With COVID in our lives for nearly two years, the most progressive healthcare organizations see handling the virus largely in their rearview mirrors. Now the work involves implementing the lessons learned from the global pandemic and determining how to remain viable while losing fatigued and disillusioned talent. We asked leaders from a diverse set of companies to weigh in on their priorities and strategies for 2022.

What’s your biggest challenge and greatest opportunity?

Gregory Deavens: Adjusting to the uncertainty of the pandemic. We’ve been very purposeful, and I think successful, in responding to changing needs, but it’s been a roller coaster. The Blue Cross Blue Shield Association has a national strategy to create a more equitable healthcare system. It focuses on four conditions that disproportionately affect communities of color: maternal health, mental health, diabetes and cardiovascular conditions. We are working with local providers to address those challenges. Our subsidiary AmeriHealth Caritas just launched a new company called Social Determinants of Life. AmeriHealth Caritas also invested in Wider Circle, a tech-enabled health organization that connects neighbors for better health.

Michael Dowling: All challenges are opportunities. Certainly, the threat of COVID variants will be with us for the foreseeable future, but it will be especially important in the year ahead to stay engaged with staff and maintain high morale among front-line caregivers. Given the strain our staff has been under in dealing with COVID resurgences, it’s imperative that we make their physical and emotional well-being a top priority because high employee engagement correlates closely with patient satisfaction. Developing and implementing new strategies to continue our digital transformation is another challenge and opportunity. We must provide consumers with a digital-first healthcare experience that gives them data and access—where, when and how they want it.

Tim Hingtgen: Effectively supporting and managing our workforce. We talk about how essential our caregivers are. We called them heroes in the early stages of the pandemic, and they were then, and they still are. But we also know that the past two years have been exhausting and hard on our people. We are constantly working on ways to build resiliency and to provide support and appreciation for our teams. We also need to build a pipeline to attract and train the future generation of caregivers. Our nursing school partnerships and GME programs are highly prioritized right now and we expect to rapidly expand these programs in the coming year or two.

How are you dealing with price transparency?

Deavens: We’ve implemented a care cost estimator to help members compare providers side-by-side and estimate out-of-pocket costs based on their specific health plan; designed business models with hospitals that emphasize shared accountability for the quality and cost of care; aligned incentives for providers to deliver the right care, at the right place, at the right price; exchanged real-time claims data and electronic medical records with providers so they have a complete view of our members’ health issues and can fill gaps in care; lastly, we’ve introduced a wide range of digital tools to make it easy for members to manage their benefits and live healthy lives.

Dowling: Northwell focuses on what matters most to patients—the amount that they may be asked to pay out of pocket —the prices charged to patients for their unique episodes of care. Our overarching goal has always been to help patients understand the cost of care and the availability of financial assistance and flexible, no-interest payment options. We strongly support logical price transparency, but whatever information is shared with the public should be practical and useful for consumers, not machine-readable files that most patients can’t decipher. The medical coding that providers use is part of a very complicated billing and payment process understood by few consumers, which is why Northwell invests heavily in educating and counseling patients individually.

Hingtgen: Our organization has been compliant with the price transparency regulations—even before many of those requirements went into effect. But what we think is more important is working directly with our patients to help them understand their financial responsibility and the options available to help them manage the cost of care. We have financial counselors available in all of our hospitals and offer eligibility screening to help patients who qualify for assistance, such as Medicaid, to get the financial support they may need. Over the past two years, we’ve enrolled more than 100,000 people in federal, state and local programs that provide financial assistance. This is important because these patients can now get preventive care.

What’s your biggest spend?

Deavens: Prescription drugs continue to drive our spending, and the growth is unsustainable. Today, a drug’s price is increased by more than five times before it gets to a patient, driven by all the intermediaries who touch it, and at best the value created at each step in the chain is opaque. Often those costs cannot be directly traced to improved outcomes. We need innovation to meet this challenge. In 2021, Independence and four other Blue plans invested in Evio, an independent pharmacy solutions startup. The goal is better clinical outcomes, reduced costs and a better experience for patients and providers.

Dowling: We are investing about $1.2 billion in 2022 in infrastructure and IT. In a place like New York, ongoing infrastructure improvements are necessary because the facilities are much older. For that reason, we are investing in infrastructure improvements at our hospitals, especially our tertiary facilities. But the expansion efforts go well beyond our hospitals. Our outpatient footprint and physician network are among the largest in the country, and we continue to grow. All of these investments are intended to modernize our facilities and improve care delivery. From an IT perspective, we are making unprecedented investments in our digital strategy, which encompasses almost everything we do.

