At a Glance
- Accountable care organizations and population health management may require changes to the healthcare team, including new job descriptions.
- Catholic Health Initiatives (CHI) has added new leaders to focus on population health.
- CHI has standardized job descriptions for upper management to reflect a focus on primary care.
I had an “aha” moment a few weeks ago during a conversation with a physician friend who has practiced as a public health officer for most of his professional life. We were talking about the topic at the forefront of most of our colleagues’ minds: healthcare reform.
“You must be excited,” I said. “This country is finally moving away from ‘sick care’ to a system in which prevention and community health will be more important. That’s just what public health leaders have been telling us for years!”
After a pause, he answered. “Well, to tell the truth, ‘excited’ isn’t exactly the right word. We public health executives are kind of wondering about our future. The drug and grocery stores have all but taken away our immunization programs. Now you hospital people are getting ready to move into population health. We’ve got to figure out where we fit in this new healthcare paradigm.”
His words startled me because up until then, I had limited my thoughts about healthcare reform to changes affecting my own world: physician practices, hospitals, long-term care facilities, and home care. But at that moment, it became clear to me how much healthcare reform is changing the rules for all of us, including those who may have greater roles in the next era of health care.
That next era has been described by the American Hospital Association (AHA) and others as the second curve of health care. The first curve—our present reality—is provider-centric, acute-care focused, fragmented, and geared toward treating sickness. The second curve is our projected future: customer-centric, primary-care focused, seamless, and geared toward health status and health outcomes.a In such an environment, integration of systemwide goals may be critical, and population health management may be as important as individual care.
In fact, every segment of health care is facing revolutionary transformation. For example, large numbers of physicians are giving up their roles as private business owners to become employees. According to a 2011 Accenture survey, fewer than one-third of physicians may remain truly independent in 2013.b As they migrate to new care models like medical homes and team-based care, some physicians realize they need to learn how to be more collaborative.c And it’s not just physicians who need to change. Other members of the clinical team may require new job descriptions and roles, according to the AHA.d Case managers and registered nurses, for example, will need to learn new roles as care managers outside the hospital walls or as virtual team leaders both inside and outside of acute care.
New Roles for Executives
Direct caregivers are not the only team members experiencing role changes and who may need to learn new skills as our systems become more integrated. Take, for example, executives who have “grown up” in acute care settings or experienced successful careers in single hospital facilities. These leaders face changing job descriptions as their organizations experience increasing pressure to consolidate to improve operating efficiency and diversify risks.e
By growing larger, health systems are also gaining access to more non-acute services across the continuum of care. Leaders at these systems recognize that population health management may require accountable care organizations (ACOs) with continuing care capabilities. They understand that when the second curve comes, there may be fewer growth opportunities for their acute care business and greater growth opportunities in other segments of the continuum.
Forward-thinking system leaders also see centralization and standardization as norms for the next era. Centralization refers to direct corporate management of functions across an organization, including, for example, human resources, materials management, bioengineering, food services, laboratory services, home health, legal services, IT, strategy, medical management, nursing, and all aspects of finance. Standardization refers to a decrease in variance of practices across the system and can apply to financial as well as clinical operations.
Centralization models have been evolving for years. In 2000, a study at Northwestern University compared the financial performance of healthcare systems with various levels of centralization. It found that moderately centralized systems demonstrated the best financial performance, followed by highly centralized networks. The poorest financial performance was found in systems with little centralization.f
And according to a 2010 Thomson Reuters study, it isn’t only finances that improve with centralization. The Thomson Reuters analysis showed that centralized oversight of performance improvement also improves the quality of patient care systemwide.g
For these reasons, diverse functions such as those cited previously are being centralized or standardized to various extents at organizations across the country. At the same time, many health systems are assessing their readiness to serve as ACOs. As a result, responsibilities and accountabilities are shifting for almost everyone on the healthcare team. And sometimes a system needs to seek out new talent.
One System’s Response to Changing Roles
Catholic Health Initiatives (CHI) is one system that has been preparing for the next era by centralizing some of its key services, including materials management, legal services, risk and insurance, revenue cycle, compliance, business intelligence, IT, and performance management. In these centralized departments, employees may be physically located in the markets they serve but report to centralized departments in the corporate office.
CHI has also added new leaders for population care to its management team. In the past year, we have hired new executives for continuum care management, physician office quality, team-based care, managed care financial operations, and telehealth services in the corporate office.
At the same time, CHI has been standardizing executive job descriptions throughout the system. New job descriptions for CEOs, chief nursing officers (CNOs), and chief medical officers (CMOs) were released in January 2013.
In preparing these new job descriptions for upper management, CHI leaders sought to replace the acute care focus with a primary care focus. In the next era, executive leadership will be needed to manage the entire continuum—not just hospital care. CHI has addressed this changing paradigm by dividing executive roles into two camps: “market” jobs that provide executive leadership for all components of a market’s continuum (such as CEOs, CNOs, and CMOs) and jobs that concentrate on just one of the components of the continuum (such as a hospital president or vice president position). At CHI, hospital executives report to market leaders, just as other continuum executives do—or will, as other components of the continuum are developed.
