The start of 2018 looked pretty bleak for Mountain View's local community clinic.
MayView Community Health Center, which serves thousands of the city's low-income residents with affordable health care services, was facing dire financial straits and struggling to retain medical staff and hire new employees in a surprisingly tight market for physicians and nurses. Competition from hospital giants with bigger budgets on the Peninsula was largely to blame.
But after a change in leadership, some badly needed tech upgrades and an infusion of cash from public agencies, MayView's financial future is looking bright. Instead of slashing hours, MayView officials are now seeking to expand services for needy North County patients. It's been a busy year of reorganization and rebuilding since January, said Interim CEO Ken Graham, and staving off red ink is still a work in progress.
"We have a ways to go to be more financially stable and provide a broad array of services," said Graham, who previously led El Camino Hospital as its president and CEO.
More than 6,000 patients rely on MayView's clinics, located in Sunnyvale, Mountain View and Palo Alto, for primary care, preventative medicine, women's health and pregnancy services. While the clinic's service area extends from Palo Alto south to parts of Santa Clara, the largest group of patients -- about 37 percent -- come from Mountain View.
MayView is one of seven nonprofit organizations serving Mountain View residents that benefit from the Voice's annual Holiday Fund. Donations to the fund are divided equally among the nonprofits and are administered by the Silicon Valley Community Foundation at no cost, so 100 percent of contributions go to the recipients.
Since opening its doors in 1972, the clinic has become an integral part of the safety net for North County residents with few alternatives. Santa Clara County doesn't have a clinic in the area, and Mountain View's RotaCare clinic shut down in in 2016. An estimated 70 percent of MayView's patients are on some form of Medi-Cal, and 20 percent are either uninsured or under-insured. Fees are based on a sliding scale, and the clinic has a policy not to hassle those who are unable to pay the bill, Graham said.
The lack of other health care options for low-income residents -- particularly anything nearby and trusted among immigrant communities -- made MayView's previously faltering finances all the more grim. Santa Clara County supervisors in April agreed to pitch in $375,000 in "emergency stabilization funding" to hire an additional physician and part-time nurse just to keep the doors open. At the time, MayView's employee count was dropping so fast it was expected to lose half its medical staff in five months, and there was a real fear that the Sunnyvale clinic would need to shutter.
Graham, who came out of retirement to lead MayView through troubled waters, said it's been a busy year to get the network of clinics back on track, starting with a spree of accreditations and license recertifications along with reorganizing care in "medical teams," where staffers with different roles work together as a unit to help patients at individual clinics. Along with better pay, Graham said the organization has also sought some much-needed quality of life upgrades for both patients and staff.
One obvious improvement is upgrading MayView's medical records system, which is about five generations old and hasn't been popular for more than a decade, bogging down everyone from physicians to social workers and behavioral health staff. Another is the call system to make appointments, which Graham said fell well short of today's expectations.
"The phone system is very antique," he said. "It's a clunky call tree that's very difficult to manage and change, and in this day in age everyone wants something within 20 seconds."
One source of MayView's troubles is that it simply wasn't ready to take on the huge number of patients who used to go to the RotaCare clinic and were referred to MayView following its closure, said Mike Fischetti, a Mountain View resident serving on MayView's board of directors. The clinics continued to operate as they had in past years despite a stark increase in volume, lacking essential structures for human resources and quality assurance for MayView's patients and staff alike.
Major shifts within MayView's leadership, including Graham as CEO and a board roster now full of medical expertise, has helped regain the confidence of the staff and created the sense of a MayView "family" with a mission to help needy residents.
"Ken (Graham) recognized that the most valuable asset at MayView was his staff," Fischetti said. "There are lots of people who chose to work there for less money because they believed in the commitment, so he set out to improve the morale of the staff."
Some of the changes were small and easy fixes, but signaled to the MayView staff that they weren't on a sinking ship. Marilyn Winkleby, also on the board, said Graham sought to throw out old furniture and equipment in the hallways of the clinics, making more room to move around. The little things told employees, psychologically, that the clinic was poised for a rebound under Graham's leadership.
Coming over the next several months is MayView's launch of dental services, which are tough to find for Medi-Cal and uninsured patients. Similar to RotaCare when it was launched in Mountain View in the 1990s, Graham said dentistry often falls outside the scope of a community clinic due to its surgical procedures and reliance on repeat visits. Dentistry will likely begin at the Palo Alto clinic, located in the same building as the Palo Alto Courthouse.
Amid the high-tech jobs, million-dollar homes and low unemployment rates in Santa Clara County, it's easy to forget how many people are struggling, Graham said, pointing to the huge discrepancy in wealth roughly split by El Camino Real up and down the Peninsula. He said that many of the low-income patients MayView serves are hardly indigent, and that many are working service jobs.
"My experience with them is there aren't a lot of malingerers," he said. "They're there for a reason, but they aren't there intentionally."
After leaving El Camino Hospital in 2011, Graham relocated and worked at hospitals on Oahu and the Big Island serving mostly native Hawaiian populations before returning to the area in 2016. He said there's an old joke that there is no competition for helping poor people, but the number of people in need of health services and struggling with the high cost of living in the Bay Area is really starting to stretch the definition of "poor."
"Waitresses, people who sweep the streets and paint the buildings -- it's not all that obvious that these people, in this area particular, are subject to really high expenses," Graham said. "We've got some interest in exploring where is the edge of that, the core question of what is low-income in Silicon Valley anymore."
Fischetti said that over the last five to 10 years, MayView's client base has largely shifted to the working poor -- families who have been "left out of this economy" and make ends meet working two or three jobs without insurance coverage.
"It's not clear, if we were to fold, that the clientele that we see would necessarily fit in easily in the county clinics or any other kind of service," he said. "We feel a moral obligation to stay present in the community."
Another recent challenge facing MayView is that the immigrant patients, fearful and anxious over the rhetoric and policy changes from President Donald Trump's administration, are hesitant to sign up for any government-run health services. As many as 20 percent of the clinic's patients are in "some stage or another" of immigration, Graham said, some of them legal and some of them not, but all are affected by the "chill" and are less likely to sign up for anything that could amount to public charge. It's an uphill battle to assuage those fears.
"All the fear in the neighborhood about immigrants and identity, and I have a clinic right in the courthouse," he said.