Peach Tree Health is Revolutionizing Community Care Through Innovation and Impact.

What if navigating the healthcare system could be a seamless journey rather than a daunting challenge? Greg Stone, CEO of Peach Tree Health joins me to shed light on the fascinating evolution of Peach Tree Health, from its humble beginnings as a county-controlled clinic in Yuba County to a pioneering independent nonprofit and federally qualified health center. Together, we unpack the collaborative efforts with hospital systems and the critical role of outpatient care, delving into the complexities of healthcare access and insurance hurdles that many families face.

But that's not all – we explore how Peach Tree Health has expanded its services to include specialties like OBGYN, dentistry, behavioral health, and optometry all under one roof. Greg discusses innovative mobile healthcare solutions that bring essential services directly to those in need, breaking down barriers and fostering a culture of regular healthcare engagement among underserved communities. Learn about the impactful partnerships with local school districts and counties that bring crucial dental care to young children, often providing their first-ever dental visit.

In our final segment, we dive into the transformative power of telemedicine, which has transformed healthcare access, especially during the COVID-19 pandemic. Greg shares how Peach Tree Health is leveraging technology to provide flexible care options for those facing transportation or anxiety barriers. We also touch on preventive care and support for vulnerable populations, emphasizing a holistic approach that integrates medical, dental, and mental health services. Discover how these efforts are making a profound difference in marginalized communities and why healthcare should be considered a fundamental right for all.

You can learn more about PeachTree Health by visiting: https://pickpeach.org/

Episode Highlights
(00:00) Healthcare System Challenges and Solutions
(15:59) Expanding Access to Healthcare Services
(21:33) Promoting Community Health and Education
(26:26) Funding and Healthcare Team Structure
(29:58) Expanding Access Through Telemedicine Services
(39:01) Transforming Community Health Through Holistic Care
(46:19) Inclusive Community Healthcare Solutions

Chapter Summaries
(00:00) Healthcare System Challenges and Solutions
Peach Tree Health's transition to an independent nonprofit and federally qualified health center, and the complexities of healthcare access and government-funded programs.

(15:59) Expanding Access to Healthcare Services
Family medicine provider offers integrated services, including specialties, mobile healthcare, and addressing barriers for underserved populations.

(21:33) Promoting Community Health and Education
Partnership brings dental care to schools, addressing barriers and promoting preventive care for children and families.

(26:26) Funding and Healthcare Team Structure
Funding, revenue sources, challenges, grants, corporate giving, federal funding, healthcare team structure and growth, collaboration with external providers.

Thank you so much for listening! We appreciate you. Please visit the website to sign up for our email updates. https://www.nonprofpod.com/ And if you like, leave me a voicemail to comment on the program, leave a question for us to ask in the future or a message for me, Jeff Holden. I may even use your voice mail message in a future episode. https://www.nonprofpod.com/voicemail. Thanks again for your support in listening, commenting and sharing the great work our local nonprofits are accomplishing.

Transcript

Greg Stone: [00:00:00] We send children home every day with the first toothbrush in their family. What we try and do is find areas of our community, school's a good example, where they know the children that struggle with staying in school, that struggle with improving in, in school or paying attention at school. And oftentimes it's because they're hungry.

Or they have mouth pain or they can't see the board. And these are things that just go on and on without anybody recognizing it. And oftentimes bring those services to the school. We vision screen there. We do dental care. We have behavioral health embedded in schools and try and capture that early, ultimately setting them up for hopefully a lifetime of trusting health care.

Jeff Holden: Hi, I'm Jeff Holden. Welcome to the Nonprofit Podcast Network. Our purpose and passion. is to highlight a non profit [00:01:00] organization in each weekly episode, giving that organization an opportunity to tell their story, in their words, to better inform and educate the respective communities they serve, as well as provide one more tool for them to share their message to constituents and donors.

Our goal is to help build stronger communities through shared voices and to both encourage and support the growth of local non profit organizations through podcasting. Thanks to our founding partners for their foresight in helping us transform the way conversations start. CapTrust, fiduciary advice for endowments and foundations.

Runyon Saltzman Incorporated, RSE, marketing, advertising, and public relations creating integrated communications committed to improving lives. And Western Health Advantage, a full service health care plan for individuals, employer groups, and families. Just as CAP Trust, Runyon Saltzman, and Western Health saw value in supporting our program as founding sponsors, we're now able [00:02:00] to offer another exclusive opportunity to reach the valuable audience we speak to.

If you'd like to become a partner with us, please reach out and email me at Jeff at hearmenowstudio. com so I can share this new opportunity to become a valued sponsor of the program. Affordable health has been a topic of conversation for quite some time now. How do our underserved populations get the proper health care they need?

How do their children or elders get fair and equitable treatment when they may not speak the language or are challenged simply to find housing or worse yet, food? We all know the health care system is challenged and we recognize not everyone gets their needs met for a variety of reasons.

hearmenowstudio. com hearmenowstudio. com So when you don't fit into the appropriate space to belong to one of the corporate health care plans, when you're an immigrant working to simply get settled in a new country and something happens that needs immediate attention, what are your options? Add in the fact that you're in a rural community, work on a ranch or a farm and don't have simple transportation, [00:03:00] And you can see the challenges that most of us never have to experience.

Fortunately, there are programs implemented to support this group of people with the intent to minimize the challenge and improve the education and proper health maintenance to prevent a small issue from becoming a possibly life threatening one. In this episode, we're going to be talking about one of the solutions that is working, evidenced by its growth and the impact on the communities this nonprofit serves.

I'm speaking with Greg Stone, CEO of Peachtree Health. You may recognize them as a clinic and a shopping center, and that would be appropriate. But as you're going to hear in this conversation, they are so, so much more than that. How they serve, who they serve, and the services they provide will amaze.

