Sweeping across 250,000 square miles, Sanford Health has a big footprint, and CFO Nick Olson has even bigger insights to share on how systems of all stripes can achieve financial success without sacrificing quality.
For all the ground they cover, rural health providers sometimes get short shrift when it comes to coverage of healthcare innovation.
"We have over 250,000 square miles of geography that our footprint covers," says Nick Olson, executive vice president and chief financial officer at Sanford Health, a nonprofit organization based in Sioux Falls, South Dakota.
Sanford is the largest rural health system in the U.S., with 48 medical centers across South Dakota, North Dakota, and Minnesota, and hundreds of additional care locations throughout the country.
All that reach comes with its own set of challenges—and opportunities for expansive thinking that can benefit healthcare leadership writ large.
"We are really intentional about becoming the premier rural health system, so how do we do that?" Olson asks. "It's about always putting the patient at the center of every decision. And that's both an easy thing to say and do, and also a very complicated thing to say and do."
Ahead, Olson, who stepped into his CFO role in April after five years serving the system in financial VP roles, shares his strategies for balancing a big footprint with even bigger ambitions. Hint: Aside from financial acumen, it takes a heart—and smarts—for people.
Get your priorities straight
Sanford is facing a host of familiar headwinds, from high interest rates and capital cost to looming workforce shortages.
To quell them, Olson says it's all about building a culture where quality, patient experience, and employee experience are valued as much as financial performance.
"These things don't have to be mutually exclusive," Olson explains. "When there's a constant drum beat of each of those four areas being important … that's when we start to see real traction in all areas."
Straddle a 'three-legged stool'
On the financial front, Olson is prioritizing strategic investments and growth.
"The more integrated we are, the more durable we, as an organization, can be to combat things like the pandemic that was in 2020, and the economic crisis that was in 2022, and there will be something else in the future," he says. "This means we have to look proactively at the right opportunities that could strategically advance this organization."
It's a well-timed focus. The opportunity to join forces is the ripest it's been in years for nonprofit healthcare providers on both sides of a transaction, says Rex Burgdorfer, a Chicago-based partner at Juniper Advisory, which counsels not-for-profit healthcare providers pursuing mergers, acquisitions, and other partnership plays.
As we emerge from the pandemic's peak, "our clients now are much larger, much stronger, and more forward-thinking in terms of why they're joining a system, and it's caused the average size of transactions to go up significantly," Burgdorfer explains. "There's more creativity in the ways in which they're combining structurally because they're more financially sound."
When it comes to strategic investments, Olson uses a "three-legged stool" to guide prioritization and decision making:
Care delivery and financing is "first and foremost" to ensure Sanford's clinicians can see patients each and every day and that its health plan can provide insurance to its nearly 200,000 members.
Philanthropy, from both Sanford's namesake benefactor and the broader community, is another crucial piece of the puzzle. "This is really an important tool for us to continue to invest in critical technology, critical services," Olson says. "It's really been a great community engagement tool for us, as well."
Investment return on reserves is also among Olson's priorities in his early days as CFO. He sees this focus as critical "to help ensure long-term financial sustainability for Sanford and for others as well, and really provide a means for us to deliver on our promise to provide access to high-quality care no matter a patient's zip code."
It's about keeping the endgame in mind.
"Operational and financial discipline is in our DNA," Olson says. "We set targets, we hold each other accountable, we execute against our plans, and when our plans are successful, we hit those targets. It allows us to expand access for patients and allows us to invest into new services, and those are things that everybody can rally behind."
"I believe that will fundamentally transform how we deliver care in our communities," Olson says. "[It] allows patients to be seen without having to travel to a medical center that might be 100 or 200 miles away."
"It's a real challenge when a hospital in a rural setting wants to recruit a provider, to lure that provider away from the big city system," Burgdorfer says. "So competing for recruiting talent is a major trend."
It's a big part of why telehealth is so central to Sanford's strategy.
"Having a virtual care center is going to combat those economics and those stats by allowing us … to recruit physicians to a more urban area," Olson explains. "So you'll still be able to provide the same type of quality care across the rural footprint that we have."
It's another timely play, as industry groups petition lawmakers to extend and expand key telehealth regulations that gained popularity during the height of the pandemic and stand to shape virtual care for the foreseeable future.
Although Sanford is squaring up against some formidable workforce challenges, Olson doesn't anticipate that the Federal Trade Commission's buzzy non-compete ban will be chief among them.
"We're certainly continuing to monitor those facts and those rulings, but at this point, we still feel really confident with the virtual care strategy well into the future," he explains.
Nonprofits like Sanford, which make up more than three-quarters of the nation's healthcare systems, are exempt from the non-compete ban, though things may get dicier for organizations that generate revenue for for-profit institutions.
Act as 'a true operating system'
Sanford's vast expanse means it's essential to have both a unified vision and a flexible approach to execution so every region is empowered to act.
"We'd like to give … the right level of local autonomy for the leadership in each of those communities because those are the ones that know certainly the patients, but the communities and the stakeholders in those communities," Olson explains. "They need to be able to have that autonomy to make decisions at a local level."
That way, enterprise leadership can help radiate locally grown insights across the organization. "If there's a good idea in Bemidji, Minnesota, we can implement that over in Bismarck, North Dakota, as well," Olson explains.
On the purpose front, CEO Bill Gassen and his administrative team make frequent trips to individual sites and convene the enterprise in regular virtual conversations to ensure a shared message sticks.
That message, Olson says, is simple but powerful: "We're in the business of providing world-class healthcare. Why we exist will never change. But how we deliver care needs to continue to evolve. So that we can not only provide the highest quality care but continue to be sustainable and viable for the next generations that come after us."
Medicare Advantage rate cuts are coming next year, but prior-auth provisions slated for 2026 could tide palmier payer partnerships.
CMS released finalized 2025 payment updates for the Medicare Advantage (MA) program on April 1, and the aftershocks were no joke: Confirmed cuts to base pay sent insurer share values plummeting 6–12% the next day.
The announcement comes on the heels of a January 17 final rule requiring MA plans and their federally facilitated insurance counterparts to streamline prior authorization processes beginning in 2026.
Despite widespread trepidation over what pay cuts could mean for already-tight margins, the recent MA moves, taken together, are cause for cautious optimism, says Denise Scoffic, chief financial officer, east region, at Mercy, a St. Louis, Missouri–headquartered health system with more than 50 hospitals and 50,000 team members across four states.
"We are encouraged," says Scoffic. "The key […] will be the accountability and enforcement."
Many feel slighted by 'slight' cut
CMS locked in a 2025 benchmark increase of 2.33% for MA plans, down from 2.44% in the January advance notice. The dip comes in part from adding Medicare fee-for-service spending data from the final fiscal quarter of 2023 to the equation. Next year also marks the second of a three-year phase-in of changes to the MA risk adjustment model.
All told, the decisions are a departure from CMS' typical practice of raising the final reimbursement from the proposed version, Reuters reports. They could also be a signal of waning support for the costly and denial-rife plans, albeit a tepid one in this presidential election year: Despite the immediate Wall Street backlash, the cuts are ultimately "slight," and federal payouts for MA plans are expected to increase by an average of 3.7%, or $16B, next year (also consistent with January's proposal).
AHIP wrote in its advance-notice comments that the growth rate likely "will lead to benchmark changes that are insufficient to cover the cost of caring for 33 million MA beneficiaries in 2025," sentiments the insurer trade group reinforced in a press release once the rates were finalized.
For their part, providers "will have to absorb yet another round of payment reductions," said Jerry Penso, MD, MBA, president and CEO of the American Medical Group Association, in an April 3 statement. "I'm concerned plans will reduce their benefit packages to account for this cut, which will be detrimental to patients and providers."
Dismissing fears of steeper costs and diminished benefits, CMS says the rate policies "will provide continued stability to the MA market and MA beneficiaries." As proof, the agency points out that plan availability, enrollment, and benefit offerings have remained stable or grown in 2024, even with the 3.32% net impact this year representing a big drop from the 8.50% increase in 2023.
The picture of premium and benefit impacts could start to crystallize next month, when plans submit their bids for 2025 MA coverage, the Healthcare Financial Management Association reports.
The makings of a 'mutual growth' agenda?
The new MA rules could be a flashpoint in long-inflamed payer-provider relations.
As a result, many health systems have been retooling or terminating their MA partnerships, stoking "flames of conflict" that shifting regulatory winds are further fanning, says Richard F. Bajner, partner and payer and provider leader at Guidehouse.
But amid all the heartburn is hope for a new negotiating table—one with "mutual growth" on the menu—as early as next year.
"It's forcing the dialogue between payers and providers to shift," says Brian Fisher, Guidehouse's director of healthcare strategy, provider and payer. "It's becoming less transactional and more focused on, 'What are our demands and pain points that, on each side of the table, we need to solve for?'"
'26 prior-auth policies could pave a new path
New, good-sense prior authorization requirements could lay the groundwork for palmier provider-payer partnerships. "It will be a win-win if we can take out the excess work on both sides and really see that those regulations are enforced," Scoffic says.
In its January-released final rule, CMS says insurers must implement and maintain application programming interfaces to "improve the electronic exchange of health care data, as well as to streamline prior authorization processes." Additionally, the agency puts forth new process requirements for payers meant to ease administrative burdens and care delays, including:
Turning around prior authorization decisions within 72 hours for urgent requests and seven calendar days for standard requests
Notifying providers of the specific reasons behind prior authorization denials
Publicly reporting certain prior authorization metrics on their websites
Provider reception of the policies, many of which take effect January 2026, has been positive.
"The AHA commends CMS for removing barriers to patient care by streamlining the prior authorization process," said association President and CEO Rick Pollack in a statement.
