Anticipating 2024: Healthcare executives' budget and strategy plans

Anticipating 2024: Healthcare executives' budget and strategy plans unknown

Becker's asked C-suite executives from hospitals and health systems across the U.S. to share their organization's areas of growth for the next few years. 

The 49 executives featured in this article are all speaking at the Becker's Healthcare 11th Annual CEO+CFO Roundtable on Nov. 13-16, 2023, at the Hyatt Regency in Chicago.

To learn more about this event, click here.

If you would like to join as a speaker or a reviewer, contact Mariah Muhammad at mmuhammad@beckershealthcare.com or agendateam@beckershealthcare.com. For more information on sponsorship opportunities, contact Jessica Cole at jcole@beckershealthcare.com

As part of an ongoing series, Becker's is talking to healthcare leaders who will speak at our conference. The following are answers from our speakers at the event.

Question: Looking ahead to 2024, what are you anticipating for your budget and strategy discussions with your executive team?

Eugene Woods. CEO of Advocate Health (Charlotte, N.C.): While the pandemic pushed so many of us in the healthcare system to the brink, it also catalyzed innovation and transformed the way we deliver care in so many ways. Looking ahead to 2024, the Advocate Health leadership team is doubling down on innovation and continuing to cultivate strong partnerships across industries, while we strengthen our financial position and drive significant synergy savings consistent with our pledges to make care more affordable. We intend to pioneer out-of-the-box approaches to harness the full potential of new technologies, whether that's AI or deepening our partnerships with robotics and other leading-edge companies to bring inventive approaches to the bedside faster. 

Peter D. Banko. Division President of CommonSpirit Health (Chicago): It is really tough out there financially right now. I anticipate this tough environment – inflation, workforce challenges, and slower growth to name just a few – to be with us for the next 24 to 36 months. But, despite all this, the future is exceptionally bright. Meeting budget expectations, to fuel and fund growth, will require a turnaround mindset. Saying it and doing it. A nose for people and operations, a process- and system-orientation, setting high but reasonable goals, and a focus on results rather than activities. At the same time, through this difficult and unpopular work, we must create a compelling and engaging vision (and plan) for growth – consumer-driven, physician network, ambulatory network, and winning in both select geographies and services.

Robert S.D. Higgins, MD. President of Brigham and Women's Hospital (Boston); Executive Vice President of Mass General Brigham (Boston): It is a challenging time in healthcare and we continue to work to absorb significant inflation in both labor and supply costs while supporting and nurturing our employees who are central to our mission of providing high-quality, compassionate healthcare to our patients and their families. From a strategy perspective, we will continue to focus on how to protect and grow our research, education, and community service missions in this increasingly challenging financial environment.

Shelly Schorer. Interim President of Northern California at Dignity Health (San Francisco): We continue to look for opportunities to provide additional access to the communities we serve. We will continue to review the best options for us to grow where we need to and maintain excellent care where we are located. Managing access with inflation outpacing reimbursement is a challenge every day but one we will face with continued passion and vision for California.

Svetlana Lipyanskaya. CEO at NYC Health+Hospitals/South Brooklyn Health: In a very challenging budgetary landscape, we are planning to focus on the three key factors that we believe universally impact performance – care experience, drive to zero harm and access to care. Every member of our staff, whether bedside or back office, can have a positive impact on the services that we provide to our patients and thus on our ultimate bottom line. 

Paul R. Hinchey, MD. COO of University Hospitals (Cleveland): As we approach 2024, we on the executive team at University Hospitals will continue to discuss, develop and deploy our Systems of Care operating model. We believe we can optimize our clinical services to better fit the size and needs of the local market while providing access channels to meet patients on their own terms. Our hospitals remain the hub, but they are by no means the only or even the most appropriate site of care for every patient.

One key component of our Systems of Care model are volume centers. These are preferred transfer destinations in our community market where we are optimally resourced with top-notch facilities, equipment, providers, clinical caregivers, support staff and services to be able to provide care for low to moderate acuity patients -- at scale and in a high-quality and highly reproducible manner. 

As we know, volume drives repetition, which drives excellence. Higher volume centers have better outcomes, shorter stays, fewer complications and better patient experience. Our center of excellence (COE) for total joint replacement is a great example. Among patients who have joint replacement, the length of stay in our COE was 1.08 days, compared with 3.15 days in an Ohio peer group. Readmission rates also showed significant differences, with a readmission rate of 0.65 percent in our COE compared with 3.67 percent in an Ohio peer group.

