Alan Levine got his start in the health care field in Florida. He was a health policy advisor to Governor Bush before being appointed Secretary of Florida’s Agency for Health Care Administration, which oversees all hospitals. He later headed the North Broward Hospital District before being tapped as Louisiana Governor Bobby Jindal’s Secretary of Health and Hospitals. He moved to the private sector as Florida Group President for Health Management Associates before becoming head of Ballad Health, a Johnson City, Tennessee-based rural hospital system covering the Appalachian Mountain areas of Tennessee, Kentucky, Virginia, and North Carolina.
“What’s happening throughout the country right now is large hospital systems are getting bigger and bigger through consolidation. They’re leveraging their size, to increase their pricing and unfortunately that’s happening because insurance companies have gotten so big. Patients are getting stuck in the middle and the employers and taxpayers are paying for it,” he said.
Even before the pandemic, the U.S. was facing the worst nursing shortage in history, with 176,000 nurse openings per year. More than one million nurses were projected to leave nursing between 2019 and 2030. Levine said the nursing shortage, the aging of the population, and specific to Florida, the state’s booming population growth have combined to create a critical challenge. “Is Florida going to have the health care manpower to care for its growing population?” he pondered.
Nursing school enrollment is not keeping up with demand, in part because of a faculty shortage. One solution, Levine offered, is to take more advantage of the two-plus-two program, where students spend two years in a community or state college, then transfer to a University for their last two years, a system that he says has a mismatch. “There’s always a food fight between the doctors and the nurses and the different professions, as they all try to expand and grow their own profession, which is understandable. But what happens is, more and more of these professions go back and say, ‘well, we need more Doctorate of Nursing Practice degrees, we need more advanced nursing degrees.’ When you’re running a health system, we don’t need more of those, we need more of nurses who want to be bedside nurses.”
More than 80 million Americans are projected to be over the age of 65 in the next few years. “Combined with more chronic illness, such as diabetes, cardiovascular disease, and mental illness, all contribute to poor health. These manifest themselves in health care costs as people age and the shifting and changing of payment models, with more reliance on Medicare and Medicaid,” he said.
Levine explained to the Club what Ballad Health is doing to cope with these challenges and how it’s been dealing with the coronavirus pandemic in its rural service area. He said the system had to consolidate staffing and defer elective surgeries to prevent nurses and doctors from becoming overwhelmed in a region that saw more than 100,000 COVID cases with 2,000-plus deaths. They expanded the use of telemedicine to maintain access for patients with routine and chronic conditions and used federal enhanced unemployment benefits which allowed them to furlough employees and reduce costs.
Ballad Health’s telemedicine visits skyrocketed from 2,400 in the pre-pandemic period of July 2019 to March 2020, to more than 15,000 in the months of April and May 2020 alone, thanks in part to changes in federal reimbursement policies for doctor’s visits. “So annually, we’re now doing 80,000 plus telemedicine visits a year. And I don’t think that goes away. Particularly with all the investments in technology, the use of telemedicine connected to artificial intelligence is going to transform how healthcare is delivered into the future,” Levine said. The need will grow even greater with COVID patients suffering long-haul symptoms.
Levine and Club members, through their questions, discussed other innovations taking place and the need to transition to different funding models that impact the burgeoning Medicaid and Medicare budgets, to keep up with health care demand, while trying to control costs.