Category Archives: CEO

CFO base pay raises outpace CEOs’

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Dive Brief:

  • CFO salary increases edged out CEO increases in 2022, with CFOs on average seeing an increase in base salary of 5.5% while CEOs’ pay increased by 4.4%, according to a recent report by Compensation Advisory Partners.
  • Most (80%) of both CFOs and CEOs saw increases in base salary, the report from the compensation consulting firm found. Of those companies making increases, CEOs saw a typical range between 3.4% to 7.4%, compared to the 3.6% to 9.1% range for CFOs.
  • A notable portion of both CFOs and CEOs saw significant increases in total compensation for 2022, with 40% of CEOs and one-third of CFOs seeing a 25% increase in total compensation compared to their total pay for the prior year.

Dive Insight:

The report, based on proxy statements, provides an early look at payment trends even as filings continue to trickle in during March and early April.

The bigger CFO salary gains could be partially due to the fact that the finance chiefs’ role has changed over time from a pure reporting function — the  “level of sophistication for the role has been increasing,” Ryan Colucci, principal for CAP and the author of the report, said in an interview.

Lingering stresses from the COVID-19 pandemic — which put particular strain on certain roles including the chief legal or chief human resource officer as well as CFOs — could also be contributing to the boost in salary, for that matter.

Executive team priorities have shifted since the pandemic, with individuals searching for a greater work-life balance which could be causing both higher turnover in these roles — Colucci has seen greater CFO turnover over the past six to 12 months, he said — as well as efforts by companies to hang on to skilled, dependable executives.

“I think if you have someone good, you want to reinforce it with a nice increase,” he said.

Equity awards also remained the bulk of the pay mix for the majority of executives, representing two-thirds of total compensation for CEOs, and 56% of total compensation for CFOs. Additionally, while top executives saw higher increases in total compensation compared to their finance chiefs, they were also more prone to significant fluctuations in the area of incentive compensation.

A higher percentage of CEOs experienced increases or decreases of 25% or more concerning their incentive compensation than CFOs, with one-fifth of companies keeping their equity awards on par with the prior years’ grants.

Raises for U.S. CFOs of small to mid-sized businesses outpaced inflation, an August report by French fintech startup Spendesk showed, surging 16% from 2021 to reach approximately $224,000.

Colucci expects future filings to continue to show salary increases in 2022. As companies facing economic headwinds seek out steady financial leaders, increases “might be a little preventative” from some companies as they look to entice their financial leaders to stay put, he said.

“I think, not that there’s a CFO shortage by any means, but I think because it is a more important role than it was maybe five, 10 years ago, I think that kind of lends itself to more movement,” he said. “I don’t see it slowing down. I think the pace of transitions will probably keep up for this year.”

While CFO base salary increases beat out top executives, CEOs still saw higher increases in total compensation, according to the report. The increase in total compensation on average was mild, rising by 4% for CEOs compared with the 2% average for finance chiefs. However, 40% of CEOs and approximately 33% of CFOs saw a significant 25% increase in total compensation compared to their total pay for the prior year.

This could also be driving trends in CFO payments —  “the biggest thing driving the trend of CFO pay going up is that CEO pay is going up, and other executives follow,” Rosanna Landis Weaver, director, wage justice & executive pay for consumer advocacy group As You Sow wrote in an email to CFO Dive.

CEO pay has continued to increase, a trend that shareholders will likely push back on as company performance wobbles ahead of a downturn. “That will be particularly true if we see companies that try to game ‘pay for performance,’” she wrote. “Shareholders are clear that structures should mean pays goes down when performance goes down.”

“I have never read in a proxy statement that the company’s performance is influenced by externals when the externals are positive,” Weaver wrote in an email, noting that “when the externals may affect performance on the downside, we read endless language about how challenging things are. Shareholders are becoming cynical about that.”

Companies are gearing up for an environment where they will soon need to share further details surrounding both executive pay and financial performance. Pay-versus-performance rules, which were adopted last year by the Securities and Exchange Commission, require large public companies to disclose additional information regarding executive compensation, including a table that covers compensation and financial performance indicators.

The financial performance measures will include the companies’ total shareholder return and net income, according to the SEC. 

Executive pay policy rejections ticked up in 2022 from 2021, according to recent data from Willis Towers Watson, up to 86 last year compared to 71 in the year prior — marking the highest number of rejections since “say-on-pay” was made mandatory in 2011, the company said.

