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Becker’s Healthcare Podcast
Virtual Critical Care and Workforce Strategy at Advocate Health with Dennis L. Disch
00:17:41
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- [00:02]
A
Every year, Becker's annual meeting brings healthcare leaders together to unpack the most pressing issues facing the industry. And every year, those conversations shift in profound and unexpected ways. This April, more than 3,500 healthcare executives will return to Chicago for Becker's 16th annual meeting. 795 elite speakers will offer new lessons, new case studies, and predictions about what comes next. Join us April 13th through the 16th. For the agenda and event details, visit BeckersHospitalReview.com and click on the Events tab in the upper right.
- [00:38]
B
This is Laura Dearda with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Dennis Dish, Vice President of the hospital based specialty service line at the Illinois and Wisconsin divisions of Advocate Health. Dennis, it's a pleasure to have you on the podcast today.
- [00:52]
A
My pleasure, Laura. Thanks very much for having me this morning. I've been looking forward to the conversation.
- [00:56]
B
Well, absolutely, as have I. I think it's just such a fascinating time in healthcare today and truly interesting to see all the changes and transformations and evolutions happening, especially at a health system like Advocate, a large system and very well respected. So I'm excited to learn more from you about what you've been up to and how you're thinking about the future. But before we do that, can you tell me a little bit more about yourself, your background and the organization?
- [01:22]
A
Yes, happy to. Thank you. So as you mentioned, I currently serve as the Vice President and physician leader for the hospital based specialty service line for Advocate Health, which is our largest service line and includes anesthesia services, radiology, hospital medicine, emergency medicine and critical care services. Prior to my current role, I spent two years as the physician leader for the cardiovascular service line for Advocate. Before that I was with corewell Health in Michigan, serving as the cardiovascular service line leader for its south region as well as the chief medical and chief operating officer for one of its hospitals. In terms of Advocate Health, just a couple of facts about Advocate. We're the third largest nonprofit health system in the United States with 69 hospitals across four states. We currently have three state based divisions, which is how it breaks down. These are the Illinois Division, the Wisconsin Division, and then there is a combined North Carolina and Georgia division. My leadership role spans our 10 hospitals in the Chicago area which make up the Illinois division, as well as our 17 adult hospitals in Eastern Wisconsin that make up the Wisconsin division.
- [02:25]
B
That's fantastic to hear and definitely exciting to have that kind of accountability over such a wide space, but an important population and community as well. Now, when you think about the last year or so could you tell us a little bit more about an initiative that you led? What did you do and what were the results?
- [02:43]
A
Sure. Well, with such a busy service line, it's been a busy year, so there's a lot going on. But one highlight I think for 2025 was the integration of our virtual critical care services across all three divisions of Advocate Health onto one common technology platform and one emerging common care delivery model. So we're very fortunate actually to have been able to integrate two of the largest and longest standing virtual critical care programs in the country. So, example, our Chicago area program has been operational since 2003 and covers over 200 ICO beds across 14 hospitals. Whereas our Charlotte program started back in 2013, covers almost 300 beds across 17 facilities. So a lot of experience coming together to create that care model. We've also had outside contracts with other systems across nine different states. And these programs include virtual nursing as well, virtual pharmacy support, virtual pulmonary support, and then virtual respiratory therapy support at many locations. So for 2026, we're position to fully reimagine the way in which we integrate virtual critical care into an overall strategy so we can provide the most advanced, highest quality critical care services at all of our 69 hospitals, no matter what size or scope of services each location provides. This is really relevant for that sort of kind of the sweet spot for this model is that group of hospitals which are large enough to have higher acuity patients requiring ICU care, but aren't quite large enough to really need 24 hour in house ICU provider coverage. So by having this virtual critical care coverage availability across the whole system, we can now tailor the amount of virtual coverage that's required at each site. And then we can also flex this coverage as needed based on future growth in services, seasonal variations and total census numbers like we're seeing right now, and on patient acuity. This integration has also allowed us to bring provider coverage completely in house, which obviates the need for third party locums coverage, which obviously can be expensive. And it also allows us to really standardize our care model across the entire geography of Advocate Health so that our patients in even the most remote locations can really benefit from the same level of expertise and adherence to evidence based practices as for example, those patients in Chicago, Milwaukee or Charlotte.
- [04:53]
B
Got it. That's helpful to understand and really cool to have that ability to roll out a model like that and keep everything in house. I'm curious when you look at how you're thinking about virtual and the technology it takes as well as the people change management aspect. Is there anything that you have learned over the last year or so as you're thinking through the technology, how you're reimagin and putting that into strategy that's been particularly effective in something that'd be interesting, of course, for other health systems to know about?
