Capital Region Cares Capital Region Cares 2017-2018 | Page 57

n
Opinion
Whole person Health care
BRITTA GUERRERO, CEO, SACRAMENTO NATIVE AMERICAN HEALTH CENTER
O
scription. Patients are interviewed, at which time barriers
to positive health outcomes are identified, such as lack of
stable housing, unreliable transportation, language access,
food insecurity and Medi-Cal eligibility. Through the iden-
tification of these barriers we are able to assist with program
eligibility and guide patients toward long-term stability.
At SNAHC, health care is respectful of the whole person:
physical, emotional and spiritual. Our approach includes
integrated and comprehensive behavioral health and sub-
stance abuse services. We now host one of the largest com-
munity dental clinics in Northern California and are open to
patients six days a week.
In the primary care environment, we have been able to
diagnose serious medical conditions, like cancer, that would
otherwise have gone undetected until it was too late. Our
staff has saved lives, offered life-changing options to pa-
tients with substance abuse issues, and addressed medical
and dental problems early, before they became major health
issues. We have kept dozens of patients each month out of
hospital emergency rooms. Is this entirely due to the Afford-
able Care Act? No, but it has certainly helped.
However, there have been unique challenges. Change
is hard, and rapid change can be excruciating. But we in-
creased our workforce significantly and were identified as
one of Midtown’s largest employers and fastest-growing
companies by the Sacramento Business Journal in 2016. We
have since expanded, and developed key partnerships with
hospitals and other organizations.
As Congress moves to repeal and replace the health
care law, we are in a holding pattern. A full repeal of the
ACA — without a replacement that keeps our patients cov-
ered — would stop our growth, reduce our ability to provide
these necessary services and further strain our resources. It
wouldn’t be the first time we’ve had to decrease our scope
of practice because of changes to Medi-Cal. In 2009, Califor-
nia lawmakers cut dental and behavioral health services to
Medi-Cal beneficiaries, with near catastrophic results. It has
taken several years to get our new patients into our new sys-
tem and they are finally responding.
We have come so far. To turn back now would be abso-
lutely heartbreaking. We will survive, but I can’t help but
worry about what will happen to our patients. n
comstocksmag.com | 2017 CAPITAL REGION CARES
n March 23, 2010, President Obama signed the Afford-
able Care Act. I was on the phone with my dad; we were
witnessing history together. Not since President Lyn-
don B. Johnson signed into law the bill that would eventually
become Medicare and Medicaid had we experienced such a
monumental healthcare shift.
It was overwhelmingly important to me because of my
role as the CEO of the Sacramento Native American Health
Center. SNAHC is an urban Indian, nonprofit and federally-
qualified health center, located in Midtown Sacramento. We
are committed to enhancing quality of life by providing a
culturally-competent, holistic and patient-centered contin-
uum of care. There are no tribal or ethnic requirements to
receive care here, as we see ourselves as a gift from the Na-
tive American community to the Sacramento community
at-large.
The day after the bill was signed into law, we hit the
ground running. I read the new Affordable Care Act over and
over. What would this mean for us? How would we prepare
for all of the newly eligible patients? How would we build a
system of care to support them? What would come next?
Medi-Cal, California’s version of Medicaid, ballooned
from covering 8.6 million people three years ago to 13.4 mil-
lion now — more than a third of the entire state population.
Patients can either buy insurance plans through Covered
California, or are able to join Medi-Cal since the law in-
creased the Medi-Cal eligibility to 138 percent of the federal
poverty level in 2014. Today, 35 percent of Sacramento’s pop-
ulation is Medi-Cal dependent. This is a big deal.
SNAHC opened its doors in January 2007. Since the Af-
fordable Care Act was authorized in 2010, we have expand-
ed and grown continuously to meet our increasing patient
population. Recently we expanded our primary care center
to triple its pre-ACA size. We have added specialty care, in-
cluding optometry, podiatry, chiropractic care, a pediatric
residency training program in partnership with UC Davis,
Women Infants and Children services and CalFresh enroll-
ment office.
For the first time in my professional career, we are seeing
patients who had never received care outside of an emergen-
cy room. Many haven’t seen a doctor in more than a decade,
let alone made an appointment to establish care with a pri-
mary care provider. We have patients arriving with multiple
uncontrolled conditions, including hypertension, diabetes
and undiagnosed behavioral issues. We designed a system to
care for them, and it was scary and wonderful.
When dealing with issues of concentrated poverty, pa-
tients require more than just a physical exam and a pre-
57