The health care industry straddles a delicate line in the business world. On one side, it must uphold its responsibility for the community’s wellness, and on the other side, it has to turn a profit (it is a business after all). In order to be successful, health care providers have to respond to the changing habits of the population they serve, whether it’s investing in new technologies and research or bringing services closer to home, in the hopes of becoming the preferred provider when a person becomes a patient.
Looking around New Jersey—and the whole country really—health care is booming. In the U.S., we spent approximately 17% of the gross domestic product (GDP) in 2019 on health consumption, a number that is expected to rise in 2020 statistics. It’s the highest among all developed countries. A report from New Jersey’s Department of Labor and Workforce Development shows the “health care cluster” contributed more than $44 billion to the state’s GDP in 2019, a little more than 7%. The industry adds jobs every year, with ambulatory health care services surpassing hospitals as the top employer in the sector.
The industry has faced challenges never before seen, dealing with a public health emergency while also staying the course on its larger plans for the community. This once-in-a-century event has changed the course of health care forever, taking future-forecasted trends and making them a reality practically overnight, causing providers to innovate and reach patients in new ways. Health care may be changing, but for the better, and South Jersey’s patients are well-positioned to reap the benefits.
The Pandemic Pivot
Ask anyone in health care the No. 1 long-term change in the industry caused by the pandemic and their answer will be “telehealth.”
“Any transformation that had been happening in health care suddenly accelerated in the pandemic,” says Brian Sweeney, president and CEO, Jefferson Health – New Jersey. “Prior to the pandemic, we had invested in telehealth for years, trying to get it widely adopted, but it was slow to evolve. Even though we promoted it, adoption was low. Then the pandemic happened and there was no choice but to embrace it.”
John Matsinger, D.O., chief operating officer of Virtua Health, says it felt like implementing 10 years of innovation in 10 days. “We had to switch to telehealth almost overnight. We relied on it heavily during the pandemic and we continue to rely on it. It’s here to stay,” he says.
Fear of change had potentially been holding both providers and patients back from embracing the technology. “One of the biggest lessons we and other health care organizations learned throughout the pandemic was how quickly we should—and could—change how we provide care to better serve our patients. We learned that we could provide care from within the home, using telemedicine or home care,” says Mary Ann Yehl, D.O., medical director, telemedicine and ambulatory quality, AtlantiCare. “We do not foresee the industry going back to the ‘old way.’ Based on national trends and what we have experienced, we anticipate that telehealth will continue to be a vital part of getting and giving care.”
Any concerns about telehealth creating disconnect between patient and doctor, or being a barrier for the older generation, proved unfounded. As someone who deals with patients at their end of life, Dr. Stephen Goldfine, chief medical officer of Samaritan, remarks that he was skeptical about its success, but admits that using the technology didn’t inhibit difficult conversations, but was actually an aid in the process.
“I had always heard telehealth wouldn’t work with the elderly population. I found that not to be the case. It wasn’t a barrier at all and actually created more engagement with families and patients at a time when there could not be in-person visits,” he says. “Even now, we’re still doing telehealth visits and I have been shocked at how we’re able to maintain deep relationships.”
Virtual meetings have also been a positive for leaders within an organization who would have otherwise spent valuable time and money traveling. Thomas A. Dwyer, M.D., is the president/CEO of Premier Orthopaedic Associates, with nine locations across four counties in South Jersey. He says the pandemic’s limits on in-person meetings paved the way for Zoom meetings. “We have nine locations and if we want to get together for a meeting it would require a good deal of traveling,” he says. “But now, we realize we don’t need to do as much in person. All we have to do is set up the technology and host our organizational meetings in Zoom format and it saves stress, time and probably money too.”
As much as the continuation of quality care has been emphasized in the last 18-plus months, from a business perspective, the pandemic has also revealed certain risks for loss of revenue, namely in emergency room visits.
“When you look at the ER, it went way down. People were not coming in and that has rebounded in the past six months but it’s never going back to where it was,” Sweeney says. “There have been permanent changes to the delivery system for those with lower acuity type complaints and they aren’t coming back.”
Joseph Chirichella, president and CEO of Deborah Heart and Lung Center, recognizes this fact too. “There are some opinions that ER visits in 2022 will get closer to the 2019 volume, and others say no. I think they are gone forever and they have found a new home, whether they are being managed by telehealth, ambulatory centers or have opted for a competitor that entered the market,” he says. “I think this would have happened with or without COVID; it was a natural evolution.”
