Latest / Becker’s Healthcare Podcast / Virtual Critical Care and Workforce Strategy at Advocate Health with Dr. Dennis L. Disch

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Virtual Critical Care and Workforce Strategy at Advocate Health with Dr. Dennis L. Disch · Becker’s Healthcare Podcast

• 0:01
  Every year, Becker's annual meeting brings health care
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  leaders together to unpack the most pressing issues
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  facing the industry.
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  And every year, those conversations shift in profound
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  healthcare executives will return to Chicago for Becker's
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  sixteenth annual meeting.
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  For the agenda and event details,
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  visit beckershospitalreview.com
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  and click on the events tab in the
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  upper right.
• 0:37
  This is Laura Dirda with the Becker's Healthcare
• 0:40
  podcast. I'm thrilled today to be joined by
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  Dennis Dish, vice president of the hospital based
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  specialty service line at the Illinois and Wisconsin
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  Divisions of Advocate Health. Dennis, it's a pleasure
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  to have you on the podcast today.
• 0:51
  My pleasure, Laura. Thanks, very much for having
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  me this morning. I've been looking forward to
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  the conversation.
• 0:56
  Oh, absolutely. As have I. I I think
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  it's just such a
• 0:59
  fascinating time in health care today and, you
• 1:01
  know, truly interesting to see all the,
• 1:04
  changes and transformations and evolutions happening, especially at
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  a health system like ADVOCATE, you know, a
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  large system and very well respected. So I'm
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  excited to learn more from you about what
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  you've been up to and how you're thinking
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  about the future. But before we do that,
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  can you tell me a little bit more
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  about yourself, your background, and,
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  the organization?
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  Yes. Happy to. Thank you. So as you
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  mentioned, I currently serve as the vice president
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  and physician leader for the hospital based specialty
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  service line for Advocate Health, which is our
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  largest service line and includes anesthesia services, radiology,
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  hospital medicine, emergency medicine, and critical care services.
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  Prior to my current role, I spent two
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  years as the physician leader for the cardiovascular
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  service line for Advocate. And before that, I
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  was with CorVel Health at Michigan serving as
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  the cardiovascular service line leader for its South
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  Region, as well as the chief medical and
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  chief operating officer for one of its hospitals.
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  In terms of Advocate Health, just a couple
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  of, facts about, Advocate. We're the third largest
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  nonprofit health system in The United States, with
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  69 hospitals across four states.
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  We currently have three state based divisions, which
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  is how it breaks down. So there are,
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  these are the Illinois division, the Wisconsin division,
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  and then there is a combined North Carolina
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  and Georgia division. So my leadership role spans
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  our 10 hospitals in the Chicago area, which
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  make up the Illinois division, as well as
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  our 17 adult hospitals in Eastern Wisconsin that
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  make up the Wisconsin division.
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  That's fantastic to hear. And, you know, definitely,
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  exciting to have that kind of accountability over,
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  you know, social wide
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  wide space, but an important population of community
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  as well. Now when you think about the
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  last year or so, could you tell us
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  a little bit more about an initiative that
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  you led? What did you do, and what
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  were the results?
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  Sure. Well, with such a busy service line,
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  it's been a busy year, so there's a
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  lot going on. But on one highlight, I
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  think, for 2025
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  was the integration of our virtual critical care
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  services across all three divisions of Advocate Health
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  onto one common technology platform and one emerging
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  common care delivery model. So So we're very
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  fortunate actually to have been able to integrate
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  two of the largest and longest standing virtual
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  critical care programs in the country. So for
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  example, our Chicago area program has been operational
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  since 2003 and covers over 200 ICO bids
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  across 14 hospitals.
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  Whereas our Charlotte program started back in 2013
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  covers almost 300 beds across 17 facilities. So
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  a lot of experience coming together to create
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  that care model. We've also had outside contracts
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  with other systems across nine different states. And
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  these programs include virtual nursing as well, virtual
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  pharmacy support, virtual, virtual pulmonary support, and then
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  virtual respiratory therapy support at many locations.
