Castle Family Health Centers, Inc.: Realizing Its Potential

by HCE Exchange on January 9, 2014

Edward-Lujano-thumbEdward H. Lujano had spent a career tallying figures and crunching numbers, mainly as chief financial officer for various community health centers.

At some point, however, he realized his career was stagnating and he needed to do something more with his skills.

So, Lujano returned to school, obtaining his master’s and doctoral degrees in business administration. His goal was to be in frontline health-care management.

The first call he received after he finished his doctoral studies was from the multi-site, non-profit Castle Family Health Centers.

His first impression upon visiting CFHC’s facilities in Atwater, Calif., was potential. He felt CFHC had so much more potential than it was realizing at the time.

Lujano accepted the role of chief executive officer on a year’s contract. Eight productive years later, he continues to pursue CFHC’s potential.

Changing designations and expanding operations

During Lujano’s time with CFHC, the organization attained a designation similar to ones held by Federal Qualified Health Centers. Its three locations have gone from seeing approximately 45,000 patients to seeing over 111,000 patients in 2012. Its operating budget has doubled, an impressive feat considering that CFHC receives no federal funding or grants and is driven exclusively by patient revenue.

With a predominantly Medicaid population, CFHC has addressed its need to expand into a number of specialties, including dermatology, nephrology, and pulmonology. In many ways, Lujano said, CFHC has become a model for other health centers in the community since its clinics offer specialty care that its competition does not.

This is no small achievement, he added, given that most specialists are reluctant to see patient populations whose payer source is unclear, nonexistent, or unreliable.

The importance of partnerships

As a former CFO, Lujano said he is always examining CFHC’s newest initiatives from a business perspective. He views partnerships as being vital to the organization’s continued success, which is one reason he has strengthened ties with Bloss Memorial Healthcare District and initiated a relationship with UC Berkeley’s School of Optometry.

“I got UC Berkeley to partner with us, and we became their first rotation site in a community health center, giving the students truly an eye-opener of an opportunity to see patients with glaucoma, who are diabetics, from children to elderly,” he said.

CFHC has become the school’s flagship over the last few years, as students request time at the clinics so they can receive hands-on experience with a diverse demographic of patients.

The UC Berkeley relationship also opened doors to financial opportunities for CFHC. By the second year of the program, the optometry department was bringing in revenue of $200,000.

“If we’re going to get into something, it has to make a business sense,” Lujano said. “As much as it is providing care, it has to make a business sense. Otherwise, we’re not going to be able to provide anything.”

Reaching out to a diverse population

With 175 employees, CFHC is centered in a large agricultural region. About 60 percent of the population comprises the younger demographics, while the senior population is only about 8 percent, with the adult population coming in at 51 percent.

Approximately 36 percent of the children in the area under 18 are below federal poverty guidelines. About 80 to 83 percent of individuals speak a language other than English in their homes. Approximately 65 percent are Hispanic, 22 percent Caucasian, 7 percent Asian, 4 percent African American, and 2 percent Indian.

It’s important, therefore, that care providers are not only multilingual, Lujano said, but that they are also culturally sensitive.

For example, some patients come to CFHC with their home remedies in tow. Some will only see a provider of the same gender, while Hispanic patients will bring their entire families with them.

Also, the payer sources for CFHC’s patient population aren’t always clear, and many are uninsured, although Lujano is hopeful that the Affordable Care Act will remedy this.

In spite of the odds, though, he said recruitment is rarely a problem. CFHC is often able to conduct it without hiring any agencies.

“People enjoy coming to work here,” Lujano said. “We have probably a 3-percent turnover rate in employment, so we hold on to our employees or they stay with us.”

CFHC’s oldest employee has been with them for 25 years, he added.

While the pay is competitive, CFHC has also mastered a positive environment.

“I am a believer in empowerment, making people feel not only that they belong, but that they add value to the organization,” Lujano said.

The clinics close down twice a year so CFHC can hold organizational meetings that emphasize communication with its employees. This emphasis has netted positive returns for CFHC. While most organizations are cutting back, Lujano said he is increasing wages and still holding Christmas parties, picnics, and recognizing employees for their efforts.

“It’s because of them that I’m able to keep moving the organization forward. It really becomes what we call a family.”

A willingness to move forward

In many respects, CFHC is not your average community health clinic.

With a comprehensive lab program, CFHC conducts 85 percent of its labs in-house. It offers radiology, mammography, ultrasound, and urgent care, plus it has one of the only child-adolescent psychiatrists in the county on its staff, along with a team of licensed clinical social workers.

Its adult daybreak health-care program sees approximately 25 individuals on an ongoing basis, and its pediatric center employs two of only four pediatricians in the county.

Lujano attributes CFHC’s continued success to a simple three-pronged philosophy he applies not just to his leadership, but to every endeavor the organization undertakes.

“Be willing to change, be willing to learn, and be willing to teach. We have to change in order to stay ahead of the game, we have to learn about the change and change the way we see and do things, and we have to teach and give back our knowledge to others, so others can be ready to help and lead when their time comes.”

by Pete Fernbaugh

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