Through this thoughtful process of redesigning our clinical services, we believe we'll be positioned to provide the highest quality care at a lower system cost, allowing us to compete on value, match local market demand and enhance the experience for both our patients and our providers.

Wasif Rasheed. Chief Revenue and Growth Officer at Providence (Renton, Wash.): We head into 2024 facing many of the same headwinds as 2023, including the risk of recession, an uncertain regulatory landscape, and staffing pressure and burnout among clinicians amidst rising patient demand. Top-of-mind priorities for our leadership team will be simplification and deconstruction – to ensure our caregivers are as well positioned as possible to support our patient communities and that Providence is oriented around what our health system can do best. We anticipate announcements in 2024 reflecting the culmination of our long-term strategy discussions and will ensure our health system stays on a positive trajectory for the future.

Damond Boatwright. President and CEO of Hospital Sisters Health System (Springfield, Ill.): We developed a strategic plan that includes three key pillars – mission, strength and growth – and those pillars will drive our strategy and budget priorities in 2024 and beyond. As a Catholic health ministry, mission sits at the center of all we do. It also informs the investments we make in our colleagues so they can live up to their human potential during their careers with us. Strength and growth are multi-faceted. Our team will be focused on operational excellence and financial stewardship as we determine how best to meet the needs of each of our markets in this challenging environment.

Mark Gridley. President and CEO at FHN Memorial Hospital (Freeport, Ill.): Our current budget and strategy discussions are being framed within a 3-year proactive view. Key areas of focus are workforce redesign/retention, capital planning needs, and liquidity positioning. Looking at what we will build on and what areas we will exit are important decisions for us as a team as we weigh the long-term health impact on our community.

Jandel Allen-Davis, MD. President and CEO of Craig Hospital (Englewood, Colo.): In the upcoming budget cycle, the operative words are "fiscal prudence on steroids." The level of uncertainty in today's economy demands this. Whether riding the waves of inflation, retaining the best workforce through the right investments in talent development while keeping our wages and benefits competitive, or working with insurers in contract negotiations that are increasingly challenging, this is a time of uncertainly and opportunity. Those things that can wait, in order to reserve some resources for the unexpected, is the name of the game. And the unexpected might include opportunistic plays as well as threats and challenges!

Tom R. Siemers. CEO of Wilbarger General Hospital (Vernon, Texas): While strategic growth is critical, our big focus is on reducing revenue deductions: Contractuals, denials, write-offs, etc. Growth without strong internal controls is meaningless. We've set up four cash flow teams to monitor key areas weekly, identify opportunities and adopt best practices. We follow the principle of "Trust but verify" to ensure focus and accountability.

Kenneth Rose. President and CEO of Texas Health Hospital Mansfield: Growth! As a part of AdventHealth, we are blessed with a strong balance sheet and we want to use that to take our mission of "Extending the healing ministry of Christ" to more people. The healthcare industry will continue to be disrupted and we want to be on the offensive versus the defensive side of that positive disruption. 

Brian Peters. CEO of Michigan Health Hospital Association (Okemos, Mich.): Maximizing existing state and federal programs to alleviate pressure on Michigan hospitals and health systems due to rising costs related to workforce, pharmaceuticals, supplies and inflation is a key focus of the Michigan Health & Hospital Association over the next year. For example, prescription drugs are the second largest expense for Michigan hospitals behind labor and it continues to increase. Our association remains committed to protecting the 340B drug pricing program for Michigan-covered entities so they can continue to provide low-cost access to care in Michigan communities. 

Additional activities include ensuring the continuation of existing targeted funding pools in the state budget that support programs such as graduate medical education, small and rural providers and obstetrical services.

Andrew Goldfranch. Chief Operating Officer of Arrowhead Regional Medical Center (Colton, Calif.): 2024 is going to be an exciting time for hospitals as we continue to drive our focus towards innovation, quality performance measures and workforce development. More and more our strategies are shifting towards population health and delivering care differently to our community; while tackling the national workforce shortages. For our organization, these are key components as the only safety net organization for over 20,000 square miles and a population of over 2 million people.