Hingtgen: Capital investments. We are investing in our markets at higher levels, especially where we see opportunities to increase access, respond to the healthcare needs of our communities, and grow our competitive position in the marketplace. We opened a new hospital in Fort Wayne, Indiana, this year and another will open in our Tucson, Arizona, market in 2022. And while new hospitals get a lot of attention, we also have been adding bed capacity across our existing network of hospitals. At the same time, we are expanding outpatient locations—primary care, urgent care, free-standing emergency departments, and ambulatory surgery centers—to ensure a balance of outpatient and acute-care hospital services. We have more than 1,000 outpatient sites of care and 83 acute-are hospitals, so you can see the importance we are placing on primary care and other services to help keep patients healthy.

What is your biggest revenue driver?

Deavens: We’ve seen growth in Medicaid managed care through AmeriHealth Caritas and we are continuing to make investments in value-based care. Telemedicine, health equity, mental health accessibility, self-funded membership, price sensitivity and legislative impacts are all trends we continue to monitor. We are always evaluating the best ways to ensure we’re diversifying our business to best serve our customers.

Dowling: While inpatient care and surgery continue to be the biggest drivers of revenue, our organization has evolved well beyond a hospital system. Over the past decade, we’ve dramatically expanded primary care, post-acute services and other outpatient services. The strategy was not driven solely by a desire to generate greater revenue, but to meet consumers’ changing expectations by providing them with easier access to care and greater convenience.

As a result, our ambulatory care network—which includes more than 850 outpatient locations throughout the New York area—will drive nearly half of Northwell’s $15 billion in revenue in 2022. By comparison, a little more than a decade ago, about 80% of our revenue came from inpatient care.

Hingtgen: I just mentioned that we are taking a balanced approach to growth, with considerable investments in outpatient services as well as our hospital operations. That balanced approach is reflected in what we see as the drivers of our revenue and earnings growth in the coming years, with approximately equal amounts coming from organic growth, capital investments and operational improvements.

About half of our revenue comes from outpatient services with an increasing trend in that direction and we expect that trend to continue in 2022. We are well positioned for the continuing shift to outpatient care—when services can be provided without hospitalization and at a lower cost—and also able to provide higher-acuity care when that is needed. Offering a full continuum of care also helps us to build deeper relationships with our patients because we can provide services in primary care or specialty care settings before and after their acute care experience.

How is technology affecting your operating costs?

Deavens: We capture valuable insights from our providers, using advanced data, analytics and technology to proactively help our members manage their “whole person” health. We also offer innovative products and solutions that lower costs and improve health outcomes. We continue to expand our telemedicine and mental health support. While we offered telemedicine prior to the pandemic, COVID-19 served as a catalyst for its adoption, especially for mental healthcare. Our collaboration with Quartet Health will help doctors more easily refer their patients for mental health services through the company’s SmartMatch technology.

Dowling: The biggest priority for our organization is expanding our digital footprint. While our strategy has been evolving for many years, we will be maximizing the use of technology and artificial intelligence during this coming year to transform patients’ digital experience during every encounter with our health system. More so than at any time in our history, we have directed leaders of every facet of our organization to develop and implement a digital vision and road map, and ensure that it is integrated and aligned with our organizational strategy.

Hingtgen: We are implementing a wide variety of innovative technologies to support patient care, including an AI solution in our maternity departments, tele-sitting services and remote nursing support, remote patient monitoring for certain chronic conditions, and other solutions that improve our interactions with patients before, during and after episodes of care. These investments increase operating costs but we also expect a high return on the investments in terms of patient safety, improved outcomes and workforce support.

We are also a founding member of Heritage Fund, one of the largest healthcare innovation investment funds. Through this partnership we are investors, and sometimes customers, of a wide variety of healthcare-supporting startup and emerging companies that will help propel healthcare forward—and we really like being part of that experience, especially because of the opportunity for early access to innovative products and services.

How are leadership roles changing and why?

Deavens: I take pride that Independence is one of the most diverse organizations that I’ve worked for. We consider it our responsibility to lead by example and show what diverse leadership looks like from the top down. Over the past two years, 56% of our new hires were diverse. For promotions, the breakdown was 49%. And of the eight people we’ve welcomed to officer roles, six are women of color, including the chief people officer position. And out of six existing officers who were promoted to higher level roles, two are women and two are men of color, including the positions of CEO and chief financial officer. We also hired our first-ever executive director of health equity, an African-American woman.

Dowling: We are always looking for new talent, new ways to restructure, and reevaluating the roles of our administrative and clinical leadership. We have developed a leadership structure within three distinct regions, all of which report up to system-wide leadership. This approach helps prioritize needs and ensures local input from leaders within our hospitals, ambulatory and post-acute care facilities, as well as our physicians.

