Healthcare 2030: The Chartis Group and Bank of America discuss embracing disruptors and rethinking care delivery

Melissa McCain: A lot of consumer expectations circle around access, and if you can begin addressing that much more proactively, you can stay ahead of some of the disruption.

Erika Grotto: Strategizing for the future by embracing disruptors and rethinking care delivery, today on HFMA’s Voices in Healthcare Finance podcast.

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Hello, and welcome to the podcast. I’m your host, Erika Grotto. Today, we are revisiting our Healthcare 2030 series that began in 2021. We have interviews with Melissa McCain of The Chartis Group and Charles Alston from Bank of America. Those were two of the organizations that supported this project in 2021. As you may already know, the series is coming back this year with some new topics, but that doesn’t mean we’re abandoning what we’ve discussed before. So let’s jump in with what we’re talking about today.

Last week on the podcast, HFMA senior editor Nick Hut and policy director Shawn Stack discussed what disruptors to watch in the industry this year. And whenever we talk about companies like Amazon or Walmart announcing a new healthcare venture, hospitals and health systems tend to get nervous. My first guest today says it’s best to focus on the consumer, rather than the companies coming in to court them. Melissa McCain is the director and leader of the consumer access and digital transformation practice at The Chartis Group. We started our conversation talking about that fear and how healthcare organizations might start thinking about these disruptors as partners instead of competitors.

Our survey results showed that CFOs are concerned about disruption from outside the industry in the area of meeting consumer expectations, and we’ve had no shortage of stories in the last handful of years about companies entering the healthcare space that previously were not part of it. So, when asked how vulnerable the industry is to outside disruptors in this area (1 being not vulnerable, 5 being very vulnerable), more than 68% of our survey respondents came back with a 4 or a 5. So, how do you respond to those CFO concerns, and how can they plan now to take advantage of what these disruptors might have to offer as a friend instead of a foe as we look toward 2030?

McCain: First, I’d say they are spot on. They should be concerned about lagging behind in meeting consumer expectations. It has moved from the theoretical to something that’s feeling, I think, much more tangible and therefore hopefully compels more health systems to action. It was interesting, and I’d say encouraging, that they were consistent in being concerned about disruption not only with consumer expectations, but if I recall, primary care and access—all three. And although legitimate to be concerned about these as individual categories, when you put those three together, it’s exponential with what disruption is happening, when you think about access to care, consumer expectations, circling around primary care. To your questions, it’s important to determine fairly quickly what are the advantages to seeking to or partnering with specific disruptors. These are certainly strategic and financial questions that are always best explored when you have sufficient time and leverage, meaning sooner rather than later. I’d say the second piece is not to wait until the disruptor has taken a foothold in your market. There are certain truisms to meeting consumer expectations today. In reality, a lot of consumer expectations are bundled with the concepts of consumer access to care and information. So we suggest, move beyond the delayed satisfaction surveys and really get to know your consumers, complement what you’re doing on real-time surveying with things like focus groups and persona development—other tactics that have been used in industries outside of healthcare for a long time, but they’re finding their way now into healthcare. And then as we said, a lot of the consumer expectations circle around access, and if you can begin addressing that much more proactively, you can stay ahead of some of the disruption. You’d be doing things like creating a multi-modal, simply we-need-options, approach to how consumers can access care—phones, online, through the doctor’s office. And then also helping consumers access information that they need in a way that they’re likely to want it and need it. Access to care for us is always about care and information. In fact, if you think about it, a lot of early access needs for consumers not yet using the health system are going to be about information gathering to identify and get themselves kind of triaged to the right care.

Grotto: Yeah. Your answer reminds me of something that’s come up many, many times on the podcast and in interviews for our magazine, hfm. It’s this idea of, you have to disrupt yourself. You can’t just stand still and wait for the disruptors to come and then respond to them. You have to anticipate and make improvements in your own organization.

McCain: Absolutely. I think when you, as an organization, really begin to orient towards the consumer, you’re not even thinking of it almost in terms of in advance of something. It is what is the right thing to do for your consumers, and you’re propelled by that as much as something that may be happening in your market that compels you. So it gets pretty exciting and proactive the further into true consumer behavior people permit the organizations to get and to help guide them in terms of priorities.

