Carlos Migoya took over the helm of Jackson Health System, one of the nation’s largest and finest healthcare systems, on June 1 as President and Chief Executive Officer. Since then, the veteran banker has quickly and deftly begun the daunting task of steering the financially troubled system onto a sounder course and off the shoals of uncertainty. It is a challenge Migoya accepted with the support of the business community and 10 months’ experience balancing Miami’s budget.
With its centerpiece Jackson Memorial Hospital (continually ranked by U. S. News & World Report as one of the “Best Hospitals in America”), the integrated, public healthcare system includes multiple primary and specialty care centers, school-based clinics, two long-term care nursing facilities, six Corrections Health Services clinics, a network of mental health facilities, Holtz Children’s Hospital, Jackson Rehabilitation Hospital, Jackson Mental Health Hospital, Jackson North Medical Center, and Jackson South Community Hospital.
Despite its acclaim, the system has been running a budget gap of nearly $400 million. This year alone, it stands to lose some $200 million. Migoya expects to correct that course over the next 18 months.
“At the end of the day, it’s all about common sense … common business sense,” said Migoya. “I’m not a healthcare professional, so I can ask out-of-the-box questions.” Migoya’s questions have initially focused on trimming costs and restructuring the highly ranked system to better serve the 2.5 million residents of Miami-Dade in the years ahead. His strategy is multi-pronged.
“Clearly, our pricing and expenses as a more academically focused organization have outpaced revenues,” said Migoya. “We need to change that. We need to ensure we are aligning charges with expenses so that we can better compete for paying patients.”
Current labor costs for the cash-strapped healthcare system are a major factor in that disconnect. “We must ensure our pension plans, which now represent 18 percent of total compensation, are in line with what most hospitals offer,” said Migoya, who aims to true that up without layoffs. “The biggest challenge is being able to get accurate financial information,” noted Migoya, who has brought on board a former global director from Ernst & Young and an executive from Westinghouse to help him identify key areas needing transformation.
Migoya’s strategic plan also aims to tweak Jackson Health System’s delivery of patient care at the community level. “Nationwide, the focus of healthcare is on outpatient care. Not so much here,” he said. “We need to take healthcare for Miami-Dade from one of need to prevention, ” stressed Migoya, who wants to strengthen partnerships with the community and local school systems, from elementary through middle schools and into high schools. “We need a preventive approach to diseases such as asthma and diabetes, especially in our poorer communities where they are particularly prevalent.” To that end, Migoya and his team also are identifying ambulatory centers at the community level where patients can be given better frontline care before referral to a hospital where costs escalate.
Migoya also wants to ensure Jackson Health System remains a positive experience for all residents of Southeast Florida, and importantly for internationals, primarily people of Hispanic and Latino origins who comprise about 65 percent of the population. “The drawdown is to the individual patient,” said Migoya. “We must ensure we have the facilities and the structure in place to serve the community today and into the future.”
The father of two, a Miami banker and an attorney in Denver, Carlos Migoya is justifiably proud of the system he runs today and the people who are stepping up to make it all happen.
He sees a bright future for Jackson Health System. And his greatest reward: “Knowing that we are saving lives and giving the best basic care every day to all who seek our help.”