to broaden your own capabilities and skill sets. Some might be more external-facing, perhaps with involvement in, for example, fundraising.  

· There is a perceived or real sense of alignment of working styles that complement those of the CEO. Executives are willing to collaborate with you on specific areas such as operations and finance. There’s a strong, symbiotic relationship between a well-developed board and the CEO.

· Your career won’t stall once you accept the role, and career development is supported.

· The organization utilizes a comprehensive onboarding and acculturation process - a formal transition experience throughout the first year that effectively facilitates one’s transition into a new organization and local community. Management knows that where you live and what you can do there when you’re not working is as important as the work you do.

If much of the above applies to your next healthcare job opportunity, chances are you’re on your way to a rewarding new chapter. your professional life. Congrats! If it doesn’t, pause and consider. 

Stephanie Stephens, MA, is a journalist, producer, and host in Orange County, California.

Healthcare and business professionals share insight on the reasons you should or shouldn’t take a leap into a new career step.

How to Know if This Promotion Is Right for You

Generational differences make it difficult to satisfy the needs and wants of patients across varying age groups. Not long ago, it was expected that patients would be, well, patient and deferential. They may not have been thrilled about thumbing through magazines in a waiting room, but they tolerated it. Today, younger patients have much different expectations. 

Kaveh Safavi, MD, JD, senior managing director for Accenture’s global healthcare business, says younger patients want prompt service and see availability as paramount; if you cannot see them in a timely way, they will move on to the next doctor.  Or maybe skip seeing a doctor altogether and go to a retail health clinic or use a telehealth service. Meanwhile, older patients may want more time and attention. You may be seeing them with an adult child with lots of questions. Their schedules may be inflexible because they depend on family or friends to drive them to an office for an appointment. 

“We live in a world of instant gratification, and patient satisfaction is paramount,” Safavi says. “Think in terms of what you would want in a restaurant. A reservation that is not honored or a rude staff member not only takes that place off your favorite list, but also sends you to the keyboard for a harsh review.” That’s why he suggests not overbooking appointments and hiring front-office staff with good customer service skills.  

“If you are fully booked, do not just leave it at that. Give patients a solution that is appropriate,” Safavi advises. “Whether it be urgent care, minute clinic, or a direct referral to the proper specialist or emergency room, explain why the referral is appropriate for their need. This is something that people of any generation will appreciate.” 

Geeta Nayyar, MD, chief medical officer at Greenway Health, a health information technology and services provider, notes that the typical 25-year-old patient is going to have different medical needs than the typical 65-year-old patient. Healthcare providers and organizations cannot use a one-size-fits-all approach - and the need for generational sensitivity applies to everything from how people schedule appointments to the one-on-one conversations they have with clinicians.

Handling The Business Challenges Of Healthcare Consumerism

“With younger patients, physicians have to be more educational and consultative, speaking with them more about prevention of conditions and diseases,” she says. “With older generations, conversations are a bit more sensitive in nature and may include discussions about end-of-life planning and how to stay healthy and active during retirement.”

In addition, Nayyar notes, it’s important for older patients to be held more accountable for their care and health outcomes, ensuring they know where and how to find their health records so that information can be shared with all members of their care team. 

Thomas Horowitz, DO, a family medicine specialist at CHA Hollywood Presbyterian Medical Center in Los Angeles, says the key to working with people of all age groups and from different generations is to understand their preferences so that organizations can respond and adjust accordingly. 

“The challenge is that preferences are constantly evolving,” he says. “Further, behaviors around healthcare services are redefining how consumers engage with providers across each stage of care. Expectations for convenience, affordability, and quality are shifting. 

“Younger generations, in particular, are increasingly dissatisfied with healthcare’s status quo and are looking to nontraditional providers for services.”

Digital capabilities are influencing how younger generations choose their medical providers. Accenture research shows that 13% of baby boomers and the generation before them - some are calling it the Silent Generation - use remote or telemonitoring devices. The proportion is double among millennials and the 1995-2015 birth cohort that has been dubbed Gen Z. 

The Accenture research found that younger consumers (millennials and the Gen Zers) are dissatisfied with many aspects of traditional healthcare services. They are increasingly looking for effective, convenient means for receiving healthcare. The waiting room is not for them.