Their work is not so simple, and their funding can be equally as challenging. But the need for what it is they provide the communities they serve you. is unquestionable. Greg Stone, welcome to the nonprofit podcast network. [00:04:00] 

Greg Stone: Thank you. Glad to be here. Oh, 

Jeff Holden: we're excited. This is the first healthcare program or healthcare system or healthcare entity.

I should say that we've had on since our inception. 

Greg Stone: It's about time. 

Jeff Holden: So tell me a little bit about how Peachtree Health came to be. 

Greg Stone: Okay, Peachtree as a community health center kind of had its, its seed much like many other health centers in America, which is coming out of some other organization. In our case, it was the counties.

So Yuba and Sutter counties where we started, started divesting a lot of their services in outpatient clinics that were traditionally county run. The health center movement created a new vehicle for that and moved, be able to create a new non profit and move it into a different business model. Still sustain, maybe grow services in the community, but take it out of county control.

So we did. So that was back in, 91. It's over 33 years ago. [00:05:00] Peachtree took over, well, Yuba County that kind of divested their clinic, put it into the Peachtree Mall there in Marysville, got our illustrious name, Peachtree Clinic. So it 

Jeff Holden: did come from the mall because you were a mall center. It was because we were in 

Greg Stone: center.

There was, you know, after the, the mall flooded, they tried to re instill businesses and the county put a lot of services in the, in the, in the mall at that time. 

Jeff Holden: Boy, what goes around comes around. And now we have, Clinics going back into malls again. That's right. 

Greg Stone: So you gotta go where the people go, right?

So, yeah. So we, you know, we, we started there and eventually they became their own nonprofit and applied for a federal grant to become a federally qualified health center. 

Jeff Holden: Let me ask you, you've got Right Out Hospital up there? Correct. The differences between clinic service versus hospital system as a, as a consumer.

Why would I just not go to the hospital or why would I just not, not go to the hospital and stay at the clinic? 

Greg Stone: Yeah, that's a fair question. And I, I don't think the answer is the same in every community. If you look at most [00:06:00] hospital systems now, they are focused on traditional services that require some sort of inpatient stay, so you're staying in the facility, or some sort of traumatic entrance, right?

There's some an emergent need that couldn't wait for some other scheduled event. So, through an emergency department, through an ambulance bay, you're going to come into the hospital. They're treating very acute situations, you know, things that need long term care or surgery, et cetera. What we do is really the, the traditional family medicine and outpatient care.

You know, we, we want to be your, your family's doctor. So, we want to be in front of that. We don't compete with the hospitals in that way. Although hospitals will have often outpatient clinics that will have doctors and services in different communities or in the region around their hospitals to help feed kind of specialty care services to themselves and create better contact with their community.

But, You know, we don't really compete in that [00:07:00] way. We are very reliant on the hospital system and all their specialists and we refer patients in and out. We follow patients in and out of the hospital that are our patients. But if you need an x ray, you need surgery, you've had some traumatic injury, you need to go to a hospital.

Sure. And everything else we try and deal with outside the hospital. And that's mostly a function of convenience and, and cost really. 

Jeff Holden: I think that's important for people to understand, too, that it is a collaborative effort. You have to share services. There's things that you just can't provide, otherwise you become a hospital with a full blown facility and surgical capability.

You 

Greg Stone: have different, we have a different slice of the pie, right? We overlap in some regions, but we generally don't compete. We augment each other. We have services that they uniquely don't offer and yet our patients often need to those advanced care services that move into the hospital system and back and forth.

So, for the layperson coming to America or moving into, into a new community, it's difficult to know [00:08:00] like how do I get healthcare, even defining what that healthcare is. So, traditionally, if you're confused, you go to the hospital, right? And you go to the emergency department. And they're notoriously impacted with pretty much unnecessary emergencies, because there's no other clear avenue in the community to do that, either because they don't have the right healthcare coverage, or they don't know the area, or it's an hour, it's the off hours where their normal outpatient services aren't open.

Jeff Holden: Yeah, or even no healthcare coverage. 

Greg Stone: That happens. 

Jeff Holden: Yes. Right? 

Greg Stone: Or it's very confusing even how to utilize your healthcare coverage, you know, all these ideas of being in and out of networks and being assigned and unassigned. 

Jeff Holden: PPO, HMO. It's a, 

Greg Stone: it's a very complicated business to someone who just needs something done.

Jeff Holden: You just said the key word there, business. 

Greg Stone: Yeah. 

Jeff Holden: Let's touch on that. We were talking about it a little bit prior. Yeah. Before we got started. Hospital systems, healthcare as a business versus as a business. [00:09:00] Yeah. Not that they are distinctly different, but there's issue there. 

Greg Stone: There is. I mean, I think fundamentally, America has continued a journey of trying to determine what health care should be for its citizens.

We've really gravitated towards a business model where providers of all sorts of traditional health are business owners, and they contract with payers, and they provide services for fees, and these transactions go on and on. And so, you know, some make it, some don't, some are successful, some aren't, some are more high quality than others, but it's a business, much like a restaurant would begin or fail.

So, That is okay, but it doesn't really solve the problem. The reality is the vast majority of the health care that we deal with, you think about Medicaid and Medicare, think about the veteran services or disability, all these things, these are government funded health care programs. They're not insurance.[00:10:00] 

It's, these are programs. They're reimbursements. And there's a lot of barriers around. There's lots of boxes around those services, like what you can and can't do, where you can do it. Where you can and can't charge. You can't play with the rates, right? They are what they are. So, when you are trying to solve a problem in healthcare that is a fixed payment model, like a Medicare and Medicaid, in a world of escalating costs and changing needs, it's really difficult to run a business in that model.

Right. So if you have a, any other control your 

Jeff Holden: expenses, well, 

Greg Stone: you can, or, or even the services that you offer, right. Or where you offer them. So if you're running your own business, you can determine that this item is selling more than this, or this food item is an order as much as that. And you can change your food prices.

