Last week we mentioned a number of high level factors affecting healthcare providers as the trend of care moving out of hospitals accelerates. The first of those factors is operational efficiency: reimbursement is coming down and margins are tighter so providers have to do more with less.

To kick off our focus on operational efficiency, we hosted a roundtable discussion with four healthcare executives to learn more about the ways in which people managing various programs day-to-day are handling these challenges:

We chose not to identify the participants so that they could speak freely. Generally, though, each was a VP of a provider organization, and their respective areas of responsibility included telehealth, strategy and operations, and business development. Several also have experience on the payer side.

In addition, Health:Further executives Marcus Whitney (CEO) and Steve Tremitiere (Chief Development Officer) joined the conversation.

In this post, we’ll highlight the main ideas that came out of the roundtable. As you read these notes and quotes, we want you to respond with your own thoughts. Tell us how you’re dealing with the following issues, push back on the opinions presented, or ask questions related to these and other topics within the area of operational efficiency. We will be taking all of this insight, combining it with additional research and interviews, and publishing it as articles and reports throughout the next couple of months.

Get in touch by leaving a message at (615)205-1214 or in the comments below.

The most striking thing from the roundtable was how quickly the conversation turned towards people more than processes. Though patient education and experience, and employee engagement are certainly areas of emphasis in literature discussing operational efficiency, it was remarkable how these topics took precedence over other issues like technology, interoperability, streamlining workflows, and billing management.

(please note that quotes have been lightly edited for clarity. Also, Tremitiere is named so you know where you’re getting a Health:Further perspective.)

Holistic, Integrated Care

Healthcare is still fragmented, which is both a cause and a symptom of taking a fragmented view of patients. And the consequences of fragmentation are negative both financially and personally.

“How do we work as a system of systems and how do we start to really ensure that we’re have been taking a total patient focus instead of breaking things down segment by segment.? […] Really being able to recognize that there are different segments [like acute care and pre-hospital care], but flattening […] so that each of them supports wherever those patients enter the system, so we’re able to continue to support that patient and to be a trusted health partner for life.”

“What I think is so interesting coming from the payer side into a more clinical side is the mindset of saying, ‘this [procedure] cost this,’ or, ‘I’m going to do this service.’ But how we approach patients and care in the future should be more from a preventive space. If you think about the long game, people wouldn’t incur all these costs if they were taking care of their health. How do we reimburse doctors to be preventive versus to be fixing things that are always break? Because not everything is always going to break if we have a different focus. And I know that that is a lot of this new payer mindset: how do we avoid costs by keeping people healthy?”

Employee Engagement

Employees expectations have changed. A lot.

“It’s a whole new ballgame out there. If I think about when I started my career, people stayed in careers for 20, 30 years at the same company. Now it’s the norm to change all the time. […] So there’s a little bit of onus back on leaders and leadership to find out how to engage people and keep them engaged and give them rewards that keep them there.”

“Now we’re seeing physicians come in that say, ‘my son, my daughter’s got to be picked up at three and I want to be there for that.’ Or they have a soccer game this afternoon. And so you’re having to reconfigure schedules and if you can’t see patients you’re not doing procedures, making money.”

You can increase productivity and efficiency by giving people a mission.

“I think some of your lower wage employees that are critical to pushing beds, moving people around, they’re not really engaged […] Right now we’re paid to focus on the actual incident […] With the staff, they’re saying, ‘okay, where am I going with this?’ And we’re saying, ‘we need you right here, right now. We don’t really know where you’re going with this, but I’ve got to have somebody who could clean a stretcher or help the patient downstairs.’”

“The most important person is the gurney pusher because that’s the first person that that patient sees when you walk in and the last interaction is the person who drops you at your car. And if they’re grouchy, oh by the way, you’re handing them the patient satisfaction form right after that.”

“What are the tools, what’s the next generation of how you can engage and make people feel like they’re a part of something? And not just feel like it but where they truly are a part of something different than just shuffling paper back and forth.”


The noise is dying down and the industry is honing in on what actually works.

“I don’t know how many patient engagement apps I’ve seen over the last five years, but it’s in the thousands probably. How many of them actually work? I think we are getting to the point where we’re getting past a lot of that. We’re figuring out what works. […] Forget about how fancy something is. What will actually work for the patient and help navigate the journey?” (Tremitiere)

“The consolidation of technology in my experience over the last two years has been tremendous because a lot of the amusements in the space are starting to fall to the wayside. I think we’re starting to realize a level of maturity.”

The industry has made progress but health tech is still too fragmented

“There is no crossover. You go to [Hospital X] and then you turn around and go down the road to [Hospital Y], and your medical record doesn’t transport.”

“I think a lot of people get stuck on, ‘I have to have a tool to make me successful.’ or, ‘I have to have this data that interacts to make us get to the next place.’ And they forget about the patient experience. Because if you make your patients happy and you give them a good experience, they don’t care what tool is and you’ll grow more patients.”

“All of us for a decade probably have been [thinking about] interoperability, HIE, and we’re trying to solve individual problems with a global solution instead of maybe turning that upside down and saying, where can we solve things on a more individual basis that can then scale up? […]

Revenue Cycle Management

Providers are sweating the small stuff

“[The challenge is] really good rev cycle, especially on the smaller stuff […] If there’s a $100,000 bill out there, I have folks who have the time to do that. My problem is the 10,000 $250 bills and the time to put people on that […] And my gut tells me that we’ve got a whole lot of people using old processes in order to do that. If we can get more savvy, I think that would be lower cost for us and the insurance industry and we could deploy [those savings] to other areas.”

“I think it’s the whole dental model. When you go to the dentist, you expect to pay on the way out. You walk past the front desk and you give me your credit card, your HSA, whatever it is. We’re not there. We’re still in this whole EOB, let me send it off, come back three weeks later and then you’re paying. And let me tell you, if I’ve already had the procedure I’m a whole lot less inclined to be paying then as opposed to if I was supposed to pay up front.”

A problem that came up is that in some situations the upfront cost is unclear, even for the provider. Complex and/or high-acuity cases often see more interventions added in real time, leading to a dramatically higher total cost than a simple version of the same case would have incurred. Part of the solution? Give a rough order of magnitude for the cost based on other events that might occur.

Agree, disagree or have something you’d like to add? leave a comment below or call (615)205-1214

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