From Beds to Clinics: How 37 Healthcare Leaders Are Adapting to Outpatient Strategy

From Beds to Clinics: How 37 Healthcare Leaders Are Adapting to ... 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 37 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: How has your hospital or health system's outpatient strategy evolved in the last 3 years? What is your organization doing as care continues to move from inpatient to outpatient environments?

Kevin Mahoney. CEO of the University of Pennsylvania Health System (Philadelphia): At Penn Medicine, we're focused on meeting patients where they are by delivering care across four sites: in a hospital, at a multispecialty center, in the home, or through telehealth. With this model, we leverage the latest medical and surgical approaches with technological advances to enhance patients' comfort, increase access to care, and encourage treatment adherence.

Through multispecialty center care, patients avoid lengthy hospital stays, and at-home care offers a range of services in a familiar setting. During the last year alone, nearly 700,000 healthcare appointments were held in private residences. These include visits from the Cancer Care at Home program, which has successfully shifted more than 50 percent of Penn Medicine-administered infusions and chemotherapy treatments to the home.

Two Penn Medicine-owned pharmacies are dedicated to supporting the effort. The SOAR (Supporting Older Adults at Risk) pairs geriatric patients at high risk for readmission with nurses who provide more check-ins and follow-up care. Telemedicine further augments these efforts, allowing virtual case management teams to follow up with patients in between scheduled visits. Since the start of the pandemic, we've monitored more than 11,000 unique patients for a total of 2.1 million virtual visits.

Pete November. CEO of Ochsner Health (New Orleans): The shift to the outpatient setting is only intensifying, and at Ochsner, outpatient care continues to be a focus of our strategy. First off, it's what patients want. People want to go home after a treatment or a procedure to heal with their loved ones; it's more convenient, more comfortable, and less costly. Just earlier this year, we invested in a new outpatient medical complex in New Orleans to meet the changing needs of the people we serve – offering primary and wellness care, labs and testing, outpatient surgery and other services.

Shifting more care to the outpatient setting is also the right thing to do to truly make a difference in improving the health of our communities across the Gulf South. As we accelerate value-based care, outpatient care is an important part of how we partner with people on their health to keep them well, rather than treating them after they're sick or injured. Our recent announcement with Novant Health to scale our innovative 65 Plus clinic model is another example of how we are expanding access to outpatient care while meeting the unique healthcare needs of the senior population. Our customized approach provides benefits beyond medical care, including social support and wellness resources to care for the whole person.

At Ochsner, we offer the full continuum of clinical services to meet our communities needs. Shifting more services to the outpatient setting is most effective for patients when complemented by the tertiary and quaternary services available through an integrated health system.

David Lubarsky, MD. CEO and Vice Chancellor of Human Health Sciences at UC Davis Health (Sacramento, Calif.): We're adapting our hospital to care primarily for higher acuity patients, as we expect low acuity inpatient care will virtually disappear from hospitals, especially academic medical centers, over the next decade. For example, inpatient care like orthopedics is moving to a purely outpatient practice, along with other previously inpatient treatments.

Additionally, patients increasingly expect care to be available when and how it's most convenient for them. This includes things like on-demand virtual care, at-home prescription delivery, remote monitoring, digital diagnostics and decision support, and self-service applications. At UC Davis Health, for example, we're working to reduce, and hopefully eliminate, pre- and post-op in-person visits, replacing them with remote video visits that are more convenient for both patient and provider.

Ronda Lehman. President of Mercy Health Lima (Ohio): The outpatient strategy for Mercy Health St. Rita's has evolved considerably in the past three years. We saw a strong desire during the pandemic for people to not come into the hospital environment, and the demand for telehealth services and outpatient services skyrocketed. We had to quickly adapt to providing services once traditionally provided in a hospital setting to outpatient and virtual.

