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AVIA 2018 Network Summit

NETWORK SUMMITACCELERATINGIMPACT 2018

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AVIA MEMBERS ARE DRIVING IMPACT LINDA FINKEL PRESIDENT

At AVIA, our mission is nothing short of driving exponential change for our families, our communities, and for the country. Our shared goal is to make healthcare better through digital transformation.

Given the incredible energy at this year’s AVIA Network Summit, we believe we can achieve it. Speakers shared an impressive arsenal of digital success stories, proving our health system Members are unlocking the power of digital to move the needle on pressing challenges.

Members are disrupting their own systems, using new technologies to optimize everything from waiting room time to community resource referrals. They’re forming new partnerships with other providers, community organizations, and start-ups to build solutions that address mission-critical work – expanding access to care, meeting needs of the most vulnerable, and accelerating growth. And they’re moving quickly.

Still, we need to do more. We designed this year’s Summit to help our Members:

1. Act with intention – and get to scaled results

2. Commit to measuring value

3. Do more faster – with excellence

4. Focus on the greatest opportunities to drive impact now – and to disrupt the future

With more than 200 senior executives at the Summit representing 400 hospitals and $140 billion in net patient revenue, our Members represent a force that can move healthcare toward a brighter future. And after this year’s Summit, I know we will.

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Ten years from now, the health systems that stand out as thriving providers of care will be the ones that intently focus on advancing their digital strategies today.

The field of play is shifting. So many other industries—from retail to finance to

manufacturing—have lowered their cost to serve and boosted productivity

by unlocking the power of digital.

Now it’s healthcare’s turn.

We’ve reached the tipping point, in part, because

the math doesn’t work. In 2016, the Congressional

Budget Office projected that 41% to 60% of hospitals

could be operating at negative margins by 2025,

absent transformative gains in productivity1. A

2018 analysis from Deloitte reported that labor

costs comprise approximately 60% of a hospital’s

noncapital costs and is the largest driver of

operating expenses2.

It’s simply unsustainable. Cast in this light, digital

isn’t just the smart answer, it’s the only answer for

healthcare organizations that intend to serve their

communities for decades to come.

Fortunately, many healthcare leaders have

already come to this realization and have

mandated that their organizations take action.

At this year’s J.P. Morgan Healthcare Conference,

Intermountain Healthcare CEO Mark Harrison told

the audience that Intermountain would not build

more hospital towers. Instead, the organization will

turn its investment focus toward digital solutions,

with the stated target of becoming “the first

consumer-centric, digitally enabled consumer

health system3.”

Across every industry, a strong digital strategy

doesn’t simply enhance an organization’s chance

of success; digital strength correlates directly with

revenue growth and share price performance.

Global agency Isobar’s Digital Strength Index offers

analysis based on five years of data capture and

benchmarking4, and the indisputable evidence

points to this: the digitally strong outperform the

digitally weak.

Where do you start? How can you move faster?

At the most basic level, we recommend taking

a pragmatic, holistic, and unvarnished look at

where your organization is today with your digital

initiatives. Use that assessment as a launchpad to

build the plan for where you want to go. And then

find opportunities to learn from others who share

your goals, who have declared similar goals or

made similar missteps, who know how challenging

it can be to measure return on such bold visions

and can work alongside you to figure it out. Put

more succinctly, you start by realizing that you don’t

have to walk alone on your digital journey.

The AVIA Network harnesses the power of

collaboration and scale. Our members learn with

every investment, every implementation, and

every move toward scale. In every experience

and connection, we learn—and our tools, best

practices, and benchmarks for success push

healthcare forward. That’s how we win together.

TODAY’S DIGITAL IMPERATIVE ERIC LANGSHUR CO-FOUNDER/CEO

1 https://www.cbo.gov/publication/51919

2http://blogs.deloitte.com/centerforhealthsolutions/no-sick-days-no-collars-how-tech-might-help-hospitals-shrink-labor-costs/

3https://www.healthleadersmedia.com/strategy/no-regrets-intermountain-healthcares-top-leader

4https://www.isobar.com/us/en/news/isobar-digital-strength-index/

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““There have to be alternative ways for growth to occur besides the traditional means.”