You can change your ticket. You can add more people in the day. These are things that we largely can't do in healthcare. We, a lot of our, you Our delivery requirements and the cost of them are very fixed, and our [00:11:00] game in the business is to figure out how to survive in that, in that box, and it's increasingly difficult.

So there isn't an area in healthcare that isn't struggling right now. 

Jeff Holden: We all have our We're seeing hospitals close, which you would never have thought could happen. 

Greg Stone: They're very difficult businesses. I mean, it's, it has a different business profile than the outpatient service that we operate in, but it is such that you don't know who's coming through the door.

You can't control what is about to happen to you. You have a suite of services you have to keep ready all the time. And if the wrong pair comes through or too many of a certain type of thing come through, It could really decimate a very fragile bottom line. And of course, healthcare is one of those rare services that can't be automated.

And it just can't be replicated without people. It's a very people forward. And we hope so. We do. But it is, it is the vast majority of the cost of healthcare. [00:12:00] And increasingly, certainly after the pandemic, a career path that a lot of people are really taking a second thought about and the few people in the game can entertain a much better salary, much more than we can charge for.

Right. So that's the pressure everywhere. It's just a traditional supply and demand. 

Jeff Holden: I've seen that in particular specialties and specialists can't find them. They don't, they don't exist in the few that you do find. If they're good, you're going to pay exorbitant amounts just to get them to service the, the 

Greg Stone: Yeah.

Yeah. It is a traditional market pressures of supply and demand that we've seen coming for years that there just wasn't enough providers and allied services to cover our pending need. But the pandemic really flushed out all the people who were on the fence that push people into retirement that might add a few more years.

It took people out that were just starting. It, it made people change their mind about how much they want to invest in that. 

Jeff Holden: Yeah. 

Greg Stone: And, and the few people that are out there now really command a lot [00:13:00] of, of power in the market. 

Jeff Holden: As a clinic, do you have a little bit more nimble step as a result of that?

Because you don't have this massive facility and acres of property that gives you the ability to maybe shift a little bit or pivot based on what you're seeing as need. 

Greg Stone: Not really. Okay. I mean, and you, you know, we, we all have our fixed costs. Our, our plant costs are, are, are very limited relative to a hospital or a specialty service.

Mm-Hmm. . But it is commensurate with our, our reimbursement rates. You know, we are seeing primarily Medicare and Medicaid patients. 85% of our, our patient base are our, our paid for by the, these, these government programs. And they're very fixed costs and they're closely managed. Right. As, as we talked about the, the, the government looks at this as being.

You know, not a right necessarily, but more of a covered service to a certain point. And so there's a very firm line about where it begins and ends, how often you can [00:14:00] utilize it, where you go. So when we see things change in the community, as far as populations that are underserved, communities that are growing and don't have access.

It's really difficult to pick up and start something new there. There's not a lot of profit left to simply go build a new facility, open new services, expand into those areas. Our model is still really focused on treating people after they're already sick or injured. It's a treatment program, and we are paid a fee for every time we treat somebody.

The reality is that, you know, That healthcare is much more than just treatment of disease and injury. But we have no way to monetize that. The only way we can make money is to see people who have a need. And by then, it's already pretty advanced, it's expensive, it's going to start impacting the whole continuum of healthcare when we might have prevented that somewhere upstream with housing, with education, with food, [00:15:00] with behavioral health and substance abuse treatment.

All these things that impact people from having a healthy life. But there's no, there's no reimbursement in our fee for service model to do that, right? Unless you come into a hospital, as you come into a licensed clinic, we can't bill services and, and those are uncovered. 

Jeff Holden: But 

Greg Stone: that's really, I think the magic wand moment is, what is the solution?

It's finding a way to monetize The improvement of healthcare in your community without turning it into this, almost like supportment of wellness to Yes. It's maintain as possible. It's, and it's a generational change. Yeah. I mean, it's a, it's a commitment that's gonna require, you know, really many different political office elected officials and a long-term view of it.

We have a lot to undo. Mm-Hmm, . But just taking care of people who are sick is unsustainably expensive. And we're not really gaining on it in most cases. 

Jeff Holden: We got deep 

Greg Stone: quick. Yeah, sorry. No, no, but I think that's really 

Jeff Holden: helpful to [00:16:00] understand. Let's take a step back. You've got multiple locations in the Yuba County area, Marysville, Yuba City, Chico, Yeah.

Who is the community you serve? Who do you see most in the clinics? 

Greg Stone: So, you know, by race and ethnicity, those are pretty varied communities. And we're spread out through those communities. But as an aggregate, we are a reflection of the community. So, you know, most of those communities would be considered white, non Hispanic.

followed closely by, you know, Hispanic and, and all, all related. So then moving next, it's into, would be considered an Asian, whether that comes from India or peoples from Southeast Asia or the far, far East. But increasingly it's difficult to put a finger on it because we, we are becoming such more of that melting pot.

And so we see more and more people identifying as more than one race. [00:17:00] So this idea that there is some, like, like healthcare is related to your race or ethnicity isn't necessarily wrong, but it's difficult. to really verify any longer. So our business, since we take care of people who primarily don't have access to large commercial and very expensive health care, we take care of those communities that, that really reflect traditional poverty and neglect and, and, You know, in California, what, 40 percent of Californians are on Medi Cal?

It's a stunning number, over 15 million people. And in our communities that we serve, the Sacramento, Yuba, Sutter, Butte County areas, anywhere from, what, 25 to 29 percent of them are on Medicaid. It's a big swath of our community. These are people making just over 20, 000 a year to qualify for Medicaid.

That's pretty impoverished in California. 

Jeff Holden: Right. 

Greg Stone: They have a lot of needs, and health care is typically one of them. 

