How Community Health Systems approaches digital innovation in health

Cadence Team
Cadence Team
November 10, 2022
How Community Health Systems approaches digital innovation in health

Tim Hingtgen, CEO of Community Health Systems, recently joined Cadence co-founder and board member Kareem Zaki for a conversation about the growing partnership between CHS and Cadence, along with CHS' overall strategy when it comes to digital innovation and technology.

The conversation took place on the sidelines of a recent Cadence team meeting in Nashville, Tennessee and was recorded as a new episode of Cadence Conversations — a podcast from Cadence, featuring clinicians, healthcare executives, as well as tech entrepreneurs discussing their experiences driving innovation and progress.

Previous episodes of Cadence Conversations include Rob Jay, CEO of ScionHealth discussing the hospital system's partnership with Cadence, Dr. David Shulkin, 9th Secretary, U.S. Department of Veteran Affairs discussing the future of remote patient monitoring (RPM), and Dr. Toby Cosgrove, former President and CEO of Cleveland Clinic and currently an Executive Advisor to a number of startups, discussing how to ensure effective partnerships between health systems and technology companies, as well as two clinicians from Hickory, North Carolina discussing how Cadence benefits clinicians and patients.

Hingtgen began by discussing CHS's growing partnership with Cadence, as well as the initial impetus for entering into the relationship. The partnership, which was announced earlier this year, brings Cadence’s remote patient monitoring and virtual care solution to thousands of CHS patients nationwide. 

"There's a lot of people who are out there trying to go it alone and be disruptors in the healthcare industry," Hingtgen shared. "What we really liked about Cadence was your concept of partnership. At the end of the day, people can be disruptors, but we have a lot of patients that we're already caring for. So to align with your technology, to align with your caregiver model, and then to really disrupt in a positive way that drives our purpose was like the trifecta for us."

I'm very excited to partner in such a deliberate way that drives all those key deliverables for our communities," he said.

Since the partnership was initially announced, Cadence and CHS have worked to scale the technology and make it available across CHS' network of affiliated hospitals and physician offices in 16 states. Hingtgen spoke about some of the key learnings in the early days of scaling the partnership, and how the two companies have managed to get clinicians excited about the program.

"Doctors and providers, rightfully so, are very protective of their patient relationship," he shared. "We do everything we can to reinforce that partnership. [Cadence] is not more work for doctors. It actually probably is less work and is driving better outcomes. Every deployment has proven that out."

Beyond the health system's relationship with Cadence, Hingtgen and Zaki also discussed CHS' approach to digital innovation more broadly, including the company's recently announced partnership with PeriWatch Vigilance, an AI-based maternal fetal warning system. Hingtgen painted a picture of the future and shed light on how digital innovation fits into CHS' longer-term goals. 

"In five years, I want to make sure that [our] purpose statement was more than just words on a piece of paper, [and that] this is an organization that's driven and committed to making a difference in the communities it serves," he said. 

"I'd like to see the expansion of our digital innovations into touching more patients, connecting more patients to our healthcare delivery system. And by doing all that, we will drive that competitive position of our strategic imperative, I think, in a very deliberate purpose-driven way. So that's really exciting for us."

Listen to the entire podcast episode above and be sure to subscribe to Cadence Conversations wherever you get your podcasts to listen to future episodes.

If you're interested in learning more information about Cadence and how to get involved, visit Cadence.care and please get in touch with our team.

Read the full transcript of the conversation below:

Episode Transcript

Introduction: Welcome to Cadence Conversations, where we're talking with prominent physicians, healthcare leaders, and tech entrepreneurs about their experiences driving innovation and progress. We recently had the privilege of sitting down with Tim Hingtgen, CEO of Community Health Systems. CHS is one of Cadence's health system partners, and both teams have a shared purpose of improving patient care. Tim joined Cadence co-founder and board member Kareem Zaki during a recent meeting in Nashville, Tennessee to share his thoughts on the growing partnership between CHS and Cadence, along with the CHS overall strategy. So let's get to this week's Cadence Conversation.

Kareem Zaki (KZ): Thank you again for being here with the Cadence team in your hometown of Nashville. We're really excited to have this conversation today, both because of the unique mission of CHS and how you all are delivering care to patients, but also the fact that you've been one of the early and close partners for Cadence, so we feel really fortunate to be partner with you and also to have you spending time with the Cadence team today.

