Trends in Healthcare & Governance

Cybersecurity has become a critical concern for healthcare trustees. Healthcare remains the most attacked sector of all U.S. “critical infrastructures.” The question is no longer if a healthcare organization will get attacked, but when. The average settlement from HHS’ Office for Civil Rights for a protected health information breach is over $10 million.

At HTNYS’ recent Annual Trustee Conference, Kristopher Kusche, senior vice president and chief information officer of Albany Med Health System, provided crucial tips to board members for overseeing cybersecurity. He said, in sum, boards need to understand the organization’s cybersecurity program, how they should be involved and how cyber risks are managed programmatically. He asserted that boards:

Need to ask/know

• About their organization’s cybersecurity foundations:
  • Is the cyber program compliance and maturity based on qualified frameworks? (e.g., NIST 800, COBIT)
  • Is an annual (mandatory, third party) cyber risk assessment completed?
  • Is this risk assessment reported to executive management and the board?

Need to hear

• Their organization’s risk assessment findings:
  • What cyber vulnerabilities exist for the organization?
  • What is the risk (likelihood of occurrence and impact) of these vulnerabilities?
  • How will management respond to these risk findings (RA must inform/drive operational spending)?
• What major incidents have occurred, what was the response, what was the impact and how can they be prevented in the future?

Need to ensure

• Programmatic support across the organization:
  • Structural, financial, board access/reporting
  • Regulatory and business prioritization
  • Ability to address rapid changes in the landscape
• Methodical planning/operations based on risk assessment
• Incident response, disaster recovery, business continuity planning

Kusche’s biggest recommendation for the audience was to hire a third-party risk assessment company. IT and cybersecurity are critical functions for healthcare organizations and should be considered risk mitigators, not revenue generators when weighing the cost of the incident versus the expense of protection.

This October marks the 21st Cybersecurity Awareness Month, when public and private sectors work together to raise awareness about the importance of cybersecurity. We encourage all hospitals and health systems to engage in this year’s efforts by creating their own awareness campaigns. Use CISA’s Cybersecurity Awareness Month 2024 toolkit to help the organization learn the basics of cybersecurity and stay safe online.

Information for this article was obtained from:

• CISA Cybersecurity Awareness Month
• The Cyber Savvy Board, HTNYS Trustee Conference presentation, Kristopher Kusche, Sept. 14, 2024

The rapidly evolving and uncertain healthcare landscape necessitates a forward-thinking mindset that embraces innovation, leverages new technologies and anticipates the needs of a changing patient demographic.

The Case for Change

At HTNYS’ 44th Annual Conference earlier this month, HANYS President Bea Grause gave trustees and other leaders an overview of The Case for Change. This HANYS publication identified four drivers that are pushing New York's healthcare delivery system to a point of collapse — an existential cliff:

1. Healthcare demand is increasing and changing. From 2015 to 2040, the percentage of the total population age 65+ is expected to increase from 15% to 22%. Older people require more medical care, so demand for services is increasing. And the types of services needed are changing. For example, patients who would have had their lives shortened by cardiovascular disease several decades ago are now living longer, leading to higher rates of many types of cancer.
2. The number and mix of healthcare workers cannot meet demand. We have a healthcare workforce supply shortage, and we lack the specific types of workers trained to address New Yorkers’ evolving care needs. For example, the demand for home health and personal care aides to serve the aging population and those with chronic conditions is projected to increase by 39.1% by 2030.
3. Health disparities persist. Disparities in patient health and access to care are driven by factors traditionally outside the healthcare delivery system’s control, including economic stability, housing, food security and access to transportation. In particular, disparities persist across two factors: household income and race/ethnicity.
4. The healthcare affordability crisis for all stakeholders is growing. The Case for Change explores healthcare affordability problems for consumers, employers, government and providers. Each sector — consumers to government — tends to look at affordability through their own narrow lens and advocate for solutions that help make healthcare more affordable for their sector. This approach may reduce their spending but increase spending in other areas. It’s not sustainable.

As Grause explained, The Case for Change does not offer solutions but serves as a starting point for stakeholders in New York state to acknowledge these problems and begin a dialogue on how to change course.

