In September, the Congressional Budget Office released a working paper that said hospital profitability in the future will depend heavily on hospitals improving productivity faster than the overall economy. If they don't, the percentage of the nation's hospitals with negative profit margins could grow from 25 percent now to as much as 60 percent by 2025.

That economic scenario will increase the pressure on hospitals and other providers to employ executives who can dramatically reduce operating costs while improving clinical outcomes. The executives, in turn, will need the right staff doing the right things in the right settings to make it all happen.

The need for health care organizations to leverage effective staffing to drive success is reflected in five of the most-read blog posts on over the past few months. Each of the five posts highlights the significant role that staff play in driving more value from the current health care delivery system.

In “ The Future of Cancer Care Reimbursement,” McKesson's Marcus Neubauer, M.D., discusses the short- and long-term industry impact of Medicare's Oncology Care Model program. The program, which began in 2015, pays oncology practices an extra per beneficiary per month fee for adding and following six features in their approach to patient care. All six - including patient navigation services and 24/7 patient access to clinicians with real-time access to patients' medical records - require the right staff with the right skill sets to make them work. “All of this will be a major change in responsibilities and workflows for a typical community oncology practice. Everyone is involved in practice transformation. It means training and cross-training office staff, educating and training oncologists and, perhaps, hiring additional staff,” says Dr. Neubauer, who is medical director of oncology services at US Oncology Network and McKesson Specialty Health.

In “ Incorporating Advanced Practice Providers into an Oncology Practice,” McKesson's Gabe Torres outlines the decision-making process that oncology practices should go through to determine whether they and their patients could benefit from adding one or more advanced practice providers, or APPs, to their staff. APPs are mid-level clinicians like nurse practitioners who can perform many routine clinical functions in lieu of physicians. The process to make that decision should go beyond simply yes or no but include a plan to identify, hire and retain the right APP, says Torres, director of innovative practice services at McKesson Specialty Health. For example, he says practices should “seek an APP who shares the practice's unique clinical philosophy. This fit is a critical component of success.”

In “ The Evolving Role of Nurse Executives,” McKesson's Catherine Whelchel, senior product manager and clinical strategist at McKesson Capacity Management, provides insights on how the chief nursing officer position has changed, particularly following the passage of the Patient Protection and Affordable Care Act in 2010. Whelchel says the ACA is driving an expansion of the traditional CNO's skill sets and job duties. On the business side, CNOs must become adept at using advanced data analytics to understand the financial impact of changes in clinical services and staffing. On the clinical side, “Nurse executives must also expand their perspective from an acute-care focus to a population health focus, which requires enhancing patient engagement and education,” Whelchel says.

In “ Unleashing Home Care's Cost-Controlling Potential,” McKesson's Karen Utterback touts the promise of expanded home-care services as the key to controlling overall health spending in the future. Utterback, vice president of strategy and business development in McKesson's Extended Care Solutions, cites advances in home-care technologies and remote monitoring capabilities as delivery innovations that allow higher acuity patients to receive higher intensity care in lower-cost home settings. But someone has to use all those technologies and capabilities, and that someone, according to Utterback, is a new home-care services workforce. “They're no longer `workers' but clinicians who have superior patient assessment skills. Home care clinicians also possess the technical skills to use the mobile and portable medical devices now available for home use,” she says.

In “ Achieving Financial Health on the Road to Value-Based Care,” McKesson experts John Wallace and Mary Tatsch provide insights on what it will take to make value-based reimbursement work for providers, payers and patients. As for the talent part of that equation, Wallace, who is vice president and general manager of ACO services for McKesson Business Performance Services, says it will require “… proactive outreach, good care management, good transitional care management and overall coordination of care.” Tatsch, who is vice president and general manager of reimbursement solutions at RelayHealth Financial, says it will take a “…change in behavior, processes, culture and infrastructure. An organization that is truly committed to making these changes will drive forward with an assortment of tools and levers and leadership commitment in place to make that happen.”

Leadership. Culture. Behavior. Coordination. Management. Skill. Focus. Philosophy. Training. Education. Expertise. All are attributes or values of a successful health care organization, according to the subject matter experts featured in five of the top-read blog posts on over the past few months. And all will be needed to drive improvements in delivery productivity required to maintain business and clinical success in the future.

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