New MetroHealth CEO suspends bonuses that led to predecessor’s firing

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https://www.beckershospitalreview.com/compensation-issues/new-metrohealth-ceo-suspends-bonuses-that-led-to-predecessors-firing.html?origin=CEOE&utm_source=CEOE&utm_medium=email&utm_content=newsletter&oly_enc_id=2893H2397267F7G

MetroHealth CEO Airica Steed, EdD, RN, is suspending supplemental and one-time bonus programs that led to the firing of former CEO Akram Boutros, MD, Cleveland.com reported March 14. 

Dr. Steed also told Cuyahoga County Council that new safeguards are being put in place after Dr. Boutros was accused of taking $1.9 million in what the health system’s board called “improper bonuses,” according to the report.

The plan outlined by Dr. Steed includes a national search to fill several critical executive roles, including a human resources officer who will ensure the department is thoroughly involved in compensation matters going forward, according to the report. Dr. Steed said that structure was not previously in place. 

The system is also seeking a permanent CFO after Craig Richmond resigned from the role, according to the report. Geoff Himes, the health system’s former vice president of finance, is serving as interim CFO. 

The plan also calls for creating a workplace culture where “no one is afraid to speak up if they’re not sure what’s being asked of them is the right thing to do,” according to the report.  

A report from the accounting firm BDO at the request of the system’s board found that Dr. Boutros paid himself $1.9 million in unauthorized bonuses and concealed the actions from the board, according to Cleveland.com. He was fired in November after the payments came to light. He was set to retire at the end of 2022. 

The BDO report said Dr. Boutros created the Supplemental Performance Based Variable Compensation/Supplemental Incentive Compensation program without involving the human resources department. Former CFO Mr. Richmond allegedly forwarded details of the program down the chain for payroll approval without confirming there had been board approval.  

Dr. Boutros’ attorney Jason Bristol sent a letter to Cuyahoga County Council alleging the BDO report is “biased, inaccurate and seriously flawed,” according to Cleveland.com. Mr. Bristol argued the report contained no supporting evidence for the assertion Dr. Boutros secretly created a bonus program. He also said Mr. Richmond resigned because he believed the report “inaccurate, incomplete, and misleading,” citing a letter released by Mr. Richmond’s attorney. Mr. Richmond resigned two days before the report was released. 

Dr. Boutros has filed multiple lawsuits since his firing. He filed a lawsuit Nov. 28 in Cuyahoga County Common Pleas Court, alleging violations of Ohio’s Open Meetings Act and the board bylaws. Dr. Boutros also alleges board retaliation and accuses the MetroHealth board of violating the law in its hiring of Dr. Steed. Dr. Boutros filed a separate lawsuit against the health system in December alleging breach of contract. He has repaid the system $2.1 million for the bonuses and interest. 

‘We’re going to come out of this winning:’ Northwell CEO on labor challenges and the system’s biggest growth area

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https://www.beckershospitalreview.com/hospital-management-administration/were-going-to-come-out-of-this-winning-ceo-michael-dowling-on-northwells-labor-challenges-growth-areas.html?utm_medium=email&utm_content=newsletter

New Hyde Park, N.Y.-based Northwell Health began 2023 with a low, but positive operating margin, but labor costs are expected to increase again this year on the back of recent union activity in the state. 

To offset such increases that were not anticipated in the 2023 budget, Northwell is evaluating opportunities to reduce expenses and increase revenue across the health system, which includes 21 hospitals and about 83,000 employees.

Michael Dowling, CEO of Northwell, spoke to Becker’s Hospital Review about the health system’s biggest challenge this year, how it approaches cost-cutting and why outpatient care is its biggest growth area.

Editor’s note: Responses are lightly edited for length and clarity.

Question: Many health systems saw margins dip last year amid rising inflation, increased labor costs and declining patient volumes. How have you led Northwell through the challenges of last year? 

Michael Dowling: We ended 2022 with a low, but positive margin. We’ve been coming back from COVID quite successfully, and we’re back pretty much in all areas to where we were prior to the pandemic. Volumes have returned and we’re very busy. We came into 2023 with a positive budget and a positive margin. We anticipate that you’re always going to have challenges and disturbances, but it’s important to stay focused and deal with it. We have a very detailed strategic plan, which outlines our various goals, and we stick to it. 

Q: What is your top priority today?

