[caption id="attachment_230264" align="aligncenter" width="1024"] ChristianaCare President and CEO Dr. Janice Nevin meets with Moxi, a robot that handles small tasks in the hospital. Her vision is to include more technology while caring for patients in need in the growing system. | PHOTO COURTESY OF CHRISTIANACARE[/caption] WILMINGTON — ChristianaCare is not only the state’s largest health care provider, it’s the largest private employer in Delaware. For years, it has been carefully evaluating the communities and planning its next stage. And for ChristianaCare President and CEO Dr. Janice Nevin, it’s not so much about brick-and-mortar expansion, although the health care system has invested in new offices, acquired hospitals in Maryland and Pennsylvania, and investigated buying an entire health system in Pennsylvania.  It’s more about how to deliver that care to patients in innovative ways: in Delaware, schools and home care programs, through robots to handle menial tasks and cutting-edge, gene-editing science. “We’re continually evolving our journey to transform health care,” Nevin told the Delaware Business Times in a sit-down interview. “In particular, I do think these last two and a half years have been about connecting people back to how we heal. Creating health together means we can’t do this alone, and we need to go beyond the traditional boundaries of how we think of our communities and how we think of medicine.” Physical growth Since 2020, ChristianaCare has added eight new practices — including three in central and southern Delaware — and two hospitals in Elkton, Md., and in southern Chester County, Pa. Three primary care practices in Jennersville, West Grove and Kennett Square comprise the core care for 22,000 residents in southern Pennsylvania, in concert with the former Jennersville hospital. One practice added was a women’s health center in Glasgow, and another was a pediatric office in Dover. Last year, ChristianaCare aimed to supercharge its growth plans by signing a letter of intent to acquire four hospitals and more outpatient services from the troubled Crozer Health. That deal ultimately did not come to pass, and ChristianaCare officials declined to comment further on the reasons why, citing a confidentiality agreement signed between both parties. Right now, Nevin said ChristianaCare is not actively pursuing another major acquisition in Pennsylvania or Maryland’s Eastern Shore — but she didn’t entirely rule out the possibility in the future. “We need to grow in order to be sustainable, for where we see our future. So we are looking at Delaware County, Southern Chester County and thinking, ‘What are the needs in that community? Are there gaps that it may make sense for us to fill?’” she said. That also leads into ChristianaCare’s strategy in opening primary care offices. For example, a new Rehoboth Beach location includes family medicine and personalized care for senior citizens, targeting the retiree demographic flocking to coastal Delaware. [caption id="attachment_230267" align="alignright" width="300"] ChristianaCare has also started rolling out mobile vans to expand beyond brick-and-mortar locations. | PHOTO COURTESY OF CHRISTIANACARE[/caption] In Pennsylvania, ChristianaCare officials have held listening sessions for the Jennersville Hospital on their community needs. Nevin said while ChristianaCare is not prepared to speak directly about specifics for its plans for the Keystone state, it’s clear that the health care system is ready to double down on its investment there.  “When we think about growth, we think of it as caring for our neighbors. It’s rewarding that we have partnered deeply with the community and understand what is top of mind. We want to build sustainable programs for them that will be there for years to come,” she said. Outside brick-and-mortar locations, ChristianaCare has already expanded in unique ways. There are school-based wellness centers in 22 schools in New Castle County, with the Kuumba Academy Charter School most recently added last summer. Serving mostly high schools, the idea is to give teens access to primary care, mental health services and other targeted areas, like tobacco cessation and substance abuse treatment and referrals. Health services vans are also bringing health care to the patients, offering physicals, diabetes screenings, behavioral health appointments and OB-GYN services. Funded by a $1 million donation from Barclays, the van has started making weekly stops in Laurel. Financial stability ChristianaCare, much like hospitals across the country, was hit hard by the COVID-19 pandemic and its effects on the workforce. While its hospital was at 125% capacity in the winter of 2022, ChristianaCare faced struggles with finding and retaining workers while prices for equipment rose with inflation. The last S&P Global Ratings outlook issued in October 2022 noted ChristianaCare’s light debt load, but a “volatile operating performance,” in the last three years, as well as a small revenue base compared to similar health systems.  