At the 2023 Southern California State of Reform Health Policy Conference, healthcare industry leaders discussed the state of California’s healthcare system, including financial hardships and workforce challenges.
George Greene, president and CEO of the Hospital Association of Southern California, emphasized the importance of good infrastructure. He said if the healthcare system is not adequately set up, it will continue to swallow up money while neglecting to address and fix systemic issues. Greene also discussed ways to strengthen and grow the healthcare workforce.
“When you look at our youth today, they want flexibility. They want to be able to make their own schedules. A lot of them want to work from home. When you look at healthcare—the frontline healthcare, the operations of healthcare—there’s a lot of opportunity.”
— Greene
Greene thinks there’s opportunity to better educate youth, and a better job of raising the profile of the healthcare industry at large. During the COVID-19 pandemic, Greene said he was proud of healthcare professionals who continued to go into work daily, despite exhaustion, challenges, and death. He said the branding of healthcare workers needs to be seen in a similar manner of law enforcement officers and firefighters—like heroes.
Sameer Amin, MD, chief medical officer of LA Care Health Plan, said student debt has influenced fields that youth are entering, particularly doctor and nursing fields.
“They don’t get the opportunity to come work in healthcare, particularly in the safety net, because maybe the pay may not be as good. In times past, they make that decision and say, “Hey, listen, the pay may not be great but I’m settled with half-a-million dollars in debt, and I’ll still be able to make my payments, and I’ll still be able to live a life here.” But, it’s hard to live in Los Angeles County with a massive amount of debt.”
— Amin
Amin said the industry can’t address financial hardships within a silo—such as solely focusing on reimbursements or lowering salary thresholds for being in the safety net—but that the industry must have a sobering conversation about how they facilitate individuals entering the healthcare system.
“What we’re doing right now, is we’re asking people to make decisions that a rational person wouldn’t be able to make,” Amin said.
Amin believes grants, wiping out student debt, and increasing minimum wage statewide are more cohesive approaches to what the industry has been doing to increase the workforce.
Toni Johnson-Chavis, MD, chief medical officer of De Novo Healthcare Community, explained how there are ways to increase worker’s overall incomes: by layering services they have been trained for. For example, if a medical assistant is also taught how to bill, code, and work as a community health worker, that individual now has four skill sets, and financial incentives can be layered.
Medi-Cal managed care plans offer incentive payments to providers who offer value-based services for certain high-cost populations. Johnson-Chavis said layering services is the “secret sauce,” and that providers must be trained at the highest attainable tier of care. This would result in increased value-based payments and increased scores at health centers.
“There are ways that money incrementally can be added on within the system of care. It’s fun. It’s exciting,” Johnson-Chavis said.
Johnson-Chavis brought up another issue that patients regularly face.
“Everyone wants to send the specialty [care] back to primary care.”
— Johnson-Chavis
When patients are sent from specialty care back to primary care, oftentimes, the primary care physician is not trained to handle specialty care issues. Primary care providers are often asked to step out of their comfort zones in caring for specialty patients, which Johnson-Chavis said they won’t do because of malpractice concerns.
“We have to be very careful to know that we don’t have provider directories that are really up to date—that are really telling us where our board-certified doctors are,” Johnson-Chavis said.