The Strategy Catalyst Dispatch

Priority Fog: The Gap Between Access Ambition and Execution

• Strategy Catalyst • Season 1 • Episode 48

Share episode

Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.

0:00 | 28:07

THMA-Tegria research finds 82% of systems call access a strategic pillar but most have trouble executing. We unpack the finance gap, post-acute blind spots, and the governance structures that separate progress from priority fog.

Resources mentioned in this episode:

Wesley Adams

would say many CFOs that we spoke with are exceptionalists, meaning they think their own entity is so unique that normal comparisons or outside findings just don't apply to them, which I get. But of course, the consumer doesn't think that way

Anika (2)

Welcome to the Strategy Catalyst Dispatch, a podcast from the Strategy Catalyst team at the Health Management Academy. I'm your host, Anika Rashid Senior Analyst, and each episode we'll explore The trends and insights shaping healthcare strategy today. Let's dive in.

Anika

For today's episode, I'm joined by Wes Adams, Managing Director of Industry Custom Services at the Health Management Academy. Wes and his team recently partnered with Tegria, a healthcare consulting and technology services firm, on a research report called The Access-Driven Enterprise. The report surveyed senior health system executives and included interviews with chief financial officers to understand how systems are defining, governing, and investing in access strategy and where the critical gaps are We talk about how access gets defined differently across the C-suite and the priority fog that that can create for the people actually executing the strategy. We look at finance's role in access strategy, the data on how involved they actually are, how that shapes investment decisions, and what happens when the time horizon for return on investment gets shorter. And we get into whether systems are thinking about access competitively or mostly measuring against their own baseline. And Wes walks through the governance structures that are helping systems close the gap between access as a strategic priority and access as an operational reality. Wes, thanks so much for joining me today. Could you tell us a little bit about the report and what prompted the research?

Wesley Adams

Thanks, Anika. I'm Wes Adams. I manage our industry services vertical at the Health Management Academy, which all the research that isn't within a Catalyst program at the firm. the report that we partnered with Tegria on was a state of the union assessment of how different executives outside of strategy, define and operationalize access strategy at their system. And it was really meant to be a complement to all the deep dives that-- a-all the work that strategy Catalyst team has done the strategy leaders at health systems around access strategy. So, it was a way for us to pull in different perspectives and to, to maybe see where there were, opportunities for alignment to help improve strategy moving forward. But that was kind of the onus of it. We did a, a thirty to forty executive sample survey that, that covered kind of broad questions on how they define access and how they measure it, how they operationalize, and what their perceived gaps were. also did in that survey effort is we, we sat down and we had discussions with a handful of chief finance officers in particular, because what we saw in the data was a lack of involvement or, or a particular misalignment between the CFOs and the rest of the executive cohort. we sat down with several CFOs to dive into that a little bit more and understand their perspective on access and where systems could improve alignment or efforts moving forward.

Anika

So you surveyed COOs, CIOs, CMIOs, strategy leaders, and then layered in CFO interviews on top of that. I want to kind of go down the path of one of the, headline findings in the report. So 82% of the systems you surveyed now position access as a strategic pillar on par with growth, quality, finance. And then at the same time, 32% of the respondents still primarily see access as a technical initiative, and that's kind of a wide gap. So when you saw that number, that 82%, did it surprise you?

Wesley Adams

Yeah, it's a good question. It's what we lead on. And so we had a chance to actually present this data at HIMSS and a couple of other conferences and forums. thing that we learned in those presentations as well as in our own data, every system. mean, if we're being real, is gonna say that access is a strategic priority, but almost every executive defines access differently. And that's the problem with access, is that unlike other priorities, it means different things for different executives, and it accomplishes different things for different executives. So you mentioned thirty-two percent see it as kind of a, a technical or tactical priority. we saw a range of different definitions. Some that viewed access specifically as digital front door investment, some that viewed it broadly as how are we meeting the patient or consumer they are, how they want it, at their price point, et cetera. And so there's a huge spectrum in how executives are defining it. And I'll say there's not really a correlation between executive type and how they're defining it. It's kind of a system-by-system thing. the CIOs and the tech leaders are naturally more likely to bring up the digital front door and kind of the digital activation piece. when you're speaking with finance or operations or clinical, it can take a bunch of different approaches. So that was kind of the first finding is like, you know, we have a ton of alignment that this is a priority, it's a strategic pillar, how is that actually operationalized? How is that defined? That is fundamentally different between executives, and that's kind of the first gap.