Tim Hingtgen (TH): Great to be here again. Look forward to the discussion.

How Community Health Systems Has Evolved Over Time

KZ: Tim, you've been at CHS now for over 14 years leading up to your role now as CEO. Can you give a brief overview of how you've seen CHS evolve over that time?

TH: I was a hospital CEO in Las Vegas, Nevada before I moved to Nashville about 15 years ago now. And at that point, healthcare was very hospital-centric. I think you would all agree with that. When I joined CHS, it was already in the midst of a revolution or an evolution of its portfolio. It was historically a non-urban or rural hospital player. We still have some of those core assets in our portfolio, but in general, the company had just finished an acquisition of Triad Healthcare, which really broadened the asset base to more suburban and smaller urban markets. So the company was already transitioning into more of a full concept healthcare system development organization.

So I joined right after that had happened. That happened in 2007. I came in 2008. I think it's important to note, historically, the company grew through acquisition, and so we've really pivoted to divesting certain non-core assets, making sure we free up resources and capital, and really our strategies evolving around building out healthcare delivery systems, not just focused on hospitals. Again, I think we always talked about access points, recruiting doctors, employing doctors, adding clinic sites.

We really put that into hyperdrive in 2016 when we started the portfolio divestiture program. That gave us the ability to reinvest back into those markets and really drive our core purpose, pretty methodical about a shared purpose across the organization of really helping people get well and live healthier. So everything we do revolves around that. So I think that's probably our biggest change, change the portfolio, change the operating model, change the way we resource things, and then really embrace doing things I think that are really to the benefit of our patients and our communities.

KZ: Thank you for sharing. Can you dig in a little bit more on kind of your key focus areas now as CEOs and the things that are top of mind for your executive team?

TH: I mentioned our purpose, so we keep that purpose at front and center at all times. I gave you the headline of the purpose. There's other guiding elements in there. One of them is building enduring relationships with our patients. We call that connected care. Safety and quality is in our purpose statement because we know we will not be successful without advancing outcomes and the safety and the quality of the care we deliver. And then we talk about adding value to our community.

So all that's in our purpose statement. But again, all of that as the enabling elements to driving that, helping people get well and live healthier. But then we had a pandemic. It put the purpose to its test. I believe our providers and our clinicians and our healthcare leaders, all of our employee teams, the corporate support teams, performed admirably throughout that.

Then we had the year 2022, which is what we call the aftermath of COVID, not as much COVID in terms of our care delivery systems, but the inflationary impacts, all the other ripple effects that I'm sure you're familiar with. That's really what consumes the greatest amount of our time right now to make sure that we are driving that purpose. Number one on that list, human capital. I'm sure you're dealing with some of the same things as leaders in your organization, just the impacts not just into the quantity of the healthcare delivery workforce, but also the burnout, trying to work through the resiliency angles of that. The other part on human capital that really keeps us up at night is really trying to innovate around care delivery models because we know we are going to have a shortage of healthcare professionals in this country. Again, our partnership with you, we believe, is very enabling to solving for that.

But we also take matters into our own hands. We started up nursing programs on many of our campuses. We implemented student loan repayment programs to try to retain and demonstrate our profound appreciation and gratitude for our workforce. We also stood up our own in-house recruitment function. Again, it used to be very decentralized. One of the benefits of being a multi-state, multi-jurisdictional healthcare provider is we can build scale around certain things like physician recruitment and nurse recruitment. We kicked that off before the pandemic, and we accelerated its deployment last year just because we knew that human capital was going to be a core issue for us, and we're very grateful.

The next item, cost structures, As much as we want to drive purpose and deliver great healthcare, we have to be cognizant of the inflationary impacts and the cost structures. Again, our partnership is key to this. Our digital innovation is key to this, how do we automate and really let people do what people do best, which is the human touch part of their work. So we're really focused on the cost structures, and then also making sure that we're driving value through further investments in building out those healthcare delivery systems.