It is imperative as we look towards the future of healthcare, that we consider the 'entire' person, not just the episodic hospital care we delivered in the past. From lifestyle choices to the communities they live, play and work in – we must view healthcare as primarily outpatient with the occasional inpatient hospital need, a dramatic shift from the traditional viewpoint. This will be evidenced by the community investments we make, the partnerships we enter into and the decisions around buildings and expansion projects in the future.

Kevin Churchwell, MD. President and CEO of Boston Children's Hospital: Boston Children's supports a distributed pediatric network: to serve Massachusetts, the region, and patients traveling further, retaining its main campus for patients requiring the most complex care and breakthrough therapies. In addition to Boston Children's main campus access improvements, it has expanded ambulatory practices to eight locations across the state to provide convenient access to integrated specialty services to pediatric patients. Expanding access, we can move appropriate care, previously offered at the main campus, outward to state-of-the-art, convenient ambulatory facilities, our primary care network, partner institutions, and pediatric referral relationships.

Providing care at access points outside Boston can meaningfully reduce barriers to care — from the time and expense of transportation into the city to easier physical access to space with wider and smoother parking lots and sidewalks to smaller, less congested, and more easily navigated hospital spaces. These prior barriers may be more acute in the pediatric context, where treatment involves family members. Co-location of multidisciplinary services in locations alternative to the main Boston campus allows patients to receive a continuum of care in one accessible location.

We also continue to grow our Pediatric Physicians Organization at Children's (PPOC), a network of local pediatricians, including the co-branded Boston Children's Primary Care Alliance.

We proactively manage our access metrics across all of these locations and clinical operations to improve patient/family experience.

Paul Hinchey, MD. COO of University Hospitals (Cleveland): At University Hospitals (UH), we fully embrace the move to value in healthcare – providing the highest quality care at the lowest possible cost to the patient while at the same time optimizing efficiency for patients, providers and payers. Crucial to this goal is creating an effective system of care that provides patients with a wide range of outpatient access options, effectively meeting them on their own terms.

We've currently embarked on a plan to open multiple new urgent care locations across Northeast Ohio. Additionally, we are expanding hours and moving to other locations to make them more convenient for our patients. We're also progressing on the development of three UH Community Wellness Centers with one adjacent to a new mixed-income multifamily housing development.

With openings currently slated for later this year, these centers will provide preventive healthcare and solutions for social determinants of health, such as healthy cooking demonstrations, food pantry services, programs for pregnant women and young mothers, programs to fight senior citizen isolation, telehealth services, as well as workforce development and financial literacy training. Additionally, by focusing on preventive care and population health management, we can reduce readmission rates for many chronic health conditions

We also continue to increase the utilization of our existing ambulatory surgery sites while expanding our offerings. In 2022, we broke ground on a state-of-the-art surgery center with five operating rooms and one procedure room, focusing predominantly on orthopedic surgical procedures and including spine, ENT and pain management services.

As healthcare changes, we are adapting to consumer demand by expanding our access through the introduction of new sites and care modalities, consolidating to multispecialty practices or adding facilities in key locations to assure we are meeting patients' care needs, where and how they prefer to have them met. At UH, we're designing a system of care with many outpatient access points that embrace this new reality.

Robert S.D. Higgins, MD. President of Brigham and Women's Hospital; Executive Vice President of Mass General Brigham (Boston): As we come out of a more emergent situation with the pandemic, we continue to face immense challenges with capacity and patient acuity. These challenges, coupled with our necessary focus on improving both health equity and access to quality healthcare, are front of mind for me as we look at the state of care locally and nationally.

One of the strategies of the Mass General Brigham system is bringing the strengths of each entity into one efficient, integrated care delivery model. This is important in terms of access because it will provide a single entry point for patients. It also gets into how we move care to the right place, with less reliance on inpatient environments by identifying issues before patients come to the emergency department.

