Transformative Concepts and Technologies Changing Health Care Cost and Workforce Challenges

From Omaha’s central location in the U.S., health care organizations are playing a major role in developing and adopting next-generation concepts and technologies to transform the industry in the midst of a pandemic.

In fact, Omaha-based Strada Healthcare describes itself as “the health care model of the future.” Strada provides Direct Primary Care, a concept that revolves around patients accessing primary care providers directly for a flat monthly fee.

“More consumers are learning that health care is cheaper when you pay for it directly,” said Ryne Bessmer, Strada’s director of growth. “Historically, we have been conditioned to think we need to use our health insurance to access care. And that’s just not the case anymore.”
Within the DPC concept, Bessmer said providers can focus all of their efforts on the medical care that is delivered to health care consumers who work with them directly.

“And not waste time on unnecessary paperwork, pre-authorizations, or red tape” associated with the insurance industry, he said.

He went on to say that organizations should “do everything in their power” to encourage and incentivize people to have deep relationships with their primary care providers.

“‘Relationship’ is the cornerstone of good care,” Bessmer said. “When it happens, it benefits both the patient and the doctor.”

A nod to industry-wide shifts, he said physicians across the community are beginning to offer services at “a transparent cost that consumers can pay for directly.”

“There are now more than 12 Direct Primary Care clinics in the Omaha metro that work outside of the confines of insurance,” he added. “Additionally, we are seeing more and more specialty care providers offering extreme discounts for services if they are paid directly instead of through insurance.”

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According to Strada information, the organization has negotiated deep discounts on many procedures and services as most procedures – when paid for in cash – can be done at “more than a 50% discount when compared to insurance rates.”

Common services that are “cash-priced” range from imaging (X-rays, CT scans, ultrasound) to labs (CBC, lipid panel, pap smear). It was further noted that, in some cases, paying for specialty care with insurance may make sense – such as if one knows they are going to meet an insurance deductible in a given year. But, even if cash-pay is cheaper, it will not count towards one’s deductible.

The aforementioned movements within the health care industry, Bessmer continued, can be a “game-changer” for self-funded employer groups that are looking for ways to save money on benefits for employees.

Directly to the Source

When asked about industry shifts and their implications, Dr. Douglas Tewes of Nebraska Orthopaedic Center remarked that, secondary to government policy, the changing landscape of health care has “created significantly increased pressures on all independent practitioners.”

The double board-certified orthopedic surgeon and orthopedic sports medicine practitioner summed it up with: “The increased influence of insurance companies (that has created financial burdens through inefficient authorizations), the increasing control of all facets of medicine by health care systems, and the burdensome regulatory environment of the government has made it increasingly difficult for independent practitioners to continue to provide excellent care for their patients.”

It was the desire to provide exceptional care to patients, Tewes continued, which led to two orthopedic groups – Lincoln Orthopaedic Center and Nebraska Orthopaedic and Sports Medicine – merging to become what is now Nebraska Orthopaedic Center, PC. Reportedly, the merged practice became effective at the start of the new year.

The merger represented the joining of forces for the community’s biggest orthopedic medicine practices. The consolidated center operates a north office at 575 S. 70th St., and a south office at 6900 A St. in Lincoln.

As it relates to specific organizational priorities and initiatives, fellow clinician and specialist in the likes of hip and knee joint replacement, Dr. James Gallentine, and NOC Chief Executive Officer, Dave Zauha, both highlighted its Ortho Quick Care Service (located at the south office) as noteworthy investments or upgrades.

“At Nebraska Orthopaedic Center, we know that injuries occur when least expected,” Gallentine said. “We offer same-day orthopedic care for new injuries at our NOC Ortho Quick Care. Our Ortho Quick Care provides immediate treatment for patients suffering from acute orthopedic injuries.”

The service, he continued, is considered a “specialist visit.”

“So, you won’t pay for the higher co-pays that some insurance plans require for urgent care services,” he said. “Our goal is to be here when the community needs us most, allowing for expert orthopedic care when individuals need it most.”

Sports or orthopedic injuries may be cared for, same day, with services each day of the week – extended morning and evening hours Monday through Friday and limited morning and afternoon hours Saturday and Sunday.

“We are committed to working with our community as partners in this endeavor and increasing the availability of specialty orthopedic care in the region,” Gallentine added.

Zauha further weighed in by saying that NOC’s goal is to provide the “most efficient experience for orthopedic care.”

He noted this notion spans its ability to see urgent injuries at Ortho Quick Care, as well as NOC’s capacity to provide onsite (and most times) same-day imaging. This could be with either X-rays or MRIs.

Zauha also highlighted its “ability to give patients their bracing supplies at their visit, and our ability to provide a surgical option for patients that are helping to control costs and experience through our ambulatory surgery center” as among the key ways that the investments they’ve made and services they have offered are “revolutionizing” health care.
QLI specializes in rehabilitation for individuals who are facing a neurological injury diagnosis. Intensive therapy is coupled with finding innovative ways to harness each individual’s identity.

“Technology advancements are driving improved outcomes, accessibility, efficiencies, and the customer experience generally,” said President and CEO Patricia Kearns, who is also trained as a physical therapist. “Health care workforce shortages, on the other hand, are putting incredible strain on providers and consumers. It is very likely that the workforce shortages will force all of us sooner, rather than later, to adopt new routines made possible by technology.”

As a significant example, Kearns highlighted telehealth.

“QLI started a telehealth platform almost three years ago called Kintinu, which allows access to physical, occupational, speech, psychology, and wellness services from a client’s home,” she said. “We’ve seen great growth with this business in a relatively short period of time.”

