2019 Trends in Healthcare & Governance

• Did you know that only 10% to 20% of health outcomes are tied directly to healthcare, with 70% tied to social determinants of health?
• Social determinants such as food, housing, income, education and safe living and work environments significantly impact overall health and quality of life for people in your communities.
• Boards can have a variety of leadership roles to impact social determinants of health and focus on community health. Trustees can serve as strategic advisors, facilitators and influencers to advance the understanding of community health needs and determine how their organizations can support the development of sustainable solutions to address them.
• As a trustee, if you have not heard about your hospital or health system's community health needs assessment, please ask your board chair and CEO to have this placed on your next board agenda.

Trustees have a vital role in hospital and healthcare system governance and business operations. As such, trustees need to understand the importance of the patient experience and how improving it advances the mission, vision and values of their organization.

The board has a vested interest in ensuring a consistently positive patient experience. Often, board members and their families are users of the services provided by the healthcare organization they serve. There should be accountability for delivering the highest quality care to patients while maintaining a positive, trust-building reputation for the organization.

Key questions boards should ask about patient experience:

• What are our patient satisfaction scores? How do they compare to the organization's goals?
• What are our leaders' top priorities for making improvements?
• How should board members handle complaints from community members? What is the process?
• How is the hospital/system monitoring and managing consumer feedback through social media?
• How can board members support leaders' efforts?

It's a balancing act. Trustees must ensure that high-quality care is delivered while also representing the voice of the community in the boardroom. This can be a balancing act. Board members must avoid getting involved in their neighbor's drama when listening to complaints. Trustees are most helpful when they are prepared to respond to negative comments about patient experiences. That means listening, acknowledging and assuring the person that their concerns will be shared with the appropriate people. Board members have a responsibility both to the community and the hospital administration to pass along concerns, complaints or compliments about patient experiences so they can be handled through the appropriate channels.

How can board members help? Board members can also support the organization's efforts to improve the patient experience by serving on committees focused on that goal. That doesn't necessarily require a unique board committee — trustees can leverage existing committee work by reviewing patient experience metrics as part of the quality committee, for example.

HTNYS is pleased to present Healthcare Trends: Insight for Resilience, a strategic planning resource for your governing board and leadership team. This HANYS report examines the changing healthcare landscape in New York, provides key data points and offers strategies for resilience.

Insight for Resilience includes the report, an accompanying slide deck and a video that offers a brief overview of the report.

Insight for Resilience is a product of HANYS' Strategy, Innovation and Policy Committee, which built on the work of the HANYS Board of Trustees' year-long scenario planning process. It examines the healthcare landscape in New York with data points across four broad categories:

• Healthcare Cost and Payment
• Access to Care and Insurance Coverage
• Technology and Consumerism
• Market Shifts

We encourage you to use this publication as a planning and strategy resource for your organization.

What is an SDH? Non-medical needs known as social determinants of health reach beyond the clinical setting and influence the physical and mental well-being of individuals. This Trends highlights a hospital’s community health program that addresses the SDH, “food insecurity.”

• What is the impact of food insecurity? A person is considered food-insecure if he or she lacks reliable access to a sufficient quantity of affordable, nutritious food. This SDH is a major risk factor for the use of emergency departments and inpatient healthcare services. Those with the highest healthcare costs are often food-insecure. Food-insecure populations often face challenges such as inadequate health insurance, forcing people to delay or forgo treatment until conditions worsen and become more costly. Addressing food insecurity can avoid a choice between timely medical treatment and food.
• Putnam Hospital case study: Putnam Hospital in Carmel, New York, is in its third successful season of hosting a farmers market. This community health initiative provides fresh and affordable food options and fosters healthy eating habits and the prevention of chronic diseases. The farmers market offers nutritional tips, recipes and demonstrations. When Putnam Hospital opened its farmers market, there were only four other farmers markets in Putnam County, an area that encompasses six towns, three villages and more than 99,000 residents. Last season, Putnam Hospital’s farmers market sold more than 2,200 pounds of produce to the local community. For more information, contact Marcela Rojas, public and community affairs manager, at mrojas1@health-quest.org.
• How can trustees help? Trustees can include addressing SDH on board agendas for discussion. The impact of social determinant-focused programs extends beyond satisfying basic needs to keeping individuals healthy in their communities. In turn, this creates opportunities for system cost savings by reducing hospital admissions and readmissions.

For more information, see HTNYS’ recent publication, Social Determinants of Health: A Primer for Healthcare Trustees.

• There are three types of governance: fiduciary, strategic and generative. Most trustees are familiar with and operate in the fiduciary and strategic modes of governance. However, a new model of governance – generative – is beginning to emerge and transform the way boards work.
• Does your board appear to be disinterested during meetings? The generative model of governance looks at framing problems and asking “What is the key question?” Thinking and operating in the generative mode enables boards to shift their thinking. Generative insight requires that the board have a strong understanding of the organization’s identity to tailor their solutions to the organization’s goals and values.
• To embrace a generative mode of governance, boards must be prepared to engage on a different level of analyzing and discussing issues from a macro lens. One major factor that will need to change to adapt to this mode is the way board meetings are structured by an agenda. More time needs to be built into the agenda for critical thinking and debate on bigger-picture issues.