As we head into 2023 and beyond, we are redefining the patient experience. Whether through our successful home hospital program, telehealth, or pilot programs that improve access to care at the community level for our patients, we're embracing new ways and technology to deliver the same high-quality, compassionate care our patients know they'll receive here at the Brigham and throughout Mass General Brigham.

Robert Corona. CEO of SUNY Upstate Medical University (Syracuse, N.Y.): We have a very aggressive outpatient strategy. We recently opened a 200,000-square-foot outpatient primary and specialty care center that has a focus on preventive medicine and wellness. We opened an additional outpatient university medical center a couple of years ago and are opening another large facility in October 2023. We have some innovative programs like CMS-approved 'hospital at home', telehealth, and 'connect care' which bridge emergency room discharged patients to a primary care provider.

Charles Powell, MD, MBA. CEO of Mount Sinai Respiratory Therapy Institute (New York City): The Respiratory Institute's outpatient strategy focuses on building upon the successful pillars of our program that have increased market share and reputation. We aim to leverage institutional expertise and innovative technology to enhance patient connectivity and improve care delivery. The key pillars of our strategy include:

1. Multidisciplinary academic approach to respiratory disease: The Respiratory Institute emphasizes an onsite approach that involves a team of specialists working together to diagnose and treat both simple and complex respiratory diseases. We have expanded this approach by creating new teams dedicated to lung transplantation and early lung cancer diagnosis and treatment. We have also expanded our portfolio of late-phase clinical trials that evaluate treatments that may improve outcomes for patients with lung conditions such as asthma, COPD, bronchiectasis, sarcoidosis, and lung fibrosis.
2. Patient experience improvement: The Respiratory Institute is implementing several innovative approaches to enhance the patient experience. One such approach is the use of the MyMountSinai application, which allows patients to schedule appointments, communicate with clinicians, monitor medical results, and seek advice on managing common symptoms.
3. Remote monitoring platform: To improve care and connectivity with patients suffering from COPD (Chronic Obstructive Pulmonary Disease) and those who have undergone lung transplants, the institute has deployed a remote monitoring platform. This platform enables the passive transmission of patient vital sign data, monitoring of symptoms, and tracking of medication compliance.
4. AI and machine learning integration: Leveraging institutional expertise in AI and machine learning, the hospital uses AI tools to support radiologists in diagnosing respiratory conditions. Additionally, the Respiratory Institute is evaluating the impact of AI assessment on quantitative interpretation of lung and cardiac health from chest CT scans, right at the point of care.

The integration of these advances is aimed at significantly enhancing the impact of ambulatory care delivery. It also supports the ongoing transition of care delivery from inpatient to outpatient environments, reflecting a forward-looking and patient-centered approach to healthcare.

Allan S. Klapper, MD. President of Wexford (Pa.) Hospital: As an integrated delivery system in western PA that includes a large insurance payer and a 14-hospital system, we continue to implement strategies that drive value in healthcare and for our communities while moving rapidly towards a full-risk model. In balancing our focus on quality, safety, and equity as well as patient and employee experience with reducing overall cost, integrated strategies have been implemented between the hospitals and the outpatient environments to improve alignment while reducing redundancies and waste. As care moves further into the outpatient environment, it requires a continuous reassessment of the business and operating model to ensure the highest quality and safest care in a fiscally responsible way.

Richard O. Davis, PhD. CEO of Rochester Regional Health (N.Y.): Rochester Regional Health has an expansive clinical network spanning 550-plus sites and 25,000 square miles. We remain hyper-focused on equitable access to care as this remains one of the most significant challenges in our market and nationally. We continually evaluate where we have opportunities to close gaps in access to care to ensure that we provide the right complement of holistic services focused on improving the well-being of our patients and communities.

Our system is doubling down on our digital and virtual access tools portfolio (e.g., direct digital scheduling for patients) and continuing to leverage technological advances in AI (in our centralized communications and beyond) to provide our patients with seamless access to care close to home as we forecast additional impactful shifts in care from the inpatient to outpatient setting over the next three years.