The urgent imperative for transformational change

Paul Keckley of The Keckley Report stresses the urgency of this imperative for transformational change and that the future of the U.S. health system cannot repeat its past. He points out unprecedented discontent with the healthcare industry:

• The majority of voters are dissatisfied with the status quo, as 69% think the healthcare system is fundamentally flawed and in need of major change, vs. 7% who think otherwise.
• 60% believe it puts its profits above patient care vs. 13% who disagree.

Keckley reports that most boards default to less risky, short-term strategies, with “transformational change” taking a back seat. Per McKinsey & Company, only one in eight organizations is successful in fully implementing transformational change completely. Those who can transform outperform their competition three-to-one on measures of growth and effectiveness. Keckley urges trustees to consider insight from organizations outside healthcare whose experiences are instructive:

• Transformational change does not happen overnight and can occur over a span of 20 to 25 years.
• Transformational change is not weakened by regulatory hurdles and advocacy is key.
• The recognition of improved value by consumers institutionalizes transformational success.

In light of this, Keckley urges healthcare trustees to ask four basic questions:

• Is the future of the U.S. health system a repeat of the past or something else?
• How will its structure, roles and responsibilities change?
• How will affordability, quality, innovation and value be defined and validated?
• How will it be funded?

It is important for healthcare leaders to recognize the imperative for transformational change but realize that no sector — hospitals, insurers, drug companies, government, physicians — has all the answers and they are not alone in facing enormous headwinds.

Information for this article was obtained from:

• The Case for Change, HANYS
• The Four Questions Healthcare Boards must Answer, The Keckley Report

Artificial intelligence should be a topic on every board’s agenda. However, its rapid growth makes it hard to keep up. To provide proper oversight of their hospitals and health systems and make strategic decisions, healthcare trustees should be familiar with the basics and understand implications such as the below:

What is AI?

Steven M. Berkowitz, MD, defines AI as: Artificial intelligence is the process whereby humans program a computer with a set of problem-solving algorithms and supply it with a database upon which to apply these algorithms. The computer then provides a solution to the problem, simulating human intelligence.

However, he states that a practical definition of AI must “include the observed concepts of emergent properties and hallucinations,” and offers the following amended “realistic” definition: A process whereby humans give a computer access to algorithms and data. The computer applies these algorithms to the data and generates a solution imitating human intelligence. But randomly, the computer may provide an unjustified or false solution.

How do we conceptualize and define AI?

Complicated AI programs and applications are better understood and analyzed by breaking down the process into three components that work synergistically:

1. Hardware: Computer processing speed and efficiency are essential in developing more advanced capabilities.
2. Software: The application of machine learning and complex reasoning through sophisticated software allows AI to evolve beyond the confines of initial data sets and algorithms.
3. Connectivity: Interoperability allows the boundaries between the computer, the brain, robotics and networks such as the internet to be intermeshed.

What are key AI concepts and controversies that trustees will encounter?

• Generative pre-trained transformer: OpenAI’s ChatGPT is an AI-powered chatbot that simulates a human and can generate responses when asked questions. It can compose essays, code computer programs, summarize complex topics, analyze pictures and more. The possibilities are endless and the potential in healthcare is overwhelming.
• Deep fakes: It is now possible to generate images, videos or audio recordings that are indistinguishable from the originals, which causes controversies in regulation and copyright laws.
• Inherent biases of AI: There are several opportunities for bias to be introduced in the AI process. This includes a bias from the programmer (unintentionally or deliberately) who created the initial algorithms and training data, bias in large data sets and information from the internet, bias introduced by emergent properties (behaviors that were not explicitly programmed) and hallucinations (false statements).
• AI and consciousness: ChatGPT’s responses have been rated to be more empathic than humans. Does the computer actually “feel” empathic or is it just responding in an empathically programmed fashion? At what point could it be considered “conscious” or self-aware? If this is accomplished, it would be a significant step toward singularity.
• The concept of singularity: This describes a hypothetical future where technology is vastly more intelligent than humans.

