How Grady is expanding into Atlanta's 'healthcare desert'

Expanding access to medical care, forging partnerships to expand behavioral health and  treating a growing uninsured population are priorities for Atlanta-based Grady Health System. 

While Grady is looking to expand care into Georgia communities affected by recent hospital closures, such as Wellstar Atlanta Medical Center, it's not untouched by staffing or Medicaid challenges, CFO Anthony Saul told Becker's.

As it transitions to a post-COVID reality, the health system reports a healthy balance sheet, but knows other headwinds loom. But that's OK, says Mr. Saul. "Grady thrives in the middle of chaos."

To learn more about the health system's financial strategy, Becker's caught up with Mr. Saul:

Question: What are your financial priorities going into the next fiscal year?

Anthony Saul: Our financial priorities really align with the mission and goals of Grady. Top of mind for us is expanding access, as we are in a major metropolitan market that actually lost two hospitals in the last year. It has been Grady and other healthcare partners standing in the wind to ensure that our patients are being taken care of. Other top priorities, from a financial perspective that really aligns with our mission, is continuing to invest in strategic service lines. We have seen the highest acuity patient in the city of Atlanta last year with the other level one trauma center closing, and so that's been a major resource commitment in some of our strategic service lines, such as orthopedics, trauma and cardiovascular. As we continue to strive to meet the demand in the city, growing those service lines, adding physicians, adding service center access points is paramount, not only from a commitment to the community but also for financial priority. Thirdly, it's our commitment to continue investing in people and communities. Looking at the work we build from a health equity lens, it's paramount that we expand our ambulatory footprint; we have with the opening of a new ambulatory center earlier this year. As we look out to 2024 and beyond getting access points in the communities we serve, whether it's additional mobile units, additional clinic sites, or expanding tech access points, we're looking at making those investments to continue furthering our clinical mission.

Q: When it comes to expanding care, are you considering any mergers, acquisitions or partnerships?

AS: As a public hospital serving Fulton and DeKalb counties, the M&A activity is limited but not non-existent. We mostly work with our government agencies and other partners who want to expand within our community. So, for instance, we're expanding behavioral health partnerships with the two major counties that we serve. We are expanding our clinics in both communities and we're assessing our portfolio with two major hospitals closing in a year in the Atlanta market. We're looking at what investments make the most sense in the newly identified healthcare desert that has lost hospitals.

Q: What is the biggest financial challenge Grady is facing?

AS: We have additional risk, given that not only did Medicaid not expand in Georgia, we still have north of 25 percent uninsured population. At Grady, 30 percent of our patient population is uninsured. The added stress of Medicaid redetermination is definitely a looming financial challenge. There are additional financial pressures that we're seeing on the horizon. While the labor shortage has improved and, we think we're on another side of that cycle. We're not out of the woods yet, especially given the national dynamics with large health systems like Kaiser and some others in the Midwest potentially facing strikes. That then reduces the pool and starts another cycle where we see our nurses leaving for short-term lucrative deals. 

Additionally, this time around, the physician shortage and increasing costs, retaining and or attracting new providers, we think is going to be a larger factor in the near term. As the providers themselves face the same life question: am I earning enough at my current institution? Many physicians did not see the increases that other clinical staff saw during the pandemic and so we think that's on the horizon. That is another contributing factor that's going to increase the cost of providing care.

Q: Are you turning toward digital tools, such as virtual nursing, to help tackle the staffing crisis?

AS: We have been investing in the digital catalog of services. In 2016, we rolled out remote patient monitoring for chronic heart failure patients. So, those lessons of the pandemic really helped further our commitment and expansion in adding new capabilities; having a strong digital presence is really a part of our strategic undertaking. We're currently investing in expanding our virtual front door through the various services that provide enhanced customer satisfaction for our patients. One of our pillars in the expansion of access that I mentioned earlier, such as having the ability to provide care anywhere and have access to clinicians for our patients at any time, is going to be a key part of diversifying, which allows us to be a little more insulated from other pandemic type events that could occur in the future.

Q: How are you financially preparing for those unforeseen events, such as global pandemics?

AS: We have all looked in the mirror at ourselves since the COVID-19 pandemic and questioned the principles we thought were foundational. It is paramount at Grady or any organization of our size, that we have a healthy balance sheet. That allows us to weather the storm but also make investments that can help mitigate some of the challenges any such future pandemics may present. Right now, Grady is enjoying the strongest liquidity position we have had in decades. We are in a healthy position, but we are investing more than we have in decades. When I look at a 10-year horizon from 2020 to 2030, our plan is to invest over a billion dollars. We look at additional business aspects such as what we do differently in our supply chain, to be ready for such events. So it is really about preparing for the unexpected and Grady thrives in the middle of chaos. 

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