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  So for 2026,
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  we're now positioned to fully, really, fully reimagine
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  the way in which we integrate virtual critical
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  care into an overall strategy.
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  So we can provide the most advanced, highest
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  quality critical care services at all of our
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  69 hospitals, no matter what size or scope
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  of services each location provides.
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  This is really relevant for that sort of,
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  kind of the sweet spot for this model
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  is that that's that group of hospitals, which
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  are large enough to have higher acuity patients
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  requiring ICU care, but aren't quite large enough
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  to really need twenty four hour in house
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  ICU provider coverage. So by having this virtual
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  critical care coverage availability across the whole system,
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  we can now tailor the amount of virtual
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  coverage that's required at each site. And then
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  we can also flex this coverage as needed
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  based on future growth in services,
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  seasonal variations in total census numbers like we're
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  seeing right now, and on patient acuity.
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  This integration has also allowed us to bring
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  provider coverage completely in house, which obviates the
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  need for third party locums coverage, which obviously
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  can be expensive.
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  And it also allows us to really standardize
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  our care model across the entire geography of
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  Advocate Health so that our patients in even
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  the most remote locations
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  can really benefit from the same level of
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  expertise and adherence to evidence based practices
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  as, for example, those patients in Chicago, Milwaukee,
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  or Charlotte.
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  Got it. That's helpful to understand and, you
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  know, really cool to have that ability,
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  to roll out a model like that and,
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  keep everything in house. I'm curious when you
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  look at how you're thinking about virtual and
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  the technology it takes as well as the
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  people change management aspect. Is there anything that
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  you have learned over the last year or
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  so as you're thinking through the technology, how
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  you're reimagining care and and putting that into
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  strategy,
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  that's been particularly effective in something that'd be
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  interesting, of course, for other health systems to
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  know about?
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  Yeah. You know, we're we're trying to apply
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  that virtual technology in a number of different
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  ways.
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  I think sometimes it's easy to think of,
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  you know, virtual care as sort of an
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  easy answer,
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  or the easy button, if you will, for
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  a lot of issues. But I think you
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  really have to think about how it can
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  really make a difference applied to specific situations.
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  So for example, we have a tele triage
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  program, through our emergency departments that's really helped
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  us,
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  address some of our, issues with hospital boarding
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  or emergency room boarding.
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  We can move people through the system much
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  faster. And it's been a real boon to
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  our ability to sort of,
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  sort of streamline that care model in the
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  emergency department. We have a very active telehospitalist
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  program, for example. And so we only apply
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  it in areas where it's really needed. So
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  instead of it just being this all encompassing
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  model of virtual care coverage, it's really more
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  of a tool to use to solve particular
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  bottlenecks and issues within the health system.
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  That's so helpful to understand. And, you know,
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  what a a great example of how the
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  technology can make a big difference and, you
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  know, truly integrated into the the broader mission
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  of the organization. Now looking ahead, what are
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  some of the big priorities and headwinds that
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  you're focused on for 2026?
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  Well, I think 2026 is going to be
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  an interesting and challenging year, for a lot
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  of the reasons that I think your listeners
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  all have an appreciation of. I think it's
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  the challenge of providing hospital based services like
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  the ones that I oversee,
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  at a reasonable cost to the organization continues
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  to grow, we're really gonna need to prospectively
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  assess the viability of all of our provider
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  models across each of our hospital based specialties,
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  not just those staffed by employed providers, by
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  the way, but also those staffed by our
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  independent and aligned
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  providers. And we have quite a few of
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  those valued colleagues, not only in the Chicago
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  market, but also in the Charlotte market.
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  I think we have to really assume the
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  reimbursement is going to continue to decline as
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  we've seen, and labor costs obviously are going
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  to continue to increase due to clinician shortages
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  and also just the increasing costs of providing
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  healthcare coverage for these clinicians. So therefore, you
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  know, the business models that have really served
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  our valued independent physician partners well in the
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  past may just not, may long, may not
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  really any longer make sense on twenty twenty
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  six.
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  We're seeing this especially in anesthesia services, as
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  is everybody, but we're also seeing this in
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  radiology, for example, hospital medicine, and even emergency
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  medicine in a couple of our locations.
