The Biggest Challenges Facing the Healthcare Industry | New Healthcare Career Roles Emerging

well I think that one of the biggest challenges is cost and I think that society is recognizing that we can't continue to deliver medical care the way we have in the past and they've delivered the medical industry and we are an industry an ultimatum and the ultimatum is is you you're gonna have to change this or we're going to change it for you and so I think that one of the things we deal with every day is understanding that we're gonna have to change the entire paradigm and one of the things that I think has happened in San Diego and rady and sharp and a lot of other folks have taken a leadership position is in is in population health in helping to drive health out into the community because all of us recognize that driving health into the community and helping to create a healthier environment and Nick has been a huge proponent of this as has the community clinics over the years is is if we can deliver care in the community whether it's through home health care whether it's through visits with nurses and other professionals in the home itself you are keeping people healthier out of the hospital reducing cost it's a win for everybody so I'd suggest to you that that is probably number one two and three on the list cost cost cost we're blessed in San Diego that we're able to work together to me what's fascinating the biggest change and one that has really prepared San Diego well because we live it is how the market is evolving nationally one to become of coopertition and see in San Diego we're able to compete and collaborate at the same time that is highly unusual but yet it's required now to achieve carrying inside an institution to the community is going to require a great deal of collaboration outside the walls of institutions across institutions which they'll try to collaborate inside institutions for some of us in government but how you succeed in a cooperative mock market is no easy task and so what we have demonstrated for decades in San Diego is the ability to do that they talk about big data and and so forth we haven't been calling it that way but we've been doing that here in San Diego clearly even with our trauma system and I'm dan can talk more about that was there involved with that but what's exciting to me is that we're able to come together and really map out you know what is the best quality across the whole lifespan not just for the sick but how do we keep people healthy how do everyone's heard about the sick care into the healthcare I think we're going from sick care in San Diego and we're not insecure I'm sandy I would say we're more in health and we're also contending with the huge primary care shortage that we have and so while we are in this collaborative competition there is competition and so for some of us who are limited resources right it's it's it's it's a challenge and so that's what we're contending with since the ACA had been passed so now we have all of this folks that are now insured right ACAB ACA being the Affordable Care Act and most of this folks are coming into the community health centers since most of them are within the Medicaid expansion right and so our doors have been jammed with folks and we're not able to meet the demand as we have them right now and so there's a lot of work around meeting those demands so I actually wrote my master's capstone on group visits and so yes we've been doing that it's a very innovative I thought that was a question down the line but yes right yes that's one of the things that we've been doing you know some some more progressive organizations out there such as the Cleveland Clinic since Sutter Health they've been doing this for years even Kaiser up north has been doing this isn't it's a very innovative way of delivering service because you're then able to capture more patients with less resources while you stimulate for me and I think my colleagues started to address is if I look at the macro picture we still have a major challenge today around healthcare economics you know Don and others refer to the piece of it around the cost but there's also a very huge challenge around what I call the the revenue side of the equation what we truly are still wrestling with greatly is how do we make certain that there is enough revenue to basically provide the quality care and service that we want and need as we also redesigned delivery systems and to focus on populations of care not to go too deep here but one of the big issues and I think sometimes an issue that's not had enough light that it shines on it if you take a look at most healthcare systems their largest revenue stream comes from the government Medicare and Medicaid if you look at those two largest populations and where the greatest amount of the revenue comes today that does not cover the cost of care especially within the state of California where you see some of the lowest Medicaid or Medicare reimbursement rates these colleagues – around me know all about that challenge so if you're losing money if you will or there's not equity revenue to cover your largest population how do you stay afloat well you stay afloat and we have historically by doing something called cost shifting so those who are insured and have insurance you know they pay a lot more than cost to keep the books balanced well what we know today cost shifting is over employers can't handle more increases every one of us who contract as a provider have people knocking about reduction in rates and when we keep moving those rates down and we hit the bottom and we're not at the bottom but getting closer and closer to a cost of care being at its lowest we we have a real crisis occurring I think within this state in particular so I would say our healthcare economics our payment systems and the cost shifting challenges are very very large and huge the analytical skills to be both these as we just discuss now big picture as well as understanding