Many issues keep the top Texas healthcare executives up at night.

The primary concerns surround the ability to provide affordable healthcare options, how to improve staff engagement and retention and what the direction of federal healthcare regulation will be. 

The officials called on the more than 400 attendees at Bisnow's Healthcare South event Feb. 27 in Houston to find real estate and technology solutions to these ongoing issues. 

Texas Health Resources Executive Vice President Elizabeth Ransom said the cost of care is a tremendous barrier and burden to many individuals and to health systems.

“We are getting close to a real tipping point,” she said. “It is too much of a burden for too many people.”

Eliminating the duplication of services and waste in the system will hopefully start bending the cost curve for patients.

UTMB Health Assistant Vice President Gaurav Khadse said as healthcare systems expand in markets, that puts more pressure on cost. 

"With growth, you cannot keep the cost climbing," he said. "You have to depress cost to make things work." 

Healthcare systems must ensure the right number of physicians are located within each market along with having the appropriate facilities in place, he said. 

UT Southwestern Medical Center Vice President and Chief Quality Officer Will Daniel called for more investment and awareness of employee engagement.  

“You can look specifically at medical students coming in and they are twice as happy as the general population," he said."But, by year three, they are half as happy. This focus on ourselves — how are we keeping ourselves safe and well — is actually going to be something that we are heavily investing in and continue to think about.”

Technology is set to greatly improve the experience for patients and the healthcare staff alike. On the consumer side, new programs allow patients to check in online, check pricing and services and even see a doctor online. For the staff, technology will improve efficiencies and create streamlined processes.   

CHRISTUS Health Group Vice President Karen Bryant is concerned about the future of the insurance system and the consolidation of insurers and large employers. She wonders what role healthcare systems will play in this discussion. Where does that position the systems?

The aggressive push to move to a single-payer healthcare system worries Houston Methodist Senior Vice President Sidney Sanders.

“We made a lot of progress with the [Affordable Care Act],” he said. “I believe the ACA needs to be tweaked, and the competition is essential. If you move toward a single-payer system driven by the federal government, it will be a disaster.”

Check out photos from National Healthcare South: