Health Care Management

As the health care system continues to evolve in terms of the delivery of services, new laws (or revisions to existing ones such as the Affordable Care Act), and the mechanisms through which care is financed, job duties and required skills (in areas such as performance improvement, data analytics, strategic planning, information technology, and financial analysis) for health care managers are also changing. Major trends that have impacted the health care industry include:

• mergers and acquisitions of health care providers, including hospitals, nursing homes, physicians practices, and home care agencies
• an increase in the provision of services in an outpatient as opposed to an inpatient setting
• the development of health care networks providing different levels of service, from preventive care and outpatient diagnostic services to inpatient hospital and long-term care services
• the growth of managed care
• the emergence and proliferation of specialty niche providers of care, such as renal/dialysis, cardiac and cancer care
• the development of clinical service lines or product lines in specialty areas such as women’s and children’s care, rehabilitation, and cardiac services
• the expansion of long-term care services, including assisted living in response to an aging population
• the growth of medical management to control utilization of services and improve quality of care
• the closure of more than 140 rural hospitals since 2010, according to The Chartris Center for Rural Health; the results: worse health outcomes for rural residents and challenges for the managers and other staff at surviving rural facilities
• increased emphasis on customer service and satisfaction; “Tomorrow’s patients will want their doctors, health insurance plans, and drug companies to provide the same degree of convenience and personalization they get from their neighborhood grocery store and local bank,” according to the digital services firm West Monroe.
• the increasing focus on diversity, equity, and inclusion efforts
• shortages in professional staff, such as physicians, nurses, and pharmacists
• the increasing role of information technology in the diagnosis and provision of care as well as by consumers to obtain information and data regarding treatment options and the performance of hospitals, nursing homes, and physicians; the development of pay-for-performance systems to reimburse providers of care
• the transition of the U.S. health system from a volume-based to a value-based care model

Each of these trends has and will impact the requirements and regulations that health care managers must comply with, and in turn, the knowledge base managers need to possess. The following paragraphs take a look at some of these trends in more detail.

The Expansion of Long-Term Care Services

In September 2022, there were approximately 15,151 skilled nursing facilities in the United States, according to the U.S. Department of Health & Human Services. There were nearly 1.7 million beds. The aging of the population in the U.S. will dramatically affect the need for long-term care services. In 2000 there were approximately 35 million people in the U.S. over age 65, according to the U.S. Census Bureau. By 2034 that number is expected to increase to 77 million. The number of people age 85 and older is expected to increase from 4.2 million in 2000 to almost 9.6 million in 2030. Approximately 8 percent of individuals over age 85 resided in nursing facilities in 2020, according to the U.S. Census Bureau. The need for additional nursing home beds or alternate types of long-term care is evident.

The Shift to Outpatient Settings

Driven primarily by skyrocketing health care costs and the development of new technology, health care services continue to shift from inpatient to outpatient settings. The cost of providing care on an outpatient basis as opposed to an inpatient or hospital setting is often less than half, due in large part to the very high overhead costs in hospitals related to their capital expenses (the cost of construction, renovation, and high-technology equipment); their 24-hour, 365-day operation including, in many cases, emergency rooms; and in some part, operational inefficiencies. “Hospital outpatient, ambulatory surgery, laboratory services, physical therapy, emergency medicine and oncology centers will all benefit from outpatient growth, as do patients who seek more convenient and accessible care,” said Alison Flynn Gaffney, President-Healthcare Division at professional services firm JLL, in an article about the trend. “Reimbursement policies will continue to support this shift, and specialized care options will further drive competition within the industry.”

The growth of ambulatory surgery centers is one example of this change. Many surgical procedures in specialties such as ophthalmology (e.g., cataract surgery), podiatry, urology, and gynecology that were previously performed in hospital operating rooms are now done in hospital-based or freestanding surgical centers. Patients at these facilities generally go home the same day as surgery. New technologies, equipment, procedures, and techniques have made the growth of ambulatory surgery possible.

Hospital systems are also getting into the act by creating (or purchasing) outpatient care facilities to reduce costs and increase revenue. The aggregate outpatient share of total hospital revenue increased from 28 percent in 1994 to 48 percent in 2018, according to Deloitte.

