Health care in the SCV: an evolving marketplace

Standing, from left, Ivan Volschenk, Dr. Gary Hajjar, Marlee Lauffer, John Musella and Steve Roberts, Cynthia Cifuentes and Dr. Chris Avelino (sitting) gathered for a roundtable discussion of health care issues at The Signal’s office in Santa Clarita. Dan Watson
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The Santa Clarita Valley Business Journal and the SCV Chamber of Commerce welcomed leaders from the SCV’s health care community to have a discussion about the issues facing this sector of the business community.

The discussion began with everyone introducing their respective organizations’ niches in the local health care scene.

Cynthia Cifuentes, senior director of public affairs and brand communications for Kaiser Permanente: We brought specialty care closer to home here, and Santa Clarita is one of our areas of focus, where we’re looking to do more expansion, provide more care and offering more care-delivery services here in the Santa Clarita Valley. We’re excited to grow with Santa Clarita. This year marks our 30-year anniversary of Kaiser Permanente in the Santa Clarita Valley.

Marlee Lauffer, vice president of marketing and communications for Henry Mayo Newhall Hospital and also president of our foundation: Henry Mayo is the only community hospital in the Santa Clarita Valley, so we focus on acute care, we’ve got a very busy emergency room with over 60,000 visitors a year going through there.

Dr. George Hajjar, oncologist for City of Hope, regional medical director for the North Valley: We try to deliver the care that people can get at our main campus, close to home — trying to get the surgeries done at local hospitals, the specialty care … oncology, urology physicians who specially trained in cancer, which is what we do, and we have brain surgeons who try, again, to serve the community. We’ve been here for about three years.

Dr. Christopher Avelino, the vice president of Facey Medical Group: Facey takes care of about 70,000 patients here in the Santa Clarita Valley … and we are very strong partners with the hospital. … We’re a large multi-specialist medical group, including a lot of the things mentioned here.

Steve Roberts, director of operations for Heritage Sierra Medical Group: (Heritage Sierra Medical Group) is a group here in Santa Clarita, and we’ve only been here for a couple of years. I think one of the unique facts about us is that we have about 25 unique primary care doctors throughout Santa Clarita, and it’s almost now become known as concierge’s medicine, because it’s the small one- and two-doctor office practice.

1. Talk about where you’re seeing the growth for your respective agencies in the health care field.

Cifuentes: Where we’re seeing a lot of growth in the SCV is particularly with the young and healthy, and that’s for many of us in health care. … Kaiser Permanente really provides itself on preventative medicine, so we want to make sure we give you the tools and teach you ways to be healthy … so we don’t have to see you when you’re sick. … we find that there’s an influx of growth, particularly within the commuter population, folks are looking for more affordable housing that are in higher socioeconomic levels … and then also what we call within the ‘soccer moms’: they make their decision based on families … it’s really upped the ante in terms of how we’ve customized our tele-health offerings, how we can provide video visits.

Marlee: Well obviously our household is growing right now to meet the needs of the community. So we’re building a new tower which will bring 90 private patient rooms to our facility … And so we’re growing our center for women and newborns — we’ve got a brand new facility on the second floor of the tower with dedicated surgical suites for the center for women and newborns, and ante- and postpartum and labor and delivery rooms. … A lot of offerings that we’re doing there from the physical side, but also through educational programs, mindfulness, preventative programs.

Dr. Hajjarr: … There’s an aging population here, too, which, unfortunately, as we age we have a higher chance for different kinds of malignancies. … We have surgical oncologists who are surgeons who have specialty training to do the major surgeries for cancer. We are collaborating with the hospital … and they apparently are planning for an oncology floor at the hospital in the new (patient) tower, which will be great.

Dr. Avelino: We’ve always been very happy with Henry Mayo hospital and we’ve always been very strong collaborators with them. But at Facey really as the population has grown, it’s also started to be able to get a little bit older. … For right now, we’re really honing in on senior patients, as well as behavioral health. … we’ve integrated behavioral health into our primary care, as well. … We feel like the access is there to take care of those patients.

