Latest / Becker’s Healthcare Podcast / Cástulo de la Rocha on Building AltaMed Health Services Corporation Around Access, Trust, and Community

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Cástulo de la Rocha on Building AltaMed Health Services Corporation Around Access, Trust, and Community · Becker’s Healthcare Podcast

0:00
This is Laura Dierda with the Becker's Healthcare
0:02
podcast.
0:03
I'm thrilled today to be joined by Castillo
0:05
del Rocha,
0:06
who is the CEO and president of AltaMed.
0:09
Castillo, it's a pleasure to have you on
0:11
the podcast today. Well, thank you very much,
0:13
Laura. I'm really looking forward to the interview.
0:16
Fantastic. Well, I think first and foremost, you
0:19
fled AltaMed from a single clinic back in
0:21
1977
0:22
into now a 61 site system. Can you
0:25
tell us a little bit about the organization
0:27
and, you know, what you saw in those
0:28
early days that shaped the vision for what
0:30
it's become today?
0:32
Well, certainly. You know what? Back in 1977,
0:35
I did not see a health care system
0:38
of it of any sort.
0:40
What I did see was
0:42
a a very long line of elders, parents,
0:45
and and children
0:47
waiting to receive or to get a ticket
0:50
to see a doctor.
0:52
If you could imagine a very long line
0:55
of people waiting to,
0:57
get a ticket to see a doctor that
1:01
afternoon.
1:02
What shaped the vision was not scaled at
1:05
that point. It it was really about dignity.
1:08
Our founders,
1:11
believe that social justice begins with a healthy
1:14
community.
1:16
That belief still drives
1:19
us at at ultimate.
1:21
Health care is is really not it's not
1:22
a commodity.
1:24
It is a right.
1:26
Growth was
1:27
never a code.
1:30
Access to health care has always been fundamental
1:33
to to this organization.
1:35
So scale
1:37
came because of
1:40
the trust that we develop
1:42
in the community
1:44
and
1:44
certain,
1:46
reliance
1:47
that, we felt on our system by by
1:50
members of our community.
1:52
And that's fantastic to hear. And, you know,
1:54
it's clear that you have established quite a
1:56
reputation within the community and and important
1:59
community that you're in as well. Could you
2:02
just tell us a little bit about yourself
2:03
too and how you've grown up within your
2:05
career? What's been inspiring and where this passion
2:08
comes from?
2:10
Yeah. Well, I was I was born and
2:12
and raised in a very small,
2:15
community
2:16
in the mountains,
2:18
in the state of Chihuahua, Mexico.
2:21
And I immigrated
2:22
to to East Los Angeles when I was
2:24
10 years of age.
2:26
I did study law because I wanted to
2:29
fight injustices,
2:32
but in 1977,
2:33
I found my true calling standing in front
2:36
of,
2:37
and outside of a small clinic in East
2:40
LA called the East LA Barrio,
2:42
Free Clinic.
2:43
Watching those people that I mentioned standing in
2:46
line,
2:47
waiting to receive a ticket to see a
2:49
doctor late in the afternoon.
2:52
That clinic,
2:54
sort of has has become my life's work,
2:57
in certain respects.
2:59
Not certain respects, in all respects, to be
3:01
honest with you.
3:03
Today, that one storefront,
3:06
has grown,
3:08
into Ultimate,
3:10
the nation's largest federally qualified
3:12
community health center,
3:14
servicing
3:15
over 700,000
3:17
patients annually
3:19
across Southern California.
3:21
I I would say that we
3:24
were born out of the civil rights movement,
3:26
out of the Chicano movement,
3:29
and and
3:30
our mission has has remained the same. You
3:34
know, that health care
3:35
is a fundamental human right. And,
3:38
quite frankly, what what what evolved
3:41
on was
3:42
was a health care system
3:44
that was deeply rooted,
3:47
in
3:47
value based care
3:49
and invested
3:51
in the community.
3:53
But
3:54
but the core
3:56
of that organization,
3:58
is still
3:59
about dignity
4:00
and about access and and trust.
4:03
That's who I am, and, that's who we
4:06
are today at Ultimate.
4:09
I love that. I mean, it it's so
4:11
amazing to think about that story and how
4:13
you've been able to maneuver it and grow
4:15
within the community and then make such a
4:17
big impact on so many patients in their
4:20
community and family members' lives.
4:23
Now I know a big thing that you
4:25
work on at UltaMed is talking about financial
4:27
flexibility for families. What does that look like
4:30
in practice, and how do you come to
4:32
see it as essential for improving health?