These topics give us a great deal to think about. Trustees must consider the pros and cons of AI as they provide oversight and strategic direction for their hospital/health system.

To learn more about AI, attend our 44th Annual Trustee Conference, Sept. 12-14 at The Saratoga Hilton! Berkowitz will provide more details on the above concepts with particular emphasis on their applications in healthcare, examine the present and future impact of AI on healthcare systems, patients and providers, and discuss the moral implications of AI and the role of future regulations and compliance.

Information for this article was obtained from:

• The Impact of Artificial Intelligence in Health Care, AHA Trustee Services, © Used with permission of the American Hospital Association.

Does your board engage in rounding in your hospital? A board visit or a walk-in-the-shoes experience can make a big difference and provide important context when making decisions in the boardroom.

Rounding is a great opportunity for board members to:

• get out onto the hospital floor to gain direct insight;
• interact with hospital employees and medical staff and hear directly from them what the job is like and how they work;
• hear about the wonderful things happening in the hospital;
• learn about the people who provide direct patient care and those in support roles;
• witness innovations that save lives and make a difference in the community;
• show their appreciation for the hospital workforce; and
• absorb the organizational culture firsthand.

How to conduct rounding

When planning rounding, make sure to structure the program thoughtfully, communicate its purpose and continually evaluate its effectiveness to maximize the benefits.

• Conduct rounding regularly and rotate board members through different departments at a frequency that makes sense for the size of the hospital’s board.
• Plan and schedule the visit with the department leaders in advance to prepare staff and explain the purpose of the visit.
• During the rounding tour, observe the hospital’s environment and workflow.
• During the visit, board members should first introduce themselves and share their roles, then shadow staff and ask questions about their day-to-day work.
• Board members should ask open-ended questions focusing on understanding staff roles, challenges they face and ideas for improvement.
• Have a C-suite member accompany board members to help field operational questions. Emphasize visits are for learning, not evaluating.
• Board members should share visit highlights at board meetings and use insights to inform decisions and strategy.
• Share details about the visits on your social media channels, newsletters and employee communications (making sure to follow all Health Insurance Portability and Accountability Act regulations) to educate staff on board governance and build engagement.

Board rounding can be an effective board engagement strategy

Governance expert Todd Linden, who spoke at this year’s HANYS Annual Membership Conference, recommends rounding as one way to optimize a CEO’s relationship with the board. His recent article for AHA Trustee Services, “Wonder, Wander and Round Intentionally,” summarizes his interview with four leaders on how they implement board visits, what their experience has been and advice they would give to others. The leaders said they find it incredibly valuable and recommend all boards do these visits.

To hear more practical methods to increase board engagement, join us at our 44th Annual Trustee Conference, Sept. 12 - 14 at The Saratoga Hilton!

Information for this article was obtained from:

• Wonder, Wander and Round Intentionally, AHA Trustee Services, © Used with permission of the American Hospital Association.

During the COVID-19 pandemic, hospitals and health systems were forced to focus on day-to-day operations with little time to strategize for the future, while competitors were able to invest in growth opportunities, technology advancements and care delivery innovation. This led to a strategic gap and now healthcare leaders are questioning whether the operating model that worked well in the past will continue to serve them in the future.

The American Hospital Association held a discussion with Adventist Health about the health system’s journey to reinvent it’s operating model with a focus on integration, agility and honoring the organizational commitment to its mission.

In this case study, Adventist Health reported the following leading practice strategies:

• refocusing on the needs of their community helped Adventist be more clear on what matters most;
• to create an integrated platform of care with the best quality and at an affordable cost, Adventist used technology and team integration to optimize the patient experience;
• focusing on the value-based arena, physician organization, care delivery and empowering local leadership to make real-time decisions;
• balancing day-to-day demands with long-term strategy by building capabilities to offer services across the full continuum of care and partnering with employers and payers in unique ways to deliver care that meets community needs; and
• creating a Capital Management Council that decides where to invest major capital year-round, focusing on community needs and where things are headed.

