Roundtables

about 6.5 million people, soon to be 7 million. So when I say resource allocation, it includes both capital and people. How do we attract and retain the best people, particularly clinical personnel, when there is such a shortage of them? Q: What are some unique cir- cumstances facing your orga- nization? Are any especially helpful or thwarting? SA: We do have a good payer mix for a children's hospital, but we serve patients in southeastern Pennsylvania and from at least two states that border our Main Campus — New Jersey and Dela- ware. All have different Medicaid plans and different Medicaid managed care players, and some of these plans are difficult to maintain relationships with. I think that's definitely a challenge. SS: As the national healthcare system shis, we are in a unique situation to support our way of providing care. Montefiore was an accountable care organization before ACOs existed to manage our patients' chronic conditions and keep them out of the hospi- tal. is has been Montefiore's model and we know from ex- perience, including having the best performance of 32 Pioneer ACOs in the first year of the pro- gram, that the model works. We embrace the opportunity to be accountable for the quality of our care, our patient outcomes and the cost of our care. WT: In Louisiana, we have a fair- ly large indigent population and a significant amount of chronic disease such as diabetes, stroke and heart disease. As the largest nonprofit healthcare provider in the state, it's extremely important to us that we play a major role in improving the health of the communities we serve as well as helping the state address the health challenges of the overall population. Additionally, one of the unique things about Ochsner is that we play an important role in each of the Southeast Louisiana com- munities where we are located, and at the same time, we are a regional and national referral center taking care of people from across the country. Managing the process of serving our local areas with the highest quality care while also ensuring access to the same for patients who come to us from out of state can be a unique situation. We are fortunate, however, to have so many people who count on us and significant demand for our services — as well as playing an important role in our commu- nities. DW: Something we've been deal- ing with for 15 years is the poor payer mix. Texas, for years, has led the country in the amount of uninsured individuals. Houston is about 34 percent uninsured. e uninsured problem is com- pounded by the state of Texas' decision not to expand Medicaid and the PPACA prohibition of selling insurance to undocu- mented individuals. Houston is estimated to have 16 to 18 per- cent of its population as unin- sured, undocumented individ- uals. Even if the state of Texas expanded Medicaid, and the PPACA worked wonderfully well, we would still have to deal with 16 to 18 percent of the patient population having no ability to pay. is demographic creates a unique challenge for our system's vision of population health; spe- cifically, how do we keep all these people healthy and well when they have no access to health- care? We don't see this challenge going away. It's something we grapple with every day. Q: What in healthcare remains difficult despite new advances in technology? What challeng- es will likely persist even while technology continues to prog- ress? SA: Technology can really be very, very helpful in healthcare. Certainly technology can lead to improvements in patient safety and quality and enhance communications with patients and between different providers within the care team. e imple- mentation of technology, though, 4 Top Priorities, Challenges & Innovation in Healthcare

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