Interview: Mike Schultz

Long-term care

Emphasizing patient care beyond the hospital stay helps maintain patient health, and reduces the cost of healthcare

Why has your organization decided to focus on preventative healthcare? One of the key aspects of preventive healthcare is our model of never discharging a patient. Historically, hospitals wheel out their patients and wave goodbye to them. We have taken the stance that we don’t ever want to discharge a patient. A visit may end, but we connect with our patients before they leave any of our facilities and ask them if we can assist them through the next level of care. That may be a follow-up visit, a better dietary regiment or access to medication. We offer 95% of our 200,000-plus annual patients access to care navigation and a large percentage of our patients accept the offer. That is a way of making sure they don’t go home and start repeating the same actions that brought them to the hospital in the first Mike Schultz President & CEO, West Florida Division AdventHealth

place. This helps with maintaining health, reducing cost of healthcare and gets us in a space where we are directly connected to the patient.

We have been intentional in making sure our consumers have a wide variety of access to different sites of service based on cost. This allows them to make the smart decision and not go to an emergency room for a simple cough that could be treated at a physician’s office or an Urgent Care Center. We want to be transparent about the costs in healthcare so that consumers can make educated decisions regarding their medical needs.

What challenges emerge from providing healthcare to diverse demographics, younger and older populations? In many markets in and around Tampa Bay we are seeing a more elderly population moving in. Retirees are starting to discover the beauty of Tampa Bay. But in general Tampa Bay is a fast-growing, diverse community and it is a large geographic area. The key to addressing the healthcare needs of the diverse demographics is to ensure close to home access points, and the ability to connect any time any where.

We also believe we need to make every effort to make healthcare more affordable. Perhaps the way of the future is to help change the reimbursement model. Currently, you pay when you are sick, a health system is incentivized to provide services to get you well. What if we changed that? For example: a health system might get $10,000 a year regardless if you are well or sick. If you get sick, and it cost the health system $25,000 to take care of you, it loses money. If the health system keeps you well, and able to keep medical cost at $5,000 because it was proactive in looking out for your wellness, the system makes money.

AdventHealth sees over 200,000 patients annually.

( ) had no teeth after the penalty was removed by the current administration. “They argued that since the U.S. Supreme Court had upheld the ACA in 2012 specifically because it was a valid exercise of Congress’ taxing power, taking the tax away makes the entire rest of the law unconstitutional,” according to National Public Radio. The battle could end with the entire act being invalidated, jeopardizing access to healthcare coverage for many, especially in Florida.

Over 1.7 million people enrolled in ACA plans through the Florida exchange during the open enrollment period for 2019 coverage — by far the highest enrollment of any state in the country and an increase of 4 percent on the year. If the ACA is invalidated in Florida, the implications would be substantial. A huge healthcare gap exists because the state has rejected federal funding to expand Medicaid, affecting those with income levels below the poverty line. But this hasn’t seemed to deter Floridians, 1.9 million of whom signed up for 2020 enrollment, again outpacing the rest of the country.

Health insurance As of 2018, 87.9% of the population of Tampa-St. Petersburg-Clearwater had health coverage, with 40.6% on employee plans, 15.5% on Medicaid, 13.9% on Medicare, 15.3% on nongroup plans, and 2.54% on military or VA plans. Between 2016 and 2020, the percent of uninsured citizens in the region grew from 11.7% to around 13%. In Florida, the cost of insuring a single person rose from $4,517 in 2008 to $6,674 in

2018. For a family, the numbers increased from under $13,000 to nearly $19,000.

But health insurance premiums for workers in Florida are among the highest in the country, according to the Commonwealth Fund. In Florida in 2018, this accounted for an average of 14.5% of median household income, up from 10.1 percent in 2008. Florida workers also spent a larger chunk on deductibles than most other states.

Another fallout from the potential elimination of the ACA is the increased funding needed to finance Florida KidCare, a program that covers children up to age 18 and includes a subsidized health-insurance program for school-aged children based on both federal and state funding. If ACA were to end, it could mean the end of federal funding for this initiative. According to economists, costs for the program will continue to rise over the next five years, with an extra $162 million in public funds required by 2024.

That being said, if the ACA is to remain in place, 2020 will be the first year premiums hold steady in the state of Florida as the system balances itself. Premiums soared in the last few years, mainly as the federal requirement to obtain healthcare was eliminated and insurance companies corrected rates for lower subscriber numbers. But the market in Florida was more stable than anticipated, according to Steve Ullmann, a healthcare policy expert at the University of Miami. This is set to encourage increased subscription in the program.

Current expensive and patchy access to healthcare