4:35
I say Federally Qualified Community Health Centers. One
4:38
of the prerequisites,
4:40
in establishing
4:41
a Federally
4:42
Qualified Community Health Center is really,
4:45
is to establish those centers as envisioned way
4:48
back in the days when Ted Kennedy was
4:51
an a one of the the principal,
4:55
senators that introduced the concept of community health
4:58
centers,
4:59
was to establish community health centers in medically
5:02
underserved
5:03
health professional shortage areas and quite frankly,
5:07
in poor communities. That's the origins of our
5:10
organization.
5:11
So the issue of financial flexibility,
5:14
it really
5:15
as you think about financial
5:17
instability,
5:18
it it is it is that social determinant
5:21
of of health that sort of unlocks or
5:24
blocks,
5:26
others. Like, for example, housing, food,
5:29
transportation,
5:30
and all and all of that sort of
5:32
float
5:33
downstream from from economic
5:35
insecurity.
5:37
So we firmly believe that health and economic
5:40
stability
5:41
are are inseparable.
5:43
And as a very good example, there would
5:45
be a family
5:46
that has won medical bill from a financial
5:49
crisis.
5:51
That's not healthy in any community. We've seen
5:54
that historically
5:55
in in in our communities.
5:57
But by offering primary care,
6:01
preventive care in early
6:03
intervention,
6:04
it it it's it's only possible, of course,
6:08
when a person can can walk through the
6:11
door,
6:12
and they could afford to really walk through
6:14
the door.
6:15
Financial
6:16
obstacles,
6:17
like
6:19
insurances and the like, they become obstacles to
6:22
that. And, ultimately, we really don't turn anyone
6:25
away. We have instituted a a sliding fee
6:29
scale, have had it, from the very beginning,
6:32
and when this organization
6:34
was developed.
6:35
We are the largest provider of Medi Cal
6:37
services in in Southern California,
6:40
and are one of the largest providers,
6:42
PACE programs for a frail elderly population.
6:46
So that when a family
6:49
is able the family is able to avoid,
6:51
you know,
6:52
ED emergency services, for example, because we're able
6:55
to offer,
6:57
and and manage
6:58
their care early on
7:00
through prevention, education, and, of course, through primary
7:03
care services.
7:04
Our programs work to to to avoid unnecessary
7:08
admissions,
7:09
and quite frankly, all this is really
7:12
the idea of keeping people healthy
7:15
and in in their communities.
7:17
So that for me
7:20
is what is is financial
7:23
stability,
7:24
is is being able to provide care to,
7:28
anyone that needs it at any time,
7:31
at a community setting.
7:33
I love that mission, and and certainly being
7:36
able to understand that historical concept and then
7:39
how it's grown and continue to scale as
7:41
time goes on and evolved. I mean, you
7:43
know, health care looks so different today than
7:45
it did back then, but, you know, funnily
7:47
enough, the, mission and core,
7:51
goals of health care and caring for communities
7:53
is the same. And so I know Ultimate
7:55
has long prioritized
7:57
culturally responsive care.
7:59
Can you tell me a little bit more
8:00
about that as well and how you've built
8:02
trust in communities
8:03
that may have felt overlooked by some of
8:05
the traditional health care systems?
8:07
You know, one of the the
8:09
an interesting
8:11
the question, the way it is is is
8:13
framed,
8:14
it says, if you ask whether,
8:17
a community that may have felt
8:19
overlooked,
8:21
the truth of the matter is that there
8:23
have
8:24
been obstacles
8:25
over the course of the history of community
8:28
health
8:29
where that prevented many communities from accessing any
8:33
kind of of health care.
8:35
And to me,
8:37
building trust and a trusting relationship
8:40
with a community is absolutely essential.
8:43
So trust is more than just the, you
8:45
know, good bedside manners.
8:48
It is earned through
8:49
consistency,
8:50
through through representation,
8:54
advocacy,
8:54
and engagement.
8:56
Trust is earned really,
8:58
you know,
9:00
working and building a relationship
9:02
with
9:03
patients,
9:04
one at a time
9:06
over a a course of of of years.
9:09
I certainly feel that we have done that
9:12
at at at Ultimate.
9:14
It's built it's built by showing up,
9:18
consistently,
9:19
so that over the last fifty eight years,
9:22
we have been embedded in in our community,
9:25
and we have shown up there and been
9:27
there,
9:28
and been in in this community for the
9:31
long haul. And I tell you that in
9:33
the times like this,
9:36
a community,
9:38
that a community meaning a patient body, a
9:42
group of patients,
9:44
a group of employees that are engaged in
9:47
the mission of the organization
9:49
and connected to the community,
9:52
all that,
9:54
and and in the sense that that that
9:57
organization
9:58
is
9:58
is engaged in the issues that impact that
10:02
community,
10:03
that engagement
10:04
is always represented by the willingness
10:07
of that organization
10:08
to stand up for that community
10:11
under any circumstances, and particularly,
10:14
when there are challenging times.