MD: The biggest issue for us today is labor costs. We have lots of union activity in New York at the moment. There were various nurse strikes in New York City at the beginning of the year. None of our hospitals were involved in those deliberations, but some of those hospitals agreed to contracts that have increases that were not anticipated in anybody’s 2023 budget. That’s going to have an effect on us. We have negotiations ongoing with the nurses’ union, and have 10 unions overall. About 90 percent of Northwell’s facilities have unions, so the bottom line is we are going to have expenses as a result of these contracts that were not anticipated in the budget. I don’t know the final number on these contracts yet, but it’s definitely going to be more than what we anticipated. 

The unions in New York get a lot of government support and have become very empowered and quite aggressive. The bottom line is there’s more expense than we anticipated in our budget, so we need to figure out how to address that. We’re looking at everything across our health system to find expense reductions or revenue enhancements to be able to make up for the increased labor costs and be optimistic about ending the year with a positive margin. But we’re in a good place and are not like some other health systems that are struggling financially. 

Q: Where are the biggest opportunities to reduce expenses or increase revenue to offset the increased labor costs?

MD: It’s a combination of a lot of things. We have a detailed capital plan that we may slow down. We hire about 300 people a week, so maybe we’ll target that hiring into specific areas and not be as broad based as we thought we could be. We will examine if we have specific programs or initiatives we can curtail without doing any damage to our core mission. It will end up being a portfolio of items; it won’t be one big thing. On the revenue side, we’re working very hard to increase our neurosurgery, cardiac, cancer and orthopedic businesses. Over the next couple of months, all of those things will be taken into consideration. The bottom line is we are going to come out of this winning.

Q: Looking three or four years down the line, where do you see the biggest growth opportunities for Northwell?

MD: Our biggest growth is in outpatient care. A lot of surgeries are moving outpatient, so we have to get ahead of that. Some think we are only a hospital system, but only about 46 percent of our business is from our hospital sector today. Home care is going to grow phenomenally, especially given the new technology that’s available. Digital health will also dramatically expand. 

We’re also looking at expanding into new geographic areas and markets. It’s about positioning your offerings in places close to where people live, so you reduce the inconvenience of people having to travel long distances for care when it should be available to them closer to home. When you do that, you increase market share. We’re constantly increasing our market share by being very aggressive about going to where the customer is and providing the highest quality care that we can. Part of that is also being able to recruit top-line, quality physicians. When you do that, you attract new business because you have competencies that you didn’t have before. It’s a combination of all of these things, but there’s certainly no limit to the opportunities in front of us. We’re not in a world of challenges; we’re in a world of opportunity. The question is are we aggressive enough and do we have enough tolerance for some risk? We need to be as aggressive as we possibly can to take advantage of some of those opportunities. 

Q: What is the biggest challenge on the horizon for Northwell?

MD: The biggest challenge is the huge growth in government payer business — Medicare and Medicaid. The problem with Medicaid — especially in a union environment — is it doesn’t cover your costs. The government is a big part of a potential future issue there. By increasing Medicaid, the more of your business becomes Medicaid and the worse you end up doing, unless you can increase your commercial payer business to continue to cross-subsidize. We also have a lot of union negotiations over the next couple of months, which will put a strain on our 2023 budget, but we will resolve it.

Q: How do you see hospitals and health systems evolving as CMS, commercial payers and patients continue to push more services to outpatient settings, where they can arguably be performed at a higher quality and lower cost?

MD: I think it’s going to continue to grow. For example, Northwell has 23 hospitals — 21 of which it owns — yet it has 890 outpatient facilities. We’ve been ahead of this curve a long time. Our primary expansion is in ambulatory care, not in-hospital care. Like I said, only 46 percent of Northwell’s total business is its hospital business. If you’re relying on the hospital to be the core provider of the future, you’re going to lose. You’ve got to take a little bit of a hit by going out and expanding your ambulatory presence. But the more you expand ambulatory and grow in the right locations, the more you increase market share, which brings more of the necessary inpatient care back to your hospitals. Our hospitals are growing and getting busier in addition to our outpatient centers because we are growing market share. If we enter a new community and see 100 people, five of them will need to be hospitalized. That’s a new market. Ambulatory cannot be disassociated from its connection to the inpatient market. 

Q: Many financial experts are projecting a recession this year. How might that affect hospitals and health systems, and how can they best prepare? 