Anuj Vohra. Chairman and Medical Director of Department of Emergency Medicine at Charlotte Hungerford Hospital (Torrington, Conn.): We are looking to clinically redesign the way we practice, reduce waste and improve costs. This entails questioning ourselves to ensure we are testing for the right reason not just because it is the way we have always practiced. This redesign touches each department in the hospital. In the emergency department, we are focusing on our CT utilization to look for opportunities. After that, we will do a deeper dive on laboratory testing utilization. 

Joshua M. Prostek, PharmD. Director of Retail Pharmacy, 340B Officer at ThedaCare (Neenah, Wis.): Here at ThedaCare, from a pharmacy perspective, our budgetary and strategy conversations are really focused on appropriate 340B utilization and self-administrating functionalities that we traditionally would have engaged a vendor for. 

Furthermore, there is a robust interest in non-340B cost containment methodologies for ultra-rare high-cost disease treatments. Specifically thinking, how can we predict our at-risk population, and how can we partner in new types of arrangements, such as value-based pharmacy contracts as a mitigating factor.

K. Sarah Hoehn, MD. Chief Medical Officer of La Rabida Children's Hospital (Chicago): From a budget and strategy perspective for medical staffing, we will be focusing on flexibility and wellness. They may seem mutually exclusive, but we must address wellness to have stability in our workforce. Flexibility is needed from all stakeholders so we can keep the patients at the center. We need to find ways to cultivate pride and build loyalty to reduce turnover. I think 2024 will be a great and cohesive year for all of us in healthcare, as we establish new norms post-pandemic. 

Susmita Pati, MD. Chief of Primary Care Pediatrics and Chief Medical Program Advisor, The Alan Alda Center for Communicating Science at Stony Brook (N.Y.) University: I anticipate budget and strategy discussions with our executive team will focus on further operationalizing our newly released strategic plan for 2024-2029 which prioritizes supporting our workforce by fostering a high-performance culture. Our organization has tremendous opportunities to leverage existing, proven approaches to supporting healthcare team cohesion and collaboration by making strategic investments. 

In particular, our unique Alda Healthcare Experience professional development workshops tap into the power of improvisational theater exercises to build interprofessional team communication skills that, in turn, support team cohesion and organizational resilience. Furthermore, we are focused on capitalizing on healthcare technologies – such as telehealth and digital scribes – to enable our workforce to focus on building the human connection with patients that is necessary to provide high-quality care. We hope to invest in these strategies across Stony Brook Medicine to support long-term sustainability for our current and future workforce that, in turn, leads to improved healthcare delivery and patient outcomes.

Tammy Needham. Chief Clinical Officer of Island Health (Anacortes, Wash.): Island Health's budget and strategy discussions for 2024 are underway now. The executive team is guided by our 2022-2025 Strategic Plan, and Our Purpose: To be the best healthcare partner for those we serve. As a Washington public hospital, we are committed to meeting the needs of our community. Our community health needs assessment and strategic planning process outlined key areas of focus, expand access to primary and preventative care, expand non-surgical specialty care, and expand existing surgical specialties.

Angelo Milazzo, MD. Vice Chair of Practice and Clinical Affairs, Department, Pediatrics; Professor of Pediatrics, Division of Pediatric Cardiology at Duke Health (Durham, N.C.): A key area of focus in our strategy discussions for the coming year will be opportunities to improve the work experience for our healthcare team members. We are asking more and more of physicians, advanced practice providers, nurses, technicians, and support staff, and so we must consider the impact of increasing service demands on our workforce. It would be foolish to ignore shifting societal attitudes toward work and toward the relationship between management and front-line employees. Our organization is developing an ambitious hiring plan, based on our understanding of community healthcare demand, but that plan needs also to account for the expectations of a workforce increasingly concerned about work-life balance, about meaning in work, and about the impact our organization has beyond our core functions.

Michael Archuleta. CIO of Mt. San Rafael Hospital (Trinidad, Colo.): Looking ahead to 2024, my focus on budget and strategy discussions with my executive team centers on several key areas crucial for our healthcare organization. Firstly, we anticipate a significant allocation of our budget towards further enhancing our cybersecurity measures. As the healthcare sector continues to face evolving cyber threats, it's paramount that we invest in cutting-edge technologies and training to safeguard patient data and maintain operational resilience.