For her part, Scoffic is hopeful the rule will cut through some serious red tape.
"We are not only losing millions of dollars of revenue every year, but there is also so much excess time being spent on Mercy's side—and I'm sure on the payer side—doing non-value-add work," she says. Major culprits of costly denials and appeals processes are two-midnight rule discrepancies, excessive prior authorizations, and AI-powered batch denials, she adds.
As they await implementation of the prior-auth rule—and petition government leaders for thoughtful enforcement—Mercy's managed care team members are chipping away at inefficiencies by meticulously tracking denials, as well as the system's impressive quality and cost efficiency metrics, Scoffic explains.
All these numbers come in handy for leading "very frank conversations" with insurance partners (e.g., during peer-to-peer reviews or contract negotiations), she notes. "We're starting to see a few payers who are willing to automate that authorization process for specific common procedures."
It's a point in favor of keeping all eyes on the big prize. "Our goal here is to get the patients the timely and appropriate care that they deserve," Scoffic says. "Those conversations, and putting that data in front of them, has shown some early successes."
Healthcare insiders 'DSH' on IPPS, 340B eligibility, and the future of telehealth.
The fiscal year (FY) 2025 IPPS proposed rule, released April 10, bodes ever-tighter financial futures for hospitals: Next year's projected increase is 2.6%, down from this year's 3.1% bump.
"That will truly be a challenge for us, and I'm sure all healthcare systems," says Denise Scoffic, CFO, east region, at Mercy, a St. Louis, Missouri–headquartered health system with more than 50 hospitals and 50,000 team members across four states. "It's disappointing to see the lack of recognition of the current state of inflation that we're in, both from a labor perspective and from a supply and drug perspective."
Disappointing—"woefully" so, perhaps—but not surprising.
"I'm in Washington, DC. No one's talking on Capitol Hill about, 'let's put more money in healthcare,'" says Richard L. Gundling, FHFMA, CMA, senior vice president of content and professional practice guidance at Healthcare Financial Management Association.
For health system CFOs, it means getting even comfier doing more with less—while keeping an eye toward the regulatory movement bubbling beneath the surface.
"If you're not paying attention […] that can come back and bite you on the back end," says Venson Wallin, CPA, CGMA, CFE, CHC, CHFP, FHFMA, HCISPP, managing director and national healthcare compliance and regulatory leader at BDO, a global financial advisory firm.
Ahead, how not to get bit by less-buzzy regs.
Setting the stage
Mercy's fiscal year ends June 30, so forecasting is top of mind. "We definitely need to be realistic about what's coming our way," says Scoffic. "We must build in these regulatory challenges, such as the IPPS rate increase," even as "we'll continue to advocate for more reimbursement."
It's a balancing act.
Given the slim increase proposed for 2026, Mercy is seeking ways to "think and act even more quickly," says Scoffic, in part by exploring automation and ensuring all caregivers are working to the top of their licenses. She's also tapping team members across the organization for insight.
Mercy Hospital St. Louis, which is part of the system's east region that Scoffic helms, has an innovation center in one of their inpatient nursing units "where we engage the frontline caregivers to collaborate and think with us" about how to maintain high care standards while improving efficiency, she explains. The collaboration has yielded "great progress in reducing our length of stay and improving our throughput."
Wallin also supports a long view. When it comes to regulations, finance leaders should think beyond basic compliance to areas of risk and reward. "Where is your biggest focal point, and what could either benefit the hospital the most, or what could create the largest negative impact by not addressing it immediately?" Wallin asks.
As an example, CMS introduced new cost reporting requirements in the 2024 IPPS final rule, which apply to Medicare bad debts, Medicaid eligible days for disproportionate share hospitals (DSH), charity care charges by patient, and total bad debt by patient.
"This is not something that has been traditionally done in the past," Wallin says. And failure to comply could bring increased audit risk or, in the worst-case scenario, a "pause" on certain federal payments that hampers cash flow and threatens 340B eligibility (more on that next).
DSHing on 340B eligibility
CMS projects Medicare uncompensated care payments to DSH providers will increase $560M in FY2025. Although that'd be a rebound from this year's "staggering" $957M cut for providers serving a significant number of low-income patients, it may not be enough of a boost.
That's because DSH rules impact hospitals' eligibility for the federal 340B Drug Pricing Program, which requires Medicaid-participating pharmaceutical manufacturers to sell outpatient drugs at a discount to providers that care for many uninsured and low-income patients.
"The 340B program is on the radar, and under a lot of pressure at national and state levels," Scoffic says. Mercy Hospital Saint Louis, like several sibling sites, qualifies for 340B based on their share of Medicaid patients. "It's very important that we continue to advocate with our governmental officials."
Adding to recent stress on the program, this year's final rule introduced tightened criteria for Medicaid Section 1115 days that can be included in the DSH payment calculation. And fewer days could mean less reimbursement for many.
It could also jeopardize providers' access to 340B dollars altogether.
"With DSH, if you reduce your percentage, it reduces your reimbursement; with 340B, if you fall below the threshold, you get nothing," Wallin explains. The potential loss is magnified for small- to mid-sized community hospitals that may rely on 340B to make payroll and keep the lights on, he adds.
If your status stands to shift, consider reassessing your intake process to ensure you're properly capturing Medicaid eligibility as soon as patients walk through the door, Wallin advises. And if losing eligibility is unavoidable, brace for that impact to your bottom line.
Despite the challenges, Scoffic is heartened by recent moves to enhance the 340B program oversight. She points to an April 19 final rule introducing a pathway for resolving pricing disputes with drug manufacturers.
Additionally, Scoffic believes in the power of storytelling to win hearts and minds. "It's important to […] put stories to those dollars that we hope and think will be helpful in advocating that that 340B program continues on."
As part of their advocacy efforts, Mercy Hospital St. Louis puts a percentage of 340B dollars each month into a dedicated patient assistance fund, which is governed by a committee composed of members from the community, the hospital's mission team, and clinical leadership. All told, they're able to provide over $2M in annual assistance to patients undergoing costly drug therapies.
The hospital has also used program benefits to stand up substance use recovery programs; hire additional social workers to serve areas with underinsured patients; and invest in new technologies, like modern imaging platforms, in those same areas, "which, honestly with the pressure on finances, we wouldn't otherwise be able to do," Scoffic notes.
It's a testament to the program's role in "really, truly allowing us to get healthcare access back to those challenged communities," she says, "not just dropping to the bottom line."
Transcending physical boundaries
Looking at reimbursement beyond the IPPS, healthcare insiders are bullish on virtual care. In a recent address to AHA members, Rep. Brett Guthrie, R-Ky, who chairs the House Energy and Commerce Subcommittee on Health, said "there will be an extension of telehealth" because it's "convenient" and "helpful."
The remarks came days after AHA submitted a statement to the subcommittee, voicing support for telehealth proposals that would extend flexibilities set to expire this year and expand patient access.
At Mercy, whose systemwide virtual care program serves 600,000 patients across seven states, there's excitement over "starting to see recognition from a reimbursement perspective," Scoffic says. "Virtual care is really important to bring care to the patient, regardless [of] if they're in a rural area or elsewhere, with a goal of making the access [...] even easier."
M&As are on the rise. Take a page from one exec's playbook on how to find your perfect partnership.
M&As are all the rage.
The past 12 months have seen 81 health system deals announced—the highest volume in the past few years, according to an April report from healthcare investment banking firm Cain Brothers.
The first quarter of 2024 has been especially busy, racking up 18 prospective transactions, worth $10 billion for buyers. That's a 50% uptick in deal volume and 194% increase in revenue compared to the same period last year.
For the savvy CFO, it all spells opportunity to forge new paths to delivering high-quality care on "record-small margins" that many are still seeing, says Kevin Lenahan, CPA, FHFMA, executive vice president and chief business and strategy officer at Atlantic Health System, which has seven—soon to be eight—hospitals across New Jersey and Pennsylvania.
In a January letter of intent, the $3.7B non-profit system unveiled plans to welcome Saint Peter's Healthcare System, a $583M Catholic not-for-profit with a single, 478-bed hospital in New Brunswick, New Jersey, into the fold. Lenahan hopes the two organizations will finalize a definitive agreement within the next few weeks.
Ahead, more on how to find—and align—the right fits from someone going through it.
Meeting the moment
Transitioning from the pandemic's peak, everyone is "trying to figure out what the new norm is," and "feeling the pinch," Lenahan says.
Although they're easing in some areas, expenses are still high on everything from labor to transportation, and payer compensation—which is often locked in two to three years out on the private side—is failing to keep up with inflation. "It's very difficult to make up that differential cost," Lenahan says. So joining forces to streamline operations can make all the difference.
Beyond the bottom line, M&As can help systems honor their commitments to quality, affordable care, Lenahan says, by opening additional access points or new specialty services.
Charting the course
Once Saint Peter's and Atlantic Health have signed their definitive agreement, next steps include garnering state approval according to the Community Health Care Assets Protection Act, which Lenahan said could take 12–14 months.
Additionally, he's hopeful the deal will pass muster with the Federal Trade Commission (FTC), which blocked Saint Peter's proposed merger with RWJBarnabas Health in a 2022 complaint, citing anti-competitive practices that could arise from merging New Brunswick's only two hospitals.
In contrast, Atlantic Health and Saint Peter's have "no overlapping territory," Lenahan says. "In my mind, this is a green light." The system's attorneys agree, he adds.
Building on a track record of success
The Saint Peter's deal would extend Atlantic Health's lineage of successful integrations: The system acquired Chilton Medical Center in 2014 and, within a year, helped the location top the list of Jersey's Best hospitals with fewer than 350 beds, a distinction it's held eight years running. CentraState, which became part of the system in 2021, also charted in its category, as did four additional Atlantic Health locations.
