5 noteworthy insights to help health organizations thrive in 2023 and beyond

Recently, operational, financial, clinical, and digital executives from leading healthcare organizations across the US convened in Napa, California for Noteworthy, Notable’s user conference, to learn, connect, and discuss the next phase of digital transformation for healthcare. 

For many industries, innovation may seem to take off overnight, but it often takes years of slow and steady work before the tipping point is reached. This moment in healthcare has taken on the urgency of an inflection point. 

Tomi Ogundimu, VP of Research and Education at the Health Management Academy (HMA), opened the event with a stark reality: “53% of hospitals in the United States are projected to have a negative operating margin by the end of the year. I don’t know of another time in our history where the economic picture has looked this challenging.” 

She went on to share that so much of this picture is painted by the rising cost of labor (+29%) and supply (+19%). By the end of this year, health systems are projected to sit at a 0.25% profit margin. Fast forward to 2023: Inflation will be omnipresent and labor costs will continue to outpace that inflation. By the end of 2023, the average hospital's margins will linger in the realm of -1.7% to -3.3%. 

So much opportunity in healthcare lies in its challenges: patient engagement and retention, staff burnout and capacity. On the clinical side, the question remains: “How do we invest in technology and resources to bring value back to our providers, to help them operate more efficiently at scale?” On the administrative side, it's about reducing efficiencies in favor of more centralized operational rigor that drives revenue growth. 

While health system growth was top of mind, there were other key messages that underscored every conversation. The following are five core themes that emerged throughout the two day event:

1. Overcome the “great patient disconnect”

The foundation of this current inflection point can be attributed to the great patient disconnect. This refers to the gap between what matters to providers and what matters to patients. 

According to Ms. Ogundiumu’s work at the HMA, “There’s a difference between what we as providers want, which is for patients to be engaged and  what patients or consumers want, which is success: a successful experience, a successful outcome. How best do we bring those things together?” 

Health systems tend to assume they know what patients want, instead of asking them. Adam Cherrington, Sr Director of Research for Patient Engagement and Patient Voice at KLAS, drove this point home: “It’s an oxymoron to call it patient engagement and not involve the patient.”

According to KLAS research on patient engagement, patients indicated appointment availability and location are the most important factors in choosing where to receive care. Convenience matters from every dimension, like the ability to check in online or from their mobile device. 

Interestingly, according to CHIME’s 2021 Most Wired Report, patients who have logged into their patient portal once in the last year are considered to be “engaged.” By this standard, 83% of hospitals report more than 25% of patients with portal accounts have logged in one time in the past year – and this is considered top performance. The reality is that patients aren’t engaging with portals. We can improve engagement by accurately measuring it, and one way to do this is by building digital experiences that are personalized to the individual needs of each patient, and that will ultimately result in a conversion.

“I think Chick-fil-A knows me better than my doctor does,” said Cherrington. “They know what I ordered last time, my payment method. We can lean into that disruption.” 

Several of our health system partners have worked with us to learn how to improve and refine how they engage their patients. Reid Health, for example, is leveraging real-time data and reporting capabilities they previously did not have access to. “Notable is giving us so much information that we didn’t have prior — we’re getting written comments everyday so we know what patients care about. Respecting their time is very important to them, and avoiding the ‘clipboard of death’. In the past, it would've been very difficult for us to own that data mining, collection, and presentation within our own organization,” said Michelle McClurg, VP and Chief Patient Experience Officer at Reid Health. 

To learn more about how Reid Health is leveraging data through Notable, read the case study. 

2. Take care of caregivers

Health systems across the country are still reeling from staffing shortages and general burnout caused by the COVID-19 pandemic. Many of the executives in attendance at Noteworthy opened up about their persistent struggles with recruitment and retention. 

Brenda Rodriguez, Chief Strategy and Finance Officer at Lowell Community Health Center, described the climate that led her to pursue automation: “At the height of the pandemic, calls were overflowing. Patients were confused and scared and staff were completely burned out. We needed to provide a little bit of relief.”

She saw automation as an investment in caregivers, as a way to safeguard their time to have deeper, more meaningful conversations with patients, and to be more inspired and engaged. 

Read more of Lowell Community Health Center’s story here. 

It is critical to support caregivers. Marc Harrison, MD, former President and CEO of Intermountain Healthcare, highlighted how technology can help: “It’s multifactorial. We need people to practice at the top of their license. In this case, it’s going to be enabled through technology to guide people through healthcare. And then, it’s using AI-powered tools to help things move faster… we need to consider all the tools in our toolbox.” 

Certainly, it takes more than automation to truly take care of caregivers. However, intelligent automation keeps the system moving by filling in gaps left by FTE vacancies or EHR/workflow inefficiencies that ultimately result in more work and re-work. The goal is to free staff from repetitive work in order to engage more deeply, focus more intently, and work smarter, not harder. 

“Patients get frustrated. Caregivers are frustrated. Providers are frustrated by delays in care. It’s 360 frustration,” said Krysten Blanchette, VP of Revenue Cycle at Care New England.

Care New England is working toward alleviating frustration at the front-end, by leveraging intelligent automation to streamline their revenue cycle operations. They recognized that delays in care due to delayed or missing prior authorizations hampers the patient experience, but also means the difference between receiving life-saving care, or not.