Secondly, we foresee a substantial portion of the budget being directed towards digital health initiatives. Telehealth, remote patient monitoring, and other digital solutions have become integral to healthcare delivery. We plan to optimize and expand these services, ensuring they are seamlessly integrated into our patient care model.

Additionally, data analytics and artificial intelligence will be fundamental components of our strategy discussions. Leveraging advanced analytics to derive actionable insights from our data will aid in informed decision-making, operational efficiency, and improving patient outcomes. AI applications, particularly in diagnostics and predictive analytics, will be explored to enhance clinical decision support.

In alignment with our commitment to patient-centric care, we'll allocate resources to optimize our EHR system, focusing on usability and interoperability. A smooth, user-friendly EHR experience improves clinical workflows and enhances patient care coordination across our organization and with external partners.

Lastly, investing in talent and fostering a culture of innovation will be a core aspect of our strategy discussions. We aim to attract and retain top IT talent, ensuring we have a team well-equipped to drive technological advancements and embrace emerging trends in healthcare IT.

In summary, our budget and strategy discussions for 2024 will revolve around fortifying cybersecurity, advancing digital health initiatives, harnessing the power of data analytics and AI, optimizing EHR systems, and nurturing a culture of innovation within our organization. These efforts will collectively steer us toward delivering enhanced care, operational efficiency, and a seamless patient experience.

Noomi Hirsch. CEO at Encompass Health Rehabilitation Hospital of Littleton (Colo.): We are excited to welcome a new year in a few months and have already begun conversations within our executive team on what the new year's focus should be. There is no doubt that we will continue our focus and efforts on growth and labor management. In addition to that we have agreed that we need to think creatively on how to make our processes more efficient without just adding resources. This mindset goes for everything we do in our hospital from greeting visitors to cleaning and of course, caring for our patients.

Tony Thrasher, DO. Medical Director of Crisis Services at Milwaukee (Wis.) County Behavioral Health Division: I see this as two separate, yet synergistic approaches. Namely, what are we doing externally versus internally? Externally speaking, who are we trying to engage with...and more importantly, do we have an accurate read on what they want (not what we think they need)? 

Internally speaking, this becomes all about the recruitment, retention, and growth of a talented workforce. Their needs have evolved as much as our patients' needs have changed. As such, it is paramount to make sure that we are offering opportunities for hard-working individuals to grow and learn within our organizations while they are caring for those we serve. By speaking to both approaches (external and internal), we can better allocate our budgetary resources and create a strategic plan that has sustainability.

Troy D. Miller. Chief Strategic Officer of Holzer Health System (Gallipolis, Ohio): Three areas of focus for 2024 things: 1)Staffing flexibility: evaluate and offer opportunities for the ultimate flexible work arrangements in healthcare to encourage recruitment and retention among all caregivers; 2) Financial and operational optimization including access ease for primary care, specialty care and surgical services, for revenue expansion and expense mitigation; 3) Culture commitment – growing loyalty, longevity, commitment, and trust among our staff. All three of these areas will require a committed investment upfront, leveraging internal talent as well as experts in the field to produce proven cost-effective implementation and ongoing management. 

Karen McConnell. System Vice President of Pharmacy Enterprise and Chief Pharmacy Officer at CommonSpirit Health (Chicago): For the pharmacy enterprise, we are adding drug margin to the discussions we are having with our senior leaders. A large percentage of our drug spend is for separately reimbursable drugs, which should be associated with a positive drug margin (good spend). However, it is important to monitor the drug margins to ensure we are getting reimbursed appropriately. Unfortunately, this is not always the case and requires systems in place to ensure this occurs. 

Reshma Gupta, MD. Chief of Population Health and Accountable Care at UC Davis Health (Sacramento, Calif.): Over the next year, we are focusing strategy on our long-held mission to keep patients healthier at home by addressing equity (upstream, midstream, and late stream) and by implementing large scale care at home programs. 

Creating an equity-focused health system operation plan requires directed strategy and resources to support understanding our patient and community needs, how they tie to health and healthcare outcomes, building trusted partnerships within and outside of the organization, and supporting systems to implement and sustain improvements. 

Additionally, our institution continues to support large-scale programs to deliver more care at home supported by our care management teams who can identify high-risk patients and our IT department and Care at Home teams to obtain broader program reach.

