IMPROVING HEALTH THROUGH
Community, Collaboration & Connection
2017 COMMUNITY REPORT
over 20 years of health
HPSJ, a Founding Collaborator in This Movement for a Healthy Community We are the major, nonprofit, managed care, public health plan in San Joaquin and Stanislaus counties, serving almost 350,000 members who are mostly working families and children. In 2017, we became especially focused on our commitment to community building, one of our core strengths, as we advocated for our community’s health and wellbeing. The national Commonwealth Fund agreed. In “Health Care Improvement in Stockton, California: Collaboration, Capacity Building, and Medicaid Expansion,” they found: “The Northern California region of Stockton…stands out along with Akron, Ohio, for having improved on more performance measures than any other region.” They noted: “The region’s improvement efforts appear to be facilitated by supportive state policy and the market dominance of a locally governed Medicaid managed care plan” – HPSJ. “With 90 percent of the market share in San Joaquin County and over 60 percent in Stanislaus County and long-standing relationships with nearly all local health providers – it has been in the community for 20 years – the insurer has the leverage to promote broad-scale performance improvements.” Health cannot exist in a vacuum. Central Valley community building became essential in the Great Recession’s wake. We’re taking longer than much of California to recover; our local health status remains impacted. But, HPSJ is well positioned to leverage limited resources – and unlimited local relationships – to go above and beyond, from convening an opioids crisis collaboration, to pioneering local palliative care partnerships. For 2018 and beyond, HPSJ will continue to focus on our members and enhancing our community. We invite you in the pages ahead to learn about some of the ways we’re working toward strengthening our community’s health. Amy Shin, CEO, Health Plan of San Joaquin
Now more than ever, we are finding that sticking to our founding principles – local, partnering, hands-on and high-touch – makes a world of difference for our community. That is how we will continue, with a Commission whose members are themselves a collaboration of local doctors, and government, public and community representatives, operating as a board that understands local and regional health care needs. – Greg Diederich, Chair, San Joaquin Health Commission
Our Health Commission – Moving Us Forward With Oversight And Guidance Greg Diederich (Chair) Director of Health Care Services, San Joaquin County
Sheela Kapre, MD Chief Medical Officer, San Joaquin General Hospital
Monica Nino San Joaquin County Administrator
Michael Herrera, DO Medical Society Delegate
George M. Khoury, MD Medical Society Delegate
John Zeiter, MD San Joaquin County Medical Society
Miguel Villapudua San Joaquin County Board of Supervisors
Brian Jensen Hospital Council of Central & Northern California
Tom Patti San Joaquin County Board of Supervisors
Frank “Larry” Ruhstaller Community Representative
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Michael Kirkpatrick Community Representative
Understanding Cultural Differences To Provide Better Care Despite Medi-Cal’s comprehensive health coverage, we’ve known that diverse HPSJ members are not taking full advantage of their preventative care options. As part of our ongoing Cultural & Linguistics (C&L) Program, HPSJ has launched a Health Disparities for Women Initiative focused on listening to the needs, concerns and practical barriers facing local women when it comes to accessing their health care. To start, we’re concentrating on four areas: prenatal and post-partum health care for moms; mammograms; STDs tests (especially chlamydia); and cervical cancer exams. Success will come when more women participate in preventative services and enjoy measurably better health outcomes. Doreatia Hart Healthy babies start with healthy mothers. For black women, fundamental barriers to seeking good health care too often get in the way of connecting with their provider. For younger women during pregnancy and after childbirth, barriers can include practicalities like transportation and time off from work. Underlying those stumbling blocks are issues of race, trust and feeling respected by providers. The Black Infant Health Program has been working for decades to empower women, giving them tools for resiliency, so they can feel ‘happy, healthy and whole’ for their baby and themselves. We also work to interrupt generations of social isolation, providing tools to build supports. We are thrilled to collaborate with HPSJ, community organizations and providers for this initiative. – Doreatia Hart, BSN, RN, PHN, Senior Public Health Nurse and Black Infant Health Program Coordinator, San Joaquin County Public Health Services – Maternal Child and Adolescent Health Department
Last October, we partnered with HPSJ, Healings in Motion and Public Health Advocates to host our region’s first African-American Health Empowerment Luncheon. We looked at health disparities facing African-Americans, and local health care resources. From the business sector, we remain committed to HPSJ’s Health Disparities Initiative. Women’s health, like health for diverse communities in our region – whether Latino, AfricanAmerican or South East Asian – is of concern to us all. – Brandie Owusu-Spencer, African American Chamber President
Did You Know? San Joaquin County: 36% of Latinas ages 20-29 do not access HPSJ prenatal care benefits. Stanislaus County: 62% of black women between ages 20 and 29 do not make use of the postpartum care available to them.
