‘If we don’t change, change will change us’: How 5 systems are rethinking care models

Leaders at five health systems gathered at Becker’s 16th Annual Meeting to share how their organizations are dismantling legacy assumptions and building sustainable care models.

One session featured executives from Danville, Pa.-based Geisinger, Sayre, Pa.-based Guthrie Clinic, Hartford (Conn.) HealthCare, Marlton, N.J.-based Virtua Health and Rockville Centre, N.Y.-based Catholic Health.

Breaking the hospital-centric assumption

Panelists agreed that one of the most persistent — and costly — legacy assumptions is that the hospital is the center of all care.

“There are much less costly locations to deliver care in,” said Suparna Dutta, MD, chair of medicine at Hartford HealthCare’s Hartford Hospital. “That’s one assumption that we, as a healthcare system in general, need to start moving away from.”

She also pushed back on the assumption that a hospitalist’s responsibility ends at discharge.

“We can’t just think within the four walls of the hospital and expect our work to end,” she said.

James Newman, vice president of patient logistics at Virtua Health, also underlined the financial cost of in-hospital care. As an example, he said building one patient room can cost between $2 million and $3 million.

To reach more patients, Virtua is utilizing care models inside and outside hospital walls, including telemedicine, virtual care, camera technology, mobile integrated health and hospital at home.

What makes a care model financially durable

When asked what separates care models that become financially sustainable from those that quietly stall, the health system leaders pointed to three themes: data, front-line inclusion and operational feasibility.

“Any care model that you put together … will be financially durable if you’re able to show that it’s performing,” Dr. Dutta said.

She cautioned against deciding on one solution before data analysis.

“We should never fall in love with the solution,” Dr. Dutta said. “We have to fall in love with the problem.”

Zeshan Anwar, MD, system chief for hospital medicine at Guthrie Clinic and associate chief medical officer for the system’s Pennsylvania hospitals, urged a pilot-first approach: start small, track a specific few metrics and be prepared to pivot.

“If we don’t change, change will change us,” Dr. Anwar said.

To ensure a care model makes sense financially and operationally, several panelists pointed to adaptability.

“When I’m mentoring leaders, one of the first things I tell them when we’re bringing on new projects is, ‘Get really comfortable with the idea of failing early and failing cheap,'” Mr. Newman said. “Make the quick, early adjustments when it’s cheap because if you let it go too long … it’s going to get really expensive, really fast.”

Allison Roditi, vice president of the musculoskeletal service line at Catholic Health, shared an account of attempting to launch an integrated spine center. The initiative was about to go live before a key stakeholder group shut it down.

Rather than force a culture change, the system stepped back, pulled additional data, talked to more stakeholders and redesigned the model around physical therapy and primary care partnerships in the community.

“It’s baby steps,” she said. “We had to pivot before it got costly.”

A three-year bet

Panelists were asked where they would place a single major strategic bet through 2029 and what they would be willing to deprioritize to fund it.

Mr. Newman said he would invest in care-at-home strategies and deprioritize construction and capital assets. Dr. Anwar chose AI, saying it will improve efficiency, reduce cognitive burden on employees and improve retention.

Dr. Dutta and Ms. Roditi each raised the same concern: bridging the digital divide.

“There’s a population that’s not going to be able to tap into that [new technology],” Dr. Dutta said. “How do we make sure we’re not leaving them behind?”

Kenneth Altman, MD, PhD, chair of otolaryngology at Geisinger, may have best captured the group’s collective outlook: “Use your endowments if you expect to survive.”

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