Other integration highlights include launching robotics surgery at Newton Medical Center, which came aboard in 2011, and growing Hackettstown Medical Center, which joined in 2016, to accommodate more admissions than they've seen in a decade, and more ED patients than ever before, Lenahan notes.
Successes aside, Atlantic Health has been selective in adding hospitals, instead focusing most of its expansion efforts on new and acquired ambulatory centers that can help "reduce the total cost of care" and "create more access points," Lenahan explains.
They've been adding specialty centers, which feature services like urgent and primary care, radiology, PT, lab, cardiology, and oncology, at a rate of 1–2 per year over the past five years and plan to continue at this clip.
"Let's meet the patients where they are," Lenahan says. "That's what drives us."
Finding the perfect match
When assessing potential partnerships, Lenahan looks for fit across a few key dimensions:
Quality: It's Atlantic Health's top focus in potential partnerships. System decision makers consider ACO, state, LeapFrog, and Magnet award data, and they aren't afraid to "walk away" from potential opportunities with organizations that don't show progress or promise on the quality front. "Too many people make gut decisions," Lenahan says. "Let the data support what you're trying to do." Also let it check you on your biases. "Be open that you may have some," he advises. "When you look at the data, it will identify new processes, new ideas, and new suggestions."
Beyond reviewing metrics that matter, consider relationships and past work together. As an example, Lenahan has "a lot of respect" for Saint Peter's mission and leadership because he's known CEO Leslie Hirsch for over a decade and partnered with the system on initiatives like the Healthcare Transformation Consortium, in which New Jersey–based health systems team up to administer their self-insured employee health plans.
Culture: For Atlantic Health, that means shared values must amount to more than lip service. "We believe in population health. If you […] believe mostly in fee-for-service, it's not going to work here," he explains. "So you've really got to ask probing questions." And once a deal is closed, the real cultural work begins. "We will send our Atlantic team down to Saint Peter's to be the at-the-elbow support, so they're going to get to meet their Atlantic brethren," Lenahan says. "That will assimilate the cultures really well."
Geography: Saint Peter's location fills a "white space" in Atlantic Health's central Jersey assets, Lenahan says, which makes the system more "attractive" to partners like insurance companies and employers, plus more convenient for patients who already visit Atlantic Health's physician offices in the area.
When considering geographic needs, take the long view, Lenahan advises. "If you do one transaction, does that prohibit you from doing another one because now, all the sudden, there's another territory that you can't do?"
Business structure: Pay attention to operational and organizational nuances that'll need to be codified, Lenahan advises. As an example, Saint Peter's, a Catholic-run institution, is bound by the Ethical and Religious Directives for Catholic Health Care Services, so when it comes to the balance sheet, Atlantic Health will designate the location as an entity under the system rather than as part of AHS Hospital Corp, Lenahan says, to "honor the Catholic integrity agreement for Saint Peter's at Saint Peter's."
Cyber security: Given the high-profile, higher-stakes breaches as of late, strength of cyber management is an increasingly vital consideration when vetting potential partners, Lenahan says. Atlantic Health now engages an independent contractor to conduct cyber analysis on all entities they're interested in acquiring "because once you're in the system, you're in the system, and you know, we want to make sure we identify anything up front."
Infrastructure, both the physical and technological kind: Once the deal closes, early integration goals include transitioning the new joiner to Atlantic Health's EHR instance "as quickly as possible," Lenahan says. "All our partners go on Epic so that we can just track those patients to make sure they're getting the right care in the right spot for us." When it comes to Saint Peter's physical infrastructure, Lenahan anticipates early investments will center on building out the location's ambulatory network and connecting it with the system's assets in neighboring regions.
Openness: Though rigor in dealmaking is vital, so too is curiosity. "Be open-minded," Lenahan says. "Every acquisition we've ever made in Atlantic, particularly the big ones, we've learned something new, […] and it enhanced all of Atlantic."
"Folks are very frustrated right now," says Robin Damschroder, MHSA, FACHE, executive vice president and chief financial and business development officer at Michigan health system Henry Ford Health (HFH), which has more than 250 care locations, including five acute care hospitals, and upward of 650,000 members enrolled in its Health Alliance Plan (HAP).
"Profitability on Medicare Advantage plans has dropped significantly below fee-for-service payments" for many providers, Damschroder explains.
It means "you're seeing more and more health systems selectively partnering and/or exiting" their MA partnerships, says Brian Fisher, director of healthcare strategy, provider and payer, at global consulting firm Guidehouse.
And now, shifting regulatory winds are only fanning these "flames of conflict," says Richard F. Bajner, partner and payer and provider leader at Guidehouse.
During the height of COVID, payment "very much tilted in favor of health plans," he explains. Now, things are "tilting a little bit back," and payers are feeling the heat. But amid all the heartburn is hope for a new negotiating table—one with "mutual growth" on the menu—as early as next year.
"It's forcing the dialogue between payers and providers to shift," Fisher says. "It's becoming less transactional and more focused on, 'What are our demands and pain points that, on each side of the table, we need to solve for.'"
Make your pitch
Determine what you need from—and can offer to—prospective payer partners based on your goals and circumstances. Consider what you "need to solve" on strategic and operational fronts, both today and five years from now, and who's going to help you get there, Fisher advises.
Because payers are doing the same. "They're looking at markets and saying, 'okay, who do we want to align with as our health system leader or health system of choice that helps us improve on our cost of care, our quality, and our initiatives," Bajner explains.
To find common ground, "focus on alignment where growth benefits both parties," Fisher says, and look beyond cost to compatibility in places like service lines, quality aims, and administration and marketing capabilities.
In other words, lean in on where you can complement (and maybe even compliment) each other. Despite "the animosity," payers and providers both have roles to play in delivering value-based care, says Richard L. Gundling, FHFMA, CMA, senior vice president of content and professional practice guidance at the Healthcare Financial Management Association. "Providers are great at performance improvement; payers are great at risk management." So how can you work together to do both?
Take it easy on the hardball
Too often, both payers and providers come into negotiations with the mindset of, "'Here's our set of demands, and if you aren't able to reach those demands, we're going to walk,'" Fisher says. "That's a tough line to toe, and you know, sometimes it's not putting the patients and the members at the forefront."
Instead, come to the table prepared to give and take on multiple fronts, not just "how are we getting paid?" he advises. "It gets important to say, 'here are our objectives,' but doing so in a way that leaves the options for how we contract or partner together rather open."
This framing will allow you to have better, more strategic conversations from the vetting process onward. And sometimes, Fisher says, that may mean culling partnerships from your portfolio that are no longer a fit. So don't be afraid to say, "Look, if this doesn't make sense for us, and it doesn't make sense for our patients, then maybe this isn't something that we need to be participating in moving forward."
At the same time, remember that real change takes time, Damschroder says. Quality scores are—rightfully—"often a gatekeeper" to dollars in risk-sharing agreements, "and you can't affect those by being in a contract for one or two years."
Go long (and short)
Once you've determined your needs and offerings, shape them into an incisive value proposition. The sooner the better, Fisher says, because "time kills deals."
Not so fast, though. Even in today's environment, "where short-term returns are creating the necessity to prioritize short-term actions," speed shouldn't equal shortsightedness, Bajner says.
Instead, he recommends seeing payer partners "as another lever and chassis for growth." And that means thinking beyond terms like unit prices to bigger-picture considerations like PMPMs.
It's about creating a "strategy where short-term decisions don't negatively impact that longer-term strategy and sustainable model," Fisher says. Because moves that are "helpful tomorrow" don't always aid "those growth opportunities five years from now."
Field admin curveballs
Ending the "administrative arms race" is a must to reduce the cost of providing and receiving care, Damschroder says.
Your payer partners should help, not hinder, this goal. "How is a health plan willing to invest in health system capabilities so that we're better managing patients across the continuum of care?" Fisher asks.
Assess how your collaborations can strengthen core administrative functions, including those involving utilization, prior authorization, medical necessity reviews, referrals, care management, and related documentation, experts advise.
When such considerations are overlooked or mismanaged, it's patients who are left in the lurch, Gundling says. "It just causes so much dissatisfaction and plus just adds a lot of administrative costs" in an environment where "no more money's coming in."
Finding efficiencies takes a lot of talking, says Damschroder, who has "ongoing dialogues" with Michigan's dominant payer, Blue Cross Blue Shield, along with other major players like Aetna and Humana.
Additionally, Henry Ford Health just revved up their machine for addressing denials and audits—both of which are up by 30%—with more staff and tech capabilities, including Epic's payer platform to "ease the exchange" of documentation, Damschroder says.
Since rolling out these enhancements, HFH has managed to overturn 90% of the denials. But it hasn't been cheap.
The system is planning a sit-down with their largest payer to discuss how administrative hurdles are costing both entities, Damschroder says. "We spend $4.5 million dollars on pre-authorization for their members, and we want to know, if we're spending $4.5, how much are they spending, and collectively, what could we do to reduce that spend?"
It's all in service of something better, Damschroder says: developing "a mechanism where we trust each other."
Aside from staving off skirmishes with external payers, proponents say it's a way to boost care quality, integration, and affordability for their communities.
But that doesn't mean it's easy going.
"It is not for the faint of heart," says Robin Damschroder, MHSA, FACHE, executive vice president and chief financial and business development officer at Henry Ford Health (HFH), which has more than 250 care locations, including five acute care hospitals; more than 33,000 team members; and upward of 650,000 covered lives throughout Michigan. "You do have to live through the insurance cycles."
For HFH—whose Health Alliance Plan (HAP) was born in 1960 from automaker union and community members championing high-quality, affordable healthcare—that's meant braving everything from the genesis of DRGs and tightly managed care in the 1980s and 1990s to the emergence of Medicare Advantage in the 2000s.
