Kert Anzilotti, Chief Physician Executive/ President, ChristianaCare/ChristianaCare Medical Group

Kert Anzilotti, chief physician executive of ChristianaCare and president of the ChristianaCare Medical Group, spoke with Invest: about expanding and evolving the footprint of the healthcare system. “The two most important things are creating access points closer to where patients live and work, and making healthcare affordable. We believe in being excellent today and even better tomorrow,” said Anzilotti.

What changes internally and externally have influenced your leadership priorities for the region?

The past year has been both challenging and exciting for our organization. There is a lot of pressure on hospital-based healthcare systems. Our multi-hospital system focuses on acute care and our ambulatory network. There are many macro forces impacting us at the federal level and impacting our funding sources. Locally, workforce pressures are an ongoing challenge, including the need to recruit and retain top talent in a highly competitive marketplace. Safety is also an increasing concern — as violence against healthcare workers is on the rise nationally, we are focusing resources to ensure the safety of our caregivers and our patients. The economics of healthcare are changing, and inflation in supply chains is a new challenge, while payer reimbursements are not keeping up.

What pressing challenges are facing not-for-profit health systems in today’s economic and regulatory environment?

Our most pressing challenge is the provider workforce. There have been significant changes since the COVID pandemic. Many of these changes were originally happening naturally and slowly but were accelerated during that period. Many people left the healthcare industry, retired early or shifted to part-time roles. It is putting significant pressure on the caregiver workforce. We are thinking differently and paying attention to our workforce. Salaries have gone up for employed and independent physicians. We are also focused on well-being and supporting our workforce by making their jobs easier with the best tools and technology. Investments in ambient listening technology have helped physicians do their jobs more effectively and easily. These changes are helping physicians to find joy in their work and not get burned out. 

Healthcare is becoming more expensive, and reimbursements are not keeping up with those expenses. We need to think about providing care at the lowest appropriate cost. We are prioritizing providing care efficiently with limited and increasingly expensive resources. 

What trends are affecting operations, and where do you see some of the greatest opportunities for your organization to make an impact in the community?

Demographic trends, particularly the aging population, are working against healthcare systems. We’ve seen many patients convert to government payers, which makes it harder for the economics to work in our system. As people age, they utilize more healthcare and demand increases. Emergency department (ED) visits have risen. We’re also seeing contraction of access points in our market and other nearby markets. The upcoming federal mandates and changes will bring uncertainty and less funding. 

There are also many granular changes, such as increases in substance use disorder, which are increasing needs for complex care. Another trend having a significant impact on healthcare providers is the change in the social contract between providers and the public. The way we interact and display respect and empathy has changed. Workplace violence is a concern, and we have to train our workforce on de-escalation and self-preservation techniques when dealing with violent patients. 

Is there any particular social factor you attribute these changes to? What are patients demanding more from providers?

Patient expectations have changed. Widely available information online has led to patients telling doctors and nurses what the treatment should be before they are evaluated. The United States is seeing a change in its society wherein violence is becoming an accepted way to transact with people in public places, and we are seeing that in our care environments. 

How are you working with regional partners to expand access points for patients?

We are thoughtful about creating a healthcare ecosystem that is sustainable. The two most important things are creating access points closer to where patients live and work, and making healthcare affordable. We recently opened a neighborhood hospital, a small-footprint inpatient facility with ancillaries and diagnostics, with only 10 inpatient and 10 emergency department beds. Patients don’t have to travel to a large hospital to get the care they need. This is a sustainable model that becomes part of the community, and we think this is the future of creating health care access points. 

We have a large initiative around ambulatory surgery centers. Our operating rooms at our main hospital are in high demand, and a number of those surgeries can be performed at a lower cost, and in a more sustainable way, at a smaller location convenient to where people live and work. We have significantly increased our urgent care footprint, up to 14 locations, spanning across Delaware, Maryland and Pennsylvania. All these access points are less congested, easier to access, and provide care at a lower cost and in a more sustainable way. We are also heavily investing in our primary care network. There aren’t enough primary care doctors in the U.S. We have hired 28 primary care physicians across four different states in just the past few months. Primary care is one of the most effective ways to provide care, manage chronic disease, prevent ED visits and prevent higher-cost surgeries. A robust, sustainable primary care network can lower the cost of care, create a value-based proposition in our care model and create a sustainable model in our market that can serve the healthcare needs of our neighbors.

How has Christiana Care leveraged data analytics technology to improve access and care coordination?

We are a high-reliability, data-driven organization. We are constantly using data and technology to fine-tune our care models. Data and AI are related but separate strategies. We are using data to maximize and create efficiencies in every care environment in our organization, from operating room procedures to primary care office scheduling. The patients with the highest risks and most urgent needs are being seen, and physicians are using their time as effectively as possible. 

This year we are doubling down on AI and leveraging it across our organization. We have radiology apps that help radiologists interpret images more effectively. We have a number of AI tools helping clinicians make better decisions and find diagnoses more quickly. AI also aids in our back office procedures, including processing insurance payments and pre-authorizations. Having machines do these rote processes creates opportunities for efficiency and increased effectiveness in every aspect of our organization. AI can also help utilize the skillset of our employees, such as placing nurses with particular skill sets into the most optimal places. 

What are Christiana Care’s top priorities over the next two to three years?

We are on a growth trajectory, and growing into our geography while addressing the specific healthcare needs of the region is a top priority. It’s a reality of healthcare in the U.S. that size does matter, and growing to create sustainable networks has become a necessity. Our workforce pipeline is another top priority. We have a number of programs such as our certified registered nurse anesthetist program, residencies and partnerships with local and state universities to create talent pipelines. We’ve created a work environment where people want to work and can flourish and grow as professionals. We believe in being excellent today, and even better tomorrow.