“We did some value stream mapping and realized the team doing the prior authorizations was doing the best they could,” said Erin Pelletier, VP of Operational Excellence at Care New England. “With Notable, we’re able to work the prior authorization as soon as the test is scheduled, right on day one, instead of three or four days later. We’re hoping to create an experience where patients don’t even know a prior authorization was required in the first place.”

3. Invest in specialization

While there are many challenges in healthcare, there is a light at the end of the tunnel. Caroline Brown, Chief External Affairs Officer at the Medical University of South Carolina (MUSC) said it best: “Healthcare has three major competitive advantages we need to continue to capitalize on: Trust, infrastructure and talent, and business complexity. Health systems have an incredible advantage because we understand how the business works, but we have to acknowledge that we are horrible at clean, frictionless seamless patient experience. We need help in some areas.” 

Several attendees voiced the importance of leaning on experts whose areas of specialization complement their own, or to fill gaps where they are lacking — particularly when it comes to technology and innovation. “The arrogance of delivery systems to believe they can do anything is really almost endless,” said Dr. Harrison. “But [companies and upstarts] are so much better than us at this. This is where the idea of partnership comes in.” 

Annie Lamont, Co-Founder and Managing Partner at Oak HC/FT, offered another word of advice: “Partner with those for whom this is the most important thing they think about. It’s fundamental specialization.”

Technology vendors can not only build new, but also take on the work of improving and maintaining the product over time on behalf of the health system. Because they are solely-focused on a specific area or problem, they can devote more time and resources to redefine what’s possible.

4. Extend and scale population health initiatives

Increasingly, health systems are moving towards value-based care (VBC) and population health, which focuses on improving health outcomes across the care continuum while lowering the total cost of care. But the imperative of preventative care means additional work to outreach to patients to help them stay on top of their care. This additional work can be an onerous burden for health systems that are already stretched for staff.

Much of the time, there is no standardization for how clinical information is gathered about a patient population, stored or reported on. For example, it can take an army of people to scrub patient records to identify additional HCC codes and open care gaps. 

Patrick Cawley, MD, CEO and EVP of Health Affairs at MUSC, believes that the move to value-based care is the right direction for academic medical centers. The challenge is that while the EHR has digitized patient data, it has not made it easier to action that data. “We’re trying to go to value-based care as fast as possible but part of what holds us back is you need all these care coordinators,” said Dr. Cawley. “Getting information [about a patient population] is incredibly difficult. And once you’ve got that information, now we’ve got a problem. How do we remind our patients with diabetes to get their hemoglobin A1c? That’s where Notable can help us move quickly and send a reminder to the patient with much greater accuracy of follow up.”

Leaders from ThedaCare are also focused on using automation to scale population health initiatives. Notable surfaces care gaps and automatically performs care gap outreach to patients, prompting them to schedule care. Using Notable, ThedaCare has closed 1,000+ care gaps, saving over 3,500 hours for staff. 

Learn more about ThedaCare’s journey with care gap automation here. 

It is no surprise that the cost of manual work required to maintain a value based care model can quickly outpace any additional revenue. “If the phone gets answered 30% of the time, you’ve got to call the patient 3.3 times to get that care gap closed. That’s a lot of work being done by talent in high-turnover roles — clinical care coordinators to scrub those charts, schedulers to make those calls. And the costs end up far surpassing the financial gains,” said Carle Falk, Head of Research at Notable.

All the same, Dr. Harrison noted, “The right thing to do is to keep people well.” Automating chart scrubbing and patient outreach are foundational to making population health more financially viable.

5. Be bold to redefine what's possible; don’t just optimize

Laughter spread through the audience as Paola Turchi, Notable’s RCM Solutions Lead observed that “People become very efficient at their inefficiencies.” Despite the byzantine workflows in healthcare, many organizations have managed to become effective at mobilizing vast numbers of people to complete repetitive, manual tasks, instead of eliminating those tasks altogether, using automation. 

Austin Regional Clinic (ARC) was one such example. “The reason we engaged with Notable wasn’t necessarily because we were underperforming on denials,” said Dr. Manish Naik, Chief Medical Officer at ARC. “We had some of the best [denial] rates, but we were doing it with an army of people. It becomes not just a question of the number of people, but the quality of their lives when we keep adding more to their plate. Not having people in a state of burnout greatly improves their morale and the patient experience.”

Learn more about ARC’s work automating their revenue cycle here. 

Optimizing a fragmented system isn’t enough. Healthcare is known for being very stop-and-start, or hurry-up-and-wait, but why should it stay this way? It’s not enough to automate existing workflows. The status quo needs to be radically changed; simplified, to have the highest impact for patients, providers and staff. After all, creating more capacity per FTE means less FTE needs (read: constraints) over time.

“We didn’t want to be part of another optimization project,” said Brenda Rodriguez of Lowell Community Health Center. “For example, we don’t just want forms in English and Spanish. We need them in all our top languages: English, Spanish, Portuguese and Khmer. If we’re going to drive health equity, we have to be fierce, more bold, more demanding. Notable said yes and that’s what we want – partners who will say yes to being bold.”

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There is so much opportunity in healthcare to create real, transformative change, and to improve caregiver and patient experiences. That also means there are lots of possible paths to take. The important thing is to start.

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