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Craig Wagoner, President and CEO of Community Health System, joins Adam Goodman on 13th and Park for an in-depth conversation about one of California's most consequential but least-known health systems. Serving more than 4 million residents across 15,000 square miles of the Central Valley, Community Health System operates five hospitals, nearly 12,000 employees, and the only Level 1 trauma center and burn center between Los Angeles and Sacramento. Wagoner explains what it truly means to be a safety net provider, accepting every patient regardless of ability to pay, and why that mission comes at a steep financial cost: the system loses roughly $600 on every government-insured patient, a burden that has pushed the organization into the red despite running one of the leanest cost structures of any hospital system in California.

Wagoner details the specific pressures facing the system, from chronic physician shortages in a community where there are roughly 2,000 residents per primary care doctor, to the structural mismatch between Medicaid and Medicare reimbursement rates and the real cost of delivering care. He shares the system's goal of being back in the black by 2029, and outlines the strategies driving that turnaround, including a nurse navigator diabetes pilot program that has already produced a 33% reduction in emergency visits and measurable improvements in patient blood sugar levels. He makes the case that Community Health System, with its overwhelming concentration of Medicaid and Medicare patients, is a natural proving ground for population health models that could be scaled nationally.

The conversation turns to Wagoner's personal journey through 35 years in healthcare across 22 hospitals and six states, and what drew him to the Central Valley's mission-driven culture. He describes a workforce where some employees have been with the organization for over 50 years, a staff he says has hearts bigger than any place he has ever worked. He closes with a call for a fundamental realignment of incentives across the entire healthcare system, bringing pharmaceutical companies, payers, providers, and labor to the same table to design something better, arguing that at 18% of GDP, the current path simply is not sustainable.

Chapters
0:00 Intro
1:22 Welcome to 13th and Park
1:40 What Is Community Health System?
2:32 Financial Pressures of Safety Net Care
3:14 Serving 4 Million Across 15,000 Square Miles
4:27 Lowest Cost Provider in California
6:14 Physician Training and Shortages
7:36 Top Medicaid Rankings: Pride and Warning
8:51 Operating in the Red
9:38 Diabetes Pilot Program Success
10:46 What Flexibility Is Needed from Government
11:55 CMS, Cost Savings, and Access
13:09 Expanding to COPD, Cardiac, and GLP-1s
13:48 The Ultimate Test Model for Medicaid
14:43 35 Years in Healthcare
15:47 From Montana to the Central Valley
17:38 The 12,000-Person Mission
19:23 Right Care, Right Time, Right Place
20:45 Optimism for a Better System
21:32 Closing Thoughts

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Website: https://thecommunitycause.org

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