1: What are some of your biggest concerns for Medi-Cal managed care in the coming year?

Amy Shin: The two biggest concerns are intertwined and ongoing. They are –

1. Can the State of California supply adequate, actuarially-sound reimbursements sufficient to provide all necessary care for Medi-Cal beneficiaries?
2. How will we deal with the mounting shortage of healthcare providers serving the Medi-Cal population, especially in critical provider-shortage areas like the Central Valley?

Key to success on both concerns is the need to invest in access to quality health care with adequate dollars and more providers. Improving state payments would allow plans like HPSJ – the major local, public managed care plan in our service area – to further incentivize and attract more new providers, leading to increases for specific quality measures and overall better health of our community.

Additionally, if we provide higher reimbursements, it is possible more in-area providers now refusing to serve Medi-Cal members would reconsider. I can see all of this creating an upward, positive spiral, turning two large challenges into leveraged opportunities for our local and statewide healthcare landscapes.

2: What economic challenges do members in your service area face?

Amy Shin: About four in ten Californians are living in or near poverty. Among San Joaquin County’s more than 700,000 residents, 41% of working age adults and 25% of county children are living in poverty. Forty-eight percent (48%) of low income families reported food insecurities. In Stanislaus County, with a population of 550,000, one in five adults and one in three children live in poverty. Forty-six percent (46%) of Stanislaus’ low income working age adults and families are food insecure.

It’s also important to look at this part of the Central Valley in the wake of the Great Recession. Our region took a tremendous economic hit and there are lingering economic challenges. Just in San Joaquin County, during the downturn one of our cities – Stockton – was the only California city to be forced into bankruptcy. Though our region is coming back, it is taking longer than many other parts of California to recover. Here’s one telling statistic: Nearly one in five Medi-Cal enrollees in San Joaquin and Stanislaus counties does not have a car for regular use. That, in turn, makes it much tougher to get to medical appointments, have testing done, and even get to the pharmacy for prescriptions.

Here in the Central Valley there are larger percentages of Medi-Cal eligibles in our counties compared to much of the state. For just HPSJ’s two counties, one in four of our residents are eligible. Add in some of the state’s highest levels of poverty and social determinants that mire communities with health endangering issues rooted in everyday personal safety, food and housing insecurity, and illiteracy. Taking our philosophy of “it takes a village,” HPSJ is collaborating with community leaders in programs to support the homeless, leading literacy efforts, and organizing efforts around food insecurity.

3: Are there other unique aspects of managing healthcare in California’s Central Valley compared to other parts of the state?

Amy Shin: This region is one of the most culturally rich within an increasingly diverse state. This is a point of great pride. Over 50 percent of our residents are of Latino origin, 21 percent are Caucasian, 13 percent are Asian/Pacific Islander, and 8 percent are African American. And that’s just the start of what makes each of us unique. But that same diversity presents healthcare hurdles. The different languages and cultural and caregiving traditions can also make it more challenging to connect residents and providers in ways that foster trusting, health-enhancing interactions.

There’s an old saying that parallel lines never meet. HPSJ, with the help of a wide variety of community collaborators, together with our providers and members, is working hard to bridge these divides. With a shortage of providers, and an even greater shortage of diverse doctors, patients usually enter an examination room, and a relationship, that brings together two very different people. HPSJ is working with community leaders on several healthcare workforce development initiatives, promoting current diverse residents to become healthcare practitioners and serve their own diverse communities. We believe, while these initiatives take time to bear fruit, they are the most sustainable and practical ways to lessen the cultural divide. Currently, HPSJ support for patients and practices ranges from translation and interpreter services to coordination for traditional healers as part of an HPSJ-provided health and wellness continuum of care.

Also, let me put the spotlight on the Central Valley’s Secret Sauce – Collaboration. Things are improving, even if slower than we all would like. For this steady improvement we can thank something else we believe is unique to the Central Valley: deep, abiding commitments to community partnerships and collaborations.

