Eclipsing the ‘social deterrents’ of health
Think of them as health care genies. On a daily basis, and several times a day, they make magic, seeking out and serving people from all over Santa Clara County with exemplary care. They are even actively looking to treat people who might never have imagined receiving top-quality comprehensive medical care.
At Santa Clara Valley Medical Center, these miracle workers perform above and beyond the call of duty and at all levels of SCVMC’s intricately designed health care network. They are nurses; front-line staff; physicians; phlebotomists; lab technicians; ambulatory care center managers; nurse navigators; and members of the so-called backpack team, to name just a few. Each of these people, independently and collectively, plays a number of important roles in elevating the care offered at this nationally recognized public health care system. They do so driven by their shared mission and purpose: To provide highquality, compassionate and accessible health care for all individuals in Santa Clara County regardless of their socioeconomic status and ability to pay.
“We are addressing the many social deterrents to health care,” said Paul Lorenz, CEO of Santa Clara ValleyMedical Center, noting that, among those barriers is the expected decrease in the number of people covered by any health insurance. At a time when the uninsured rate in the U.S. is already increasing, and is expected to increase still more before 2023,* SCVMC is proactively aiming to make its whole-person integrated system of medical care easily accessible to all. From the financially stable who are covered by comprehensive group health insurance to the unemployed, underemployed, homeless, undocumented or povertystricken, SCVMC treats everyone; no one is turned away.
“Some people call or come into one of our centers feeling lost and afraid because they’re uninsured or they don’t know if they’re eligible for anything,” said Jackie Ramos, ambulatory services manager, who oversees SCVMC’s clerical front line, patient preregistration and practice management operations.
“The front-line service staff members are the face of SCVMC,” Ramos said. “They are trained to look for that person who is lost, afraid or embarrassed; they introduce themselves to the person, address their needs, assure them that no one is turned away and that they will help them find the service they need.” The fact that the front-line staff provide both clinical and clerical services helps everyone think outside the box, Ramos added. By being key members of the team, these front-line professionals are acutely aware of the team’s needs and what can be done to reach the goal of patient satisfaction.
“So often, patients say that they don’t want to be a burden to the system, or they’ll say ‘No, I’ll just be treated for this one thing, pay what I owe and be on my way,’ ” said Ramos. Those individuals may be worried that they will be billed for care they need but cannot afford. “From the very start, we assure them that we’ve created financial programs for county residents and that they’re entitled to wholeperson care.” Their relief is palpable, she said, when they learn — whether from a front-line staff member, a nurse navigator, a financial adviser or other care provider — that they can receive comprehensive care.
Compassionate patient access
Networking with each of these professionals are the members of SCVMC’s Patient Access Department, who are often the first to address each patient’s needs, whether someone calls in or visits one of the 10 integrated health clinic centers. After speaking with patient access team members, those people are connected with a financial adviser who works closely with them to determine any health care or other social benefits they are eligible to receive. “Sometimes, it might be an undocumented person who is worried about their status,” said Ramos. “But we let them know that their legal status is not of concern when it comes to health.”
Among the most heartwarming stories of SCVMC’s whole-person countywide care are those that happen on the streets through the Valley Health Homeless Program. There, the Backpack Team brings packs filled with basic medicines and tools to people who are known to be homeless. “One of the backpack teams discovered a couple that was homeless and just had a baby girl,” said Ramos. “They were hiding the baby, but in the end, the Backpack Team helped the family to get out of the encampment and the baby received medical care.”
Combined with the many social deterrents to health care, even medical insurance alone isn’t the solution to improving public wellness. And although health insurance may provide some coverage for medical costs, explained CEO Lorenz, it does not provide for the continuity of care that people need. “If someone is bouncing from coverage to coverage, even if they are able to afford the Covered California premium, they will always benefit from having a medical home, which is what we’ve created here,” Lorenz said.
This medical home approach is exactly what SCVMC already provides. “This is the future of health care; it’s what health care and wellness should be and can be.”
*From “California’s Health Coverage Gains to Erode without Further State Action – Projections from California Simulation of InsuranceMarkets (CasSIM) model” (November 2018: UC Berkeley Center for Labor Research and Education & the UCLA Center for Health Policy)”: The federal law zeroing out the ACA individual mandate penalty beginning in 2019 will result in lower individual market andMedi-Cal enrollment, but significant uncertainty exists about how much enrollment will decline in California. Using our California Simulation of InsuranceMarkets (CalSIM) microsimulation model and a range of assumptions about the extent to which the penalty influences enrollment decisions, we project that between 150,000 and 450,000 more Californians will be uninsured in 2020, growing to between 490,000 and 790,000 more uninsured in 2023, compared to the projected number if the ACA penalty had been maintained.