Medicare and other insurers have promoted same day surgery by changing their reimbursement policies, whereby certain procedures will only be paid at an ambulatory surgery rate and will not be reimbursed if performed in an inpatient setting. These changes have led to the development of ambulatory surgery centers at the vast majority of hospitals with surgical services in the United States, and the development of freestanding surgery centers in communities throughout the country. There were 6,179 Medicare-certified ambulatory surgery centers (ASCs) in the United States in August 2023—up from only about 1,000 ASCs in 1988. ASCs perform an estimated 30 million surgeries annually.

These new facilities have prompted the creation of new management roles, including nurse managers, ambulatory surgery center directors, business managers, and administrators of these centers. The need for operational efficiencies, high levels of patient satisfaction, and effective financial management in terms of cost control and negotiation, and management of insurance contracts and reimbursement have created a new kind of manager—a surgi-center specialist.

Similar changes continue to take place with regard to outpatient treatment centers, diagnostic centers, and procedure centers. Utilization and quality review organizations, under contract with Medicare and Medicaid and managed care (insurance) organizations, monitor appropriate utilization of hospitals’ services and often deny payment of services provided in a hospital that they have determined could have been provided in an outpatient setting. Outpatient dialysis; radiation therapy; cardiac diagnostic services such as cardiac stress tests and angiography; MRIs; and CT scans are examples of these services. As with ambulatory surgery centers, these outpatient centers have generated a need for health care mangers with expertise in these areas.

Emergence and Proliferation of Specialty Providers

As health care became increasingly complex from the 1970s forward, in terms of new technologies, medical research, new modalities of treatment, greater physician specialization, and complicated reimbursement and financing mechanisms, specialty providers emerged. These providers of health care services, such as renal/dialysis, cardiac care, orthopedic care, and cancer care, utilized clinical, technical, and financial expertise in the area of specialty to develop service and facilities that were on the cutting edge of treatment. At the same time, many hospitals and health systems chose not to continue to provide these services and entered into affiliation agreements with specialty providers through which patients requiring these services are referred. Other hospitals and health systems elected to create their own specialty niches by forming clinical service lines and in many cases developing separate institutes and facilities for specialty care. Expect this trend to continue as hospitals (especially for-profit chains) maintain their emphasis on watching their bottom lines and focus on providing services that generate the most revenue.

Mergers, Acquisitions, and New Career Paths

As expenses have increased due to costly new technologies and medications, and rising labor rates, hospitals and other health care facilities are seeking easy ways to reduce costs and increase revenue. Mergers and acquisitions are intended to provide more leverage with managed care companies, negotiate higher payment rates, and realize economies of scale in the form of merged services, the elimination of duplicative services and positions, and create greater purchasing power with vendors.

They are also being initiated to achieve strategic initiatives, including clinical excellence through the integration of research programs, medical education programs and physician expertise, and enhancing the reputation of health care providers. Merged institutions also seek to keep referrals within their system, thereby generating more volume and revenue. For example, a hospital system with a cardiac surgery service at one site might encourage all physicians at all the hospitals in the system to refer cases to the cardiac surgeons at the hospital with the cardiac surgery service. Merged entities also offer greater opportunity for branding, a marketing strategy through which they establish an identity that helps differentiate them from competitors and serves to form a connection to consumers. Health care systems that have employed this approach often have logos and tag lines, such as “your care is our only concern,” to increase consumer awareness and use of the system and its services. Finally, the development of health systems through mergers and acquisitions has facilitated the formation of clinical service lines, also called product lines or centers of excellence. By pooling clinical and financial resources, systems have created areas of clinical expertise that are extensively marketed to consumers.

The bottom line: look for the merger and acquisition frenzy to continue as large health care providers seek a competitive edge and an increase in profits as smaller facilities and systems struggle to compete in a bigger-is-better market. Mergers and acquisitions will reduce the number of health care managers in some instances, but new career paths are emerging to create demand. Here are a few examples:

• chief artificial intelligence officers, who explore potential applications of AI in patient- and business-focused areas, and then gather funds, experts, and other resources to implement these technologies
• chief data governance officers, who establish policies regarding how data is collected, evaluated, and used based on ethical, privacy, and other considerations
• chief experience officers, who assess and improve customer service and the overall patient experience
• chief integration officers, who work to integrate new technology, new departments, or entire companies into an existing health care provider
• chief medical information officers, who are increasingly being hired to manage cutting-edge technology and develop and implement data analytics strategies
• chief transformation officers, physician executives who work with the heads of various departments across the hospital to identify opportunities for clinical performance improvement, integration, and coordination of care across the health care continuum
• chief wellness officers, who lead efforts to combat employee disengagement and burnout

Managers will continue to face new challenges, which will necessitate the creation of more specialized jobs. “As they adapt to change, many organizations are weighing expanding their senior management cadre to assume responsibility for broad initiatives,” according to staffing firm B.E. Smith. “Titles to watch include chiefs of strategy, diversity, sustainability, and artificial intelligence.”

