HEALTHCARE

ROUNDTABLE PARTICIPANTS

California Schools VEBA

California Schools VEBA is a non-profit healthcare trust that delivers high quality, affordable and accessible healthcare for education, municipal and public agency employees. Formed in 1993 − through the combined efforts of school superintendents and school labor leaders − VEBA currently serves more than 65 participating employers and over 150,000 members, throughout Southern California. To continue improving health care for its members VEBA launched the VEBA Resource Center (VRC) in 2019 to help members assess, identify and remove barriers to achieving optimal health. The VRC provides an extensive range of programs, classes, services and events for members to take a holistic and proactive approach to their overall well-being.

Kaiser Permanente

Kaiser Permanente San Diego’s Positive Choice Integrative Wellness Center strives to not merely treat symptoms or illness, but to evaluate an individual’s entire lifestyle and create a sustainable plan for behavior change to achieve better health and wellness. The Positive Choice Integrative Wellness Center offers a variety of evidence-based programs to help San Diegans achieve their ultimate well-being. Services include medical weight management programs, nutrition counseling, fitness testing, personal training, exercise classes, free wellness seminars, biofeedback, mindfulness programs, plant-based healthy cooking classes, integrative physician appointments, and therapeutic massage. All services are facilitated by a highly trained, caring, and professional staff. Many of the programs are available to all members of the community (not just Kaiser Permanente members). Visit www.positivechoice.org or call 858-616-5685 to learn more.

Palomar Health Medical Group

Palomar Health Medical Group is Southern California’s premier healthcare system committed to removing the fear that is often associated with healthcare. Arch Health and Graybill, two of Southern California’s most prominent medical groups, have combined and become one extraordinary healthcare system. Their network of 300 world-class doctors treats you like family by ensuring you feel safe, cared for and at home right from the moment you walk through our doors. At Palomar Health Medical Group, every physician is dedicated to your healthcare journey every step of the way. Our world-class team reimagines the entire healthcare experience, created with only one person in mind. You.

Tri-City Medical Center

Tri-City Medical Center has served San Diego County’s coastal communities of Carlsbad, Oceanside and Vista, as well as the surrounding region for more than 60 years and is one of the largest employers in North San Diego County. Tri-City is administered by the Tri-City Healthcare District, a California Hospital District. As a full-service acute care hospital with over 500 physicians practicing in over 60 specialties, Tri-City is vital to the well-being of our community and serves as a healthcare safety net for many of our citizens. Tri-City Medical Center prides itself on being the home to leading orthopedic, spine and cardiovascular health and emergency services while also specializing in world-class women’s health, robotic surgery, cancer and emergency care. Tri-City partners with over 80 local non-profit and community organizations as part of our COASTAL Commitment initiative. Together we are helping tackle some of our communities’ pressing health and social needs.

TrueCare

For over 50 years, TrueCare has not wavered in its commitment to patients, their families, and its communities. As a non-profit community health center, TrueCare is dedicated to delivering a superior and compassionate healthcare experience to nearly 60,000 patients every year, reducing barriers and increasing accessibility to quality care. TrueCare cares for the diverse communities of North San Diego and South Riverside Counties with services ranging from primary care, pediatrics, women’s health, behavioral health, chiropractic treatments and dentistry. In addition, TrueCare offers transportation services, community health outreach, insurance enrollment assistance and case management programs. For more information, visit www.truecare.org.

Dr. Reyzan Shali, Tri-City Primary Care:

Preventative medicine equals health protection. It is well known to all of us that many of the so-called complex chronic diseases can be prevented. The role of preventative healthcare and the preventative healthcare provider is to screen and diagnose early those chronic diseases before they cause long-term damage. The return on investment of preventative medicine is clear — the time, energy and resources spent on preventative medicine pales in comparison to the costs of treating illnesses after they occur.

Dr. Marie Russell, TrueCare:

Preventative healthcare is taking action ahead of time to stop illness from occurring in the first place. The medical research I have reviewed shows that about 60% of health and quality of life are related to lifestyle practices, 10% are hereditary, and the remaining 30% are likely due to environmental causes. Routine screenings can detect certain medical conditions at an early stage when treatment is likely to work best. These include tests to reveal colon or breast cancer. Also, monitoring blood pressure regularly can uncover certain heart conditions before they become serious. It is also important to stay active physically and eat healthy foods especially, plenty of fruits and vegetables. Eat other foods in moderation. Quitting smoking is vital and limiting alcohol is a good practice.