Larry Antonucci, MD. President of Lee Health (Fort Myers, Fla.): Over the past several years, Lee Health has initiated a transformative evolution in our outpatient strategy to address the changing landscape of healthcare and meet the evolving needs of our patients. We recognized the shift in patient preferences, which indicated an increasing demand for outpatient services. Consequently, we strategically reevaluated our approach to outpatient care to ensure accessible, patient-centered, and efficient services.

We think we've found the secret sauce and have developed a blueprint for comprehensive outpatient services in one building that delivers a superior level of coordinated care and exceptional patient experience through the right mix of services. We've determined that we are meeting 95 percent of the local community's needs without the expense of hospital beds. We plan to build similar facilities at strategic locations throughout our marketplace.

Embracing innovative technologies is another cornerstone of our strategy. We are investing in telemedicine solutions, remote patient monitoring platforms, and digital health tools to extend our reach and enhance virtual care capabilities. We have an app in development that will centralize all the tools you need to manage your health into one platform. It goes beyond a singular patient portal and allows your health data across physicians, connected health platforms and wearable devices to be together in one place. This approach enables patients to stay engaged in their health at their convenience.

Overall, Lee Health is embracing the paradigm shift in healthcare and is dedicated to being a leader in delivering high-quality outpatient care. Our commitment to innovation and patient-centered approaches will enable us to thrive in this evolving healthcare landscape.

Jeffrey Hoffman, MD, FACS. Chief Medical Officer and President of Cambridge Health Alliance Physician Organization (Mass.): The trend nationally over the past decade is moving care for patients to outpatient from inpatient environments. The Cambridge Health Alliance has embraced this trend as care for the correct patients in the outpatient and home environments is better for the patient as well as being good stewards of healthcare dollars and embracing value-based care. We have embraced enhanced recovery after-surgery programs for joint replacements and gynecologic procedures.

We have developed a homegrown program of mobile integrated health for patient care at home instead of hospitalization as well as a house call program. In addition, we are developing programs in the cardiac service line for outpatient CHF with diuresis and virtual cardiac rehabilitation. Our goal is to give the best possible care in the setting that is most appropriate for the individual patient. Lastly, we are expanding our outpatient footprint geographically as well as with providers, maximizing existing space along with procedure suites, utilizing telehealth and developing/expanding the digital front door.

Michael R. Canady, MD. CEO of Holzer Health System (Gallipolis, Ohio): We are fortunate that our decade-old merger created a natural business model heavily focused on our ambulatory practice. The majority of our revenue results from our ambulatory business. The cost of acute care will continue to drive patients to ambulatory settings, when possible.

David Lenihan, JD, PhD. President and CEO of Ponce Health Sciences University (Puerto Rico): The campus of Ponce Health Sciences University that's based in Ponce, Puerto Rico offers medical services to residents of the surrounding region. An area in which we've made a tremendous investment of time and resources is mental healthcare. While we've always offered local mental healthcare support, we've recently streamlined our delivery system to be more efficient and patient-centric.

We've also modified our logistics to ensure that patients have reduced wait times to receive the care that they need and upgraded our EMR system so that we're able to provide quality care to a larger population. Finally, we've shifted from being totally in-house to sending our practitioners out into the community to work one-on-one with patients beginning with initial consultations and continuing with thorough follow-up. These out-of-office touchpoints include not just phone and Zoom contacts, they also include at-home visits. This comprehensive effort began with the outreach that we provided following the devastation of Hurricane Maria in 2017 all the way through the most difficult and dangerous days of COVID – and it continues today.