Sure, it's a rollercoaster, but success is possible with staying power and prowess, financial execs and experts tell HealthLeaders. Ahead, some tips for stout-hearted CFOs mulling a payvider play.
Why (or why not) now?
While value-based partnerships between payers and providers have been around for years, payvider models, which involve a contractual or joint ownership arrangement between the two entities, have gained popularity in recent years amid forces like intensifying financial strain, an aging population, and a redoubled emphasis on the quadruple aim.
In a 2021 Guidehouse and Healthcare Financial Management Association (HFMA) survey of health system CFOs and finance and managed care executives, more than half of participants indicated that they were pursuing payvider model(s), including shared-risk/capitation payment arrangements (54.7%), direct-to-employer partnerships (47.4%), provider-sponsored health plans (32.8%), and payer/provider joint ventures (30.7%).
Today, though, shifting winds are fanning "flames of conflict" and forcing reconsideration, says Richard F. Bajner, partner and payer and provider leader at Guidehouse.
During the peak of COVID, payment "very much tilted in favor of health plans," Bajner explains. Now, things are "tilting a little bit back the other way," he says, pointing to a March MedPAC report, which recommends increased Medicare reimbursement for hospitals in 2025.
That means health plans may be feeling a financial pinch. "So now you have two parties that are saying they're financially challenged, and one needs to save more money and the other one needs more money, and how do we get past that?" asks Brian Fisher, Guidehouse's director of healthcare strategy, provider and payer.
It's an impasse that could shape a new state of play, including a "mutual growth agenda," as soon as next year, Bajner says, assuming we can muck through "all the mudslinging."
In the meantime, there's a bit more trepidation when it comes to payvider models—even the provider-sponsored kind—compared to what we were seeing five or 10 years ago, Fisher says. "Capital is a challenging thing to overcome and getting to scale is equally as challenging."
And when the going gets tough, "delivery systems start to get out," Damschroder says.
So why bother?
Payvider proponents see provider-sponsored plans as one way to wrest back some control over reimbursements and reduce wrestling matches with external payers doling out denials.
And, they argue, it can be just as rewarding for the communities they serve. The model provides "a microcosm" where providers can "manage the value-based care," says Richard L. Gundling, FHFMA, CMA, senior vice president of content and professional practice guidance at HFMA.
Indeed, Henry Ford Health's value-driven approach has brought "a lot of success" in the quality arena, Damschroder says. As an example, HAP's covered lives have consistently earned high NCQA scores for services like HbA1C control and breast cancer screening. "When you combine being the insurer with being the provider, you get a lot more flexibility of what you can decide to do as it relates to programming and driving engagement and health and the outcomes that you're seeking."
Plus, the model can be a hotbed for innovation, creating opportunities to "pilot and try out and incubate different kinds of care and insurance models that could get us that much further," Gundling says. "And maybe to eliminate some of the denials."
What does success look like?
It's no surprise that competition is fierce, with "really large national companies" like UnitedHealthcare and Aetna CVS Health expanding their footprints across government and commercial markets, Damschroder says. So partnering up can make all the difference.
"We, as integrated delivery systems and provider-sponsored payviders, are going to have to think about things that we can do together to help us compete," she explains.
In January, for example, HAP teamed up with managed care provider CareSource on a state Medicaid bid, a move enabled by the pair securing regulatory approval last year to pursue a joint venture. The decision, Damschroder says, stemmed from the desire to create "comprehensive capabilities that would actually change the outcomes we see here in the state of Michigan."
It's something that would be hard to deliver alone.
"We all want to meet our benchmarks for quality, safety, experience, and financial outcomes, but truly, when we come together and look at it, and we put that partnership together, it was really, how could we do better?" Damschroder recalls. "And we owe the state of Michigan to do better."
This isn't the first time Henry Ford Health has collaborated to better serve their state.
Available to Medicare-eligible individuals throughout Michigan, the plan features a $0 premium and $0 primary care provider copay, plus a flex card to use on benefits like dental, vision, hearing, and companion services. Members have access to HAP's full HMO network of more than 50,000 practitioners across the state.
Pictured: Robin Damschroder, MHSA, FACHE, executive vice president, chief financial and business development officer of Henry Ford Health. Photo courtesy of Henry Ford Health.
Building on successes in the plan's first full year of operation, the 2024 offering expands availability to individuals in 48 Michigan counties, compared to 46 at launch. And it has provided a springboard for MSU Health Care to announce its intentions to introduce additional MA plans on the employer front, along with insurance products in the commercial arena. "We want to get in the game and be what is the future of healthcare: a payvider," MSU's CEO, Seth Ciabotti, said on a recent podcast.
What does it take?
Clear benefits aside, getting an in-house offering up to scale at speed is a big challenge.
"What we've seen over the past 10 to 15 years is provider-sponsored health plans that are really challenged to grow a large enough market share or bolus of members to mitigate risk, particularly in a new insurance company," Fisher says.
To ramp up, providers often accept "significant discounts on their own health plan," Bajner explains. And with capital constraints being what they are today, CFOs should ask themselves whether these cuts, which can be as high as 30% to 50%, are the right move.
Here's what can make the juice worth the squeeze.
Analysis: You need a good read on the regulatory environment, especially for government payers, as well as the competitive landscape for commercial entities, Damschroder stresses. And that includes what's on the horizon. "We've had to change with the times as different programs and different emphases come into play," she says. Without this expertise and foresight, "you can lose a lot of money, and then quickly, it feels like a money pit."
Capability: Sponsoring a health plan requires "a completely new set of capabilities, particularly on the administrative end, that, without a partner, have to be created from scratch or contracted out," Fisher says. So prioritize finding the right collaborator—or developing the requisite skill sets in house, Damschroder advises.
Balance: Ensure your offering covers people in a range of health circumstances, or risk getting "kicked out of the market," Damschroder says. "When you look at the COVID cycle that's just gone on, there's been a lot of volatility in medical claims, right, and you actually have to have the fortitude to maintain your risk-based capital with the department of insurance in your state," which wants to know that you're "investing and supporting the medical claims activity."
Stamina: This isn't "a get rich quick scheme," Damschroder says. "You have to be in it for the long term; it's not a three-to-five–years game where you're automatically going to be making money." It means "doing what's right for the community and getting those health outcomes," as well as "pricing reasonably" and making enough profit to cover losses, particularly in the Medicare and Medicaid domains. Also look for openings in the market. As an example, UnitedHealthcare is focused on profitable services (e.g., ambulatory and physician) and "staying away from hospitals," Damschroder says. "That would be our domain."
(More) collaboration: "Many times, even within a health system that has a payer and a provider side, they still are not as close as you would think they were," Gundling says.
That's because infighting can flare around competing priorities, such as how to handle administrative hurdles like prior authorization and medical necessity. And it's the patients who suffer most.
"If somebody really needs back surgery, let's not delay it for three months to get them that surgery or to have them scared that they're going to get a huge bill at the end of it," Gundling says. "They're having back surgery. Let's alleviate that other stuff."
It takes a balancing act, Damschroder says. "Culturally, you have to be suited for that tension, and I think you also have to be well invested in the health of the population—of what you can do together, versus separately," she explains.
Henry Ford Health has worked hard over the past two years to integrate its care management team across its provider and payer entities. The partnership has produced a protocol of care that limits pre-authorization requests between HAP and HFH to a handful of circumstances, such as when certain new drugs are in play or there's variability in how a service is being delivered across the system.
"Our clinicians and our medical management team at the plan have been able to come together to develop processes that aren't an administrative burden, don't cost a lot of money, and better yet, the patients' speed to care treatment is quicker," Damschroder explains.
Resolve: If a plan of your own is the right fit, don't let the challenges scare you away from a model that could improve care quality, access, and affordability for those you serve. "We're highly integrated into our communities, and I think we're a very important part of this ecosystem," Damschroder says. "There's a danger if we just hand this over."
Don’t let unchecked tech prune your most promising candidates before their application even crosses a human's desk.
AI is making a splash in talent pools. Or is it a belly flop?
According to a February report from Rutgers University's Heldrich Center for Workforce Development, 71% of workers are concerned about the impact of artificial intelligence (AI) on jobs and just as many are worried about employers using the tech in hiring and promotion decisions.
That means HR leaders who want to attract and keep top talent must champion the ethical application of emerging tools in People domains.
"We've had unconscious bias for so long and have underestimated women, people of color, people with disabilities for decades in the workplace," says Hilke Schellmann, assistant professor of journalism at New York University and author of The Algorithm: How AI Decides Who Gets Hired, Monitored, Promoted, and Fired and Why We Need to Fight Back Now. "Humans have caused massive damage, so we don't want to go back to that."
In hiring, this can play out like an AI-powered applicant tracking system (ATS) scoring candidates based on irrelevant and potentially discriminatory application details that it mistakes for predictors of success, such as the name "Thomas" or hobby "baseball" appearing on a resume (both real examples from Schellmann's research).
Legal and ethical implications aside, failing to mitigate such risks can mean your AI tool does the exact opposite of what you're intending: Weed out your most promising candidates before their application crosses a human's desk.
"AI can be a powerful addition to any recruitment team's arsenal … but I think it's equally important who you choose to do business with and why you choose to do business with them," says John Higgins, vice president of talent management at Essentia Health, which has 14 hospitals and more than 15,000 employees in Minnesota, Wisconsin, and North Dakota.
Higgins has partnered with several third-party vendors to introduce AI-enabled chatbot and programmatic advertising capabilities to accelerate the hiring process and enhance the candidate experience. "Ensuring that [vendors are] eliminating bias is part of the way in which those tools are supporting you. Because the last thing you want to do is make it more difficult, especially in healthcare, to find the right talent."