MD: Even if we do have a recession, it doesn’t mean that people don’t get sick. In fact, people’s problems increase. Our business does not slow down if we have a recession; our business will probably increase. On the revenue side, it won’t necessarily affect our government reimbursement, which we don’t do well on anyway. The things you worry about during a recession is if employers give up the coverage of their staff. Then those employees with no insurance may go on a state Medicaid program, and that might affect hospitals. 

In the healthcare sector, even in a recession, the need for hospital services actually increases. No recession could be as bad as what we experienced during COVID, yet we managed it. We had a problem that we didn’t even understand, and we worked through it. I think healthcare deserves an extraordinary credit for what was done during COVID. If there is a recession, we will deal with it. It’s just one of those things that happens, and we will respond to it in as comprehensive a way as we can. I can’t control it, but I can control our response. Leadership to me is about having a positive disposition; basically saying that whatever happens to you, you’re going to win. 

The No. 1 problem keeping hospital CEOs up at night

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https://www.beckershospitalreview.com/hospital-management-administration/the-no-1-problem-keeping-hospital-ceos-up-at-night.html?utm_medium=email&utm_content=newsletter

Workforce problems in U.S. hospitals are troublesome enough for the American College of Healthcare Executives to devote a new category to them in its annual survey on hospital CEOs’ concerns. In the latest survey, executives identified “workforce challenges” as the No. 1 concern for the second year in a row.

Financial challenges, which consistently held the top spot for 16 years in a row until 2021, were listed the second-most pressing concern in the American College of Healthcare Executives’ annual survey.

Although workforce challenges were not seen as the most pressing concern for 16 years, they rocketed to the top quickly and rather universally for healthcare organizations in the past two years. Most CEOs (90 percent) ranked shortages of registered nurses as the most pressing within the category of workforce challenges, followed by shortages of technicians (83 percent) and burnout among non-physician staff (80 percent). 

Here are the most concerning issues hospital CEOs ranked in 2022, along with the score of how pressing CEOs find each issue. 

1. Workforce challenges (includes personnel shortages and staff burnout, among other issues) — 1.8 

2. Financial challenges — 2.8

3. Behavioral health and addiction issues — 5.2 

4. Patient safety and quality — 5.9

5. Governmental mandates — 5.9

6. Access to care — 6.0  

7. Patient satisfaction — 6.6

8. Physician-hospital relations — 7.6

9. Technology — 7.7 

10. Population health management — 8.6

11. Reorganization (mergers and acquisitions, partnerships and restructuring) — 8.7 

Within financial challenges, most CEOs (89 percent) ranked increasing costs for staff and supplies as the most pressing, followed by operating costs (66 percent) and Medicaid reimbursement (63 percent). CEOs are less concerned about price transparency and moving away from fee-for-service.

Seventy-eight percent of CEOs ranked lack of appropriate facilities/programs as most pressing within the category of behavioral health and addiction issues. That was followed by lack of funding for addressing behavioral health and addiction issues (77 percent).

The results are based on a survey administered to CEOs of community hospitals (non-federal, short-term, non-specialty hospitals). ACHE asked respondents to rank 11 issues affecting their hospitals in order of how pressing they are. Results are based on responses from 281 executives.

Has the backlash against physician employment begun?

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https://mailchi.mp/d62b14db92fb/the-weekly-gist-february-10-2023?e=d1e747d2d8

Given the economic situation most hospitals face today, it was only a matter of time before we started to hear comments like we heard recently from a system CEO. 

“We’ve got to pump the brakes on physician employment this year,” she said. “This arms race with Optum and PE firms has gotten out of control, and we’re looking at almost $300K per year of loss per employed doc.”

 Of course, that system (like most) has been calling that loss a “subsidy” or an “investment” for the past several years, justified by the ability to pursue an integrated model of care and to grow the overall system book of business.

But with non-hospital competitors unfettered by the requirement to pay “fair market value” for physicians, the bidding war for doctors has become unsustainable for many hospitals. Around half of physicians are now employed by hospitals, with many more employed in other corporate settings.

There’s a growing sense that the pendulum has swung too far in the direction of employment, and now the phrase “stopping the bleed”—commonplace in the post-PhyCor days of the early 2000s—has begun to ring out again.
 
One challenge: finding ways to talk openly about “pumping the brakes” with the board, given that most systems have key physician stakeholders as part of their governance structure. Twice in the last month we’ve had CEOs ask us about reconfiguring their boards so that there are fewer doctors involved in governance—a sharp about-face from the “integration” narrative of just a few years ago.