Jeff Holden: In those areas, because you were in [00:18:00] a highly agricultural area there, with a Sikh influence and certainly Hispanic influence, do you see a lot of the migrant population? 

Greg Stone: So, we have traditionally seen many of the same families come through in, in my farm.

Generationally? Yeah, somewhat. I, as far as our records go, but what I've seen in those communities is a decrease in what we would consider truly migrant farm workers, mostly because I think of the, the transition of the type of agriculture that's going on. They moved away from a lot of the people dependent fruit crops, 

Jeff Holden: the 

Greg Stone: peaches and the apples and the pears that required people to pick them and they were seasonally there and people would run through and do that.

And moving more into nut crops and rice and things that are very mechanical. So we see more resident farm workers than we do migrant in our area. I think it's mostly a reflection of that, of the change in agriculture. 

Jeff Holden: Is there a particular service that you see more prevalent than others? [00:19:00] 

Greg Stone: Well, we are at our core a family medicine provider, right?

So that's, that's full scope adult care as well as pediatric and adolescent care. So that is really the vast majority of our services. The traditional go see your doctor, whether that be for wellness or whether it be for illness or injury, your traditional family medicine doctors and nurses and, and allied practitioners are all our, our bread and butter.

Now, saying that, there's a lot of overflow that now that we have you, oh, you, you're also pregnant. And so, we have an OBGYN program, right? And you, you also need dentistry and you also need behavioral health and you also need your eyes checked. And so, over time, we've kind of grown from this core of just being the family doctor into more of a full service medicine for, a population of people who don't have access to many of those.

It's difficult with Medi Cal to walk into most communities and find someone who will, an optometrist who will take your insurance and do your exam and give you glasses. [00:20:00] Or if you're pregnant, where are you going to find a doctor to take care of you? So we have over time found ourselves becoming more specialized and insourcing a lot of the things that were traditionally outsourced, mostly because we have a constant demand of that, and it doesn't make a lot of sense to send people someplace else.

So, you know, it's, it's become a much more integrated program. And that's been our focus is once you become a healthcare customer of ours and you start to get the benefit of all these services. So you may come through a door because you needed some dental care or you needed revision checked. And now that we have you, we can introduce you to full healthcare and we screen you and we assess what you need.

and bring you into healthcare. I think it's a beautiful whole person care sort of a model that, that really benefits the people that, that come to community health centers where most private providers are very specialized in just what they do. And everything after that is probably your problem to go [00:21:00] find.

And that's increasingly difficult. to navigate. 

Jeff Holden: That's a beautiful opportunity though, because not only for you with the breadth and scope of service, because it helps offset expense, because some of those are more expensive than others. Yeah. But the other part of it is you really get somebody from head to toe.

Yeah. And once you've got them in the clinic, you now can see the entire body. You know, from eyes to mouth to, you know, organs and everything else, which has to be beneficial to that individual too, because it's unlikely they're going to go from specialist to specialist to specialist. They just won't do it.

Greg Stone: Or they can't do it. Or 

Jeff Holden: they can't do it, right. 

Greg Stone: And so, I think you're right. This, the way that we've really expanded our capabilities within the restrictions of what we do is to try and fit as many services into those health centers as possible or refer you to another one of our health centers nearby that do that or move it to telemedicine 

Jeff Holden: or 

Greg Stone: do a lot of things.

So, we are constantly trying to figure out where the gaps are in the community. [00:22:00] There are communities that we serve that, that might have good dentistry for MediCal patients or uninsured people. So we don't offer it there. And there are others that nobody does vision. So we have a big optometry. Right. We try not to duplicate services or compete with other providers.

But within our system, you have access to everything. And that's a unique part about being a patient at a community health center is that you, you do have access to an extremely deep pool of care. 

Jeff Holden: And is that typical with most? community health care centers. 

Greg Stone: It is. Yeah, increasingly. The more rural you are, the more isolated you are, the typically the more focused.

care needs to be. So, it's traditionally just family medicine and few specialty care. But, but in most cases, you know, even what we consider somewhat rural, some of our largest health centers are in, you know, very rural areas. And that's just because that population really does not have access to it. And so, we continue to grow and provide that.

And it's, it's a way for [00:23:00] For us to not let people fall through the cracks, we are trying to get people into a culture of care. I think a lot of people growing up in poverty really didn't have a opportunity to think about health care as being something that's just part of your day. And most of their experience is either when they're in extreme pain or they're in the emergency department and that, that's a lot of bills, that's a lot of, that's a lot of shame.

Let's 

Jeff Holden: avoid that at all costs. 

Greg Stone: Right. So it's, it, it's something that takes a long time to build. So as people come through the door for something, we try and now introduce them to all the other things that they're available to. And they don't, they're typically not aware that all these services are available to them.

Jeff Holden: You mentioned a couple of things in, in response to. The last couple of questions I want to approach. You have some really neat novel items, let's say, out there for health care service. You have the mobile vehicle for general health care and you also have the tooth mobile, I think it is. That's [00:24:00] right. If I'm not mistaken.

Yeah, we, we, we. Tell us a little 

Greg Stone: bit about those. So, you know. It's great to have a large community health center with lots of inclusive services available to your patients. But there are still parts of the community that just can't get there. There are still people living in your community that, that can't access your care through transportation or availability or work or daycare, what have you.

So the next step is trying to take core services into communities where the people are during the day. And so our partnerships, like an example being our mobile dental program has been going on for over a decade, is a partnership with the Marysville, Marysville Joint Unified School District, the Yuba County First 5, and Peachtree.

where we all pool our funds and staff to, to bring full service dental care to all the elementary schools in, in the Yuba County area. That's wonderful. So, we are the first dental visit for the vast majority of children [00:25:00] under five in, in Yuba County. And it happened for years. And, you know, those are patients who, who typically don't engage with dental care until they're in pain.

Jeff Holden: Uh huh. 

