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Five years in, WellSpan CEO looks ahead

In January 2019, Roxanna Gapstur became president and CEO of WellSpan Health, one of the largest employers in Central Pennsylvania.

In little over a year after her first day on the job, she was guiding the health system through one of its most visible challenges, the Covid-19 pandemic.

The pandemic has subsided. But WellSpan and other health systems continue to face headwinds. They include rising costs and workforce shortages, as well as adapting to new payment models and deciding where to invest in new technologies.

Health systems also are growing larger. WellSpan, for example, is preparing to acquire Evangelical Community Hospital in Lewisburg, extending the York-based health system into Lycoming, Northumberland, Snyder and Union counties. WellSpan, which employs more than 21,00 people, currently operates in Adams, Cumberland, Franklin, Lancaster, Lebanon and York counties.

In its existing footprint, WellSpan is building a series of three mini hospitals in Cumberland and York counties, with the first one rising off Interstate 83 near Shrewsbury.

Gapstur spoke recently with biznewsPA about the big-picture issues for the health system she leads.

The following interview has been edited for length and clarity.

biznewsPA: What are the biggest changes you’ve seen in healthcare over the last five years?

Roxanna Gapstur: About one year after I got here, the pandemic hit. So, one of the biggest changes was going through that experience, which for us lasted about three years. The other big changes have been the growth of value-based payment approaches in our markets, which is good. There is a lot more use of technology in healthcare, and the ways in which we use technology are different. And then, coming out of the pandemic, we’ve seen lots of headwinds from the economy, inflation, labor shortages. Those things have impacted all industries, not just ours.

Roxanna Gapstur joined WellSpan Health as president and CEO in 2019.

biznewsPA: What has been the impact of value-based payment models at WellSpan?

Gapstur: When I got to WellSpan, we had pretty traditional relationships with our payers. They weren’t bad, but they weren’t innovative. Now, we have about 240,000 patients under what we call risk arrangements, which means we take risk on the care we provide and the outcomes for those patients. And that’s a better payment model, to be paid for keeping people healthy and for improving their health.

biznewsPA: What are the biggest changes in technology you’ve seen in the last five years?

Gapstur: The biggest change for us has been in the use of artificial intelligence. We have several applications here. One is called ambient listening. That’s where our physicians, starting about three and a half years ago, slip their iPhones in their pockets, go into the exam room and just talk to the patient. There’s no talking to the technology, but it listens during the visit. It used to take two to four hours for notes to come back after the end of a patient visit. They now come back in 15 seconds with generative AI and there’s no human involved there. We’ve watched it ourselves as a team. Our chief technology officer is a physician, so he uses all these things himself, and he did it in our huddle one morning and it was scary good how nice the note came out. That’s really transformational. I tell my medical group leaders that in five years, I don’t think we’ll be typing into the record at all. I think everything’s going to be voice-generated or automatic.

biznewsPA: How are you incorporating technology while maintaining the personal touch that people look for in healthcare, that they may not necessarily look for in an Amazon?

Gapstur: We are trying to become more personalized in everything we do. In January, for example, we started a navigator program. We often have people reach out to find a primary care physician and discover that everything seems full on the portal. What we do now is, we use our chatbots and our technology to ask that person, ‘Would you like to speak to a nurse navigator?’ It may be the first time they’ve tried to connect with us. The nurse navigator will get on and find out exactly what they need.

biznewsPA: How did the decision come about to use drones at WellSpan? (The health system announced a partnership in February with drone operator Zipline to use autonomous drones to ferry patient prescriptions, lab samples and other medical products.)

Gapstur: I was at a national meeting and saw a presentation from the CEO of Zipline. It just seemed that, for our geography in a rural area, it could be really transformational. So, I reached out to him and found out that they were just getting into the United States. They’ve been in Africa for a decade.

biznewsPA: People on the outside might look in and say you’re spending a lot of money on technology, such as drones and AI. How should people view that, and should they be concerned that those investments increase costs?

Gapstur: I don’t think so. This is how we’re looking at it: There’s not enough people to provide healthcare in this country. There’s a shortage of nurses, a shortage of physicians, and there’s a shortage of other workers as well. Knowing that there’s not going to be enough people, we believe that we have to use people, process and technology differently together. And so that’s the goal of the innovations that we’re investing in. We believe technology will be so important to how we care for people in the future, we think it would be negligent of us to not be focused in that area.

biznewsPA: We have been hearing about value-based care for years. Why is it taking so long to implement?

