There’s a common misconception in healthcare when it comes to value. “It’s not just about cost reduction,” said Karen Wilding during a recent interview. Although that’s certainly part of the picture, “it’s also about improving quality and looking at experience and well-being.”
At Nemours, value is a core component of the strategic vision, along with health and equity, said Wilding, who became the organization’s first Chief Value Officer in January 2022. It’s a position that’s still pretty rare; however, with care extending outside the four walls and digital technology becoming more pervasive, there’s a “growing need to have value influence strategic decisions around clinical, financial, data, operations and experience.”
It’s also an opportunity to cultivate partnerships and “bridge gaps across the C-suite” by serving as a translator, aggregator, innovator, and connector,” noted Wilding. During the interview, she talked about her key areas of focus — particularly when it comes to payer relationships, and how Nemours is navigating a period of tremendous growth. She also discussed how her team is working to maximize the “tools under our belt” to create a better experience for pediatric patients and their families, and why mentorship is so important to her.
- On the CVO role: “I really see it as an opportunity for me to bring partnerships and bridge gaps across the C-suite. It’s being able to serve as a translator, an aggregator, an innovator, and a connector.”
- On what ‘value’ means: “There’s a misnomer that value is just about cost and cost reduction. That’s not true. Value is about bending the cost curve, but it’s also about improving quality and looking at experience and wellbeing. It’s creating an environment.
- On fee-for-service’s limitations: “Health means access, quality, and outcomes, and medical care is part of that. It’s about changing the trajectory of what we pay for; that’s not a conversation we’re having often enough, but it’s one we need to have — as parents and as humans.
- On Maximizing technology: “You need to think how you mobilize and use the technology that you have. We have a wonderful telehealth program. We have a patient portal — we have all of these tools under our belt. It’s about how we can maximize the”
- On pop health: “Most organizations have woven population health into their strategy, because they realize that the market demands it. Payers have demanded it. Regulatory bodies have demanded it. We know that’s where CMS is going from a payment transformation standpoint with Medicare… if it’s not on your radar, I’m not sure what’s going on.”
- On mentorship: “That’s an area where I feel I have so much opportunity to help others grow. I’m here because someone made room for me at the table. I’m here because people believed in me and supported me, and it’s my responsibility to do the same for my team.
Q&A with Karen Wilding, VP & Chief Value Officer, Nemours
On the nature of the CVO role: “Bridging gaps and building partnerships”
Gamble: Can you talk a bit about the role of Chief Value Officer and what you consider to be your core objectives? It’s a title we haven’t seen much, at least yet.
Wilding: It is true. There aren’t very many chief value officers in the, in the industry, and I really see it as an opportunity for me as Chief Value Officer to bring partnerships and bridge gaps across the C-suite. It’s being able to serve as a translator, an aggregator, an innovator, and a connector across nursing, finance, technology, marketing, etc. It’s being able to look at how we’re automating care and how we’re working with strategic partners like payers in different ways that are innovative, and leveraging our data insights in ways that help achieve value.
There’s a misnomer that value is just about cost and cost reduction. That’s not true. Value is about bending the cost curve, but it’s also about improving quality and looking at experience and wellbeing. It’s creating an environment.
On collaborating with the C-suite
Gamble: I imagine you interact with a lot of different members of the C-suite. Who do you find yourself working with most — or does it vary depending on the initiative?
Wilding: It does vary by initiative. I think the data and analytics work that we do is foundational to so much of what we do. And so, I certainly lean on the infrastructure that we have in place to do analytics work and to make sure we better understand the populations we’re taking care of. I also work closely with finance leadership across the organization to understand the payer relation partnerships. And then there’s clinical care, along with many other areas.
On health, value, and equity as a pillar
Gamble: What do you consider to be your key priorities at this time?
Wilding: In terms of the strategic framework, we’ve identified a pillar called Health, Value, and Equity. Under that strategic pillar, we’re focusing on whole-child health. In other words, how do we bring the patient to the center with all the wraparound services that we have, whether that’s ambulatory or acute. That also includes social determinants of health and how we connect and engage with those, as well as community partnerships. That’s health.
Our value area focuses on payer partnerships and being able to leverage our clinically integrated network to extend into our community and our community providers, our specialists, and our hospitals across the care continuum.
Equity looks at how we can adjust health inequities and disparities in communities, leveraging our health informatics teams to help identify key interventions that we need to help address inequities.
On social determinants in pediatrics
Gamble: And you’re doing it with a population that’s largely children — we haven’t heard as much about using social determinants in that area. I’m sure that’s interesting, but also very challenging.
Wilding: It’s a very different lens in how you approach addressing social determinants of health. Most adult organizations have been doing some sort of population health for at least the past 5 or 10 years — some longer, depending on their maturity. If you think about it, so much of the work we do in primary care pediatrics is around prevention. That’s our bread and butter.