More to QLI’s efforts and priorities in 2022, Kearns referred to maximizing the use of existing technologies to enhance the care that they provide, and to drive efficiencies.

“QLI will be introducing smart apartments to our campus, which will utilize the latest environmental control technologies, robotics, AI and digital experiences to create a therapeutic space for recovery,” she said. “Some of these technologies will be implemented campus-wide to allow the individuals we serve to live with a greater level of independence while reducing the workload for our team members.”

QLI is also looking at new wearable technologies, which serve to monitor clients’ safety and general health.

“All of the technologies being implemented create efficiencies that enhance our mission of delivering life-changing rehabilitation and care, and can make work a little easier,” Kearns said. “Ultimately, this leads to better experiences and boosts morale for our team members.”

Another nod to its investments in a healthy work culture, founding CEO Dr. Kim Hoogeveen’s leadership model has evolved into training organization MindSet. Kearns said its concepts are ingrained into every fiber of QLI and serve them well today by sustaining a positive, growth-oriented environment.

“This, in turn, creates an environment in which our clients can thrive,” she said.

“Maintaining a healthy culture requires constant effort, but it’s worth every second because it allows us to either prevent burnout or address it quickly.”

Additionally, Kearns said QLI regularly evaluates pay, benefits and merit-based reward systems and has made significant wage-related changes – especially for nursing, residential, and entry-level team members (while still maintaining terrific benefits including very cost-effective health insurance).

“We are also doing some creative things with benefits, such as offering onsite personal coaching and resource navigation through a partnership with the Greater Omaha Worklab (GrOW) and implementing a flexible benefits platform through local partner Maxwell (,” she explained. “Taking great care of our team members is a priority and we are thankful for local resources to help us do this well.”

Technologies Readying Next-generation Professionals

Technology is very much changing the way that Dr. Juliann G. Sebastian and her team teach and do outreach for the University of Nebraska Medical Center College of Nursing.
“UNMC is known for using technology in very progressive ways, and to enrich student education,” the dean and professor said. “We have a long history of doing that in nursing and in UNMC more broadly to link our campuses, and to add simulation and experiential learning opportunities.”

She noted the pandemic has pushed their organization to think about technology in new ways.

“The College of Nursing has five campuses across Nebraska,” she said, a reference to locations in the metro, Lincoln, and Greater Nebraska – Kearney, Norfolk and Scottsbluff. “We are using technology to deliver education across the state and we will continue to do so.”

An example of the university’s pioneering ways, Sebastian referenced iEXCEL at the Davis Global Center in Omaha. According to UNMC information, the center was designed to promote interdisciplinary collaboration, team training, and the “transfer of care” through the “total health care system.” iEXCEL specifically stands for “Interprofessional Experiential Center for Enduring Learning.” As the center notes, the program was developed to “transform health professions education and offer unprecedented opportunities for research and development.”

Such technology “in action” includes the use of interactive digital “iWalls.”
“These are variously-sized electronic walls that have computers embedded in them,” she explained. “It allows for groups of people to work on a wall at multiple times.”

Sometimes compared to oversized iPads, Sebastian stressed that iWalls are uniquely designed to facilitate the ability for many people working together in teams – with multiple people touching the wall. And, since each campus boasts such technology, iWalls are bringing down logistical walls or barriers. Functional for a few years, an Omaha-based student can collaborate in real-time with Scottsbluff-based students.

“We worked with the company to ensure that they could provide us with the software to connect the iWalls in different areas,” she explained. “The iWalls have allowed us to add an experiential element to connecting across campuses and using technology for learning.”

Once the pandemic hit, Sebastian also noted how UNMC began investing in virtual simulation technology, which can be accessed by students from home. Students dial into a platform that engages them in answering questions and demonstrating knowledge about, say, a fictitious chart.

“It’s two-dimensional and students have access as long as they have access to Wifi,” she said.

Three in-person simulations include “low-fidelity” use of a mannequin or model of a piece of an anatomy, such as an eye or an arm, for training on tasks. “High-fidelity” simulation uses computerized mannequins programmed with responses like, “Ouch! That hurts,” or “I can’t sleep”.

These models feature computerized functions, such as respiration or abdominal sounds, and may be programmed to practice certain skills. For instance, obstetrical simulators aid students in training to deliver babies.

“The third type of simulation, we hire actors and actresses who go through special training to be a patient, and to talk about certain signs and symptoms,” she said.

Sebastian sometimes encounters the question of, “Why use a simulation? Why not put students in the clinical environment?” Partly, she explained, one can’t always be sure what types of health problems people have in clinical settings. Yet, the need remains to be trained on caring for someone with specific problems.

“We can simulate those,” she said. “And, before [students] go into a clinical environment, they can feel more comfortable and confident.”

In turn, patient comfort is supported, too. So, these simulations present an important supplement to the clinical experience.

Independent of the pandemic, Sebastian said over the last several years, UNMC has readied students on the use of telehealth by adding a telehealth learning suite in Omaha and other campuses, acknowledging that this has “become a very important way to deliver care.”

In addition to equipping students with technical skills, Sebastian indicated UNMC is also arming students with skills that transcend medical knowledge and the walls of the classroom, wherever that may be.

“We want our students to have the skills and abilities to know what burnout is, and we want to do our best to prevent burnout,” she said.

While, to some extent, she said occasional stress is “part of the human condition,” they focus on addressing and eliminating the stigma associated with getting support, and on building resilience, stress management, and strengths-based coping. Courses may include the likes of “mindfulness moments,” or certified pet therapy animals may visit prior to exams.