Greg Stone: And then they have a lifelong fear of dentistry. Uh huh. 

Jeff Holden: This is a way for us to experience is a horrible it is and 

Greg Stone: it's in and their parents are afraid of it Yeah, and it's a whole we got to break the cycle by having them go to school someplace safe I have the school endorse and bring them into the clinic and then we take care not only proactively but we have a full Surgical availability there to a lot of education and outreach and it's a good example of you know A service where beyond just taking care of the immediate need You We send children home every day with the first toothbrush in their family.

That still happens. 

Jeff Holden: You know. That is hard to believe. 

Greg Stone: And their family. First, 

Jeff Holden: second, third, fourth, whatever grade. 

Greg Stone: Yeah. It just, it wasn't part of, of their family culture to have self [00:26:00] care and dental care. It was emergent. They had problems. You'll have problems. People have problems. So. You know, when you think about the barriers to care, just to start with, they've never, never had toothbrush and no one's ever showed him how to brush their teeth in their language.

Or they can't see the chalkboard, but never complained because They don't take them to the eye doctor because there really isn't an eye doctor and, and they suffer unnecessarily with vision loss. So 

Jeff Holden: what I'm sure it translates to hearing to all these things, you name it. 

Greg Stone: And so what we try and do is find areas of our community.

School's a good example where they, they know the children that, that struggle with staying in school. They know the children that stay, that struggle with improving in, in school or paying attention at school. And oftentimes it's because they're hungry. or they have mouth pain, or they can't see the board, or they don't understand the language.

And these are things that just go on and on without anybody recognizing it. [00:27:00] But we interact with the schools for those referrals and oftentimes bring those services to the school. We vision screen there, we do dental care, we have behavioral health embedded in schools and try and capture that early. And they start to turn that around, make it safe, make people feel like, make these kids feel like they're someone that's, that's listening to them, solving some of their problems and ultimately setting them up for hopefully a lifetime of trusting healthcare and engaging in proactive healthcare and not just reactive.

Jeff Holden: And not to mention that also gives them the familiarity with you. Right. You know, with Peachtree as a service that's provided in the community so that student takes it home, mom and dad get sick, somebody gets sick, gets hurt, whatever, they tend to be the ones that lead because they're. It's true. Language is better.

And then they can, you know, navigate the system in some way, shape or form. 

Greg Stone: You know, there, it's very common to have a child referred to us for, for vision services, for example, and we, we're the [00:28:00] largest Medicaid eye provider of, in Northern California. And we have services all over these areas, but people are referred to us for eye care and the, the, the, when the children come in, they bring the whole family.

Because the family doesn't really understand what's about to happen. 

Jeff Holden: Right. 

Greg Stone: They've, none of them have been to the, you know, maybe multiple generations are together. And while you're 

Jeff Holden: here, let's take a look at Let's all take a look. Let's all sit 

Greg Stone: down. And these are, these are kind of scary machines. These are kind of dark rooms.

Yeah. What are we doing? There are language and cultural barriers to overcome. So we try and take the time to get everybody into the room and, and have everybody look through what the child's looking through and see what it looks like. Okay. and ultimately give their permission for us to care for their child, but also start thinking about mom, why don't you sit down?

Why don't you, you know, and, and it's not just, The vision loss and I have unclear vision. It's more and more just, you know, eye disease due to Diabetes and hypertension and things that are impacting their family that they thought is just something that happens in their family They [00:29:00] didn't know they were preventable 

Jeff Holden: and who would think I would imagine Glasses are not unfamiliar people see it.

They watch television, but to think for me Well, I, I, it has to cost a fortune. I can't afford that. 

Greg Stone: It's luxury. 

Jeff Holden: Right. 

Greg Stone: Yeah. 

Jeff Holden: It gets us into the next question of funding. We'll be right back with Greg Stone to learn a little more about how the organization is funded right after this message from the people who make the program possible.

I was in the media business for over 35 years and had the great privilege of working with Runyon Saltzman, RSE, Marketing, Advertising, and Public Relations. We collaborated on many different campaigns, but their commitment to the nonprofit sector hasn't changed since their founder Gene Runyon started the agency.

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Scott Thomas: Hello, this is Scott Thomas with CAP Trust in our Sacramento office. I specialize in working with local nonprofits and associations. Annually, we survey private and public nonprofit organizations across the country to better understand challenges they see in today's environment.

In our more recent survey, we heard concerns about proper board governance, mission aligned investment, and how to implement alternative investments. If you would like a copy of the survey or to discuss your organization, look me up, scottthomasatcaptrust. com. 

Jeff Holden: I'm thrilled to have Western Health Advantage partnering with us as they do so much to support so many non profit agencies in our community.

As a truly local health plan, you'll find individual and family options, employer options, plans for CalPERS and Medicare [00:31:00] Advantage. From medical services to pharmacy, health and wellness support, as well as behavioral health care, Western Health Advantage has a plan that fits what you need. As an employer, for profit or non profit business, you'll

How are you funded? Because a lot of the people you are dealing with are, you know, Medicare, Medi Cal, and some sort of social service. And we talked about the challenges of that. Is it just government funding, or do you have access to other? sources. 

Greg Stone: So it's a big bucket, right? So the short answer is most of our revenue comes from billing for services, right?

So we accept dozens of commercial insurances. We, we accept all patients without the ability to pay for their care. So we have the ability to completely waive their care. We have the ability to give them an affordable sliding fee for their care. We meet them where [00:32:00] they're at. So, when you think about providing an eye exam and it's, it's not just I'm billing Medicaid or Medicare, but it's all these different commercials.

Maybe it's some out of pocket cost for somebody that's uninsured that could pay for it. Or maybe it's someone who has no ability to pay for their care. So you know that our actual cost per eye exam. I care visit. It really varies depending on who walks through the door and what community we're working in 

Jeff Holden: and the severity of whatever the I care is, 

Greg Stone: you know, but it, you know, in our, our reimbursement for that, whether we spent 10 minutes or an hour with you is the same, it's just the way the system works.