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  So we're really gonna need to expand our
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  employed clinician workforce even faster than we previously
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  anticipated in order to provide these valued clinicians
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  with fair compensation for partnering with us to
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  take the best care of our patients and
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  communities.
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  So we're having these conversations early and often
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  with our independent partners in order to prevent
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  any interruption in crucial hospital services.
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  And then the second priority I would mention
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  is that we're really continuing to refine our
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  best place to care initiative, which is advocates'
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  approach to building and supporting our clinician workforce.
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  This involves really kind of three just very
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  basic elements. First is, successful recruiting, onboarding, and
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  retaining our really talented clinician workforce. We absolutely
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  have to prioritize that because
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  no strategic plan is gonna make sense or
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  is gonna be operational,
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  if we don't have the top talent and
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  we can't keep top talent. So that's really
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  important to us. The second limb of that
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  is making it easier for these clinicians to
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  really take the best care of their patients
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  through the use of new technology and appropriate
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  staffing. So really removing the friction of taking
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  care of these patients.
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  And then thirdly, and just as importantly, supporting
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  their professional fulfillment through programs that optimize their
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  well-being,
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  give them a voice in the organization, and
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  really facilitate opportunities for career advancement and leadership.
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  I think the success of our organization is
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  really going to depend on our ability to
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  do this well.
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  I love that. I I think having that
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  kind of focus on the clinical operation, being
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  able to, you know, make the,
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  nimbleness, I guess, that you need given some
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  of the challenges and changes that will likely
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  occur with reimbursements and and continued increases on
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  the cost
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  side in supplies and labor and more.
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  From your perspective, when you look at, you
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  know, how all of this is coming together
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  and and likely, will continue to to be
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  a challenge in the next couple of years,
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  and and then as you mentioned, being able
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  to keep optimizing,
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  you know, clinician well-being, career advancement, those kinds
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  of things. Are there any types of investments
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  or programs that, you're you're trying out or
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  have tried out in the last year that
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  have been successful, you know, just to help
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  boost up that clinical workforce and give them
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  something that will make sure you're retaining them
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  moving forward?
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  Yeah. I just mentioned a couple. That's a
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  great question.
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  One is one I think that a lot
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  of health systems are working on is that
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  is really increasingly utilizing the,
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  the Ambiance Listening technology,
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  to help with note generation
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  and reporting notes and that sort of thing.
• 10:06
  We now have the largest
• 10:09
  application of Dragon CoPilot in the country that
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  we're partnering with Epic on. And so we're
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  really and we have about 50% of our
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  physicians using that across most of our specialties.
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  And so really have had very successful adoption
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  of that technology, which has dramatically improved,
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  that,
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  pajama time, somebody call it, to try to
• 10:30
  generating those notes after you go home. We
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  really want our physicians to be able to,
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  and our APPs to be able to finish
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  all of that before they go home.
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  The other thing is that, you know, we're
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  really trying to develop
• 10:41
  our virtual health technology,
• 10:44
  for a couple of reasons. Number one is
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  the most obvious is that,
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  more and more patients are really wanting to
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  have virtual care visits. But the one that's
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  a little, I think, a little less obvious
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  is that on the provider side or on
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  the clinician side, there are a lot of
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  clinicians who are wanting to actually take on
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  more and more virtual work,
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  that they can do remotely rather than being
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  in an office. And so I think as
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  we continue to really focus on meeting patients
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  and providing the care where they want it,
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  interestingly,
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  that's also going to meet the needs of
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  a lot of our clinicians who really enjoy
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  at least spending part of their time,
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  providing care off-site virtually rather than on-site in
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  person.
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  That's helpful to understand. Thank you so much
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  for,
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  diving in there. Now what do you think
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  the hardest thing you'll have to do in
• 11:31
  the next year will be?
• 11:32
  Yeah. I think we're gonna have a lot
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  of challenges. I said, you know, 2026 is
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  gonna be a big year for health systems
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  in a lot of ways.