But when you start expanding into social determinants of health and asking questions about food insecurity, for example, you’re not just asking questions for that child. It really is impacting the entire family, and so, you have to be able to address some of those social determinants at a family level.
And then there’s transportation. If a parent or caregiver can’t get to the appointment, how do we leverage different digital technologies to communication? We’ve created school-based health centers where a parent can have a teleconference with an advanced practitioner to address a child’s asthma, refill medication, or do a well exam. You have to be very creative when you’re dealing with a pediatric population.
The costs for school-based health centers, however, aren’t always covered. That’s the challenge of a fee-for-service environment — we’re very limited in how we pay for care. At Nemours, I have an opportunity as Chief Value Officer to change that. So, how do we pay for health? Health means access, quality, and outcomes, and medical care is part of that. It’s about changing the trajectory of what we pay for; that’s not a conversation we’re having often enough, but it’s one we need to have — as parents and as humans.
On innovation: “Pediatrics is at the tip of the iceberg”
Gamble: You’re looking to do more with less. How does innovation factor into all of this?
Wilding: Innovation is defined in so many different ways. There’s micro and macro innovation. There’s large-disruptor, aggregated tech startups, which is very exciting. But pediatrics is still at the very tip of the iceberg. It’s more mature in the adult healthcare space.
We’re also seeing some innovation in terms of workflow optimization, which may not seem like innovation. But some organizations are really changing the healthcare trajectory and optimizing workflows and doing practice transformation work. There’s definitely a full spectrum.
Gamble: Do you have a chief innovation officer?
Wilding: We do. Nemours has a Chief Innovation Officer [Eric V. Jackson, Jr., MD] and a Chief Health Equity Officer [Rachel Thornton, MD]. They’re part of the same core team. As Chief Value Officer, my job is to help connect in those areas, but we need a full team to address areas like tech startups or health disparities. It’s just too big. We have a core team of executives focused on mobilizing all of these work efforts together.
On pediatrics as “a breath of fresh air”
Gamble: And you’ve been with Nemours since January of 2022. Is this your first role with a pediatric health system?
Wilding: It is. I came from the University of Maryland, which was a wonderful experience. I had the opportunity to learn in a large academic setting. We did care for children; we had a children’s hospital embedded within our academic facility, but it’s a very different pace in academic medicine than in pediatrics, as well as some of the core items we focus on. Pediatrics is a breath of fresh air. It’s really been exciting. I’m a mom of five, and so, the ability to change healthcare is really exciting. I feel like it’s a great opportunity, and in some ways, it’s my responsibility as a mom to change the direction of healthcare. To me, that’s a calling. It’s a big part of why I got into pediatrics.
Gamble: Five kids? That’s impressive. What’s the age range?
Wilding: They are 16, 11, 10, 7, and 4. It’s great. And I think in some ways, it’s almost a competitive advantage to be a parent and think about how we’re delivering care. How does it resonate? How is it working? I’ve always appreciated that lens, and it’s certainly been helpful as I’ve thought about things like population health.
On her first year at Nemours
Gamble: When you look back at your first year with Nemours, did it meet your expectations? Were there things that surprised you?
Wilding: The first year went really fast. I’m a hard critic of myself, and so, I feel like there’s so much more that I wanted to accomplish. But I will say, the team is incredible. I feel so well supported, not only by our leadership team, but also the core team I work with. I oversee a primary care team that just grew exponentially. We’ve added more primary care providers, increased our preventative screening, and took on additional patients, which was wonderful work to see.
We almost doubled our data and analytics infrastructure and team. They’ve been working on maturing those tools and getting them out beyond primary care. We have a medical management team to which we’ve brought on more care managers, social workers, and CHWs. We’re expanding our pop health footprint. We’re doing more social determinants of healthcare screening. The team has done an incredible amount of work in the last year. It went quick.
On maximizing technology
Gamble: Looking ahead, do you see more happening with prevention and leveraging technologies in that space?
Wilding: I do. It’s really about access. Access is a core component of that, and you need to think how you mobilize and use the technology that you have. We have a wonderful telehealth program. We have a patient portal — we have all of these tools under our belt. It’s about how we can maximize them.
We’re doing some of that with early registration and pre-visit planning. Those are huge efficiency wins for the organization. They’re wins for patients and caregivers. They’re a win for the health system. And so, I definitely see a lot of technology being woven into the strategies to support value. I also see us looking at how do we not only work on preventative services, but also looking at the medically complex children who are very sick.
How do we look at care algorithms? How do we maximize the support services that are needed for them across the container? Because a lot of the care they provide is not just in our hospital. It’s in their specialist’s office.
