UPMC's CMO Lays Out Strategy for Healthcare Transformation in 2024

Healthcare has reached one of the most challenging inflection points in more than 100 years, Donald Yealy says. And that requires new ways of addressing challenges.

Donald Yealy, MD, chief medical officer and senior vice president of the health services division at University of Pittsburgh Medical Center (UPMC), says 2024 is a challenging year for CMOs.

Yealy says the top challenges include change management, improving healthcare access, and learning from the coronavirus pandemic to prepare for the next existential threat to healthcare.

1. Change management

Yealy says healthcare has reached one of the most challenging inflection points in more than 100 years because of three factors.

• The push for consumerism in healthcare that began several years ago is now "unassailable," he says. People seeking healthcare want and will have a much more dominant voice in what that healthcare is and how it is assessed to be helpful or not helpful. In the past, there was much more trust in how, when, and where to get healthcare on the professional side. Now, healthcare is more of a partnership or driven by individual people seeking care. Their expectations and desires have become more important.

• Healthcare economics are changing dramatically, he says. Patients want all of the goodness and availability of healthcare, but they want healthcare in a manner that fits their ability to access it from a financial perspective. Decades of growth in expenditures on healthcare are likely over, Yealy says.
   
• There is not a single human endeavor that has continued for an extended period of time without an ability to adapt to new demands and find new ways to do things better, and healthcare is not an exception, he says.

When you put these three factors together coming off a once-in-a-lifetime pandemic, there is tremendous pressure for change, Yealy says.

"As a CMO, I have to get people to understand the need to change, what the change is, and the tools to achieve change," he says. "That is not easy, and change needs to happen in a compressed timeframe. Up until this year, we would think about change in the months-to-years horizon, but healthcare providers do not have months to years to figure this out. We must get better much more quickly, and better in a way that not only we feel is better but also the people we are serving feels is better."

Health systems and hospitals need to take a hard look at what they do and do not do well, Yealy says. Then they need to be willing to let go of things that do not serve the people who come to them for care well.

"You must have the insight as well as the ability and the discipline to change," he says. "The ability to change is not going to just involve new tools such as artificial intelligence, new diagnostic devices, and molecular personalized medicine. All of those are tools to do the job better, but we need to get our individual providers such as physicians, nurses, and advanced practice providers to embrace them in a much quicker fashion."

During the pandemic, the vaccine program was a great example of how the healthcare sector developed something from the best available data and had it up and running within a year rather than decades.

"This is the model for change—having an idea, testing it quickly, then getting it out to the people we serve," Yealy says.

Donald Yealy, MD, chief medical officer and senior vice president of the health services division at University of Pittsburgh Medical Center (UPMC). Photo courtesy of UPMC.

2. Improving healthcare access

Healthcare providers must recognize the needs of people seeking care and meet them in ways that are most comfortable and efficient for them, Yealy says.

"For older patients who seek care, the traditional approach of coming to a hospital or physician's office is probably still OK," he says. "But for other patients who are younger or face barriers to coming to a healthcare setting, we need to think about all of the different platforms that we can use. It could be through a smartphone or regional locations. We need to make healthcare accessible to everybody, whether they are in a big city or rural area."

While providers can use technology ,such as smartphones and other deployed devices, to reach patients, health systems and hospitals need to look at ways to build care opportunities that are nearby and accessible to people who have a healthcare need, he says.

"There are different ways we can construct our use of healthcare providers and healthcare locations, whether they are formal bricks-and-mortar facilities or something else," Yealy says. "It will be a combination of virtual and electronic methods as well as a different type of footprint for bricks-and-mortar locations."

Health systems must push ahead with a bricks-and-mortar strategy that goes beyond traditional hospitals, he says.

"We need to deploy more micro hospitals, urgent care centers, and other outpatient settings that have a different footprint than we have been used to for decades," he says. "These facilities need to be embedded in communities and to serve basic and acute needs while being connected to other parts of the healthcare delivery system to ensure ongoing wellness."

3. Learning from the pandemic

The healthcare system is on the tail end of the pandemic, Yealy says, and CMOs need to lead the charge to determine what has been learned from the crisis to be ready for the next threat. Providers need to look at the opportunities that were fumbled away during the pandemic, as well as the successes and failures at several levels: individual sites of care, health systems, states, and the nation.

"While we are doing some of this work, it is not well coordinated, he says. "For example, the communication during the pandemic left a lot to be desired. There has been a degradation in the public trust in the government and healthcare providers because people feel that they did not get straight or consistent answers. We need to concentrate on communicating better."

With messaging, people need clarity about a health threat and what their response to the threat should be, he says, while providers need to embrace the fact that a new threat may not be completely understood.

"Substituting a clear message for a truthful message is a dangerous thing," Yealy says. "We can say things that are dramatic and elicit behavioral changes, but if what we say ends up not being true, it is hard to get trust back. We learned from the pandemic that we should not substitute simplistic clarity for truthfulness in our messaging—they both must be present, not one or the other."

The industry learned some hard lessons with regard to the supply chain, he says. For years, health systems and hospitals honed the supply chain to have what was needed immediately available at the best possible price, but not enough thought went into what happens during a disruption in the supply chain.

"At the beginning of the pandemic, there were shortages of personal protective equipment such as masks and gowns; we learned a lesson from that," Yealy says. "Before the pandemic, we thought we managed PPE well because we only had what we needed. We found out that need can change dramatically, and the supply can change as well."