For patients though, this isn’t bad for their health, Sweeney recognizes. “We need to be focused on getting patients to the right site of service. We’ve seen that we can do a lot of surgeries in the outpatient setting, which lowers the cost and makes it more efficient. That’s a positive.”
The New Frontier of Care
Along with telehealth, providers have found other ways to connect with patients outside of the traditional walls with the help of technology, many of which are predicted to be the new norm among certain populations.
Within the industry, the term “digital front door” aims to bring patients seamlessly through their health care journey, beginning with scheduling an appointment. Amy Mansue, Inspira Health’s president and CEO, says, “We know that many people live their lives online, so we have created a digital front door that allows most health care conversations to begin online. Whether it’s booking an appointment with an Inspira Medical Group physician, asking your provider a question, getting appointment reminders on your phone or signing up for classes on our website or app, we have made it quicker and easier to connect with us.”
Online communication has become common in nearly every other industry, so why wouldn’t it be expected in health care, posits Matsinger. “We want convenience in all aspects of our life and medicine is no different. In-person, virtual, secure texting—I think all of those things have to come into the mix and make sure we’re meeting patients where they want to be and when they want to be met,” he says.
Chirichella says the look of health care will be influenced by the next generations. “As baby boomers evolve out of the health care system, Gen X and Millennials will redefine what bedside manner is. Boomers were a high-touch generation that preferred shaking hands and hugging, and I’m not sure if the other generations need that but they still want a connection, just not in the conventional way,” he says. “There’s no reason that patients shouldn’t be able to log onto an app and renew prescriptions or message their physician if there is a change in symptoms and get feedback directly about a change in dosage or a request to come in for further testing. … Providers need to adapt and it’s likely they will be peers of those age groups and comfortable with a reliance on electronic exchanges.”
Deborah and other providers are also entering a new frontier of remote patient monitoring, which allows patients to use different technologies and devices in their own home to capture health metrics that are then transmitted to the health care provider. This technology is likely to branch out to a wide range of patient populations.
Inspira found it helpful for treating patients with COVID-19. “We began by offering [remote patient monitoring] to people with chronic illnesses such as diabetes and heart failure. Early in the pandemic we quickly pivoted to use this technology to help safely discharge patients with COVID-19 sooner,” Mansue says. “With real-time monitoring, instant access to a nurse and prescribed health actions (e.g., taking a pulse ox reading) we were able to send some patients with COVID-19 home earlier. The technology helped make the patient and the physician comfortable that a safe recovery at home was possible.”
Matsinger says this technology was crucial in helping Virtua navigate the surges in COVID patients. “If we could send them home earlier with monitoring, it freed up beds and helped us catch our breath.”
The prevalence of personal wearables like the Apple Watch offers more opportunity to tap into this technology, Chirichella believes. “Some Apple Watches have been able to detect arrhythmias, but they are not connected to a provider. That’s the Holy Grail, to have a provider monitoring you through the wearable and contact you directly when something is off. … I think in short order that will come to the market either for free or with a subscription service.”
The larger goal, Yehl says, is integrating the information from these apps into EMRs, electronic medical records.
“Everyone has a tool or app in health care,” adds Sweeney, “so how do we reel it all in for a total view? If a patient saw an independent physician outside of our network or went to urgent care, how do we see that as well? We want to pull in the whole story [to their EMR] in a secure way.”
Competition and Consolidation
The decades-long trend of consolidation and mergers is not expected to change.
Jefferson just marked its fourth anniversary of its acquisition of Kennedy Health System. Sweeney feels this brought a host of benefits to South Jersey. “We made promises and have accomplished many things already, one of which was building more advanced programs and services in New Jersey. We have made huge capital investments with the new patient pavilions in Washington Township and Cherry Hill, projects that kept on pace and were completed on schedule and on budget during the pandemic,” he says.
The organization has also committed to keeping patients local, bringing more specialized services to this side of the bridge, including recruiting physicians for GI, ENT and neurosciences, and opening the Sydney Kimmel Cancer Center in Washington Township.
Matsinger says Virtua’s merger with Lourdes in 2019 was a pivotal moment in its history. “It totally changed our organization. Becoming a fully integrated health network made us stronger and better helped us through the pandemic,” he says. “Lourdes brought us tertiary capabilities we didn’t have. People needing life-saving measures who would have otherwise had to go across the river were able to stay in their own community.”