Often outfitted with AI and built either in-house or by a vendor, the software helps move candidates through the hiring process by storing their information and materials; tracking the status of applications; and automating time-intensive tasks such as screening for fit, reading resumes, scheduling interviews, and sending out notifications.
Additionally, AI is increasingly used to prescreen candidates before they make it to a conversation with a human recruiter through tasks such as gamified assessments and one-way interviews with pre-recorded prompts, both completed from computer or phone, Schellmann says.
Chatbots are attractive for teams who look after talent, both current and prospective, because they can help manage work influxes stemming from acquisitions, mergers, and notorious busy seasons. Open enrollment, for example, is the "Super Bowl for HR," says Ayanna Pierce, vice president of benefits and talent relations at Mercy, a St. Louis, Missouri–headquartered health system with more than 50 hospitals and 50,000 co-workers across four states.
To help with such upticks—and replace a chatbot that was retired at the same time as their previous benefits system—Pierce's team collaborated with their tech counterparts to launch Joy in late February, just in time to help with the winddown of open enrollment. Within a week, the benefits chatbot had answered 1,200 questions, a number that's expected to keep climbing as news of the launch spreads.
"We have so many benefits at Mercy that it can be overwhelming for co-workers," Pierce says. "We communicate a lot and so to have a chatbot that can synthesize the information and help people get what they need when they want it is huge, and it's a satisfier for our co-workers."
Essentia Health partnered with vendor Paradox to launch their recruiting-focused bot, Olivia, which appears as a widget on the system's career website and moves candidates through the hiring process by answering questions in real-time, at any time—including when human recruiters are sleeping—about things such as benefits, company culture, and specific roles, Higgins says.
Once candidates are engaged, the bot can help them complete applications for many roles through a simple text conversation rather than any formal submission process. And, because the bot integrates with Essentia Health's instances of Workday and Office 365, it can schedule a phone interview with a recruiter or hiring leader. All told, it makes things "easier" and more "delightful," Higgins says.
How AI can help
Chief among the goals of using AI, talent leaders tell HealthLeaders, is creating resonant experiences for candidates and employees by enhancing—not replacing—the talent team's capabilities.
Recruiting "can be really administrative heavy," Higgins says. Offloading tasks such as scheduling frees up time for recruiters to "be more consultative" by "nurturing their relationships with those candidates and partnering with those hiring leaders to make better hiring decisions."
Beyond empowering teams to work "at the top of their license," Essentia Health uses AI to make things fast for candidates. "It's all about … getting them in front of us more quickly because in today's world—especially in rural healthcare—speed wins."
Because Essentia Health is a rural institution, Higgins also uses AI in a way that flouts prevailing narratives: to widen, rather than narrow, the talent funnel. "The concept of screening out candidates is not something that we want necessarily a technology to do for us," Higgins says. "We're looking more for, how can we screen candidates in?"
To that end, his team uses AI-powered programmatic advertising to mete out marketing dollars swiftly and strategically across all available roles, which can sometimes reach upward of 1,000 at once. "It's monitoring the number of applications that are coming in, and once it hits certain thresholds of, 'hey, you've got plenty of candidates for this job,' it stops funding the advertising for that particular element and shifts the dollars to jobs that aren't receiving applicants," Higgins explains. "It puts dollars where you need them to generate more candidate flow and make sure you're not overspending" on jobs that prove easier to fill.
The AI investments have paid off, Higgins says. Essentia Health is now scheduling more than twice as many interviews and hiring 20% more people, he estimates. Plus, they've reduced the average time from application to an interview with the hiring leader from 10 or 15 days to five.
How AI can hurt
The risks in AI are well documented. Among them: Hallucinations that confidently proffer incorrect information; encoded bias that amplifies the assumptions of the tech's human creators and perpetuates historical disparities reflected in training data; and privacy, copyright, consent, and labor issues stemming from whose work, art, or personal information is used to build the tech. Such pitfalls can translate to hiring misfires in several ways, according to Schellmann's research.
1. Using biased proxies for success
Calibrating tools using data solely from people who are or have been in the roles you're looking to fill can amplify bias that has historically existed and shown up as underrepresentation of marginalized groups such as women, people of color, and disabled people within positions of leadership or positions, period, within the organization.
"We see this again and again," Schellmann says. "These biased proxies come into play even though, you know, it may look facially neutral."
For her book, she talked to lots of employment lawyers and industrial organizational (IO) psychologists who are often brought into the AI technology vetting process for due diligence.
"What some of them have found is biased keywords, broadly speaking, in resume screeners," she says. In one screener, for example, the name "Thomas" was a "proxy for success." So those who had that word on their resume (e.g., as part of their name) "got more points." Ditto for the hobby "baseball" as compared to softball, and the countries "Syria" and "Canada" compared to their counterparts around the world.
"What this points to is problems in the training data and the way these tools are calibrated and the way these tools are monitored," Schellmann says. "There is no supervision" as the system keeps learning what success looks like from biased proxies even as organizations attempt to diversify their candidate pool.
"This is really concerning for employment lawyers," she says, because a court might consider such issues discrimination based on protected classes (e.g., national origin or gender).
And, what's more, because people are not a monolith, representation isn't always enough, especially in the realm of disabilities, which "express themselves so individually," Schellmann explains. For example, even if an autistic person is part of the training data, "that doesn't mean that their data would actually map onto the next autistic person," she says. "There's a real problem here, how a one-size-fits-all tool that is being used for hiring would work on people whose disability is expressed so individually and who are often not part of the training data, so I think that's a huge question that I'm not sure companies have started to grapple with."
2. Not measuring what you think you're measuring
A similar type of bias can play out in gamified assessments by elevating candidates who display similar behaviors, regardless of their relevance to success on the job—or whether style of gameplay even translates to the real world.
Typically, candidates play through a set of simple tasks such as using the spacebar on their computer keyboard to pump up balloons as quickly as possible to collect money. To determine what constitutes success, the organization has people already in the given role play the game to identify what sets them apart from the general population. An employer might determine, for example, that their current accountants are comparatively bigger risk takers. And so the tool would start moving applicants who display that behavior during gameplay into the "yes" pile.
Using an assessment that relies on dexterity and speed to determine fit for a job that doesn't have those same requirements poses risks for discrimination, Schellmann says.
When she tested one such game with someone who has a physical disability, "he was really worried that, if people had a motor disability in the hands, that maybe they couldn't hit the spacebar as fast as possible, they would get rejected for the job, although they could absolutely do the job," she recalls. "Are we excluding people who may have a motor impairment or another disability for no reason?"
And though U.S. companies must offer reasonable accommodations, a common challenge among the disabled job seekers Schellmann interviewed is, "they don't necessarily know what awaits them on the other side" of a "start assessment" button and thus what accommodation they might need.
Aside from the discrimination risks, being a "daredevil" in a video game doesn't necessarily translate to being a risk taker in real life and on the job, Schellmann explains.
One IO psychologist she spoke to described how a hospital found their most successful nurses were "way more compassionate than the general population." So the thought process for an organization looking to translate that finding to a gamified assessment might be, "okay, maybe we need to find people who are very compassionate, more compassionate than the general population, so we need to have a game that finds that," she says.
The problem is, when the IO psychologist went on to test the unsuccessful nurses, they, too, were far more compassionate than the general population. In other words, compassion set nurses apart, but it's not what made them successful. "Turns out, the successful nurses were more conscientious," Schellmann recalls.
How to make it work
This is the moment for People leaders "to feel very empowered," Schellmann says. It means asking tough questions early and often. "We have to be a whole lot more skeptical of these tools and that starts with asking very skeptical questions and not just believing the marketing language that vendors sell."
Go for the goal: To avoid succumbing to shiny-object syndrome, start by defining a goal and then looking for vendors and tech that can help achieve it.
For Essentia Health, that meant making the job search faster, easier, and more satisfying than what they could offer with their ATS' out-of-the box capabilities.
It also meant meeting candidates where they're at: about 70% of visitors to Essentia Health's job site get there on their phones, so "if we rely on solutions that are PC-based, we lose," Higgins explains. It's why they've opted for a chatbot with robust SMS texting functionality for app completion.
For their part, Mercy looked for places where they could make swift, safe enhancements to the colleague experience. Launching Joy in the benefits space made sense because it presented a big opportunity with relatively low risk compared to a clinical use case. "We felt like it was something that we could do pretty accurately and that there was a benefit to our co-workers," says Kerry Bommarito, PhD, vice president of enterprise data science at Mercy.
Plus, the tech they had available at the time of the build—GPT-3.5 within Microsoft Azure— "allowed us to explore that branch of AI in a protected environment with no risk of protected health information (PHI) exposure or personal data being shared," she explains. They're now setting sights on newer GPT models for clinical use cases.
Lead with values: Make sure vendors and external partners share "the ethos of your organization," Higgins advises. Essentia Health focuses much of its programmatic advertising on Indeed.com not only because of the job aggregator's marketplace dominance—about 40% to 50% of Essentia Health's applicants come from it—but also because the organizations have similar stances on AI accuracy, bias mitigation, and relevance in matching candidates to jobs, as well as social justice and DEI. Both, for example, emphasize fair-chance hiring for people who've previously been incarcerated or convicted of an offense. "The work they're doing from a charter, mission perspective aligns really well," Higgins says. "So we choose to partner with them versus maybe choosing to partner with other organizations that don't have … those kinds of deep commitments in place."
Start small: Consider a focused test before committing wholesale, Schellmann advises. "Can we do a pilot program where we don't make higher stakes decisions yet, but we test the tool in the background?" Also consider the "question of consent," by letting employees and job seekers know what from their data, and how much of it, is being used to train AI systems, she adds.
