What are we learning from the current flu crisis?Raigosa: The flu hit quite early this year and what is interesting about it is the severity of the virus. The vaccination is successful in 30%-40% of the population. Typically it is successful in 50% of the population. The flu is causing a huge influx in volume of patients. Children, the elderly and those in compromised states are bearing the brunt. We have brought all our resources to take care of it. Marter: They just missed on this one (the vaccine) in a lot of ways. Raigosa: Those who have been vaccinated can get the flu, but the severity of illness is decreased. There is still value in getting vaccinated. We’re right in the middle of it but I would recommend still getting vaccinated. The flu season can last for several months.
Are any of your facilities having to care for people in unusual places due to the volume of patients?Raigosa: Flu is generally something that is cared for by primary care physicians, OBGYN doctors, emergency room physicians. We have been considering that if it gets so severe we need to enlist the help of our specialists—an infectious disease doctor for instance, a rheumatologist. (Treatment of flu) is just basic doctoring. Marter: In Henry Mayo, we’re using one of the cafeteria rooms to see patients. Moody: We have a contingency plan that we have not had to deploy, that is to set up a tent next to the emergency department. Our waiting room is getting very crowded.
Other than the flu, how are your facilities prepared for disasters or other emergency situations?Moody: We train for that. We do an exercise at least once a year. We set up several triage areas. We work with the sheriff’s department, the fire department. The scenario of this last one was an overturned bus at the 210 and the 5 and there were terrorists on the bus. It was a daylong training that about just about everyone in the facility participated in. I feel like we’re pretty well prepared. Gelfound: There is a community organization called Community Emergency Response Teams (CERT) who go through extensive training. I just attended at Henry Mayor a Stop the Bleed program that takes into account disasters and how residents without clinical backgrounds can save patients’ lives—knowing how to use a tourniquet etc. I found it phenomenal. Raigosa: We at Kaiser Permanente routinely do these drills. It’s about planning, having the right materials, creating the right coalitions. We just had the fires here in Santa Clarita about a month ago and we treated that as a disaster scenario.
How are your companies growing as the Santa Clarita Valley continues to grow?Raigosa: We are opening up a new medical office building just two doors down from our current medical office building. We are bringing specialty care to Santa Clarita. We’re bringing orthopedics, we’re bringing a surgery center, more outpatient procedure suites, cardiology—the whole gamut of specialty services in addition to our current office building that has all the primary care services. That’s going to happen in March. Santa Clarita is very important to us. We get involved in our community benefit campaigns. This year, we gave over $62,000 in grants to the community. We’re also moving our urgent care from the existing building to the new building. It’s going to be much better. Wiener: That helps me out because I sell Kaiser to the community. We were all very excited about opening up this new facility. Marter: Our urgent care underwent changes in the last few months as well. We had some staffing issues, but we will be opening up fully seven days a week. We’re right there at Valencia and McBean. We’ve renovated a little bit. We’ve also partnered with Exer (medical staffing) in Stevenson Ranch. We’re building a new office building in Canyon Country. In that we’ll have an urgent care as well. We’ll contract out with Exer to staff that as well. We’ll also be staying with current facility in Valencia and expanding. We look to be opening next summer in Canyon Country. Moody: We’re a community hospital. We try to identify areas of the community that are not served. For example, we have hyperbaric treatment now. We’re expanding our cardiovascular services. We’re also expanding our electrophysiology services for people with AFib. Marter: Henry Mayo has been very successful with their cardiovascular program. Gelfound: We’re Heritage Sierra Medical Group. We’re part of Heritage Provider Network that owns 10 medical practices. We love being on the campus of Henry Mayo. We too enlarged our services. Although there is an urgent care on the campus of Henry Mayo we have urgent care facilities as well. We hope to be healthy competitors but good partners in medicine helping the Santa Clarita community. Wiener: We’re trying to work with the groups to get people insured. The individual marketplace is tanking. Anthem pulled out of the individual marketplace in Southern California. So, we had a lot of work to do to get people insured elsewhere. There’s only really Kaiser, Health Net and Aetna. We need to get everybody in a really good place and educating them on where they need to go. It’s really nice to know that there will be some more urgent care here. It has really been a dilemma on my front when I have clients calling saying we have nowhere to go. I’m glad there’s going to be more options for us to communicate to the people. I am talking to the people who live here.
HEALTH CARE UNCERTAINTY
There is uncertainty in health care with failure to repeal the Affordable Care Act and the repeal of the individual mandate for instance. How are health care companies preparing for the future amid this uncertainty?Raigosa: Uncertainty is not the best friend of any business. We certainly feel it in our health care industry. Speaker for Kaiser, we tend to adapt well to these challenges. We have contingencies in place and try to work with the best possible offerings out there. The best solution is to have the greatest number of people to have access to medical care. For the longest time it has been group coverage on commercial lines (through their workplace.) That is going well. Marter: The individual mandate makes sense from an insurance point of view. If you’re providing insurance, you need a lot of people providing the insurance. Ultimately the more people that have insurance of some sort and they’re willing to access health care before they get deeply sick makes a lot more sense than waiting till they’re almost dead to show up. It’s much more expensive. You need to be able to access it early on. Gelfound: I believe, partisanship aside, there are enough health care professionals who want to find some workable solution without being “socialized.” How it affects providers and deliverers is very serious. All this in and out and try to repeal and not repeal, it has caused such concern in the marketplace for the consumer. (Consumers) just hung back (from making any changes to plans). And seniors, even with Medicare Advantage which has enriched the program, seniors don’t want to change. Even with richer benefits and they can access more coverage with less premiums, folks were just real skeptical about making changes. Wiener: In my industry, people just didn’t want to move (health insurance coverage) after all the moving we have done over the last two or three years. Most people wanted to stay where they were.