Carla M. Granger. Assistant Dean of Administration of Rowan University School of Osteopathic Medicine (Stratford, N.J.): Looking forward to 2024, similar to many healthcare institutions across the country, we are looking for ways to maximize efficiency and streamline processes to help support our bottom line. In strategy discussions with our executive teams, we have explored ways to co-locate services and share resources to make a better experience for our patients, as well as eliminate redundancy. 

We're maximizing our space and attempting to invest in our own facilities, as opposed to lease or rental agreements, which in the long term supports the health of our finances. We're also focusing on our employees, and incorporating wellness strategies, as well as advancing our initiatives to be a workplace of choice, in order to retain high-functioning faculty and staff while reducing expenses related to turnover.

Amy Smiley. CEO of Northern Virginia Mental Health Institute (Annandale, Va.): The complexity of medical issues among behavioral health patients is rising, particularly among high utilizers who tend to be sicker and have distinct demographics and insurance coverage. Distinguishing medical needs from social and behavioral factors driving service utilization is challenging yet crucial because inpatient psychiatric facilities are not equipped to address medically complex patients.

Social and behavioral factors significantly impact health outcomes and healthcare utilization, with psychiatric diagnoses often associated with high costs. Coexisting mental and medical conditions can prolong treatments, leading to costly and unnecessary urgent care. Recognizing these factors is vital for predicting healthcare costs and improving patient care through comprehensive social and behavioral health services.

Sarah Chouinard, MD. Chief Clinical Advisor of Community Care of West Virginia (Rock Cave): As Community Care of WV looks to 2024, our focus is on investing in value-based care workflows and care team expansion to address social determinants of health. As we climb the ladder from fee-for-service to shared risk and finally to global capitated payments, we are reinvesting shared savings and incentive payments in people and technology so that we can be fully prepared for new payment models and opportunities for FQHCs.

Eilidh Pederson. CEO of Western Wisconsin Health (Baldwin): 2024 will be the year of reinvesting back into staff. Focusing on competitive wages, reinvesting in education and growth, after a multi-year hiatus, and investing in areas that give hospitals a competitive advantage over their collaborators and other industries. At our hospital, we call this human infrastructure. Meaningful careers, favorable cultures and standout leaders are built by investing in individuals. For us, this looks like investing in childcare for employees, provision of free mental health services for all staff, dedicated coaches and creating personalized career pathways for motivated employees. This is the year of investing in our most valuable resource…people.

Michael Canady, MD. CEO of Holzer Health System (Gallipolis, Ohio): Our budget for this fiscal year was essentially break even and was broken very quickly. All of the cost side is over budget due to ongoing contract labor and drug costs. Revenue is good, but payers continue to squeeze with aggressive denials and bundling strategies. All this with payers posting record profits. Unless there is quick attention, this will not end well. 

Carrie Herzke, MD. Chief Medical Officer - Charleston of Medical University of South Carolina (Charleston): As with many organizations we are focusing on retention, employee engagement, and rewards and recognition. We continue to focus on how we can serve our community, which in many cases comprises meeting the quaternary care needs of the state of South Carolina.

Herman Williams, MD. Chief Medical Officer of Nashville General Hospital (Tenn.): Our budget and strategy discussions will include the following:

1. Introducing new technology for our surgeons to expand capability to our patients.

2. Looking for land to build a new hospital.

Mayank K. Shah, MD. Vice President and Chief Medical Officer of Advocate Condell Medical Center at Advocate Aurora Health (Downers Grove, Ill.): Looking forward to 2024, we are constantly talking about our opportunities in value-based care models. Healthcare has gone through unprecedented change in the last few years. Consumer-centric services are demanding care model shifts from hospitals to alternative places of care delivery. Our strategies continue to center on innovating in this space with a balance of quality and safety. The shrinking margins for hospital systems continue to stress the importance of focusing on ROI as we look toward technology and innovative solutions. 

Finally, we continue to align our corporate mission with investments in health equity and community integration. The pandemic has accelerated tremendous opportunities with technology but also continues to pressure test investments as reimbursement rates tighten. Optimizing population health, value-based care growth and operational efficiencies will remain the focus for 2024.

Jim Spicer. Vice President of Operations and Chief Administrative Officer at Firelands Health (Sandusky, Ohio): With so many headwinds and tailwinds and continued unpredictability surrounding both regulatory and payer environments, 2024 will demand a more balanced-risk approach for our team. For example, strategic growth opportunities will be critically important to our sustainability and overall mission, however, these will be tempered by several variables including the impact of expense-reduction initiatives and negative actions across the payer coverage and reimbursement landscape. 