It’s a tricky balance to strike. We recently heard a fascinating statistic that we’re working to verify: a third of all hospital CEO turnover in the last year was driven by votes of no-confidence by the medical staff. True or not, there’s no doubt that running afoul of physicians can be a career-limiting move for hospital executives, so if we’re about to enter an era of dialing back physician employment strategies, it’ll be fascinating to see how the conversations unfold. We’ll continue to keep an eye on this shift in direction and would love to know what you’re hearing as well, and to discuss how we might be of assistance in navigating what are sure to be a series of difficult choices.

Call coverage woes surface again

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https://mailchi.mp/a44243cd0759/the-weekly-gist-february-3-2023?e=d1e747d2d8

Recent conversations with executive teams about physician issues have made us feel like we’ve time-travelled back to 2006. Both health systems and large independent physician groups report having difficulties hiring physicians willing to take call, even among specialties where it has long been part of the job expectations.

“We stopped paying for call fifteen years ago,” one CMO shared. “But now, even though we’ve started paying again, it’s hard to get takers.” While procedural specialties seem to be the hardest to cover, with orthopedics, urology, and GI cited most frequently, we’re also hearing challenges with medical specialty coverage. One hospital CEO (who lamented that call coverage had once again risen to a CEO-level problem) shared that cardiologist candidates were looking for positions without call obligations. 
 
The knee-jerk reaction of older executives is to blame a younger generation of doctors seeking more work-life balance. Surely this contributes, but as one astute medical group CEO pointed out, the only way doctors can draw this line in the sand with health systems is if there are alternatives that don’t require call.

He referenced the growing number of investor-backed specialty practices focused squarely on outpatient growth and even offering doctors no-call positions straight out of training. In his market, he felt these doctors were discouraged from taking call: “When 80 percent of the procedures are done in a surgery center, an orthopod doesn’t need referrals from call to fill his schedule with new patients. And the patients they encounter in our ED are more likely to be uninsured or government pay, so they don’t want them anyway.”

Beyond simply paying for call, a few other solutions are gaining traction. Some hospitals are expanding the number of in-house, hospitalist-like positions for other specialties. Others are deploying virtual consult services with some success, even in procedural specialties. As one orthopedic surgeon told us, the virtual call coverage does a decent job with triage and can often save the doctor from having to come in overnight. 

Ultimately, as the number of investor-owned specialty groups expands, health systems must develop collaborative relationships to solve care delivery challenges across the continuum. 

Where CEOs need to focus in 2023—and beyond

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https://www.advisory.com/daily-briefing/2023/02/02/radio-advisory-146?utm_source=member_db&utm_medium=email&utm_campaign=2023feb02&utm_content=member_headline_finalb_infogram_x_x_x&elq_cid=4838956&

Radio Advisory’s Rachel Woods sat down with Advisory Board‘s Aaron Mauck and Natalie Trebes to talk about where leaders need to focus their attention on longer-term industry challenges—like growing competition, behavioral health infrastructure, and finding success in value-based care.

Read a lightly edited excerpt from the interview below and download the episode for the full conversation.https://player.fireside.fm/v2/HO0EUJAe+VhuSvHlL?theme=dark

Rachel Woods: So I’ve been thinking about the last conversation that we had about what executives need to know to be prepared to be successful in 2023, and I feel like my big takeaway is that the present feels aggressively urgent. The business climate today is extraordinarily tough, there are all these disruptive forces that are changing the competitive landscape, right? That’s where we focused most of our last conversation.

But we also agreed that those were still kind of near-term problems. My question is why, if things feel like they are in such a crisis, do we need to also focus our attention on longer term challenges?

Aaron Mauck: It’s pretty clear that the business environment really isn’t sustainable as it currently stands, and there’s a tendency, of course, for all businesses to focus on the urgent and important items at the expense of the non-urgent and important items. And we have a lot of non-urgent important things that are coming on the horizon that we have to address.

Obviously, you think about the aging population. We have the baby boom reaching an age where they’re going to have multiple care needs that have to be addressed that constitute pretty significant challenges. That aging population is a central concern for all of us.

Costly specialty therapeutics that are coming down the pipeline that are going to yield great results for certain patient segments, but are going to be very expensive. Unmanaged behavioral needs, disagreements around appropriate spending. So we have lots of challenges, myriad of challenges we’re going to have to address simultaneously.