How CHS Approaches Digital Innovation Across Its National Hospital Footprint

KZ: I'd love to double click on that digital innovation point. You mentioned CHS being a multi-state provider. I think it's 16 states to be exact, which is just a really unique lens, and I'm sure all those 16 states are really diverse communities. How does the fact that you have such a national footprint, diverse footprint, influence your thinking about digital innovation and how to serve your patients?

TH: You're right. I mean, really agnostic to the type of market, whether it's a non-urban rural market, a suburban or a primary market. But with all that being said, digital innovation is at the core of this. We understand, again, with the human capital challenges, with the ability to leverage smart technology, partnering it with human touch, that is so key to the game right now. I mentioned our approach and our desire to build enduring relationships with our patients, no matter what size the market. Anytime we can make the patient or the consumer's journey easier through scheduling, through navigation, through patient portals... Remember, we were all forced to do patient portals. Everyone thought it was going to be the end all be all. They're still very important, but they're still very two dimensional. So we look at this as all the ways we can get patients involved, more involved, as active consumers in their outcomes for their healthcare delivery.

Why CHS Entered Into a Partnership With Cadence

KZ: Well, I'd like to shift a little bit to Cadence. Obviously, we have the cadence team here in the room now. Maybe we'll just start about what got you excited about the concept of Cadence in the first place and for us to partner together?

TH: I think many of you have met Dr. Simon. She's our Chief Medical Officer. We, about two years ago, really tried to pivot more of our energy into innovation. So we've asked her to scan the environment, what's out there. You can imagine we get hit up quite a bit on, "Hey, try this, try this, try this." And there's a lot of people who are out there trying to go it alone and be disruptors in the healthcare industry. What we really liked about Cadence was your concept of partnership. At the end of the day, again, people can be disruptors, but we have a lot of patients that we're already caring for. So to align with your technology, to align with your caregiver model, the human touch I referenced, and then to really kind of, I'll say, disrupt in a positive way that drives our purpose. It was like the trifecta for us. I'm very excited to partner in such a deliberate way that drives all those key deliverables for our communities.

The Benefits of Cadence for CHS Clinicians and Patients

KZ: Means a lot to hear that. I think one of the things we're talking about is how do we not just give a tool to our partners, but how do we really own the solution together and really be in that partnership together? And I know it's a big part about the alignment of the model that we have together. I'd be curious, now that we're a little bit into working together, kind of what you've heard, initial reactions from physicians and patients and people in the CHS ecosystem.

TH: Yeah. It certainly has also been an evolution, and I'll say it gets easier, I think, with every successful deployment. So thank you to all of you again for your intense work and focus and on I think the lessons learned in making sure we communicate better to the next market that we enter together.

Initially, I think there was just concern. As I said, we get hit up a lot for people saying they have the answer. And doctors and providers, rightfully so, are very protective of their patient relationship, and we can never underestimate how important that is. We do everything we can to reinforce that partnership, and I think our messaging and our rollouts, making sure that we didn't overstep our bounds with technology or the care coordinators, making sure that it's not more work for doctors. It actually probably is less work and is driving better outcomes. Every deployment, I think, has proven that out.

And then your podcast, with some of our key early adopters, our key influencers, I think have been very beneficial. And honestly, now I think we have wait lists for doctors who've heard that this is working, who want to get their patients on it. And right before we started, I got the September briefing on our partnership, very, very successful in terms of the number of patients that were enrolled. And so I think that speaks to the physician and the patient adoption.

KZ: Sometimes with change comes a little bit of apprehension. You commented a little bit on it. I'd be curious, for the people who hear about the Cadence partnership and worry that yes, there's good that comes with change, but sometimes a little bad that comes with change, where you would help them think around why you think this is the way for patients in the future and why this is the model that makes sense for CHS and a lot of their patients.

TH: I think just kind of building upon past successes is so important in the change management model. No matter what we're doing, we always expect a certain amount of resistance just because if people don't think that the current system's broke, why change it, right? I think demonstrating through all of our means of communication, through our physician communications, through our corporate teams communications, with our hospital leaders and our corporate leaders, we give a Cadence update every quarter. So people, number one, feel good about the partnership and the investment that we're making together in this, but also to speak to the outcomes. So I think always sharing those success stories is just absolutely key to the change management program. And then, like I said, I think at this stage, we have so many providers who are just eager to get their markets up and running.