Similarly, doubling down on our work to address health equity and social determinants will need to be balanced by realistic goals and our ability to generate enough margin in the face of uncertain legislative changes such as site neutrality, DSH payment changes and payer steerage. Successful prioritization of this more balanced-risk approach across each strategic area will call for more careful consideration and teamwork as well as listening and learning from a broader group of key stakeholders than we have traditionally in the past. 

Sarah Morrison. CEO of Shepherd Center (Atlanta): Like many of our peer organizations, Shepherd Center continues to seek a balance between executing critical strategic initiatives and the need to generate revenue. In the post-pandemic world, expenses continue to rise while reimbursement for services provided remains flat – or due to legislation – decreases. For the next two years, Shepherd Center will continue to focus on Vision 2025, which we established in 2020. The three main strategies are:

1. Access: We are unable to admit 250 to 300 people to our inpatient programs per year due to capacity constraints and an overwhelming need for our highly specialized neurorehabilitation. In addition, some of our outpatient clinics/programs have a wait list of up to six months. In today's healthcare environment and for the health of those who need care, this is unacceptable. To mitigate our capacity challenges, we are adding 48 more inpatient beds and growing our outpatient programs to reduce wait times and better serve our patients and the community.

2. Innovation: Potential collaborative research and development efforts can occur in many disciplines – from developing new devices and technologies to fellowships and training for the next generation. We believe that new and improved ways to care for people experiencing the most complex conditions, including spinal cord and brain injuries, multi-trauma, traumatic amputations, stroke, multiple sclerosis, and pain, are within reach. To help us in their discovery, Shepherd Center is building a 30,000-square-foot Innovation Institute that will allow us to continue participating in cure research and put us at the forefront of technology discoveries that can significantly increase independence. 

Shepherd Center is also in the initial stages of creating precision rehabilitation by analyzing our 25 years of electronic data on individuals with spinal cord and brain injuries. By further customizing rehabilitation plans for our patients, we hope to reduce the short and long-term costs for the types of catastrophic injuries we treat and set the standard for peer institutions worldwide.

3. Patient experience: To enhance the patient and family experience and increase the independence of our patients while they are in our inpatient programs, we are updating all rooms to smart rooms. Patients and families will be able to better control their environment and comfort and have immediate access to medical records. We're also building a new housing tower that will more than double our housing capacity so families can be near their loved ones through rehabilitation as they begin again after injury or illness. 

Most importantly, we will continue to deliver life-renewing neurorehabilitation with unwavering heart, humor, and hope while infusing extraordinary care and compassion into every interaction.

Jean Ann Larson, EdD. Chief Leadership Development Officer and Senior Associate Dean of Leadership Development at the University of Alabama at Birmingham Heersink School of Medicine, UAB Health System: With respect to budget and strategy discussions with our executive team, we will advocate for continued investment in our leaders and their development. The challenges in healthcare are not lessening and we need capable and skilled leaders more than ever. We want to lean into succession planning in a more structured way. We need to be both strategic and tactical in our approach. Like other organizations, we are seeing many retirements and we need to have qualified successors prepared to step in. We also need to prepare our leaders at all levels for their next opportunity.

Paula M. Ellis, DNP. Interim CEO of F.W. Huston Medical Center (Winchester, Kan.): Budget discussions will continue to focus on the elimination of contract labor. We previously put several initiatives in place to "grow our own" folks in difficult-to-fill positions. We need to look at the cost-benefit of those initiatives and consider what to keep in place. We also improved benefits aimed at attracting professionals. Again, we need to determine the cost-benefit of those changes. 

Strategy discussions will center on the rural emergency hospital designation to determine if this is a model to pursue in the future. In the meantime, we continue as a critical access hospital and, as such, focus on population needs and services we can safely provide. The emphasis will be on opportunities involving partnerships and ventures in the ambulatory space. 

Bill Munley. Market Administrator, Southeast of Shriners Children's Greenville (S.C.): At Shriners Children's, our strategy is simple: see more kids in more places! While other health systems are cutting back on services, we are growing. Therefore, our budget is growing. Many insurance companies and employers have discovered how beneficial our value-based care can be for their constituents. In Greenville, we are also partnering with other healthcare systems that are struggling to provide care for some of the 85 different pediatric orthopedic conditions that we treat. Additionally, we have made FQHCs as well as rural and critical access hospitals areas of focus for 2024.

