San Diego In 2002, Rakesh Patel started as a family physician at Neighborhood Healthcare, an organization he now leads.
In the intervening years he transitioned into administrative roles, taking over as CEO in November.
Patel succeeded Tracy Ream, who was CEO for 31 years, and oversaw the nonprofit’s transformation from a small office in Escondido to a health system serving 67,000 low-income and uninsured patients a year.
Neighborhood, which has 12 community clinics, of which nine are in San Diego, has an annual budget of $68 million.
Patel completed his residency at Scripps Family Practice Residency in Chula Vista, received his MD from the Medical College of Wisconsin and recently became a certified physician executive. He’s in the process of completing his MBA.
In this Q&A, Patel talks funding, Neighborhood Healthcare as a safety net and why more physicians are gaining seats at the leadership table.
Q: Tell me about how Neighborhood fits into San Diego’s health care ecosystem?
A: In San Diego County, we do not have a county health system, such as in L.A. County. So we’re a safety net, where any patient can come, whether they have insurance or not.
Most of our patients are on state Medi-Cal plans, but we also take Medicare. It’s the entire spectrum, from babies to the elderly. We provide comprehensive health care, meaning that we take care of primary care and mental health needs as well as offer dental care services.
At the end of the day, our mission is really to improve the health of our communities regardless of the patient’s ability to pay.
Q: The agency’s annual budget has grown to $68 million and it employs 650 people. Do you see those figures continuing to grow in the coming years?
A: Part of the challenge we have currently is with health care funding. Some of our funding is at risk currently, so it does put somewhat of a damper on what you can do.
But overall, long term, we’re looking at expansion, which is really about comprehensive services at our current sites. That means providing chiropractic, possibly optometry, and expanding behavioral health services.
We do have a new health center that will be opening hopefully by late spring or early summer in Poway. That definitely will create some additional sources of revenues and positions as well. So I will definitely say our revenue and number of employees will continue to increase.
Q: But it sounds like you have some potential funding that could be lost because of what’s happening federally?
A: Correct. Right now we’re hearing about the fiscal cliff affecting health centers, which for us could equate to about a 4.2 million dollar loss (in federal funding). We anticipate a solution at the federal level. Health centers have received bipartisan support historically.
But unfortunately just because of the way things are, and because of different prevailing issues, our funding has been delayed. We’ve also seen funding with CHIP, which is the funding for children and pregnant women, has also been delayed. Those impacts are starting to be felt in California with a shortfall in funding for those patients.
We’re hoping for a minimum two-year funding resolution.
Q: In November you succeeded Tracy Ream, the long-time CEO. What’s it like stepping into the role?
A: It’s exciting. One of the main reasons I have stuck around with Neighborhood Healthcare was that we’re an organization that really puts patients first. Our leadership has always had a very strong clinician voice. I’ve been at the table for several years as part of the executive team.
And part of Tracy’s legacy was really that leadership style. For me to step into this role, and getting to be a part of the organization that I started my career with has been phenomenal. There obviously is a learning curve. But it’s been less because I’ve been part of this organization and I understand our culture and what makes Neighborhood tick — and then where we want to head and what the future holds, especially as health care delivery changes.
Q: It’s becoming more common for physicians to lead health organizations. Why do you think that is?
A: We’re moving to a world of value-based payment where really the emphasis is on quality outcomes, and not just about bottom line. It’s really making sure we are providing the highest quality and the lowest cost.
To drive that change, you need physicians who understand both sides of that equation. Speaking to other physicians, peer to peer, goes a lot further than an administrator telling a physician what do. Part of my current role, I plan to continue seeing patients four hours a week just to stay engaged with our clinician staff, in the weeds with them, and making sure I understand the challenges they’re facing in delivering high-quality care for our patients.
With physician leaders, they’re getting that training to understand finances, understand the other aspects of the organization, and balance that with the needs of the patient.
This Q&A was edited for clarity and brevity.