Christopher Heslin, MS, CNS, Positive Choice Integrative Wellness Center:

As the saying goes, “an ounce of prevention is worth a pound of cure.” Preventative health care combines keeping individuals well through routine check-ups and screenings with effective evidence-based health education programs that empower them to engage in behaviors that support and maintain a healthy lifestyle. The goal is to keep members well and out of the doctor’s office or hospital whenever possible. It is one of the founding principles of Kaiser Permanente. Without a sound focus on prevention, the community’s overall health may be compromised.

Dr. Camille Santos, Palomar Health Medical Group:

Preventative healthcare is the practice of promoting wellness, avoiding disease and ultimately preventing premature death. It also includes looking at social and family histories that may be clues to health risks. It includes identifying unhealthy practices, such as smoking and excessive alcohol intake, that will increase patients’ risk for chronic diseases. It is a time of honest inventory of our health, that patients sometimes don’t feel comfortable talking about, or have been ignoring. Preventative healthcare is a great opportunity to dialogue about current health status and talk about future health goals. It’s also an opportunity to reinforce healthy habits that patients are already practicing. I am blessed as a healthcare provider for the opportunity to partner with my patients toward their goals. For me, preventative healthcare is a window to get to know my patients well.

Laura Josh, Gallagher, on behalf of California Schools VEBA:

Preventative healthcare refers to preemptive measures taken now to prevent future disease. These include health screenings, dental visits, vaccinations, weight loss, healthy eating and overall well-being. Preventative care is key because it can not only lower the long-term cost of disease management, but also reduces the risk of disease, disability and even death. At VEBA, we encourage members to engage in preventative care – like taking advantage of preventative services covered through their health plan. VEBA members also receive access to our VEBA Resource Center (VRC), where we provide both wellbeing and education resources designed to work in conjunction with clinical care. As part of our commitment to our members’ well-being, VEBA has a partnered with the U.S. Department of Health and Human Services and the Office of Disease Prevention and Health Promotion to join Healthy People 2030 – an initiative with the goal to improve our nation’s health and well-being over the next decade. As a Healthy People 2030 champion, we provide tools, resources and education so VEBA members can access the preventative care they need.

As the saying goes, ‘an ounce of prevention is worth a pound of cure.’

Christopher Heslin, MS, CNS

Department Administrator Positive Choice Integrative Wellness Center

Chief Medical Officer and Chief Operations Officer TrueCare

The medical research I have reviewed shows that about 60% of health and quality of life [issues] are related to lifestyle practices …

Dr. Marie Russell

The early months of the pandemic took a significant toll on preventive healthcare. All but the most urgent procedures were being delayed …

Laura Josh

Area President Gallagher, on behalf of California Schools VEBA

After the advent of COVID vaccines, patients started gaining confidence again in coming for preventative healthcare.

Dr. Camille Santos

Primary Care Palomar Health Medical Group

Christopher Heslin, MS, CNS, Positive Choice Integrative Wellness Center:

Some of the critical factors that impact the health of a community, as a whole, include 1) access to high-quality healthcare, 2) healthy, affordable food options, 3) adequate green spaces for recreation, 4) free programs/organizations to provide community and social connection, and 5) adequate regulations for public safety (i.e., water quality, infrastructure repair, etc.). On an individual level, the previously mentioned remains true, but with the addition of adequate mental health support, social connection through family, friends and community, and most importantly, a sense of purpose.

Dr. Reyzan Shali, Tri-City Primary Care:

In a word — lifestyle. It is well-known and well-documented that unhealthy lifestyles, including poor diet and lack of physical activity, among others, have been linked to many of the so-called chronic diseases, including diabetes, high blood pressure, coronary artery disease and more. Unhealthy lifestyle has also been linked to increased risk of chronic inflammation and chronic elevation of inflammatory markers, which has been linked to increased risk of many cancers and different musculoskeletal disorders. Also, poor diet and sedentary lifestyle is strongly linked to many mental health disorders, including depression and cognitive decline.