“Healthcare providers should consider investing in nontraditional means to engage with younger generations,” says Horowitz. “This could include setting up online patient portals where they can view lab results and making them aware that they can reach their HCP [healthcare provider] via email if they have any questions.”

Safavi notes that the younger the patients, the more likely they will expect a doctor’s office to be digitally up to date. 

“This is not only important for the electronic medical record in the exam room, but also on the website where portals and online scheduling are expected more and more among patients,” he says. “The doctor’s offices that look best online are conveying a service mindset to their patients.”

Younger patients will appreciate - and may even expect -Wi-Fi availability in the doctor’s office. The phone has replaced the magazine as a time killer. 

The generational split may not be as wide as it is commonly portrayed, in Nayyar’s view.  

“Regardless of whether you’re a millennial or a baby boomer, all patients want quick access to their healthcare records and to find helpful information online,” she says. “As long as physicians today provide that accessibility and quality care, combined with good bedside manner, people of all ages will remain engaged and satisfied.”

But Nayyar acknowledges that healthcare providers and organizations need to be attuned to generational differences. 

“Younger generations, for example, want their healthcare experiences to be quicker and more transactional, so it’s no surprise that 60% of millennials support the use of telehealth options to eliminate in-person visits,” she says. “The challenge here is ensuring critical information is not lost during these swift transactions.”

Meanwhile, older patients prefer face-to-face interactions. Many want to establish a more personal relationship with their physician. Of course, it remains to see whether millennials and Gen Zers will feel the same way come the mid-21st century, when they will start to experience old age and health issues that are often more complex and frequently chronic.

Laura Reyher, MSN, RN, is a member of the nursing faculty at West Texas A&M University in Canyon, Texas, and has 42 years of experience in healthcare. She notes that while some older patients may be tech savvy, doctors shouldn’t make any assumptions. 

“Many don’t own a computer and don’t have internet access,” she says. “A critical issue that many older patients fear is that they will be overlooked because they are elderly. Senior adults worry that they are viewed as helpless and hopeless, which is very discouraging to them.” 

Even something as simple as how you address patients may benefit from some generational awareness, notes Reyher. Younger patients are used to being called by their first names right from the beginning. Older adults should always be addressed as Mr, Mrs, or Ms, until they ask to be called by their first name, advises Reyher.

“It seems like a no-brainer, but you can never go wrong by being respectful - with all ages,” she continues. “Too often, patients feel that everyone is rushed; they are viewed as another item on the checklist and no one has time to hear their concerns. Most patients are fearful. All of us in healthcare need to guard against being oblivious to these fearful situations and take the time to let the patient - of any age - know that they are in safe hands and that we’re here for them. All patients respond positively when they know that we care.” 

Satisfying Patient Needs Across the Generations 

Your success depends on more than your vision and long-range planning. What you do in the short term - indeed, each day - can make you a more effective leader and colleague, help the bottom line, and tilt probabilities toward your success. 

Top healthcare executives shared 10 surprising ways to up your game daily with 

Jennifer Vachon, executive vice president at Blue Cross Blue Shield Association in Chicago, ends her workday with emails thanking staffers. “We tend to quickly move to the next thing, but this forces me to reflect,” says Vachon, who may commend a small gesture or a major effort. “It doesn’t take long but means so much to my team, making it a great time investment.”

Learn staff members’ names and special traits 

A casual conversation led to a daily resolution for Mooyeon Oh-Park, MD, MS, senior vice president and chief medical officer at Burke Rehabilitation Hospital. Oh-Park had just joined the physical rehab center in White Plains, New York, when an employee revealed knowledge about what her job required.

“Our strength as an institution is the diversity of our people,” she says. “I develop closer connections and know who can troubleshoot creatively.”

At Stanford Health Care in Palo Alto, California, leaders hold daily 15-minute meetings with their teams to brainstorm solutions for the day’s challenges. “It helps formalize touching base with your team each day,” says Alpa Vyas, vice president of patient experience. “Leaders understand what needs to be done, and employees are less reluctant to report problems because they know there’s a mechanism to solve them.”