For more about how we’re listening, understanding and helping overcome cultural health care divides, go to www.hpsj.com/community.
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Opioids: Beating A 21St Century Epidemic HPSJ and our local partners – San Joaquin General Hospital (SJGH), Community Medical Centers (CMC) and San Joaquin County Behavioral Health Services – are deep into an 18-month pilot project to assess gaps in opioid-related local care and training. While caring for HPSJ members, including rigorous reviews of prescription patterns, our Opioid pilot partnership includes medical and behavioral health teams within SJGH and CMC that are delivering intense care to HPSJ patients. Partners meet regularly to share what’s working and where challenges remain. When ready to scale-up region wide, we’ll be confident that our programs will be most effective for the communities we serve.
Billy Olpin
For years there’s been a portion of our people struggling with heroin or alcohol. Now opioids have introduced addiction to every age. We’re heartened this collaboration and partnership with HPSJ recognizes all the dimensions to stopping addiction, helping adults and children in the midst of it. The road to success will come from considering the whole person, how to get past stigma, determining which best medical and behavioral practices to deploy, and providing education and training for all of us – providers, patients and families. – Billy Olpin, MSW, Deputy Director, San Joaquin
County Behavioral Health Services
In June of this year, I lost my beautiful 23-year-old daughter to opioid addiction. It was nobody’s fault – least of all hers. But there just weren’t the kind of services that could have saved her. For my talented, award-winning daughter, I just hope that we’re finally on the right path with this opioid project. No other parent or family should have to go through what we are now experiencing. It hurts. – Kerrie Melton, HPSJ Community Advisory Committee
For more about Opioids, go to www.hpsj.com/community.
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Kerrie Melton
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Children’s Health: Going Above And Beyond As chronic health conditions threaten our children, HPSJ is finding ways to innovate, leading or joining in to help turn the tide. We continue successful initiatives like: Oral Health for Children; long-term community investments in health literacy; and connecting with the Healthier Community Coalition to support Healthy South Stockton – now addressing trauma for kids and families. For 2017, we added new collaborations with our members, community partners, agencies and HPSJ’s provider network. Some examples are: (1) a parents-pharmacy-pediatrician partnership for better ADHD therapies; (2) emotional support for families with children testing on the autism scale, through our seasoned partner, Beacon Behavioral Health; and (3) overcoming childhood obesity – essential to helping prevent the onset of childhood diabetes.
Dr. Silvia Diego and a young patient she regularly sees for asthma care.
