Health Plan of San Mateo (HPSM) partners with a range of healthcare professionals and providers, one of which is San Mateo Medical Center (SMMC). This 137-bed facility and its associated community clinics serve as a safety-net provider for more than 70,000 underserved residents. Here is the story of one HPSM member who received lifesaving treatment at SMMC.
San Mateo Medical Center delivers lifesaving care
In 1972, Paul got shot point-blank while being robbed. This severely damaged his stomach and pancreas, starting a series of lifelong health problems, including Type 2 diabetes. Paul lost his health insurance in 1986 when he was laid off from his job as a Marine Biologist at Stanford Research Institute. Because he had a pre-existing condition, Paul had trouble finding employer group health plans to cover him. As a result, Paul was limited to contract work that didn’t come with healthcare benefits, and had no health insurance for the next 25 years.
“I couldn’t afford the equipment to monitor my blood sugar,” Paul said, “so I would sometimes pass out at the dinner table, which scared my two young sons. I was scared too because if something happened to me, who would take care of my boys?” Diabetes caused Paul to suffer other health problems as well, such as foot ulcers. He had one foot ulcer that lasted for nearly two years because he couldn’t afford medical care. He treated it using Band-Aids and Neosporin while fearing every day that it might get infected.
In 1990, a diving accident tore the tissues around Paul’s stomach scar open, causing a hernia. It grew to the size of a grapefruit and kept popping out of his abdomen. Paul lived with this painful and dangerous condition for over a decade, until he finally got surgery at SMMC in 2011. The cost of the operation was covered when he enrolled in San Mateo County’s Access to Care for Everyone (ACE) program. ACE is a local health coverage program managed by HPSM and is available to low-income adults who don’t have access to health insurance options. ACE enabled Paul to finally get ongoing treatment for his medical issues. This gave him a level of stability and security that he hadn’t had for a quarter century.
In 2014, Paul became eligible for Medi-Cal through the Affordable Care Act (ACA) expansion. This gave him more comprehensive benefits and provider options. When he turned 65, Paul became eligible for Medicare and enrolled in HPSM’s CareAdvantage Cal MediConnect (CMC) plan, which integrates both his Medicare and Medi-Cal benefits in one plan.
While Paul has had three different health plans since 2011, there has been one constant on his journey back to health: SMMC. Through SMMC he gets medication for his atrial fibrillation and sees a cardiologist twice a year. He has regular appointments with an endocrinologist, Dr. Bradd Silver, who helps Paul manage his diabetes. “The opportunity to partner with patients like Mr. Haskins for their endocrine care on a regular basis provides the ongoing follow up they deserve,” Dr. Silver said.
Paul likes SMMC so much that he chooses to make it his primary care provider (PCP). And it’s not just because of the high-quality care the medical center provides for Paul—it’s also about the people who provide it. “The doctors and support staff really listen,” said Paul. “They ask what is bothering me, and anything that pops up, they’ve got somebody for it.”
One way SMMC listens is through its Patient and Family Advisory Council (PFAC). Paul is one of 12 active Improvement Partners who visit patients in the hospital to ask about their experiences. “SMMC is here for patients like Paul who haven’t always had access to quality health care. But what’s really amazing is how Paul helps us improve the experience of other patients,” explained SMMC’s CEO, Dr. CJ Kunnappilly. SMMC uses the feedback from patients to continually improve quality of care.
“As active patients, the Council members have a unique perspective,” Paul said. “We see things doctors might not see.” When asked why being an Improvement Partner is meaningful, Paul replied “SMMC has given me a real gift. Being on the council allows me to give back to them and the community. I’ll be forever grateful for everything SMMC has done and continues to do for me. I want to help them help other people just like me.”