Increasing Focus on Diversity, Equity, and Inclusion Efforts

McKinsey & Co. describes DEI as “three closely linked values held by many organizations that are working to be supportive of different groups of individuals, including people of different races, ethnicities, religions, abilities, genders, and sexual orientations.” Forty-two percent of workers surveyed by Gallup in 2022 said that it was “very important” for a potential employer to be diverse and inclusive of all types of people. “As many employers have discovered, workers today are demanding concrete, substantial change on these issues, beyond platitudes,” according to Gallup.

The staffing firm AMN Healthcare surveyed managers at all levels for its 2022 Healthcare Trends Survey. The following responses show that considerable work is needed to increase DEI efforts at their organizations:

• Only 34 percent of managers and executives said that their employer had defined measurable targets for diversity success.
• Forty-six percent of respondents said that employees from different backgrounds were “definitely” encouraged to apply for higher positions in their organizations. Twenty-eight percent responded “probably,” which leaves 26 percent of employers that did not encourage the creation of diverse leadership.

On the positive side, 67 percent said that their organizations were “extremely” or “very accepting” of differences among employees. Twenty-three percent said that their organizations were “moderately accepting.”

Health care leaders must take DEI values seriously as they build and manage teams and strive to meet the expectations of patients and shareholders. “There is strong evidence that diverse teams and inclusive cultures drive better outcomes (especially among diverse patient populations), more effective problem-solving, greater engagement, and higher employee retention,” according to the American Hospital Association.

Health Care Industry Disruption

An increasing number of companies (many not health-related) are making inroads into the health care industry and competing with existing providers. As a result, the lines are blurring between traditional market segments such as insurance, pharmaceuticals, and health care providers. Hundreds, if not thousands, of startups and established companies (such as IBM, Microsoft, and Google) are working on artificial intelligence applications in health care. In 2017, the drugstore giant CVS Health purchased Aetna, one of the largest health insurers in the United States. “The transaction…reflects the increasingly blurred lines between the traditionally separate spheres of a rapidly changing industry,” according to the New York Times. “It represents an effort to make both companies more appealing to consumers as health care that was once delivered in a doctor’s office more often reaches consumers over the phone, at a retail clinic, or via an app.” Another example of this industry blurring occurred when UnitedHealth Group, one of the largest insurers in the U.S., purchased a large physician group from DaVita, a large for-profit chain of dialysis centers. It’s goal was to build a large ambulatory care business. In 2023, Amazon completed its acquisition of One Medical, which offers in-office and 24/7 virtual health care services. It also operates Amazon Clinic, a virtual health care marketplace that provides treatment for about 35 common health conditions.

In 2018, Amazon (logistics and technology), Berkshire Hathaway (insurance), and JPMorgan Chase (finance) announced that they would create an independent, nonprofit health care company for their employees. In March 2019, the companies announced that the new company would be called Haven. But logistical hurdles and other challenges caused the company to be dissolved in 2021. These are not the first large companies that have sought more direct control over their employees’ health care, but industry watchers had been eager to see what large companies from different sectors could accomplish by working together. Walmart and Caterpillar have both tried to reduce the cost of health care for their employees. Similar attempts may be attempted by companies or groups of companies in the future.

It is uncertain how these moves and new ventures will ultimately affect the health care industry. They may cause management positions at traditional health care providers to be lost, while creating new ones at pharmacies, corporate-created health plans, and in other settings.

