Executive Summit 2024 Performing today while transforming tomorrow

How do you build a plane while you’re flying it? This was the central challenge posed to more than 200 CxOs from 170 providers across 40 countries gathered in Munich on October 21-22 for the Siemens Healthineers Executive Summit. Health systems globally face down spiraling costs, rising disease burdens, ageing populations and workforce development. Closing down for renovations is not an option, nor is carrying on until everything breaks - so how do we deliver for patients today and transform for tomorrow?

CommonSpirit Health is the result of the 2019 merger of two healthcare systems: Dignity Health and Catholic Health Initiatives. “Our goal is to keep the best of both organizations and create a unified culture, but that doesn’t mean it needs to be uniform,” said Lassiter. Driving efficiency and change requires helping people understand why these initiatives are essential, while also encouraging innovation to surface. 

Does bigger always equal better? “There’s no advantage to scale unless you make purposeful decisions,” said Lassiter. CommonSpirit has built its own group purchasing organization, which is expected to save millions in operational costs over the next two years. Where it used to have 1,200 different patient call centers to manage access, there are now just a handful. Investments in the right technologies and processes with clinical command centers and virtual intensive care units have also enabled the system to leverage its scale. 

Yet, size, mission and technology are still not enough to tackle mounting workforce challenges. The system has created a center to train and upskill its staff which provides better career paths and economic stability. “This is where partnerships to assist in upskilling can make an impact,” said Lassiter.

The ability to scale initiatives is fundamental to achieving healthcare equity, but scale isn’t easy to achieve, especially in a highly fragmented and regulated sector such as healthcare. As health systems pivot from sick care to predictive, predictive, personalized, and participatory clinical management, there are certain key levers for scale.

Denise Santos, CEO of Beneficência Portuguesa (BP), a four-hospital group in São Paulo, Brazil highlights the role of Public Private Partnerships (PPP). Leveraging Brazil’s 5G infrastructure and partnering with the SUS (Sistema Único de Saúde) public health system, BP is delivering more than 80, 000 telemedicine appointments per month including to remote parts of the Amazon. Providing ultrasound and ECG services in these widespread regions has accelerated diagnoses from 200 days to a matter of hours, explained Santos.

In another PPP project with the Ministry of Health and Hospital Israelita Albert Einstein, BP is mapping Brazil’s genomics to improve public policy and deliver targeted prevention programs, with a particular focus on oncology and cardiovascular disease - the latter causing 30% of deaths in Brazil. Attempting to map the genome of 200 million people is a daunting task that no single entity can tackle alone. “This project is a serious investment in prevention, far beyond calling people to get tested,” said Santos.

Participation remains the central challenge for Santos, who noted that even the COVID-19 pandemic hasn’t catalyzed a large enough change in people’s habits to manage their own health.

“A really great health system needs to get the population to participate in prevention and education is essential to that,” said Manuel Bosch, Chief Transformation Officer at Ribera Salud.

Spain’s Ribera Salud is a 13 hospital, 14 primary care and 60 outpatient center group that operates within a capitated payment system, receiving a fixed annual amount for each citizen’s care. This approach incentivizes preventive measures and pathway designs that prioritize early detection, ultimately leading to substantial cost savings.

Bosch laid out its prevention model which leverages technology, AI and large data sets. It groups patients into 17 different layers of care needs and more than 200,000 care plans. Predictive models are then used to track easy data points like clinical worsening or readmission rates, and complex advanced predictions are made using biomarkers. Bosch said that this has enabled them to predict breast cancer 9-18 months earlier, reducing the need for high-cost interventions.

How can we be sure that this upfront investment is really working?

Bosch said that public audits show 90-95% of patients are satisfied with their outcomes. Compared to its peers, Ribera Salud has achieved a 20% reduction in primary care referrals and a 50-60% reduction in readmission rates for high-risk patients. In the region of Valencia, Bosch said Ribera operates at 20-25% lower cost compared to others.

Healthcare exists to serve patients, their families, and their communities, but systems are designed around how it wants to serve them rather than how they want to be served. Service models in all other aspects of a patient’s life have shifted to meet a broad range of demands and needs, so how can healthcare models shift to address patients as consumers? Following a cancer diagnosis that gave her just a 3% chance of survival and months to live, Caroline Justich founded Be accepted, a platform to empower cancer patients. Today she chairs the European Society of Radiology’s patient advocacy group. Through a combination of sheer determination to live, access to a top radiologist in the U.S., and enduring intensive therapy, she beat the odds and 8 years later remains cancer-free. But not everyone starts with this same fighting chance.

Delivering patient-centered care relies on a mindset shift where leaders, clinicians and caregivers must actively seek and integrate the patient’s perspective into care pathways. Triggering a mindset shift is not easy, but seeing is believing. There is a wealth of easily obtainable and untapped data points at providers’ fingertips, which demonstrate the true economic and quality value of redesigning care models. 