Over 80 percent of our revenue comes from that process of just reimbursement fee for service, right? So I'm gonna, I'm gonna bill some program for that care I just provided. Beyond that, we are a non profit. So we, we do have the opportunity to apply for large grants and corporate giving that you. allow us to provide services that are otherwise unfunded.

We also receive a federal grant as [00:33:00] part of our designation to help offset some of the cost for people who can't afford their health care, but we, we overrun that by millions of dollars every year. So it's, you know, when you think about operating a business, any business where any customer can walk through will never be denied, but you are not sure how much they're going to pay you for that service.

It could be anywhere from, it could be nothing to full price. And you have to think about kind of what services you offer and how often you offer them. And it's a difficult part of the business, but the reimbursement is, is the biggest problem to work within. And it's actually the biggest limitation because it focuses you into areas where you can generate billable visits with patients when really the need might be somewhere else but is, it's unfunded, right?

And it's one of the traps of healthcare, the way we've designed it. So, you know, we do the best we can within that, but there's no way of getting out of the, the [00:34:00] business of seeing hundreds of people a day in a very traditional medicine way. 

Jeff Holden: Tell me a little bit about your healthcare team. How many people do you employ?

Okay. Peach 

Greg Stone: will be probably about 280 employees at the end of the year. We are a growing organization right now. We also enjoy long collaborations with other contractors and other service providers that aren't direct employees. So there's many more hundreds of people working on our behalf to do that.

But, That's our clearly our number one cost is people. We're, we're a people business. It's people providing services to other people. So their, their salary and benefits is, is our increasingly difficult problem to solve. 

Jeff Holden: You mentioned telehealth, telemedicine. And I'm imagining in the channels that you're serving that could be difficult because they may not have access to a computer or internet or wireless.

They do have a cell phone. What percentage do you see starting to gravitate [00:35:00] to telehealth in some way, shape or form? 

Greg Stone: You know, the, all forms of telemedicine, whether it be just a telephone or, or video audio really was something that we could not do for money prior to the epidemic. So after COVID, there was such success when the states kind of waived the rights to telemedicine so we can actually reach out to our patients by phone or by, by computer.

Jeff Holden: I didn't realize that, that was the transition point. 

Greg Stone: Medicare had a small window of opportunity to provide services through telemedicine, but it was very defined and difficult to manage. But Medi Cal did not allow it in most cases. So in this case, they've kept that in place because they saw such a dramatic increase in access.

And, and certainly with people who previously weren't accessing healthcare, whether they live too far, they never have transportation, they might be disabled, they don't have help, but any, any number of things. So we have really taken a look at that over time and, and realized that there's a large portion [00:36:00] of our patient base who really only want to receive their healthcare through some telemedicine service.

So we've been progressively adding that to our program. Starting initially with behavioral health, where, you know, a telephone call with your therapist is, is, is very therapeutic and very helpful and, and, tremendously more impactful than getting up, getting dressed, going into a community health center and sitting in a waiting room and dealing with your anxiety and your depression in public and all those fears.

So we, we saw a lot of our patients gravitate and stay with telemedicine. We have since really invested in this idea by expanding those services quite a lot in the last two years. We now have a large team of physicians who only work in telemedicine. Many of them don't live in the state and are licensed here, but they live elsewhere.

And, and we have a whole team that just connects people to telemedicine care, both same day service and, and scheduled services. And some people who their, their primary care doctor is [00:37:00] remote. And that has brought so much relief to, to areas of our community. We just haven't been able to touch. It's, it's an area we keep expanding.

The telephone still is the main way to your point. 

Jeff Holden: Mm hmm. 

Greg Stone: Pulling up an iPad and having an audio visual experience with your doctor is, is something that is pretty far out of, out of most of our patient's grasp, but a telephone isn't. So we have a lot of good interactions with, with telephones. It's flexible.

People can be in their car during the lunch break. They can go, you know, go in the bedroom at home and have some privacy and, and that those are access barriers now. And so they've been overcome. So we continue to invest in that. Our mobile services, we have other mobile services that, that go out in the community that have behavioral health and, and medical services embedded in them.

They also have telemedicine. You might be in a very remote area. You can still see a specialist. You can still see somebody at the health center, even though your provider isn't on the van that day. We are starting a program of putting full telemedicine [00:38:00] kiosks into key areas in our community where people often aggregate, whether it being a homeless support area, a coordinated housing, schools.

And, and then patients can come on a scheduled time and, and have a full telemedicine visit with us, video and audio. And it really is starting to break down those barriers of, I just can't get there, which is increasingly the, the, the, That's the main problem to solve for us. 

Jeff Holden: But what a beautiful way to minimize some of the, if somebody puts something off, it only gets worse if they know that they can make a call and maybe it's just an antibiotic or something simple that can be taken care of before they get in and find themselves in the ER.

That's right. That's, and it's, they become more and more familiar. I would imagine they get more and more comfortable. and family members, somebody calls for the other family member, whatever the case may be. Yeah. To catch it before it gets to a point of. 

Greg Stone: We, we send patients home with self monitoring devices for blood pressure, for [00:39:00] blood glucose, and some of those are uploaded directly to our computer every morning, others they record.

Perfect. And so, when we see a problem, we can call them or have a, a doctor call them and say, Hey, are you taking your medication or what's changed with your diet? And, you know, you can have a, the conversation you would have in an exam room. 

Jeff Holden: Yeah. 

Greg Stone: Patients that don't show for a scheduled appointment in the clinic, they get a phone call saying, Hey, we expected to see you at three o'clock.