From Volume-Based to Value-Based Care

“The evolution of the U.S. health system from volume-to value-based care is under way,” according to professional services firm Deloitte. “In the United States, the shift toward value is being accelerated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which offers significant financial incentives for health care professionals to participate in risk-bearing, coordinated care models and to move away from the traditional FFS system.” The current volume-based system financially rewards (through Medicare and Medicaid) physicians and health care providers for seeing more patients and conducting more tests and procedures. “One result of this payment based on volume model is enormous variation in rates of procedures and tests such as imaging and screening,” says Dartmouth-Hitchcock, an academic health system that serves patients across New England and a national leader in patient-centered health care. “There is a 2.5-fold variation in Medicare spending nationally, even after adjusting for differences in local prices, age, race, and underlying health of the population. This geographic variation in spending is unwarranted; patients who live in areas where Medicare spends more per capita are neither sicker than those who live in regions where Medicare spends less, nor do they prefer more care. Perhaps most surprising, they show no evidence of better health outcomes.”

Faced with these challenges, the health care industry is gradually moving toward a value-based care model in which data analytics are used to assess the effectiveness of treatments and physicians and other health care providers work more closely with patients regarding their care (i.e., discussing the cost of the procedure and spending more time describing the expected results and potential complications of the therapy, procedure, or treatment based on concrete data). Dartmouth-Hitchcock describes this process as “employing evidence-based medicine and proven treatments and techniques that take into account the patients’ wishes and preferences,” and with an outcome for patients translating into “safe, appropriate, and effective care with enduring results, at reasonable cost.” The transition from volume to value-based care is prompting several occupational changes. Chief financial officers, chief nursing officers, and chief executive officers will increasingly be expected to have more clinical and financial expertise than previously required. The use of data analytics will create demand for chief information officers or, as they’re sometimes known in the health care industry, chief medical information officers. The global healthcare analytics market is expected to reach $167 billion by 2030, up from $5.8 billion in 2015, according to a 2022 study by Grand View Research, Inc. The market research and consulting company says that “hospitals are now using healthcare analytics to manage the number of workers working in a particular shift, for instance, a hospital in Paris uses healthcare analytics to predict the number of patients that may be hospitalized. This data can be used to decide the number of staff members that will be needed for a particular shift, which helps in reducing labor cost in hospitals.”

Telemedicine and “Hospital at Home”

The use of telemedicine (or telehealth)—in which physicians and other health care professionals consult with colleagues, and treat patients, who are off-site by using video and other technologies—is expected to become even more popular in the future. The COVID-19 pandemic, which began in late 2019, increased demand for telemedicine services. In April 2020, 43 percent of all Medicare primary care visits were conducted via telemedicine, up from 0.1 percent in February 2020, according to the U.S. Department of Health & Human Services. In 2022, nearly 85 percent of physicians who were surveyed by the American Medical Association reported that they used telehealth to care for patients. Patients and their families report being very satisfied with the technology. According to the J.D. Power’s 2022 U.S. Telehealth Satisfaction Study, 94 percent of patients and their families who received medical services through a telehealth provider in the past 12 months said they “definitely would” or “probably would” use telehealth to receive medical services in the future. “Telehealth and digital technologies are transforming how patients seek and receive healthcare,” said Christopher Lis, managing director of global healthcare intelligence at J.D. Power. “Telehealth has the potential to increase access, convenience, care coordination and continuity, improve outcomes, and fill in gaps in provider coverage, particularly in underserved areas. As technology adoption and consumer demand continue to increase, it will be important to keep evaluating what’s working well and which areas need improvement, with the aim being to improve equitable access, quality of care and patient outcomes that complement in-person care.”

A related trend is the increasing use of “hospital at home” programs, which utilize portable medical treatment, communications technology, monitoring devices (that send a patient’s vital signs and other data to the health care provider), and visits by paramedics, nurses, and doctors. Eligible patients include those who are acutely ill (chronic heart failure, diabetes, infections, and even COVID-19), but that do not need 24/7 care. These programs currently provide services to only a small percentage of the more than 34 million Americans who are hospitalized each year, but more providers are utilizing hospital at home programs to reduce the chances that high-risk patients who would normally be hospitalized will contract COVID-19 or other diseases or encounter other complications. These programs also help health care companies save money on in-house staffing and reduce the need to construct new hospitals to meet rising consumer demand for health care services. In addition to facing a reduced risk of infection and other complications during hospital stays, patients who receive in-home care benefit from being in a more welcoming and relaxing environment. Studies show that patients who participate in hospital at home programs recover faster, have fewer medical complications, and are more satisfied with their care than patients who were hospitalized.