However, a Moody’s report one month later noted that ChristianaCare stood very strong with unrestricted cash and investment that would provide a cushion for operating pressure. It also anticipated cash flows to strengthen in Fiscal Year 2023, although margins would be more modest. In Fiscal Year 2022, ChristianaCare reported approximately $2.6 billion in revenue and captured over 60,000 admissions. “When it comes to health care, we do have a math problem. Two-thirds of revenue generally comes from the government, and expenses have gone up enormously, and there’s little elasticity. We’ve made a lot of decisions over the last three years, driven by taking care of our community. We did things like prepay for hotel rooms, child care and we had a rock-star supply chain,” Nevin said. “We brought in labor as needed, and that proved to be very expensive and it was a major driver.” Contract labor costs were at a high of almost $5.5 million in July 2022, but ChristianaCare has also been implementing a new strategy through hiring and using smarter workforce practices via technology to bring that down. In October, it was at $3.3 million, and is projected to drop to $2.7 million by June 2023. “Our goal is to have our workforce stay with us permanently, and some of our purchased labor teams have stayed,” Nevin said. “We are in a good place, and I am confident that while we are still emerging from the pandemic, we will be able to live our mission of creating health together so every person can flourish.” Recent financial reports dated March 1 show that operating income was at $40 million for the six months between June and December 2022. Excess of revenues over expenses was $72 million in the same six-month period. [caption id="attachment_230266" align="alignleft" width="300"] ChristianaCare HomeHealth program has demonstrated its focus on leveraging technology to meet patients where they are. | PHOTO COURTESY OF CHRISTIANACARE[/caption] New foundation At the crux of it, balancing growth as well as financial stability is a balancing act, and Nevin believes that it can be achieved through careful management and leveraging tools and partnerships. That’s where technology fills the gaps – by using a smartphone to check in ahead of the appointment, or relying on a robot to run supplies or medicine roughly 200 times a day.  The “cobot” has made 11,000 deliveries since it first rolled out last year. In 2019, ChristianaCare launched Unite Delaware, to bring health and social service organizations closer together, track patient outcomes and make referrals easier. Technology has also opened unconventional ways to grow. The Hospital Care at Home program, launched in 2021, has treated 350 patients by bringing high-acute care in a combination of in-person visits in the home and telehealth appointments. Another initiative includes Unite Delaware, which brings health and social service organizations closer together, track patient outcomes and make referrals easier. “Health systems are growing constantly, and in this world of today, bricks and mortar is one way to do it. But frankly, we also need to grow in other ways. It’s how we build the ability to care for someone from birth to to when they’re frail,” she said. “It’s about maintaining that relationship.” ChristianaCare has also taken a closer look at caring for its caregivers in recent times, including a Center for WorkLife Wellbeing to provide peer counselors and calming rooms. This year, ChristianaCare is offering psychological first aid training to its leaders to train them in responding effectively to staff in moments of stress. “Our leaders want to know how to help someone that might be in distress, and this training will equip them with the ability to have the conversation they’re worried about,” Nevin said. “COVID, in some cases, really brought the future to the front door. We’re not dealing with anything we haven’t been before, but the issues come faster and harder. And we continue to evolve to meet those needs.” Another first is the cutting-edge technology coming out of ChristianaCare, via its Gene Editing Institute. CorriXR Therapeutics, a commercial company incubated from its investment and research at ChristianaCare, launched last year with aims to disable diseases like tumors. Nevin is excited about the CRISPR technology that fuels the research at the institute, seeing it as a way to open new doors for diagnostics and therapeutics. “I do feel like the Gene Institute is reflective of us as an organization,” she said. “They’re doing amazing, breakthrough science with the potential to treat cancer. I think this may be the first of many to come.”