Natalie Trebes: Yeah, that’s right. And I would add that all of those things are at threshold moments where they are pivoting into becoming our real big problems that are very soon going to be the near term problems. And the environment that we talked about last time, it’s competitive chaos that’s happening right now, is actually the perfect time to be making some changes because all the challenges we’re going to talk about require really significant restructuring of how we do business. That’s hard to do when things are stable.

Woods: Yes. But I still think you’re going to get some people who disagree. And let me tell you why. I think there’s two reasons why people are going to disagree. The first reason is, again, they are dealing with not just one massive fire in front of them, but what feels like countless massive fires in front of them that’s just demanding all of their strategic attention. That was the first thing you said every executive needs to know going into this year, and maybe not know, but accept, if I’m thinking about the stages of grief.

But the second reason why I think people are going to push back is the laundry list of things that Aaron just spoke of are areas where, I’m not saying the healthcare industry shouldn’t be focused on them, but we haven’t actually made meaningful progress so far.

Is 2023 actually the year where we should start chipping away at some of those huge industry challenges? That’s where I think you’re going to get disagreement. What do you say to that?

Trebes: I think that’s fair. I think it’s partly that we have to start transforming today and organizations are going to diverge from here in terms of how they are affected. So far, we’ve been really kind of sharing the pain of a lot of these challenges, it’s bits and pieces here. We’re all having to eat a little slice of this.

I think different organizations right now, if they are careful about understanding their vulnerabilities and thinking about where they’re exposed, are going to be setting themselves up to pass along some of that to other organizations. And so this is the moment to really understand how do we collectively want to address these challenges rather than continue to try to touch as little of it as we possibly can and scrape by?

Woods: That’s interesting because it’s also probably not just preparing for where you have vulnerabilities that are going to be exposed sooner rather than later, but also where might you have a first mover advantage? That gets back to what you were talking about when it comes to the kind of competitive landscape, and there’s probably people who can use these as an opportunity for the future.

Mauck: Crises are always opportunities and even for those players across the healthcare system who have really felt like they’re boxers in the later rounds covering up under a lot of blows, there’s opportunities for them to come back and devise strategies for the long term that really yield growth.

We shouldn’t treat this as a time just of contraction. There are major opportunities even for some of the traditional incumbents if they’re approaching these challenges in the right fashion. When we think about that in terms of things like labor or care delivery models, there’s huge opportunities and when I talk with C-suites from across the sector, they recognize those opportunities. They’re thinking in the long term, they need to think in the long term if they’re going to sustain themselves. It is a time of existential crisis, but also a time for existential opportunity.

Trebes: Yeah, let’s be real, there is a big risk of being a first mover, but there is a really big opportunity in being on the forefront of designing the infrastructure and setting the table of where we want to go and designing this to work for you. Because changes have to happen, you really want to be involved in that kind of decision making.

Woods: And in the vein of acceptance, we should all accept that this isn’t going to be easy. The challenges that I think we want to focus on for the rest of this conversation are challenges that up to this point have seemed unsolvable. What are the specific areas that you think should really demand executive attention in 2023?

Trebes: Well, I think they break into a few different categories. We are having real debates about how do we decide what are appropriate outcomes in healthcare? And so the concept of measuring value and paying for value. We have to make some decisions about what trade-offs we want to make there, and how do we build in health equity into our business model and do we want to make that a reality for everyone?

Another category is all of the expensive care that we have to figure out how to deliver and finance over the coming years. So we’re talking about the already inadequate behavioral health infrastructure that’s seen a huge influx in demand.

We’re talking about what Aaron mentioned, the growing senior population, especially with boomers getting older and requiring a lot more care, and the pipeline of high-cost therapies. All of this is not what we are ready as the healthcare system as it exists today to manage appropriately in a financially sustainable way. And that’s going to be really hard for purchasers who are financing all of this.

Ketul J. Patel, Division President, Pacific Northwest; Chief Executive Officer, CommonSpirit Health; Virginia Mason Franciscan Health

Posted on by • Posted in Affordability, CEO, Challenge, Competition, Continuum of Care, Culture, Digital Health, Digital Health Initiatives, Diversified Workforce, Financial Stewardship, Financial Strength, Financial Viability, Health System, Home-Based Care, Home-Hospital Care, Innovation, Innovative Care Models, Labor Shortages, Labor Spend Management, Leadership, Leadership Culture, Leadership Listens, Leadership Rounding, Productivity, Quality of Care, Strategy, Thought Leaders, Virtual Care Strategy, Virtual Healthcare, Workforce Shortages, Workforce Solutions • Leave a comment
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There is no shortage of challenges to confront in healthcare today, from workforce shortages and burnout to innovation and health equity (and so much more). We’re committed to giving industry leaders a platform for sharing best practices and exchanging ideas that can improve care, operations and patient outcomes.