How has the pandemic impacted preventative healthcare? Laura Josh, Gallagher, on behalf of California Schools VEBA:

The early months of the pandemic took a significant toll on preventive healthcare. All but the most urgent procedures were being delayed, which meant important services like cancer screenings and regular checkups fell to the wayside. Unable to catch early warning signs and manage conditions before they become serious, there were fears of an explosion in highacuity health needs once people were finally able to return to the doctor’s office. However, these concerns catalyzed some positive change in the preventive health space. Hoping to avoid the onslaught of bad health outcomes, providers, plans and employers got creative about bringing preventive care to the patients. Payers offered no- or low-cost virtual primary care visits, and opened up pathways for patients to self-screen for conditions in their own homes. At VEBA, we knew that we needed to take a proactive approach to ensure our members’ mental and physical well-being was being supported. Within six weeks, we overhauled our system to provide over 200 monthly classes, programs and services which could be accessed online. The jury is still out on whether these efforts were enough to outweigh the initial care avoidance, but it’s clear they will have a positive impact on access to preventive care going forward.

Christopher Heslin, MS, CNS, Positive Choice Integrative Wellness Center:

The initial shutdown brought on by the pandemic created barriers to healthcare in general and significantly impacted access to preventative care. Since most people were confined to their homes, preventative screenings came to a standstill, leading to a tremendous increase in service demand as the pandemic eased. Mental health also became a huge concern as individuals on lockdown began feeling hopeless and isolated, while healthcare workers on the front lines experienced unprecedented levels of burnout. Some positives have come from the pandemic, including a much more robust virtual delivery of care model, which now allows members to receive care where they are and when they want it, and the reduction of the stigma around mental health and wellness, leading to higher prioritizing and increased resources for those in need.

Dr. Camille Santos, Palomar Health Medical Group:

The COVID-19 pandemic has certainly impacted preventative healthcare. Early in the pandemic, there was a shift in priorities in healthcare. This was done in order to accommodate more acute needs in the community. There were also staffing issues as healthcare workers were getting sick, creating more burdens in the healthcare system. There was fear of coming in to the doctor’s office for “wellness exams” for fear of “getting sick.” After the advent of COVID vaccines, patients started gaining confidence again in coming for preventative healthcare. As a

result, we have seen cases of uncontrolled hypertension, development of diabetes in patients who have been prediabetic for some time, increased body mass index to name a few.

Dr. Reyzan Shali, Tri-City Primary Care:

The pandemic impacted preventative healthcare in a dramatic way. Many individuals put preventative health measures and screening tests on the back burner during the pandemic. We as physicians and healthcare providers were so involved — and overwhelmed, frankly — caring for COVID-19 individuals that we may not have dedicated as much time as normal to reminding our patients to catch up on preventative screening tests. Cancer screening, such as mammogram, Pap smears and colonoscopies were all delayed, because the main focus during the first one to two years of the pandemic was to isolate, stay home and minimize exposure. We are still trying to catch up on all these preventative screening measures.

How do you promote preventative care among your employees or the population that you serve? Laura Josh, Gallagher, on behalf of California Schools VEBA:

VEBA has long been a proponent of engaging our members in preventative care and we promote it in a variety of ways. We work with our carrier partners to ensure that VEBA members have the information that they need to take advantage of covered preventative services. Through the VEBA Resource Center, we offer holistic wellness services such as yoga, meditation and cooking classes – which can be utilized in person, online, or at a member’s worksite. We work with community partners such as LiveWell San Diego to provide health screenings for our members and the community at large. We also have a dedicated Well-Being team that consults with our employers to build workforces that are engines of well-being, teaching VEBA members how to live healthy, well-balanced lives.

Dr. Marie Russell, TrueCare:

We advise all companies regardless of size to invest in their employees’ healthcare because workers are a vital asset to any business. This valuable investment begins by giving employees time off for medical appointments. We also recommend offering fun health and fitness challenges to encourage friendly competition. If a company cannot provide health insurance, community health centers like TrueCare can provide access to quality healthcare and resources, regardless of insurance status or income. As a non-profit community health center, TrueCare is dedicated to delivering a superior and compassionate healthcare experience to nearly 60,000 patients every year throughout North San Diego County and South Riverside Counties, reducing barriers and increasing accessibility to quality care. TrueCare never turns anyone away because of their inability to pay.

