Editor’s note, Oct. 10: Update made to the potential financial impacts to TFHS due to HR-1 if unchanged.
The healthcare landscape under President Donald Trump’s administration is facing significant changes, including funding cuts and shifting qualifications for patient eligibility. As Tahoe Forest Health System prepares to navigate such impacts, it continues to find its footing after a year and a half of major transition.
First, a refresher:
Previous President and CEO Harry Weis, who served more than eight years at the helm, separated from the health system in June 2024 after claims of the local medical community “crumbling” under Weis’ guidance (read CEO’s Departure Paves Way for New Leadership Model at Hospital District).
In direct connection to Weis’ departure were board discussions of implementing an entirely new leadership model that would pair physicians with non-physicians for healthcare oversight, known as dyadic leadership. Since March of 2025, according to hospital district staff, there has been further clarity on incorporating dyadic leadership into decision-making. “We are still on the journey,” shared Ted Owens, TFHS executive director of governance and business.
Organizational development firm WittKieffer was hired to find TFHS’s next CEO.
Last fall, incumbent Bob Barnett lost his board seat to Dr. Robert Darzynkiewicz.
In January of this year, the hospital district announced the hiring of Anna Roth, RN, MS, MPH, as its new president and CEO. Roth finished up her tenure as CEO at Contra Costa Health, where she served in the position for 15 years, amid the fallout of a 2023 Department of Health Care Services audit and a whistleblower situation. Both the audit and whistleblower claimed patient medical needs were being ignored. Further, an NBC Bay Area news station reported a criminal investigation by the California Department of Justice was taking place at the East Bay hospital system.
The California Department of Justice’s Division of Medi-Cal Fraud and Elder Abuse was unable to confirm whether such an investigation happened, adding that if such records existed, they would be considered confidential, and such records “do not lose their exempt status due to a decision not to prosecute, or the close of an investigation,” according to an email from a legal secretary.
Contra Costa County released a statement on the claim in March, saying it was unaware of such an investigation. “There is no indication that a criminal investigation is taking place. There have been no requests for records, no requests to preserve documents, and no interviews of key personnel by the Department of Justice.”
On July 3, 2025, Trump’s One Big Beautiful Bill, or HR-1, passed. The bill, among other impactful measures such as tax provisions, boosting national defense and enforcement, and federal spending cuts, is anticipated to cut an estimated $1.02 trillion on Medicaid and Children’s Health Insurance Program and an estimated $5.1 billion in Medicare over 10 years — both numbers per the nonpartisan Congressional Budget Office. The nonprofit and advocacy group Third Way projected a $6.7 million loss annually in Medicaid funding for TFHS.
Under such internal and external sea changes at one of Truckee/North Tahoe’s most public-facing special districts, it seemed a sit-down with Roth was in order.
It’s been about seven months since you donned the Tahoe Forest Health System CEO mantle. How has the adjustment period gone?
I feel like it’s gone by so fast, but I think it’s because I’ve been having so much fun. I love this region because the weather keeps time for you. I arrived at the tail end of winter, I got sort of spring … and now we’re moving into fall.
Top of mind for me, first, the community and the staff have been so welcoming. It’s such an extraordinary place. I’m struck by how much abundance is present here at the top of the mountain and at lake level. There’s extraordinary people living here, there’s extraordinary people working here. It’s really been such a level up for me to join this team.
That’s the thing for me that has been a takeaway, is people really are deeply connected to each other here and deeply connected to the work. And it isn’t that people aren’t connected in other places, but it’s palpable here, and I think it’s a point of pride and a point of strength for this region. That has been my takeaway as I’ve initially arrived. Everyone I’ve met, from town leadership to the different leaders across the regions, they’re all thinking in a very forward-thinking manner. I love that this region, the people here, greet challenge with a sort of like, okay, challenge accepted.
The previous CEO, Harry Weis, departed from the health system in May 2024 under intense scrutiny from staff and community members. With your tenure, there’s the desire to become a more transparent district — starting “a new chapter,” as you called it during a July Good Morning Truckee presentation. What shifts are being made to accommodate that goal?
I can’t speak for what, of course, really happened before I got here, but what I can say is healthcare is incredibly complicated. Across the industry, let’s say the last five years, 2020 to 2025, was incredibly fraught. I think we know here at Tahoe Forest, and one of the things that the leadership team and myself are working on, is there’s actually a lot of information out there, but we really need to work on being the interface specialist and help demystify this information. Maybe package it slightly different. We’ve been doing this in sort of mundane, technical ways. For those who watch … the district meetings … you may note there’s been sort of a shift; we’re moving more things into open session from closed session. We’re pushing the presenters to approach this instead of a technical update to the board, maybe a TED Talk or something, so that the public can follow along a little bit easier.
