Latest / Becker’s Healthcare Podcast / Driving Financial Discipline and Access at a Safety Net Health System with Adriana Herrera

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Driving Financial Discipline and Access at a Safety Net Health System with Adriana Herrera · Becker’s Healthcare Podcast

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  This is Laura Dierda with the Becker Healthcare
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  Podcast.
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  I'm thrilled today to be joined by Adriana
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  Herrera, vice president of finance at Jackson Health
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  System. Adriana, it's a pleasure to have you
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  on the podcast today.
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  Thank you. It's a pleasure to be here,
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  Laura. Thank you for having me. Absolutely.
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  Now I'm excited for our conversation because I
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  know health care is such a dynamic time
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  right now, so I'm looking forward to learning
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  more about what you're doing at Jackson Health
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  System and how you're thinking about the future.
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  But before we dive in, can you tell
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  us just a little bit more about yourself
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  as well as the organization?
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  Yeah. Absolutely.
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  Like you said, my name is Adriana Herrera.
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  I am the vice president of finance for
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  Jackson Health System. We are located here in
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  Miami Dade, Florida.
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  I am a CPA. I have over twenty
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  years of experience in finance health care,
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  and I am incredibly fortunate to work for
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  an organization that truly believes in its mission.
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  For most of you that don't know, Jackson
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  is one of the largest, most complex safety
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  net academic medical centers in the country.
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  We're a fully integrated,
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  health system serving Miami Dade residents regardless of
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  their ability to pay.
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  We have seven hospitals, ambulatory centers,
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  six urgent care sites, and some long care
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  facilities
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  strategically located across Miami Dade County.
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  And we also provide high acuity,
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  specialties such as trauma, transplant, and specialty care,
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  and it is at the level of some
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  of the leading academic medical systems.
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  I have the privilege of leading an exceptional
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  finance team.
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  We have financial planning and analysis, the controller's
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  office, treasury, payroll, and accounts payable.
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  And really what ties me to this organization
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  is the mission that we have trying to
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  serve and help our residents here in Miami
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  Dade County.
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  I love that. I I think it's such
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  an important community that you're serving there and
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  and really cool that you're able to expand
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  so many different services. I know that's so
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  needed, within any community.
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  Now could you talk a little bit more
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  about an initiative that you led in the
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  last year? What did you do, and what
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  were the results?
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  Yeah. So, you know, coming out of COVID,
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  I think the entire nation saw significant increases
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  in our premium pay.
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  You know, overtime agency and contract label was
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  really at the at the core of COVID.
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  We paid a lot of that. So our
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  workforce shortages really put a strain not only
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  on our health care system, I think on
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  health care systems across the nation. And so,
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  you know, through the height of the pandemic,
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  we really were paying these premium prices. And
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  so we entered into,
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  what we called j 35, which was an
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  initiative to really look at some of our
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  processes and on our efficiencies and what we
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  were paying,
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  high dollars.
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  So I partnered up with nursing leadership, human
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  resources,
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  and teams from the hospital operations really like
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  a multidisciplinary
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  task force. I led the finance part of
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  it and really is to look strategically,
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  on how we were using our premium pay
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  and what we can do to bring it
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  down as an organization.
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  We brought in
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  what we did is we had, like, a
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  biweekly meeting where we brought in the highest
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  variance, departments,
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  And we had them walk us through the
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  three different things. One, what was driving their
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  premium pay,
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  what corrective action plans they had in place,
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  and what support,
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  they needed in order to be able to,
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  you you know, to bring this premium pay
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  down. So if it was like, hey. We
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  have staffing shortages
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  in nursing with this kind of high acuity.
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  We knew that our HR partners will focus
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  on that. Like, how can we attract that
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  talent to be able to come in and
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  work for us, you know, on a full
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  time basis where we're not paying agency or
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  these premium pays? That really helped our organization
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  save a lot of money. We brought down
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  our premium pay from an average of about
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  $12,000,000
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  per month, and now our premium pay spending
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  is about $7,000,000. So that was an average
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  of, like, $5,000,000 per month, and that was
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  really helpful to the organization.