How to Make an Impact and Drive Change in the U.S. Healthcare System

KZ: A lot of people in this room, some people have worked in healthcare their whole career. Some people, this is their first experience in healthcare. We think that's one of the things that makes the Cadence team special. Some of the people come with a technology lens, others from a clinical lens, others from an operational lens, kind of coming together. For those who are maybe a bit newer to healthcare, any advice or insight you would share around how best to think about innovating in the healthcare space?

TH: All great questions, of course, and you make me think through this because I don't want to belittle the industry, but it's kind of a tough industry to move. It's very entrenched in its ways. It's heavily regulated. A lot of the regulations stand in the way of being really aggressively innovative, if you will, the payment paradigms from the governmental payers, which again, we're fortunate in this case that the government sees the value and they will reimburse by and large for the important care that's being delivered.

But I think that's the biggest barrier to change. It isn't just because we're obtuse in our thinking. As I said, we really try to work on understanding shifts of care, driving better value in healthcare. But the rate limiting step typically has been just the complexities of this industry. I mentioned other disruptors wanting to come in and go it alone. I think they find out pretty quickly that that becomes very challenging because of the... I think they maybe underestimate the complexities of the regulatory environment, the reimbursement environment.

So I would just throw that out there. Everything we do, we want to do it so that it's sustainable. And that does mean we have to make sure that there's a valuable funding source, as well as those who want to advocate for us to keep expanding into this space.

Why CHS Partnered With PeriWatch Vigilance, an AI-based Maternal Fetal Warning System

KZ: Staying on digital innovation, we're shifting a little bit from Cadence. We saw that you recently announced a partnership with PeriWatch Vigilance, an AI-based maternal fetal warning system. Can you tell us a little bit more about that partnership?

TH: That's another exciting one, a little bit of a different space of leveraging technology and AI, but partnering with caregivers, but in the same realm as what we're doing with you. I'll say this for those who are not familiar with how OB programs work, but there's a process called fetal monitoring. We've had technology where you can attach a fetal monitor to the mom and the baby. During the delivery process, if it goes awry, we get early alerts because someone's monitoring that. Through the AI component of this, we're able to put a protective layer over it versus just a nurse or a technician monitoring. We now have the technology monitoring for those abnormal abnormalities that could be devastating to a positive outcome. So again, it's a really cool program for that. Number one, it drives that part of our purpose of helping people get well and live healthier through better patient safety. So it checks that box.

It also helps us pinpoint where we may have deficits at one market or one OB program, perhaps in the training program, because if it's being missed by the human and it's being caught by the technology first, we can enhance the education and the support of our caregivers locally.

And then another thing which it ties to is the human capital component. We actually believe there is a competitive advantage to using technology to bring in the best caregivers because it's a protective layer for them as well. There is not an OB nurse in the country who wants a bad outcome on their watch. So when we have technology that really supports them, doesn't supplant them but supports them, it does make them feel more comfortable.

And I'll give you a little story. I was actually rounding during our deployment of this in one of our Texas hospitals. Nurses, again, are great, but they're so used to technology changes. We change our EMRs, and we reprogram this. They're used to the real technical pieces of this. But this one, they said it really feels like it's intuitive to what they do. And then the onboarding, the training was kind of like innovators do. It was different. It was kind of a scavenger hunt through the system. It wasn't just push this button, look for this, look for that. It really was a great, great deployment. So again, I challenge anyone who's embedding technology solutions in healthcare to look at how are you educating and orienting the end users on it.

Tim Hingtgen's Leadership Lessons for Managing Teams in Healthcare 

KZ: I'd love maybe to shift a little bit to kind of the managers in the room. Can you talk a little bit about your leadership style and especially how you think about trying to motivate teams given kind of the large geographic reach, probably the diversity of the environments that your team has to operate in?

TH: It's been a privilege to work with CHS for the last 14 years. And getting the CEO job, I was like, okay, what am I going to do different? How are we going to be more crystallized around what's important to us? So through the help of the executive team, we really put forth a stronger push on alignment through communication and transparency. So that's very important to us. When we perform well, we're going to celebrate the success. When we have to perform better, we're not just going to say everything's up Sunshine Mountain. We actually have to perform better. So I think we've built some credibility through this process over the last five or six years of really making sure I mention those quarterly updates. They're content specific, but very aligned to what's important, what drives our model.