Grotto: One of the trends that we hear about a lot today is the digital front door. That’s something that was discussed quite a bit in the Healthcare 2030 panel discussion at HFMA’s Annual Conference in November. In that session, The Chartis Group Performance Leader Rob Gamble mentioned that having a digital front door alone will not be enough for providers looking to create a seamless consumer experience in the future. So I’m curious, how do you see health systems transforming their consumer experience to help consumers not only access care on their terms but also stay informed so they can make decisions about their care?

McCain: I’ll say that I think there’s always a risk when a topic starts gaining momentum, such as I think digital front door today, that some organizations may see it as the answer, or one of only two answers. In reality, what is happening in consumer expectations and consumer experience in our perspective is, it’s more additive. It’s not replacing anything. It’s adding to what you may have. So you’re going to need to take what you have—say, a basic, mediocre call center—and you’re going to make it better by adding things like automation to expedite repetitive tasks, CRM to help personalize each call experience, and seeing new complementary workflow to expedite intake process for cancer patients. And you’re going to offer a similar experience consistent—at least in terms of ease of use, at least—for those who want to do things online. And you’re going to recognize that you’re going to want to tailor the experience—either a digital experience, a phone experience—when the consumer is actually a referring provider versus the patient. And so I think, in part, what Rob was mentioning just has to do with, it’s not a single digital door. It’s multiple digital doors. It’s a front door for new patients. It’s what we’d call a “stage door” for the referring provider, and maybe the side door for established patients who already have gone through the front door and know their way around the system a bit. And you’re going to need to be enhancing those other, more human-based interactions such as the phone. I would say if I could emblazon one word in every board room, C-suite, access center, advisor’s room, I would say it would be the word “options.” You’ll need to create many options for how consumers access care and information, because at the end of the day, consumer expectations is about getting their preferences met. My expectation is that how I want to receive care or access care, tap into information, how I want to do that is going to be available to me. My preference is going to be met. It’s pretty pure and simple. Really hard to pull off, but pure and simple in concept.

Grotto: Something that I’ve heard is, we see something, you know, kind of the new shiny thing out in front of us and want to throw away the old thing and go toward the shiny thing. And to your point, that’s not what we should be doing. You know, the shiny thing might be a great tool, but we can’t throw out what we’ve done. Using it as an enhancement will help move us forward, rather than expecting your patients to adapt to something completely different from what they’re used to. That’s not going to be any more helpful than just staying where you are.

McCain: That is exactly right, because to your point, some patients may want that shiny new object—in this case, a digital access point—whereas many others may still want the phone encounter. They may still want to be able to ask a series of questions and not click their way to answers, and that is OK. That is fine. That should be encouraged and supported. Over time, the health system will be able to figure out the general proportion of patients that may prefer one way of accessing over another, but it will be both, and it will be and. It will be extended beyond what we are even talking about today, I’m sure, in another 2-3 years. This area of access in our perspective is one of the ones that’s growing the fastest and evolving the fastest. And I think health systems need to do that in order not to be disrupted in a bad way, to be on the other, the wrong end, the tail end of disruption from others.

Grotto: Thank you so much for your time today. I appreciate it. And thank you to Chartis for supporting this research. This has been a really interesting year of research and editorial pieces, and we appreciate the opportunity to partner with Chartis to get this done.

McCain: We appreciate it as well. It’s always exciting to be part of something as important as this, and to gain insights from the industry is second to none, so thank you for the opportunity.

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Grotto: At HFMA’s Annual Conference in November, I had the honor of co-moderating the Healthcare 2030 panel session with my colleague, Paul Barr. It was fascinating to hear the different perspectives of the panelists and what they think provider organizations should be preparing for. One of those panelists was Charles Alston, market executive leader of Bank of America’s healthcare team for the southeastern United States. Recently, I reconnected with him to talk about part 4 of the series, The Future of Strategic Investment, and how hospitals should not only be planning to rethink healthcare but be viable while they implement new strategies.