Anika

That makes sense. So the word itself, access, it, it's doing, it's doing a lot of work, and maybe, maybe too much work because it can be very broad. Of course, all of these things often are access, but how do you kind of, circumvent the risk of, of trying to do too much with access, I guess?

Wesley Adams

Yeah. So I think the, biggest thing that we harped on, as it related to this, and, and I actually have to credit Steve Nelson at Tegria, 'cause this is kind of his term, is that all of this, this misalignment in how strategy is actually defined leads to a, a difference in how it's operationalized, leads to a difference in how it's measured. And what you get is this priority fog that actual operators of the strategy have to navigate, different priorities from different verticals. and that creates an inability to align investments to key objectives and measure value that aligns kind of across stakeholders. And that, of course, leads to poor experience and inefficiencies for the operators, but also the providers and patients. and so what we see is, you know, at its forefront, a lot of systems that are driving alignment better, refocusing on kind of OKRs, objectives and key results, that stem from extensive root cause analyses around some of their access gaps, and really trying to focus on, well, what are kind of the two or three immediate things that we need to tackle, that we need to align the organization on, and that we're going to set, again, an OKR framework from a governance perspective. We're gonna instill the committees that are gonna review investments on a monthly or bi-weekly cadence to assess that investments or different actions are aligned with those OKRs, and that trickles down to the operator. And so we're starting to see some systems, again, put in the governance or reinforce the governance framework to be more targeted in, in their access work and being intentional about bringing in multiple stakeholders, clinical, finance, operations, et cetera. So, does that answer your question a little bit,

Anika

Yeah. Yeah, definitely. I, I think we're seeing, kind of what you're emphasizing, in one of the case studies from the access work. I think that was something that Emory did with, one of their access sprints is, like, really aligning on, okay, what do we want out of this, and getting a lot of stakeholders in the room and having all of those conversations. I think the priority fog framing, is a really useful one 'cause it kind of names the thing that makes this so hard, 'cause everyone obviously agrees that access is a priority, but then it's hard to work on the same version of what that means. all of that kind of cascades down to the middle managers and the frontline teams who are then actually trying to execute.

Wesley Adams

Right. Well, because what we learned, too, is that, you know, even with systems that have very defined objectives, and KPIs they wanna inflect, that still doesn't always trickle down to the middle manager there still is this sense of, perceived misalignment that their work isn't being recognized, the value they drive isn't being recognized, or the value that the CFO or other leaders are looking for isn't what they're actually measuring or being tasked with measuring. So the, the follow-through is also such a critical piece of it, and I think the Emory case study speaks to that as well, where they talk about how executive alignment is really critical for the near-term immediate wins. Like, never discredit the, the speed to action that executive alignment can drive. But long term, That's not the only thing that drives a sustainable and successful access strategy. It's also driving that culture and that alignment down to the middle manager, and that's obviously a much more difficult process And so, for those of you that have had a chance to work with, Steve at Tegria, that's kind of the first thing he immediately goes to.

Anika

I wanna go back to something that you had already sort of touched on when you mentioned finance and how finance is sometimes absent from the conversation. I think one of the really striking findings is that only 32% of systems involve finance leadership in developing access strategy, and just 6% involve them in operationalizing it. Obviously, like, we don't, we don't necessarily want finance running access, but if access is truly an enterprise strategic pillar, what does it mean that the people who control capital allocation are largely absent from the conversation?