And, and they say, sorry, I couldn't get off work or I couldn't get daycare or my ride didn't show up. Right. Well, can we, can we talk? Can you talk to your doctor right now by the phone? Sure, and we just get them on the phone and they get most of the work done. You know, checking in, is that working? How are you feeling?

You know, do the headaches go away? Did the rash resolve itself? 

Jeff Holden: Yep. 

Greg Stone: And if they need to come in and they need to get a vaccine, they need to take a test, they can come in any time to one of our clinics and see a nurse without an appointment. And then now you have the complete. So, we're trying to decouple this idea of health care only happens in exam rooms at scheduled times.

And we're trying to meet [00:40:00] people with, with restrictions, kind of where they're at with still providing a high quality service. And increasingly, it's the biggest growing part of our business. 

Jeff Holden: That's great to hear. 

Greg Stone: Yeah. 

Jeff Holden: Last two questions. First one's big picture. Okay. Money's no object. What does it look like?

Greg Stone: Wow. So, I think I would go back to that idea of uncoupling your healthcare from the restrictions of your life. insurance or government program, right? So, if you come to my clinic, I can't see you for two or three things at one time, only one of the things. I can't see you two times this week because I can only see you twice a month.

Because that's 

Jeff Holden: the way the reimbursement works. Because that's the 

Greg Stone: way the restrictions for whatever program that is. So the best thing would have been that it's hard for you to get to the clinic. But when you get there, you are going to be screened by the nurse. They're going to check all your vitals.

They're going to check all your, your testing. Your doctor's going to have that information before they see you. And while you're there, you're [00:41:00] overdue for your eye exam. And also we're going to get you this booster that you're overdue for. 

Jeff Holden: And by the way, you had a cavity the last time we couldn't take care of it on time.

That's right. So 

Greg Stone: if you can spend an hour and a half, two hours with us, we can do two or three services with you and, and get it all done and have a full picture of your whole health right now. Like, wow, you're, you came in just for an eye appointment, but your eye pressure is so high. You need to see your doctor or.

You're overdue for your podiatrist, that's part of your diabetes care plan. And so we can do it right now. And we struggle with that and we try and pick the most important thing for them to come in for and, and, and work it out. And it's a, it's really not an ideal way. So if money were no object, I would do the first thing, which is to uncouple the services from these reimbursements and do the right thing when needed.

And the next part would be to not rely on this, this fee for service barrier for reimbursement. And so now I can, I really can have, have healthcare. I can meet you at school. I can meet [00:42:00] you at work. We can really have some robust healthcare. I can provide high speed internet to your community. I can do all sorts of things that connects you in a way for 

Jeff Holden: mobile vehicles.

Greg Stone: There could be any number of things that. I think building more clinics and offering more of that traditional service to just see more visits is a trap. I mean, there's, there's just not enough people to do that long term. We have to find ways upstream to, to prevent the illness that's, that's impending, right?

And a lot of it's just through education and, and just access and early screening. And certainly our access, you know, getting young, Children and adolescents is one of our main focus right now as far as making sure that they have really good service and really good connections with health care so that hopefully in the rest of their life, they seek it out, and they don't shy away from it.

Yeah, for 

Jeff Holden: their families as they grow up, but even for the generation above them that's at home to see, that's, that's a big deal. The benefit that I see that collaboration with the schools is so [00:43:00] huge. 

Greg Stone: It is. 

Jeff Holden: To, to integrate and start early, especially since every parent has a concern for their child too.

Greg Stone: Yep. 

Jeff Holden: And they don't want to see their child in pain, so they're going to be supportive of whatever that is, even though it may be frightening to them because they haven't experienced it before. 

Greg Stone: Yeah, and they don't know what's offered to them. Right. I mean, a lot of people come to us thinking that they have no ability to pay for health care, but California is an amazing state to be in, in a way of accessing services.

Medicaid is very accessible, and there are a lot of other services around it that, that are little to no money that most people fall into. You know, The bucket of, of patients in our communities that is truly unable to be covered by any sort of program is increasingly small. In other counties in California, it is a big burden.

But in our region, we've really been able to impact that. And so, it's just letting people know, it's like, this isn't, this is free to you. Right. Or this is covered. Or you don't, don't worry. And you can also, you can also see the dentist and you can also see the doctor. And, [00:44:00] and so. I think we try and use that idea of whatever door they come through is to now kind of be an ambassador to whole person care and think about this.

So, if you come in for a dental exam, we screen you for depression. 

Jeff Holden: Mm hmm. 

Greg Stone: It's just an opportunity we may not get again. And oftentimes, you know, we, we capture a patient now that didn't know that they can be connected to a therapist. 

Jeff Holden: Yeah. 

Greg Stone: So, we try and, and, and couple these things in, in, in ways that, that grab people when they finally do engage.

Mm hmm. And whether that be at school, don't let go. Yeah. And then, you know, and then increasingly we're We have staff outside of our health centers who are, who are managing those, those very delicate cases. Those people who are transitioning from the hospital to home or that are always in and out of care or in and out of homelessness.

We have people who track and follow them and make sure that they don't completely fall down and we can get them back. You know, housing becomes something we provide, you know, food is something we provide, we [00:45:00] run our own pharmacies. Is that true? 

Jeff Holden: Through collaboration with other entities and organizations in the community?

It is. It is. Both 

Greg Stone: to ourselves and through others. We work with Habitat for Humanity. We work with all the counties as far as integrating those programs. And I, I, it's, you know, from our patient standpoint, I'm hoping it's feeling more seamless as they are in their most vulnerable time. 

Jeff Holden: Right. 

Greg Stone: Right. They get handed off really carefully between these agencies and, and we get people that are referred up and we refer people out.