In my practice, we see so many kids dealing with dangerously complex, chronic asthma. HPSJ has been an essential partner as we work to keep kids healthy, active, in school, learning – and out of the ER. This year, HPSJ’s new Medication Management-Asthma Initiative has meant parents do stay on top of prescriptions. Now, if parents are not keeping up with prescribed asthma controller medications, HPSJ, the pharmacist and I team up with them. HPSJ Customer Service and Medical Management staff even help parents overcome barriers in getting to the pharmacy. My practice partner and I also are big fans of CHEER, HPSJ’s Community Health Education and Engagement Referral Program. – Dr. Silvia Diego, MD, HPSJ Provider Network pediatrician, Family First Medical Care (Modesto)
My collaboration with HPSJ began through the San Joaquin Dental Task Force, where health care professionals and community leaders identified the lack of dental resources for local children had resulted in one of California’s highest rates of early childhood dental caries. HPSJ developed a program to train their pediatric providers to place fluoride varnish on the teeth of young patients during regular wellness visits. The continuing partnership of providers, San Joaquin Public Health, dental hygiene educators and HPSJ is making a real difference. – Elly Francisco, Oral Health Educator, San Joaquin and Stanislaus counties
For more about innovations for Children’s Health, go to www.hpsj.com/community. Elly Francisco
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Palliative Care Options In September 2016 HPSJ and our partner, San Joaquin General Hospital (SJGH), opened a Palliative Care Program within an SJGH clinic. It provides patient- and family-centered care for HPSJ patients with end-stage liver disease, advanced cancer, end-stage congestive heart failure or end-stage chronic pulmonary disease. HPSJ’s Medical Management team supports SJGH in offering patients four options: home visits from certified nurses, hospital outpatient clinic visits, a telephone care program with a certified social worker, or any combination of these. Building on success, and with grant funding for staff education, outreach, program development, oversight and evaluation, in July 2017, HPSJ launched an outpatient palliative care pilot. Offering in-home consultation and 24/7 telephonic support through SJGH and two of our palliative care agency partners, we’ve expanded local care expertise and capacity. Our Palliative Care Options partners are Community Care Choices – Palliative Care Program of Community Hospice (Stanislaus County) and Transitions Palliative Care, a service of Hospice of San Joaquin (San Joaquin County). HPSJ, which is funding the cost of this pilot for clinical services, is offering our members these services as a head-start to a state-wide Medi-Cal palliative care benefit starting in 2018.
With palliative care, we’re supporting and encouraging patients, making sure they have the resources they need, and the information they require to make the best decisions about care. – Sandra Smith, RN, Palliative Care Director, Transitions Palliative Care
This is holistic care that closes gaps in our health care system. The whole-person care team brings many disciplines, but is completely united to focus on this one patient and their unique physical, emotional and spiritual needs. The growing ability to offer local palliative care began as a partnership with HPSJ and is now a widening local collaboration. – Syung M. Jung, MD, Palliative Care Clinic Director, San Joaquin General Hospital
Sandra Smith
To learn about the differences between palliative and hospice care, and for more about the HPSJ-led collaboration, Palliative Care Options, go to www.hpsj.com/community.
Dr. Syung M. Jung 6 2017 COMMUNITY REPORT
Two Decades of Stewardship and Service Has Us on Firm Footing Through the collaborative business model we’ve pioneered from the start, HPSJ operates at increasing levels of efficiency – dedicating revenues to the health care of our members, while providing support for the regional local health care infrastructure.
$1 Billion
On an annual basis, HPSJ distributes nearly $1 billion dollars in state and federal health care funds, providing access to quality care for members.
311 The number of current HPSJ employees
230,081
Average monthly number of Medi-Cal claims paid by HPSJ, highlighting the many interactions between HPSJ patients and HPSJ Network providers to support our members’ health.
$74.9 Million HPSJ’s average monthly
focused on increasing health outcomes for HPSJ members, families and our communities.
medical expenses paid for Medi-Cal members’ health care, such as office visits to primary physicians and specialists, lab tests, pharmacy prescriptions and hospital care.
4% The small portion of our revenue that
348,035 Nearly one-third of San
goes to administrative costs (compared to estimates of up to 15% for the commercial health insurance industry).
Joaquin County residents and over one-in-four Stanislaus County residents are HPSJ members.
Revenue Growth Revenue through state/federal funding
1,000,000,000 900,000,000 800,000,000 700,000,000 600,000,000 500,000,000 400,000,000 300,000,000 200,000,000 100,000,000 2012
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over 20 years of health
HPSJ San Joaquin County 7751 South Manthey Road French Camp, CA 95231 HPSJ Stanislaus County 1025 J. Street Modesto, CA 95354
www.HPSJ.com 888.936.PLAN (7526) TTY/TDD 711
Copyright © 2018 Health Plan of San Joaquin