Northwestern Medicine, a $10 billion, 11-hospital, academic medical center based in Chicago, sought to deliver a transparent, easy, service-like experience that patients expect in all other areas of their lives to healthcare. “I can get from one side of the world to the other, know the weather, directions and where my bags are far more easily than I can get a dermatology appointment,” said its CEO, Howard Chrisman. Northwestern established new processes based on segmenting patients into three groups, leading to huge gains in efficiency, patient reported experience, and patient throughput. Chrisman said they had hardwired this new culture through data and built performance teams to identify and fix problems. Northwestern is also engaging clinicians and deploying technology to think about ways to further drive efficiencies around the patient.

“We need to break the culture so that patients receive care when and how they want it, not when a doctor wants it,” said Jesper Erdal, Deputy Chief Executive of Mary Elizabeth’s Hospital, a new children's hospital belonging to Copenhagen’s largest teaching hospital, Rigshospitalet. This thinking was applied to designing their new building. From designing workflows, so the patient stays and clinicians come to them, to smaller details like lighting and furniture, each aspect tested was redesigned and tested again with patients and their families. Beyond meeting patients in person, Rigshospitalet recognized that both clinicians and patients value remote consultations. With equal reimbursement for virtual and physical appointments given by the Danish health authority, Rigshopitalet now conducts half a million virtual consultations a year, saving money for both the hospital and the patients. 

Remote patient monitoring is the key to driving further cost saving through the evolution of outpatient care into home-based care. The first obstacle to wider adoption is convincing clinicians to accept it. Ravi Sachdev, Chief Clinical Informatics Officer at Singapore’s Tan Tock Seng Hospital explained that this was the biggest challenge when it introduced its virtual care offering particularly around the idea of a remote physical examination. 

The end goal for remote patient monitoring will be reducing the complexity for patients and converging on a single device, the smartphone, where patients already control nearly all other aspects of their lives. Although current consumer and medical devices face challenges in delivering comparable clinical quality, Sachdev envisions a future where technology converges, enabling smartphones across various price points to provide consistent, high-quality care and democratizing access for all patients.

The UK’s National Health Service launched in 1948; the first universal health system, free at the point of care in Western society. But a recent independent report by Lord Darzi, commissioned by the UK’s new Labour government, found a broken system. The NHS was introduced because the disease burden at the time represented a barrier to progress, much like the rise of non-communicable diseases today. How can this enormous and talismanic health system transform to ensure it lasts another 78 years? 

The Right Honourable Patricia Hewitt, former Secretary of State for Health and Chair of NHS Norfolk & Waveney Integrated Care Board, points to the importance of smart and well thought out investment as a foundation for transformation. “There will never be enough money to meet everything the system needs, so we need to use money in a smart way looking at the system as a whole instead of patching in an uncoordinated fashion,” she stated.

The new government has stated that the NHS needs reform, or it will die. The plan is to push more into the community, get serious about prevention, and to support this plan with a robust digital infrastructure. In a system which exists to serve a community, the voice of that community and the ability to express its specific needs is essential to transform care. 

“The move to community care is core to the preventative agenda,” said Sir David Sloman, former Chief Operating Officer at NHS England. For Sloman, digitalization and empowering the patient to take more control over their health is pivotal and the momentum brought about by the Covid pandemic should be leveraged. There is no silver bullet to deliver transformation, it requires hard work, strong leadership and partnering with experts where needed.

Healthcare is all about people but as patients increase, the workforce is flatlining with a predicted shortfall of 18 million workers globally by 2030¹That is just over five years away. So how do we bridge this workforce gap to recruit, retain, and engage talent across multiple generations? 

Northwell Health is New York’s largest private employer with 85, 000 people spread across 21 hospitals and 900 outpatient facilities. Matthew Kurth, Deputy Chief People Officer shared that depending on the timeline for workforce need, the group deploys a build, buy or borrow approach. “Our focus is on the workforce we will need in the next three-plus years and how we get really good at workforce planning,” said Kurth. 

Once you’ve bought, borrowed or built a workforce, how do you keep them? Kurth believes the biggest lever for retention is empowering frontline leadership: “We need to remove the administration burden. You want your nurse managers out on the floor coaching other nurses and not sitting in an office behind a desk, focusing on scheduling.” He strongly believes in the power of AI to reduce this burden and shared that Northwell is developing a large language model platform to unify its non-clinical administrative systems, enabling staff to access everything through a single login.

Aldo Rolfo, Executive Manager for Growth at Australia-based, global oncology platform ICON Group, outlined a four-pronged approach to workforce strategy: role evolution, role revolution, digital enablement and leveraging its global scale. The latter is helpful in Asia and Australia, where there are significant workforce gaps. ICON Group is able to use its global scale to alleviate the strain of workforce shortages by flying clinicians to where they are needed. Its role evolution program seeks to offer a pathway where people join as administrators and, through partnerships with universities and other stakeholders, creates career pathways and training opportunities. Rolfo stated that ICON Group aims for 25% of its roles to be filled in this way.