Dr. Justin McGoldrick Chief Medical Officer, Research and Innovation

Mercy Health

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STRUCTURE FOR DIGITAL SUCCESS

To accelerate innovation healthcare organizations need to build the right scaffolding to fast-track execution.

“Seven years ago, innovation was a bullet point. Now, it’s one of our system goals,” says Michelle Conger, Chief Strategy Officer for OSF HealthCare.

In other words, organizations looking to implement successful digital strategies should embed innovation into the infrastructure.

“There have to be alternative ways for growth to occur besides the traditional means,” says Mercy Health’s Chief Medical Officer Dr. Justin McGoldrick, adding that besides spurring growth, digital strategies must also reduce the per-unit cost of care.

Today, both OSF HealthCare and Mercy Health have strategically hardwired innovation by establishing clear goals that cascade throughout their organizations.

Part of building the right structure means educating people within a system about how digital tools can advance healthcare. “It’s change management 101,” says Matthew Fenty, Director of Innovation and Strategic Partnerships at St. Luke’s University Health Network. “It’s educating our clinical staff that in certain scenarios, a video visit can be just as effective as a face-to-face encounter.”

Digital innovation advocates must also educate stakeholders about the strategy behind specific tools, says OSF HealthCare’s Conger. “We’ve been educating our organization about the fact that the dialogue around digital is about launching a new business model,” she says. “You can’t think about it as just augmenting your existing business model.” She adds that at OSF, her

SUMMIT AT A GLANCE —

60PERCENT GROWTH OF THE AVIA

INNOVATOR NETWORK IN THE LAST

12 MONTHS

$140+MILLION LIVES TOUCHED BY THE AVIA

INNOVATOR NETWORK

MAJOR HEALTH SYSTEMS IN THE AVIA

INNOVATOR NETWORK

35+

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STRUCTURE FOR DIGITAL SUCCESS (cont.)

team created its digital infrastructure by first getting buy-in from the board, then bringing the rest of the system along.

Those conversations with stakeholders are critical, says MD Anderson Cancer Center’s Chief Innovation Officer Rebecca Kaul. “Be iterative and collaborate with the operational and clinical stakeholders,” she says. “Have a bias towards action.”

Kaul outlines six steps for rolling out a digital plan successfully: “First of all you have to find a champion,” she says. “Second, tell, don’t ask. Third, make people uncomfortable. Fourth, show value. Fifth, see things through, and sixth, make sure you’re solving the right problem.”

Solving the right problem is key, Kaul explains: “Putting a great solution into a flawed system is not going to bring you the results you desire.” She says she saw the necessity of matching the problem to a solution when administrators in MD Anderson Cancer Center’s infusion clinic asked for more space in the waiting room. Through an intense research process with a digital company, the innovation team discovered that the real problem wasn’t waiting room real estate at all, it was scheduling, which they were then able to tackle.

After deploying the solution, MD Anderson’s infusion clinics saw a 10 percent increase in patient volume and a 12 percent reduction in wait times. Also, its diagnostic imaging clinic reduced end-to-end wait time by half.

Decision-makers may be overwhelmed by the volume of digital opportunities, but to achieve real change, they have to prioritize. “We started off with an assessment that pointed us in the right direction by establishing our ecosystem,” says Mercy Health’s Dr. McGoldrick. “That helped us understand what’s out there, prioritize decisions, pilot initiatives and then, obviously, scale them.”

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MEASURE CORRECTLY TO MOTIVATE EFFECTIVELY Once prioritized, digital initiatives are only as good as their measurable ROI – something that Chris Wing, Chief Executive Officer of SCAN Health Plan, has been demanding from his quality improvement work with physicians.

“If you show a physician a meaningful metric that has to do with quality that’s connected to their Five-Star bonus, and you show where they’re below the 50th percentile, I’ll guarantee you’ll get a motivated physician group,” Wing says.

He explains how he used data to transform an underper-forming health plan into a fast-growing, Four-Star plan. Starting with leadership, SCAN invested resources and infrastructure to support a data-driven culture.