Use your commute to bone up on business skills with audiobooks

Alexander Ronzino, founder and CEO at Coalition Recovery, a substance abuse treatment center in Tampa, Florida, listens to nonfiction management and finance books en route. “I find the perspectives of CEOs and entrepreneurs most candid and useful versus those of management consultants.” Military strategy and priority-setting audiobooks are most appealing to Oh-Park. Her recent favorites are “Essentialism: The Disciplined Pursuit of Less” by Greg McKeown and “The Art of War” by Sun Tzu.

“During moments of high anxiety, I noticed my mood could be felt by those around me - and was infectious,” says Oh-Park. “That didn’t help anyone.” Smiling eased her distress and the distress of others. “A positive mindset helps us find the best solutions.”

Get in early, before the members of your team

It pays to arrive a half-hour to an hour before anyone else, say several healthcare executives. “I never was a morning person - until I opted to become one,” quips Ronzino. The extra time and clear head give him a chance to prepare mentally and adjust his schedule to face potential challenges. “It’s made a tremendous difference in my overall productivity,” says Ronzino. Likewise, Ernie Schwefler, chief contracting officer for the University of Southern California’s Keck School of Medicine, arrives early to focus “before fires have to be put out. Knowing my priorities enables me to be nimble.” Rhonda Mims, executive vice president and chief public affairs officer at WellCare Health Plans in Tampa starts her workday at home with her eyes shut and mind open. “That helps balance me,” she says, adding that as a mother it’s her sole chance at solitude. “I run through any talking points mentally.”

Prepare for the next day before leaving the office 

Karen Murray, MD, physician in chief of Cleveland Clinic Children’s and president of the Cleveland Clinic Children’s Hospital for Rehabilitation, ends her day by getting ready for the next one. She might study an applicant’s CV, review the topics to be discussed at a meeting, or reserve time to talk with influencers. “I walk into the office with clear goals and the security of knowing people’s likely decisions,” says Murray.

Talking can be so easy, especially if others believe they must listen to you because you’re the boss. But Murray strives to listen - and listen intently. “Ultimately, everything is my responsibility,” she says. “So, if someone comes to me with an opportunity or concern, I try to really hear what they’re saying and what they’re not saying.”

Don’t wait for organized meetings to check in with your team, suggests Schwefler. He keeps his door open and regularly strolls through the workspace to speak with his team. “You have a view [of what’s happening in your organization], but those in the trenches may have a different one,” Schwefler says. For Ronzino, “casual chats foster a culture of collaboration and result in projects getting completed faster.”

Schedule tasks for when you will do them best  

With so many roles at Cleveland Clinic, Murray is careful to block out time for each function, whether it is an administrative task, a clinical visit, or writing papers. “I block time for when I’m most productive at that task,” she says. She also checks in with staff beforehand. “Medicine is a team sport, and the workflow needs to be best for everyone involved.” 

Michele Meyer is a freelance writer from Houston. 

Your success depends on more than your vision and long-range planning. What you do in the short term - indeed, each day - can make you a more effective leader and colleague, help the bottom line, and tilt probabilities toward your success.

Ten Habits That  Lead To Success

They say healthcare is a team sport, but teams can sag, get discouraged, lose focus, and stop functioning as, well, a team.  Anyone in a leadership position must stay attuned to how the team members are feeling and keep people motivated. Keeping your team motivated and maintaining enthusiasm requires attention, creativity, and planning.

Here are five examples of how healthcare organizations have worked to keep motivation high: 

UMass Memorial Health Care, in Worcester, Massachusetts, uses the “idea system” to motivate teams to transform care delivery and save lives. For example, the neonatal intensive care unit’s (NICU) pharmacy team wanted to reduce the time it took to provide antibiotics to its most vulnerable patients. The changes included streamlining the process for a clinician to order an antibiotic and having it verified and prepared by a pharmacist. As a result of the NICU pharmacy team’s work, the time to get critical medications to sick infants dropped from 75 minutes to 53. Since the idea system started six years ago, team members at UMass Memorial have submitted more than 78,000 ideas, says Eric W. Dickson, MD, president and CEO. 

Kelly M. Johnson, PhD, RN, NEA-C, former vice president of patient care services and chief nursing officer at Stanford Children’s Health in Palo Alto, California, brings together members of the patient care services team at the end of the fiscal year at a retreat to reflect, recharge, and connect. “We share and celebrate accomplishments in the division and solidify priorities for the coming year. More importantly, the time is critical for team building, self-care, and reflection on the important work we do,” says Johnson, who’s also chief nursing officer at the hospital, which provides pediatric and obstetric care in the San Francisco Bay area.