John Cacciamani, MD, President and CEO of Chestnut Hill Hospital, Temple Health (Philadelphia):

1. Survival to growth strategy after change of ownership.
2. Focus on primary care physician market penetration.
3. Leveraging this population with payers.
4. Organizing with technology, EHR, etc., to take advantage of shared savings and risk contracts

Marty Bonick. President and CEO of Ardent Health (Nashville, Tenn.): We have prioritized putting the consumer at the center of everything we do, from investing in digital tools that make care easier to access to building the clinical infrastructure that allows us to care for patients across a variety of settings beyond the hospital to include outpatient, digital, and virtual settings. Ardent is focused on building an ecosystem of healthcare services to meet patients where they are with the right care at the right time.

While the hospital will always be the hub for complex care, we are focused on empowering providers with tools to help them stay connected with patients and manage their care from anywhere. This means offering more telehealth, adding virtual care options, and using technology to help caregivers work smarter and deliver better, more personalized care. Better understanding patients and their needs will help us build a healthcare experience that wraps around a person throughout every stage of their health journey.

Russ Johnson. President and CEO of LMH Health (Lawrence, Kan.): Almost 80 percent of our revenue already comes from outpatient services so, in many ways, we think we're ahead of the game with the shift from dependency on inpatient revenue to outpatient market dynamics. Our strategy over the next three years is built on our base of a strong and aligned physician enterprise with practices across medical and surgical specialties and primary care depth and breadth. These efforts will focus on enhancing access to care through our primary care division and leveraging a more unified brand across our primary care sites. Access will include the expansion of walk-in and same-day services for our patients and the development of our expertise and sophistication in consumer-engaging technologies.

Kevin Tulipana, DO. President of City of Hope, Phoenix: As cancer treatment becomes less toxic, we are seeing many treatments move to the outpatient arena. However, this does not preclude us from having the tools necessary to manage complications. At City of Hope, we have been at the forefront of moving therapies that have traditionally been administered in the inpatient setting to the outpatient setting by establishing things such as on-site housing for close observation of patients, and remote patient monitoring and nurse management.

Additionally, we have made a concerted effort at establishing a community network of oncology clinics that administer a full spectrum of oncology care, including clinical trials. All of this is done in the spirit of 'Democratizing' cancer care, bringing both routine standard of care and cutting-edge clinical trials and research to the patients closest to home.

Brian Peters. CEO of Michigan Health Hospital Association (Okemos, Mich.): Recognizing the shift from inpatient to outpatient care settings, the MHA secured the first significant statewide outpatient Medicaid fee increase in nearly 20 years in the state fiscal year 2021 budget, and we have successfully protected this increased rate ever since – a change which has been vital to maintaining access to care for patients across our state.

In addition, much of our work, whether it be on advocacy, policy, safety and quality improvement, or operational support, is now focused on improving the health and wellness of individuals and communities outside the walls of a traditional inpatient hospital setting. Our association and our members are very intentional in addressing health equity and social determinants of health to help reduce the need for inpatient hospital care for many residents.

Stephen DelRossi. CFO and Interim CEO of Northern Inyo Healthcare District (Bishop, Calif.): Northern Inyo Healthcare District has expanded critical and elective services as we are a four-hour drive from any major medical hospital. We have also expanded our regional healthcare center and partnered with adjacent hospitals to provide women's care. We continue to evaluate patients for the best quality of care and service locations. We have expanded our number of specialties.

Jim Heilsberg. CFO of Tri-State Memorial Hospital and Medical Campus (Clarkston, Wash.): TSH strategy continues to be focused on growing outpatient services while providing great inpatient care. TSH is opening a $30 million dollar inpatient/ICU wing on 8/7/23 which will further the ongoing mission to provide great inpatient care. TSH continues to develop physician clinic services including expanding all specialties with a high focus on surgical and related services. TSH will be upgrading CT and MRI units with new units for both and adding an additional CT unit.

Sarah Chouinard, MD. Chief Clinical Advisor of Community Care of West Virginia (Buckhannon, W.Va.): The right care at the right place and the right time remains the North Star for rural medicine. The ideal setting for healthcare delivery in rural communities continues to evolve, and with rural hospital closures following COVID and other temporary financial constraints, the importance of high-quality outpatient care is increasingly important to ensure access is maintained in these communities, while also being delivered in a financially sustainable model long term.

