Nearly two years into battling a global pandemic, there's no question healthcare providers and facilities have faced difficult headwinds. Emotional and physical exhaustion, overcrowding, supply chain issues, frustration over vaccine misinformation, disruption in services ... it would be easy to paint a bleak picture of healthcare in 2021.
Yet, COVID also created a space where innovation and collaboration offered new solutions to address problems that extend beyond the immediate pandemic, including building vaccines on a different platform and increasing access to care through telehealth. Social justice also took center stage over the past two years with a spotlight that laid bare the health inequities impacting people of color. Piercing the national consciousness, a will to address health disparities in a meaningful way has resulted in new programs, grants and initiatives to both address root causes and increase diversity among providers, researchers and clinical trial participants.
Stepping into this climate of real concern mixed with real hope, the Nashville Health Care Council hosted the panel "Health Care Next" last month to explore the pandemic's impact on the industry and forecast for the future. The panel marked the final event in a series celebrating the Council's 25th anniversary.
The esteemed panel included experts spanning primary and acute care, behavioral health, academic medicine, home health, hospice and health equity. Moderator Hayley Hovious, president of the Nashville Health Care Council, introduced Sam Hazen, CEO of HCA Healthcare; James E.K. Hildreth, PhD, MD, president and CEO of Meharry Medical College; Paul Kusserow, CEO and chairman of Amedisys; and Debbie Osteen, CEO of Acadia Healthcare.
Economic Starting Point
Before diving into the future, Hovious shared the Council's recently released impact study, created in collaboration with economist Murat Arik, PhD, associate director of the Business and Economic Research Center at Middle Tennessee State University's Jennings A. Jones College of Business. The report showed Middle Tennessee's healthcare ecosystem represents $66.89 billion of the state's business revenue or approximately 9.23 percent of Tennessee's total business revenue and 25.77 percent of the Nashville metropolitan area's total business revenue in 2019.
Primarily focused on economic impact between 2014 and 2019, the report also showed a total of 602 new core healthcare establishments emerged in Nashville, bringing the total to 3,731. Nashville's healthcare industry cluster was responsible for more than one-third of the Nashville metropolitan area's total personal income in 2019, and one in every eight new jobs between 2018 and 2028 is projected to be in healthcare in Tennessee.
The report also found Nashville's healthcare industry was responsible for 328,598 jobs in 2019, which is 25 percent of the total nonfarm employment within the Nashville MSA. Globally, Middle Tennessee's 18 publicly traded companies account for nearly 499,434 jobs and more than $95 billion in revenues.
And Then Came COVID
While the industry was rocking along, a disruptor in the form of a global pandemic came along to shine a light on critical issues. Hazen shared that HCA Healthcare, similar to other health systems across the U.S. and globally, has struggled with employee burnout.
"Never in my almost 40 years have I seen this level of anxiety and uncertainty for their own safety and the flood of patients. It's been emotionally, spiritually and physically taxing. Everyone from leadership to clinical employees are affected and that can compromise care delivery," he said. "We're focused on employee assistance programs, stress education and training, advanced chaplaincy programs and more. It all comes together to deal with capacity constraint. We are in a long-run battle in our workforce."
And a Spirit of Innovation
In addition to revealing challenges, the pandemic also accelerated healthcare innovation and improvement. The panelists agreed telehealth and digital tools introduced during the pandemic will remain and have advanced care delivery and access, but the industry has more work to do to ensure health equity.
"This crisis has greatly impacted the underserved. We talk about the right care in the right place and at the right time, and some of these populations are not getting that. Telehealth is a helpful mechanism but not everyone has the technology to make it work," Osteen said. "We're thinking about how to promote access and reach patients. The Department of Health and Human Services and Substance Abuse and Mental Health Services Administration have allocated funds for mobile methadone clinics that can go into communities to support those who can't come to us."
The pandemic shone a bright light on disparities and renewed energy around addressing these inequities. For Middle Tennesseans, healthcare organizations didn't have to look far for expertise and guidance with Meharry Medical College making health equity a priority since its founding in 1876.
James E.K. Hildreth
"Meharry was originally created because there was nowhere for Black people to learn about healthcare," said Hildreth. "COVID-19 underscored the technology and equity gap - when providers quickly pivoted to telemedicine to continue offering care, we had a challenging time because many of our patients don't have access to that technology. We had to scramble for other resources and methodologies. We have to find ways to ensure tech and access to care for everyone, equally, and that's what we're focused on now."
Hildreth pointed to Meharry's new School of Applied Computational Sciences, which will educate the next generation of physicians to use data science to address health disparities and support underserved populations.
And Rethinking the Delivery System
Kusserow explained how the pandemic shifted patients' priorities and confirmed the Amedisys commitment to meeting patients where they are with home-based care.
"We saw tremendous demand for care at home," he said. "COVID-19 gave people - especially baby boomers - a definitive understanding of home-based care, and now patients and their families are fighting to be at home. It even impacted the way skilled nursing and senior living facilities refer patients to us. As a company, we're trying to shift even more toward home-based care and ensure we can provide a low cost, high-touch environment and the highest quality of care."
The Next Decade
Hovious asked the group to identify investment areas that will have the greatest impact for the next five to 10 years. Osteen said Acadia is focused on partnerships to share expertise and resources and help holistically care for patients. Currently, Acadia has seven active partnerships and has announced six more.
Amedisys is experiencing increases in demand for services and is investing time and resources into recruitment, retention and productivity. Alongside home-based care coordination, Kusserow plans for the organization to build a digital platform to ensure care continuity.
Meharry Medical College has embarked on Meharry 2026, a 10-year strategic plan in conjunction with the college's 150th anniversary, to transform Meharry into a self-sustaining, economically diverse institution. The school has also recently launched a number of exciting partnerships and initiatives to improve equity among providers, researchers and patients.
Hazen aims to continue developing HCA Healthcare's ambulatory network and focus on the professional growth of its workforce. HCA's physician graduate programs host approximately 5,000 residents, and Hazen expects within five years of expanding their nursing school, HCA will become one of the largest nurse educators in the U.S.