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Setting and accelerating growth strategies

A Q&A about health care organization growth

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Driving growth strategies for hospitals

Health care organization growth is gaining momentum as we emerge from the COVID-19 pandemic. Keith Shah, senior vice president for strategy and growth with Optum® Advisory Services, says there are many levers for growth.

We sat down with Keith Shah to hear his thoughts on growth opportunities and challenges for organizations.

How do you define system growth?

Oftentimes, growth gets pocketed into a little bit more of a limited definition. We take one that is multifaceted.

It’s certainly financial and it gets back to the “no margin, no mission” sort of thing. We must have solvency and we have to help our partners work toward that. We also include the operational — from the standpoint of expansion and capabilities.

We must also look at what health systems are being asked to do directly by the patients they serve, or by the community. What are they seeing from aggressive organizations coming into their market space? Are these organizations patient skimming or looking at certain aspects of care and disrupting a little bit of the integration that they hoped to achieve?

Finally, I would say we have to consider the overall experience offered. The growth of that experience quotient doesn’t just rest with the patient. It certainly includes all facets of the provider, the clinicians within their organization, and what they are trying to improve.

How do you work with organizations to set and accelerate their growth strategies?

Great question. We, along with the entire health care ecosystem, have been on this journey to find alignment around the right balance of performance.

The table stakes — what we’re working toward — are affordability and cost competitiveness for our partner health systems and the organizations we work with. But how does that align with the growth agenda as well?

Growth is a question that is gaining momentum and interest as the pandemic and future iterations of health care — and what the tolerance may look like — become clearer.

More and more, senior leaders are really getting assertive in saying, “How do we pivot in a positive way? How do we go after the type of growth that’s going to be both meaningful for the community and in alignment with our mission?”

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Expansion of risk and arrangements, value-based care and population health are certainly areas of interest in terms of growth. Can you talk a little bit about the focus on efficiency over volume?

Let’s think about this journey we’ve been on for the last 18–24 months. We had real concerns at the beginning of the pandemic around the progress, albeit slow, toward value-based care. We wondered where that was going to go and what it would look like for our partners and many of the health systems that we support.

In mid-2020, we began to see a doubling or tripling down, a re-emphasis, really, on the tenets of value-based care.

That wasn’t just on the health system side. Even the payers, or at least the ones looking for a positive way to support their networks, were very interested in doing more and getting more involved.

So that trajectory has really continued. We’ve seen a tremendous amount of momentum. It’s exciting in terms of some of the questions that are being posed now that I would say, on the pre-pandemic trajectory, we just wouldn’t have been able to get to. What we’ve been able to accomplish thus far, and what we have in terms of future projections along those lines, is really exciting.

I know another big focus for your team is consumer acquisition and retention. Can you talk a little bit about what that looks like and your strategies in that area?

Consumer acquisition and retention is an area where we spend a considerable amount of time, and take a very broad perspective when we talk about customer experience. We define the customer as both the consumer and the clinician — so two branches of the tree. Under consumer, as additional branches, we have members and patients within a given community that we may not be serving.

We take a very analytical look across those dimensions. But when it comes to consumer acquisition and retention, it’s almost a question of leakage, as we’re looking at some of the critical issues inherent to value-based care.

Some of the share-of-wallet discussions that we want to increase come with a better understanding of our consumer base and what they are asking for.

As I’ve mentioned, we want to know about other non-health system competitors appearing in the marketplace. What do they really represent, and what are they providing patients or consumers that can be integrated back into a more traditional setting? Not just for quality of care and the outcomes, but also for the overall patient experience and what they are asking for.

COVID-19 made many hospitals and health systems focus more on expansion and leveraging their strengths. How do you look at service and service line expansion?

When we’re talking about these organizations in general, there’s a lot of work we do that’s very exploratory and data-driven in terms of trends that we’re seeing. We can leverage the best of both claims and clinical historical trends to model out movement and growth.

Health systems, more specifically, have the added mission or burden of making sure that, from a community standpoint, they’re involved in most all aspects of care.