Amidst evolving market forces, our primary goal is to ensure that the access offered by former inpatient care (e.g., emergency, specialists, diagnostics, etc.) is maintained through innovative approaches such as satellite clinics, specialty referral partnerships and more. The role of technology through remote patient monitoring, telemedicine, and other tools will augment in-person outpatient services. We strongly believe that patients need high-touch navigation services to understand how and when they need to access medical services, particularly advanced care. Ultimately, a dedicated workforce focused on access and navigation will ensure that care is in the right place with the right team for each patient's needs.

As care continues to shift from inpatient to outpatient environments, we remain committed to providing comprehensive and patient-centered services that cater to the unique needs of our rural communities while developing a new rural healthcare workforce to address the diverse needs of patients.

Ellen Feinstein. Vice President, Cancer Service Line Administration of Advocate Health (Charlotte, N.C.): Our organization is continuing to pursue innovation and shifting sites of care to promote growth and respond to evolving patient/consumer preferences.

We have accelerated the deployment of virtual visits and telemedicine through the establishment of a Department of Digital Medicine, and have dramatically changed our care delivery model to improve access to our leading experts.

As outpatient surgeries are moving out of the hospital setting, we are shifting cases to our outpatient surgery departments and are investing in our ASC network to free up inpatient capacity for our most acute patients. We have also been decanting unnecessary ED visits to alternative care sites where possible and effective.

Howard Haronian, MD. Vice President, Chief Quality and Innovation Officer of Hartford (Conn.) HealthCare: Hartford HealthCare is on a mission to be the caregiver of choice for personalized coordinated care. That requires a pivot of focus from hospital acute care to delivering the highest quality care close to home. To support the patient in the most convenient and cost-effective manner, we have invested in state-of-the-art comfortable ambulatory offices across two states. We create multispecialty clinics with embedded onsite services including imaging and lab testing.

Second, we embrace technology that allows us to deliver expertise throughout our ambulatory footprint, reducing reliance on the traditional spoke-hub model. One example is our Heart & Vascular Institute developing a system-wide approach to remote monitoring of heart failure patients, and optimizing enterprise cardiac PACS to support advanced cardiac imaging with our expert cardiologists reviewing at a distance. Third, our ambulatory strategy includes a coordinated systemwide approach to RPM led by clinicians across key specialties.

Reshma Gupta, MD. Chief of Population Health and Accountable Care at UC Davis Health (Sacramento, Calif.): Our outpatient strategy has transformed over the last three years. We have gone full force in developing strategies and infrastructure to support and bring in teams to understand the needs of our patient population from a clinical, social, and equity perspective. This work has involved patient story mapping and gap analyses. The findings from this work have focused our emphasis on developing care pathways and intensive care management programs to keep patients as healthy as possible at home. Interventions and tools that expand the reach of these programs include care at home and digitally enabled care across the spectrum of chronic to acute care delivery.

Asa Oxner, MD. Vice President and Associate Chief Medical Officer for Ambulatory of Tampa (Fla.) General Hospital: TGH@Home is a suite of services that we have launched, including hospital-at-home for patients who qualify for inpatient admission but live within a certain catchment zone that our @Home provider team can reach for daily bedside/couchside rounds, labs, and med drops. This also includes urgent care at home for single acute visits to established patients and our own employees and families as well as home healthcare in the traditional sense of LPNs/RNs conducting visits based on physician orders for IV meds, wound care, or other needs.

Formed a new direct service organization called USFTGP and transferred the employees who staff ambulatory clinics but also our revenue cycle, front desk, call center, referrals coordinators, etc., into this new DSO which has joined the ambulatory primary care and specialty practices from USF and TGH into a single practice infrastructure. There are hiccups in the first year, primarily staffing these types of positions during The Great Resignation, but also joining cultures of existing organizations is a big, big deal. But overall it will unify and standardize our ambulatory operations and make it easier for us to grow in the market.