Cybersecurity Concerns

The increasing use of technology and data analytics by the health care industry has improved patient outcomes and reduced costs for health care providers. But it also has exposed these organizations—and the private data of patients—to hacking, ransomware attacks, and other cybercrimes. University researchers studied ransomware attacks on the health care sector from 2016 to 2021 and published their research in “Trends in Ransomware Attacks on US Hospitals, Clinics, and Other Health Care Delivery Organizations, 2016-2021” in JAMA Health Forum. According to their report, “during the study period, we documented 374 ransomware attacks on health care delivery organizations that exposed the personal health information of 41,987,751 individuals. From 2016 to 2021, the annual number of ransomware attacks more than doubled, from 43 to 91.” A ransomware attack involves a cyberthief accessing patient files or other data and denying access to the rightful owner until a ransom is paid. Health care companies are easy targets because they often pay ransoms because access to patient and other information is so critical. “Healthcare continues to experience the highest data breach costs of all industries, increasing from $10.10 million in 2022 to $10.93 million in 2023—an increase of 8.2 percent,” according to the Cost of a Data Breach Report 2023 from The Ponemon Institute and IBM Security. “Over the past three years, the average cost of a data breach in healthcare has grown 53.3 percent, increasing more than $3 million compared to the average cost of $7.13 million in 2020.” In a data breach, patient data, business records, and other data is stolen or destroyed. “Organizations are ramping up spending on cybersecurity in urgent response,” according to the recruiting firm B.E. Smith. “They are also expanding staff and creating chief information security officer positions. Hundreds of technology firms offer healthcare-specific deterrents using biometrics, threat-detection software, network traffic analytics, and even blockchain.”

The integration of technology into the health care sector is further complicated because many digital devices used in hospitals and other settings are now interconnected and can exchange information (this is known as the “Internet of things” or, in the medical sector, the “Internet of medical things”) to better serve patient and business needs. The utilization of the Internet of medical things has “proven particularly valuable in remote clinical monitoring, chronic disease management, preventive care, assisted living for the elderly, and fitness monitoring,” according to Deloitte. But “bad actors” can hack into these devices, steal information, or cause the devices to malfunction.

Health care managers must work closely with their organization’s chief information security officer and cybersecurity specialists to ensure that systems are protected from hackers and patient privacy is protected.

Employment for information security analysts in the healthcare and social assistance sector is expected to increase by 25 percent from 2022 to 2032, according to the U.S. Department of Labor. This is much faster than the average for all careers. This strong growth for information security analysts suggests that job opportunities will also be excellent for chief information security officers and other managers in information security.

Artificial Intelligence, Machine Learning, and Blockchain Technology

Technology continues to change the health care industry. Two emerging fields are artificial intelligence (AI) and machine learning (ML). AI is technology that can be programmed to make decisions which normally require human thought and act independently of humans. Machine learning is a method of data analysis that incorporates artificial intelligence to help computers study data, identify patterns or other strategic goals, and make decisions with minimal or no intervention from humans. Artificial intelligence and machine learning are having a significant impact on the health care industry. They are being used to automate many lower-level tasks and study vast amounts of data that would be a challenge for humans. Here are some examples of how AI and ML are being used in the health care industry, according to Surveying the AI Health Care Landscape (https://www.aha.org/center/emerging-issues/market-insights/ai/surveying-ai-health-care-landscape), which was published by the American Hospital Association’s Center for Health Innovation:

• Administrative: appointment scheduling, customer services responses, licensure verification, and quality measure reporting
• Financial: billing and collections, claims management, and insurance eligibility verification
• Operations: inventory management, materials management, and supply chain management
• Clinical: predictive technologies, interventional technologies, automated image interpretation, precision/personalized medicine, predictive and prescriptive analytics, and sensors and wearables for diagnostics and remote monitoring

“Expect to see more automation software and AI in health care supply chains,” advises Geoffrey Martin, the global chief executive officer of GE Healthcare Consulting.” “In addition to freeing personnel from repetitive tasks, these technologies can assist decision-makers in identifying trends and providing resources to workers.”

