California health system works to ensure access

Chicago - The Imperial Valley Health District in southeastern California is looking to serve its patients in need while also connecting with those leaving the region for healthcare services.

The public healthcare district, which includes two hospitals, is near the border with Mexico. About 80% of the district’s patients are on Medicare or Medi-Cal, California’s Medicaid program, says Chris Bjornberg, chief executive officer of the Imperial Valley Healthcare District.

With flat reimbursements and rising costs, Bjornberg says new approaches are needed.

“We really have to think about how we do things differently now, and think about what things are essential,” Bjornberg says. “We really have to look at the services that are being provided and say … does the cost of the labor actually work for what we want to do for that service line?”

Bjornberg spoke with Chief Healthcare Executive® in a recent interview at the Fairmont Hotel in Chicago, while he was in town for the Becker’s Healthcare 16th Annual Meeting.

He talked about the challenges for the Imperial Valley Healthcare District and the way the system is looking at ways to innovate, including strategic partnerships.

Access and stability

Health systems, including safety net hospitals and rural hospitals, are facing tougher decisions in the wake of uncertain federal aid and increasing costs. Bjornberg points to hospitals nationwide that have cut labor and delivery services. Since 2014, more than 50 labor and delivery units have shut down in California, according to the California Hospital Association.

The Imperial Valley Healthcare District was created in 2023 to ensure access to care for residents with lower incomes. The district serves Imperial County and its population of nearly 180,000 residents.

Bjornberg says the district strives to maintain essential services. But as he says, “Access and financial stability don't necessarily go hand in hand.”

Some residents with higher incomes choose providers in Palm Springs, about 90 minutes away, and San Diego, a drive of about two hours. Some patients are willing to make a longer drive because they think that the care will be better, he says.

“Realistically, that's where we have to do better as an organization,” Bjornberg says. “We have to look for opportunities to be able to provide those services, and that's what we are doing.”

Bjornberg says the system is looking at data to indicate the services patients are seeking in other communities. The district is looking at ways to provide those services in the community.

He also says that could involve looking for partners to help provide services through telehealth to give patients more options without having to travel.

“Each organization has to see, what is it that's essential for them, and how are they going to provide those services? Whether it's something that they can do themselves, or whether it's something they're going to have to partner up with somebody else to make sure that those services are available,” he says.

The health district is also bracing for the prospect of Medicaid cuts in the coming years as a result of HR 1, also known as the One Big Beautiful Bill. Healthcare analysts project millions of Americans could lose Medicaid coverage, and hospitals are facing uncertain funding even as they expect to care for more people without insurance.

“Medicare cuts in particular are always going to be problematic for us, and that's something that we're going to have to really be vigilant as we move forward,” Bjornberg says.

He says the system is looking to find ways to help staff practice at the top of their license, while maintaining a human connection.

“If people don't feel like they're going to get good care when they come there, they're not going to come,” he says. “If they feel like their customer service is bad, then they're not going to come.”

Seeking strategic partnerships

Even with limited resources, Bjornberg says the district can’t afford not to pursue strategic opportunities.

“If you don't look for those opportunities, and you're not always trying to better your opportunities, whether that's through strategic partnerships or or whatever the case might be, then it doesn't matter how much liquidity you have,” he says.

“You always have to be looking to get better and strategic partnerships, I think, is where it's going to be, and we're driven to that more now than at any point in time that I've seen in my career, and it has to do with all of these constraints that we're dealing with,” Bjornberg says.

He points to the value of competition, which can lead to innovation. But he says partnerships can lead to better services for patients.

“I think that people also need to remember that healthcare is more of an industry of collaboration,” Bjornberg says.

“Looking for those strategic partnerships, I think, is going to be key,” he says. “And if you can take that money and make money, then that's where it becomes important. If the money is just sitting there, it doesn't really do you any good. Rainy Day Money does not move healthcare forward. It might just keep you afloat for a little while longer. But if you're not making movements to become better and to provide more services and to do those types of things, that's not helping anybody either.”

(Nicole Jussen interviewed Chris Bjornberg in Chicago.)