Angelo Milazzo, MD. Vice Chair of Practice and Clinical Affairs in the Department, Pediatrics; Professor of Pediatrics in the Division of Pediatric Cardiology of Duke Health (Durham, N.C.): In the last few years, we have re-engineered our approach to outpatient practice by designing systems from the perspective of the people we serve. We have always been proficient at managing practice to our convenience, and now we are flipping that script.

Our attention has been focused on broadening access, and many of our newest tools put primary control of that access in the hands of patients. Our electronic health record platform and our online sites are increasingly being applied in the service of lowering the barriers to entry into our system, through innovations including patient-initiated scheduling of appointments (either with or without a pre-existing relationship to our system), automated waiting lists, and scheduled, virtual patient encounters held via secure messaging (in lieu of fragmented back-and-forth messaging between patients and providers).

We are also trying to create a better match between capacity and demand by seeing patients during both standard hours and off-hours; by creating coverage models, as we do for inpatient programs so that provider-initiated cancellations can be reduced; and by incentivizing providers who provide service beyond their expected effort.

Arshad Rahim, MD. Chief Medical Officer and Senior Vice President of Population Health at Mount Sinai Health System (New York City): Our strategy is supported by substantial investments in our ambulatory offering and footprint:

1. We are increasingly focused on home-based interventions whether that is remote patient monitoring for chronic conditions and other home-based offerings such as hospital at-home and palliative care at home. Increased virtual offerings including virtual urgent care and virtual primary care.
2. Bolster and further empower our primary care provider base. Invest in a team-based care model and optimize ambulatory EMR functionality.
3. Invest in ambulatory surgery center ownership.

This is also important to our competitiveness in the employer healthcare market.

Gian Varbaro, MD. Chief Medical Officer and Vice President of Ambulatory Services at Bergen New Bridge Medical Center (Paramus, N.J.): Over the last 3 years we have been focusing on our outpatient strategy as that will be the 'front door' for new patients to enter the system. We have been trying to make it easier for patients to navigate our system and to offer fully integrative care leveraging the full breadth of services we offer.

Chad M. Teven, MD. Reconstructive Microsurgeon and Clinical Assistant Professor of the Surgery Department at Northwestern University Feinberg School of Medicine (Chicago): Recently, mechanisms to optimize outpatient operations at our organization have been a key focus. Facilitated initially in large part by the COVID pandemic, the increasing trend of outpatient healthcare delivery is likely only going to increase. Organizations, therefore, ought to embrace this shift and identify and implement relevant strategies.

For example, many of our patients prefer telehealth evaluation when possible, to avoid long travel distances and other inconveniences associated with the hospital. To address this, resources have been allocated toward IT and EMR-based solutions. In addition, efforts to improve patient's access to appointments and clinic scheduling (i.e., open access scheduling) have likely led to an increase in patient satisfaction as well as clinic volumes.

Similarly, we have leveraged internet-based solutions (e.g., mobile applications) that improve communication between providers and patients outside of the hospital to provide advice and other health information.

Adam C. Haas. Administrative Program Coordinator II, PMO of Cleveland Clinic Lou Ruvo Center for Brain Health (Las Vegas): Over the past three years, Cleveland Clinic's outpatient strategy in Nevada has evolved to further align with the needs and preferences of our patients. For the majority of clinical and non-clinical interventions, we now provide both physical and virtual options, as well as on-demand education and support services. Our patient population has responded well to shared medical appointments, as they value the opportunity to share experiences, difficulties, and solutions. We are looking for innovative ways to reach more individuals with limited resources as patients transition from inpatient to outpatient settings across the globe.