Get technical: Both Mercy and Essentia Health vetted vendors for safety and fit with their existing People technology ecosystems. "We do incredibly deep dives on things like IT security when we're looking at vendors" to ensure they meet internal privacy protection and compliance standards, Higgins says.
Also ask for a vendor's technical report, which shows how they built and validated the tool, including any steps they took to test for bias, Schellmann advises. If they don't have one, "that's a red flag."
Within the report—or the internal equivalent for tools built in house—look at the size and demographics of the test group and how that all matches up with your current and prospective employees. "Sample size matters," Schellmann says. "It also matters, you know, were they diverse enough? Was there a wide plethora of people of different ages, abilities, demographic backgrounds, genders?"
Don't stop at individual EEOC protected classes; really probe how the tool treats the data of people with multiple marginalized identities. "We see a lot of tools start discriminating when you look at white men versus, for example, African American women," Schellmann says. "We don't see really a lot of scrutiny on that front."
Break things: HR and talent leaders can "test these tools before they're being implemented," Schellmann says. You don't need a technical background. And, in fact, if you can break a tool without one, that's a bad sign. "If I can test these tools and they break on impact because I speak a different language to them or deep fake my voice and just type out answers, and that is not being detected, and I get a result," it means the tool might not work the way it's advertised, she explains.
Get guardrails: To supplement the content filters that Microsoft's open AI service has in place to prevent inappropriate questions and answers, Bommarito's team programmed Joy using "retrieval-augmented generation." It means the bot only addresses questions that it can answer using information in Mercy's benefits documents. "It does minimize the risk of providing inaccurate information," Bommarito explains. When someone asks a question that's not benefits related, Joy is instructed to tell the co-worker that it doesn't know the answer and, as relevant, provide contact information for a live team member.
"They really did take steps to make sure that Joy won't go rogue," Pierce says.
This was a vital consideration because even though benefits may be lower stakes than PHI, they aren't without risks. Take, for example, someone who may access Joy when choosing between Mercy's two plan options for short-term disability. "We want to make sure co-workers don’t feel forced into an election that doesn’t work for them," Pierce explains. "And so they have definitely taken the liberties of vetting the process to make sure that Joy gives informative information but isn't making decisions."
Train your people: Don't assume that everyone is excited about AI, let alone well practiced in tools like ChatGPT. "Guiding people in how to phrase questions is important," Bommarito says. She's teaching colleagues that, for the best results, they should talk with Joy like they would with a talent colleague on the phone and ask follow-up questions as needed to gain clarity or context. "You're not just going to type in the word 'speech therapy.' You're going to say, 'how many speech therapy visits are covered by this specific insurance plan?'" Bommarito says. Her team has created tipsheets, FAQs, and other resources to help colleagues get the hang of it.
Part of this training is cueing people to the tech's limitations.
"Joy won't be able to solve everything," Pierce says. "There are things that take human empathy and compassion to deal with the situation and make thoughtful decisions. You know, HR is not black and white. We're gray, and that's our area of expertise. We deal in the gray, and you need people to deal in the gray."
Find out how to create an effective workplace wellbeing program at your organization.
Wellbeing is having a moment.
Mental health, resilience, and burnout alleviation are among today’s top healthcare HR focuses, according to sweeping research that professional services firm AON released in December, which pulses benefits trends across 160 U.S. health systems and more than 3.3 million employees.
But it's no small feat to cultivate a shared sense of wellness and engagement in the hundreds to thousands to hundreds of thousands of people who make up a modern workforce. In fact, a new study out of the U.K. has cast some doubt—and kicked up a LinkedIn debate—on whether individual-level interventions even work.
Complexity aside, investing in wellbeing is essential to attracting and keeping talent, HR executives tell HealthLeaders. To do it, get crystal clear on which offerings actually resonate and bake those into a broader culture that honors employees as whole people.
"What we're trying to do is to create a culture where everybody feels that they belong," says Ian Lee Brown, vice president and chief employee experience officer at Duke Health, which has more than 26,000 full-time employees across its three hospitals and 110 clinics in North Carolina. "It makes me feel better, and I become a better contributor, and I stay with the organization for a longer period of time because I feel that the organization cares about me.”
Individual interventions might not cut it…
Published last month in the Industrial Relations Journal, "Employee well-being outcomes from individual-level mental health interventions: Cross-sectional evidence from the United Kingdom," synthesizes survey data from 46,336 workers in 233 organizations. The study, while focused on the U.K., sheds light on benefits that are just as popular in U.S. workplaces.
Its author, William J. Flemming, PhD, of the Wellbeing Research Centre at University of Oxford, found that use of organizational offerings targeting individual-level mental health, such as mindfulness and sleep apps, resilience training, stress and time management, and relaxation classes, left participants "no better off" in terms of wellbeing.
Popular initiatives centering on a narrow aspect of individual health, such as step-counting competitions, haven't always borne out the desired outcomes, tending to reward those with readier means of participating "as opposed to really focusing on the needs of individuals that maybe didn't have that same privilege," Kivett explains.
Programs can also fall short when they fail to account for the myriad dimensions of wellbeing, from the physical and emotional to the social and material. Instead, people leaders should "look holistically at the individual and also holistically at the organization," Brown says, to create "intentional opportunity for the employee to feel they're connected to a system that's going to support their overall health and wellbeing."
The U.K. study supports this systems-level view. While Fleming acknowledges limitations in his research, including selection bias, the evaluation of interventions in isolation, and methodological challenges stemming from cross-sectional data analysis, he concludes that "more emphasis must be placed on the greater benefits of organisational rather than individual change, as well as on the importance of high-quality intervention implementation."
…Unless you get to the root
To ensure wellbeing offerings, including the individual ones, resonate, take an employee-first stance, Kivett advises. "If you take care of your team members, they are going to take care of your clients, your patients, your visitors, and really be an extension of our mission and our shared purpose."
It starts with asking employees what they need to feel well cared for—and bracing for surprise answers.
Two years ago, TGH learned through their annual engagement survey that they were "missing the mark" when it came to mental health, despite offering what they considered a robust set of services, including a 24/7 help line, Kivett says.
So her team dug deeper. In partnership with their third-party administrator, Gallagher, they launched a biennial research initiative: a dedicated benefits survey followed by focus groups where benefits team members and leaders could observe but not speak. Around 60% of employees took part in the first cycle.
The results were humbling.
"What we heard was not only that our mental health support wasn't good enough—it's that we didn't have any," Kivett recalls. "You can imagine the shock."
It's why she says it's important to test assumptions. "A lot of people assumed what would rise to the top, and nobody had it on their list that it would be mental health because we had all of these programs."
So her team took a step back to acknowledge that the current offerings, however good on paper, weren't having the intended impact. Then they got to work.
Make individual supports scale
Based on their research, Kivett's team scrapped their existing offerings and, in October 2022, debuted Tava Health, a third-party, out-of-the-box platform that connects team members and their dependents to a wide array of mental health resources, including a licensed therapist within 72 hours of request. It also addresses other aspects of wellbeing such as financial health.
It's been a hit. In 2023—the first full year of implementation—TGH racked up close to 5,000 visits from nearly 1,000 team members and their dependents, representing more than 12% of their pre-acquisition workforce.
Beyond the quick and enthusiastic uptake, Kivett's team is seeing success across several metrics.
Anecdotally, employees often cite the program as a reason they're excited to come to work in "What Fills Your Cup" conversations with executive leaders and through other feedback avenues, such as emails featuring "amazing stories from our team members," Kivett says.
Same goes for their loved ones. "The dependent piece of this is very important, especially when we think about adolescents," Kivett explains. Employees have shared that their children are especially keen on the quick and confidential process for connecting with "a live person."
Her team has also seen a decrease in FMLA cases, a trend they plan to further evaluate in year two, plus less benefits "leakage" from mental health services.
To get the program up and running, Kivett tapped TGH's total rewards leaders to helm the vendor selection process, which involved evaluating candidates to ensure alignment with the health system's purpose and a "frictionless" experience for team members, who had voiced frustration with the "clunkiness" of their EAP program.
When it comes to communicating about Tava, "the platform makes it really easy," Kivett says. TGH shares a feed of employee names and email addresses, and the vendor takes outreach and reminders from there.
Kivett's team then finds organic opportunities to reinforce. "It always comes up every orientation," she says. Leaders also reference it in written benefits overviews and ensure it's presented as an option in moments of need, such as when someone reaches out to share that they're considering FMLA or struggling with a team member interaction.
The biggest challenge to implementation? Cost. TGH found the money by reallocating funds from the mental health programs they disbanded to make way for Tava, plus gained significant funding from their foundation. For organizations without such resources, Kivett says to "look at grants," which proliferate in the mental health space.
Also work with prospective vendors. TGH's total rewards VP negotiated an extended trial period with Tava, garnering the hospital four full months to roll out and pressure test the platform. The move was not only cost effective, but also revelatory in terms of vendor fit. "That's probably what stood out to us the most—to say, if they're willing to offer us this platform for free to see if it works for us, then why wouldn't we take that opportunity?" Kivett says.
If a new platform isn't in the cards, consider lower-cost opportunities to improve wellbeing. For example, by investigating benefits leakage, Kivett's team noticed that employees were having trouble getting timely appointments to confirm they were pregnant. Now, thanks to a joint effort by the physician medical group and hospital benefits team, TGH reserves Wednesdays for their own employees' confirmations, and prioritizes appointments when members call into their experience center.
Kivett's team is getting ready to launch their second cycle of benefits research this month to ensure program enhancements are "still working" and "that we can present a package that really does support our team members as a whole," Kivett says. "That's why we want to keep doing that survey—because it gives us real-time information that we can act on."