When reinventing your operating model and improving performance, Guidehouse recommends that you consider:

• improving the ambulatory footprint, whether centered on surgery, diagnostics, retail offerings, urgent care or other services, to achieve sustainable growth;
• nurturing a high-performing provider network that aligns physicians and groups with an intentional focus on retaining business that’s already attributed to that particular provider network;
• striving for robust, diversified revenue strategies by expanding portfolio services such as hospital-at-home or virtual offerings;
• standardizing workforce processes to ensure accountabilities are clearly defined across functions and roles to eliminate redundancies;
• supporting employees with sufficient training and development as people are asked to do new things and change the way they deliver care;
• embracing a comprehensive digital strategy that encompasses artificial intelligence, machine learning, automation and other forms of consumer enablement and engagement; and
• achieving a disciplined “operating rhythm” featuring routine monthly operations reviews and quarterly strategic reviews to provide discipline to the task of allocating capital in ways that are aligned with vision and strategy.

For more on this topic, attend our 44th Annual Trustee Conference, Sept. 12 - 14, in Saratoga Springs (registration to open in July). Thought leader Shawn DuBravac will kick off the conference with a discussion on redefining hospital strategy. He asserts that leaders must recognize the forces driving change — such as technological advancements, policy shifts, changing patient expectations and economic pressures — to effectively redefine their approach to healthcare delivery. Leaders who are forward-thinking and embrace and leverage these forces can guide their organizations toward sustainable success. Read more in Shawn DuBravac’s blog, Transforming Healthcare: Navigating Technological Innovations, Policy Shifts, and Changing Patient Expectations.

Information for this article was obtained from:

• Reinventing Your Operating Model to Address Disruption and Integration, AHA Podcast
• Reinventing the Health System Operating Model, Guidehouse

Healthcare trustees are discussing the use of artificial intelligence in hospitals and health systems, but have you considered how it can be used in the boardroom to enhance board governance?

How are boards using AI today?

Believe it or not, some boards already use AI to help their organizations become more modern, efficient and productive.

One of the most common ways professionals use AI is to summarize and synthesize documents. An intelligent assistant product, for example, could allow you to upload a financial statement and ask it to summarize it and identify the top five risks. The output would be akin to what an analyst would produce, but much faster.

Right now, AI is great at eliminating administrative tasks and streamlining operations. Some HANYS member executive assistants and board coordinators use AI to schedule meetings and transcribe meeting minutes.

How will AI evolve in the boardroom?

AI tools will be embedded in most software we use during the next few years. AI will allow boards to offload mundane tasks so they can focus on true governance.

AI might enrich boardroom experiences through:

• Efficiency: Boards will be able to use AI to make all board work more efficient, such as developing agendas and key documentation.
• Better governance: With less time needed for research, board members can focus on governing more effectively.
• Better compliance: It can streamline compliance processes by automating tasks such as legal document review (with oversight from your legal department) and data privacy compliance.
• Risk mitigation: Predictive modeling and machine learning help AI foresee risks that may not be otherwise apparent.
• Data-driven focus: AI models can provide boards with insights into what’s working well, what isn’t and how to improve problem areas.
• Navigation through unconscious bias: AI can mitigate biases by thoroughly analyzing objective data and providing impartial insights.
• Fostering enhanced collaboration: It allows directors to seamlessly exchange information, orchestrate meetings and share insights across time and geographical divides.
• Driving decision-making: It can process vast volumes of data and provide boards with comprehensive and real-time intelligence. Soon, AI may play a pivotal role in decision-making processes that could empower boards to identify opportunities, assess risks and strategize with precision.

How should your board prepare?

• Board education: Your chief technology or chief information officer can host an informational session or invite an independent expert to guide your board’s approach to managing potential AI risks and opportunities.
• Back up your policies: Connect AI to the compliance and regulatory guidelines that are already in place.
• Consider your AI strategy: Make sure this new technology aligns with your business goals. Develop timeframes for training and create benchmarks for reviewing proper implementation.
• Remember AI’s limitations: Verify any AI-generated data and use sound judgment on what to trust. No technology can replace the judgment of an experienced board member. Consider these tools as supplemental support that informs the board’s decision-making.