She acquired a new position in March 2020 as vice president, chief nursing officer, UCSF Benioff Childrens Hospital, ACNO, UCSF Health at the University of California, San Francisco.

The Apps Healthcare Execs Can’t Live Without

Cigna finalized its acquisition of Express Scripts in December 2018. During the integration, the company featured a “Thursday Thank You” segment on its intranet to celebrate team members’ successes, says Kristen Gorodetzer, senior vice president of total rewards, talent acquisition, and employee services at Cigna. The intranet posts focused on a different team each week and garnered significant engagement because “people want an opportunity to say thank you to pat each other on the back,” says Gorodetzer.

Patients calling to schedule appointments with UMass Memorial’s call center were waiting an average of 11 minutes, up from between 40 to 50 seconds. That spike in wait time was driven by the healthcare system’s electronic health record  implementation, says Dickson. He credits a dedicated leader on the call center team with using daily team huddles to sustain team members’ enthusiasm for streamlining the call greeting, activating an auto-answer feature to remove the 18-second ring cycle, and shortening the prerecorded appointment information. 

The end result is that the average call wait is now 5.6 seconds; it has been maintained by continuing to meet daily, review metrics five times a day, and provide training when necessary.

Sujata Sanghvi, deputy chief financial officer at AllWays Health Partners, a Somerville, Massachusetts, not-for-profit payer, says recognition of employee success is crucial. 

“It’s not only important for leaders to recognize their teams but also to encourage their teams to recognize each other,” she says. Sanghvi has a few ideas to make it fun: tie it to a reward, a raffle, even a silly rotating “trophy” to highlight the recognition. 

“By integrating opportunities like these into your regular practices, you can help create a sense of camaraderie to build a high-performing team that takes pride in their work and can depend on one another,” she says. 

Clinicians at UMass Memorial Health Care recommend strategies to better motivate team members, transform care delivery and save lives. 

Five Ways to Motivate Your Team

COVID-19 has disrupted American healthcare. But there are still important non-COVID-19 trends to keep an eye on.  

1) Wellness: Real Deal, Not a Passing Fad

As the cost of healthcare in this nation continues its relentless climb, health system and managed care executives are focusing on the development of strong population health programs and preventive care initiatives as a way to keep patients healthy and avoid chronic conditions that drive up drug and medical services expenditures.  

Anthony Viceroy, CEO of Westmed Medical Group, a multispecialty group in Westchester County, New York, and Fairfield County, Connecticut, believes that “wellness” is not just a popular trend or a passing fad. “By preventing or delaying chronic diseases, such as diabetes, hypertension, and heart disease, we can help improve the quality of care for patients, while reducing unnecessary costs in the system,” he says. “It is our belief that the only way to bend the cost curve of healthcare is to champion disease prevention and to promote healthy habits outside of the exam room.”

Viceroy says at Westmed they have noticed that millennials are better than boomers and other generations when it comes to being participants in their own healthcare. They are proving to be more mindful of activities that promote wellness and disease prevention. “This demographic readily adopts innovation and technology to help them track their heart [health], weight, nutrition, and fitness,” says Viceroy. 

Handling the Business Challenges of Healthcare Consumerism

He adds large medical groups like Westmed have an important role to play in partnering with patients to help them stay out of the hospital and be the healthiest versions of themselves. “I think as a result, you will see more outpatient practices and healthcare systems using data and community health programs to keep patients healthy outside of the doctor’s office.”

As 2020 unfolds, Scott D. Hayworth, MD, believes there will be a growing - and increasingly urgent - need to collect and analyze data. 

“Over the past decade, value-based reimbursement and compensation have become more dominant. Providers who cannot tap into the power of data collection, analysis, and guided action will simply not survive,” says Hayworth, who is president and CEO of CareMount Medical in Chappaqua, New York. “Patients are demanding, and payers are rewarding more cost-effective, versatile, and accessible systems of care.”

Depending on in-house resources likely won’t be the way to go. Data management service businesses will become essential partners to many provider groups and institutions, to manage both population health and the increasingly personalized care, says Hayworth. 