This is the changing reality of health care, and Matsinger says it’s not just mergers and acquisitions, but partnerships too. Virtua is currently partnering with Penn Medicine and Oncology to open a proton therapy unit in Voorhees in the near future.
“For Inspira, mergers and partnerships have allowed us to grow our services so that more people in our region have access to quality care close to home, including more specialized care than ever before,” Mansue says. “Our Deborah F. Sager NICU in Vineland, our comprehensive cancer centers in Mullica Hill and Vineland and our robust minimally invasive/robotic surgery program are good examples of this growth. Our partnerships with Nemours for pediatric services, Cooper for cardiac services and Bayada for homecare and hospice all bring our communities increased expertise and access.”
Deborah is unique however in that it remains independent. “I’m not so convinced that giant systems demonstrate better outcomes or lower costs. The data isn’t there yet,” Chirichella says. “In our history we have never balance-billed patients, everyone gets the same care as long as medically appropriate with no bill. I’m not sure if we merged that would stay in place.”
As these collaborations continue, nationwide physicians have been leaving their private practices for years, seeing the benefits of joining a health system, says Sweeney. “It’s tough to be a small physician’s office and provide care to patients while managing all the realities of running a business—billing, the regulatory environment, compliance, Medicare and Medicaid. Physicians want to provide care and not get bogged down by the nuances,” he says.
In August, Cooper University Health Care announced the formation of Cooper Care Alliance, its second physicians group of community-based doctors employed by Cooper to complement its existing academic medical group.
Dwyer says he recognized 15 years ago that the only way a private orthopedic practice could negotiate with large national payers would be expanding his footprint. “Our primary objective is to provide state-of-the-art orthopedic care to the community and we have to make sure to do it in a cost-effective manner, which requires us to maximize our contracts with payers. … A small company with one location has no leverage with a large insurance company, but a large company with a large number of providers covering numerous counties—insurance companies are far more likely to sit down and negotiate.”
Premier has partnered with Inspira with respect to orthopedic surgery. Dwyer says Premier’s partnership has fostered collaboration on several joint ventures that have been mutually beneficial, including negotiating insurance contracts and adding physicians and locations to better serve the health system’s geographic area.
“Initially we would be considered competitors but now we realize there is strength in numbers and together we can both benefit from decreased risk and exposure,” Dwyer says. “And for the patient population, we can now provide university-quality medicine in their own backyard.”
What the Future Holds
Even with the pandemic still taking a toll on the people in the health care industry, providers have to constantly be thinking about the next public health crisis. For many, this means getting involved in issues that haven’t traditionally fallen under their purview, including food insecurity.
Virtua launched a mobile grocery store late last year, bringing fresh, healthy food into food deserts, in addition to its mobile farmers market. The organization also has two food pharmacies where patients can fill prescriptions for food and dietary counseling to help them stay healthy.
“We continuously assess the needs of our community including social determinants of health of food insecurity, lack of secure, safe housing and transportation and other issues,” says Yehl. “We have long focused on these issues. We provide transportation assistance, offer a food pantry and are working toward housing solutions. Involving community leaders and other stakeholders in addressing and solving for these issues remains paramount.”
Behavioral and mental health is a shared concern as well, something that has been exacerbated by the pandemic. “The data showing increases in anxiety, depression and suicide is just shocking,” says Sweeney. “We have to come together as a community because this is a real issue and the consequences are very concerning.”
“The business of health care has to span both well care—keeping people healthy—as well as diagnosing and treating illnesses, and this spectrum has to cover traditional health care and behavioral health. Large organizations are looking at this with a new awareness,” Chirichella says.
This is evidenced in Cooper’s January 2021 opening of The Recovery Village Cherry Hill at Cooper, a new, 90-bed inpatient drug and alcohol treatment center in Cherry Hill, in partnership with Advanced Recovery Systems (ARS).
The community’s needs will continue to be the deciding factor in how health care delivery succeeds in a consumer-centric environment. Ten years from now, that may look very different.
“I think we will not recognize health care in 10 years,” says Mansue. “The consumers’ expectations are entirely different. They want to access health care as they define it. They are going to expect services at home and will be receiving so many more services in the outpatient arena than we see today. It is a very exciting time to be in health care. … Advances in technology will continue to make new ways of delivering care possible.”
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Published (and copyrighted) in South Jersey Biz, Volume 11, Issue 9 (September 2021).
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