Consider how the COVID-19 pandemic forced boards to meet virtually. We were forced to adapt, adopt and embrace new approaches to technology. We’ve experienced emerging, disruptive technologies before, and AI is just another example. AI is a present-day reality so stay informed and keep it on your radar.

Looking for information on what healthcare leaders need to know about AI in healthcare? Attend an informative session at this year’s HTNYS Trustee Conference on Sept. 12 - 14 in Saratoga Springs. Stay tuned for more details coming soon.

Information for this article was obtained from:

• Addressing AI’s Future Role in the Boardroom, OnBoard
• AI in the Boardroom: The Inevitable Evolution of Decision-Making, Forbes
• How to Invite AI into the Boardroom — And How it Will Impact Governance, Chief Executive

Healthcare trustees are responsible for ensuring their hospital or health system provides safe, high-quality care. Recent data show room for improvement — trustees should prioritize this topic in boardroom discussions.

Safety in healthcare 2024

Press Ganey’s new report, Safety in healthcare 2024, explores emerging trends and strategies top-performing healthcare organizations leverage to improve patient and employee safety. Key takeaways include:

• People feel less safe in hospitals. The gap in patient perception of safety in inpatient and outpatient settings is now 2.5 times wider than before the pandemic. While patients in medical practices and ambulatory settings felt safer in 2023 (81.9%) compared to pre-pandemic levels (78.1%), perceptions of safety in hospitals fell 5.1% to 68.5%.
• Workplace culture is improving. Following record lows in 2021, perceptions of workplace safety culture are improving. Employee views of safety within their organization have risen 1.2% over the last two years, but nearly half still report unfavorable perceptions of safety culture.
• Assaults are increasing. Reported assaults against nursing personnel jumped 5% year over year. In 2023, the rate of reported assaults against nurses increased to 2.71 per 100 nursing personnel, from 2.59 the previous year.
• Safety outcomes show continued momentum. The biggest improvement was seen in catheter-associated urinary tract infection rates, which are lower than pre-pandemic levels.

Oversight of care quality and safety is paramount

The importance of trustees’ oversight of quality and safety has grown in recent years as healthcare organizations face new regulatory and accreditation requirements. Evidence shows that organizations with engaged boards have better quality outcomes; yet many struggle with quality and safety oversight.

Based on data from The Joint Commission’s hospital surveys in 2022, more than 40% of hospitals had citations in the “leadership” chapter. The third most frequently cited leadership standard (LD.01.03.01) addresses the role of the governing body: The governing body is accountable for the safety and quality of care, treatment and services.

Framework for effective quality oversight governance

A framework for effective quality oversight can clarify trustees’ roles, responsibilities and actions that support staff and patients. Boards can prepare to fulfill their responsibilities by taking the following six steps:

1. assess performance;
2. select board members;
3. gain knowledge;
4. set the agenda;
5. oversee quality; and
6. create the culture.

Resources for trustees

For more details on this framework, read the American Hospital Association Trustee Insights article, Leadership Matters: A Roadmap Toward Effective Governance of Quality and Safety. For more resources on this topic, refer to:

• HTNYS’ new Boardroom Essentials video series: How trustees can impact quality and patient safety; and coming soon, Making sense of public hospital quality ratings.
• HTNYS’ Board Responsibilities resource library includes resources on the board’s role in quality oversight.
• TJC’s Board Education Resource Center offers information and educational resources, descriptions of regulatory and accreditation requirements, tools and templates that trustees can use to learn more about quality. In addition, video messages from hospital leaders and board members offer leading practices, and innovative ways to engage and use the expertise of the board.

Information for this article was obtained from:

• Leadership Matters: A Roadmap Toward Effective Governance of Quality and Safety, AHA Trustee Services Boardroom Brief. © Used with permission of the American Hospital Association
• Safety in healthcare 2024, Press Ganey.

Healthcare trustees have a responsibility to ensure their community has equitable access to quality care. To achieve this, health equity must be prioritized and embedded in your organization’s strategic plan. It starts at the top; when a board member serves as a health equity champion it helps to emphasize its importance organization-wide.