Gapstur: We have had such a complex reimbursement system in the U.S, it’s not a simple fix. The work that CMS (Centers for Medicare and Medicaid Services) does and the work that we do with our payers is really important. My hope is that we will get to a tipping point. Many people thought the tipping point would’ve come a long time ago, but it hasn’t.

biznewsPA: What would that tipping point look like?

Gapstur: I hope it will look like more stable revenue for health systems, not necessarily higher revenue. During the pandemic, when we all had to shut down, what happened? The revenue went away. If we had been paid on population-based payments, we would have had revenue still coming in. If anything, the pandemic taught us that this idea that volume is the way to go is tenuous during different times.

biznewsPA: Were there other lessons from the pandemic?

Gapstur: We learned that being a system really helped. Some of our hospitals, if they had still been independent, would have had a hard time. We were shifting team members around to help each other depending on where we were hardest hit. It showed us about our public health system and some of the gaps because many of us had to step up and fill some of those gaps. In the area of supply chain, it taught us that we shouldn’t be too dependent on one country or one contract. We’ve really diversified our supply chain, and we’re using more local suppliers. Being able to touch and feel and see your suppliers, we learned, is more important than we thought. We thought we were getting so large that it would be hard for local suppliers to supply us. But we learned that some companies were able to work with us.

biznewsPA: Where do you see WellSpan five years from now?

Gapstur: We’ll be working very differently. Robotics is going to be very big in healthcare. We’re going to have more human-plus-machine work than we’ve ever had before. We’ll probably have fewer people, but more highly skilled people. There will be opportunities for people to hold roles and jobs within WellSpan and other health systems that we didn’t imagine before. Care will eventually become more affordable if we stay on this value-based care path. I hope we don’t have another pandemic.

biznewsPA: Where do you see robotics playing a role?

Gapstur: We use lots of robotics in surgery already. But we’re going to start using one in food services. It’s called RoboEatz and it can make a thousand meals every 24 hours. It can make anything that can be put into a bowl. We serve about 3 million meals a year across WellSpan. So, it’s a lot. The robot doesn’t really need a break or doesn’t get overtired. And our understanding is that the uptime is very good.

Officials break ground April 23 on WellSpan Shrewsbury Hospital, a new 'mini hospital.'

In January 2019, Roxanna Gapstur became president and CEO of WellSpan Health, one of the largest employers in Central Pennsylvania.

In little over a year after her first day on the job, she was guiding the health system through one of its most visible challenges, the Covid-19 pandemic.

The pandemic has subsided. But WellSpan and other health systems continue to face headwinds. They include rising costs and workforce shortages, as well as adapting to new payment models and deciding where to invest in new technologies.

Health systems also are growing larger. WellSpan, for example, is preparing to acquire Evangelical Community Hospital in Lewisburg, extending the York-based health system into Lycoming, Northumberland, Snyder and Union counties. WellSpan, which employs more than 21,00 people, currently operates in Adams, Cumberland, Franklin, Lancaster, Lebanon and York counties.

In its existing footprint, WellSpan is building a series of three mini hospitals in Cumberland and York counties, with the first one rising off Interstate 83 near Shrewsbury.

Gapstur spoke recently with biznewsPA about the big-picture issues for the health system she leads.

The following interview has been edited for length and clarity.

biznewsPA: What are the biggest changes you’ve seen in healthcare over the last five years?

Roxanna Gapstur: About one year after I got here, the pandemic hit. So, one of the biggest changes was going through that experience, which for us lasted about three years. The other big changes have been the growth of value-based payment approaches in our markets, which is good. There is a lot more use of technology in healthcare, and the ways in which we use technology are different. And then, coming out of the pandemic, we’ve seen lots of headwinds from the economy, inflation, labor shortages. Those things have impacted all industries, not just ours.

Roxanna Gapstur joined WellSpan Health as president and CEO in 2019.

biznewsPA: What has been the impact of value-based payment models at WellSpan?

Gapstur: When I got to WellSpan, we had pretty traditional relationships with our payers. They weren’t bad, but they weren’t innovative. Now, we have about 240,000 patients under what we call risk arrangements, which means we take risk on the care we provide and the outcomes for those patients. And that’s a better payment model, to be paid for keeping people healthy and for improving their health.

biznewsPA: What are the biggest changes in technology you’ve seen in the last five years?

