Ben Spence is new to his role as COO of Fort Myers, Fla.-based Lee Health. However, as a nearly 30-year veteran of the organization, he has played a key role in its past and shaping its future.
Mr. Spence joined Lee Health in 1995 and has held leadership roles in the system's finance department, including system director of reimbursement. Most recently, he served as chief financial and business services officer from 2014 to 2024, and was appointed to the dual role of COO and CFO in December.
Mr. Spence will continue to fulfill financial leadership responsibilities while Lee Health searches for a new CFO.
He told Becker's that, as COO, he is focused on the culture of the organization, as well as ensuring improved access to care. He also discussed Lee Health's decision to convert to a private nonprofit health system, as well as strategies for maintaining strong financial performance.
Editor's note: Responses were lightly edited for length and clarity.
Question: Under your leadership as CFO, Lee Health expanded facilities and services, including the development of a Medicare accountable care organization and a direct-to-employer health network. As COO, what are your priorities for further strategic growth, and how do you plan to enhance access to high-quality care in the community?
Ben Spence: As COO, one of my initial focuses and ongoing focus will be fostering the culture of the organization — creating a value-driven culture where you feel empowered.
When I came here 30 years ago, I came as a clerk and I felt that sense of empowerment at a very early stage of my career, that there were tremendous opportunities to work at Lee. But the culture is so important as we're trying to grow the organization and keep up with the rapidly changing healthcare industry that's moving extremely fast. It takes a real focus on bringing people together.
We have over 15,000 employees. Our services span from primary care to specialty care, hospital outpatient services, ancillary acute care and post-acute care. Bringing everybody together is a challenge — to make sure everybody's aligned towards the same operational objectives. So we do lay those out pretty clearly every year: What are our primary operational objectives that are going to help us execute on the strategy of the organization?
And that takes a strong spirit of collaboration — people working across division lines, coming together, understanding what needs to change, why we need to change, and how we're going to implement those changes. Bringing them together to work as a team creates a momentum to move forward together, where we're all aligned.
In southwest Florida, it's a very fast-growing area — one of the fastest in the nation. It's a destination for seniors, but also for businesses and families. Our obstetrics department delivers the equivalent of a kindergarten class every day. That's how fast the population is growing.
As the population grows, a part of our challenge is access. One of our No. 1 priorities is to help create new ways to access care — improving the way we deliver care. And that requires growth of our physical assets, so we're growing. We have over 90 locations where we provide services today, but we're going to continue expanding.
We're investing over $1 billion over the next five years to expand access in various physical locations, including a replacement campus — which is a big chunk of that.
But we're also innovating. So, it's not just physical assets — we're providing care in new ways. We want to provide access where, when and how a person wants to access it. And it's different for different generations.
We're finding that virtual urgent care, urgent care to the home, and in-home care are gaining traction. We're starting a hospital-at-home program, so patients can receive acute care at home, which can greatly help us reduce long-term capital expenditures. Today, we have five hospitals, and in season, they tend to be full. So, having this ability to admit a patient to acute care and treat them in the comfort of their own home is something we think is really going to take off.
We've started that, and we continue to innovate because the world is changing fast, and competition is fierce in this space. We have to continue to be creative and attuned to what the consumer really wants to ensure we achieve our strategic aim — to be the provider of choice for southwest Florida.
Q: Lee Health has been working toward converting from a public nonprofit to a private nonprofit health system. Could you elaborate on the anticipated benefits of this transition, and how it will impact the organization's operations and ability to compete in the healthcare market?
BS: As a public entity, we had enabling legislation that restricted us to stay within the boundaries of Lee County.
So, in the state of Florida, we used to have a certificate of need that required new hospital entrants to prove need before they could be granted the ability to open or build a hospital in an area. That has since gone away. And so what we were facing was that anybody could come into our area and build a hospital at any time with no requirements, while we could not go outside of our county. We had to stay within our borders.
In one respect, it was a way of leveling the playing field with competitors. We do feel that in this industry, scale is important to compete in the long run, and we're going to have to become more efficient — and scale is one way to do that. But if you're limited to geographic boundaries, it's an unfair disadvantage that we had.
So, that's one benefit that's been removed. It gives us that ability. We have a lot going on in Lee County— the $1 billion that we're planning on spending is dedicated to projects we've already planned for Lee County, and we'll continue pursuing. But now, we're able to go outside our borders and start to look at opportunities to expand people's access to the benefits of Lee Health. That's one of the benefits.
The other is, as a public entity, all of our board meetings and every communication, essentially, were all public because, as a public entity, we're in the Sunshine State. There are Sunshine Laws that require everything to be available to the public.
So, if you're going to talk about strategic direction for the organization in a board meeting, your competitors could sit in that same room with you — because you couldn't prohibit them from coming in.
Q: You've successfully led initiatives that increased positive cash flow. What innovative financial strategies do you plan to implement to ensure continued financial sustainability, especially in the face of evolving healthcare challenges?
BS: We're very proud of our financial results over the last 10 years — growing from an $800 million-a-year system to a $3.2 billion-per-year revenue system. Moody's actually gave us a positive outlook in their last credit rating. And so, if we continue performing as we have been, we would expect a credit operating upgrade next year.
Part of that really boils down to our growth strategy. Can we continue to grow our revenues? Can we manage expenditures in a way that's going to create efficiencies? I think part of that will always be finding innovative ways of delivering care at a lower cost. Moving care to the right place at the right time can avoid a lot of the costs we're incurring today. Sometimes people access your emergency room because it's what's available to them. As we provide more locations in the community for people to access primary and specialty care, that eliminates the need to always use the ED, which is one of the most expensive methods of accessing care.
We're entering into more value-based arrangements, which allow us the opportunity to share in savings with Medicare and other payers. If we lower the cost of care for a payer, we can share in those savings. It's a benefit — improving outcomes while doing so at a lower cost.
Another strategy that will continue to evolve over time, and where we're having some success, is in improving health outcomes. One of the most important things we're doing is identifying a patient's risk factors early on. So, as we conduct primary care visits or annual wellness visits, we're trying to capture as much as we can about the risks associated with a patient's prior conditions that need continued treatment.
By addressing those conditions early, we can avoid the onset of progressive disease, prevent hospital admissions, and mitigate cardiovascular disease or certain cancers by better managing care ahead of time. But a lot of that happens in the outpatient world — where we can get ahead of these things. That ultimately not only lowers costs but significantly improves the health of the community.
It takes doing things differently — changing processes, really analyzing where we are today, where we want to go, and how we can get there. Change can be really good when you create awareness of why it's important and the desire for it — what's in it for the community, for our employees, and for our staff.
We're also actively pursuing the growth of our primary care base, continually adding new providers and locations to increase access to care. We have graduate medical education programs where we train residents, and that has become a feeder for future physicians who end up staying in our community. About 50% of graduates remain here, raising their families and building their careers. So, we continue to grow those programs as a strategy to provide greater access to care, and it's worked really well.