Now data is ingrained in the business. Wing says “We talk about our performance all the time. We’re evangelistic – at every board meeting we’re talking about our metrics. Every time we’re in front of the leadership team we’re talking about our performance.”

Knowing where to find data and which data is needed is critical, especially in risk-based arrangements. To do this, organizations must invest in analytical capabilities to gather and view both payer and provider data across the continuum of care. Wing discussed the importance of assessing longitudinal patient data to identify interventions that will move the needle for the most complex patients, those with multiple comorbidities.

Health systems looking to implement innovative solutions can break their digital acceleration plan into three steps: 1) build the right infrastructure, 2) identify and address the most important problem, and 3) track targeted metrics to measure success.

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““Be iterative and collaborate with the operational and clinical stakeholders. Have a bias towards action.”

Rebecca Kaul Chief Innovation Officer

MD Anderson Cancer Center

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Innovative healthcare leaders need to take cues from other industries and start walking in consumers’ shoes.

Healthcare shares a common core purpose with another industry – hospitality – and that purpose is service, says Hyatt Hotels Corporation CEO Mark Hoplamazian.

“We are a guest in their lives, not the other way around,” he says. With that thinking, he adds, Hyatt Hotels has embedded what Hoplamazian calls “reverse empathy” into its culture – a paradigm shift that he argues would benefit healthcare organizations too.

“The empathy that comes from a reverse perspective is the common denominator between our industries,” he says. “It can be the key to unlocking performance and innovation.”

Healthcare leaders are already applying this thinking to redefine digital consumer engagement.

Armed with a consumer-first mentality, Memorial Hermann Health System decided to shed clunky legacy technology, says Chief Information Officer Amanda Hammel. “We started our digital journey by getting rid of what we lovingly call ‘the strip mall of apps’ to create the platform that we envision will put us at the forefront of truly consumer-centric healthcare,” she says. “Now, we don’t talk about portals anymore. We don’t have one of those – we have a consumer engagement platform.”

Focusing on the patient perspective led BayCare Health System to launch the digital self-triage mobile app HealthNav, according to Chief Strategy and Marketing Officer Ed Rafalski. “Sometimes it is difficult to get an

immediate appointment with a physician, particularly when you or your family member is very sick,” he says. HealthNav guides patients through a symptom checker and then uses the patient-entered information to recommend the most appropriate site of care—everything from the emergency department or urgent care clinic to telehealth services delivered through the health system’s BayCareAnywhere app.

Digital platforms can also create a crucial online presence for health systems as more and more patients seek care through online search. These platforms also enable patients to engage along the continuum of care – before they enter a health system, while they’re receiving treatment, then during and after the handoff.

“The one thing I want to stress is these new patients are just waiting for you outside the digital door, and they’re asking healthcare organizations what’s taking so long to provide basic digital convenience,” says Aaron Martin, Executive Vice President and Chief Digital Officer at Providence St. Joseph Health.

To meet that need, Martin says his team has made Providence St. Joseph Health easier for patients to discover through search search, transact online, and engage in on ongoing digital relationship. For example, through search engine optimization of PSJH’s Swedish affiliate’s website in Seattle, Martin’s team

MEET CONSUMERS WHERE THEY ARE

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boosted traffic to physician detail pages by 2,000 percent, which the organization estimates to be worth an extra $2 million per year to the system.

Patients can now schedule their visits online whether looking for a physician or booking a same-day urgent care appointment. They can start a telehealth visit on demand or they can even summon a provider to their home. In Providence’s Express Care brand, 55 percent of last year’s visits were scheduled online, 80 percent were commercially insured, with 30 percent of those visits coming from new patients. After an appointment, physicians can use the Xealth platform to prescribe digital content, apps, services and products that will improve their health and wellness.

MEET CONSUMERS WHERE THEY ARE (cont.)

“[Consumers] want to build digital relationships with a brand. If a health system doesn’t, someone else will.”

Aaron Martin, Executive Vice President and Chief Digital Officer, Providence St. Joseph Health.

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INNOVATE AT THE INTERSECTION OF MISSION AND MARGIN

At the heart of digital transformation, there’s a moral imperative and a business case for helping the most vulnerable populations, according to several Summit speakers.