Be better together
When it comes to creating the right container for wellbeing, make things official. Duke Health enshrines their initiatives in cultural commitments—such as an anti-racism pledge enacted following George Floyd's murder in 2020 and an update to the university's anti-discrimination policy in 2022 to "prohibit discrimination or harassment based on hair texture or hairstyles commonly associated with a particular race." They also create measures to support and evaluate safety—"not just physical safety but psychological safety as well," Brown says.
As part of their overarching Better Together strategy, his team fosters cohesion around measures such as ease of discussing errors in the work unit. This empowers team members to share their perspective, shape strategy, and speak up when things go awry. "In healthcare, that's really important because we want to make sure that people feel that when something happens, they can actually raise their hand and say, 'oh gee, here, I made a mistake. Let's figure out how we solve this issue that created the opportunity for me to make this mistake, so, ultimately down the road, it may not happen again.'"
Another focus, professional accountability, ensures disrespectful behaviors are handled in such a way that "they won't happen again, and that people feel that when they see something that's contrary to our values, and contrary to our commitments, contrary to our culture, that they can call it out and feel that, as an organization, we're going to work really hard to solve them."
Take it from the top
For these messages to stick, they need to come from the top. "A lot of this culture transformation efforts start with our leaders," Brown says. "We need our leaders to own and commit to behaviors and then cascade them down throughout the organization."
To help people internalize and spread this skill in their spheres of influence, Duke recently launched inclusive leadership training that centers self-awareness. The rationale? "The more I know about myself, the more vulnerable I can become," Brown explains. "As I become more vulnerable, it allows for me to be more empathetic with the folks who are around me, to be more compassionate, and also to invite different, diverse perspectives to the table."
It's working. In its initial run with nearly 300 leaders, the program received high praise, with participants reporting they're better equipped to "listen more intently, to be more empathetic in their approach to folks who may have made a mistake, to understand more in terms of what may be going on in someone's life outside of work," Brown explains. Based on this reception, his team is expanding the experience to about 3,000 additional leaders across the organization.
This intentional care for team members as whole people has created the trust and space for open, honest dialogue, even around deeply personal subjects, such as loss, and fraught ones, such as the Israel-Hamas War. Such discussions are facilitated by people from within the organization, and sometimes outside it, to provide a more objective vantage point.
"What we see around us can have a devastating impact on our wellbeing," Brown says. "Conversations with colleagues have been really impactful in getting folks to come to the table and share perspectives on what's going on across the world."
It all translates to better, and more rewarding, work.
"That's how we thrive, and that's how we create joy in work, when we feel that we can have these deeper conversations among teams to build a deeper sense of trust," Brown says. "At the heart of what we do is creating deeper teamwork that ultimately leads to the experience of the patient, when they come in, leaving feeling that, no matter what challenges this team faces, they're going to make sure that they deliver ultimate care."
People beyond their career midpoint want to feel supported through big transitions—even those once considered off-limits at the office.
Note: This is Part 2 in a two-part series. Read Part 1 here.
With five generations at work for the first time in U.S. history, HR execs are charting a growing constellation of roles, identities, and life stages in their benefits plans and experiences.
The good news? The call for flexibility and help taking care of loved ones is “just as applicable” for people past their career midpoint as it is for those who’ve recently joined the workforce, says Gregg Nevola, vice president and chief of total wellbeing at Northwell Health, which has over 85,000 team members across 21 hospitals and more than 850 outpatient facilities throughout New York.
As we spend more of life’s seasons at work, that means supporting employees through big transitions—in their relationships, careers, and beings—even those once considered taboo office topics. Things like how to navigate strife and feelings of selfishness in caregiving choices, bodily changes from menopause, and continued connection to a valued work community in retirement.
“How do you normalize those types of conversations, and make it be acceptable, and take that responsibility, that stress, off of team members?” Nevola asks.
For HR leaders, it’s by scaling systems that provide personalized support at those inflection points and help people say the quiet parts out loud.
“If you just happen to share some time with folks in those circumstances, and when they get that relief valve, it’s really a 180 for them in terms of their engagement and their ability to focus on what they need to focus on,” Nevola says.
Get personal
For Nevola, one of the most interesting developments in benefits over the past three years has been the “concentrated effort to find areas that we could do better in terms of the health of different segments of our population.”
Because women make up 70% of Northwell Health’s workforce, Nevola’s team partners with the system’s women’s health network, the Katz Institute, to shape resonant benefits.
It’s a tight working relationship.
Recently, Nevola “physically handed” a benefits plan document to the head of the institute and asked, “If you were in my job, what would you change?”
His team ended up implementing all 20 of her recommendations, which ranged from nutritional coverage for pregnancy to diet programs centering on holistic wellness rather than drug regimens.
This deep, ongoing collaboration is core to Nevola’s approach. “Get as many voices as possible to help frame the strategy,” he advises.
Northwell Health builds and refines their benefit program based on the demographics and perceptions of their people, which they collect through dedicated engagement and benefits surveys. “Spend a lot of time talking to them, understanding how they think, and what they’re looking for in their programs,” Nevola says. “Try to tailor that.”
Often, these efforts will surface opportunities to implement what Nevola calls “a forgotten type of benefit”—that is, a form of support for a life milestone, event, or circumstance that employees have traditionally had to shoulder in silence. His team is currently validating plans to offer bereavement days for miscarriages, which they hope to roll out next month.
To develop benefits that stick, ensure the right people are plugged in, Nevola says. Beyond the Katz Institute, he’s tapped clinical specialists to ensure prospective benefits like miscarriage bereavement reflect the patient’s perspective. Additionally, his team partners with finance “from the beginning, so there are no budget surprises at the end of the day.”
Once new benefits launch, keep listening to make sure they’re actually landing. “Sometimes they don’t work,” Nevola says. “If it’s not a fit, it’s not a fit. Put it to the side and find something similar or new that your resources are better spent at.”
Support relational transitions
Nevola is the executive sponsor for Northwell Health’s caregiver business employee resource group (BERG). To account for the range of needs in this arena, the group has carved out two problem-solving tracks: one focused on children and the other on aging loved ones. The sandwich generation benefits from both.
In some ways, the childcare question can be “a little bit easier” because “it’s a pathway that’s well traveled,” Nevola says. When it comes to the other end of the spectrum, “parents are living longer, and we have all the relationships outside of our traditional parent relationships—aunts, uncles—that we have just as strong a bond with,” he explains.
A dedicated, representative group can help “normalize caregiving for a parent, grandparent, a family member” just as we “worked hard as a society to normalize that relationship with our children,” he says.
Northwell Health’s caregiver BERG is creating and emanating a culture where employees “feel more comfortable” sharing and solving their challenges together. Through their EAP program, they’ve facilitated hour-long sessions where people can voice their experiences and offer affirmation, support, and best practices.
It’s created “an environment of trust and, in some cases, healing,” Nevola says. “It was very, very raw when they had some of these conversations, and they were relieved to find out that people were going through the same thing, that it’s okay to feel like you’re not being successful. It’s okay to feel like there’s more you can do. It’s okay to take time for yourself.”
In addition to connection, Northwell Health has invested in resources to help employees navigate caregiving stressors like determining whether to put a parent’s house into an estate and how to deal with inter-caregiver conflicts. “Those are really high-tech types of issues that there was no answer for before, and people just struggled with them,” Nevola explains.
To provide some clarity, his team partnered with a vendor to create a resource hub, where employees can now access discounts on estate attorneys, webinars on navigating social security and Medicare options, and telehealth services that allow team members to accompany loved ones to appointments regardless of their geographical proximity.
The organization also increased communication around existing benefits, like at-home PT and lab work. It’s a strategy Nevola returns to again and again: “Find pockets of people” who are likeliest to benefit from a given offering, and keep them in the loop through email, text message, and other creative means.
Listening data can inform the specific channels and timing. Consider, for example, whether it might be helpful to point team members to retirement planning resources before they turn 65, or to push educational material to employees about a benefit they’ve looked up on the intranet.
Support bodily transitions
Menopause benefits, which have already begun gaining ground in places like the U.K., are now starting to take root in the U.S. This evolution is thanks in part to the June 2023 passage of the Pregnant Workers Fairness Act, which requires covered employers to “provide ‘reasonable accommodations’ to a worker’s known limitations related to pregnancy, childbirth, or related medical conditions,” according to the U.S. Equal Employment Opportunity Commission’s (EEOC) website.
Despite what the legislation’s title might suggest, the EEOC’s interpretive guidance considers “the entire arc” of reproductive health, from fertility and pregnancy to perimenopause and menopause, says Nonnie Shivers. She’s a shareholder at labor and employment law firm Ogletree Deakins, where she partners with HR executives as part of the healthcare, employment law, and diversity and inclusion groups, among others.
“There’s still a lot of mystery surrounding that menopause, perimenopause stage,” Shivers says. So benefits should provide proactive support, while education should focus on “demystifying” and reducing stigma surrounding experiences “that affect over half our workforce”—and that some employees may still see as fair game for poking fun and exacerbating stereotypes, she explains. Offerings should be codified in policies on diversity, equity, and inclusion; equal employment opportunity; or non-discrimination, she adds.
Last year, Northwell Health partnered with virtual care startup Upliv to roll out a menopause program for the 80,000 participants in its core health plan, following a successful pilot with nurses (who make up the largest part of the system’s female workforce). It’s an effort to sharpen focus “on women’s health in an area that too often has been ignored,” Nevola says.
The program, which the Katz Institute helped develop, offers participants appointments with clinicians who specialize in menopausal care, as well as sessions with coaches who provide tactical support in navigating change. “It’s not something you just have to endure,” Nevola says. “That has made all the difference in the world.”
