Managing post-COVID healthcare transformation

 Managing Post-COVID Healthcare Transformation

June 7, 2023 | By Dean Sevin Yeltekin

Since 2013, Dr. Michael F. Rotondo has steered the University of Rochester’s Medical Faculty Group through an era of dramatic turbulence and growth. Over the past three years of his tenure, the COVID-19 pandemic has exacerbated existing challenges, catalyzed emerging trends, and created new opportunities for innovation.

Below, I speak with him about the unique features of the post-pandemic healthcare landscape and the need for business skills in guiding the transformation taking place.

As we emerge from the COVID-19 pandemic, how would you characterize this moment in healthcare?

There are major external forces for change, from labor market shifts to digital transformation, that are rapidly reshaping the way we approach and deliver healthcare. You can look at this in two ways: There is so much chaos in healthcare that you don’t want to be anywhere near it—or you must be a part of it. By nature, I live in the latter category. I was a trauma surgeon in my clinical life, working to bring order to chaos.

What is the single greatest challenge you are facing in healthcare delivery today?

Building and maintaining a stable workforce is easily the top challenge we face in healthcare delivery. Even before the pandemic, we were already starting to see shortages across positions, from physicians and technicians to physical therapists and food service providers. Part of this is due to a demographic shift—physicians, for example, were already starting to retire earlier. The nursing shortage fueled the exponential growth of travel nursing, the cost of which is only sustainable in the short term. Another factor is the overall diminution of trades in the U.S. It takes a large volume of people in HVAC, plumbing, and electrical trades to support an institution of our size, and there are not as many people as we would like to fill these roles.

These trends were all emerging in the years leading up to COVID, and the pandemic did not make healthcare any more attractive to current or potential employees. Burnout and instability were widespread throughout our industry, and those who remained began to place a greater emphasis on work-life balance, particularly when it comes to flexible hours and leave. We recognize that this shift in mindset is a positive thing for our employees’ quality of life, but it represents a net change in productivity for our system as a whole. We are facing the dual challenge of cultivating a healthy and supportive workplace while grappling with the cost of the transition to a new way of operating. I expect we will remain in a hiring trough for a while, but the combination of improved retention efforts and higher market-driven compensation will eventually fill the gaps and stabilize staffing levels.

What are some of the other external forces that are reshaping healthcare?

From a systemic view, it’s important to recognize that more than half of health systems and hospital systems are starting to tilt into negative margin, largely due to the rising cost of labor and materials. Many were already close to zero margin, but the descent into the red is an alarming shift that could eventually lead to greater movement toward a single-payer healthcare system, price controls, or other forms of government intervention to avoid the collapse of entire health systems.
 
Another sizable force of disruption is the entrance of tech companies and venture capitalists into the healthcare industry while health plans are simultaneously expanding to become “payviders.” By and large, these new players are venturing into primary care, not specialized services. At URMC, our academic mission rests on our clinical success. If disruptors like Amazon and CVS cleave off substantial portions of our margin-producing business, we will struggle to maintain our current delivery system for mission-based services that do not produce a margin.

How are you harnessing the forces of digital transformation to improve patient care?

Digital transformation has prompted us to rethink and redesign delivery methods. Many years ago, a physician or midwife would visit a patient’s home to provide care. Believe it or not, we are heading back in that direction because of the ways we can use digital platforms to connect patients to providers more seamlessly. I have hypertension, for example, so I use a home monitor to measure my blood pressure. That information has the potential to be transmitted from my digital device directly to my electronic health record. As more and more data is captured, it reveals something about my overall cardiovascular health—and, over time, we will be able to make connections between my day-to-day cardiovascular status and my overall health. This will be happening more and more in countless areas of medicine.

We are also starting to put new tools in the pockets of providers to equip them to serve patients more efficiently. For example, we have recently introduced an ultrasound platform that leverages AI technology to direct and improve bedside imaging, offers cloud storage for images, and feeds results into a patient’s electronic health record. Using this kind of technology, our providers will be able to confirm diagnoses more quickly and expedite patient care. Over time, we aspire to reach the point where we have captured and analyzed so much data that we can know what a patient needs before a problem arises.

What is the value of a business perspective in confronting emerging healthcare challenges?

While I don’t have an MBA, the time I spent learning the language and culture of business through seminar courses, independent learning, and on-the-job experience completely changed my outlook on healthcare delivery. I knew instinctively that translating fundamental ideas of business to my administrative work could improve my success in ways I could never have imagined when I was immersed in basic sciences and clinical work. You don’t need an MD to change the face of medicine. Whether it’s finance, accounting, human resources, negotiation, or governance and policy, there isn’t a single area of business that isn’t transferable and important in medicine. We have faculty members at URMC who go to Simon to complete an MBA, and we have Simon MBAs who come to URMC for fellowships. There is enormous value in being able to bridge the gap between business and medicine.

What is one healthcare problem that is ripe for analysis by institutions like Simon?

In healthcare administration, we are constantly struggling with issues related to the value chain. It's incredibly complex to define and understand all the subjective and objective variables that go into determining value and costs. We need to determine which parties we are considering when measuring cost, whether it’s patient, provider, healthcare system, insurer, or government, and whether a given outcome is worth the expense to achieve. This is one area where business and medicine could really come together to move the needle in a positive direction.

Dr. Michael F. Rotondo is the CEO of the University of Rochester Medical Faculty Group.

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