John Showalter, MD, MSIS, chief product officer of Jvion, a healthcare analytics and AI firm in suburban Atlanta, says that with a CMS evaluation showing that the next generation of ACOs aren’t saving money, population health will be seen as less effective. “I think that will lead to a trend of increasing focus on individual impact,” he says. “There will be a move from cohort management to individual risk management; specifically, there will be an increased discussion about how AI can help.” 

4) The Medical-Social Support “Mash-Up” 

Don McDaniel, CEO of Canton & Company, a Baltimore healthcare consultant, believes there will be a continued focus on “mash-ups” that go beyond traditional healthcare services spending and include social services, housing, nutrition, and the like.

“This is the year that I think we’ll find out if SDoH [social determinants of health] can be more than a science experiment,” he says. “There’s been lots of money spent on initiatives, but the jury is out in terms of return. So, can the various actors positively impact detrimental community, social and environmental impacts to improve health status and to reduce the amount spent on vulnerable, underserved populations?” In McDaniel’s estimation, integrated delivery systems that are at risk for the cost of caring for populations are in the strongest position to tackle SDoH projects.

Kurt Waltenbaugh, founder and CEO of Carrot Health, a Minneapolis SDoH and health data company, says greater access to consumer information will increase the industry’s ability to pinpoint barriers to health at the individual level. “Access to a broader array of consumer information will expose the role that upstream barriers, the so-called social determinants of health, play in continuously rising healthcare costs,” Waltenbaugh says. “More data will help us better understand how to remove those barriers and pinpoint healthcare down to the individual consumer level.” 

Part of the reason for the lack-until recently-of insight into SDoH until recently, he says, is the barriers are not evenly distributed. They tend to cluster in disadvantaged communities, which are disproportionately affected by declining health and rising costs. This year, Waltenbaugh says, he expects to see interventions based on broader consumer information emerge from the pilot stage and be deployed on a larger scale. “However,” he adds, “this scale deployment will only happen in areas where ROI has been demonstrated over a 12-month period. Any longer will require policy and funding changes, which are not currently on the horizon.”

6) Pharmacists as Deliverers of Medication Optimization

Varun Goyal, co-founder and CEO of Indiana-based Illuminate Health, believes medication optimization-making sure patients get the right dosage and support to stay adherent-is needed for every disease. Who better to deliver on the promise of medication optimization than pharmacists? “Providers and payers are now rethinking the role of pharmacists on their care teams,” he says. “Across the country, healthcare organizations are attempting to expand the scope of practice to allow pharmacists to extend patient oversight and assist with outpatient care.”

Healthcare organizations of all stripes are recognizing that pharmacists can help them realize the potential of value-based care. “By realizing the value of pharmacists and incorporating them to provide this patient-centered care model, they can help to reduce costs, ensure safe and accurate medication therapy, and help prevent patient readmissions and chronic disease progression,” says Goyal.

For the past several years, the transformative power of big data and AI has been a hot topic of conversation, and there’s some reality behind it too. “More recently, however, thanks to well-publicized incidents around data security and access, the conversation has pivoted to the dangers of increased access to data, and how to manage this risk,” says Eric Peterson, healthcare expert at PA Consulting. “Solving this problem will require significant cross-industry collaboration, which can obviously be challenging.”

Bill Stinneford, senior vice president and healthcare lead at Buxton, a healthcare intelligence company in Fort Worth, Texas, notes that one of the hottest healthcare trends is a “holistic access strategy.” Stinneford notes, “In the last five years, there has been a tremendous rise in outpatient location expansion within the healthcare industry. Retailers like CVS and Walgreens have opened thousands of clinics, and urgent care facilities have boomed. Even health systems have jumped on the trend by partnering with retailers or opening their own outpatient facilities.”

Among the reasons for this shift: It’s where the money is. The money is there because of reimbursement rates and incentives to keep nonemergency patients out of the emergency department. “Outpatient facilities are an important tool in the strategy to lower healthcare costs,” Peterson says. “But the factors that make a healthcare provider successful in an outpatient setting are very different from the factors that lead to success in a traditional inpatient environment.” 

In Peterson’s view, success in outpatient healthcare hinges on understanding and integrating three factors into a holistic strategy: consumer knowledge, retail real estate fundamentals, and traditional healthcare performance drivers. 