Wesley Adams

Yeah, it's a great question, and it's one that sparked our discussions with CFOs. And one caveat I'll say is I think every system involves finance in their strategic plans obviously, and access is a part of that. I would say that thirty-two represent-- the percentage of systems where finance is, like actively involved in that discussion and actively shaping that access strategy with the CSO and with the clinical and operations leaders. And so, thirty-two percent of, of systems have finance kind of strategically involved in that process. And I think your point, what we're saying on the operations side is, is finance doesn't need to or shouldn't be the operator, but it needs to be brought along every step of the way. And we do see a clear difference between systems that have engaged finance early on in their access work and have kept finance in the process, validating returns throughout the operationalization of that strategy those that didn't. We see that systems that do the former report being more successful. Now, now there is maybe some measurement bias there always, but it does seem universal. So a couple of years ago, we had Adventist, Healthcare over in West Coast present to us on their patient activation case study. And the whole point of that presentation, or what was largely underpinning it, was the success. they were mulling over, do we invest in consumer 2.0 strategy? they were also dealing with the same level of point solution fatigue post-COVID and ROI fatigue or lack of ROI, from those investments. I think they were dealing with an environment that was actually more fragmented from the investments they made before. what they were really intentional about when they were looking at their next level of patient activation strategy was looping in finance and operations in the strategy development and also performance optimization and monitoring process. what that meant is, like, when they were actually, operationalizing the strategy, finance was involved in validating the revenue using patient MRN data to validate the revenue generated point of service from the activation that occurred. And so they were able to craft this narrative with finance along the way so that they could validate the actual revenue lift generated from the investment, and also working with the operations leaders to make sure that the activation was met with actual capacity to serve those patients later in the continuum. I think that's a good example of finance, not an operator, but with the operator every step of the way There is also a spectrum of risk aversion between the CFOs. There are some CFOs that are more closely involved in strategy and finance, more risk-taking in that front. There are others that are more reactive, that are more of that hurdle to clear. And I think the way that the executive C-suite loops in these finance executives into strategy development and into performance monitoring plays a key role in kind of where they ultimately land on that risk aversion spectrum. that's a really key point, and one thing that we wanted to make sure we pointed out with our, our CFO data.

Anika

Okay. So it's not that we want finance to be the operators. We also don't want them to just be a hurdle to clear or like a box to check. It's kind of if they're not involved in validating what the return should look like from the start, and then kind of tracking whether those returns materialize as you implement, you might run the risk of potentially operations and strategy building one thing and then, like, finance evaluating something entirely different maybe. And then that's how you kind of go down these two different paths.

Wesley Adams

Yeah. E-exactly. and so it-it's very critical that these leaders are involved in the process, even if it creates a level of inertia, because in that process you'll be developing an aligned revenue and cost model that it'll be easier to validate your returns, easier to add onto that investment from that endpoint. I think that's kind of the critical gap. the other thing that we found, is CFO's view on to ROI

Anika

Yeah.

Wesley Adams

Meaning the current environment, almost every CFO, even if they were on the strategic side of that risk aversion spectrum that we spoke about, immediate ROI is the priority. So almost every CFO says they don't want to invest in an initiative that has two to three degrees of separation from return on

Anika

Mm-hmm.

Wesley Adams

And that was something that is again. And so when you're under that strict of a return requirement, it again reiterates the need to be looping in finance early and often in validating the revenue and cost model of your investment keeping them in the loop as that's being operationalized so that you can accurately validate.

Anika

I think that that is a good transition, probably explains, some of the investment pattern that we saw in the report in that systems are investing a lot into ambulatory clinics, hospital, outpatient, telehealth, the settings where they can sort of more directly control outcomes, and where that return is more visible. but the settings where the return takes longer to materialize or where the systems don't have direct control, like more of the post-acute stuff, is kind of at the bottom of the list. But the report also identifies post-acute bottlenecks as kind of a key barrier to throughput. So how do you kind of reconcile those two findings, when it comes to access, especially from a strategy perspective?

Wesley Adams

Yeah, it's a good question. It's actually a huge point of focus and, and concern. It's multifaceted, of course. No executive's gonna say post-acute care isn't a priority. It is. It plays such a critical role in your hospital operations in particular. But systems also have to assess the capital opportunity cost of investing in post-acute versus other assets that they, to your point, have, have a stronger expertise in operating. So like I think with the traditional post-acute, if talking about SNF, inpatient rehab, LTAC, et cetera, historically, those were strong margin businesses, but that narrative is just fundamentally shifting. And so margins are eroding, then the regulatory scrutiny has always been a problem. SNFs have more red tape than nuclear power plants. And so all that combined, you look at capital opportunity cost, investing in what systems know they're good at and strategically divesting from areas that they might not be as good at a priority to consider. And I think what you see as a result is maybe capital investment planning around post-acute care declining, but still a strategic priority. And so systems are rather looking at what are less aggressive capital deployment opportunities, maybe stronger focus on strategic partnerships or low-cost models to help reinforce their post-acute landscape. And so I think it's a big issue. I mean, it's been five years since the peak of COVID, and systems are still dealing with length of stay issues from post-acute bottlenecks. So it's absolutely a priority. It's just more about what is the capital-light way to solve for it. Tech and partners play a huge role in that. so I think it's very nuanced, and I think just looking at it from, like, an investment roadmap perspective is probably not the full picture, but it is a concern when you think about how prevalent the issue still is.