“We embrace [working with the Medicaid population] because it’s part of our heritage and our culture,” says Bruce Swartz, Senior Vice President of Physician Integration at Dignity Health. “That said, we also have to get return on the investment.”

“We have spent millions of dollars building our infrastructure to handle risk,” Swartz says. “And the results we’re having in terms of patients getting the right level of care – of patients not being re-admitted within 30 days – has actually proven to be very positive.”

Several forces are coalescing now to create a business case for healthcare solutions for the Medicaid population, says David Smith, AVIA’s Medicaid Transformation Project Executive.

“Every day we’re learning more and more about new technology-enabled care models,” he says, “and we’re seeing an evidence base begin to swell that’s telling us how we can have a disproportionate impact on vulnerable populations.”

The business case is clear, agreed former CMS Acting Administrator, AVIA Senior Advisor, and General Partner of Town Hall Ventures Andy Slavitt. “I think people know that there’s an ROI here even though it’s been less explored. But my interest is not in helping people take some money from their balance sheet and be able to help them use it to feel good. Because that’s not going to sustain us over the next decade.”

Instead, he says, he’s interested in investments that do

THE MEDICAID TRANSFORMATION PROJECT

AVIA has joined forces with Andy Slavitt, former CMS Acting Administrator, AVIA Senior Advisor, and General Partner of Town Hall Ventures, to take on a national challenge: innovating to find a financially-sustainable way to deliver high-quality care for Medicaid-eligble patients and other vulnerable populations.

This population is disastrously underserved, according to Slavitt. “Compared to the commercial population, they have relatively ordinary healthcare needs, but poor outcomes,” he says.

To achieve this mission, AVIA and Slavitt are launching the Medicaid Transformation Project, a national, multi-year movement that organizes leading health systems across AVIA’s Network to source, build, invest in, or co-develop scalable solutions that impact the cost and quality of care for Medicaid beneficiaries. These influential health system partners can accelerate action by bringing attention, insight, innovation, and scale to this work in areas including emergency department utilization and behavioral health, says AVIA President Linda Finkel.

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INNOVATE AT THE INTERSECTION OF MISSION AND MARGIN(cont.) good in the world that also have known returns. For example, he says, funding interventions that enable mothers to deliver at nine months instead of eight months would have a tremendous ROI. “If you could give a kid the right, healthy start to the first three years of life, that is an enormously positive and powerful investment.”

Leaders looking to tackle issues that impact the Medicaid population shouldn’t become paralyzed by the complexity of the problem. Or, in the words of Navicent Health CEO Dr. Ninfa Saunders, “Start anywhere.”

Instead of boiling the ocean, she recommends targeting specific issues. For example, she says her team found a 30 percent difference in the readmission rates between African-American and Caucasian patients at her hospital.

“When we started to intervene, we were able to get it to parity, and today we have no disparities on the patients admitted into our organization when it comes to readmission.” Incredibly, she says, “It took us six months.”

None of this would have been possible without taking the initial step. According to Saunders, “If you start trying to overanalyze it, you’ll never get anything done.”

THE MEDICAID TRANSFORMATION PROJECT (CONT.)

More than 20 leading health systems have already signed on to the project.

This work is a high priority for AVIA Members since the Network serves geographies that include nearly 61 million Medicaid beneficiaries. Health system CEOs, AVIA, and Slavitt all believe the time is now to create real, longstanding solutions for the Medicaid population. “We wish it were as easy as a silver bullet, but we know if we want to make an impact on the populations we’re serving, we have to understand their lives – understand their problems,” Slavitt says. “We dramatically under-invest in innovation in this community.”

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““Technology that makes physicians’ lives easier can be incredibly valuable, even if it’s costly.”

Dr. Edmondo Robinson Chief Transformation Officer

Christiana Care Health System

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EMPOWER EMPLOYEES THROUGH TECHNOLOGY

Scanning across the health technology landscape of the past 15 to 20 years, it’s safe to say that most technologies were not built to create delight for the end-user clinicians.

As a result, many technologies have become a burden for clinicians, contributing to the growing problem of physician burnout.