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  Well, that's amazing to hear. And, you know,
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  that's significant
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  amount of money that you're able to save
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  it and really just by going through and
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  making sure that the teams had what they
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  needed in order to to be supported and
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  not, you know, needing so much of that
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  contract to work. And when you were going
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  through these conversations, was there anything that you
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  uncovered during them or, you know, were surprised
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  that you were able to fix relatively easily,
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  but without these conversations, you know, might not
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  have gotten done.
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  Yeah. You know, as a finance leader, I
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  think of dollars and cents. Right? I am
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  only thinking about how much money can we
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  save. But there's really a lot of aspect
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  to this, which is the human component. Right?
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  So our HR partners brought in things like
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  what's gonna make us retain
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  our our staff? What's gonna make them stay
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  here where we're not, you know, losing them
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  to our competitors just because of money? The
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  other thing from a nursing leadership perspective, you
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  know, what kind of talent do we need?
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  How can we maybe take our own staff
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  that we have in here and train them
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  up to some of these more acute, let's
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  say, ICU staffing, which I would have never
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  thought about if we weren't in these multidisciplinary
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  teams.
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  You know, in other areas where we think
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  about, like, some of our support staff, you
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  know, where can we take some of these
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  entry level, let's say, housekeepers or food and
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  nutrition,
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  network and invest in them in order to
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  be able to put them into some kind
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  of tech position such as an x-ray tech
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  or a nursing tech, and that really helped
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  us think about things in in different ways.
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  So I think that was very helpful to
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  bring the team together because, again, we all
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  brought different aspects of what we're thinking about,
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  but, ultimately, I learned a lot through this
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  process as well.
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  That's so helpful to understand, and what a
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  a great point in in way to involve
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  more people within the organization to get a
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  true, you know, more full picture of everything
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  that goes into these types of decisions and
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  what,
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  staffing needs departments have. Now looking ahead to
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  the next year or so, what are some
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  of the big priorities and headwinds that you're
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  focused on?
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  So looking ahead in 2026,
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  our big biggest priority is really navigating some
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  of the external
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  financial headwinds, while we continue to invest in
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  our mission. And so, you know, what I'm
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  talking about is that we've seen a lot
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  of these, you know,
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  affordable care at reduction or elimination.
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  Some of the things that came through the
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  big beautiful bill where there's some pricing reforms
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  on the three forty forty b program.
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  Again, since we are a public health system,
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  we do get tax dollars, and some of
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  these changes do impact us financially.
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  And so it's really like understanding what the
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  impact for us is gonna be financially
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  while we still continue to invest in some
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  of the services that are really needed in
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  the community. And then also have
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  kind of a strategic
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  investment, the discipline,
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  and the operation and efficiency. So really, you
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  know, efficiencies
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  and making sure that we're investing in the
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  right programs and we're investing
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  in in the right,
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  you know, investments to make sure that we
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  can continue to serve our community.
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  That makes a lot of sense. And I
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  know it is a challenge and anxiety felt
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  by so many hospitals and systems across the
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  country, especially when you're looking at some of
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  the changes that have been made in the
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  last year in in, you know, some uncertainties
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  in terms of how they'll be implemented and
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  then other changes potentially ahead. And so, you
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  know, when you're looking at some of the
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  changes from, the OBBBA
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  or, you know, thinking about three forty b
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  in the future,
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  how do you I guess, what ways are
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  some of the contingency plans that you and
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  your teams have been talking through in order
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  to make sure that you are able to
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  have a financially stable future?
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  Yeah. So some of the things that we're
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  really focused on is making sure that, you
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  know, we are providing
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  the right care at the right,
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  you know, level of care at the right
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  area. So, for example, you know, we have
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  a lot of uninsured patients that come in
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  through our emergency department, and we have a
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  big focus,
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  with our populate
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  population health,
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  department
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  where they are finding out what are the
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  needs of these patients. So a a simple
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  example is a patient that's coming into the
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  ED to get dialysis, but they don't have
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  insurance.
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  Well, that cost is higher in the ED.
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  And what we try to do is get
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  that patient into the right level of care
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  to one of the dialysis centers that either
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  we have or work with us where it's
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  gonna be easier to, you know, give them
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  the service that they need all while reducing
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  the cost of the organization. So that's a
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  really big focus,
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  that we have in the next year to
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  try to really contain
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  the cost to the services that we provide.