Christopher Heslin, MS, CNS, Positive Choice Integrative Wellness Center:

The key is creating and fostering a “culture of health” in the workplace. Often, leaders in large, fast-paced organizations put the business mission as the top priority, which usually leads to burnout, less productivity and a less happy team. Ideas for leaders to consider to ensure this doesn’t happen are 1) invest time and resources aside from daily operational duties for employees to focus on their health and wellness (i.e., sponsoring a “wellness club” committee), 2) encourage employees to take time off to recharge periodically, and even building this into operational schedules, 3) recognizing/celebrating employees who take steps to be healthier by staying up to date on their health screenings, participating in healthy workplace activities, etc., and 4) modeling the healthy behaviors themselves.

Dr. Reyzan Shali, Tri-City Primary Care:

Taking few minutes out of the day to check on my colleagues, coworkers and nursing staff, and make sure they are prioritizing their health and catching up on preventative measures is not only important, but will generate a very fulfilling and caring work environment. Taking a few extra minutes while visiting with a patient regardless of the type of visit to make sure they are able to update their preventative screening testing is very impactful. I could be seeing a patient for follow up on diabetes or to help with URI symptoms, but I also try to take extra time to remind the patient of the need to schedule for Pap smear or mammogram or any of the other screening tests.

We are still trying to catch up on all these preventative screening measures.

Dr. Reyzan Shali

Internal Medicine/ Primary Care Physician Tri-City Primary Care

The key is creating and fostering a ‘culture of health’ in the workplace.

Christopher Heslin, MS, CNS

Department Administrator Positive Choice Integrative Wellness Center

What preventative health measures can be taken at home? Dr. Camille Santos, Palomar Health Medical Group:

Our home is our sanctuary and our living space. It should be a nurturing place for ourselves and for our loved ones. Out of it should come healthy individuals thriving in the community. There are a lot of preventative measures we can do at home, and I like to break it down into four categories: 1) Food: The “cleaner” our food, the longer our body will run, the better we will feel, the less diseases we will encounter, and the stronger immunity we will build. 2) Activity: Exercise at least 30 minutes per day, five days a week. 3) Sleep: Try to get eight hours of uninterrupted sleep. 4) Relationships: Nurture relationships at home.

Dr. Reyzan Shali, Tri-City Primary Care:

Many preventative health measures can be taken at home. Most importantly, promoting and encouraging a healthy lifestyle among family members is key in preventing many of the burdensome chronic diseases. Engaging family members to go out for a walk, take a hike and bike rides, or any other form of physical activity, is an excellent way to promote preventative health. Preparing and cooking meals at home not only provides opportunities for excellent storytelling and laughter but also ensures that better quality food is served at home.

What types of preventative health screenings should be done regularly? Dr. Camille Santos, Palomar Health Medical Group:

Some recommended preventative screenings are: Pap smear to screen for cervical cancer, colonoscopy to screen for colon cancer and mammograms to screen for breast cancer. Smoking cigarettes increases risk of lung cancer; however, by catching it early through a low-dose CT, the risk of dying from lung cancer reduces by 20%. We order blood tests to screen for diabetes, prostate cancer and hypercholesterolemia. Some patients don’t feel when their blood pressure is elevated, so they don’t come in for their preventive healthcare, they might not know they have hypertension, which puts them at greater risk for having a stroke or heart attack. Preventive healthcare is very important to identify risk factors early so patients can avoid diseases and increase the chance for longevity.

What is the most effective way to address mental health needs for staff and present options for support? Christopher Heslin, MS, CNS, Positive Choice Integrative Wellness Center:

Understanding of the importance of mental health, and mental health care, has improved dramatically over the past few years, along with a significant reduction in the stigma sometimes associated with receiving mental health care. The business community, as a whole, has embraced the concept that everyone can benefit from mental health support. To help foster awareness and understanding, employers can initiate discussions around mental health in the workplace consistently through direct report rounding, department meetings and huddles. Employers can also provide mental health support through access to internal Employee Assistance programs or by providing information and resources for employees to access mental health support resources in the community.