I think there is actually no dearth of information. I think there’s a lot of information out there, but what we have to figure out is how to talk about it in a way that people can actually follow along, and even better and more importantly, where we can sort of make [information] visible.
This is a natural evolution in healthcare, right? I started in the ’80s, early ’90s, and information and how that information was managed belonged to the health providers, to the professionals. Fast forward, now people have patient portals and stuff. We’ve had to figure out the clinical side, like how do we present a lab test? Now it’s, how do we talk about these very technical policy pieces? Because healthcare reform was sort of a concept in the early 2000s. Now we’re in the center of reform, and I think the public wants to participate.
There’s been sort of a shift [during board of director meetings]; we’re moving more things into open session from closed session. We’re pushing the presenters to approach this instead of a technical update to the board, maybe a TED Talk or something, so that the public can follow along a little bit easier.”
~ Anna Roth, TFHS president and CEO
We could duck and cover, but the reality is, is that change isn’t going away, and change is the only constant that I’ve actually experienced in healthcare. Really the best way to do that is in partnership with the public. But it’s hard for them to do that if our information is so technical.
[We’re] reworking our website to be a little more user friendly. Reworking how we talk about the work we’re doing, present it in a way that people can actually interact with it.
The board prior to your arrival had already been talking about demystifying, et cetera. Are you and the board 100% together in this shift to more open communication? Or were they pushing to adopt that mindset?
I didn’t feel pushed by the board. I actually felt the board was very aligned. This is something that I feel all of us really need. The board was really supportive of supporting transparency. And I would say again, because I don’t struggle with the word transparency, but I struggle with the implication that we as healthcare aren’t transparent; we just don’t do a good job explaining the information. And I think that’s universal.
The duty of leadership is twofold: One, to really deeply understand the needs of those they’re serving, which is, in our case, people who both live in the district and visit the district … But also, the duty is to tell the story of what the staff are doing. That is really easy here because it’s remarkable what they’re doing. Staff love that and deserve that. They come to work every day. They drive through snowstorms and leave their family and come to do amazing work. It’s our responsibility and duty to tell that story.
Do you have an example of something that was pushed to move from a closed session to an open session?
The quality report … [which is how] we track our performance up against national performance. So, things like patient satisfaction, which … it’s not that earth shattering because a lot of this is already publicly available but would require people who know or community members to go and retrieve it. So, we sort of ask ourselves, why is this in closed session? We could put our performance into open session, and so the quality report, most of it — not all of it, because anything that is really [under] investigation or anything that could have personnel as a one-off case; those things go into a whole analysis; there’s legal protection. But for the most part, how you’re generally performing, those aggregate data, we can now move those [to open session].
Does that include internal surveys about staff burnout?
It does include that … I’ll give an example of the physician self-described engagements. I think in 2024 when they did that survey, they were in the 10th percentile [which in this case put TFHS in the bottom 10% of how well employees and staff understand and feel connected to their organization’s mission, goals, and values]. This year, they actually exceeded the national average [by rebounding to the 48th percentile], a significant improvement.
Editor’s note: Per the chief medical officer report at the Aug. 28, 2025, TFHS board meeting, “The Alignment Composite Score rose by 19%, reaching the 48th percentile nationally, while Engagement improved by 8%, now placing us in the 70th percentile. Press Ganey noted that increases of this magnitude in medical staff alignment and engagement are rare.” Roth credited the improvements in alignment to Dr. Johanna Koch, chief of staff, and Dr. Brian Evans, CMO.
Workforce is really important in these regions where there’s already a shortage, but then it actually is exacerbated in the rural regions … It’s a big decision to think about coming [to work at TFHS] … and I think those people who are here, they really want to be here. This is the one area where I think abundance might not apply. We have an abundance in the talent, but … these rural regions … it’s tricky, especially with workforce challenges.
Is there something or some things that you might be able to directly attribute that significant rise in the composite score to?
I will just say there is a plethora of efforts going on. Before I arrived, the internal leadership team and our chief medical officer were doing a ton of work with the provider staff. I want to acknowledge that. A lot of the staff themselves — there’s caring for the caregiver, there’s a wellness committee — there’s a lot of work going on.
Some of it is time. People came out of the pandemic — and again, I can’t speak for exactly here, but I can tell you this has been a national phenomenon — exhausted and upset. It’s possible maybe some recovery is also based on just the distance from what we know was a shared difficult experience. Again, I don’t know what exactly to attribute it to, but we’re going to actually try to study that this coming year.
Healthcare reformations are on many people’s minds under recent proposals in the One Big Beautiful Bill Act, or HR-1. What is TFHS anticipating impact-wise, and how could this affect Truckee/Tahoe residents?
I feel like at this point, I’m sitting in the air traffic control tower at JFK or some place; there’s a million things on the radar. To be clear, health reform is sort of taking up probably 50% of those … There’s many, many studies out there, and I think a couple of things: if you’ve seen one study, you’ve seen one study. We have tried to project a worst-case scenario.