10:17
The value for Ultimate, and and I think
10:19
that you look at the workforce at at
10:22
Ultimate,
10:23
I know that 76%
10:25
of our employees, of 6,000
10:28
employees at Ultimate,
10:29
76%
10:30
of those employees live within, you know, five
10:33
miles of the sites,
10:35
that that we we presently operate.
10:38
Almost 90%
10:39
of the employees are minority,
10:42
with about 71
10:43
of that population
10:45
Latino.
10:46
It's interesting
10:48
because as I sit and I ask my
10:50
residents, and I ask the nurses that we
10:53
train here at at at Antomed, and the
10:56
the family practice
10:57
physicians that we train at Antomed,
11:00
sitting with them informally,
11:02
it's it's incredible to hear their stories.
11:06
Mister De La Roche,
11:08
I I I wanted to go to medical
11:10
school because I grew up just a few
11:12
blocks away from the site that I'm presently
11:15
practicing,
11:16
or I was a patient at Altamet, or
11:18
my family
11:19
was a patient at Altamet.
11:21
So that in fact,
11:23
the employees of Altamet,
11:26
in many cases have grown up in communities
11:29
like the the communities that they're practicing.
11:32
They're committed to come back and provide services
11:35
to that that community.
11:37
They speak the language. They understand the culture
11:41
and are directly
11:43
connected in one way or another to that
11:45
community. That builds the trust, I believe,
11:49
that allows us then to build the models,
11:53
that, the financial models
11:55
as well as the models, to to engage
11:59
patients in in the service delivery systems
12:02
that we operate.
12:03
And, ultimately, I think that there's one other
12:06
one other factor here
12:08
that's important from from my own standpoint,
12:11
is
12:12
that we have, as an organization,
12:15
certainly embraced the mission of the organization,
12:19
and part of that is engagement in the
12:21
community.
12:22
So we work
12:23
at building civic engagement activities at at Ultimate.
12:28
It it is really about,
12:30
making sure that our population, 700,000,
12:34
so of our patients are engaged,
12:37
either they're citizens
12:38
and or engaged in in civic activities,
12:42
including voting,
12:44
not for any particular candidate, but simply voting,
12:48
as a as a constitutional
12:50
right. So that engagement is is very real
12:53
and ultimate.
12:55
That's helpful to understand. And, you know, I
12:57
I know it makes a big difference in
12:59
having the, community around you and being able
13:02
to be invested in what you're doing and
13:04
and give you the right feedback and working
13:06
together collaboratively
13:08
to build the programs that are most needed
13:10
and build that trust too. From your experience,
13:13
what does it really take to design care
13:15
around the people instead of the institutions, and
13:17
where are most organizations falling short?
13:21
Well, I think that,
13:22
the value based model that we have embraced,
13:26
is what makes,
13:27
people centered care financially
13:29
sustainable.
13:30
Okay? By designing, but the design but but
13:34
designing a
13:36
a a care around people
13:37
requires sort of a shift in in in
13:40
incentives.
13:41
Most institutions,
13:42
hospital systems,
13:44
specialty care providers,
13:47
skilled nursing facilities,
13:48
ancillary care providers,
13:50
are built around value.
13:52
More visits,
13:54
more and more procedures means more fees,
13:57
for more services.
14:00
Value based
14:01
care sort of flips that payment model
14:04
to build around
14:06
outcomes. It rewards
14:08
keeping people healthy
14:10
out of emergency services
14:13
and out of hospital care
14:15
in their home and in their community.
14:18
So that value based model
14:21
has really given us the
14:24
the ability to financially,
14:27
organize our systems in a way,
14:30
that allow us then to focus on on
14:33
patient experience.
14:34
One other aspect of that value based model,
14:37
it it does help us
14:39
control,
14:41
help us somewhat help us in controlling,
14:45
the health care costs overall.
14:47
It it it gives us the ability to
14:50
influence
14:51
all aspects of care, for example, hospital care,
14:55
specialty care, and pharmacy services.
14:58
Frankly, through the the life of a patient,
15:01
whether it's prenatal care services that we're offering,
15:06
or hospice care.
15:08
So
15:09
the design
15:10
is is not simply a financial model,
15:13
it is a model that is focused
15:17
on people, and it's people centered carers, I
15:20
like to refer to it,
15:22
but it also has
15:24
that, that that that element of
15:27
cultural relevance,
15:29
community engagement,
15:31
employee engagement,
15:33
and that that element of trust,
15:36
that patients have,
15:38
in in ultimate. That's what has made it
15:41
successful.
