What that means for Carmichael is tricky work, such as changing the way the organization approaches partnerships with physicians, developing its retail strategy, and moving away from the traditional campus into more accessible locations.
"We're looking at what types of services we need to put there to make our community more healthy," she says. "How do we evolve our payer strategy to accept different kinds of reimbursement? How do we develop new partnerships with payers in the marketplace? And there's always something going on around M&A. So the scope here is fairly broad."
Carmichael adds that while St. Vincent's hospital business is still strong—and a key piece to its mission--she suspects that as the organization pivots toward a focus on managing populations and taking financial risks on those populations' health status, "I'm not sure the majority of our margins will come from inpatient care. People are busy and want to access healthcare closer to home so transitions
She says making those changes in strategy is so complex that health systems that are larger than one or two hospitals need the role of CSO to sequence strategies properly, if nothing else.
"Hospitals are not reputed to be the most nimble organizations, but that requirement is changing," she says. "Adding a CSO might be critical to retooling capabilities so we can do those things well and quickly."
If a CEO assumes his or her existing talent has the time to design and execute strategies that are different than the business as it exists today, that might be a big mistake, Carmichael says.
"Everyone's plates are really full on top of running a hospital or being responsible for operations. It's not easy to find time to focus on the future," she says. "Of course it varies from organization to organization, but if someone is struggling to execute on strategy, then a CSO might be a good addition."
Intermountain's most visible internal initiative, says Poulsen, distinguished from accountable care, is called shared accountability.
Poulsen is charged with inculcating that philosophy organizationwide.
"The concept of accountability needs to span all the providers of healthcare—docs, hospitals, and ancillary providers—but also needs to engage the consumers of healthcare—patients or prospective patients—which we don't think have adequate visibility in the accountable care framework. The role of the CSO should be aligning people's interests and engaging all parties in dialogue and discussion."