Dr. Marie Russell, TrueCare:

In addition to physical health conditions, companies must recognize their employees may also have emotional and behavioral challenges that could impact their work performance. Away from the office, staff could be struggling with family disruptions, substance abuse issues or other conditions that prevent them from functioning optimally at work. For this reason, we urge companies to give employees a safe space for open, honest and confidential discussions. Compassion is key to gaining trust. Companies can consider an Employee Assistance Program (EAP) to assist employees with personal and/or workrelated problems that may impact their job performance, health, mental and emotional well-being. For far too long, mental health conditions have been stigmatized by corporate America. We are pleased that such outmoded attitudes are changing for the better.

The ‘cleaner’ our food, the longer our body will run, the better we will feel, the less diseases we will encounter, and the stronger immunity we will build.

Dr. Camille Santos

Primary Care Palomar Health Medical Group

Preparing and cooking meals at home not only provides opportunities for excellent storytelling and laughter but also ensures that better quality food is served at home.

Dr. Reyzan Shali

Internal Medicine/ Primary Care Physician Tri-City Primary Care

In particular, mothers in the ‘sandwich generation,’ ages 35-54, feel more stress, which can impact their own health, research shows.

Dr. Marie Russell

Chief Medical Officer and Chief Operations Officer TrueCare

Investing in preventative healthcare solutions not only improves health outcomes and can save lives, but it also can improve your bottom line.

Laura Josh

Area President Gallagher, on behalf of California Schools VEBA

What are some of the biggest barriers for staff to proactively take care of their health both at work and at home? Dr. Marie Russell, TrueCare:

Time is a big barrier because many employees not only have children whose well-being they need to consider, but also elderly parents for whom health may be a major concern. Demographers call such people the “sandwich generation” — those adults with at least one living parent age 65 or older and who are raising a child younger than 18. In particular, mothers in the “sandwich generation,” ages 35-54, feel more stress, which can impact their own health, research shows. We encourage employers to allow workers to take time off work when ill and seek medical attention promptly. Employers should also make sure staff have the facts and caution them against believing the numerous healthcare myths and misinformation that proliferates via social media and other online sources.

How can leaders best support and empower employees on an individual level to put their health and wellness at the top of their priority list, while at the same time keeping them engaged in the business mission? Dr. Marie Russell, TrueCare:

Healthy employees are more productive and decrease costs for organizations, which, in turn, contributes significantly to the bottom line. Leaders know that if they are interested in their employees’ health, then employees are more likely to drive the company mission. Organizations can emphasize the importance of workplace wellness by proactively offering incentives to employees for taking good care of their health. An example is one of our most successful wellness programs for our TrueCare employees: WellnessWithin encourages employees to focus on their own personal wellness goals. They can discover exciting resources for physical, mental, social and financial wellness. They can also earn points by engaging in TrueCare activities, such as posting to a blog and earn prizes based on the points they accumulate.

Why should preventative health care be a business investment? Laura Josh, Gallagher, on behalf of California Schools VEBA:

Investing in preventative healthcare solutions not only improves health outcomes and can save lives, but it also can improve your bottom line. VEBA recognizes that there is a relationship between preventative healthcare and long-term cost control. Over the years, we have implemented strategies to ensure that our members get the preventative care they need, which in turn has drastically reduced costs. By investing in preventative care models like the VRC, we are able to provide tools and resources that encourage healthy behavior at all stages, and in all aspects of life. For example, we offer:

• Healthy cooking classes and nutrition education designed to help with weight loss,

• Yoga and meditation to support our member’s mental health,

• Financial literacy counseling to improve member’s financial health. By investing in the health of our members now, we are able to reduce the financial, emotional, and social burden of unexpected diseases in the future.

Do you offer any incentives for preventative care or healthy behavior? Laura Josh, Gallagher, on behalf of California Schools VEBA:

VEBA understands the importance for our members to not only get preventive care, but to ensure it’s the highest possible quality. That’s why we offer our members the opportunity to join one of our high-performance network plans. Members who select this option receive incentives — in the form of lower premiums, deductibles and co-pays — just for choosing to see the highest quality providers in our area. Everyone benefits from this approach: our members have lower cost-sharing and a better provider experience, we can guarantee our people are going to the best physicians in Southern California, and we have saved millions of dollars for our employer partners by reducing rates of misdiagnosis and incorrect treatment planning. It’s a win-win!