At HPSJ, we leverage our always limited resources – and unlimited local relationships – to go above and beyond toward measurably better health for our members and community. From convening an opioids crisis collaboration, to pioneering local palliative care options partnerships, to listening and understanding cultural differences that can too often get in the way of providing effective and timely care, to children’s health initiatives that partner with community-based organizations and providers throughout San Joaquin and Stanislaus counties, this is turning into a productive time here and throughout the unique Central Valley.

4: What drives your organization’s efforts regarding literacy?

Amy Shin: I understand the vulnerable feelings that many of our diverse community have while navigating healthcare systems. As a nine year old, I came with my family from South Korea. Soon, I started serving as my mother’s interpreter, seeking healthcare while uninsured. Thanks to the support of my family, and the public education that was available to me, I have been able to thrive. I went on to graduate from the University of California at Berkeley, and then earn a Pharm.D. from the University of Southern California graduate school of pharmacy. To me, personally, literacy has been key for being healthy and successful.

Here’s a statistic that never fails to shock: While only 45 percent of California third-graders can read at their grade level, here in San Joaquin it is even worse – only 34 percent can read at their third-grade level. Struggling readers leaving third grade almost never catch up with their peers and research shows they are four times more likely to drop out of high school. That is unacceptable. We know that if nothing is done, their ability to be successful – and healthy – as adults will be compromised, there will be greater demands on the social safety net, and our outlook for long-term economic viability will be weaker.

For a health plan, on a very practical level, being able to read and follow even simple care instructions is essential for our HPSJ members’ well-being. For that reason, HPSJ puts a lot of effort toward contributing to, or sustaining, or providing leadership in different community literacy programs. Here are just three programs that HPSJ has invested time and effort in:

• Rotary Read-in each year allows volunteer HPSJ staff and others from the community to read appropriate books to kindergarten through third-grade classes, then donate those books to the schools where the readings occur.
• Books on Buses is a partnership with San Joaquin Rapid Transit District where books are free to the community on various SJRTD modes of transportation.
• Little Free Libraries is a program where tiny libraries are established throughout the Central Valley – as well as nationally – to allow people to borrow the books from lots of convenient locations. Our HPSJ staff enjoy regularly restocking our local Little Free Library shelves.

5: Is there another initiative or development at HPSJ that you’re excited about and would like to share?

Amy Shin: Among our many community reinvestments, another that I am especially proud of is our Oral Health Starts at Birth Initiative. Unfortunately, our local public water is not fluoridated. Understanding the critical link between dental and physical health, we wanted to tackle this public health issue, even though HPSJ is not responsible for dental benefits.

Since 2015, HPSJ has encouraged pediatricians in our HPSJ Provider Network to talk to parents about ways to take care of baby’s teeth from birth to their first birthday – and beyond! Our public education and health promotion segments of this initiative continue throughout Stanislaus and San Joaquin counties.

At the same time, we determined that paying for supplies of fluoride varnish applications for providers would enhance pediatric oral health. Now, HPSJ hands out these supplies as part of the fluoride varnish application training we provide to doctors and their staff. This procedure had not been routine in pediatricians’ practices; we now are starting to see a change at the practice level.

We look forward to continuing this hands-on fluoride application training, part of an initiative popular with both providers and parents throughout our service area.

About Amy Shin

Amy Shin is the Chief Executive Officer of Health Plan of San Joaquin (HPSJ). An innovator with over 20 years of managed healthcare leadership experience, Amy this year celebrates her fifth anniversary heading HPSJ, the major not-for-profit, managed care public health plan for San Joaquin and Stanislaus counties. HPSJ serves almost 350,000 Medi-Cal members. Amy’s extensive board memberships include

• Community Foundation of San Joaquin (CFSJ)
• Chair, San Joaquin Community Health Information Exchange (SJCHIE)
• Chair, Local Health Plans of California (LHPC)
• Association for Community Affiliated Plans (ACAP).
• Managed Healthcare Executive’s Editorial Advisory Board