Mark R. Finucane, who becomes chief of Los Angeles County's embattled health services department this week, faces a daunting task. He must lead a huge bureaucracy's turnaround to focus on delivering outpatient care in partnership with the private sector.
He comes well-equipped for the challenge. Finucane, 48, has been director of the health services department in Northern California's Contra Costa County, which is viewed as a model integrated health system that provides comprehensive services. It includes the nation's first county-sponsored, federally qualified HMO.
Finucane replaces Robert C. Gates, who resigned last November. He must lead a system that was on the verge of collapse before President Clinton promised a $364 million Medicaid waiver last fall. But with a budget deficit of up to $200 million looming in the next fiscal year, the rescue package-to be paid over five years-is not enough to avert the collapse of the sprawling system. It includes six hospitals, six comprehensive health centers and 38 community clinics.
Since his appointment has been widely hailed, he told MODERN HEALTHCARE in an interview last month that his first priority in the new job is "to lower expectations."
Then he must address the "four or five crises" facing the department. "It's a question of what to turn the hose on first," he said.
Finucane will review the department's application to the state for capital for remodeling hospitals damaged in the 1994 Northridge earthquake. In doing so, he will consider downsizing hospitals as part of the "fundamental restructuring" required by the Medicaid waiver. "We've got to bring the county healthcare system more in sync with what the community needs and with industry standards," he said.
One of his high priorities is "stabilizing" the morale of the department, which has been "deeply affected" by the near-collapse of the healthcare system last fall and thousands of layoffs and demotions, he said. As the first outsider to run the department, he wants to validate the board of supervisors' decision to bring in new leadership.
"The job has changed dramatically over the past few years," he said. In the past, the director of the huge system "presided over a vast estate." But Finucane said he is "determined to get out into the community and interact with the private sector (as) broker, negotiator, coordinator.
"I don't deify or demonize the private sector," he said. "If they have a sustained and enduring interest in caring for Medi-Cal patients, we would take a look at working with them. But we're not going to get out of the business (of caring for the indigent) and turn it over to the private sector. It's too big for us to handle alone, but it's too important to just turn it over." Medi-Cal is California's Medicaid program.
To the extent that private providers are interested in caring for the indigent, Finucane said he intends to "exploit their interest."
Finucane wants "to make sure we have a blended system, so we're not at the mercy of our own arrogance or of the private sector.
"Change is happening at a rate that can make us dizzy. But we can't be paralyzed by it. We have to be willing to toss out preconceived notions. We must restructure so that we will never, ever again be so threatened" with the collapse of public healthcare, he said.