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CEO of Mountain Health Still a Healing Force

When Judith Shaplin and her family moved to eastern San Diego County, her grade-school principal noticed the little girl’s interest in medicine and put her in charge of cleaning up other kids’ playground scrapes.

Shaplin didn’t realize it then, but the absence of a proper school nurse spoke to a bigger problem in her sparsely populated community — inadequate access to health care.

It didn’t sink in until after she had graduated high school, completed a six-month vocational health care course and taken a job as a medical assistant and licensed X-ray technician in Alpine. The scarcity of medical resources finally hit home with the birth of her first daughter when she was forced to drive 60 miles to El Cajon to a pediatrician’s office.

“I learned the importance of accessing (health care) and why it was so critical (to get) immunizations and health visits for everybody of all ages,” she said.

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Gaining Access

Shaplin, a soft-spoken woman with a humble demeanor, is now 64 and serving as CEO of Campo-based Mountain Health and Community Services Inc., a chain of five health clinics and one community center. In her words, ensuring residents of eastern San Diego County have access to health care is “not just a mission, it’s a passion.”

Since starting with the nonprofit as a receptionist in 1985, she has led it through good times and bad, from Medi-Cal changes that threatened its existence to a federal application that may have secured its future. Along the way, she said, she has benefited from extensive advocacy training and strong mentorships.

Today the three-term former president of the California State Rural Health Association stands on the cusp of what may well be her greatest professional achievement, the opening of a 23,500-square-foot, $10.2 million health and community center in Campo. It will replace one that, at only 2,800 square feet, has long served as the town’s main health-care facility.

Henry Tuttle, CEO of Health Center Partners of Southern California, a San Diego-based consortium serving 17 health organizations including Mountain Health, said the new health center may well be her legacy.

“Some people move from job to job to job,” he said. “But this is a life’s work.”

Power of Passion

Mountain Health Chairman Randy Lenac said Shaplin so embodies Mountain Health that it’s “hard to separate” the two.

“Judy is, to me, the epitome of a bootstrap individual who was … raised out on the mountain, who didn’t have a lot of formal education or training, got involved in health care, realized that she was passionate about it” and worked her way up, he said.

By the time Shaplin applied for a job with the organization, she had been out of the workforce for six years, having become involved in her daughters’ school and Girl Scouts activities. In 1985, separated from her husband, she was a single mother of three in need of a job.

Mountain Health opened in 1974 as a subsidiary of a home health company serving senior citizens. After a regional health needs assessment, it won federal designation as California’s 13th rural health clinic.

Shaplin had taken on administrative roles while working for the doctor in Alpine, and she quickly moved up to office manager at Mountain Health. When the center’s executive director moved his family to Oregon, she was appointed operations manager. Shortly thereafter, his interim replacement left for another job, and on Jan. 1, 1989, Shaplin took over.

In the Middle of Controversy

Any notion of a honeymoon was short-lived. Mountain Health’s offices were located within a complex on a reservation operated by the Campo Kumeyaay Nation, which at that time was considering opening a dump. Some saw the proposal as threatening the area’s water supply, and differences of opinion led to conflict.

Cars parked outside were vandalized regularly. The building’s water was constantly being shut off. Items were stolen from the clinic almost nightly.

“We thought we were going to be sitting on a powder keg because we were in between,” Shaplin said.

Patients, unsurprisingly, avoided the place. Shaplin had to hire security to guard the parking lot. Eventually Campo Kumeyaay elders stepped in, the dump was called off, and things blew over.

The good times didn’t last. With the mid-1990s came a Medi-Cal change that sent Mountain Health’s patients to physicians in far-off San Diego. Problem is, patients didn’t always understand that. Many continued going to Mountain Health, which has a policy of treating everyone regardless of their ability to pay. It could no longer bill Medi-Cal for services rendered.

Payroll plummeted from 50 employees to a half-dozen. Shaplin took on almost all administrative functions, from finance to human resources.

Standing Her Ground

One day, after a meeting in San Diego, she walked up to the director of San Diego County’s Health and Human Services Agency, Dr. Robert Ross, and explained Mountain Health’s dilemma. He told her the county was setting up an umbrella for countywide Medi-Cal managed-care services. She pressed him to take her organization into account.

He did come up with a solution — that Medi-Cal managed-care plans must offer contracts to the county’s rural medical providers — but it didn’t immediately help much.

Managed care representatives who sat down with Shaplin offered her the same reimbursement they were giving urban clinics, whose costs were lower than those of a small, rural health clinic. The “capitation” fee offered — from $11 to $13 per patient per month — didn’t cover her costs of providing care for her roughly 500 patients.

“I said, ‘This is what I want,’” she recalled. “They said, ‘This is what you’re going to receive.’ I said, ‘No, this is what I want.’ ”

In the end, it came down to a test for Ross’ new umbrella organization. It held, and she won the reimbursement level she sought.

The victory allowed Mountain Health to rebuild its staff and patient base. It opened a second clinic, in Jacumba.

Creative Thinking

Another turning point came in 2002, with Mountain Health’s designation as a federally qualified health center. The label means that, in exchange for tending to an underserved population, the organization would receive higher reimbursement under Medicare and Medi-Cal. Also, payments could go toward general operations, as opposed to the program-specific grants the organization depended on previously.

Naturally, there was a catch. Federal workers told Shaplin that Mountain Health was going to have to expand its patient population by 25 percent every year.

“I said to them, ‘Well, we only have a certain number of population. I don’t know how we can increase our visits 25 percent every year. That’s impossible.’ We were already at 25 percent of the population,” Shaplin said. “They said, ‘That’s not our problem. You have to do it.’ I said, ‘OK.’”

Doing the impossible required creative thinking, and took her outside eastern San Diego County into the urban core.

A key moment came in 2007, when Mountain Health acquired a downtown San Diego medical group that served Medicare and Medi-Cal patients with no private insurance. The office was converted to a federally qualified health center.

With that and clinics in places like Escondido and Santee, Mountain Health has expanded not only in patients served but geographically. This has allowed Shaplin to spread her costs across a diverse patient population, even as the nonprofit continues to care for the underserved.

This year, 54 percent of the organization’s $13.2 million budget comes from Medi-Cal, while 34 percent is from Medicare. The remaining 12 percent stems from grants, private insurance and contributions from patients with no insurance.

New Health Center Coming

Shaplin’s focus lately has been on the new health center in Campo. When it opens next spring a mile and a half from the old center, it will have 12 exam rooms, two medical procedure rooms and telemedicine technology allowing patients to see specialists outside the area, not to mention dental, pharmacy and X-ray facilities, as well as behavioral health treatment.

Along with all that, there are plans to make part of the building a job-training center. Shaplin said high-school students will work there with the representatives of the Grossmont Healthcare District to learn work skills.

The district, long a financial supporter of Mountain Health, gave $1 million toward the new center. CEO Barry Jantz said the building has been needed for years, and he feels comfortable handing the money to Shaplin because of her transparency.

“I’ve always got a lot of confidence that (Mountain Health) is going to do what (it) said with the money,” Jantz said.

The job-training aspect seems to resonate with Shaplin, whose own career was limited by living in an area with few professional opportunities.

“I look at this building and I see an amazing opportunity,” she said. “And most of all, I see hope.”

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