- [05:23]
A
Yeah, you know, we're trying to apply that virtual technology in a number of different ways. I think sometimes it's easy to think of, you know, virtual care as sort of an easy answer or the easy button, if you will, for a lot of issues. But I think you really have to think about how it can really make a difference applied to specific situations. So, for example, we have a teletrage program through our emergency departments that's really helped us address some of our issues with hospital boarding or emergency room boarding. We can move people through the system much faster. And it's been a real boon to our ability to sort of streamline that care model. In the emergency department, we have a very active telehospitalist program, for example, and so we only apply it in areas where it's really needed. So instead of it just being this all encompassing model of virtual care coverage, it's really more of a tool to use to solve particular bottlenecks and issues within the system.
- [06:20]
B
That's so helpful to understand and you know, what a great example of how the technology can make a big difference and, you know, truly integrated into the broader mission of the organization. Now, looking ahead, what are some of the big priorities and headwinds that you're focused on for 2026?
- [06:35]
A
Well, I think 2026 is going to be an interesting and challenging year for a lot of the reasons that I think your listeners all have an appreciation of. I think it's the challenge of providing hospital based services like the ones that I oversee at a reasonable cost to the organization continues. We're really going to need to prospectively assess the viability of all of our provider models across each of our hospital based specialties. Not just those staffed by employed providers, by the way, but also those staffed by our independent aligned providers. And we have quite a few of those valued colleagues, not only in the Chicago market, but also in the Charlotte market. I think we have to really assume that reimbursement is going to continue to decline, as we've seen, and labor costs obviously are going to continue to increase due to clinician shortages and also just the increasing costs of providing health care coverage for these clinicians. So therefore, you know, the business models that have really served our valued independent Physician partners well, in the past may just not, may not really any longer make sense. In 2026. We're seeing this especially in anesthesia services, as is everybody. But we're also seeing this in radiology, for example, hospital medicine and even emergency medicine in a couple of our locations. So we're really going to need to expand our employed clinician workforce even faster than we previously anticipated in order to provide these valued clinicians with fair compensation for partnering with us to take the best care of our PAT communities. So we're having these conversations early and often with our independent partners in order to prevent any interruption in crucial hospital services. And then the second priority I would mention is that we're really continuing to refine our Best Place to Care initiative, which is advocates approach to building and supporting our clinician workforce. This involves really kind of three just very basic elements. First is successful recruiting, onboarding and retaining our really talented clinician workforce. We absolutely have to prioritize that because no strategic plan is going to make sense and or is going to be operational if we don't have the top talent and we can't keep top talent. So that's really important to us. The second limb of that is making it easier for these clinicians to really take the best care of their patients through the use of new technology and appropriate staffing. So really removing the friction of taking care of these patients. And then thirdly, and just as importantly, supporting their professional fulfillment through programs that optimize their well being, give them a voice in the organization and really facilitate opportunities for career advancement and leadership. I think the success of our organization is really going to depend on our ability to do this well.
- [09:00]
B
I love that. I think having that kind of focus on the clinical operation, being able to, you know, make the nimbleness, I guess that you need. Given some of the challenges and changes that will likely occur with reimbursements and continued increases on the cost side in supplies and labor and more. From your perspective, when you look at, you know, how all of this is coming together and likely will continue to be a challenge in the next couple of years and then as you mentioned, being able to keep optimizing clinician well being, career advancement, those kinds of things, are there any types of investments or programs that you're trying out or have tried out in the last year that have been successful just to help boost up that clinical workforce and give them something that will make sure you're retaining them moving forward?
- [09:49]
A
Yeah, I just mentioned a couple. That's a great question. One is one I think that a lot of health systems are working on is that is really increasingly utilizing the ambient listening technology to help with note generation and reporting notes and that sort of thing. We now have the largest application of Dragon Copilot in the country that we're partnering with EPIC on. And so we're really. And we have about 50% of our physicians using that across most of our specialties. And so really have had very successful adoption of that technology, which is dramatically improved that that pajama time somebody call it to try to generating those notes after you go home. We really want our physicians to be able to and our apps to be able to finish all of that before they go home. The other thing is that, you know, we're really trying to develop our virtual health technology for a couple of reasons. Number one is the most obvious is that more and more patients are really wanting to have virtual care visit. But the one that's a little, I think, a little less obvious is that on the provider side or on the clinician side, there are a lot of clinicians who are wanting to actually take on more and more virtual work that they can do remotely rather than being in an office. And so I think as we continue to really focus on meeting patients and providing the care where they want it, interestingly, that's also going to meet the needs of a lot of our clinicians who really enjoy at least spending part of their time providing care off site virtually rather than on site in person.
- [11:24]
B
That's helpful to understand. Thank you so much for diving in there. Now, what do you think the hardest thing you'll have to do in the next year will be?
