When Carlos Migoya was hired in May 2011 to run Jackson Health System, Miami-Dade County's safety net hospital system, he had no health care experience. A career banker, Migoya took over a system that bled $428 million over the previous four years. "Our cash supply was in the six- to-eight -days range," says Migoya, who came directly to Jackson after a one-year stint as Miami city manager. He found Jackson lacking budget accountability, expense controls and unable to collect on certain revenue streams. "Basically, there was no business plan going forward," he says.