Anika

so even though the capital story is harder now, the operational need hasn't gone away, I-it's not necessarily realistic to invest more capital in post-acute. It, it is about finding those capital light ways to solve the throughput problem,

Wesley Adams

Yeah. And I think it's a broader question of what can we be competitive in? What are things that we can't be competitive in? Like in post-acute, there are other and organizations that have developed efficient models to deploy this. And so, it makes sense to partner in a lot of these cases a way that still improves your length of stay, still improves your patient retention, improves your readmission rate, still gives you a revenue lift

Anika

Gotcha. I wanna jump to, another thing in the report that I thought was really interesting. So a system can significantly reduce its time to next appointment and then still fail to gain market traction if a competitor is outperforming them. So in terms of competitive positioning, what are you seeing, in how systems think about access as a competitive differentiator versus just an internal operational metric?

Wesley Adams

Yeah, this is a great point. I'm really glad you brought this up In our discussions with CFOs, there was only one system that brought this

Anika

Interesting.

Wesley Adams

market, and this could be just selection bias on our end, and so for those that are listening, it might be a different story. But for the CFOs that we spoke with, they're-- they were predominantly positioned intrinsically here, which I think is a huge risk and barrier for the strategy counterparts of these systems. of course, like benchmarking is hard. would say many CFOs that we spoke with are exceptionalists, meaning they think their own entity is so unique that normal comparisons or outside findings just don't apply to them, which I get. But of course, the consumer doesn't think that way And I think the, the CFO who brought that up falls, again, into the more strategic side of that risk aversion spectrum. They're involved early on in that discussion and, and are, co-developing the strategy. And I thought it was a useful lens benchmarking to competitors, not just yourself, and that really being the inflection point. And that could be also where systems are seeing a disconnect between measurable impact and actual financial

Anika

Mm-hmm.

Wesley Adams

because that's a critical piece of the puzzle, of course.

Anika

Mm-hmm. Yeah, I think the point about how the consumer views things is a really important one. Obviously, the consumer isn't necessarily gonna pull up your quality metrics or your history there when they're deciding, where to go. They're comparing you directly to the urgent care down the street, the retail clinic, or the disruptor telehealth option or whatever.

Wesley Adams

I mean, shameless plug for the work that you all did on the

Anika

Mm-hmm.

Wesley Adams

'cause I think that was actually really helpful, in the systems that were kind of randomly selected through that to help show that difference. And I think it just helps pull in perspective, again, you're really aiming to do. it's not just improving against your own benchmark, but against your competitor's benchmark.

Anika

there's also a related risk that the report calls out kind of about what happens, as you said, when you optimize pieces without thinking about the whole. does that pattern look like in practice? And, and how do you, circumvent this problem but not get into the priority fog issue that we talked about earlier? How do you kind of walk that line?

Wesley Adams

Yeah, I think to reframe, in other words, it's like local optimization at the expense of system performance, that thought that optimizing a subsystem will always suboptimize the whole system. And I think the most common example cited from the CFOs we spoke with or the access leaders we spoke with is that care continuum example. So a health system invests heavily in upstream demand gen and activation, whatever that looks like for the system. And let's say it works, more patients are activated, more referrals are generated, but the downstream capacity isn't there. specialty post-acute, surgical, behavioral, whatever. wasn't co-designed to absorb the volume, and that's, that's the most like critical, most prevalent one I'd say most systems experience. And I think that's just an example of that. The subsystem optimized here, the upstream component of the care continuum, but the optimization is actually at the expense of performance downstream. yields burnout, cost inefficiencies, and more importantly, decline patient trust and experience. And so, that's a great example of how optimizing within one vertical silo kind of augments the fragmentation with the other vertical silos of the organization. And so it has to be horizontal.

