Designing our Future: Hospital Leadership
in Innovation and Transformation
LHA 2019 Rural Health Leadership Conference
Andy Shin
Chief Operating Officer
AHA Center for Health Innovation
November 7, 2019
Disclosure of Relevant Financial Relationships
The following faculty of this continuing education
activity has no relevant financial relationships with
commercial interests to disclose:
Andy Shin
Redefining the healthcare ENVIRONMENT
Cultivating new MINDSETS
Reimagining the PRACTICE of healthcare
Collaborating through an ECOSYSTEM approach
Leading with COMPASSION
Transformational healthcare leadership looks like…
AHA Agenda for Innovation And Transformation
• Public PolicyLong-term policy planning
• Center for InnovationThe Value InitiativeMarket intelligenceEducation and learningBuilding innovation
capacityTools, data and products
• Field EngagementNew methods of
engagementEngaging other
stakeholders
• Best-in-Class Operations
Developed to enhance assistance and value to our members in this rapidly changing environment.
Encourages fluidity between the areas of public policy, innovation and field engagement to leverage all aspects of the AHA.
All areas of the AHA are working together through the One AHA approach to advance members’ priority issues at the center of our work.
The goal: To assist members in a seamless and simplified way, getting the field the tools and resources they need to achieve optimal health in their communities.
AHA Agenda for Innovation And Transformation
Innovation [in-uh-vey-shuh n]
noun, verb
One possible definition:
• The process of taking new
‘ideas from inception to
impact’
• An ‘idea’ is the match
between a problem and a
solution
• The process is critical, not
products or services
Services are aligned to assist members in 3 areas
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Redefining the Healthcare
Environment
“The two things you don’t want to be running, for the next ten
years are… academics and healthcare”
-Austin Goolsbee (The Forbes Napa Conference), August 2013
IS BEING “SIMPLY THE BEST” ENOUGH ANYMORE?
…OR DO YOU HAVE TO BE UNIQUE?
…and make trade-offs!
When your smartphone replaces the entire store
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We don’t decide who our
competition is…
THE CONSUMER DOES.
2018: A Year of
New Entrants
2019: The
“potential”
disruptors
have a name
Healthcare is Prime for Disruption
Patient Expectations
Consumers of health care expect an
experience similar to other industries where
access to services and information is easy,
convenient and on their terms
Changing Incentives
The shift from fee-for-service to value-
based-care is changing the roles the
various sectors in health care play as
well as how they interact with one
another.
Complex Care
Advances in science and medicine are
increasing the complexity of care delivery.
Meanwhile, changing lifestyles and
increasing life expectancies are leading to
further complicated diseases and conditions.
Rising Costs
With health care expenditures
representing nearly 20% of GDP, there
is opportunity to capture revenue as
well as reduce costs.
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Hospital & Health System Disruptor Framework
Hospitals
and Health
Systems
1. Technology-based
Innovation
3. Market Structure
Transformation
Big Tech:Amazon, Google, Apple, Microsoft,
Epic, IBM, etc.
Startup Tech-enabled Services:Babylon, Virta, Omada, Cricket,
Livongo, Pear, etc.
Virtual Care Providers:Teladoc, American Well, MDLive,
InTouch, Doctor on Demand,
SOC Telemed, etc.Vertical Integrators:
CVS/Aetna, United/Optum,
Walmart, Cigna/Express Scripts
Payer Organizations:Oscar Health, Devoted Health,
Clover Health, Bright Health, etc.
2. New Model Organizations
Provider Organizations:One Medical, Cityblock, Landmark,
ChenMed, Contessa, etc.
Source: AHA Center for Health Innovation Market Insights
https://www.aha.org/center/emerging-issues/market-insights/year-in-review
THE NEW HEALTHCARE STRATEGY
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Cultivating New Mindsets
“If every instinct you have is wrong, doing the exact opposite must be right”
- [Paraphrasing] George Costanza (Seinfeld)
““
In the word question,
there is a beautiful word – quest.
I love that word.
Elie Wiesel
22
A Quest for Catalytic Questions…
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DISCOVERY
SKILLS
4 Year Olds- 95%
Novelty Rate
Adults- 5% Novelty
Rate
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If failing is so
great…
should we aim
to fail?
““
- Ed Catmull, President of Pixar and
Disney Animation Studios
To be wrong as fast as you can is
to sign up for aggressive, rapid
learning.
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Reimagining the Practice of
Healthcare
"We're delivering, perhaps, 'Star Wars' solutions into a 'Flintstones'
health care system,"
- Dr. Freda Lewis-Hall, Chief Medical Officer, Pfizer
Digital Health
28
Digital Solutions Make for Good Headlines
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Digital as a New Asset Class
Source: AHA Center for Health Innovation Market Insights
https://www.aha.org/center/emerging-issues/market-insights/telehealth
Virtual Care is
Critical to
Transformation
Age dictates what patients value in their
healthcare consumption which closely relates
to attitudes towards AI
Retirees Millennials
Lack a Primary
Care Doctor15% 33%
Desire for Greater
Physician Attention71% 41%
Positive View of AI 82% 72%
Source: AHA Center for Health Innovation Market Insights
https://www.aha.org/center/emerging-issues/market-insights/ai
33
Don’t forget
about low tech-
high value!
