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Becker’s Healthcare Podcast
Cástulo de la Rocha on Building AltaMed Health Services Corporation Around Access, Trust, and Community
00:20:55
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- [00:00]
A
This is Laura Darda with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Castulo del Rocha, who is the CEO and president of AltaMed. Castulo, it's a pleasure to have you on the podcast today.
- [00:12]
B
Well, thank you very much, Laura. I'm really looking forward to the interview.
- [00:16]
A
Fantastic. Well, I think first and foremost you fled altamed from a single clinic back in 1977 into now a 61 site system. Can you tell us a little bit about the organization and what you saw in those early days that shaped the vision for what it's become today?
- [00:32]
B
Well, Certainly back in 1977, I did not see a health care system of any sort. What I did see was a very long line of elders, parents and children waiting to receive or to get a ticket to see a doctor. If you could imagine a very long line of people waiting to get a ticket to see a doctor that afternoon. What shaped the vision was not scaled at that point. It was really about dignity. Our founders believe that social justice begins with a healthy community. That belief still drives us at ultimate. Health care is really not. It's not a commodity. It is a right. Growth was never a gold. Access to health care has always been fundamental to this organization. So scale came because of the trust that we develop in the community and certain reliance that we felt on our system by members of our community.
- [01:53]
A
That's fantastic to hear, and it's clear that you have established quite a reputation within the community and important community that you're in as well. Could you just tell us a little bit about yourself too, and how you've grown up within your career, what's been inspiring and where this passion comes from?
- [02:11]
B
Well, I was born and raised in a very small community in the mountains in the state of Chihuahua, Mexico. And I immigrated to East Los Angeles when I was 10 years of age. I did study law because I wanted to fight injustices. But in 1977, I found my true calling standing in front of and outside of a small clinic in East LA called the East LA Barrio Free Clinic, watching those people that I mentioned standing in line waiting to receive a ticket to see a doctor late in the afternoon. That clinic sort of has become my life's work in certain respects. Not certain respects, in all respects, to be honest with you. Today that one storefront has grown into Altamet, the nation's largest federally qualified community health center, servicing over 700,000 patients annually across Southern California. I would say that we were born out of the civil rights movement, out of the Chicano movement, and Our mission has remained the same, that health care is a fundamental human right. And quite frankly what evolved was a health care system that was deeply rooted in value based care and invested in the community. But the core of that organization is still about dignity and about access and trust. That's who I am and that's who we are today at AltaMed.
- [04:10]
A
I love that. I mean it's so amazing to think about that story and how you've been able to maneuver it and grow within the community and then make such a big impact on so many patients in their community and family members lives. Now I know a big thing that you work on at ultimate is talking about financial flexibility for families. What does that look like in practice and how do you come to see it as essential for improving health as
- [04:36]
B
a federally qualified community health centers? One of the prerequisites in establishing a federally qualified community health center is really is to establish those centers as envisioned way back in the days when Ted Kennedy was an one of the principal senators that introduced the concept of community health centers was to establish community health centers in medically underserved health professional shortage areas and quite frankly in poor communities. That's the origins of our organization. So the issue of financial flexibility, it really, as you think about financial instability, it is that social determinant of health that sort of unlocks or blocks others. For example housing, food, transportation and all of that sort of float downstream from economic insecurity. So we firmly believe that health and economic stability are inseparable. And as a very good example, that would be a family that has won medical bill from a financial crisis. That's not healthy in any community. We've seen that historically in our communities. But by offering primary care, preventive care and early intervention, it's only possible of course, when a person can walk through the door and they could afford to really walk through the door. Financial obstacles like insurances and the like, they become obstacles to that at untamed. We really don't turn anyone away. We have instituted a sliding fee scale, have had it from the very beginning. And when this organization was developed, we are the largest provider of medi cal services in Southern California and are one of the largest providers of PACE programs for a frail elderly population. So that when a family is able to avoid ED emergency services, for example, because we're able to offer and manage their care early on through prevention, education and of course through primary care services, our programs were to avoid unnecessary admissions. And quite frankly, all this is really the idea of keeping people healthy and in their communities. So that for me, is what is financial stability, is being able to provide care to anyone that needs it at any time at a community setting.
- [07:34]
A
I love that mission and certainly being able to understand that historical concept and then how it's grown and continue to scale as time goes. I mean, you know, healthcare looks so different today than it did back then. But, you know, funnily enough, the mission and core goals of healthcare and caring for communities is the same. And so I know ultimate has long prioritized culturally responsive care. Can you tell me a little bit more about that as well and how you've built trust in communities that may have felt overlooked by some of the traditional healthcare systems?
