Congressman Sam Farr hosts meeting with reps from three counties
Congressman Sam Farr hosted a meeting that brought together representatives from San Benito, Monterey and Santa Cruz counties to discuss a regional approach to how federally qualified health centers serve local residents. The three health centers, the San Benito Health Foundation, based in Hollister; Salud Para La Gente, based in Watsonville; and Clinica de Salud del Valle de Salinas, based in Salinas, receive funding from the federal government based on the number of patients they serve as well as from other sources. The “safety net” clinics are charged with serving uninsured or low-income residents who do not have access to medical, dental or other health services.
County supervisors in Monterey and San Benito were concerned when Salud Para La Gente started doing outreach outside Santa Cruz County. A board member from Salud Para La Gente said their federal designation allows them to serve the tri-county area.
Out of the meeting, the three agencies agreed to create a task force to look at how to meet the needs of all patients and to be sure they are not duplicating services to the same set of patients.
Salud Para La Gente, of Watsonville, has been serving residents in south Santa Cruz County for 30 years as a federally-qualified health center. But when they started a recent spate of outreach into Monterey and San Benito counties other health centers, local officials bristled at the thought of possibly losing patients – and funding.
When staff members from all three health centers reached out to Congressman Sam Farr about meeting unmet needs in their service areas, he decided it was time to bring all the players to the table for a discussion.
“There was a question about who had the right to treat patients in any particular area,” said a spokesperson from Farr’s office. “All three clinic networks were concerned about who’s providing what services where – each came to us independently with questions.”
Rosa Vivian Fernandez, executive director for the San Benito Health Foundation, said the boundaries of the health centers are established by the Health and Human Services Department, and the meeting with Farr was not focused on those boundaries.
“What the congressman is interested in looking at is how to best meet the needs of the tri-county area,” she said. “We discussed the American Health Care Act and how we move forward in Santa Cruz, Monterey and San Benito counties.”
Farr invited county supervisors, county health and human services directors and representatives from each of the three clinics to a meeting to discuss the needs of the region and collaboration among the centers to be sure that the patients who need the services have access to them.
The San Benito Health Foundation provides medical and dental care on a sliding scale to residents who are uninsured or have partial coverage. They also manage the Women, Infant and Children program in San Benito.
The spokesperson from Farr’s office described the meeting as being a “very rolling discussion” and said that in the end they came to a consensus to set up an informal oversight panel to continue the discussion and resolve the issues among themselves.
“They will set up a process so no one is stepping on anyone’s toes and at the same time they are not duplicating services to the same set of people and they will be providing services to people who don’t have them,” the spokesperson said.
Federally qualified health centers, including San Benito Health Foundation, Salud Para La Gente and Clinica de Salud del Valle de Salinas, are considered “safety-net providers” that offer health services to underserved urban and rural communities. About 30 percent of the funding comes from the federal government and is based on the number of patient visits. They also receive funding from grants, Medicaid, private insurances and other sources. The primary goal is to serve uninsured patients.
“Because they are designated as FQHC, they have to operate in a certain way and meet certain criteria of quality and quantity of service,” the spokesperson said.
Before Farr’s office arranged the meeting, San Benito County Supervisor Robert Rivas had received a concerned call from Simon Salinas, a Monterey county supervisor.
“I got a call from Simon,” Rivas said, “Then from Rosa Vivian Fernandez that Salud Para La Gente is doing outreach outside of their jurisdiction.”
Fernandez said that she would be concerned if another agency came into the county “in terms of needs being met and also abiding by federal regulations.”
She said the San Benito Health Foundation has seen an increase in patients of about 30 percent per year in recent years.
“The reality is that we are a healthcare organization that provides services to those uninsured or who have limited funds and we want to make sure we maximize the resources available to make sure that all clients – their needs are met,” Fernandez said.
She said the agency was awarded a new access point recently and will be purchasing a van that will allow it to provide service in rural parts of the county.
“We have roughly 300 patients in San Benito County,” Rivas said. “There has been a breakdown in communication because this caught our (center) off guard. Why would they provide a service we provide? A lot of the (centers) are territorial and they should be.”
Marc Pimentel, the board president for Salud Para La Gente, said it was never his agency’s goal to siphon off patients from other counties. He said the federal designation for Salud Para La Gente includes a mission to serve the tri-county population and it is just recently they have been able to move on that mission. He did say Salud Para La Gente has been offering mobile clinics at some schools in Monterey County for 10 years, though the clinic does not offer any services in San Benito County.
He said the mobile school clinic started in a school district that straddled the Monterey-Santa Cruz county borders.
“We started a really dynamic, thoughtful approach to healthcare when we teamed up with schools,” he said. “As schools got pressures to reduce their services, one of the areas of reductions was in nurses and support programs. As a clinic, we stepped up and filled that void – of medical, dental, vision and doctors on site at schools for kids.”
He described the program as a “win-win” for schools that have healthy kids and Salud Para La Gente, which counted more patient visits.
“We get money for patient visits, but those are not our most cost-effective visits,” he said. “Not everything we do makes money, but that’s not our goal.”
In the past decade, they have expanded to schools in other districts.
“In 2010, Salud took a look at itself – where it is at in its history,” Pimentel said. “We turned 30 as an agency and we looked at ourselves – where we’ve been and where we want to go forward.”
He said the agency had some new board members and a new CEO, and he took over as board president. They developed a revised strategic plan to work on the federal designation as a “three-county entity that serves low-income, migrant populations,” Pimentel said.
“The primary mission is to provide medical coverage to anyone without the ability to pay.”
Pimentel, who did not attend the meeting with Farr’s office, said when they looked at their data they had patients driving from Hollister or Salinas to go to their clinic. He said Salud is interested only in complementing the existing services.
“We are starting to look for partnerships and ways of moving into other areas without infringing on existing networks,” Pimentel said. “That’s a new service model and it really defined our objective.”
He said with healthcare reform in 2014, there will be patients with different levels of insurance who will be looking for care.
“The timing is perfect for us to make sure we are all pointing to the same place,” he said.
Rivas said the meeting with Farr’s office “stressed the need to come together with a regional approach to keeping people safe – and about healthcare.”
He said he did not see the need for other health centers to cross the county boundaries because they all offer the same services and level of care.
“Creating this competitive environment could hurt San Benito County and siphon away our health environment,” Rivas said. “It’s not a good thing. In the end, the majority of our residents in our county depend on it. We could be hurt in the long run. That is a major concern.”
Fernandez said that she is optimistic about the task force that was created out of the Farr meeting.
“We’ve been working successfully with other health centers, including Garner Health Center (in south Santa Clara County,)” she said. “We collaborate very closely in many different ways to make sure we optimize the resources and ideas. We are looking to the future in terms of how we best serve our population.”
But she stressed that part of that is to make sure that another health center is not duplicating their services to the same population.
“The concern is the duplication of services and then not meeting the needs,” she said.