Generative artificial intelligence is one of the newest technologies being used in the health care industry. It is a form of machine learning algorithms that can be used to create new content, including text, simulations, videos, images, audio, and computer code. One of the best-known example of generative AI is ChatGPT, which was released in late 2022 by the San Francisco-based company OpenAI. Here are a few of the potential and current uses for generative AI in the health sector, according to the Boston Consulting Group:

• patient screening and on-demand
• medical image recognition
• diagnostic image enhancement and analysis
• preventive healthcare through predictive models
• automated document processing
• electronic health records interoperability
• supply chain risk identification and process augmentation
• inventory tracking and restocking
• resource allocation and utilization
• data share/interoperability
• public health surveillance

“Generative AI represents a meaningful new tool that can help unlock a piece of the unrealized $1 trillion of improvement potential present in the industry. It can do so by automating tedious and error-prone operational work, bringing years of clinical data to a clinician’s fingertips in seconds, and by modernizing health systems infrastructure.” With that said, it’s important to remember that generative AI is in its early stages of development, and significant issues remain regarding the accuracy of information and other resources that are generated, privacy and security issues, and other concerns.

Blockchain is another technology that is starting to be used in the health care industry. It is a shared, distributed ledger database that maintains a continuously-growing list of records that cannot be changed without the agreement of all parties who have access to the database (i.e., no central authority or third-party mediator, such as a bank, is involved in verifying the transaction). Each digital transaction is called a block in the chain of records, hence the blockchain moniker. Each chain is encrypted, in part, with data from the previous block to create the encryption. Both private (permissioned) and public (permissionless) blockchain ledgers can be created. Gartner, a global research and advisory firm, reports that the business value added by blockchain will grow to slightly more than $176 billion by 2025, and then surpass $3.1 trillion by 2030. Blockchain technology has the “potential to transform health care, placing the patient at the center of the health care ecosystem and increasing the security, privacy, and interoperability of health data,” according to the professional services firm Deloitte “This technology could provide a new model for health information exchanges (HIE) by making electronic medical records more efficient, disintermediated, and secure. While it is not a panacea, this new, rapidly evolving field provides fertile ground for experimentation, investment, and proof-of-concept testing.”

Health care managers must be familiar with AI, ML, blockchain technology, advanced robotics, and other emerging technologies (including augmented, virtual, and mixed reality) in order to help their hospitals or other facilities maintain a competitive edge. Large health care companies are most apt to integrate these and other technologies into their administrative, financial, operations, and clinical departments, but managers at all levels and all employer sizes would be well-served by staying up-to-date on the uses and benefits of technology.

Lack of Gender Diversity

Women comprise about 77 percent of health care workers, but only 15.3 percent of health system CEOs were women in 2021, according to a study by JAMA Network Open. Additionally, Oliver Wyman’s Women in Healthcare Leadership 2019 study found that it takes women an average of three to five years longer than men to reach the position of CEO.

Factors that have limited the number of women in leadership positions include the “old boys network” (in which senior leadership positions are mostly or all held by men, who are likely to promote other men to positions of power), the lack of females in leadership positions (reducing opportunities for promising female workers to receive mentorship and promotions), unconscious and overt bias, and the lack of company support and development programs for women, among other factors.

To address these issues, many health care employers are implementing leadership development programs and other female-friendly initiatives to increase the number of women on the leadership track. Diversity Woman publishes a list of the “100 Best Companies for Women’s Leadership Development.” The list, which includes health care employers, can be accessed at https://www.diversitywoman.com/best-100-companies-for-womens-leadership-development. Kaiser Permanente, which has 39 hospitals and 622 medical facilities, appears on Diversity Woman’s list, as well as other “best company” lists, including Fortune’s “100 Best Workplaces for Diversity,” the Latina Style 50 Report (which lists the best U.S. companies for Latinas), and Forbes’ “Best Employers for Women.” Diversity Woman reports that Kaiser Permanente’s workforce is “so diverse that there is no racial majority. The company is also three-quarters female, with many women in top positions. One-third of Kaiser’s physicians are women, as are nearly half of its executives and more than 35 percent of its board of directors, including its newest board member, former U.S. Surgeon General Regina Benjamin, MD.” Kaiser Permanente offers a variety of Business Resource Groups—including Women Empowered at Kaiser Permanente—to allow employees to connect, build relationships, and advance at the company. It also offers programs and initiatives to help employees of color advance and prosper in the workplace.

Although women are still underrepresented in leadership positions at health care employers, many companies and government agencies are recognizing the benefits of employing a workforce that better represents the gender and ethnic makeup of the U.S. population. Look for more female- and minority-focused initiatives in the future, which should continue to increase diversity at health care employers.