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  But I think, you know, most health health
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  systems are developing strategies right now to shift
• 11:43
  from more of from a hospital centric,
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  strategy to more of an ambulatory forward strategy.
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  And there's a lot of talk going on
• 11:49
  about that. And Advocate is no different. We're
• 11:51
  very focused on that as well.
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  This shift though is gonna further complicate how
• 11:56
  we approach providing anesthesia services as the decisions,
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  you know, we make on which procedures move
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  to ASCs and outpatient labs is gonna need
• 12:03
  to be coupled with adjustments on how we
• 12:05
  deploy our anesthesia workforce across each of these
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  geographies.
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  So we're really gonna focus on robust collaboration
• 12:11
  with our surgical and procedural service lines and
• 12:14
  include both employed and independent aligned positions as
• 12:16
  well, because this is gonna be very challenging
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  to put all of this together and make
• 12:20
  sure we have appropriate staffing and, at all
• 12:23
  of our locations, whether they're hospital based or
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  whether they're ambulatory.
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  We're going to really need to further expand
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  our anesthesia workforce as well, which obviously is
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  quite challenging in the current environment, and ensure
• 12:33
  that we optimize our overall coverage model to
• 12:35
  accommodate the shift in procedural volume, a lot
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  of which is really going to shift from
• 12:39
  inpatient to outpatient. So, we're asking our clinicians
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  to be more flexible in terms of providing
• 12:42
  care at multiple locations, so we can be
• 12:42
  more
• 12:46
  flexible in terms of providing care at multiple
• 12:46
  locations, so we can be more nimble on
• 12:47
  how we actually provide the highest quality care
• 12:49
  in the settings that patients and and, payers
• 12:52
  are increasingly going to prefer.
• 12:55
  That makes a lot of sense. You know,
• 12:56
  it's fascinating to think about that shift into
• 12:58
  more of the ambulatory space, more outpatient. And,
• 13:01
  you know, I very much appreciate how that
• 13:04
  changes the way you're thinking about staffing, especially
• 13:06
  in anesthesia,
• 13:07
  which across the board,
• 13:09
  you know, has a lot of different dynamics
• 13:12
  within that space.
• 13:14
  And and I'm curious when you look at
• 13:15
  how you're thinking about resources and resource management,
• 13:18
  I know it,
• 13:20
  shifts a little bit, you know, in terms
• 13:22
  of reimbursement and and how services are
• 13:25
  delivered within the organization. So when you look
• 13:27
  at resources,
• 13:28
  how do you think about that differently
• 13:31
  at the,
• 13:32
  I guess, executive level when you are looking
• 13:36
  at more ambulatory versus inpatient
• 13:39
  space and in services at the health system?
• 13:41
  Well, you know, I think, traditionally,
• 13:44
  growth
• 13:44
  has had to be coupled
• 13:47
  with increasing
• 13:48
  our current facilities in terms of brick and
• 13:51
  mortar.
• 13:52
  But I think,
• 13:53
  increasingly
• 13:54
  as a lot of this volume is gonna
• 13:56
  shift from the inpatient setting to the outpatient
• 13:59
  setting, whether, you know, whether site neutrality,
• 14:01
  conversations progress or not,
• 14:04
  we're gonna really have to be much more
• 14:06
  strategic
• 14:07
  about
• 14:08
  how we think about growth and how we
• 14:10
  fund growth. So for example, if, you know,
• 14:13
  the reimbursement for a particular procedure is gonna
• 14:16
  be less in an ASC setting than it
• 14:17
  is in a hospital setting,
• 14:19
  but that's the best thing for the health
• 14:21
  system and it's the best thing for the
• 14:22
  patient and the payers, And that's something we're
• 14:24
  gonna have to figure out how to, how
• 14:26
  to provide,
• 14:27
  in a cost effective way. But it has
• 14:30
  to be, it has to be,
• 14:32
  combined with a really strategic, thoughtful approach to
• 14:36
  how we perhaps repurpose some of our, larger,
• 14:40
  brick and mortar hospital buildings as well. So,
• 14:43
  a lot of those
• 14:45
  grand facility projects,
• 14:47
  across large hospitals
• 14:49
  may have to be may have to be
• 14:51
  substitute for more of a focus on outpatient
• 14:54
  labs at ASCs. So we just have to
• 14:56
  be more nimble and more strategic about how
• 14:59
  we develop our resources outside of our 10
• 15:02
  large hospitals in Chicago, for example,
• 15:05
  using that as one example,
• 15:07
  and figure out where exactly
• 15:09
  do we want to invest our resource in
• 15:11
  building other facilities to be able to adjust
• 15:14
  to this this sort of new model of
• 15:16
  care, if you will.