Healthcare executives and consultants told us which strategic trends to look out for - before COVID-19.

Top 8 Healthcare Business Trends

In 2010, Pat A. Basu, MD, MBA, was teaching medical and MBA students at Stanford University when he took a leave of absence to become a White House Fellow and senior adviser during the Obama administration and, for many healthcare reformers, those heady days when the ACA was signed into law. 

“I always wanted to make an impact on our country and society and help to build a better American healthcare system - one that is more accessible, higher quality, safer, and more economically sustainable,” Basu said. 

At the White House, he had a bird’s-eye view of the country’s healthcare problems and opportunities, and Basu used his time there to understand how the tangled and expensive American healthcare (non)system might be reformed.

Since April 2019, Basu has had a chance to use those insights as president and CEO of Cancer Treatment Centers of America (CTCA), a for-profit network of cancer hospitals and clinics competing in an area of healthcare dominated by some of the most recognizable names in American medicine: MD Anderson, Dana-Farber, Memorial Sloan Kettering, and Fred Hutchinson. CTCA, which is headquartered in Boca Raton, Florida, has hospitals in the Atlanta, Chicago, Philadelphia, Phoenix, and Tulsa metro areas, and two outpatient facilities in the Chicago area and three in Arizona. 

What Will Relaxation of Supervision Rules Mean for Cancer Care?

According to the results of the CTCA’s latest treatment report, Georgia residents made up the largest proportion of new patients from July 1, 2017, to June 30, 2018, on a state-by-state basis, accounting for 12% of the total (1,158 of 9,192).

“[Becoming president of the] CTCA was an opportunity to have a great impact on making the country a better place, making society a better place, and also building a better healthcare system,” says 40-year-old Basu. “Fundamentally, cancer has impacted me as a person, as a physician, and as a family member, so the opportunity to lead an organization that is fighting something that I have spent a career trying to defeat, with a platform that could leverage some of the things I have done in the past, was an incredible opportunity.”

Former Democratic Senate Majority Leader Tom Daschle was among those who showered Basu with praise when CTCA announced that he was taking the company’s top job. However, Basu took the helm of an organization that has weathered some criticism about the way it reports survival statistics; the latest treatment results report makes a point of mentioning that two outside experts reviewed the statistics. In Georgia, CTCA won a prolonged political and regulatory battle last year to expand its hospital in the Atlanta area. 

Basu says treatment results released in early 2020 show that “our survival rates and patient symptoms have only gotten better, even though we manage very complex and very sick patients.” He adds, “I want to give a great deal of credence and credit to those who’ve come before me, but I think we’ve even further upped the bar there.”

Basu has also been working on increasing the number of payers who will cover patients treated at the organization’s centers. 

“We have really expanded our access with new insurance contracts with a variety of large payers across the country,” he says. “We’ve gone from a large amount of people who had trouble accessing us because we might not have had an insurance contract to now 98%, 99% in-network with these commercial agreements.”

Basu says that when he speaks to medical students today about becoming physicians, he talks about how interacting with humanity is fulfilling and learning the scientific facts, interesting. “I just knew that I always loved helping people and making an impact, and, fundamentally, the science and innovation are so dynamic and stimulating. But putting together my love of people with the intellectual pursuit, this career drew me in from a pretty young age.” 

Basu, who is from Naperville, Illinois, a western suburb of Chicago,  earned his bachelor’s degree in mechanical engineering from the University of Illinois and his medical degree from the University of Chicago, while simultaneously getting his MBA from the university’s Booth School of Business. He went on to complete the Stanford Business School’s Faculty Leadership Program and became founding faculty director of health policy and finance. 

After leaving the White House, Basu became president and chief medical officer of vRad, a “teleradiology” company that delivers radiology services remotely. “What I learned there is that you have to be good at 1.0 healthcare, which is the traditional taking care of patients within the four walls, but start to bring in 2.0 type of solutions, such as technology and telehealth,” he says. “That leadership experience taught me that if you’re going to build the best healthcare system, you can’t just do 2.0; you need the scale and reality of 1.0.”

Before CTCA, his work included senior executive positions at UnitedHealth Group and two Chicago private equity firms, Chicago Pacific Founders and the Pritzker Group. He also helped start Doctor on Demand, a telehealth company. 