Many of the organizations we work with are safety-net health systems. To best help them, you have to take it to the next level with some of the service lines that you offer. Layers are added when you couple these complementary offerings with the growth opportunities you want to explore.

We spend a lot of time with our clients discussing this and really trying to unlock their opportunities. All of that comes back to how we work with our data — pulling all that’s available and modeling possibilities.

That brings us to the concept of geographic and modality expansion. Where do you see things going in 2022?

Well, health care is still local. But the ability — from an enablement standpoint — of various uses of technology is just tremendous. There’s a real energy and excitement that just didn’t exist a couple of years ago, pre-pandemic. Every year, it seemed, the trend toward any real movement we were hoping for got slower.

Then along came 2020. The pandemic really changed interactions and expectations for patients and providers. Even payers have challenged themselves to consider what care delivery looks like from a digital capability standpoint, starting with telehealth.

And then you had these groups of people that were that much more conditioned and excited to get into not just telehealth, but all things digital. They’re taking a much more expansive and exponential kind of view into possibilities.

It’s exciting and leads directly to that geographic component. While health care is still local, the ability to serve in an omnichannel, multiple, much more faceted way through digital has unlocked some of the other challenges we’ve faced in health care.

COVID-19 really ignited the debate around merger and acquisition vs. a partnership or outsourcing model. Do you see that accelerating on one side or the other in 2022?

We are getting to a point now where we’ve had a ton of mergers and acquisitions in the industry for quite some time, and we’re not necessarily seeing the stated end goals or results of all that activity.

Mergers and acquisitions across the board are certainly a way to grow, but they are just one of many growth levers. You can also grow organically. We’ve been talking about value-based care, consumer acquisition and service lines, geographic modalities, network aspects. All of those are levers for growth.

Mergers and acquisitions have been such a staple. I believe we will see a more prudent use of this as a tool. It’s not going away by any stretch, and there will continue to be a strain on our rural setting.

Health systems, especially freestanding ones, will probably end with some level of acquisition. But I think the larger systems, the mid-tier systems, they’re getting a little bit more sophisticated. It’s not necessarily about just gobbling up — there’s a real opportunity here to rethink what is the appropriate level of care and how we structure that across our enterprise.

C-suite leaders and other health system senior leaders really have a lot on their plates these days. How should they view their finite time?

We look at health systems as organizations with very finite resources across the board and significant community and patient responsibilities. Usually, they’re stretched too thin and they have challenges that are thrown at them in real-time.

When we look at our partnerships — and where we’re growing in our sophistication of what we bring to the marketplace — we’re working to bring the best of Optum and UnitedHealth Group to the doorsteps of our most strategic partners. We try to take a balanced approach that is performance and growth based.

It’s not just about taking costs out of the system. It’s about how to shift from acute to ambulatory in the context of increasing modalities, care venues and technology enablement.

The other piece is growth orientation. How can you do the performance piece and have it complementary to where you want to grow? What type of growth makes the most sense? We pragmatically focus on the balance of both and try to keep each at the forefront of the agenda.

It can’t be just a series of discussions where you spend 10+ hours with senior staff working through a whole array of performance questions, only to ask at the end of the day what’s being done about growth. It’s not a bolt-on. Growth has to be integrated. It’s that next level of maturity — bringing that integration together and bringing it to bear on progress.


About Keith Shah, PhD, Senior Vice President, Strategy and Growth

Keith has over 25 years of health care experience specializing in large scale transformation and growth to drive competitive differentiation. He leverages his multifaceted background and approach to drive growth and performance in rapidly changing environments in his role as the president of the Center for Applied Innovation.

Dr. Shah has led efforts that have spanned the worlds of policy, operations and technology to successfully launch, reorient and shape programs, disrupt old ways of thinking and maximize resources for improved outcomes. Dr. Shah is an expert at driving multimillion dollar productivity gains through operating platforms, business unit optimization and applied innovation by maximizing the value of data assets and transparency in health care through data driven strategies and pragmatic execution.

Dr. Shah has a bachelor’s degree from Drexel University. He holds a master’s degree in organizational development and an MBA in quantitative analysis from Clemson University. He earned his doctorate in public health and economics from the University of South Carolina.

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