Shivers concurs that insurance coverage should be “expansive enough to include thoughtful care” and “perhaps even functional medicine.” Other benefits might include hormone level and blood testing, along with education on what changes to expect and guidance on how to address them, she says. Also be ready to offer workplace modifications, such as temperature adjustments and later start times.
Although it’s too early to share specific outcomes from Northwell Health’s program, Nevola says they’re seeing “very, very high satisfaction scores,” as well as reduced PTO days and medical bill expenses stemming from symptoms.
Support career transitions
For established professionals craving flexibility, create space for experimentation. Many people approaching retirement want to “wind down a little bit from their career … and think about where they want to be in the next stage,” Nevola says. That could mean moving to a four-day work week or to a role “where they could share their value in a different spot than they traditionally have.” If the transition includes a downshift in work hours, consider updating benefit programs to keep these veterans covered, he advises.
For team members in clinical roles and other demanding positions, “make, reference, and reinforce” well-tread and emerging paths, Nevola suggests. Nurses, for example, often progress from roles at the bedside to ones in revenue cycle and quality management. Consider how to create similar trajectories for physicians and other clinicians.
Paving such “a pathway of choice” is well worth the upfront legwork. “It increases the longevity of people staying with your organizations,” Nevola says. “It retains a lot of that very valuable institutional knowledge, that very valuable clinical knowledge, within the organization and really sets you up for success.”
And don’t sleep on the team members who’ve already retired or otherwise moved on from the organization. Northwell Health is sharpening a “two-way value proposition” for its alumni program.
To make the relationship mutually beneficial, they offer alumni the opportunity to volunteer or informally mentor current staff, as well as retain affiliation through a flexible staffing agency. They’re also exploring how to reward alumni who remain engaged with continued access to Northwell Health’s wellness platform and discount programs, which “are very popular with our active employees,” Nevola says.
Figuring out how to support team members throughout the seasons of career and life is “part of what’s really fascinating about our roles,” Nevola says. “We have to challenge ourselves to be sure that we’re providing the same cutting-edge technologies and programs to our team members that we are providing to our communities.”
Start small to grow sustainably, and keep the right people plugged in, say CNOs and CNIOs in the know.
With nursing tech disruption at a fever pitch, savvy CNOs and CNIOs are putting their heads together to ensure their investments make real impact. And there’s one place in particular where they’re setting their sights.
“I think virtual nursing is definitely on the mind of every CNO, or it should be,” says Natalie Nicholson, DNP, MBA, RN, CENP, NEA-BC, associate chief nursing officer at Denver Health, which has more than 8,000 employees across its main hospital and nearly 40 additional care locations. The organization identified a virtual nursing vendor through an RFP process and plans to roll out its program this year.
Nicholson and her team are not alone. Two-thirds of U.S. chief nursing officers are already interested in, researching, or deploying virtual nursing, says Bonnie Clipper, DNP, MA, MBA, RN, CENP, FACHE, FAAN, founder and CEO of Innovation Advantage, a healthcare innovation consultancy specializing in the model.
Driving the trend is an aging population who’s requiring more care and a shortage of clinicians to provide it.
“It’s no surprise that nursing has taken a major hit with COVID in terms of staffing,” says Kathi Zarubi, DNP, MBA, RN, senior vice president and chief nursing officer at HonorHealth, which has six hospitals and more than 70 additional care locations throughout Arizona. “All hospitals in the country are trying to figure out how to safely staff.”
Zarubi sees virtual nursing as a key part of the solution, and she has led her organization in launching a pilot at one of their Phoenix medical centers in December.
Denver Health and HonorHealth’s CNO-CNIO teams share what it takes to stand up and evolve a virtual nursing program that fosters quality care and human connection from both sides of the screen.
On Team Nursing 2.0
In virtual nursing, a remote clinician can handle administrative duties that, though essential, could take time and energy away from bedside care. Zarubi says these duties often include admission or discharge documentation, as well as patient education about things like a new medication’s side effects. It’s the power of two nurses, one at the bedside and the other on the screen, combining brain power and bandwidth to better patient care.
Virtual nursing could represent the next evolution of team nursing, CNOs and CNIOs say. The context has changed significantly since the model emerged in the 1950s.
When deciding whether and how to implement virtual nursing, center your north star, CNOs and CNIOs say. Hint: It should involve high-quality care and safety.
Other objectives may include nurse recruitment, retention, and efficiency, as well as cost.
“Health systems across the nation are in financial burdens right now,” Nicholson says.
From there, Zarubi says, be sure to ask the right questions, such as “How do I retain these very precious nurses, and how do we make the work enjoyable and not a burden?”
With these big-picture considerations in mind, look to prospective end-users—both nurses and patients—to shape strategy.
With five of its six hospitals Magnet-recognized, HonorHealth already had a framework in place for sourcing input on its pilot plans, Zarubi says.
“Magnet is really a structure that supports the individual bedside nurse having a large say in how things function and the governance of care,” she says.
At HonorHealth, that looks like a transformation office that Larson co-leads with nursing colleagues to create technology solutions that support organizational strategy. Outputs flow monthly to a nursing informatics council, where, in any given meeting, about 50–60 frontline staff, clinical directors, and CNOs across care settings and locations weigh options and make decisions. For larger-scale initiatives, Larson taps a clinical technology experience council, another multidisciplinary body that brings physicians, nurses, and other clinicians to the table to help decide whether solutions under consideration should move forward.
“We really want it to work for the organization, and not just today, but in the long haul,” Zarubi says. “So these kinds of councils allow us to take a look at those technologies from that standpoint and get all the users at the table to provide their input.”
The same goes for gathering input from patients and their loved ones through a dedicated advisory council, which has been a fixture “for many years,” she says.
“Measuring the patient perspective, and the actual patient and family experience with any new technology, to me, is very important,” she says.
On Winning Hearts and Minds
Beyond empowering end users to define priorities and make decisions, CNOs and CNIOs can set programs up for success by addressing concerns head on.
“We’re not eliminating nurses by any means,” Zarubi says. “That is not the goal. The goal is to supplement the care and provide an even better experience for our patients.”
It’s also important to find champions to reinforce this message.
“It’s a win, and we've experienced that over the years with any new technology or any new piece of equipment,” Nicholson says. Some of Denver Health’s nurses also work at a nearby hospital that’s implemented virtual nursing and have been singing that program’s praises.
“Those nurses are like, ‘It’s amazing, you'll love it,’ ” she says.
The good news is that the state of nursing today means fear of the unknown is often tempered with such excitement.
“Because the nurse market is so positive, I don't think nurses are as fearful for their positions as they probably would be for other positions,” says Nicole Myers, MSN, RNC, associate chief nursing informatics officer at Denver Health.
On Choosing the Right Tech
Once the vision is set, it’s time to talk tech. Myers recommends using a roadmap to visualize initiatives coming down the pike, how they roll up to organizational goals, and whether new or existing technology might enable their success through well-sequenced actions.
For virtual nursing programs, selecting the right vendor is a crucial step. Here, CNOs and CNIOs say, focus on the seamlessness of integration with current EHR software.
Denver Health, which uses Epic, closely vetted companies that responded to their RFP to ensure implementation and maintenance wouldn’t require outsized IT effort or additional personnel, Myers says. Such technical debt is not always on a CNO’s radar, but it should be, especially given the financial strain so many are feeling.
Similarly, think long and hard about which premium features are nice-to-haves, rather than day-one musts.
“We don’t truly need every bell and whistle, and I think the nurses would agree with that on the floor,” Myers says.
Also, look at the backend to ensure prospective software offers helpful analytics, Larson says.
“Does it support our processes?” she asks. “Are we getting the output in the data that we're looking for?”
On Starting Small to Grow Sustainability
When it’s time to pilot, the prevailing advice is to start small.
That approach “allows time for change to be adapted, and to be accepted, and then start rolling it out into other areas,” Nicholson says. She and Myers plan to preempt virtual nursing services like admissions and discharges with virtual sitter services.
Zarubi and Larson are taking a similar tack. They launched their program on a single floor at one of their medical centers last month, and the laser focus has allowed them to expand quickly to all three floors earmarked for the pilot. Now, they’re refining based on early learnings and planning a full study on their nurses’ experience.
Although they’re still crunching the numbers, early signs point to improved patient experience. They’re hopeful about nurse retention, too.
“We’re trying to find that magic balance for that bedside nurse to try to get them to really enjoy their nursing experience and to home in on why they went into nursing to begin with,” Zarubi explains.
On Making Virtual Nurses Feel at Home
When laying plans, don’t forget about the people behind the screen, CNOs and CNIOs advise.
Nicholson likes the requirement she’s seen for virtual nurses to have at least three years of hands-on experience.
“I think that's fantastic; more would even be better,” she says. “There is a level of maturity and understanding when you've been in nursing for three to five years, and you can pick up on things that a new nurse takes a little bit more time to learn or recognize. It’s just experience. It’s just miles.”
In this way, the model also shows promise for mentorship by empowering veteran nurses who may not want or be able to work on the floor to impart wisdom to recent graduates at the bedside.
“They can present and have their clinical skills, or their clinical brains, shared with newer nurses and teach them and also be taking care of patients,” Nicholson says.
That’s why virtual nurses should be treated like part of the team. Even though HonorHealth’s remote partners are based outside Arizona, Zarubi and Larson onboard them “like they’re our own employees so they understand our goals and our values, our vision, our mission.”
That ethos carries all the way through to their virtual background, which displays the HonorHealth logo.
“It provides that seamless experience that they are one of our members of the care team,” Larson explains.
It also reinforces the humanity of it all.
“We don't want robotic nurses,” Zarubi says. “We want real life human beings that have a human connection.”
Pictured: Robin Damschroder, MHSA, FACHE, executive vice president, chief financial and business development officer of Henry Ford Health. Photo courtesy of Henry Ford Health.