We have four strategic imperatives. The first one, safety and quality. We always give an update as to how we're performing on safety and quality. We have operational excellence. How are we operating? Are we a place where patients want to receive care? Are we efficient in terms of throughput? We have connected care, which I mentioned earlier. How are we advancing on this connectedness and navigation and care journey? And the last is competitive position. Are we winning market share in our markets?

And so throughout the course of what's important to us in communications, it's always layered into those very specific categories. So I think we're pretty easy to navigate at any level of our organization, what's important and how we measure it. So it goes through the communication and the alignment. I think that's been key for us.

KZ: And we were talking a little bit actually before this conversation about books that have been influential to you. Any you'd like to share with the audience here?

TH: Yeah. "Extreme Ownership" is a book that was very impactful for us as an organization. And it's very easy when you're in a multi-state system like ours for people to become disconnected and then sometimes feel like they're not empowered or enabled to do what they have to do in their local market. So we rolled out Extreme Ownership in terms of really a call to action for our hospital leadership teams so that there's no blame. You can't blame anyone. And that's very liberating when you say look, maybe I don't have all control over every decision, but at the end of the day, I can influence that decision. And if I say nothing, I'm culpable to doing the wrong thing, not driving the right thing. So it's very empowering. So we love Extreme Ownership.

But in this current environment, we've kind of had to pivot a little bit more back to brass tacks. I mentioned the aftermath. So if you haven't had a chance, authors and books that have been, I think, very beneficial to me throughout my career, and I keep them on my bookshelf and I keep going back to them again and refreshing myself on the principles because they're profound, but Patrick Lencioni has a lot of great books out there, and they're all in management fables, very simple. But the ones that we really like are "The Five Dysfunctions of a Team," very, very powerful, again, in terms of saying hey, that's not our ground rules, that's not how we're going to operate here, that's not how we're going to drive our model.

And the other one that we really like is "The Motive." It really talks about what's your motive for being a leader. I think that's very important. And then he also has a really good job theory out there in terms of what does it take to hire and select the best people. And in this environment, as I said, human capital being mission critical, we're always looking for humble, hungry, and smart people. And smart people doesn't necessarily mean the brightest person in the room, but they're people smart, they're intuitive, they get what makes people tick and that they can drive and influence outcome.

How Technology and Digital Innovation Fits into CHS' Future Plans

KZ: Love that. Thank you for sharing. Last question for you. I'd like to focus on the future a bit. As you kind of look five years out, where do you hope CHS is going to be, and what role can technology play in that?

TH: None of us should be in the jobs we have today. If we don't want to aspire to be something better, I'll say bigger and better... And so I'd say five years from now, will we have quadrupled the number of hospitals we have? Probably not. Right now, we have 47 distinct healthcare delivery systems. That only includes 81 hospitals and a 1,000-plus sites of care. So I would expect to see more percentage growth on the sites of care side of the equation. I'd like to see the expansion of our digital innovations into touching more patients, connecting more patients to our healthcare delivery system.

And by doing all that, we will drive that competitive position of our strategic imperative, I think, in a very deliberate purpose-driven way. So that's really exciting for us. So in five years, I want to make sure that that purpose statement that I kind of shared with you in various bits and pieces, that people say yeah, that was more than just words on a piece of paper, this is an organization that's driven and committed to making a difference in the communities it serves. I think we're doing that today. I think we have tremendous opportunities to accelerate that in the years to come.

KZ: Well, thank you for sharing all these insights. We feel super fortunate to be your partners at CHS and looking forward to a long journey and partnership together. Thank you for coming and spending time with the team.

TH: It was my pleasure.

KZ: We really appreciate it.

Conclusion: Thanks again to Tim for taking time to visit with our team and sharing some inspiring words. If you're interested in learning more information about Cadence and how to get involved, visit cadence.care. And please get in touch with our team. To make sure you get updates on our future conversations, please subscribe to Cadence Conversations wherever you listen to podcasts. At Cadence, we believe that everyone deserves to receive the best care possible, and we won't stop working until that vision becomes reality.

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