Medi-Cal at 50

November 16, 2016

 

After 20 years of educating our communities about what Health Plan of San Joaquin does and how we do it, it’s perhaps easiest to say with our mission statement: We provide health care value and advance wellness through community partnerships within San Joaquin and Stanislaus counties.

Recent numbers demonstrate we’re seeing gains through our efforts and they highlight our impact –

  • HPSJ now annually receives and distributes almost $1 billion in federal/state Medi-Cal funding, through our strong provider partnerships with 5,585 area physicians, hospitals, ancillary services, and pharmacies.
  • Over 340,000 are HPSJ members; that’s nearly one-third of San Joaquin County residents, and over one-in-four Stanislaus County residents.
  • On a monthly basis, among all new Medi-Cal enrollees in our region, 9 out of 10 in San Joaquin County, and 8 out of 10 in Stanislaus County, choose HPSJ as their plan of choice.
  • With almost 300 dedicated employees, only 5.7 percent of our revenue goes to administrative costs (vs. 12 percent – 14 percent averages for the commercial health insurance industry).

Stepping back to see the bigger picture, it’s important to celebrate, to know where we have come from, and recognize how far we’ve yet to go.   Last year, the U.S. celebrated Medicaid’s 50th anniversary, the ground-breaking idea from President Lyndon Johnson that all Americans should have access to quality health care.  In 1966, California was among the first 10 states to implement Medicaid, what we call Medi-Cal.  Happy 50th Medi-Cal!

These were the first doors to opportunity, but then the real work began!  For every door opened and every opportunity grasped, we have moved measurably closer to a great, new norm – expanded access to quality coverage.  For example, in 1988, Medi-Cal eligibility broadened to cover low-income pregnant women and families with infants.

What began 50 years ago as national and state efforts to ensure a base level safety net, over the years began to snowball into a critical mass, generating the hope for authentic progress to expanded coverage and higher quality care for the underserved.

By 1996, the people of San Joaquin County were ready to support accelerated local progress.  So that our residents would be in a stronger position to take full advantage of Medi-Cal expansions, so that we could strengthen our healthcare infrastructure, and so that we could leverage limited resources to improve the overall viability of our region –20 years ago, HPSJ was founded by county leaders as a managed care, not-for-profit Medi-Cal plan.

From our start, HPSJ has been in an ongoing conversation with our members, our community partners, our provider network and public health systems.  In this way, we – HPSJ and our partners – continue to evolve alongside Medi-Cal.

The greatest door opening opportunity since 1966 came in 2015, with implementation of the federal Affordable Care Act.  With ACA came expanded Medi-Cal, offering coverage to childless adults and families for whom health care might otherwise be unaffordable or unobtainable.

Medi-Cal, with all of its innovations, government financial support, and enrollment expansions over the decades, is how it became possible for HPSJ to provide growing access to quality care, and to keep making gains in our reach and impact.  HPSJ continues with resolve and resourcefulness, to operate nimbly, to build efficient, secure business systems, to listen to our community, and to be alert to ways we can leverage our limited resources on behalf of the region’s viability, all the while maintaining our unique collaborative character.

HPSJ has increasingly contributed as a major regional economic force as we’ve endeavored to be strong stewards of our resources.  Viewed through my lens as chief financial officer, as HPSJ now annually distributes almost $1 billion into the local economy, what economists would call a multiplier effect is undoubtedly being felt throughout the region.  This allows HPSJ to magnify the impact of our limited public funding so that as we directly support providers in our local healthcare infrastructure, they, in turn, are able to cascade revenues towards local businesses and organizations.  

Also having a multiplier impact is HPSJ’s long-time reinvestment in our community.  Whether through sponsorship and underwriting contributions for hundreds of community partner agencies serving our underserved residents, or through HPSJ’s scholarship programs, health literacy investments, or our recently established Oral Health for Kids Initiative, we believe we are providing tangible support, as well as encouragement, that advances wellness for our members and the broader community.

As a recently appointed board member of United Way of Stanislaus County, I am also particularly proud of the personal philanthropy of HPSJ employees, who over the last 17 years have generously supported HPSJ’s collaboration with area United Ways, donating over $358,000.

We are continually heading in the right direction, toward health care justice, as we celebrate health, and celebrate the 50th  anniversary of Medi-Cal, and HPSJ’s 20th.  But, we also need to be clear about the challenges that lay ahead.  A billion dollars – even with a local economic multiplier impact – may sound like a lot, but we operate in one of the most low-funded Medi-Cal environments, while healthcare costs continue to rise.

That we are in very good company — and making every penny count — reinforces the needs to steward our resources  to maximum effect, and to strategize with area health care providers and other mission-focused collaborators to be successful in achieving our mission for healthcare value and wellness through community partnerships.

Michelle Tetreault is the chief financial officer of Health Plan of San Joaquin and a member of the United Way of Stanislaus County board of directors.  Visit HPSJ online at www.hpsj.org.

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