What is Our Goal?
Goal: Build a social movement so all care with older adults is
age-friendly care:
• Guided by an essential set of evidence-based practices (4Ms);
• Causes no harms; and
• Is consistent with What Matters to the older adult and their family.
Our first aim is to reach 20%: 1000 hospitals & 1000 primary care
practices by December 31, 2020
Age-Friendly Health Systems
The 4Ms Framework
4Ms Framework: Hospital
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The Dual Process Model
39
Pattern Matching
Infrastructure
Culture
Strategy
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Collaborating through an
Ecosystem Approach
“When an industry with a reputation for difficult economics meets a
manager with a reputation for excellence, it is usually the industry that
keeps its reputation intact.”
— Warren Buffet
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• 71% will increase
collaboration with other
providers and payers on
population health
• 80% will increase
investments in behavioral
health services
• 74% say 10%+ of their
patients will be covered by
risk-based contractsSource: Society for Healthcare Strategy & Market Development. Futurescan 2018-
2023: Health Care Trends and Implications. American Hospital Association
9 out of 10 Americans have health insurance,
but out-of-pocket expenses for premiums and
deductibles are growing faster than overall
inflation and earnings
Individual Perspective
Source: Kaiser Family Foundation. 2017 Employer Health Benefits Survey.
The Average worker
spends almost $6,000
each year on health
insurance for a family
plan.
Insurance Expenditures Growing
Source: Kaiser/HRET Surveys of Employer-Sponsored Health Benefits
On The Rise
The number of Americans with chronic conditions is rapidly rising
Source: Robert Woods Johnson Foundation. Chronic care: making the case for ongoing care. February 2010.
Number in Millions
Impact of social determinants of health
The role for hospitals and health systems
Partnering with Other Stakeholders in
the Healthcare Ecosystem
FORMING A COMMON
IDENTITY + PURPOSE
Atrium Health and Novant HealthCharlotte, North Carolina
What: One-year demonstration project to
advance health equity through hospital and
community group partnerships for place-
based interventions
Who: 10 anchor hospitals across the
country
Support: technical assistance partners
The Hospital Community Cooperative
Moving to Value
55
Blue Premier is “Leap Forward” for Risk-Based Payment
Hospital Partners
• 2-sided risk arrangement, within 3 years
(shared savings model)
• Up to 2% increase in fee for service
payments
• In 5 years, all 4 million BCBS NC
members will be attributed to a risk-
based contract
Non-affiliated physician practices
• Practices join BCBS NC ACO
program
• Infrastructure (including data) support
from Aledade
• Goal of > 10% spend on primary care
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Leading with Compassion
“Compassion is not a virtue. It is a commitment. It’s not
something we have or don’t have. It’s something we
choose to practice.”
- Bren ƴe Brown
• 77% say workforce shortages likely
to be one of the 3 most significant
challenges facing their organization
• 88% likely to implement strategies
such as increasing staff engagement,
raising salaries or expanding their
recruitment budget to compete for
talent with emerging providers
• Approximately half of all physicians
who work in a care delivery setting,
report being burned out
Source: Society for Healthcare Strategy & Market Development. Futurescan 2019-2024: Health Care Trends and Implications. American Hospital Association
Sexton JB, Adair KC, Leonard MW, Frankel TC, Proulx J, Watson SR, Magnus B, Bogan B, Jamal M,
Schwendimann R, Frankel AS. “Providing feedback following Leadership WalkRounds is associated with
better patient safety culture, higher employee engagement, and lower burnout.” BMJ Quality & Safety. 9
Oct 2017.
WELLBEING ∝ SAFETY,
QUALITY, INNOVATION
CAPACITY…
Bohman, B. et. al. “Physician Well-Being: The Reciprocity of
Practice Efficiency, Culture of Wellness, and Personal
Resilience.” NEJM Catalyst. April 26, 2017.
https://catalyst.nejm.org/physician-well-being-efficiency-
wellness-resilience/
ADMINISTRATIVE CLINICALRelationships
Communication
VISIONMISSIONGOALS
Institutional Management Patient Management
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What Will Be Your Leadership
Legacy/Signature?
• Possible Self
• Storytelling
• Authenticity
What/Who Shaped Your
Leadership Identity?
• Family, Faith, Friends…
• Inter-personal
• Empathy
How do you Lead today?
• Crucibles of Leadership
• Diversity & Inclusion
• Leading on the Edge of
Uncertainty
“Anxious Eyes”
James Stanfield, 1987
“Anxious Eyes”
@shinovation
www.aha.org/center
Thank You for Helping Us To Achieve Our
Highest Potential for Health