How trustees can begin this work

• Educate your board on the definitions of health equity and diversity.
• Create a health equity committee or hold health equity discussions in an existing committee, such as quality or governance.
  • System subsidiary boards (40%) and freestanding hospital boards (46%) reported that they discuss diversity, equity and inclusion at the full board level, and system boards reported that they discuss it in a committee (57%), according to the American Hospital Association’s 2022 National Health Care Governance Survey Report.
• Ensure there is a strategy to develop and strengthen community partnerships to help with board recruitment, workforce expansion and resource sharing. These partnerships can also create a better understanding of the community served, enhance access to care and improve outcomes.

How trustees can prioritize this work

• The board and executive leadership must hold themselves accountable, and this accountability should flow through the rest of the organization until it becomes part of the culture.
• Ensuring your board is diverse is critical to represent the community you serve.
  • A recent AHA Institute for Diversity and Health Equity survey reported that a majority of voting board members are predominantly white (76%) and male (61%), with people of color and women representing 27% and 35%, respectively, indicating much room for improvement.
  • The survey also highlighted a need to recruit younger members, as the proportion of board members age 50 or under continues to decline while those age 71 and older are increasing.
• Encourage your leaders to use the AHA Health Equity Roadmap to assess progress on your health equity journey and chart a path forward. The Lever for Diverse Representation in Leadership and Governance provides examples of how to implement this change.

Making the business case for prioritizing health equity

• Data show that racial inequities are associated with substantial annual economic losses nationally:
  • Health disparities contribute to an annual economic loss of $42 billion in untapped productivity, $93 billion in excess medical care expenditures and $175 billion in premature deaths, according to a national study conducted by the W.K. Kellogg Foundation and Altarum.
  • By 2050, the United States stands to gain $8 trillion in gross domestic product by closing our racial equity gap.
• Regulatory agencies and accrediting bodies are placing more emphasis on greater board involvement in equity issues and addressing health disparities.
  • CMS is adopting health equity-focused measures in the Inpatient Quality Reporting Program, including capturing specific hospital activities to address health inequity in strategic planning, data collection and analysis, quality improvement and leadership engagement.

Questions trustees should ask in the boardroom

• Is health equity part of your board and organization strategy?
• Does your board have a board education strategy on health equity, diversity and inclusion?
• How can your board benefit from diversifying its composition?
• How could your board restructure current meeting practices and service requirements to make serving on your board more attractive to diverse candidates?
• What are the roadblocks to pursuing health equity?
• Do trustees understand the business case for health equity as it pertains to your organization?
• What community partnerships can the organization leverage to have a more inclusive and equitable relationship with the community?
• Has your executive leadership engaged with the AHA’s Health Equity Transformation Assessment? Is your board using the Board and Leadership Lever to assist in developing and enhancing your health equity strategy?
• What are your board’s quantifiable goals to diversify its membership while ensuring proper representation from historically marginalized groups?
• Has your full board had at least one conversation about your organization’s work on DEI?

Organizations may be at different stages in their work to address health equity. There is no one-size-fits-all approach; rather, organizations should ensure that their strategies reflect their specific characteristics and the community they serve.

Additional resources

• Use HTNYS’ Health Equity and Board Diversity online resource libraries.
• Stay tuned for the next video in HTNYS’ new Boardroom Essentials series: What trustees need to know about health equity, coming soon!

Information for this article was obtained from:

• It Starts at the Top: How Boards Can Prioritize Health Equity, AHA Trustee Services Boardroom Brief. © Used with permission of the American Hospital Association.
• DEI Data Insights: Leadership and Governance in Hospitals and Health Systems, AHA Institute for Diversity and Health Equity.

As hospitals and health systems continue to deal with significant economic challenges, it makes sense that many healthcare organizations look to conventional expense reduction methods. However, in today’s environment, clinical quality improvement is a great way for leaders to address pressing financial challenges while laying the groundwork for future success. An effective quality improvement program can increase revenue, reduce costs, decrease burdens on employees and enhance both the patient and provider experience.