On the “synergies” between pediatric & adult medicine
Wilding: And I think that’s where healthcare is going. When I watch the trends between pediatrics and adults, they’re not that dissimilar. There’s actually a lot of synergy around how hospitals in general are looking at care across the continuum. They’re looking at partnerships; they’re looking at mobilizing their technology platforms. Organizations are spinning up innovation arms and thinking about how they can maximize technology and people. Everyone’s really focused on that.
Covid changed so many things. Yes, we were doing work like this before Covid. But it has sped up a lot since then. I think people have realized that they need to change their internal cost structure and look at how they can become sustainable.
On digital transformation & behavioral health
Gamble: Right. For parents, telehealth has been a game-changer. I can attest that having an appointment for your child without having to take so much time from work is huge, as I’m sure you know.
Wilding: Absolutely, and especially for behavioral health coordination. The ability to do something like an ADHD follow up or get a prescription for children that need maintenance therapy — that’s a huge opportunity.
On collaboration across a “big footprint”
Gamble: Let’s talk a little more about the role of Chief Value Officer. I imagine there’s a lot of coordination with other leaders across the organization.
Wilding: It is. And in fact, Nemours operates in multiple states. We have a hospital in Orlando and in Delaware, and we have a partnership with Baptist in Jacksonville, Fla. We have more than 90 practice locations. We have a big footprint, but it’s not just internal coordination; it’s coordination across all of those geographies. Those relationships and partnerships. It’s a lot of threading the needle.
On CIOs and value-based care
Gamble: One of those relationships is the CIO — can you talk about your relationship with Bernie Rice?
Wilding: Yes. We have a great CIO. I’m very fortunate. If I could share any words of wisdom, it’s that I believe there’s an opportunity for CIOs to make sure they’re fluent with population health, and that they know the organization’s thinking around pop health and value. CIOs have a critical role to play around digital footprint and engagement with patients and families, as well as how we approach contract performance management, third-party claims, and data aggregators, while also making sure we have the right infrastructure in place. And then there are the EMR changes that come as a result of population health.
CIOs are really uniquely positioned to support the work we do with value. And I’m fortunate to have a great partner at Nemours.
On population health myths
Gamble: When you talk about population health, do you feel that the industry’s understanding of what it means and what it entails has increased? It comes up a lot as a buzzword, but it’s not a new concept by any means.
Wilding: It’s interesting; it’s been around for a very long time — we just didn’t talk about it. And if we did talk about it, it was more in the context of a government public health agency. I think it’s often mistaken for public health, and so, there’s a lot of work to be done around busting that myth and differentiating between pop health and public health.
But I have found that most organizations have woven population health into their strategy, because they realize that the market demands it. Payers have demanded it. Regulatory bodies have demanded it. We know that’s where CMS is going from a payment transformation standpoint with Medicare. We know they’re looking to states around Medicaid transformation. And so, if it’s not on your radar, I’m not sure what’s going on.
On becoming a “pay-vider”
Gamble: One of the trends we’re seeing are health systems that have their own health plan. If that continues, things are going to look different in a few years. It’s so important, like you said, to weave that into the overall strategy.
Wilding: It is. And it requires different skillsets. Managing a health system from a technology standpoint, in terms of the data that you’re managing and the transactions around care coordination and care management is very different than what a payer is managing. And so, I think organizations that make the transition are seeing the need to look at skillsets differently, look at their hiring approaches, and look at how to become that pay-vider.
So many of these strategies are now overlapping; you have to be thoughtful that you’re not duplicating strategies and that you’re engaging. It’s very interesting to see.
On mentorship & paying it forward
Gamble: Agreed. The last topic I wanted to touch on is employee wellness. We’re seeing so much more emphasis on this than in the past, which is very encouraging. As a leader, how does that factor into your strategy?
Wilding: When I joined Nemours, we actually had a chief well-being officer. It’s incredible to see that being woven into leadership discussions. We have leadership rounds where we have the ability to round and check in, and we have peer supporters built into the fabric of the organization. We’re fortunate to have that in play.
Mentorship is also really important. That’s an area where I feel I have so much opportunity to help others grow. I’m here because someone made room for me at the table. I’m here because people believed in me and supported me, and it’s my responsibility to do the same for my team.
I believe that not only developing and growing your team, but also creating an environment where well-being is prioritized and there’s mindfulness around that, is really important.
Gamble: It’s very refreshing to hear things like mindfulness become part of the conversation, especially considering everything we’ve been through in the past few years.
Wilding: I’ve welcome it. We actually did a survey in the last year of our primary care providers to understand where they’re sitting and getting a baseline, and then being able to remeasure that and engage a dialogue around what we can do and how we can help work on that. It’s been really insightful and helpful as we think about future strategies.
Gamble: That’s great. Well, it seems like you landed with the right organization. Thanks so much for your time, and I hope we can connect again down the road.
Wilding: I’d like that. Thank you, Kate.