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  Absolutely. I think that's such a good point
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  and to understand, especially, how the uninsured population
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  is going to fluctuate likely, with some of
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  these changes is helpful. And I love the
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  fact that you brought up, a population health
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  department.
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  It's so, important right now, it seems like,
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  to tackle things from the from a population
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  health perspective, which I know is different from
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  historically how health systems have run sometimes or
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  been able to run. And so it seems
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  like that could be a really
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  big benefit for the organization in the future.
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  Yeah.
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  I think our
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  leader,
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  her name is Barbara Fontay, that has that
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  is overpopulation health, has done a phenomenal job
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  and has even brought to light how some
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  of these things like, you know, housing issues
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  or food insecurities
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  make an impact on a patient's health. And
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  so trying to work through all of that
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  so that you have, you know, a healthier
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  community, but ultimately,
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  from a health care perspective and me as
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  a finance leader, you know, this is gonna
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  help us reduce our ultimate cost.
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  That's such a great point. And, you know,
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  I I'm curious. What do you think the
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  hardest thing you'll have to do in the
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  coming year will be?
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  So I think one of the hardest things
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  in the in the coming year, and I
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  think we spoke about this a little bit,
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  is really, like, balancing the rising cost and
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  shrinking reimbursement
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  while still protecting our vision. You know, we
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  are continuing to see inflationary pressures across the
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  board, particularly in our labor expense. We are
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  a unionized
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  environment, and so we've had to have some
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  kind of,
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  cost of living adjustments and and wage prices
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  as well as drug pricing, supply costs,
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  and increasing compliance requirements. So all of that
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  comes at a cost,
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  yet reimbursement is not keeping pace. Right? In
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  many cases, it's also declining. So really trying
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  to balance out the two, you know, understanding,
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  you know, what our revenue
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  sources are gonna be, where we can go
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  and look for additional revenue sources
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  in order
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  to, at least,
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  sustain our increased cost.
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  I definitely think that that's such an important
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  lens to have and especially understanding, you know,
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  where those revenue sources could be.
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  Are you looking outside of some of the
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  traditional
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  areas that health systems have gone on, or
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  is it, you know, kind of doubling down
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  in spaces that have the opportunity or or
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  possibility for additional growth,
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  in the future?
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  So, really, as a health care system, our
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  opportunity
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  is really expanding our outpatient ambulatory foot care
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  print.
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  Historically, as a large academic medical sister system,
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  we've been focused on high acuity care such
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  as trauma, transplant,
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  and complex specialty services.
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  It really is at the core of who
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  we are, but, you know, expanding our outpatient
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  footprints is gonna provide
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  our residents more access to care and at
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  the right level of care in the right
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  setting.
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  And so that's going to improve our patient
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  experience, reduce unnecessary emergency department utilization,
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  create efficient cost structure.
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  So all of that is something that we're
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  really focused on in our next five to
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  ten year growth. In addition to that, it's
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  gonna help us grow our volume. Right? And
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  it's about having access to care. So you'll
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  come in through our primary care, you know,
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  facilities.
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  We'll send you to our specialist, and then
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  we will then refer you to our health
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  care system. So it's really about growing that
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  referral source in order to not only reduce
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  cost,
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  have the right level of care in the
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  right setting, but also increase our volume in
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  the future.
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  Fantastic.
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  Thank you so much, Adriana, for joining us
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  on the podcast today. This has been, you
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  know, an amazing discussion. I feel like I
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  I've learned a lot and certainly,
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  understand, you know, some of the challenges you're
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  going through, but also some really, really strong
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  growth opportunities. So I'm excited about that as
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  well as, you know, seeing you at our
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  annual meeting in April. I know you'll be
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  speaking on a panel and and really digging
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  deeper into some of the themes we talked
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  talked about today, and so it'll be a
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  great opportunity to connect and, further the discussion.
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  Yeah. Thank you for having me on, Lara.
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  I'm really excited to to join you in
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  April. And and really just I think this
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  is, you know, an exciting time for health
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  care. I think there's a lot of pressures,
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  but ultimately, we figure out how to navigate
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  these challenges all the time.