Ensuring that health systems are financially sustainable is crucial, but if the surrounding environment is neglected, then the future of these systems is at risk. Healthcare is responsible for nearly 5% of total greenhouse gas emissions, and climate change is a significant health issue that threatens many lives, drives disease, and threatens communities. This will not come as a shock to healthcare leaders, but how many are equipped with the tools and knowledge to significantly reduce carbon emissions?

Alison Santore, EVP and Chief Administrative Officer at Providence, a $26 billion health system with 51 hospitals and 1,000 clinics, spanning 7 U.S. states including Alaska and Texas (two states which are severely impacted by climate change), has committed to being carbon negative by 2030. Santore argued that “reducing carbon emissions is not just a moral imperative but it is actually a solid business investment.” She explained that Providence has already reduced emissions by 20%. This includes shifting 100 of its facilities to run on 100% renewable energy, resulting in an annual cost saving of $10 million.

Not all geographies start the path to net zero on equal footing. Fola Laoye, Co-Founder and CEO of Iwosan Investments, which owns a 35 hospital system in Nigeria, said that most of their facilities rely on diesel powered generators in a country where many homes rely on coal or wood. “Our growth is based on our ability to deal with energy,” said Laoye. In Nigeria, working to reduce carbon emissions in the supply chain can also be a challenge, particularly finding equipment that will work with solar energy. Iwosan has paired sustainability metrics with quality metrics to incentivize change and Laoye said “our model is to grow through acquisition, sustainability is at the bedrock of every conversation and we’re developing a toolkit that we can use when we acquire a new group.”

Ronald Lavater, the CEO of the International Hospital Federation, believes leaders need support to develop the capacity to address this specific challenge: “Running a hospital today requires the ability to think outside your own four walls and find solutions through partnerships and collaboration.” Lavater said, that the biggest carbon footprint comes from the purchases of healthcare leaders, making isolated efforts on sustainability insufficient. On the topic of how to engage the workforce to drive sustainability, Lavater pointed out that it is just a matter of time and persistence. “When reporting patient safety data figures was first introduced, people resisted it, but can you imagine not reporting patient safety numbers to your board today? It is the same thing with the introduction of sustainability,” said Lavater.

Success in any growth strategy depends on understanding strengths and the areas needing support. Building meaningful partnerships requires efforts to ensure that initial objectives remain aligned throughout the relationship. In healthcare, partnerships are essential - whether for financing, technology, treatment, or patient care pathways. So, what does it take to succeed and how do you measure benefit? 

“Partnering is a muscle that all C-suite executives need to keep exercising,” stated Jonathan Curtright, Chief Operating Officer of Oklahoma University Health (OU Health). OU Health, as a public research university, has a critical relationship with the state government. Alongside expectations for research, the state expects OU to train more healthcare professionals with the aim of retaining staff. “You need to be able to clearly define the relationship, be transparent, and be aligned on the ‘why’. A sign of a great partnership is when each side is cheering for the other to win,” emphasized Curtright. 

Abrar Mir, Co-Founder and Managing Partner at Quadria Capital, a private equity firm focused on healthcare in Asia, said that in its markets partnering with Private Equity is a necessity as the disease burden and access challenges are too great to overcome alone. “Asia is different, and the private sector is leading the infrastructure building. It isn’t just a sector; it is a lifeline,” said Mir. In Indonesia where Quadria owns Hermina Hospital group, the average income is less than $15 per day, 70% of adult males smoke, there is little access to social security and there are just 36 interventional cardiologists amongst a population of 240 million. “Our business models are based on volume, maximizing efficiency and patient throughput so partnerships with technology to handle volume is essential,” Mir stated.

Nova Scotia, Canda’s eastern most province, has a population of approximately 1 million people and since 2015, the province’s healthcare is managed by Nova Scotia Health (NSH), a public integrated payor and provider. In 2021, the newly elected provincial government sought to make wholesale changes to its health service and appointed Karen Oldfield as CEO.

As is the case with many healthcare systems, NSH needed doctors. In response to this challenge, it opened a new medical school focused entirely on rural family medicine, and NSH worked with schools in the province to increase training seats. Beyond improving education and training, the Nova Scotia government passed legislation permitting doctors who are licensed to practice medicine in any country on Earth, to also practice medicine in Nova Scotia.

To increase access, NSH launched a virtual care service which now conducts an average of 70,000 appointments a month. Additionally, they created an app that is used by more than half the population, they established more mobile clinics and opened more urgent treatment centers. Access is not the only element NSH wanted to improve, they also wanted to look at how to leverage technology to provide a better patient experience. Oldfield shared that an investment in precision radiotherapy equipment has enabled them to take the average number of radiotherapy appointments down from 20 to just 5, which in a rural area saves patients time and money traveling for treatment, additional it eases the physical toll on patients from multiple treatments.