[Referring to the $6.7 million annual loss for TFHS projected by the nonprofit and advocacy group Third Way], that’s not a completely outlandish number. Our CFO has projected even higher than that.
Editor’s note: TFHS’s CFO estimates potential financial impacts to the district caused by HR-1 could be $10 million to $11 million over the next decade, though assuming these numbers are final is unrealistic, as Roth shares.
There’s a few important things to keep in mind. One is, this bill just passed. Now the policy work begins. This sort of comes back to where I started around transparency. There is so much technical policy speak ahead of us. Honestly, [Owens] and I are sort of bracing, like how can we become the chief spokespeople to translate what’s really happening?
The Disproportionate Share Hospital [or DSH, a federal program that provides supplemental payments to hospitals serving significantly disproportionate numbers of low-income and uninsured patients] cuts, those that have been being punted for the last decade-plus, those are on the docket to kick in this October with a couple other changes that are starting. (Editor’s note: As of press deadline, TFHS does not expect any DSH impacts.) Then you see changes trickling for the next 10 years up to 2035. So much is going to happen between now and then. Changing the Medi-Cal eligibility requirements, which could in theory reduce the roles of Medi-Cal in the state of California and Medicaid in the state of Nevada. Some will be introduction of work requirements, or now you have to be redetermined every six months instead of annually. So, you could see a reduction in the Medicaid population across the two states overall, which could then, even though that’s not a huge book of business for us, it could have an indirect impact on us in terms of charity care. We are not planning on it, but you could see some healthcare providers exit markets like OB [obstetrics] or areas where there’s a lot of reliance on Medicaid.
We could see some safety nets [that] are facing significant challenges like we’re seeing down in the Chico area [where the Glenn Medical Center in Glenn County is expected to close in October because of financial hardship under Trump’s healthcare policies]. All of that will change the landscape. Studies we’re seeing now are with the current landscape, but as the landscape changes, the impacts may change. Then you may see policy emerge that says, ‘Okay, hospitals, because this has happened, there’s a funding opportunity here.’ So, again, what we are doing is modeling a variety of scenarios. That said, if I were to say what scenario I thought, it just would not be well-grounded in reality because the reality is there will be a ton of policy efforts.
There will be new funding opportunities that emerge and there will be some cuts. We have a sense of which areas [are threatened] — I mean, obviously Medicaid is blinking brightly, government funding is blinking brightly. I think I said this at Good Morning Truckee, I’ve been around a long time. I can remember when we made the very first Delivery System Incentive Reform program, I was on the team for the state that put that together with [Centers for Medicare and Medicaid Services] at the time. It was because they were changing some of the main funding mechanisms. We used an 1115 waiver to move district dollars into infrastructure and innovation. (Editor’s note: During the Great Recession, these waivers proved critical for healthcare reform, allowing states to experiment with innovative strategies while keeping costs low.)
This [One Big Beautiful Bill Act] just passed. Now the policy work begins … There is so much technical policy speak ahead of us. Honestly, [TFHS Executive Director of Governance and Business Development Ted Owens] and I are sort of bracing, like how can we become the chief spokespeople to translate what’s really happening?”
~ Anna Roth, TFHS president and CEO
You remember Meaningful Use [a program beginning in 2011 that accelerated the adoption of electronic health records to meet program requirements, per the American Medical Association] — that was another federal lever that was pulled.
What’s ahead, I can’t predict. What I can predict is there will be things ahead. And one of the reasons why we have people like [Owens] and [me] … We intend to make sure we’re not sitting on the sidelines. We will be doing everything we can to make sure that Tahoe Forest Health District is informing those policies locally as much as we can but also state and federally as appropriate.
Where can Moonshine Ink readers keep up with the latest state and federal
healthcare actions that could affect TFHS?
The California Hospital Association, and the District Hospital Leadership Forum … that is the heart of where policies or policy lives, so it is very technical and very difficult. For our district, what we are committed to doing is to really try to do sensemaking along the way. So, tune into us.
The reality is, nothing major has happened since HR-1 passed.
We are committed to making sure that our district is informed, and we did that in open session, and we’ll do that in open session. We’re trying to put out a small timeline of when the cuts are coming, and we are committed to keeping people informed because we know health is a really big deal. It’s huge. Health impacts and connects to everything. It’s understandable and it’s important that we all stay informed because there is change coming. How that looks is yet to be determined. But the way we are approaching this is we see this as an opportunity to continue with the long-standing legacy of Tahoe Forest and really use it as a transformation opportunity.
Tune In
Tahoe Forest Health System Board of Directors meetings are held on the fourth Tuesday of every month. Visit tfhd.com/about/minutes-agendas to view dates and agendas of upcoming meetings.