Our CFO survey showed that the median percentage of revenue coming from inpatient care is falling. Hospitals are getting a smaller share of national healthcare spending than they have in the past. The final piece of our editorial series for this year, The Future of Strategic Investment, touches on what kinds of services hospitals are going to be moving toward in the next decade, such as home healthcare and technological elements such as remote patient monitoring. So we know we have to rethink the way we provide care, and we need resources for that, but we also need to consider what allows us to be viable while we’re making those transitions. So if we’re looking sort of at the now-near-far scenarios, what do you think are the most crucial things for hospitals to be doing from a financial standpoint, and really what’s at stake for hospitals and health systems as they plot their strategies?

Alston: Yeah, I thought that was fascinating, looking back even farther back, that 40% of the revenue was inpatient revenue, 35 projected to be 25% in 2030. So how do you evolve, and how do you continue to be successful and viable? I think what a lot of the larger healthcare systems have been doing for quite some time is building out their continuum of care so that they can handle care whether it’s at home with home health, either directly by owning it or through partnerships, and then through primary care in the beginning as well. So a lot of healthcare systems that are larger have built up that continuum of care. But what if you’re not large enough to do that? What do you do then? Partner. Partner smart. Partner with companies that add value, that it doesn’t really make sense for you, if you’re a rural hospital or a smaller hospital to invest in. But partner wisely so that you can close the gap that you may have, and then that just turns the what should you be doing that you can control. And I think from a banker’s standpoint—again, Bank of America—it’s be resourceful and be good stewards of the capital that you have and the liquidity that you have. Be smart with your strategic plan. Allow it to focus on what your strengths are. There’s a reason why your hospital has been successful and you’ve been successful bringing care to your community, which is the mission. So continue to lean into those strengths, but make sure you’re equipping them to continue to be key strengths as you move forward, and that gets to the digital doorway and, you know, creating more access for care to be enabled for all constituents in the community.

Grotto: You were a member of the panel at the Healthcare 2030 session at HFMA’s Annual Conference in November, and as I was reviewing the audio from that session, which was a wonderful session—anybody who has access to it should go back and listen to it. But you talked about solving problems with a both/and philosophy rather than an either/or. In that moment, you were speaking specifically about value-based care, but you mentioned it as something to consider in any situation, and I’m going to quote you back to you if you don’t mind here. You said, “Either/or leads  you to easy, quick solutions that aren’t the best solutions from a sustainability standpoint.” Can you talk a little bit more about what you meant by that and how to take that idea and convert it into workable strategy?

Alston: Yeah, I know, that’s a lot packed into that, right? So I think in the context of that conversation, the both/and answer, both/and idea thinking is, it was in the construct of, right now the whole healthcare industry is straddling this fee-for-service based model and going to value-based model, which ultimately leads to a focus on better outcomes created through better front-end care, better preventative care, better investment of time, energy and effort and data that can better enable population health as well. So that’s where a both/and straddle takes effect. The both/and idea concept ties back to health equity, actually, and doing some health equity work in the community that I live in, there’s a community conversation group that’s made up of constituents across the community spectrum inclusive of healthcare and all aspects of the community. The both/and concept is one where you just simply listen to learn and understand another point of view rather than listening to respond or rebut. And in doing so, you end up with a more creative, more inclusive inventory of potential ideas and points of view from which to work towards solutions or new ways of approaching something that truly could be innovative because you’re opening up your universe of ideas and enabling it by design to be more inclusive. So that’s what both/and is and how it works. I think if you take a lot of things in healthcare today and think about some things that seem like they’re opposing to each other—here’s an easy one, price transparency. Price transparency is something that is needed in the industry. However, there’s a fear that with it, there could be commoditization of services, right, that everything will just be price shopped. I know of one CFO of a healthcare system—I don’t have this person’s permission to state who they are—but they’re doing this both/and and leaning into the disruptor, and they’ve decided in their market where they have their multi-site health system, with no. 1 market share, they’ve decided to lead with price transparency. And they’re using that. The threat is that their care could be commoditized, but their thought is that they can create better community trust by being more transparent and therefore draw more clients, more customers into their hospitals because their brand is both on trust and awareness. So that’s a good example of a both/and in that price transparency used and embraced to build trust.