processes so it's it's people processes technology and having that type of analytic skills to be every one of the employees coming in being a strategist being a service strategist not to defer to the strategy department to do strategy but we're looking for people to come in to each be part of that strategy development and that's a little bit different because we typically I'd like to say we hired sometimes in the past for your hands or your skill sets we want the whole person and the whole involvement and so understanding the issue of data when we say we're data-driven the contribution of whether you're in a service line or department or division how that inter plays beyond your own division across the entire organization and then let's have fun across the entire community and that skill set that emergent skill set of being at that integrator strategist is something we're looking for but yet also a challenge and having people come in with those type of qualifications we continue to have challenges with with with recruiting qualified nurses and of course I'm in a very unique situation because we want someone who's got lots of pediatric experience so I think we do continue to have challenges with with attracting and bringing in qualified professionals physical therapists nurses but I will leap ahead and say the challenge of the future is going to be IT and it's going to be that across the board learning how to do predictive analysis right a lot of buzzwords and you know it's it's being forced upon us really you know from the Affordable Care Act ACA because that is the way to transform population-based health is all about mining that data and figuring out who the high utilizers are who the folks are that are costing the system a ton of money so but there's not a lot of expertise within the current health health healthcare workforce currently there is a huge issue with the decrease in physician graduates on the nurse front for us today it's really about finding the experienced specialty nurse today right now within our community and our state there's not this huge nurse shortage that we had historically and it's very very sad because many of the new graduate nurses you know are coming out of programs and not finding employment and that's because the new it grad cohort has saturated the workforce and what we're really needing in our EDS our NICU Xaro ours our ICUs are people who have experience as our population continues to age and become more complex the other thing that's a challenge for us on the work front are what I call new and emerging roles and the majority of them not all are really roles that are again calling upon some clinical background and knowledge and so what we're finding is a lot of our experienced nurses are jumping into those new roles such as clinical documentation specialists so that we make certain all of our physicians are documenting for meaningful use and reimbursement issues etc as we prepare for something called icd-10 so if any of you have any interest in terms of health information management documentation if you went a side job as a coder you know you could be hired in a nanosecond and that is a really large field and then the other one that Nick referenced that resonated so well is really around leadership and management we find it very increasingly more and more difficult for first level management roles and then second level management roles in terms of workforce shortages and need around that this population first and foremost is psychiatrists you know our medical institutions our academic settings are not producing enough psychiatrists today to meet the needs and we also have to create greater incentives for physicians want to work in acute care settings we have a County behavioral health hospital in Millersville we have the largest one at sharpen in Mesa Vista both of a struggle with getting a psychiatrist recruited to this community and we're very fortunate believe it or not because we've got UCSD here with a strong psychiatry program who is feeding this community so those are kind of and probably second our advanced nurse practitioners in the behavioral health field is another area that I think we need to address in terms of the question in terms of the ACA and what type of roles would it create did it create and it kind of made me think of Knicks you know freeway and the on ramps etc I did a little I went to the literature to find out well what did they say at the beginning around role job creation around the ACA well my first surprise in terms of review there was nothing mentioned about health care providers in terms of job creation they identified six in terms of the articles I reviewed and so I wrote those down for you IT professionals management consultants lawyers insurance sales agents customer service representatives and navigators we have a move in San Diego it stands point about you have to have a vision the the Affordable Care Act didn't have a vision it the Triple Aim is not just a vision where do we want to go as a people and we have something called live well San Diego North County health services as a member of that it's a it's a collective effort of many many providers beyond just healthcare that are coming together as saying in order to build better health you also need safe communities because in the presence of violence you can't achieve health and we need to have the housing you need to be thriving we need to have education and thriving we need to deal with poverty and so you have to look at that and if we're just talking about health it's so daunting just to look at help but they say oh gosh even safety and then thriving but in order to really transform a community to live a long and purposeful life you have to do those things and that's what we're doing and that is connecting using technology but connecting with leaders together in our folks and paving our own way in San Diego to living well you

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