- [11:33]
A
Yeah, I think we're going to have a lot of challenges. 2026 is going to be a big year for health systems in a lot of ways. But I think most health systems are developing strategies right now to shift from more from a hospital centric strategy to more of an ambulatory forward strategy. And there's a lot of talk going on about that. And advocate is no different. We're very focused on that as well. This shift, though, is going to further complicate how we approach providing anesthesia services as the decisions we make on which procedures move to ASCs and outpatient labs is going to need to be coupled with adjustments in how we deploy our anesthesia workforce across each of these geographies. So we're really going to focus on robust collaboration with our surgical and procedural service line and include both employed and independent aligned physicians as well. Because this is going to be very challenging to put all of this together and make sure we have appropriate staffing at all of our locations, whether they're hospital based or whether they're ambulatory. We're going to really need to further expand our anesthesia workforce as well, which obviously is quite challenging in the current environment, and ensure that we optimize our overall coverage model to accommodate this shift in procedural volume, a lot of which is really going to shift from inpatient to outpatient. We're asking our clinicians to be more flexible in terms of providing care at multiple locations so we can be more nimble on how we actually provide the highest quality care in the settings that patients and payers are increasingly going to prefer.
- [12:55]
B
That makes a lot of sense, and it's fascinating to think about that shift into more of the ambulatory space, more outpatient. And I very much appreciate how that changes the way you're thinking about staffing, especially in anesthesia, which across the board has a lot of different dynamics within that space. And I'm curious, when you look at how you're thinking about resources and resource management, I know it shifts a little bit, you know, in terms of reimbursement and how services are delivered within the organization. So when you look at resources, how do you think about that differently at the, I guess, executive level when you are looking at more ambulatory versus inpatient space and in services at the health system?
- [13:42]
A
Well, you know, I think traditionally growth has had to be coupled with increasing our current facilities in terms of brick and mortar. But I think increasingly, as a lot of this volume is going to shift from the inpatient setting to the outpatient setting, whether, you know, whether site neutrality conversations progress or not, we're going to really have to be much more strategic about how we think about growth and how we fund growth. So, for example, if the reimbursement for a particular procedure is going to be less in an ASC setting than is in a hospital setting. But that's the best thing for the health system, and it's the best thing for the patient and the payers. And that's something we're going to have to figure out how to provide in a cost effective way. But it has to be combined with a really strategic, thoughtful approach to how we perhaps repurpose some of our larger brick and mortar hospital buildings as well. So a lot of those grand facility projects across large hospitals may have to be substituted for more of a focus on outpatient labs and ASCs. So we just have to be more nimble and more strategic about how we develop our resources outside of our 10 large hospitals in Chicago, for example, using that as one example. And figure out where exactly do we want to invest our resource in building other facilities to be able to adjust to this, this sort of new model of care, if you will.
- [15:18]
B
That's helpful to understand and I think it makes a real smart way to look at that transformation. Before we wrap up here, I wanted to ask you about growth too. Where do you see some of those opportunities for growth coming down the pipe?
- [15:30]
A
Yeah, well, you know, Advocate Health's a very large organization and we're in the midst of a very bold, comprehensive, strategic, strategic plan that's going to be operationalized through 2030. So there's a lot going on right now. But that said, I would probably highlight three particular opportunities where I really see a lot of potential for growth. So first of all, and we kind of touched on this a little bit earlier, but leveraging our virtual health and AI platforms to really expand specialty care and critical care access, as I mentioned, to these more rural communities, this work is already kind of happening with our primary care service line and our national service line for cancer, heart and vascular and neurosciences. And we're going to continue to expand our current telehospilist until the triage programs across all three divisions. So I expect to see a lot of growth within Advocate Health in that area. A second one I'll mention is the recent establishment of our national center for Clinical Trials, which is based at our academic hub, Wake Forest University School of Medicine. This is a really exciting, coordinated effort which will really streamline the process for participation of our patients in clinical trials and make some potentially lifesaving therapies available to patients across all of our communities, not just those closest to our academic medical centers. And then the third one that I would mention was we're going to continue to expand access to primary care and more specialized care to all of our communities through thoughtful care model redesign. So that's going to entail a couple of things. Number one, utilize all of our clinicians at the top of their license to provide that evidence based care in concerts with how patients really preferred to receive the care, as I mentioned earlier. And then secondly, as patients increasingly approach their healthcare with a consumer mindset, our strategic plan really has to be designed to meet each patient where they are. I think any health system that really wants to grow in 2026 is going to have to prioritize that in 2026 and beyond.
- [17:20]
B
I love it. Dennis, thank you so much for joining us on the podcast today. This has been a really fun conversation, very informative and insightful, and I look forward to seeing you as well at our annual meeting in April. I know you'll be speaking on a panel and digging deeper into many of the themes we talked about today. So looking forward to seeing you there.
- [17:35]
A
Yeah, I'm looking forward to it as well. Thanks for the opportunity, Lars. Great to talk to you.