David Lenihan, JD, PhD. President and CEO of Ponce Health Sciences University (Puerto Rico): Mild growth with increased regulatory spending. The discussion is to ensure that we meet our growth projections and that they are realistic so that we can ensure that the spending on regulation and labor does not exceed our budgets.

Daniel J. Brat, MD, PhD. Magerstadt Professor and Chair of the Department of Pathology at Northwestern University Feinberg School of Medicine; Pathologist-in-Chief at Northwestern Memorial Hospital (Chicago): As the chair of pathology at Northwestern Medicine, a large integrated academic medical center with labs at 11 hospitals and 7 major ambulatory centers, we are focused on continuing our journey of integration, consolidation, optimization and growth of our laboratory operations. There are substantial cost savings by performing tests internally rather than sending them out to our reference lab partners, and our volumes for many tests justify developing these assays. 

Consolidation efforts recognize that each laboratory test does not need to be performed at each lab, and centralization or regionalization is a more efficient manner of testing when there are no significant time restraints. We are looking towards more strategic partnerships in the reference lab and lab instrument space to ensure that our internal and external laboratory growth continues. Maintaining an engaged and loyal laboratory staff remains a priority.

Mary Jo Williamson. Chief Administrative Officer of Mayo Clinic Laboratories (Rochester, Minn.): It's more important than ever to drive investments in innovation. Healthcare must drive disruptions to take advantage of new technologies and industry changes. We are continuing to make strategic investments in our technology and data security, as well as our patient-centered innovation pipeline. We are constantly investing in our technology and data security to ensure we meet the evolving needs and preferences of our clients. 

Concurrently, we are advancing our patient-centered innovation pipeline to provide our clients and patients with trusted answers when they need them most. We also are watching to see how the impacts of AI, regulation, and reimbursement will change any of our budget forecasts for the next few years.

Chad Dilley. COO of IU Health Saxony (Fishers, Ind.): Executing our short- and long-term strategies and determining how to resource those initiatives successfully is truly a rolling, ongoing discussion for our leaders. We're deep into finalizing our course for 2024 based on what we've accomplished so far in 2023, and where we have improvements to make going forward. In broad strokes, our focus remains on hiring and retaining the best people, providing high-quality care and service with compassion and innovative thinking, improving our access and addressing the health and wellness needs of the communities we serve. Additionally at IU Health Saxony, soon to be IU Health Fishers, our eyes are on tight management of the strategic choices and budget required to complete the expansion of our hospital campus and services, set to open in 2025.

Natasha Mumford. Controller of The Rehabilitation Institute of Ohio - Premier Health, Encompass Health (Dayton): Optimization is certainly a long-term goal, but any planning around such requires a dual-focused approach that lends equal weight to efficiency improvement and enhanced quality of care. When we look at labor, offloading tasks to automation, cross-training, and redistributing administrative non-clinical duties are the low-hanging fruit, but it is not sufficient to stop there without considering existing processes to determine why they are important in the first place. If there is redundancy across departments, or the process never or no longer adds value, then we need to reconsider its necessity. 

Ensuring the continued existence of a healthcare workforce is vital, and we as providers share in that responsibility. Currently, we offer CEU courses, provide a teaching environment through numerous clinical affiliations and residency observation, and connect with local academic institutions for post-graduate career placement opportunities. I anticipate further discussion about how we can do more in this realm. 

We use patient feedback and outcome measures to identify needs and what matters to them, and that absolutely plays a role in strategic discussions as we look forward. Discovering how we can make access to data more user-friendly or how we can make the transition to the community a seamless one; these are the types of objectives that drive action planning.

We also want to enhance our service lines through targeted education in the community and market about what we do and how inpatient rehabilitation can benefit patients and other providers in the care continuum. We recently achieved certification in a second rehab diagnostic specialty and will continue to build our expertise so we can be better positioned to treat patients within those specialties. 

Over the past few years, most of our strategic focus has been consumed by pandemic recovery. Moving into 2024, we hope to shift that focus back where it belongs: to challenging the status quo and engaging in ways that have a meaningful impact on those we serve.