And ultimately, the success stories happen all the time of just someone who needed a lift. A good example of that is right now, one of our big initiatives is to, to work on the transition of people leaving incarceration in California. There's a large number of people who, who leave jails and juvenile hall that just fall back.

into the community without really following on to their, their healthcare. So we are entering into a contract with Yuba County right now to receive all patients, all people that come out of [00:46:00] incarceration and screen them, work with coordination of care, make sure they have housing, make sure they have jobs, make sure they have the behavioral health, make sure we continue their healthcare.

Well, it's, they are Medi Cal eligible. And the state is really pushing to try and solve this problem. So we are trying to connect them, let them know that we're here. Oftentimes when people go into jail, it's the first time anybody's ever treated them for their disorder. They're often dealing with a substance use disorder that they could relapse with.

They have anger issues, they don't have a place to go, they don't have a job. These are all things that we want to figure out. and ultimately be a net for them when they leave. 

Jeff Holden: So, And that is done in collaboration with the other, It's yeah, non profit agencies that recognize those. And it's the county and 

Greg Stone: Yuba County Sheriff and probation departments.

And that's fabulous. You know, we all meet together and we case manage these people and, and find the pockets of the community that need help. We work with foster families and, and family services. These are marginalized people in our community who [00:47:00] don't have access or the wherewithal to help themselves.

It's a very vulnerable time. But if with a little bit of help and hand holding, they fall right back into society. They fall right back into care and they get their kids back. They don't go back to jail. They get healthy again. They quit their addictions. That's what we all want. But it's not the traditional model of come to the clinic and see your doctor.

So, finding ways to pay for all that is the challenge right now. Those are the problems to solve. 

Jeff Holden: The offset is far greater. Finding the solution to that today is far better than the continued issue that would happen, whether it be, you know, the crime, the abuse. Absolutely. You know, just all the conditions that happen.

When that doesn't get handled because it was too expensive to do the first time. 

Greg Stone: It was and they were looking at one thing. Right. You're incarcerated, right? They have a duty to do while you're there but then they put you back out and you're, and you still have a mental health disorder. You still have a substance use issue or [00:48:00] you still have an anger problem or you don't have a job or a place to live.

And so what are you going to do? Right. you're going to re offend. Right. And um, so, you know, these are, these are long term goals. I mean, these metrics aren't something we can measure on a monthly basis. These are societal problems and long term, but we are now like finding ways to, to find the pockets of people who are just traditionally underrepresented and to find a solution for that.

And that's, what's exciting about. This part of healthcare is that, you know, that myself and the people that, that work in community health centers, you know, I think we, we all firmly believe healthcare is a right. And so when you think about healthcare through that lens, it really frees you up to find new creative solutions.

And if it's a, just a business model, then it really restricts your thinking about what you can and can't do. I've been in healthcare for over 30 years. I've done a lot of things. I've worked in hospitals. I've worked in private. I've done an emergency care. This really feeds me. Mm-Hmm. . This really feeds my company's employees.

People [00:49:00] come to work in this, this organization or organizations like ours because we make real change, right? We solve intractable problems. Mm-Hmm. . And, and they have an opportunity to go work somewhere else, but increasingly we're finding the few people we need are showing up when needed. And so we keep growing.

Jeff Holden: Well, you just brought the opening salvo all the way back, you know, to a, to, to a, a beautiful close because. If the person is healthy, the community's healthy, and what you're doing, you've got mobile medical clinics, you've got 200 plus employees, mobile dentistry, eye care, mental health services, and a concentration of where your people need it the most, and you're feeding it back into the community, not only from a health perspective, but from a functional perspective.

You're talking about jobs, but you're a clinic. Well, you know, that just. I think that screams volumes of where the, the capabilities are, what the future could look like and, you know, for what you're doing. and, and [00:50:00] how you're benefiting the communities. You know, I, I applaud you. I applaud you and your team and the doctors and the way that it's being taken care of.

And I can see the sincerity in the conversation of how you really want to change this. And we need that. 

Greg Stone: Yeah. You know, 

Jeff Holden: we need that. So, so thank you for what you're doing and. Oh, 

Greg Stone: I appreciate that. We 

Jeff Holden: appreciate it. 

Greg Stone: Yeah. It's changed. It's changed my outlook, uh, the way I look at my community. I wish I'd found health centers earlier in my career, quite frankly.

But it was a great awakening. And when, when I look in my waiting rooms or see people leaving my health centers, I see representatives from all over my community. You know, it's, it's, Most healthcare in, in America is tied to someone's employment and increasingly that's difficult to get. So you can be well employed and be completely healthcare impoverished.

So we try and have that net for everybody. And yes, we'll see the homeless. Yes, we'll see the incarcerated. And yes, we'll see the people in business suits and, and coming in on their break from Starbucks and all those things. It's, [00:51:00] we are serving the community without any stigma about where you come from.

We, we translate over 20 languages. It's, it's just, it's a beautiful thing and it's, and it's working. I mean, I, I would hold our clinical quality outcomes up against anyone. I get my healthcare and my health centers. So it's, it's, I think how health healthcare should be delivered. 

Jeff Holden: And I see the pride in it, which it just, it exudes.

And it's wonderful to see it thinking, give us all hope that there are solutions. There are. conditions that can be met. There are ways to work and it's collaborative. There's not silos that work. You know, we have to expand into the community. So again, thank you. And I'm so glad you were able to come in.

Greg Stone: Yeah, my pleasure. Thanks for having me. 

Jeff Holden: Appreciate it.

Thank you for listening to the nonprofit podcast network. I hope you enjoyed the episode. If what you heard moved you, please reach out to that organization and do what you can to help. [00:52:00] If you like and appreciate what we're doing to support local nonprofits. Please give us a positive review, subscribe, and share.

If you're a non profit with an interest in participating in an episode, you can reach me at jeff at hearmenowstudio. com. If you have a need for the services or products our sponsors offer, please reach out to them. CapTrust, fiduciary advice for endowments and foundations. Runyon Saltzman Incorporated, RSE.

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