Steve Roberts:… We already know there’s somewhat of a shortfall in physicians, so physicians are trying to do more with less. Everybody’s impacted. We are seeing an influx of specialists, which, at least, for us, we were surprised by how few there actually are. … We have people who were born here in Santa Clarita, educated here in Santa Clarita, moved away, went to medical school, did their fellowship and everything else, now, are coming back and establishing a practice, and bringing in patients.

John Musella: When you look at the technology that’s available now for health care providers … do you see the senior population taking advantage of that technology?

Cynthia: Absolutely … before it was always the millennial population was the early adopters, and then the baby boomers, they want everything in print. And what we’re seeing is that’s not so much anymore. The baby boomers are now adopting the technology, and they’re excited and they want to learn and they’re actually more inclined to email us.

Marlee: I think just in general, we’re in the age of consumerism. Everybody wants some control over their health care. They want transparency. They want access to information. They want to know what their choices are. … I think all of us, are trying to address that. At Henry Mayo, we want to be the trusted resource for information, and so we put a lot of information on the website, and we have a very robust patient portal, where people can access their own information and records.

Dr. Hajjarr: Access to a patient’s information is very crucial. We just launched, at the City of Hope, something called “Open Chart,” where, basically, the patient has access to everything in his or her chart. We just launched that and, so far, we’ve been getting a great response of people so happy because now they can remember what the doctor had told them.

Dr. Avelino: This is a service industry, and we’ve got to be partners with our consumers. And so what they want, we have to be able to deliver. We’ve got to be able to work with them individually in order to be able to meet their expectations.

Steve Roberts: I think we’re always struggling with the, “How do we make technology useful but not a barrier between the doctor-patient relationship?” And I think through mobile devices, the ability to do Facetime with patients, the televisits and those things — I think we’re closer to being able to use technology in a clinical setting … but still keep it personal and not feel as though there’s a digital barrier.

The aging population, as we discussed, creates some new challenges. And we’re also seeing an uptick in collaboration among providers. Is that part of a concerted strategy to address a growing need?

Marlee Lauffer of Henry Mayo Newhall Hospital shared about new patient services planned for the SCV’s only community hospital.

Marlee: What we really see at Henry Mayo, as a community hospital, is that we can’t be successful without partnerships. That’s why we enjoy partnerships with Kaiser (Permanente), with City of Hope, with Facey, UCLA, you see a lot of different brands and names on our campus, because we know as an independent, not-for-profit hospital, we need to partner. One of the things we’re looking at is a comprehensive community cancer program. Obviously, an entity like City of Hope is integral in that.

Dr. Hajjarr: Access is very important. … The world is getting smaller. We have great access to the local communities. In the past, we used to have to carry around the hard films, and now I can bring it up on the screen.

Cynthia: You definitely see some co-branding happening which, in Kaiser Permanente’s case we were perceived for many years a narrow network and in some cases we still are, we are looking to partner. We have contracts with other medical centers because we realized we can’t do this on our own. There’s also another paradigm shift … how do we change the perception that if you’re sick and you’re ill, you’re going to get better care at the hospital, because we actually know you can get more sick in a hospital.What we’ve found is that’s what (patients) want.

Dr. Avelino: I think what it all comes down to is the value of care to the individual. … We need to show value to the insurance company, to our consumers, who are our patients, that this is the way that they want to be treated. … To bring that value to the individual consumers and the insurance companies, is really what we try to focus on.

How has the homelessness crisis impacted your respective agencies’ ability to deliver service?

Marlee: Often there’s a correlation between mental illness, substance abuse and homelessness, and we don’t, as a community, have great resources for dealing with that. We have a Behavioral Health Unit in the hospital that sees a great number of patients, but it’s difficult for anyone under 18, and then also for continual care. … All of that ties together.

Dr. Hajjar: It’s a major problem, especially when you have a chronic disease, like cancer. … If you don’t have an address, then it’s very difficult to communicate. So it’s a problem. … It’s good that they have access to care with Covered California … but again, there’s a lot of things where we need to depend on the local hospitals to help us with that with the supportive care.