At CTCA, Basu says he is blending 2.0 skills with 1.0 elements. He is ramping up telehealth efforts and pushing the envelope on precision medicine and clinical trials. Like so many others in healthcare, Basu sees a need for collaboration: “For too long, we’ve operated in silos, so every large portion of the [cancer] ecosystem - providers, payers, employer, pharma - we’ve all worked really well…in our own verticals, but we can do much more together, and frankly, we have to do more together.

In a typical week, Basu spends a significant amount of time reaching out to partners to see what they can do together to solve problems. For instance, there might be a hospital in Seattle where CTCA has a patient in treatment for advanced or complex cancer care; Basu looks for ways to improve service for that patient by partnering with the hospital to keep them closer to home or better coordinating the care. There’s also the work of partnering with employers and insurance companies to find better solutions for value-based care and developing evidence-based pathways for the patient population at affordable rates. 

Basu says he is also working with pharmaceutical companies; he explains that CTCA is in the business of delivering their treatments, so he is looking for ways that CTCA and pharma can work together to help more people on a larger scale. “We have hundreds of thousands of sets of data that comprehensively can unlock a new therapy, a new method of diagnosis, [or] a new piece of discovery that can help develop a better cure. So we want to work with them in those capacities,” he says.

One of Basu’s latest initiatives is the launch of a dedicated value-based care oncology effort, which looks to work with employers and payers on best practice principles. He says the first nine months have been “remarkably successful.” Looking ahead, Basu is optimistic about advances in therapy, precision medicine, and telemedicine.  “What I see ahead is a patient can get our expertise while potentially not having to leave their geographical area,” he says. “We can do telehealth in oncology and coordinate care with a local provider, and there will be some network model to best care for the patient. My vision for CTCA is to help make that care more seamless.”

As president and CEO of Cancer Treatment Centers of America, Pat A. Basu, MD, MBA, looks to transform, improve, and influence cancer care on a large scale.

Basu Takes the Reins at CTCA 

When most people think about epidemics, they think of Ebola, SARS, and now, especially, the new coronavirus. But until COVID-19, when healthcare executives had thought about epidemics, they should also be thinking about diabetes, because it is growing, expensive - and deadly. 

The impact of diabetes on the lives of patients can be absolutely devastating. It is the underlying cause of serious complications, such as heart disease and stroke. Many people with diabetes are afflicted with chronic pain; it is also the leading cause of kidney failure, blindness, and amputations. Diabetes, and the complications resulting from it, ranks third behind heart disease and cancer as a cause of death in this country.  

Over 34 million Americans have been diagnosed with diabetes, mostly with the type 2 variety that is linked with being overweight or obese. Another 88 million Americans have prediabetes: They have blood sugar levels and other risk factors that could put them on the road to having full-blown diabetes. Nearly $250 billion is spent on healthcare costs related to diabetes, with an average medical expenditure of $15,000 per person with the disease. As far as drug costs are concerned, diabetes is the most expensive traditional therapeutic class on a per-member, per-month basis. 

21st Century-Style Diabetes Disease Management: Coaches and Tech-Enabled

The causal factors of the type 2 diabetes epidemic are well characterized: poor diet, obesity, lack of exercise, and aging. Diabetes also occurs more frequently in some groups because of social determinants of health, such as unsafe neighborhoods with a lack of access to recreation.

The good news is that managed healthcare can have a significant impact on all aspects of diabetes prevention and management. Through analytics and health risk appraisals, health plans can identify members with diabetes and those who are prediabetic. Focused disease management programs, combined with value-based provider contracts, can encourage engagement of members and incentivize providers to improve outcomes. Health plans can help by, among other things,  covering smartpens that can monitor injections. The same goes for stick-free glucose monitoring, which improves adherence to blood testing and insulin management. Health plans are also well positioned to work with community organizations to support efforts to educate people about proper nutrition, exercise habits, and weight management. 

When and how is difficult to say, but COVID-19 will recede. Diabetes will not. It will continue to grow as our society struggles to control the impacts of poor lifestyle habits. However, managed healthcare plans continue to play an important part in ensuring that members receive the most impactful information and care possible to manage and ultimately stop this epidemic.

