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Becker’s Healthcare Podcast
Driving Financial Discipline and Access at a Safety Net Health System with Adriana Herrera
00:12:43
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- [00:00]
A
This is Laura Deardle with the Beckers Healthcare podcast. I'm thrilled today to be joined by Adriana Herrera, Vice President of finance at Jackson Health System. Adriana, it's a pleasure to have you on the podcast today.
- [00:12]
B
Thank you. It's a pleasure to be here, Laura. Thank you for having me.
- [00:15]
A
Absolutely. Now, I'm excited for our conversation because I know health care is such a dynamic time right now. So I'm looking forward to learning more about what you're doing at Jackson Health System and how you're thinking about the future. But before we dive in, can you tell us just a little bit more about yourself as well as the organization?
- [00:31]
B
Yeah, absolutely. Like you said, my name is Adriana Herrera. I am the Vice President of Finance for Jackson Health System. We are located here in Miami Dade, Florida. I am a CPA. I have over 20 years of experience in finance healthcare, and I am incredibly fortunate to work for an organization that truly believes in its mission. For most of you that don't know, Jackson is one of the largest, most complex, safety net academic medical centers in the country. We're a fully integrated health system serving Miami Dade residents regardless of their ability to pay. We have seven hospitals, ambulatory centers, six urgent care sites, and some long care facilities strategically located across Miami Dade County. And we also provide high acuity specialties such as trauma, transplant and specialty care. And it is at the level of some of the leading academic medical systems. I have the privilege of leading an exceptional finance team. We have financial planning and analysis, the controller's office, treasury, payroll, and accounts payable. And really what ties me to this organization is the mission that we have trying to serve and help our residents here in Miami Dade County.
- [01:41]
A
I love that. I think it's such an important community that you're serving there. And really cool that you're able to expand so many different services. I know that's so needed within any community. Now, could you talk a little bit more about an initiative that you led in the last year? What did you do and what were the results?
- [01:57]
B
Yeah. So, you know, coming out of COVID I think the entire nation saw significant increases in our premium pay. You know, overtime, agency and contract labor was really at the. At the core of COVID We paid a lot of that. So our workforce shortages really put a strain not only on our healthcare system, I think on healthcare systems across the nation. And so, you know, through the height of the pandemic, we really were paying these premium prices. And so we entered into what we called J35, which was an initiative to really look at some of our processes and on our efficiencies and what we were paying high dollars. So I partnered up with nursing leadership, human resources and teams from the hospital operations, really like a multidisciplinary task force. I led the finance part of it and really is to look strategically on how we were using our premium pay and what we can do to bring it down as an organization. We brought in, what we did is we had like a bi weekly meeting where we brought in the highest variance departments and we had them walk us through three different things. One, what was driving their premium pay, what corrective action plans they had in place and what support they needed in order to be able to, you know, to bring this premium pay down. So if it was like, hey, we have staffing shortages in nursings with this kind of high acuity, we knew that our HR partners will focus on that. Like how can we attract that talent to be able to come in and work for us, you know, on a full time basis when we're not paying agency or these premium pays? That really helped our organization save a lot of money. We brought down our premium pay from an average of about $12 million per month and now our premium pay spending is about $7 million. So that was an average of like $5 million per month. And that was really helpful to the organization.
- [03:51]
A
Well, that's amazing to hear and you know, that's significant amount of money that you're able to save and really just by going through and making sure that the teams had what they needed in order to be supported and not needing so much of that contract to work. And when you were going through these conversations, was there anything that you uncovered during them or, you know, were surprised that you were able to fix relatively easily but without these conversations, you know, might not have gotten done?
- [04:16]
B
Yeah, you know, as a finance leader, I think of dollars and cents. Right. I am only thinking about how much money can we sa, but there's really a lot of aspect to this which is the human component. Right. So our HR partners brought in things like what's going to make us retain our staff, what's going to make them stay here where we're not, you know, losing them to our competitors just because of money. The other thing, from a nursing leadership perspective, you know, what kind of talent do we need? How can we maybe take our own staff that we have in here and train them up to some of these more acute, let's say ICU staffing, which I would have never thought about if we weren't in these multidisciplinary teams, teams, you know, in other areas where we think about like some of our support staff, you know, where can we take some of these entry level, let's say housekeepers or Food Nutrition Network and invest in them in order to be able to put them into some kind of tech position, such as an X ray tech or a nursing tech. And that really helped us think about things in different ways. So I think that was very helpful to bring the team together because again, we all brought different aspects of what we're doing thinking about. But ultimately I learned a lot through this process as well.
- [05:28]
A
That's so helpful to understand and what a great point and way to involve more people within the organization to get a true, you know, more full picture of everything that goes into these types of decisions in what staffing needs departments have now. Looking ahead to the next year or so, what are some of the big priorities and headwinds that you're focused on?