Three critical elements for quality improvement initiatives:

• Prioritization: Identify the most important quality areas to address, which may be based on a combination of factors, including the improvement of internal quality metrics, external consumer ratings like CMS’ Star Ratings or Leapfrog Hospital Safety Grades, financial criteria and strategic growth considerations.
• Analytics: Provide actionable insights through data and reports to end users, and track key metrics to measure improvement.
• An infrastructure based on systems and collaboration: In addition to the quality team, clinicians, frontline nurses, clinical documentation, coding and other staff must participate.

Other elements essential to quality improvement success include:

• A top-down commitment to quality: Leaders must reinforce a culture where quality is a top priority.
• Communication and change management: These are key for setting expectations about how the quality initiative fits into existing workflows and proactively engages employees.

With shifts in payment models, poor quality is now more costly than ever. For example, studies have found that surgical site infections are typically associated with an additional seven to 11 postoperative hospital days, preventing the hospital from filling medical-surgical beds with new patients.

As trustees provide oversight to their healthcare organizations, they should remember that quality initiatives result in better patient care and stronger finances.

Resources

• For more information on the board’s role in quality oversight, refer to the HTNYS Board Responsibilities online resource library.
• Stay tuned for HTNYS’ new series of educational videos on quality, coming soon. You’ll be able to watch them on your own, add them to your next board meeting agenda or include them in your new-member onboarding process.
• You can also access a variety of resources from HANYS’ Quality Advocacy, Research and Innovation team, including information regarding clinical collaboratives, learning networks and issues impacting clinical and operational oversight.

Information for this article was obtained from: Quality transformation: How hospitals are striking a balance between the bottom line and better care, Becker’s Hospital Review.

As we enter this new year, many publications have identified trends expected to impact the healthcare industry in 2024 and beyond. Common themes include continued financial pressures, workforce shortages and issues associated with commercial health insurers.

Hospitals and health systems had to cope with a multitude of challenges in 2023, including rising costs, labor shortages and endemic COVID-19. Trustees and healthcare leaders should stay informed about emerging trends nationally and locally to help strategize and position your organization for success in a changing environment.

McKinsey & Company and Becker’s Hospital Review summarized the following trends in recent publications:

Financial pressures

• Although hospitals’ margins improved in 2023, they still face significant long-term financial challenges. Greater labor and supply expenses and patient acuity will continue to challenge hospitals in the year ahead. Organizations will continue to focus on attracting and retaining patients to increase revenue and improve payer mix. Healthcare organizations will need to implement targeted approaches that focus on specific services with opportunities to increase volume and revenue.

Workforce shortages

• Healthcare workforce supply, especially nurses and physicians, will continue to lag behind the growing demand to take care of a growing, older population.
• Mental and behavioral health needs continue to grow, with the current workforce supply unable to keep pace.

Payers

• The biggest payers are 10 times the size of the largest health systems. Hospitals face challenges with negotiated rates, claims denials and slow, costly and inconsistent reimbursement policies.
• Medicare and Medicaid combined are larger than commercial payer sources. These government-funded programs present significant concerns for hospitals and health systems as they reimburse below cost and well below commercial rates.
• Enrollment in Medicare Advantage will continue to grow. It now covers more than half of the Medicare population, giving big payers even more influence.
• One of the world’s biggest insurers, UnitedHealthCare/Optum, has become the largest employer of physicians in the country. Optum added nearly 20,000 physicians in 2023, meaning it now has nearly 90,000 employed or affiliated physicians and another 40,000 advanced practice clinicians.

Technology solutions

• Technology solutions such as artificial intelligence, automation, electronic health record optimization, virtual care programs and remote patient monitoring can close some care gaps by making administrative and clinician efforts less burdensome.
• Healthcare has lagged behind other industries in AI adoption. Healthcare leaders are challenged to evaluate and ultimately unlock the value of transitioning to AI solutions unique to their organization.

Information for this article was obtained from:

• 12 healthcare trends and issues we are following for 2024, Becker’s Hospital Review, Jan. 2, 2024
• Healthcare’s next chapter: What’s ahead for the US healthcare industry, McKinsey & Company, Dec. 19, 2023
• What to expect in US healthcare in 2024 and beyond, McKinsey & Company, Jan. 5, 2024