Gapstur: The biggest change for us has been in the use of artificial intelligence. We have several applications here. One is called ambient listening. That’s where our physicians, starting about three and a half years ago, slip their iPhones in their pockets, go into the exam room and just talk to the patient. There’s no talking to the technology, but it listens during the visit. It used to take two to four hours for notes to come back after the end of a patient visit. They now come back in 15 seconds with generative AI and there’s no human involved there. We’ve watched it ourselves as a team. Our chief technology officer is a physician, so he uses all these things himself, and he did it in our huddle one morning and it was scary good how nice the note came out. That’s really transformational. I tell my medical group leaders that in five years, I don’t think we’ll be typing into the record at all. I think everything’s going to be voice-generated or automatic.

biznewsPA: How are you incorporating technology while maintaining the personal touch that people look for in healthcare, that they may not necessarily look for in an Amazon?

Gapstur: We are trying to become more personalized in everything we do. In January, for example, we started a navigator program. We often have people reach out to find a primary care physician and discover that everything seems full on the portal. What we do now is, we use our chatbots and our technology to ask that person, ‘Would you like to speak to a nurse navigator?’ It may be the first time they’ve tried to connect with us. The nurse navigator will get on and find out exactly what they need.

biznewsPA: How did the decision come about to use drones at WellSpan? (The health system announced a partnership in February with drone operator Zipline to use autonomous drones to ferry patient prescriptions, lab samples and other medical products.)

Gapstur: I was at a national meeting and saw a presentation from the CEO of Zipline. It just seemed that, for our geography in a rural area, it could be really transformational. So, I reached out to him and found out that they were just getting into the United States. They’ve been in Africa for a decade.

biznewsPA: People on the outside might look in and say you’re spending a lot of money on technology, such as drones and AI. How should people view that, and should they be concerned that those investments increase costs?

Gapstur: I don’t think so. This is how we’re looking at it: There’s not enough people to provide healthcare in this country. There’s a shortage of nurses, a shortage of physicians, and there’s a shortage of other workers as well. Knowing that there’s not going to be enough people, we believe that we have to use people, process and technology differently together. And so that’s the goal of the innovations that we’re investing in. We believe technology will be so important to how we care for people in the future, we think it would be negligent of us to not be focused in that area.

biznewsPA: We have been hearing about value-based care for years. Why is it taking so long to implement?

Gapstur: We have had such a complex reimbursement system in the U.S, it’s not a simple fix. The work that CMS (Centers for Medicare and Medicaid Services) does and the work that we do with our payers is really important. My hope is that we will get to a tipping point. Many people thought the tipping point would’ve come a long time ago, but it hasn’t.

biznewsPA: What would that tipping point look like?

Gapstur: I hope it will look like more stable revenue for health systems, not necessarily higher revenue. During the pandemic, when we all had to shut down, what happened? The revenue went away. If we had been paid on population-based payments, we would have had revenue still coming in. If anything, the pandemic taught us that this idea that volume is the way to go is tenuous during different times.

biznewsPA: Were there other lessons from the pandemic?

Gapstur: We learned that being a system really helped. Some of our hospitals, if they had still been independent, would have had a hard time. We were shifting team members around to help each other depending on where we were hardest hit. It showed us about our public health system and some of the gaps because many of us had to step up and fill some of those gaps. In the area of supply chain, it taught us that we shouldn’t be too dependent on one country or one contract. We’ve really diversified our supply chain, and we’re using more local suppliers. Being able to touch and feel and see your suppliers, we learned, is more important than we thought. We thought we were getting so large that it would be hard for local suppliers to supply us. But we learned that some companies were able to work with us.

biznewsPA: Where do you see WellSpan five years from now?

Gapstur: We’ll be working very differently. Robotics is going to be very big in healthcare. We’re going to have more human-plus-machine work than we’ve ever had before. We’ll probably have fewer people, but more highly skilled people. There will be opportunities for people to hold roles and jobs within WellSpan and other health systems that we didn’t imagine before. Care will eventually become more affordable if we stay on this value-based care path. I hope we don’t have another pandemic.

biznewsPA: Where do you see robotics playing a role?

Gapstur: We use lots of robotics in surgery already. But we’re going to start using one in food services. It’s called RoboEatz and it can make a thousand meals every 24 hours. It can make anything that can be put into a bowl. We serve about 3 million meals a year across WellSpan. So, it’s a lot. The robot doesn’t really need a break or doesn’t get overtired. And our understanding is that the uptime is very good.

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