Check out this podcast interview with Ketul J. Patel, CEO at Virginia Mason Franciscan Health and division president, Pacific Northwest at CommonSpirit Health, for his insights on where healthcare is headed in the future.

In this episode, we are joined by Ketul J. Patel, Division President, Pacific Northwest; Chief Executive Officer, CommonSpirit Health; Virginia Mason Franciscan Health, to discuss his background & what led him to executive healthcare leadership, challenges surrounding workforce shortages, the importance of having a strong workplace culture, and more.

16 Things CEOs Need to Know in 2023

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https://www.advisory.com/-/media/project/advisoryboard/abresearch/brand-campaigns/soi/wf8632394-ab-16-things-ceos-need-to-know.pdf#page=38

Understand the health care industry’s most urgent challenges—and greatest opportunities.

The health care industry is facing an increasingly tough business climate dominated by increasing costs and prices, tightening margins and capital, staffing upheaval, and state-level policymaking. These urgent, disruptive market forces mean that leaders must navigate an unusually high number of short-term crises.

But these near-term challenges also offer significant opportunities. The strategic choices health care leaders make now will have an outsized impact—positive or negative—on their organization’s long-term goals, as well as the equitability, sustainability, and affordability of the industry as a whole.

This briefing examines the biggest market forces to watch, the key strategic decisions that health care organizations must make to influence how the industry operates, and the emerging disruptions that will challenge the traditional structures of the entire industry.

Preview the insights below and download the full executive briefing (using the link above) now to learn the top 16 insights about the state of the health care industry today.

Preview the insights

Part 1 | Today’s market environment includes an overwhelming deluge of crises—and they all command strategic attention

Insight #1

The converging financial pressures of elevated input costs, a volatile macroeconomic climate, and the delayed impact of inflation on health care prices are exposing the entire industry to even greater scrutiny over affordability. Keep reading on pg. 6

Insight #2

The clinical workforce shortage is not temporary. It’s been building to a structural breaking point for years. Keep reading on pg. 8

Insight #3

Demand for health care services is growing more varied and complex—and pressuring the limited capacity of the health care industry when its bandwidth is most depleted. Keep reading on pg. 10

Insight #4

Insurance coverage shifted dramatically to publicly funded managed care. But Medicaid enrollment is poised to disperse unevenly after the public health emergency expires, while Medicare Advantage will grow (and consolidate). Keep reading on pg. 12

Part II | Competition for strategic assets continues at a rapid pace—influencing how and where patient care is delivered.

Insight #5

The current crisis conditions of hospital systems mask deeper vulnerabilities: rapidly eroding power to control procedural volumes and uncertainty around strategic acquisition and consolidation. Keep reading on pg. 15

Insight #6

Health care giants—especially national insurers, retailers, and big tech entrants—are building vertical ecosystems (and driving an asset-buying frenzy in the process). Keep reading on pg. 17

Insight #7

As employment options expand, physicians will determine which owners and partners benefit from their talent, clinical influence, and strategic capabilities—but only if these organizations can create an integrated physician enterprise. Keep reading on pg. 19

Insight #8

Broader, sustainable shifts to home-based care will require most care delivery organizations to focus on scaling select services. Keep reading on pg. 21

Insight #9

A flood of investment has expanded telehealth technology and changed what interactions with patients are possible. This has opened up new capabilities for coordinating care management or competing for consumer attention. Keep reading on pg. 23

Insight #10

Health care organizations are harnessing data and incentives to curate consumers choices—at both the service-specific and ecosystem-wide levels. Keep reading on pg. 25

Part III | Emerging structural disruptions require leaders to reckon with impacts to future business sustainability. 