• 15:18
  That's helpful to understand, and I think it
• 15:19
  makes a a really smart way to look
• 15:21
  at that transformation.
• 15:23
  Before we wrap up here, I wanted to
• 15:25
  ask you about growth too. Where do you
• 15:26
  see some of those opportunities for growth coming
• 15:28
  down the pipe?
• 15:30
  Yeah. Well, you know, Epic Health is a
• 15:31
  very large organization, and and we're in the
• 15:34
  midst of a very bold, comprehensive strategic plan
• 15:36
  that's gonna be operationalized through 2030.
• 15:38
  So there's a lot going on right now.
• 15:40
  But that said, I I would probably highlight
• 15:42
  three particular opportunities where I really see a
• 15:44
  lot of potential for growth. So first of
• 15:46
  all, and we kind of touched on this
• 15:47
  a little bit earlier, but leveraging our virtual
• 15:49
  health and AI platforms
• 15:51
  to really expand specialty care and critical care
• 15:54
  access, as I mentioned, to these more rural
• 15:56
  communities.
• 15:57
  This work is already kind of happening with
• 15:58
  our primary care service line and our national
• 16:01
  service lines for cancer, heart and vascular and
• 16:04
  neurosciences.
• 16:05
  And we're gonna continue to expand our current
• 16:08
  telehospitalist
• 16:08
  and tele triage programs across all three divisions.
• 16:11
  So I expect to see a lot of
• 16:13
  growth within Advocate Health in that area.
• 16:16
  A second one I'll mention is the recent
• 16:18
  establishment of our National Center for Clinical Trials,
• 16:21
  which is based on our academic hub, Wake
• 16:22
  Forest University School of Medicine.
• 16:25
  This is a really exciting coordinated effort, which
• 16:27
  will really streamline the process for participation of
• 16:30
  our patients in clinical trials and, make some
• 16:33
  potentially life saving therapies available to patients across
• 16:36
  all of our communities,
• 16:37
  not just those closest to our academic medical
• 16:40
  centers. And then the third one that I
• 16:41
  would mention,
• 16:42
  was we're going to continue to expand access
• 16:45
  to primary care and more specialized care to
• 16:47
  all of our communities through thoughtful care model
• 16:49
  redesign.
• 16:50
  So that's going to entail a couple of
• 16:52
  things. Number one, utilizing all of our clinicians
• 16:54
  at the top of their license to provide
• 16:57
  that evidence based care in concert with how
• 17:00
  patients really prefer to receive the care, as
• 17:02
  I mentioned earlier. And then secondly, as patients
• 17:04
  increasingly approach their healthcare with a consumer mindset,
• 17:07
  our strategic plan really has to be designed
• 17:09
  to meet each patient where they are. I
• 17:11
  think any health system that really wants to
• 17:13
  grow in 2026
• 17:15
  is gonna have to prioritize that in 2026
• 17:17
  and beyond.
• 17:19
  I love it. Dennis, thank you so much
• 17:20
  for joining us on the podcast today. This
• 17:22
  has been a really fun conversation, very informative
• 17:25
  and insightful.
• 17:26
  And I look forward to seeing you as
• 17:27
  well at our annual meeting in April. I
• 17:28
  know you'll be speaking on a panel and
• 17:30
  digging deeper into many of the themes we
• 17:31
  talked about today. So looking forward to seeing
• 17:34
  you there. Yeah. I'm looking forward to it
• 17:35
  as well. Thanks for the opportunity, Laura. It's
• 17:37
  great to talk to you.