The opioid crisis is everywhere, but it’s starting to become more of an issue here in recent years. Let’s talk about how that’s being addressed.

Cynthia: We have a robust body of work … around opioid regulation, in terms of how we administer them … and how do we get them off of it. … because that’s the hard part. It’s one thing to administer the drugs … but getting the patient on board with the idea that they’re going to be OK without it. … That’s what we’re trying to get in front of.

Steve: It also ties to that mental health issue that we talked about.  … At Heritage Sierra, we look at it one of two ways: How do we intervene, quickly, so that you don’t have to prescribe opioids. … And then, oftentimes they come to us and they’re on it. So then it’s … how do you wean them off of it. … And then that last mile is the hardest, that mental health aspect. 

Dr. Chris Avelino of Facey Medical Group said a provider Facey sees approximately 70,000 patients each year in the SCV.

Dr. Avelino: It’s so important, the mental health part. Just getting used to, ‘I’m going to take five less pills a month,’ just that first step … so this is where having a behavioral health specialist, or a pain management specialist (is critical) … We do have these built-in safety mechanisms now, and I do think that really helps our physicians, we do have extra regulations, as well.

Steve: …But the other thing that I was going to say is along the lines of the prescribing — we’re getting providers who are … just saying, ‘No, we don’t prescribe those.’ And that’s again circling back to the mental health aspect, when you just cut that population off from something they’re seeking, then oftentimes, they’ll seek it from other sources.

Dr. Hajjar: We don’t also want to go to that other (extreme), where we say we are not going to prescribe, because we are afraid this patient might become an addict. … So, yes, we don’t want to overprescribe — we don’t want you to just come every month and we’ll write a prescription for 100 pills of Norco, and then you come next week for back pain, which used to be the norm — to the point where we don’t treat our patients, which is very important, too.

John Musella: One thing we talked about going into this was the workforce development aspect of health care. As the health care market continues to grow, where is the workforce going to come from? Are we preparing the workforce to have enough doctors and nurses and specialists?

Dr. Avelino: No.

Marlee Lauffer: No.

Cynthia Cifuentes. No, there’s not. (Nervous laughter around the room) But we have a plan for that. It’s one of the big initiatives that we’re working on, and there are different cohorts. For physicians, we have a school of medicine that’s opening in 2020. … I believe the first cohort will be completely free. … From a nursing perspective, specifically in the Santa Clarita Valley, we partner with College of the Canyons, and so we have our chief nurse officer, who’s going to be able to help provide guidance on the curriculum … in order to prepare future nurses.

Marlee: We do some of that on a smaller scale, as well. We have 2,200 employees, so we’re a large employer in the Santa Clarita Valley. … And we recognize that we need to keep that pipeline coming. … Because what we find is every time we open up a new service line, all these wonderfully trained folks who are working in the San Fernando Valley or the San Gabriel Valley or Greater L.A., say, ‘Oh, we want to be closer to home. We live up here, or we want to move our family up here. 

Dr. Avelino: This is where I think the government can help, because, let’s face it: A lot of the people who are brilliant coming out of college, they don’t go into medicine. They go into computer science … entrepreneurship … because it’s just too difficult.’ … We’ve got to find a way to make it easier for our physicians. We’re recruiting a lot of physicians who’ve completed their medical schooling outside of the country because a lot of people don’t want to go into medicine because it’s very difficult the way it’s set up.

Dr. Hajjar: As a specialty health care system, everywhere you are seeing a shortage of physicians and nurses. We have requirements for our job and our care, and it’s not easy to recruit. The shortage is in any specialty you could name medical oncology, radiation oncology, surgical oncology … And this is not your regular job, this is not your 8 to 5 job … As an enterprise, we need help from the government, and from local communities, too, to attract people to be able to do these kinds of things. … A chemotherapy nurse has to have special training, so the shortage that you’re seeing in primary care exists in specialties, also. 

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