But now, smart health systems are figuring out innovative ways to turn technology into the solution.

“Technology that makes physicians’ lives easier can be incredibly valuable,” says Christiana Care Health System’s Chief Transformation Officer Dr. Edmondo Robinson. He says physicians in his system were burned out by entering data into the EHR. This persistent challenge led Christiana Care to test Augmedix, which provides Google Glass-enabled remote scribe services.

After a trial run, Dr. Robinson asked his operations team whether they should continue to work with Augmedix. The medical director was very supportive, indicating that physicians were embracing the technology. Dr. Robinson also thinks that for clinicians to practice at the top of their licenses – a key factor in preventing burnout – nurses can provide the bulk of primary care, while primary care physicians could provide mentorship and oversight.

Dr. Ries Robinson, Chief Innovation Officer at Presbyterian Healthcare Services, says that after researching physician burnout at his system, the issue of refills came up as a recurring cause. Providers were managing about 30-45 refills per day, which cost them 30-45 minutes of time.

To help alleviate the problem, Dr. Robinson is implementing an automated refill technology called healthfinch. “If physicians saved 15 minutes per day per provider across 1,000 providers, it’s equivalent to 30 FTEs. It can have a real impact,” Dr. Robinson says. “And how we got there was by listening to the physicians and then going out and sourcing a solution.”

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To survive, healthcare leaders must reinvent the market they created.

“There’s $1 trillion of waste embedded that we know will be disrupted,” says Dr. Hal Paz, Chief Medical Officer at Aetna, adding that there are much better ways to put that money to use. “We could repurpose the waste and spend it on social determinants of health and environmental health.”

Dr. Shafiq Rab, Chief Information Officer at Rush University Medical Center, says he remembers when he realized he could disrupt his system to better account for social determinants of health. “We kept on crying about [high readmission rates, saying] I don’t know why people are coming back again. Well, if somebody doesn’t have a place to live, how do you think he’s going to take a drug or a medication? If somebody doesn’t have food, how do you think the person’s going to get better?”

Dr. Rab remembers, “When that ‘aha’ moment came to my head, I gathered my team and I’m emotional. We are soldiers. We’re ready to die. The bottom line is this – we’ll go fight for it.” Dr. Rab disrupted the cycle by implementing NowPow, a technology platform that connects people to high-quality community resources to help address chronic health and social conditions.

He says that level of determination can speed the typically slow digital processes within hospitals. “We completed the whole thing in six weeks. Not months, not years. Six weeks,” he says. Through integration with Rush’s EHR, physicians can now see a list of prioritized community resources from NowPow and make recommendations for patients who are screened for social determinants. Today, a physician or a social worker at Rush can prescribe not only medication, but also lodging, food, and clothing.

In the age of digital disruption, major corporations and industry associations have also entered the fray, with the potential of substantially shifting care delivery.

Dr. Paz believes that alliances, such as the proposed Aetna merger with retail chain CVS Health, can bring scalable, localized solutions to consumers and broaden the types of beneficial relationships health leaders consider possible. “It is an opportunity to partner in local communities with the existing health infrastructure,” he says, nodding to CVS Health’s reach among key stakeholders in the new healthcare community: Physician groups, health systems, Meals on Wheels, behavioral health organizations, governmental entities, and social service groups. Dr. Paz says, “About 70 percent of the US population lives within three miles of a store. There’s an opportunity to look at health and wellness and start in the home and identify the best place at the right time for the right individual.”

True, positive change requires more than smart alliances – it depends on the ability to learn from outside disruptors too. “I was one of the few CEOs that talked immediately about what I was learning from Airbnb – most CEOs were rejecting it,” says Hyatt Hotels Corporation CEO Mark Hoplamazian. His willingness to do so, he says, has contributed to his company’s success today.

DISRUPT YOURSELF

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THANK YOU TO OUR SPONSORS

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NETWORK SUMMITACCELERATINGIMPACT 2018

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CONTACT

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AVIA leads a network of health systems working together to

innovate and transform. AVIA Innovator Network members solve

pressing challenges with digital solutions that deliver financial and

clinical results. AVIA provides strategic focus and a collaborative

approach to accelerate innovation.

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