CVS and Aetna have proposed a merger. How could that change the health-care landscape?Wiener: It seems to me that they would be keeping their drug benefit because it would be liking going to Kaiser. When you go to Kaiser you go to the Kaiser pharmacy. If they put it together like they’re thinking with the CVS Minute Clinic, Aetna members would have to go to CVS to get their prescription filled. But that doesn’t mean it will be the best place for the consumer. It could reduce the cost of the medication or they could make it more and the Aetna member wouldn’t have a choice. Gelfound: If the Aetna member doesn’t get the choice and that program is too expensive, goodbye Aetna. Wiener: With the Minute Clinic, they are going to try to eliminate seeing your provider. Not that that’s a bad thing because we have Tele-Doc now. Your kid’s sick and you don’t have to see the doctor. But I don’t know whether you want to be going to CVS for your medical care. I guess they are going to consider staffing it with some doctors or nurse practitioners. Raigosa: The big picture is the collaboration between these titans of industry in a way to transform how health care is delivered. It used to be, I am sick and I go to my doctor’s office and then to my pharmacy. Now it is how do we integrate into the lives of our patients. Where are they going to buy their groceries? Can we be in that space too? The CVS-Aetna merger with their clinics, that’s a way to do it. With Kaiser Permanente we are partnering with Target so within a few years we will have over 30 of our clinics in Target stores. There are none around here yet. We have already opened up several of them in San Diego, Orange County and the Inland Empire. We are trying to expand and not necessarily replace the traditional health care model but really go after the areas our patients live, work and play. It’s another access point to our health care system and we do it in a way that is integrated with our technology and we can do urgent care, primary care, preventive services. It’s another example of how health care is being transformed—and not be afraid of it, embrace it. Try new things. I think the Aetna-CVS merger will be a perfect example of that. Our collaboration with Target is an example of that. We see non-Kaiser Permanente members at these clinics. Marter: Providence has a relationship with Walgreens. It’s starting in L.A. and Burbank. This Aetna-CVS merger isn’t a new concept. It’s a little bit of a disrupter but we have been playing in that arena for awhile. I think that ultimately medical care needs to be more convenient for the patient. We’re all competing but I think that’s healthy. Raigosa: With our new building in Santa Clarita the concept is life integration. It will completely change how you see medical care being delivered—tablets, greeters, virtual check-ins. I think you’re going to see some big collaborations between the tech industry and health care in the next decade.
AMERICA’S OPIOID CRISIS
What can be done to make some headway in the fight against opioid abuse?Raigosa: Back in the 90s physicians were mandated to treat and address pain. Back then these (opiates) were great alternatives to treating pain. Now we’ve come full circle. I know that with Kaiser Permanente we’ve adopted our safe and appropriate opiate prescribing practices. There are true uses for these medications, surgical, post-op for example. If a patient is on these medications for 10 days or more, the likelihood of addiction goes up by a few percentage points. If they are on for a month it starts climbing—not a straight line it goes up quick. The sooner the patients can be off these the better. The way we do it is by education. We have to enlist the help of all the different specialties, not just primary care–limiting the quantities that are prescribed, education modules to know what is appropriate to prescribe in different conditions. Whether it is pain management, physical medicine specialties, acupuncture, there are other ways to treat pain not just opiates. We monitor the patients. We do urine-drug screen every six months. We see them face-to-face every six months and we go through a drug prescribing contract that tells me that this is what you use it for and that we’re going to bring it down steadily and then we’ll take you off of these. It takes a level of commitment. This is an epidemic. We have an integrated system where I can pull a report and see if a patient is above a certain level and I can focus on those group of patients. Marter: Those patients are the most difficult. Today I prescribed opioids to two patients, but I also operated on them. We had that conversation. When you don’t need it, stop taking it. We look at what they are using in the hospital then tailor it to that. There is an education that is going on. Patients are aware of it. We don’t want to go down that path, but we also don’t want them to be writhing around in pain (after surgery). So, it’s a balance. They do serve a good purpose for a short period of time. For chronic pain, that’s a tough one and opiates are typically not the best for it. The rules have changed. They push us to set expectations that you will have some pain after (a surgery) but we are going to make it manageable but this is how we’re going to do it so there is not a long-term effect. It really is an education of the patient and an education of the physician—a re-education because, originally, they were pushing us to be very proactive (with pain management). Now try to look at other medications, marijuana for instance. We’re going to have to talk about it. It actually works very well for a lot of different things. Are we comfortable with Facey prescribing marijuana? No, but as you find more and more patients access it through creams it actually works pretty well for a lot of different things without having the debilitating effects of the opioids.