As California struggles to implement the Coordinated Care Initiative to improve the health of some of its most expensive patients – “dual eligibles” who qualify for both Medicare and Medi-Cal — Robinson recalls similar efforts in San Mateo County two decades ago.
“We were trying to do that back in the 90’s,” says Robinson, a longtime aging advocate who is now the chief financial officer for the Health Plan of San Mateo County. “We were trying to arrange a coordinated effort.”
San Mateo County is well known for its leadership in such collaborations, and Robinson is essential to that legacy.
Raised poor among several Spanish-speaking friends in the Imperial Valley on the Mexican border in southeastern California, Robinson secured college scholarships and earned his Masters degree in Rehabilitation Administration from the University of San Francisco with this mantra: help others.
Four decades in health-related services — 35 of them in San Mateo County — culminated in a reward normally given to those who have died or donated plenty of cash.
The Ron Robinson Senior Care Center opened in 2004 as part of the county safety net San Mateo Medical Center.
“My overarching motivation was always advancing health care and creating access in underserved populations,” says Robinson. “With the aging of San Mateo County, one natural arm of that was increasing home and community-based services, and services in general to our ever growing senior population.”
The center is that rare breed — a safety net clinic that serves the complex needs of older adults.
It’s one piece of a larger puzzle that fits perfectly within a county known for its collaborative efforts and a seamless “no wrong number” policy between the county and its sole health plan, when others typically juggle two or more.
Not surprisingly, San Mateo County has enthusiastically joined the Coordinated Care Initiative pilot program.
Besides five physicians, two nurse practitioners, a social worker, podiatrist and two behavioral health workers (a psychiatrist and psychologist) the center is within a campus that houses the county’s Aging and Adult Services, In-Home Supportive Services (IHSS), Multiservice Senior Services Program (MSSP), and Adult Protective Services.
“We’re all part of the same campus, we’re all part of the same health system,” says Dr. Susan Joseph, the center’s supervising physician.
And it’s a godsend to the area’s low-income, ethnic elders who visit this safety net for older adults in a county where 1 in 10 residents are at or below the federal poverty level.
“For a lot of our folks, it’s really frightening to go to the doctor,” says Joseph, citing the county’s wildly diverse immigrants who speak Mandarin, Cantonese, Tagalog, Hindi, Russian, Vietnamese, Arabic, Farsi and various other local dialects. “They’re often visually relieved when I tell them ‘You’ll come back to the same place with the same staff.’”
For the past 20 years, Georgette Poggi has brought her mentally disabled brother Adolph to the center. Suffering from schizophrenia and a lack of myelin (brain protein), Adolph has extensive physical and behavioral health needs.
“They’re really good in every way,” says Poggi, praising Dr. Joseph in particular. “Any problem you feel like you’re not getting the answer to, even overtime after 6:00, she’s willing to talk to you to make sure everything you need — my brother needs — is met.”
After hours, Joseph once pleaded with Poggi “Please bear with me, I’m consulting with another doctor.”
A physician asking a patient to stay past closing time?
“She never complain about (my brother),” says Poggi. “She take the time. She never fail you.”
Another key to the success of the Ron Robinson center is the interdisciplinary team meeting, which happens twice monthly. The meetings include all of the clinical staff along with members of Aging and Adult Services, Adult Protective Services, the Older Adult Mental Health Services (OASIS) and several community service partners.
“We know each other,” says Joseph. “It creates a really different relationship. It creates a level of trust.”
During its last fiscal year, the center served more than 3,000 patients with over 13,000 visits. Over half of its patients were Latino (60%), 14% were white, 11% Asian, 7% Filipino, 14% African-American and 2% Pacific Islanders.
Providing care in 12 exam rooms for those over 60, most of its patients are over 65 and “dual eligibles” — receiving both Medicare (over 65) and Medi-Cal (low-income) assistance.
The clinic’s ultimate goal is to keep patients healthy and living at home, rather than in far more expensive nursing homes.
Given its success, why aren’t there more clinics like it?
Because it’s complicated medicine: time-intensive and expensive.
Joseph says an older adult clinic in the Willow Glen neighborhood of San Jose folded near two decades ago. And Kaiser Permanente had planned a geriatric clinic in Redwood City, but it never got off the ground.
The only other Bay Area clinic like it is in Berkeley — the Over 60 Health Clinic.
One family moved its 90 year-old mother to Ron Robinson because she suffered from various chronic diseases as well as encroaching dementia. Her cardiologist’s attitude: “What do you expect? She’s 90 years old.”
After Joseph’s initial examination, she was able to remove the elderly woman from many of her medications. Her health improved significantly.
“We spend a lot of time with people,” says Joseph. “There’s a lot of working with the family as well.”
While Medicare patients can choose from physicians anywhere in the country, the center is a magnet for older adults wanting more personal care. Even some patients who have private health plans — without government subsidies — choose to come here.
“You have a group of people here who are committed to geriatrics,” says Patrick Grisham, clinic manager. “And they could be doing a lot of other things.”
A small clinical team also visits Daly City once a week to serve north San Mateo County; funded by a new grant, a second team will soon visit Redwood City 1.5 days a week.
What makes the Ron Robinson Senior Care Center a success?
“There was a vision, it was supported, and we carried it out,” says Grisham. “And we’re still growing as of this day.”
Robinson himself remains modest — even somewhat embarrassed — that the center bears his name in appreciation for his lengthy service.
“I was just an eager participant with many other talented people,” he says.
Yet the Ron Robinson Senior Care Center fits perfectly with his youthful goals.
“I always wanted to be in a career that gave back.”