15:42
Unfortunately,
15:43
all too often,
15:44
I see that more traditional
15:46
institutions
15:47
look at it simply as a play on
15:49
a model, value based model or managed care
15:53
capitated products,
15:54
but not really understanding,
15:57
and building out the patient experiences
15:59
to the realities of the communities in which
16:02
they're working.
16:04
That's an excellent point and and certainly worth
16:06
noting in in terms of, you know, the
16:08
reality of what you can be as a
16:10
community institution versus, you know, on paper, what
16:13
it might look like or or be considered.
16:15
And, you know, certainly, that patient experience is
16:17
so important, and the community experience is so
16:20
important, something that health care organizations, you know,
16:23
have been,
16:24
chasing after. But, certainly, you have a very
16:27
much a foundation in which is so cool
16:29
to hear about and and critical.
16:31
Now as costs rise and access gaps persist,
16:34
what lessons from the community health center model
16:36
should hospitals and health system leaders be paying
16:39
closest attention to?
16:41
The truth of the matter is that community
16:43
health centers have been solving problems that hospital
16:46
systems and specialty care providers
16:49
are just now having to confront.
16:53
The difference is that we've never had the
16:56
option to look away because
16:58
we have always
16:59
had to navigate the pressures
17:02
to do more with less.
17:04
And and quite frankly, it's I think about,
17:09
health care and the cost the rising cost
17:11
of health care and the acuity levels
17:15
that the the rising
17:16
acuity levels that we see in our pay
17:19
our population mix.
17:22
I just negotiated
17:23
recently,
17:25
the
17:26
the the our our medical insurance here at
17:29
Anthem, we have about 6,000
17:31
employees.
17:32
The beginning
17:34
negotiations
17:35
with
17:36
a health insurance company
17:39
started with an increase of 30%
17:42
increase
17:43
from the previous year.
17:45
30%
17:46
increase. That's huge.
17:48
That's huge. We ended up somewhere in the
17:51
mid teens,
17:52
but nonetheless, that's still a huge increase in
17:55
in the cost of medical care.
17:58
We saw an increase in the number of
18:01
medical conditions
18:02
that our patients were seeing year over year.
18:05
We saw the acuity level of our patients
18:08
year over year.
18:10
So you have this
18:12
serious problem
18:15
of increasing the overall cost of whether it's
18:18
pharmaceuticals,
18:19
hospital care, and the like,
18:22
at the same time, the acuity levels of
18:24
our patient. Whether it's a post pandemic,
18:28
phenomenon that we're seeing, but it's real, and
18:31
we see it in the numbers,
18:33
at at at ultimate,
18:35
on a daily basis.
18:37
But this really calls for is is a
18:40
time that that,
18:42
that these kind of crises force us to
18:45
to
18:46
to so, really, to genuinely look for innovations
18:50
and new looking at new approaches to this.
18:53
And I speak about value based and other
18:55
work that we have done to move us
18:59
around value based, around patient centered care,
19:03
all focused to improve clinical outcomes, at the
19:06
same time reduce
19:08
the overall cost of health care.
19:11
We have focused on primary care,
19:14
but primary care cannot do this alone.
19:17
The whole system has to change and be
19:20
aligned
19:21
from whether it's the state or the federal
19:23
government, the HMOs,
19:25
the hospital systems, the specialty care,
19:28
we gotta share under risk.
19:30
And if you share under risk means you
19:33
gotta share
19:34
there's gotta be equitable payment systems and models.
19:38
All this has to be done,
19:40
with
19:42
with one thing in mind and one thing
19:44
in mind only.
19:46
How do we improve the care for our
19:48
patients?
19:49
That's the bottom line, and that's what we
19:51
should be looking at. Not about negotiating
19:54
a better contract
19:56
in specialty care or hospital care or with
19:59
the HMO or with the state. How do
20:01
we align
20:03
our incentives
20:04
in a way that who are benefiting from,
20:08
is directly
20:09
the patients that that we are are are
20:11
serving. So
20:13
my hope is that we all learn,
20:16
as a result of the sort of crises
20:18
that has been created both at the federal
20:21
level as well as the state level that
20:23
we cannot continue to do business as we
20:26
have done in the past. Things need to
20:28
change.
20:29
Absolutely. That's an amazing message and so inspiring
20:32
to talk to you. Castillo, thank you so
20:34
much for joining us on the podcast today.
20:36
This has been such an amazing,
20:38
time. I've, you know, really learned so much
20:40
and,
20:40
appreciate what UltiMed does. Thank you so much,
20:43
and we'll look forward to connecting with you
20:45
again soon and continuing this conversation.
20:47
Well, thank you very much. I'd appreciate the
20:49
time spent with you. Thank you.