Posts Tagged ‘Bruce Sams’

Kaiser Permanente Fresno marks its 25th anniversary

posted on December 29, 2011

Sara Beadle, Fresno’s first outpatient in 1986, with Larry Coble, MD.

Ginny McPartland, Heritage writer

It’s been a quarter of a century since Kaiser Permanente (KP) established a prepaid medical care outpost in Fresno, then unbroken territory for the health plan. Since its opening in 1986, KP Fresno has grown from 400 initial area members to over 100,000 today.  Its facilities have expanded from a remodeled space in a shopping center to several large clinics and a hospital the Fresno Bee newspaper labeled KP’s local “crown jewel” when it opened in 1995.

“It’s big, bright and modern and epitomizes health care competition in Fresno,” the Bee writer effused.

KP officials began to ponder a move into Fresno in 1985 when large statewide employers began to expand into the burgeoning Central Valley. The health plan already had a clinic in Stockton, which is north of Fresno and south of Sacramento.

Fresno’s outpatient facility opened July 1, 1986.

It made sense to go to Fresno since KP health plan members were moving there and getting their care at other KP facilities, the closest of which was three hours away. Also, employees of big companies, such as Bank of America, Pacific Gas & Electric Company and Pac Bell were retiring and settling in Fresno and other communities in the Central Valley.

“These employers wanted the advantages of having similar benefits for their employees in multiple sites, and the employees wanted access to the same quality of care and service they had grown to appreciate in the Bay Area and Southern California,” explained Larry Coble, MD, retired Fresno pediatrician and physician-in-chief. Dr. Coble wrote a history of the first 13 years of KP Fresno when he retired in 1999.

Behind the scenes, high level KP leaders had been debating about where the boundary should be between Northern California region, with a facility in Stockton, and Southern California region, which was developing a presence in Bakersfield. The argument was settled when Northern California entered Fresno and thus staked its claim in the Central Valley.

To launch a KP facility in Fresno, whose isolation made it different from most other expansion areas, KP leaders had to start at square one. No existing facility could take Fresno under its wing as a satellite.

Checking out Fresno’s potential

In 1984, TPMG executive director Bruce Sams, MD, tapped Albert Kahane, MD, associate executive director and former Sacramento Medical Center’s physician-in- chief, to work with the regional medical group to assess the potential for KP’s entry into Fresno. By early 1985, the decision to go to Fresno was made.

As the medical group facilities planning liaison, Dr. Kahane was called on to spearhead the acquisition and conversion of clinic space where the Fresno medical care program would be launched. He was also responsible for contracting for community hospital beds for KP’s patients.

Fresno’s nursing staff June 30, 1986, the day before the outpatient facility opened on First Street.

In the fall of 1985, The Permanente Medical Group (TPMG) and health plan leaders began to assemble a team to make Fresno a reality. They set the opening date for July 1, 1986, and leased a four-story building at First and Shaw streets in the former Fashion Fair Plaza. Remodeling of space for the primary care areas began right away.

The start-up team, affectionately called the A-team, was selected from the Sacramento service area. Led by Dr. Coble, the team members were: John Bowden, medical facility administrator; Shirley Edmons, RN, nursing director; Toni Hays, Support Services manager; and Edie Yoder as secretary.

Selling Kaiser Permanente

In the spring of 1986, Dr. Coble began his quest for willing professionals to make up the KP core team of primary care staff physicians, contracted specialists and laboratory and x-ray professionals. “(I was) literally going from door to door meeting with physicians, optometrists, podiatrists, laboratory supervisors, etc. At times I felt like a salesman, handing out my card wherever I went. . .that’s exactly what I was doing, selling Kaiser Permanente.”

On July 1, 1986, the Fresno team was ready and the doors opened at the medical offices at 1475 First Street, with seven physician offices, 14 exam rooms, two procedure rooms, waiting room and reception area. Seven physicians were there to treat patients the first day. They were physicians Paul Baker, Jose Rendon and Larry Coble; internists Tony Antoniou, Raj Banka and Red Uhrle; and family practitioner Sami Issi.

The first patient was 19-month-old Sara Beadle, who was brought in by her mother (Debra Shriver-Sprinkel) at 8:40 a.m. on the first day. She grew up to be a healthy young woman and distinguished herself on Fresno State University’s equestrian team in the 2003-2004 season. She studied philosophy and business in the Fresno pre-law program.

Most local residents and employers welcome KP

Dr. Coble says the people of Fresno, especially the major employers, for the most part welcomed Kaiser Permanente to the Fresno community. It took the Fresno City Council five minutes to approve a zoning change for 38 acres at Fresno Street and Alluvial Avenue to allow KP to build a 200-bed hospital and medical offices for 180 physicians. At the time, the health plan had no immediate plans to build a hospital, but opened a huge outpatient facility at the site in 1991 and added an outpatient surgery center in 1992.

