What They’re Watching: Nick Macchione

Nick Macchione is the Director of the San Diego County Health and Human Services Agency. Throughout his career, Macchione has amassed over 30 years of experience in the management, delivery, and public policy of health and human services. He joins us in this edition of “What They’re Watching” to talk about the concept of localism.

There’s a concept, we talk a lot in this nation on federalism and that’s being played out right now, from President Trump looking at more of the deregulation from federal to state. And that federalism ping pong goes with different administrations but it’s always the interplay of the feds and the states.

And we see in the next few years, states will play a more important role in health policy. But one that is a constant is something called “localism.” And localism is the interplay of counties, or cities, or local municipalities with the state and the feds. And it’s understanding the interplay of localism where we provide the services. So, think of us as the retail of health policy, where we’re rendering the services, understanding the policies with our well-intended policy makers above us at the state and federal. And we’re all tied together to get it right.

So, localism is where we meet federalism. And it’s the three branches and levels of government that have to do a better job of understanding of harmonizing the metrics and the data, to ensuring that we have the right services as we’re trying to all squeeze out the waste at all levels. But then all vigilantly focused on how do we improve the health and well-being of Americans? So, I am excited that there is a movement around localism and we’re creating these ecosystems. These health and wellbeing ecosystems are code for, how do we get all sectors to come in on the service delivery part as we begin to translate and understand the federal and state mandates and requirements? And how do we do that in concert? And I think that is going to be an amazing opportunity in the decades to come of places like San Diego and others throughout the nation that are able to create that strategic alignment and show real, measured value as a result.