Bill Munley. Administrator of Shriners Children's Greenville (S.C.): Shriners Children's has implemented a plan for the future called Vision 2035. As with most healthcare organizations, we have seen a tremendous shift from inpatient to outpatient surgeries, with a shorter length of stay. Some of our locations have transitioned from hospitals to ambulatory care to better service that they need. Additionally, since our facilities draw from a national and international referral base, we have committed to seeing more kids in more places by implementing additional outreach clinics across the country and around the world, as well as expanding our telehealth capabilities. Our key focus for all initiatives is awareness, education and access.

Natasha Mumford. Controller of The Rehabilitation Institute of Ohio - Premier Health, Encompass Health (Dayton): While outpatient services are not a part of our current service line, facilitating access to these services is vital to the continued progress of our patients as they transition back to the community. The therapy we provide is intensive but acute. Some patients have a longer road to recovery than others and would benefit from additional therapy beyond what they are able to receive during their inpatient stay. In those cases, our therapists will make recommendations for outpatient therapy and our case managers will assist the patient in connecting with those services.

We also coordinate other outpatient services as needed, such as wound care, dialysis, home health, etc. Recent years have brought the demand for convenience and efficiency to the forefront of strategic discussions, and we continue to look for opportunities to better assist our patients, even post-discharge.

Rob Bloom. CFO of Carthage Area Hospital (N.Y.): Outpatient growth is a key component of our strategy. Compared to 2019, outpatient revenue has grown by 25 percent and is now arguably the primary relationship with the community we serve. Outpatient revenue now accounts for 90 percent of the total revenue of the hospital. This growth has been driven by investments in primary and specialty care, as well as lower cost-of-care settings, such as an ambulatory surgery center. Moving forward, a key strategic driver to navigate this environment is a focus on ensuring that the finance, quality, and clinical functions of the hospital are working collaboratively to deliver value to the community.

John Bennett. Chief Ambulatory Operations Officer of UVA Health (Charlottesville, Va): In the first year of COVID-19, many things changed for all of us overnight, including how and where we delivered care. One of the beneficial outcomes of COVID-19 is that it forced the industry to turn more toward virtual care, and we realized how successfully we can deliver care in that medium. UVA Health's Center for Telehealth was already an early pioneer in the virtual care space, dating back to the 1990s, but COVID-19 served as a catalyst for the rapid expansion of those capabilities and corresponding patient adoption.

We were recently awarded a $5 million USDA grant to expand our telemedicine program to rural communities across the Commonwealth where access is minimal; so, for us, virtual care is here to stay and helping us reach new populations. Beyond telehealth, we have focused on our physical expansion through acquisitions of ambulatory services, new partnerships, serving new communities, and opening new ambulatory sites when it makes sense. For example, we recently opened the 200,000-square-foot, state-of-the-art UVA Orthopedic Center. Our future plans focus on more growth in our ambulatory service offerings, including increasing the number of channels in which patients can access our care, both virtually and in person as we continue to build world-class programs.

Jennifer Schneider, MD. Co-Founder and CEO of Homeward (San Francisco): While Homeward is not a hospital or health system, we support rural hospitals through our work as a value-based care provider and our value-based care enablement services. We partner with health systems and providers within rural communities to help them operate in a value-based care environment and allow people to maintain their existing physician relationships while receiving additional benefits, like chronic condition management, through Homeward. Through this unique combination of technology and services, we can close gaps in care and uniquely support care continuity from the hospital to the home.

We are focused on re-engaging individuals who may have not seen a doctor in years or face considerable challenges in accessing care. By delivering proactive care to those who have previously been overlooked, we can identify undiagnosed health concerns and refer high-value services to local hospitals.

Research has shown that uniting a team-based approach with home visits, via in-person or telehealth, can reduce costs, hospitalizations, and emergency department visits, as well as increase patient's overall health and well-being. It also helps maximize the valuable time of physicians and broader care teams by reducing travel and administrative burden.