There was, however, initial resistance from the Fresno area fee-for-service physicians who objected to KP’s prepaid group practice. Dr. Coble recalls: “One very ugly situation occurred in which someone obtained a copy of our contracted physician list and posted it on (a local) hospital’s physician lounge bulletin board.”  The list of specialists taking referrals from KP doctors was circled with black crepe, the symbolic “black ball” meant to intimidate physicians from supporting KP.

Fresno’s medical center opened in 1995.

Dr. Kahane says he also encountered resistance when he negotiated with local hospital administrators for KP’s use of hospital beds. He says favorable contracts were elusive because hospital leaders believed KP would eventually build its own hospital in Fresno. He told local hospital officials: “Whether it costs us less (to operate our own hospital) or not is your decision.” He explained that if the community hospitals charged prohibitive fees for contracted beds, KP would be forced to build its own Fresno hospital. “And that is exactly what happened,” he said in a recent interview.

Fresno KP gets its own medical center

In the early 1990s, with rapidly growing membership and medical staff, KP Fresno leaders started making plans for a hospital of their own. Construction began in 1993 on the site at Fresno Street north of Herndon Avenue. In 1994, Ed Glavis was appointed as administrator of the new hospital; Maura Hopkins, RN, as nursing director; and Davidson Neukom as facilities manager.

When the new hospital opened in February 1995, the Fresno Bee said: “The Kaiser Permanente Hospital is the crown jewel in a $100 million Kaiser building project in Fresno, including the $30 million ancillary building which opened in late 1992.”

“I’m terribly excited,” Dr. Coble told the Fresno Bee. “It’s going to be easier because our physicians now will be able to literally walk down the hall to see their (hospitalized) patients. . . In addition, he said, all the ancillary services, such as laboratory, x-ray and pharmacies are close at hand . . . It’s professionally a very satisfying way to provide health care.”

Opening just in time for laboring mom

Madison Ballew, first baby born in Fresno’s Medical Center February 28,1995, with her parents Rob and Angela.

On opening day, KP Fresno swung open the doors to the Birthing Center and the Emergency Department. When the maternity staff unlocked the door at 6 a.m., they were met by expectant mom Angela Ballew who was in labor and gave birth to a daughter, Madison Ballew, the same day.

One-year-old Madison was the star of the show at the party celebrating 1,167 babies born in the center’s first year. Madison’s mom, a Sanger drama teacher, told the Fresno Bee that she would deliver her second child at the center the following August.

The rest of the hospital complex was opened in October of 1995. Having received “full accreditation with commendation,” Dr. Coble reported in his memoir: “We were a full-scale, high-quality medical group and hospital!”

Continued growth and success

From its early milestones, KP Fresno has continued to grow and prosper. The Fresno KP community has been honored recently for its commitment to reduce waste and prevent pollution in its facilities. The staff has also been recognized for its excellence in employee wellness efforts and for its work to overcome obesity in the community.

KP’s Fresno Medical Center, which stopped accepting free baby formula years ago, is close to being designated as Baby-Friendly* with 75.8% of new mothers exclusively breastfeeding their newborns, the highest rate in Fresno County in 2009. The center’s maternity staff places an emphasis on breastfeeding and discourages formula supplementation for infants whose mothers intend to breastfeed exclusively.

KP’s presence in the rest of the Central Valley has continued to expand as well. In 2008, the health plan opened another exquisitely designed hospital to serve the area. The new Modesto Medical Center** follows the current version of the evolving KP hospital design template, which incorporates functionality, as well as sustainability, patient comfort, optimal use of natural light, staff efficiency and accommodation of the latest medical technology.

*Baby-Friendly USA is a national campaign to encourage breastfeeding. Fourteen of Kaiser Permanente’s facilities have received the designation, and KP leaders have vowed to have all 29 medical centers called out as “baby friendly” by Jan. 1, 2013. Already designated are: Los Angeles, San Diego, Fontana, Downey, Riverside, Anaheim, Panorama City, Irvine, Baldwin Park, and Woodland Hills in Southern California; Hayward and South Sacramento in Northern California; Honolulu, HI, and Clackamas, OR.

**For more about the KP facility template, click here.

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25 years ago: Georgia native sows seeds of success at home

posted on October 30, 2010

Harper Gaston, MD

Ginny McPartland, Heritage writer

For Harper Gaston, MD, going to Atlanta 25 years ago to start Kaiser Permanente in Georgia was much like going home. A Georgia native and alumnus of Emory University, Gaston was at first reluctant. He had been practicing internal medicine and cardiology at the Hayward Kaiser Permanente Medical Center in Northern California for 23 years and had just been elected physician-in-chief.

“I told them: I am planning on retiring to Georgia, but my intent is to serve out my term, about four more years in California,” Gaston said in an interview with Historian Steve Gilford after his retirement in 1993.