We are aggressively recruiting new leaders—and promoting talent from within the organization—who can help develop and refine our digital strategy. As we have in the past, we are also putting a big focus on succession planning. It’s an ongoing process to have in-house succession plans for major leadership roles throughout Northwell.

Hingtgen: We have added new leadership roles in the areas of digital transformation and data science. These are huge areas of opportunity for healthcare now and in the future. Since we are centralizing many functional areas, we have more shared services leaders than in the past. HR leadership roles are expanding—including in the areas of diversity, equity and inclusion, training and development, and workforce recruitment and retention. And over the past few years, we have added more physicians to our executive and administrative teams recognizing the benefit of clinical leadership to help inform and collaborate on our operational strategies.

What are regulatory challenges and opportunities?

Deavens: There are regulatory opportunities around Medicare Advantage. We made great strides for this group with enhanced telemedicine services during the pandemic and we see opportunities to integrate mental and physical healthcare. We see opportunities within quality and data collection, specifically enhancing and leveraging technology to advance care. We also aim to focus on health inequities by working with our state and federal regulators to find solutions that are successful here at home and scalable to the rest of the nation.

Dowling: As I think most healthcare leaders recognize, regulatory oversight is necessary, but it should not be an impediment that stifles innovation and creativity. We successfully navigated the challenges of COVID because some of the more onerous and unnecessary regulations were lifted. Under normal rules, for example, it would have taken years to expand bed capacity the way we did at the height of the pandemic. Government has a responsibility to reevaluate its regulatory functions and undo what is unnecessary, so it can be synergistic with the needs and demands of today’s healthcare environment.

Hingtgen: Changes in reimbursement and potential Medicare cuts, whether as a result of sequestration, cuts to the disproportionate-share program, reimbursement not keeping up with inflation or other reasons, are always a threat to healthcare providers, so we focus much of our advocacy efforts on ensuring Congress understands the value our hospitals bring to their communities and why funding is critically important to the American healthcare system. Other advocacy efforts center on regulatory improvements that enhance the delivery of care to patients in our communities.

How are you responding competitors like Google, Amazon and various health insurers?

Deavens: Through innovation, we can make meaningful and measurable differences in healthcare quality, access, experience, and cost. This can happen through partnerships like our investment in Quartet, a technology and services company that helps people get faster and easier access to high-quality mental healthcare.

We have a joint venture with Comcast on Quil, a digital health platform that delivers actionable and personalized health itineraries for patients and caregivers, answering the question “what happens next?” in their healthcare journeys. Our work with the Blue Cross Blue Shield Association and 17 other independent Blue Cross® Blue Shield® companies as well as the nonprofit Civica to form CivicaScript, a company focused on bringing lower-cost generic medicines to millions of people across the U.S. We also have worked with, and invest in, numerous healthcare-focused venture and private equity funds, as well as direct investments in a number of early- to mid-stage health technology companies.

Dowling: With technology companies, venture capitalists, insurers, pharmacies and others entering the fray, competition in the healthcare field has never been more intense. Market disruptions give all of us headaches, but they are ultimately beneficial to consumers because they force us to do a better job delivering services and meeting patients’ expectations. That’s what builds customer loyalty. Certainly, you always have to be very cognizant of what your competitors are doing. That’s why it’s so important to continually reimagine your own organization. In today’s market, you have to adapt quickly and be agile enough to either compete directly with some of these non-traditional players or look for opportunities to partner. It’s why, for instance, we recently developed a strategic affiliation with Walgreens to explore ways of developing innovative healthcare delivery models, offerings and services that improve access, quality, equity, satisfaction and efficiency of care.

Hingtgen: We understand the big brand, big convenience promises of companies like Google and Amazon – and we respect the role they plan in the future of healthcare. Disruption is not unwelcome and we are constantly learning about ways healthcare can be more responsive, agile and convenient. We have implemented digital first, patient-centered technologies like online scheduling, virtual visits through tele-health, and we use automated messaging to remind patients when they are overdue for an important health screening. The benefits of these kind of digital strategies are working. For example patients scheduled approximately 150,000 appointments online with our primary care providers in 2021 – about double the number scheduled in 2020.

But we also know that the very personal relationship between a healthcare provider and a patient is key to quality care and the best outcomes, so we remain focused on building enduring relationships with our patients. With a full continuum of healthcare services in most of our markets, we can provide whatever care a patient needs, including preventative care and health management, but also emergency services, acute care and intervention for complex healthcare needs.