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Gardner in the San Jose Mercury News

Thursday, June 26, 2014
Reymundo Espinoza, CEO

Published by the San Jose Mercury News on June 23, 2014.

Health care challenge: Medi-Cal insurance doesn't guarantee access

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act. Expanding Medi-Cal is one of the important ways the ACA increases access to health insurance, but providing insurance does not ensure health care will be available. It's important to understand the facts related to access to health care in our state.

Thankfully, California is one of the states that committed to expanding government coverage for the poor and uninsured. At this time, the number of Californians served by Medi-Cal is increasing and approaching one-third of our population, or 10 million. Unfortunately, reimbursement rates for providers who serve the poor are declining drastically.

For this and other reasons, the number of primary care and family practice physicians who accept Medi-Cal is decreasing. Private and community hospitals are also consolidating or closing, reducing the supply of Medi-Cal beds. Emergency rooms in the remaining facilities are filled, frequently with nonemergencies. All of this underscores the fact that providing insurance does not guarantee access to health care.

We have the perfect economic storm of increased demand and reduced supply. In normal environments, this would lead to higher prices. However, that option clearly does not exist as the primary payer, the government, is not prepared to pay more.

It's also important to note an estimated 13 to 15 percent of Santa Clara County residents, or approximately 220,000 people, will not qualify for government or other insurance, including Covered California plans.

Community health centers are an essential part of this impending crisis. They have always made serving underserved communities their primary focus.

Centers in Santa Clara County provided approximately 450,000 patient visits to 166,000 patients in 2012. The vast majority of those patients were covered by Medi-Cal.

Gardner Family Health Network and other centers don't turn down patients who use Medi-Cal or lack coverage. Rather, we welcome all regardless of income, immigration status, or ability to pay. We are, however, limited by capacity.

In Santa Clara County, we must increase awareness of the essential role of community health centers and improve our ability to meet the growing demand for services.

To expand and improve service delivery, we intend to strengthen our partnership with Santa Clara Valley Health and Hospital System to coordinate and implement a system of care for our most vulnerable. This includes sharing data and helping to develop a patient-centered "medical home" concept, which is designed to coordinate a patient's care among multiple providers.

 We will also collaborate with government and community partners to expand access and improve quality of care for medically underserved communities. These include immigrants, the working poor and the large homeless population of Santa Clara County.

We also will continue efforts to educate decision-makers, community-based organizations, and the general public about the impact of the ACA.

Community health centers such as Gardner are working to reach more underserved communities and continuing to improve already high-quality care, while saving taxpayer dollars. They are a proven solution for a nation searching for better returns from the health care delivery system.

As such, they deserve greater recognition and community support.

Reymundo C. Espinoza has been CEO of Gardner Health Services for 24 years.

Gardner Provides Integrated Behavioral Health

Thursday, May 22, 2014

Integrated Behavioral Health (IBH) is a program funded through the Santa Clara County Mental Health Department that is designed to help patients improve their mental well-being. Dr. Susanna Farina, Gardner’s Behavioral Health Coordinator, oversees the program.

At Gardner, we feel it's very important to have a healthy mind as well as a healthy body. Research has shown that physical and mental health are fundamentally linked. For example, it's common for people who are dealing with a chronic condition such as diabetes or heart disease to feel stressed and anxious. Over time, they can even become depressed. Conversely, people who have experienced trauma or have depression or anxiety may also experience deterioration in their physical health, especially if as a result they engage in unhealthy behaviors such as smoking, excessive drinking, or recreational drug use.

Unfortunately, there is still a great amount of stigma around mental illness, and it is especially strong within ethnic communities from which the majority of our patients come. And as Dr. Miguel Valencia explained in his blog Pioneers in Latino Mental Health, these communities have traditionally have had difficulty accessing treatment for mental illness.

For all of these reasons, we began the Integrated Behavioral Health program at Gardner’s St. James and South County clinics. In IBH, behavioral health clinicians work with primary care providers to identify patients suffering from mood disorders such as mild depression or anxiety, or the impact of trauma. For example, a patient might be having trouble managing their diabetes despite having the right medication and other medical services. In talking with the patient, the doctor comes to understand that the real issue could be that she is depressed and this is interfering with her ability to take care of herself.

With IBH, the doctor can call in one of our behavioral health workers to speak with the patient and provide an assessment during the same visit.  We can then begin treatment or, if the patient shows symptoms of a more serious mental condition, we can provide a referral to specialty mental health services, substance abuse treatment providers, or other services as appropriate.

Originally, the program was designed for people ages 16 and older. But many children also suffer from depression, anxiety, and the after-effects of trauma.  They need to see practitioners who understand children's mental health. So we were able to work with the County to change the minimum age to six. This has been a relief for families who didn't know where to turn to find help for their children.

There are many advantages to providing mental health services within a primary care setting. Firstly, medical clinics are trusted locations where people feel comfortable interacting with health professionals, and this greatly reduces stigma. Through IBH, every patient is now screened for depression and anxiety during each visit in familiar surroundings and with a medical practitioner with whom they already have a relationship.

Secondly, we have developed a collaborative approach for Gardner primary care physicians and behavioral health clinicians. We are all working as a team for each patient instead of maintaining the traditional separation between the two branches of medicine. We regularly hold joint meetings to support this emerging culture of collaborative care. Both our staff and our patients are learning more about how physical health problems affect mental health and vice versa.

There is also the issue of parity: providing the same levels of access and care for mental health as for physical health. Just as we do with our medical services, Gardner offers high-quality behavioral health services that are convenient, available in a variety of languages, and are appropriate for different ages and life situations. In addition, a significant proportion of Gardner’s patients remain uninsured because they don’t qualify for plans under the Affordable Care Act. Our IBH services are available to everyone regardless of their insurance status.

Finally, early intervention is key in mental health. If we can get people the right diagnosis and treatment we can prevent crises in the future. And in the case of those who are also suffering from chronic diseases, improving their mental health can improve their ability to manage their physical health.

We are one of the first organizations in Santa Clara County to offer mental health services within the primary care setting and currently have the largest program of its kind. Our IBH services have been designed around tested, proven models of care. As we near the end of our grant period, we are working to create a model for sustainability of this important program. Our hope is to not only continue the services but to do more outreach and education around mental health to increase understanding, acceptance, and treatment. 


El objetivo de Gardner es mejorar el estado de salud de las comunidades que servimos, en especial, de sus miembros marginales, pobres y más vulnerables. Nuestra misión es brindar atención médica integral de alta calidad, incluyendo servicios de prevención y educación, intervención temprana, tratamiento y servicios de prevencion de manera económica, respetuosa, adaptada a la cultura e idioma del paciente y adecuada para la edad del paciente.

Our Mission

Gardner is dedicated to improving the health status of the communities we serve, especially the disenfranchised, disadvantaged and most vulnerable members. Our mission is to provide high quality, comprehensive health care, including prevention and education, early intervention, treatment and advocacy services which are affordable, respectful, culturally, linguistically and age appropriate.

Gardner is an affiliation of two 501(C)(3) organizations:

  • Gardner Family Health Network, Inc. - Federal Tax Identification Number 94-1743078

  • Gardner Family Care Corporation, Inc - Federal Tax Identification Number 23-7153068

FTCA Deemed