- [08:08]
B
One of the interesting, the question, the way it is framed, it says, you ask whether a community that may have felt overlooked. The truth of the matter is that there have been obstacles over the course of the history of community health that prevented many communities from accessing any kind of health care. To me, building trust and a trusting relationship with a community is absolutely essential. Trust is more than just good bedside manners. It is earned through consistency, through representation, advocacy and engagement. Trust is earned, really. Working and building a relationship with patients one at a time over a course of years. I certainly feel that we have done that at Ultimate. It's built by showing up consistently so that over the last 58 years, we have been embedded in our community and we have shown up there, been there, and been in this community for the long haul. And I tell you that in the times like this, a community that. A community, meaning a patient body, a group of patients, a group of employees that are engaged in the mission of the organization and connected to the community. All that in the sense that that organization is engaged in the issues that impact that community. That engagement is always represented by the willingness of that organization to stand up for that community under any circumstances, and particularly when there are challenging times, the value for Ultimate. And I think as you look at the workforce at, at AltaMed, I know that 76% of our employees, of 6,000 employees at AltaMed, 76% of those employees live within five miles of the sites that we presently operate. Almost 90% of the employees are minority, with about 71% of that population Latino. It's interesting because as I sit and I ask myself, and I asked the nurses that we train here at AltaMed and the family practice physicians that we train at AltaMed, sitting with them informally. It's incredible to hear their stories. Mr. De la Roche I wanted to go to medical school because I grew up just a few blocks away. From the site that I'm presently practicing, or I was a patient at Altamet, or my family was a patient at AltaMed. So that in fact, the employees of Altame in many cases have grown up in communities like the communities that they're practicing. They're committed to come back and provide services to that community. They speak the language, they understand the culture, and are directly connected in one way or another to that community. That builds the trust, I believe that allows us then to build the models that the financial models as well as the models to engage patients in the service delivery systems that we operate. Ultimately, I think that there's one other factor here that's important from my own standpoint is that we have as an organization certainly embraced the mission of the organization. And part of that is in engagement in the community. So we work at building civic engagement activities at AltaMed. It is really about making sure that our population, 700,000 of our patients are engaged, either they're citizens and, or engaged in civic activities, including voting, not for any particular candidate, but simply voting as a constitutional right. So that engagement is, is very real at ultimate.
- [12:55]
A
That's helpful to understand and you know, I know it makes a big difference in having the community around you and being able to be invested in what you're doing and give you the right feedback and working together collaboratively to build the programs that are most needed and build that trust too. From your experience, what does it really take to design care around the people instead of the institutions? And where are most organizations falling short?
- [13:21]
B
Well, I think that the value based model that we have embraced is what makes people centered care financially sustainable. Okay, by designing, but designing a care around people requires sort of a shift in incentives. Most institutions, hospital systems, specialty care providers, skilled nursing facilities, ancillary care providers are built around volume. More visits, more and more procedures means more fees for more services. Value based care sort of flips that payment model to build around outcomes. It rewards keeping people healthy out of emergency services and out of hospital care in their home and in their community. That value based model has really given us the ability to financially organize our systems in a way that allow us then to focus on patient experience. One other aspect of that value based model, it does help us control, help us somewhat help us in controlling the health care costs overall. It gives us the ability to influence all aspects of care, for example, hospital care, specialty care, and pharmacy services, frankly, through the life of a patient, whether it's prenatal care services that we're offering or hospice care. So the design is not Simply a financial model. It is a model that is focused on people and is people centered care as I like to refer to it. But it also has that element of cultural relevance, community engagement, employee engagement and that element of trust that patients have in ultimate. That's what has made it successful. Unfortunately, all too often I see that more traditional institutions look at it simply as a play on a model, value based model or managed care capitated products, but not really understanding and building out the patient experiences to the realities of the communities in which they're working.
- [16:04]
A
That's an excellent point and certainly worth noting in terms of the reality of what you can be as a community institution versus on paper what it might look like or be considered. And certainly that patient experience is so important and the community experience is so important, something that health care organizations have been chasing after. But certainly you have very much a foundation in which is so cool to hear about and critical. Now, as costs rise and access gaps persist, what lessons from the community health center model should hospitals and health system leaders be paying closest attention to?
- [16:42]
B
The truth of the matter is that community health centers have been solving problems that hospital systems and specialty care providers are just now having to confront. The difference is that we've never had the option to look away because we have always had to navigate the pressures to do more with less. Quite frankly, as I think about health care and the rising cost of health care and the acuity levels, the rising acuity levels that we see in our population mix, I just negotiated recently our medical insurance here at antiven, about 6,000 employees. The beginning negotiations with a health insurance company started with an increase of 30% increase from the previous year. 30% increase. That's huge. That's huge. We ended up somewhere in the mid teens but nonetheless that's still a huge increase in the cost of medical care. We saw an increase in the number of medical conditions that our patients were seeing year over year. We saw the acuity level of our patients year over year. So you have this serious problem of increasing the overall cost of whether it's pharmaceuticals, hospital care and the like at the same time the acuity levels of our patient, whether it's a post pandemic phenomenon that we're seeing, but it's real and we see it in the numbers at AltaMed on a daily basis. But this really calls for. It's a time that these kind of crises force us to really genuinely look for innovations and looking at new approaches to this. I speak about value based and other work that we have done to move us around value based around patient centered care, all focused to improve clinical outcomes at the same time reduce the overall cost of health care. We have focused on primary care, but primary care cannot do this alone. The whole system has to change and be aligned from whether it's the state or the Federal government, the HMOs, the hospital systems, the specialty care. We got to share under risk. And if you share under risk means you got to share. There's got to be equitable payment systems and models. All this has to be done with one thing in mind and one thing in mind only. How do we improve the care for our patients? That's the bottom line and that's what we should be looking at. Not about negotiating a better contract in specialty care or hospital care or with the HMO or with the state. How do we align our incentives in a way that who are benefiting from is directly the patients that we are serving. So my hope is that we all learn as a result of the sort of crises that have been created both at the federal level as well as the state level, that we cannot continue to do business as we have done in the past. Things need to change.
- [20:30]
A
Absolutely. That's an amazing message and so inspiring to talk to you. Castillo, thank you so much for joining us on the podcast today. This has been such an amazing time. I really learned so much and appreciate what ultimate does. Thank you so much and we'll look forward to connecting with you again soon and continuing this conversation.
- [20:47]
B
Well, thank you very much. I appreciate the time spent with you. Thank you.