CHI leaders have also been transforming the finance function throughout the system. This effort has included preparing finance leaders for the next era. CHI has established a finance operations leadership council (FOLC), charged with helping executives understand operational implications of system initiatives. Members include regional, divisional, and national finance leaders who provide the CHI financial enterprise with leadership, strategy, policy, and development of systemwide practices. An FOLC member serves on the system’s clinical leadership council to ensure tight fiscal and clinical alignment. Finance leaders from across the system participate in virtual and in-person educational events sponsored by the national office. So far, new job descriptions for finance leaders have not been completed. However, leaders expect the finance team to take a more strategic role in the years ahead.
“CHI finance leaders of the future will possess fundamentally different skill sets and will approach their roles from a very different perspective than in the past,” says Dean Swindle, CHI’s executive vice president. “Specifically, our finance leaders will focus more energy on strategic activities relative to transactional processes and activities. There will be an elevation of the importance of collaboration across regions and functions, as well as standardized best practices to drive efficiency. Leaders should have the ability to think in a transformational way and to look for best practices beyond our industry. They will be required to have a well-rounded skill set consisting of core finance expertise paired with a business-building and strategic-thinking mindset. Our finance leaders will be held accountable for delivering excellence and will remain vigilant to cost controls while continuously driving change to improve the finance function’s effectiveness.”
Why is CHI hoping to transform its finance function? “Business as usual is unaffordable and unsustainable,” Swindle says. “The time for change is now.”
A New World for Healthcare Professionals
Most of us who work in health care know the system has to change, and that means that the work we do as individuals may change as well. Clinicians, support staff, and executives may all need to learn new skills and work with new team members in new ways as our health systems become more integrated. My friend, the public health physician, helped me realize that all of us are facing change in our jobs. We’ll still need public health. And we’ll still need effective leadership—just in new and different roles as we work together to improve our communities in the next era of health care.
Kathleen D. Sanford, RN, DBA, MBA, MA, FACHE, is senior vice president and chief nursing officer, Catholic Health Initiatives, Denver, and a member of HFMA’s Colorado Chapter (firstname.lastname@example.org).
a. Hospitals and Care Systems of the Future, American Hospital Association, September 2011.
b. “Physician Employment Trends Will Force Payers, Hospitals, and Vendors to Revise Business Strategies, According to Accenture Survey,” Accenture, June 13, 2011.
c. Krupa, C., “Med Schools Shift Focus to Team-Based Care,” American Medical News, March 19, 2012.
d. Workforce Roles in a Redesigned Primary Care Model, white paper, American Hospital Association, January 2013 .
e. “New Forces Driving Rise in Not-for-Profit Hospital Consolidation,” Moody’s Investors Service, Jan. 25, 2012.
f. Bazzoli G., Chan, B., Shortell, S.M., and D’Aunno, T., “The Financial Performance of Hospitals Belonging to Health Networks and Systems,” Inquiry, Fall 2000.
g. Wilson, L., “Top Systems Often Take Centralized Approach,” Modern Healthcare, June 21, 2010.
New Roles Added at CHI
To prepare for the second curve, Catholic Health Initiatives (CHI) has added the following jobs in recent months:
- A senior vice president for the physician enterprise
- A vice president for physician practice quality
- A vice president for care management
- A vice president for team-based care (an advanced registered nurse practitioner)
- A president for telehealth
A Market CNO Versus a Hospital Vice President of Nursing: What’s the Difference?
At Catholic Health Initiatives (CHI), leaders have established distinct job descriptions for executives who lead market-based programs, compared with those who focus on acute care. A good example of this can be seen in the roles and responsibilities of key nursing leaders.
The market CNO. This executive is responsible for the practice of nursing and nursing care throughout the market’s continuum of care sites and programs. He or she provides leadership and strategic direction for all care traditionally considered nursing care, wherever it occurs. The CNO develops and implements key strategic and operational initiatives that facilitate optimal care delivery and population health management through person-centered, financially sound, safe, and high quality care. The CNO serves as a positive role model for ethical management behavior and promotes awareness and understanding of positive ethical and moral principles. As a member of CHI’s nurse executive council, this executive partners with national nursing leaders to determine corporate nursing strategies, goals, and standards. The market CNO reports to the market CEO for operations and the corporate CNO for the practice of nursing.
The vice president of patient care. This executive is responsible for providing clinical leadership in his or her facility. The vice president of patient care fulfills this role through implementation of strategic and operational initiatives that facilitate optimal care delivery, high-quality care, financial success, risk management, and customer service. The vice president is responsible for maximizing effective hospital patient care, as well as overseeing nursing and other clinician care to create value for the system and community. He or she serves as a positive role model for ethical management behavior and promotes awareness of positive ethical and moral principles. The vice president ensures that CHI strategies, goals, and standards are implemented and monitored in his or her facility. This leader reports to the hospital president for operations and the market CNO.
Publication Date: Friday, March 01, 2013