Trends in Healthcare & Governance

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