Grotto: One of the things that you mentioned at our Annual Conference, one of the first comments that you made was, people always ask, what does Bank of America have to do with healthcare. And you kind of made a couple of references during that panel discussion about comparisons between healthcare and banking in general. And one thing that you talked about was sort of that digital front door type of experience, and I’m curious what else—now you’ve got a captive audience in healthcare—what other lessons do you think, what other maybe pieces of expertise can banking offer to healthcare when it comes to, we’ve been through this, we know you need to do this. Are there other examples, do you think?

Alston: Yes, I think so. One of the things that I didn’t mention that Bank of America does today with our healthcare clients is, we do the things you expect a bank to do. We loan money, we provide capital on that form. But we do a lot on the revenue cycle side with collections because all of our hospitals have accounts for that money to be deposited into. So there’s a lot of data that flows with those dollars. And we have a lot of technology solutions using AI as well that automate that collection of data to dollars. That’s a huge transformation from over the last decade, let’s say, for both the healthcare client and the bank from an internal processing standpoint. That solution helps the hospital take human resource that they would normally use to key all that information into their accounting systems and automates that so that they can redeploy those associates as employees to a different type of exercise or different type of employment action that’s just more fulfilling for them and more helpful for the organization as well. I think just the evolution of the workforce itself is one example. I think our physical space and the reutilization of that, I think that’s another challenge that hospitals have on the horizon, is, if these inpatient volume shifts come to fruition, there’s going to be a lot of unused hospital space potentially. And how do you reimagine the reutilization of that space? Same thing has happened with us with our financial centers and having to reimagine what that space is really wanted for and needed for by our community. So as we move more from a transactional environment—there are still transactions flowing—but more into an advisory environment, consultative environment. You can see that same thing happening in healthcare, where what’s needed quite a bit right now is mental health, advocacy in mental healthcare. There’s a shortage of mental healthcare professionals. That’s an area that needs a lot of work, and there could be space, potentially, on the horizon, for those people to be…and hospitals are doing this now already. Some of the hospitals that are leaning into this are ahead of the game. So I think it’s reimagining the space you have, reimagining the professionals you have and what they do. But it all has to tie back at the end for healthcare providers, it all has to tie back to what their mission is, and that’s to provide care efficiently and effectively and then continuously improve at that while increasing access and leveraging technology at the same time. So there are a lot of parallels between the banking industry and the healthcare industry. It will be interesting to see where we are five years from now as the digital innovation wave continues to move forward and all of us are learning at a breakneck speed. The last thing I would like to mention too is for us to think about, just the generational changes that are taking place in leadership and healthcare. And you have this whole newer generation of millennials coming up into leadership positions, Gen Z-ers as well who are technology natives, they’ve been using technology their entire lives. They don’t look at it as learning something new. They’re looking at it as, this is something new I get to use. So I think that is a different way of thinking and also will lead us into a new place that is hard for us to imagine from a digital transformational standpoint, both in healthcare and in banking.

Grotto: Yeah, I think you’re right, and I think just technology in general is a really good example of the both/and, because you can’t jump from one thing to the other. Thank you to Bank of America for supporting this project and this research. I think that these reports have been really enlightening. The survey information has taught us an awful lot to carry through. Next year, we’re going to be focusing on some different topics and digging into some different things, so I think it’s going to continue to be really enlightening. So thank you to Bank of America for their support.

Alston: Erika, thank you for engaging us in this conversation. Thank you for the great work HFMA does. We’re glad to be a partner with HFMA, and we’re glad to be a partner in the healthcare industry. Thank you.

Grotto: Voices in Healthcare Finance is produced by the Healthcare Financial Management Association and written and hosted by me, Erika Grotto. Sound editing is by Linda Chandler. Brad Dennison is our director of content strategy. Our president and CEO is Joe Fifer. If you want to get in touch with our team, you can always reach us at [email protected].