HTNYS’ 2019 Annual Conference will include a breakout session on critical thinking for boards. The complete agenda is available online. Conference registration begins on June 26.
(Note: generative governance information source: BoardSource and the American Hospital Association)

• Cardiogram, maker of a smartwatch app that uses technology to detect various heart conditions, announced that a deal with Oscar Health to give members health detection technology. This new technology will enable consumers to be monitored for signs of diabetes and atrial fibrillation, and if someone is at a high risk for one of these conditions, they will be offered a confirmatory test such as a blood test or an ECG.
• The FDA has cleared a new wearable device that uses machine learning to remotely track and analyze multiple vital signs, including respiration, pulse, oxygen saturation and temperature. The product can deliver continual updates on a patient so doctors can intervene quickly if the data signal an emerging problem. The device, called Current, is already used in hospitals and the clearance means it can monitor patients at home between visits with their doctors. It uses machine learning to analyze the data it collects and notifies doctors of problematic changes via mobile devices or in electronic health records.
• Artificial intelligence (AI) and machine learning capabilities are being integrated into workflows for many clinicians and administrative staff at hospitals and healthcare systems. AI is being used as clinical support tools to improve diagnostic accuracy and to customize treatment plans for patients. AI will also be used to automate manual tasks and improve the accuracy, predictability, and speed of managing risk compliance, insurance claims, and the supply chain.

• Aging governing boards: As healthcare providers continue to face the challenges of serving an aging population, the average age of governing boards is also increasing. Many healthcare organizations are working to recruit younger board members such as millennials and Gen Xers to increase generational diversity on their boards. Thinking outside of the box for recruitment, some organizations are looking beyond their service areas to recruit younger board members while others are beginning to consider compensating board members beyond reimbursement of expenses. Other organizations are looking to change their traditional governance structures to attract and retain millennials.
• It pays to have a digitally savvy board: Along with opportunities, the digital era brings many risks for organizations, such as cybersecurity breaches and business model disruptions. As a result, it's important for all business leaders to be digitally conversant. A recent study published in the MIT Sloan Management Review found that this characteristic is particularly critical for board members, as it is a new financial performance differentiator. This study showed that companies whose board members are digitally savvy outperform other companies in areas such as revenue growth, return on assets and market cap growth.

As the pace of technology continues to accelerate, trustees need to be aware of these changes and how your organization is planning for them.

• Alexa at the bedside: Voice assistant devices manufactured by Amazon, Google, Apple, Microsoft and others are now making deeper inroads into patient care. Hospitals are exploring new uses in intensive care units and surgical recovery rooms, and contemplating a future in which voice avatars like Alexa become a virtual member of the medical team. For example, Northwell Health is preparing to put Alexa in private rooms to allow patients to tap into their electronic medical records. Meanwhile, others are testing voice assistants for clinicians to improve or even replace EMR interactions.
• Walmart drops price of virtual visits from $40 to $4: Walmart is offering employees a 90% discount on telemedicine, dropping the price of a virtual visit from $40 to $4, according to The Denver Post. The retailer reduced the cost of telemedicine services to increase options for employees seeking care. Walmart's health benefits currently cover more than one million people enrolled it its Associates' Medical Plan. Through this plan, virtual visits through the Doctor on Demand app are covered like a normal physician’s office visit. However, just eight percent of Walmart’s employees at large and midsize companies used telemedicine benefits in 2017, according to the report.
• CVS looks to make its drugstores a destination for healthcare: CVS believes that the healthcare industry is currently organized for the convenience of doctors, hospitals and other providers of care. They see an opportunity to organize around the consumer. CVS plans to transform some of its stores and its existing retail clinics into “minute clinics” that will offer more healthcare services and products. The company says this retail approach will make it easier and cheaper for people — particularly those with chronic illnesses like diabetes, heart disease or asthma — to manage their conditions.

• Non-medical factors such as housing, nutrition, income, education, transportation, social isolation, health literacy and access to care and healthy food can affect healthcare outcomes and health.
• Societal trends and the social determinants of health greatly impact the health status of the people who live and work in our communities.

How can trustees help?

• Understand what is happening in your communities, where the problems lie and how your community can begin to address and solve these problems.
• Learn how your organization is looking at population, demographic and socioeconomic trends.
• Obtain a high-level overview of key data that highlight obstacles to addressing social determinants of health.
• Find out if your healthcare organization is already collaborating with community-based organizations, businesses and education to begin to address how these social determinants are impacting your communities.

Identifying and creating community-wide interventions with key community partners can be a first step to addressing these issues.

• Board Orientation: As new board members are elected to your boards, remember: It is very important that they have good orientation to assist them in becoming familiar with healthcare. HTNYS can help! We have great resources that can assist you with board orientation. Our Boardroom Basics publication provides a strong foundation on board roles and responsibilities. Our website contains helpful resources on key topics such as self- assessment, quality and strategic planning.
• Single Payer Primer: An issue that will likely surface in 2019 is single payer. To begin to educate trustees about the single payer issue, HTNYS developed a Single Payer Primer. It is important for you to know about the single payer issue so you and your board colleagues can begin to help us shape state and national discussions on this issue. Fundamentally, the single payer debate is not about single payer vs. no single payer; the challenge has been and will continue to be how we make New York’s healthcare system sustainable, accessible to all, of the highest quality and affordable.
• Save the dates for HTNYS’ Annual Conference, September 13-15, 2019 in Saratoga Springs: The “Power of Governance” theme was chosen to feature key topics that trustees need to fulfill their leadership roles as board members. The conference will feature exceptional speakers on key topics such as leadership, governance, the opioid crisis, behavioral and mental health issues, system-ness, and much more. More details will be coming your way soon.