Increasing Access Through Unconventional Means at Community Medical Centers

Community Medical Centers (CMC) faces a unique set of challenges. Based in Fresno, California, the network of healthcare facilities serves a population that is typically lacking in resources. Providing top-quality care for these patients in a manner that is also financially viable for the organization requires creative solutions, including paths to generate revenue to offset the costs of necessary services, finding ways to engage patients in preventive and aftercare, and motivating physicians to be a part of CMC and to align with its vision of long-term population health management. As the chief legal officer at CMC, Robynn Van Patten’s role extends far beyond the realm of law. She is heavily involved with strategy, operations, and finding solutions that best allow CMC to serve the patient base in the Central San Joaquin Valley.

Much of CMC’s patient base struggles with poverty and limited English skills. Some are undocumented workers, and as a result of their financial constraints and other hardships, many don’t have the resources or support network to adequately follow through on aftercare when they are discharged. CMC sees a high volume of emergency room visits, and it is working to decrease this by providing more preventive services and outpatient care. Additionally, there are some unique healthcare challenges to the region. Fresno is an agricultural area that sits in a basin, conditions that lead to a high rate of asthma and other pulmonary problems.

About 50 percent of this patient base receives Medi-Cal, California’s state-sponsored health plan that serves low-income individuals. Because Medi-Cal is reimbursed at a lower rate than many other managed-care providers, CMC generally suffers a financial loss from treating these patients that must be recouped elsewhere. Van Patten emphasizes that CMC’s approach to this is focused on patient care above bottom lines. “Our view isn’t ‘let’s cut corners,’ it’s ‘let’s avoid duplication,’ and be smart and thoughtful in our decision-making,” she says.

One of the ways CMC has balanced its budget is by developing its own health insurance plan, which has an HMO option, a PPO option, and covers more than eighty-five thousand of CMC’s employees and their families. The Knox-Keene licensed plan is also offered to other large employers in California’s Central Valley, and Van Patten advises and works with leadership to ensure the health plan complies with state and federal regulations.

CMC has also forged a partnership with Family Healthcare Network (FCHN), a federally qualified health center. Through this partnership, CMC was able to transfer some outpatient, preventive services, and affiliated employees to FCHN. Due to its status as a federally qualified health center, FCHN receives higher reimbursements for these services. “This enabled us to guarantee and potentially grow these services to our community for preventive and follow-up care,” Van Patten says. “It also allows us to have physicians reimbursed at a higher rate.” She explains that while this solution was costly to implement up-front, it’s a benefit for the community in the long run and saved CMC $10 million per year that it had been losing by providing these services in-house.

Internally, CMC has focused on streamlining its operations to avoid costly redundancies. Each of CMC’s four hospitals and other care facilities previously had its own CEO, as well as a CEO for the whole system; CMC consolidated the leadership team under one CEO for the whole system, in addition to one CEO for all of the hospitals. By integrating an executive team that managed all of the network’s facilities, CMC was able to consolidate food service, human resources, better manage nurse staffing, and implement other efficiencies. This has increased efficiency and has aligned vision. “When everyone rows in the same direction with the same rhythm, magic happens,” Van Patten says.

Due to the specific challenges faced by CMC, Van Patten and her colleagues are working hard to recruit and retain physicians. Van Patten focuses on being empathetic to the challenges faced by physicians themselves, especially with a low reimbursement rate, and notes that young physicians often have high student debt, older physicians must acclimate to the evolving EMR process, and all are working long hours with less face time per patient. “We get our physicians engaged with decision-making from a partnership perspective, and we include them in discussions so that they feel invested in the outcome and know they have a voice,” she says. “We have a lot of key medical directorships, academic medical rotations and opportunities, and try to recruit people who have a heart for this population.”

Ultimately, Van Patten and her team strive to work with CMC’s operations team to bring in physicians that share the same values that brought her to the organization. She points out that, like most hospitals, CMC is a nonprofit driven by a mission to serve the public good. Having witnessed the devastating consequences that can result from a lack of consistent, quality care, she is passionate about ensuring the availability of healthcare for all. “I really believe that access to quality healthcare is a fundamental human right,” Van Patten says. “Every person deserves care and access to that care on a basis that is blind to that individual’s financial status. That is my personal mission, and I am grateful to work for an organization that honors the same vision.”

Arent Fox LLP and its nationally recognized Health Care group values its relationship with Community Medical Centers, and we thank Robynn Van Patten for partnering with us. Our goal is to serve as trusted legal advisors and provide creative, cost-effective counsel and solutions to prominent institutional health care providers. Visit arentfox.com/services/health-care