Don Hall, MPH, and Sherry Rohlfing are principals of DeltaSigma, a consulting firm that specializes in strategic problem solving for managed care.

Americans have been diagnosed with diabetes, mostly with the type 2 variety linked with being overweight or obese.

Diabetes: The Quiet Epidemic That Is Not Going Away

COVID-19 has launched a massive natural experiment in work-from-home (WFH) policies and practices for employers and employees. Obviously, people involved in the direct provision of medical care can’t work for home, but, just as obviously, many people involved in office-based functions can.  

Here are six tips for healthcare executives who are managing WFH employees: 

Mary Anne Jones, senior vice president of finance and operations at Priority Health, a health insurer in Grand Rapids, Michigan, encourages healthcare leaders to communicate frequently and comprehensively. Every day during the COVID-19 outbreak, Priority Health’s executive team has communicated with employees about topics that range from staffing news to best practices to protect against infection with the SARS-CoV-2 virus to updates on resources available to WFH staff. Employees also receive information about compassionate and emergency paid-time-off opportunities.

Joe Tye, a former hospital administrator and founder and CEO of Value Coach, a consulting business, observes that healthcare workers are dedicated to their patients. One way to help remote workers feel connected, he says, is to share stories in a HIPAA-compliant manner on the organization’s intranet that illustrates how employees’ work affects patients. He offers the hypothetical example of a supply-chain clerk working from home who exceeded expectations to secure a shipment of surgical masks for the hospital. That effort might be acknowledged with a comment that “this shows how we are all caregivers and can all make a difference for the patient and for fellow caregivers,” says Tye.

Tina McKinney, regional vice president of human resources at Partners Healthcare in Boston, says WFH team members often need flexibility. Employees may need to start work early, before their children wake up, and then take a break to get their children involved in an at-home activity. McKinney says that Newton-Wellesley Hospital, one of the two hospitals where she heads up human resources for Partners, is extending the hospital’s employee assistance program to employees’ family members so they can get short-term counseling and other kinds of help. Employees have access to virtual spiritual care, where they can learn about yoga and meditation, for example. 

'The Clock Is Meaningless Now': Allegheny Health Network CEO Reports From the Front Lines of COVID-19

Being “too hunkered down” in the house can be bad for mental health, says Sherry Rohlfing, principal at DeltaSigma, a healthcare consulting firm in Littleton, Colorado. “Go outside. Social distancing doesn’t mean you’re stuck in the house,” says Rohlfing. 

3. Set up staff with the home-office tools they need

Jones says many of Priority Health’s employees aren’t used to working remotely. In response, the health insurer gives staff the equipment they need to furnish a home-office environment. Employees were allowed to take home their monitors, docking stations, and other computer equipment. Priority Health employees also receive tips on contacting IT services, setting up equipment, and accessing virtual tools, such as online meeting software. 

Craig Pirner, a managing director at The Advisory Board, advises hospitals to use virtual-meeting technology, such as Zoom or Cisco Webex. He encourages managers to use video whenever possible to help reduce social isolation. Nonverbal communication is missing during phone-based team meetings, he explains. 

Tye says that launching a virtual book club can be a good way to increase engagement among employees. “Choose a book, either fiction or nonfiction, that’s not directly work related and that inspires the heart and soul. A good start would be “The Last Lecture” by Randy Pausch, says Tye. One way to run the club is to schedule a weekly conference call with each person assigned to provide a recap and their observations about different chapters. After the book conversation, the call can be used to check in on team members.

5. Maintain focus on other problems to solve

COVID-19 has swept attention on other problems aside, but those problems are still there: keeping people with diabetes healthy, improving outcomes for hips and knees replacements, managing high drug costs. “It’s so easy for executives not to see what else is going on. The challenge is to understand there are other crises they’re going to have to deal with,” says Don Hall, who is a principal at Delta Sigma with Rohlfing and a member of the 

COVID-19 is a serious public health crisis; you don’t want to make light of it. But that doesn’t mean that people can’t share some lighthearted moments. Managers should inject a little fun into their interactions with employees, says McKinney. Some employees at Newton-Wellesley Hospital have been sharing fun videos about what they’re doing with their kids or their dogs, says McKinney, and she is perfectly OK with that. 

How healthcare executives can manage employees who are working from home.

MHE April 2020