Anika

Yeah, I really like that phrasing. You don't wanna fall into that trap of local optimization at the expense of system performance so Wes, kind of the last thing that, I wanna touch on, and thank you so much again for joining us today, is sort of if you had to distill this down for a chief strategy officer, all of the kind of things that we've talked about today, what's the one thing that this data tells them that they should be doing differently tomorrow?

Wesley Adams

Yeah, there's probably gonna be some eye rolls with this. It's boring but always true. The governance alignment piece is the biggest through line that came through in the data. executive alignment from beginning to end is the biggest takeaway and making sure that that trickles down from the executive level into the actual operating structure. OKR structures are really helpful here, and we do see a lot of systems gravitating towards more strict OKR-led governance models. OKR meaning objectives and key results. And we mentioned this earlier, systems are creating kind of regular committee meetings to review investments and to ensure alignment to those OKRs. And those are with multi-stakeholder committees with finance, strategy, ops, clinical, IT, data, et cetera. And we also see some reshuffling of executive roles to drive more streamlined decision-making and execution velocity. And all of that is to improve alignment from top to bottom in the organization and follow through and make sure again are in line with what finance deems appropriate from a revenue and cost model perspective and aligned with the strategic plan. And so that is such a critical piece that separates systems that do this really well versus systems that aren't doing it as well. I think the environment is reinforcing that structure. And so instilling this type of governance model or more strict governance assessment model has its benefits elsewhere as well outside of access. And so that's kind of the first overarching takeaway. course, I think the other thing we talked about that's also really tactical and critical is the competitor benchmarking piece, which every CSO does, but does your CFO think that way? Do your operators think that way? So I think making sure that in that process of driving alignment, you're also driving alignment around, well, what are we actually benchmarking against, and what's the actual goal? 'Cause I think that's also where the, value gap

Anika

Mm-hmm.

Wesley Adams

also generates. other thing that we didn't get a chance to mention, but of course is always just something to keep in mind, is to just consistently be executing your patient journey mapping and also your employee journey mapping. And doing that on a regular basis to help identify where key gaps are in patient experience, and always tying back the strategy to patient experience and consumer experience, is such a big, such a big goal. A lot of executives say this, that their systems can kind of get lost in some of the financial and operational metrics that they're shooting for, that, a lot of them miss an opportunity to continue updating their patient journey mapping and their employee journey mapping. it's a different example obviously, but the VA has really done incredible-- an incredible job at improving their consumer experience and sentiment just through patient journey and employee journey mapping specifically to make sure that, the experience on both ends is aligned with their overarching OKR goals. So I think that's another critical piece that we didn't really talk about today that did come up in some of our conversations when we again got a little bit more tactical.

Anika

Mm-hmm. Mm-hmm. Yeah, I'm really glad you brought up the patient journey mapping piece, of course, 'cause that is so important. And, i-in the report, I remember reading that for a lot of systems, when we get back to kind of like what even is access, a lot of systems do define it as inherently related to that patient experience, and how can we make that, experience better? So... again, going back to access. So it sounds like the execution, really depends on those shared definitions, financial alignment, governance, and financial rigor. And going back to that, you know, that competitive positioning piece, the sort of willingness to measure yourself against competitors and not just your own baseline, which as you said, you know, a lot of strategy leaders already do that, but making sure you're bringing along other leaders for the ride. Wes, I wanna thank you again for walking us through the research. The Access Driven Enterprise Report was produced in partnership with Tegria and is available, through the Health Management Academy on our website. So again, Wes, thank you so much for joining us today.

Wesley Adams

Thank you.

Anika

We'll include links to several resources in the show notes, like the Access Driven Enterprise Report from the Health Management Academy Integra, a webinar from Wes's team featuring executives from Emory, Sutter, and Indiana University discussing these findings. our Access as a Strategic Product case studies where we highlight Inova, Emory, and more, And our own secret shopper research from last year on access benchmarking The full Access-Driven Enterprise report also goes deeper on workforce dynamics, So check that out on the website with the links below

Anika (2)

That wraps up this episode of the Strategy Catalyst Dispatch. If you found this episode valuable, please like and subscribe on your podcast platform of choice and leave us a comment. If you have other thoughts or questions, we'd love to hear them. Email us at Strategy catalyst@hmacademy.com. You can also find more of our resources on HM academy.com/strategy-catalyst. That's it for this dispatch. Thanks for listening.