- [05:48]
B
So Looking ahead in 2026, our big, biggest priority is really navigating some of the external financial headwinds while we continue to invest in our mission. And so, you know, what I'm talking about is that we've seen a lot of these Affordable Care act reduction or elimination, some of the things that came through the big beautiful bill where there's some pricing reforms on the 3:40B program. Again, since we are a public health system, we do get tax dollars and some of these changes do impact us financially. And so it's really like understanding what the impact for us is going to financially while we still continue to invest in some of the services that are really needed in the community and then also have kind of a strategic investment, the discipline and the operation and efficiency. So really, you know, efficiencies and making sure that we're investing in the right programs and we're investing in, in the right, you know, investments to make sure that we can continue to serve our community.
- [06:53]
A
That makes a lot of sense. And I know it is a challenge and anxiety felt by so many hospitals and systems across the country, especially when you're looking at some of the changes that have been made in the last year in, you know, some uncertainties in terms of how they'll be implemented and then other changes potentially ahead. And so, you know, when you're looking at some of the changes from the OBVBA or, you know, thinking about 340B in the future, how do you, I guess, what ways are some of the contingency plans that you and your teams have been Talking through in order to make sure. Sure that you are able to have a financially stable future.
- [07:28]
B
Yeah. So some of the things that we're really focused on is making sure that, you know, we are providing the right care at the right, you know, level of care at the right area. So, for example, you know, we have a lot of uninsured patients that come in through our emergency department. And we have a big focus with our populate population health department where they are finding out what are the needs of these patients. So a simple example is a patient that's coming into the ED to get dialysis, but they don't have insurance. Well, that cost is higher in the ed and what we try to do is get that patient into the right level of care to one of the dialysis centers that either we have or work with us where it's going to be easier to give them the service that they need, all while reducing the cost of the organization. So that's a really big focus that we have in the next year to try to really contain the cost to the services that we provide.
- [08:23]
A
Absolutely. I think that's such a good point. And to understand especially how the uninsured population is going to fluctuate likely with some of these changes is helpful. And I love the fact that you brought up a population health department. It's so important right now, it seems like, to tackle things from the population health perspective, which I know is different from historically, how health systems have run sometimes or been able to run. And so it seems like that could be a really big benefit for the organization in the future.
- [08:54]
B
Yeah, I think our leader, her name is Barbara Fonte, that has. That is overpopulation health, has done a phenomenal job and has even brought to light how some of these things like housing issues or food insecurities make an impact on a patient's health. And so trying to work through all of that so that we have a healthier community. But ultimately, from a healthcare perspective, and me as a finance leader, this is going to help us reduce our ultimate cost.
- [09:24]
A
That's such a great point. And you know, I'm curious, what do you think the hardest thing you'll have to do in the coming year will be?
- [09:31]
B
So I think one of the hardest things in the. In the coming year, and I think we spoke about this a little bit, is really like balancing the rising costs and shrinking reimbursement while still protecting our vision. You know, we are continuing to see inflationary pressures across the board, particularly in our labor expense. We are a unionized environment and so we've had to have some kind of cost of living adjustments and wage rises, as well as drug pricing, supply costs, and increasing compliance requirements. So all of that comes at a cost. Yet reimbursement is not keeping pace. Right. In many cases, it's also declining. So really trying to balance out the two, you know, understanding, you know, what our revenue sources are going to be, where we can go and look for additional revenue sources in order to at least sustain our increased costs.
- [10:26]
A
I definitely think that that's such an important lens to have and especially understanding, you know, where those revenue sources could be. Are you looking outside of some of the traditional areas that health systems have gone on, or is it, you know, kind of doubling down in spaces that have the opportunity or possibility for additional growth in the future?
- [10:48]
B
So really, as a healthcare system, our opportunity is really expanding our outpatient and ambulatory foot care print. Historically, as a large academic medical system system, we've been focused on high acuity care, such as trauma, transplant and complex specialty services. It really is at the core of who we are. But, you know, expanding our outpatient footprints is going to provide our residents more access to care and at the right level of care in the right setting. And so that's going to improve our patient experience, reduce unnecessary emergency department utilization, create efficient cost structure. So all of that is something that we're really focused on in our next 5 to 10 year growth. In addition to that, it's going to help us grow our volume. Right. And it's about having access to care. So you'll come in through our primary care facility, you know, facilities, we'll send you to our specialist, and then we will then refer you to our healthcare system. So it's really about growing that referral source in order to not only reduce costs, have the right level of care in the right setting, but also increase our volume in the future.
- [11:59]
A
Fantastic. Thank you so much, Adriana, for joining us on the podcast today. This has been, you know, an amazing discussion. I feel like I've learned a lot and certainly understand, you know, some of the challenges you're going through, but also some really, really strong opportunities. So I'm excited about that as well as, you know, seeing you at our annual meeting in April. I know you'll be speaking on a panel and really digging deeper into some of the themes we talked about today. And so it'll be a great opportunity to connect and further the discussion.
- [12:26]
B
Yeah. Thank you for having me on, Lara. I'm really excited to join you in April and really just, I think this is, you know, an exciting time for healthcare. I think there's a lot of pressures, but ultimately, we figure out how to navigate these challenges all the time.