Lisa Moore. Executive Vice President and COO  of Cottage Health (Santa Barbara, Calif.): While we are experiencing the financial headwinds that the entire health system is facing right now, we are turning our attention to building our ambulatory platform and ensuring that our patients are not only served by but delighted by, their experience of high-quality care in our hands. Naturally, this means that we are also committed to creating a setting in which providers and members of the care team are honored to serve. We are approaching this work with a spirit of innovation and collaboration to continuously iterate the way in which we achieve these goals. It's a very exciting time!

Winnie Adams. Chief Nursing Officer of Astria Sunnyside (Wash.) Hospital at Astria Health: Looking ahead to 2024, Astria Sunnyside Hospital is poised for growth. I work collaboratively as part of the executive team and the team meets weekly. Similarly, I meet weekly with my nursing department leaders to keep on top of resource and funding needs.

We are a critical access hospital in a rural agricultural valley in Washington state. We recently hired a new orthopedic surgeon and will be focused on increasing surgical volumes across our 10 surgical disciplines. With nursing leadership, we are creating new workflows for both infusion therapy and robotic surgery. We currently use telemedicine solutions with cardiology and pulmonology and utilize Holter monitors and home sleep studies in order to accommodate more patients in their homes.

Recruitment and retention of nurses continue to be a focus area. Nursing leaders and our nurse educators have created dedicated SIM labs in the hospital; and have collaborated with other departments to put on trainings that address Code Grey, safe lifting, bloodborne pathogens, and documentation. We have created partnerships with area nursing schools to provide opportunities for job shadows, senior practicums, and internships, while we develop our own nurse residency program for new graduates. Funding for these programs will remain a priority, as nurse recruitment is still a top priority.

In addition, nursing and department directors frequently come together to address community needs, and we will continue to seek funding for those. We have a medication take-back box in our emergency room, and a new community safe sharps disposal box, and are supporting local police officers by providing naloxone to them for use in the field. 

We are working collaboratively with Astria Health's Rural Health Clinics to offer rapid care in our communities. Rapid care is similar to an urgent care model, where primary care and minor injury care are offered without appointments. Expanded rapid care hours help keep emergency department resources available for those who truly need it.

Jimmy Chung, MD. Chief Medical Officer of Advantus Health Partners (Cincinnati): We are all hands on deck for 2024. We expect patient volumes to increase but expenses to increase as well, so we continue to reduce waste and non-value-adding cost by eliminating unnecessary variations in care delivery. We plan to leverage our strong partnerships with suppliers to continue to lower costs, and we will launch new analytics capabilities to manage utilization while prioritizing quality. 

Dan Woods. CEO of El Camino Health (Mountain View, Calif.): The national and geopolitical climate we are in today influences the financial anxiety health systems have been facing the past few years, in my opinion. El Camino Health is emphasizing financial stewardship across the board, with a specific focus on tightly managing indirect patient costs. We remain bullish on investing in innovation, but we are selective in prioritizing the contemporary science of medicine that brings the highest value to our patients and the communities we serve.

One of our highest priorities is improving access to care. We engage in the use of technology, but we recognize that many people are still most comfortable in an analog environment. We are investing in conveniently located ambulatory and alternative hospital sites of care to ensure we meet the needs of the communities we serve. We are also recruiting physicians and clinical staff who support improved access to care. For more than half a century, El Camino Health has been the preferred healthcare partner of choice in our community. We want to continue to earn that trust.

Jennifer Schneider, MD. Co-Founder and CEO of Homeward (San Francisco): Looking ahead to 2024, Homeward is prioritizing supporting local primary care physicians through a combination of value-based care enablement and tech-enabled services.

In rural communities where provider shortages and hospital closures are on the rise, it is now more critical than ever to uplift existing clinicians and ensure those living in rural areas have equitable access to high-quality care. For example, in Minnesota, there are significantly fewer physicians in rural areas compared to urban areas. To make matters worse, according to the Minnesota Department of Health one in three rural physicians plan to leave the workforce within the next five years due to either retirement or burnout. 

Homeward partners with primary care practices in rural Minnesota to help them manage their massive panels. We provide the technology and expertise needed to effectively close quality gaps and operate in value-based care. Through advanced analytics, we can identify the members in need of preventive services and intervene with Homeward's own physicians, helping extend the capabilities of existing primary care practices.