Insight #11

For value-based care to succeed outside of public programs, commercial plans and providers must coalesce around a sustainable risk-based payment approach that meets employers’ experience and cost needs. Keep reading on pg. 28

Insight #12

Industry pioneers are taking steps to integrate health equity into quality metrics. This could transform the health care business model, or it could relegate equity initiatives to just another target on a dashboard. Keep reading on pg. 30

Insight #13

Unprecedented behavioral health needs are hitting an already fragmented, marginalized care infrastructure. Leaders across all sectors will need to make difficult compromises to treat and pay for behavioral health like we do other complex, chronic conditions. Keep reading on pg. 32

Insight #14

As the population ages, the fragile patchwork of government payers, unpaid caregivers, and strained nursing homes is ill-equipped to provide sustainable, equitable senior care. This is putting pressure on Medicare Advantage plans to ultimately deliver results. Keep reading on pg. 34

Insight #15

The enormous pipeline of specialized high-cost therapies in development will see limited clinical use unless the entire industry prepares for paradigm shifts in evidence evaluation, utilization management, and financing. Keep reading on pg. 36

Insight #16

Self-funded employers, who are now liable for paying “reasonable” amounts, may contest the standard business practices of brokers and plans to avoid complex legal battles with poor optics. Keep reading on pg. 38

Be Ready for the Reorganized Healthcare Landscape

Posted on by • Posted in Board, Business Model, CEO, Change, Change Management, Change Mindset, Leadership, Medicare Advantage, Mindset, Physician Compensation, Physician Employment, Physician Leadership, Physician Network, Physician Practice Acquisition, Physician Practice Management, Private Equity, Strategic Issue, Strategic Leadership, Strategy, Value Based Care Model, Value-Based Care Functions, Value-Based Contracting, Value-Based Healthcare • Leave a comment

Click to access Industry_Insights_1.25.23.pdf

Running a health system recently has proven to be a very hard job. Mounting losses in the face of higher operating expenses, softer than expected volumes, deferred capex, and strained C-suite succession planning are just a few of the immediate issues with which CEOs and boards must deal.


But frankly, none of those are the biggest strategic issue facing health systems. The biggest
strategic issue is the reorganization of the American healthcare landscape into an ambulatory care
business that emphasizes competing for covered lives at scale in lower cost and convenient settings
of care. This shift in business model has significant ramifications, if you own and operate acute care
hospitals.


Village MD and Optum are two of the organizations driving the business model shift. They are
owned by large publicly traded companies (Walgreens and UnitedHealth Group, respectively). Both
Optum and Village MD have had a string of announced major patient care acquisitions over the past
few years, none of which is in the acute care space.


The future of American healthcare will likely be dominated by large well-organized and well-run
multi-specialty physician groups with a very strong primary care component. These physician
service companies will be payer agnostic and focused on value-based care, though will still be
prepared to operate in markets where fee-for-service dominates. They will deliver highly
coordinated care in lower cost settings than hospital outpatient departments. And these companies
will be armed with tools and analytics that permit them to manage the care for populations of
patients, in order to deliver both better health outcomes and lower costs.


At the same time this is happening, we are experiencing steady growth in Medicare Advantage.
And along with it, a stream of primary care groups who operate purpose-built clinics to take full risk
on Medicare Advantage populations. These companies include ChenMed, Cano Health and Oak
Street, among others. These organizations use strong culture, training, and analytics to better
manage care, significantly reduce utilization, and produce better health outcomes and lower costs.


Public and private equity capital are pouring into the non-acute care sectors, fueling this growth. As
of the start of 2022, nearly three quarters of all physicians in the US were employed by either
corporate entities (such as private equity, insurance companies, and pharmacy companies), or
employed by health systems. And this employment trend has accelerated since the start of the
pandemic. The corporate entities, rather than health systems, are driving this increasing trend.
Corporate purchases of physician practices increased by 86% from 2019 to 2021.


What can health systems do? To succeed in the future, you must be the nexus of care for the
covered lives in your community. But that does not mean the health system must own all the
healthcare assets or employ all of the physicians. The health system can be the platform to convene these assets and services in the community. In some respects, it is similar to an Apple iPhone. They are the platform that convenes the apps. Some of those apps are developed and owned by Apple. But many more apps are developed by people outside of Apple, and the iPhone is simply the platform to provide access.


Creating this platform requires a change in mindset. And it requires capital. There are many opportunities for health systems to partner with outside capital providers, such as private equity, to position for the future – from both a capital and a mindset point of view.


The change in mindset, and the access to flexible capital, is necessary as the future becomes more and more about reorganizing into an ambulatory care business that emphasizes competing for covered lives at scale in lower cost and convenient settings of care.