However, the pressure to help establish a Georgia Region for Kaiser Permanente was intense. In 1985, Atlanta was the fastest growing city in the U.S. and was rated as the best place to do business in a survey of 400 CEOs. Atlanta was second only to Los Angeles in employer growth. Kaiser Permanente, with a presence in California, Oregon, Hawaii and the Midwest, was anxious to bring its brand of community-based prepaid health care to Atlanta, the hub of the Southeast.

Eventually convinced Atlanta was a good move, Gaston packed up with his wife, Anne Gaston, a Hayward KP pediatrician, and went to Georgia in the summer of 1985. Anne Gaston was also going home; she had come to Northern California from Georgia with her husband to join KP in 1961.
Gaston also took along two key people to start the health care program: Edgar T. Carlson of the Ohio Permanente Region who became Georgia regional manager; and Margaret Jordan, RN, a quality leader in Oakland, as Georgia health plan manager. Ron Hostettler, also from Ohio, came as assistant health plan manager and marketing director; John Blankenship came from Southern California Region as chief financial officer.

Renewing friendships

When Gaston hit the ground in Atlanta, he knew just what to do. He renewed his community contacts and got involved with Emory University, the Medical Association of Georgia, and other local physician organizations. “Knowing the leadership of these places and refurbishing old contacts was a great help. I think you can go home again.”

Louis Sullivan, MD

Gaston also picked several prominent members of the Atlanta community – banker John W. McIntyre; physician Louis Wade Sullivan, dean and director of the Morehouse College of Medicine (later to be appointed secretary of the U.S. Department of Health and Human Services); and community leader Laura Jones Hardman – to sit on the KP Georgia board of directors. Bruce Sams, MD, a native Georgian and executive director of the Northern California Permanente Medical Group, was also a key figure on the Georgia board.

As founding medical director, Gaston personally called on many of Atlanta’s physicians in their offices during 1985, the start-up year. He selected the best doctors in all parts of the metro Atlanta, including the black community, and invited them to join the Southeast Permanente Medical Group (TSPMG) to care for KP members. He negotiated contracts with three Atlanta area hospitals for KP inpatient care. “They were exactly the best hospitals in Atlanta, no question about it,” he said.

Early acceptance and rapid growth

KP Georgia’s earliest members were seen starting in October of 1985 at Northlake Medical Office in DeKalb County. Three months later, the Cumberland office was opened and then, another facility was opened near Southwest Community Hospital in the black community. The new region ended the year with 265 members, 25 health plan employees and seven TSPMG employees. Acquiring financially ailing Maxicare and securing the state of Georgia employee account in 1988, the region grew to 100,000 members by 1989.

Georgia KP had set up 10 medical facilities by the end of the 1990s and added another seven in the 2000s. This year, development has accelerated with four new buildings already launched and three more planned. Today, 280 Georgia region physicians and 2,200 staff members care for about a quarter of a million members in 20-plus facilities throughout the 28-county Atlanta metro area.

Emphasis on quality care

From the beginning, Gaston was intent on high quality for Georgia KP members. His efforts paid off.  In 1995, Georgia Kaiser Permanente was one of two health plans in Atlanta to earn the National Committee on Quality Assurance (NCQA) three-year accreditation. In 1998, Newsweek and US News and World Report rated Kaiser Permanente the No. 1 health plan in Georgia. The American Medical Group Association gave the Southeast Permanente Medical Group (TSPMG) its Preeminence Award in 2002.

More accolades were to follow:

  • Special NCQA recognition in 2006 for putting into place programs to solve health disparities for African Americans, Latinos and Asians
  • Atlanta Magazine’s 2008 award to KP as a “Best Place to Work”
  • J.D. Power’s ranking of Georgia KP as highest in customer satisfaction among health plans in the South Atlantic region, 2008
  • US News and World Report top-rated health plan in Georgia, 2008
  • 2010: the NCQA announced in October that KP Georgia has the highest breast cancer screening rate in the country, 91 percent, compared to a 71 percent national average.

Community service a given for KP

Shortly after opening in Georgia, Kaiser Permanente looked for opportunities to offer help to the community. In 1986, Permanente physicians agreed to reinstate recently discontinued hearing and vision screening for financially strapped area schools. Physicians screened 3,600 children in 17 DeKalb County elementary schools and two City of Decatur schools.

Over the years, the scale has only gotten bigger. Georgia region has sponsored the huge, area-wide Kaiser Permanente Corporate Run/Walk and Fitness Program since 2004. In 2005, the Atlanta American Red Cross named KP Georgia the Philanthropist of the Year for its sponsorship of the annual CPR Saturday program. For its 20th anniversary in 2005, KP Georgia gave $1 million to the Community Foundation for Greater Atlanta.

To wrap up its quarter of a century, Georgia KP topped itself with a $2.5 million donation for the development of the Eastside section of the Atlanta Beltline trail. The corridor of parks, trails and passenger rail service takes advantage of an old 22-mile railroad right-of-way that loops around the city. KP Georgia has also committed to a $5 million donation to Children’s Healthcare of Atlanta for a new hospital.

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