Q&A: Peg Hopkins

As executive director of the Community Health Association of Spokane (CHAS) — which serves low-income as well as uninsured patients — Peg Hopkins believes she is at the front lines of health care reform. She spoke while driving to Lewiston to open the area’s sixth CHAS clinic — the growth being fueled by a grass-roots desire for affordable, reliable health care regardless of ability to pay.

INLANDER: What does reform look like to you?
HOPKINS: It looks like a major concept shift from a commodity to thinking about it as a piece of infrastructure such as the interstate highway system.

The thing about the interstate highway system is the construction and financing and management is all shared among the states. You have basic rules and regulations that everybody understands. Everybody has a right to get on, but you get on how you please — riding a motorcycle or a semi-truck. But getting from here to there is the challenge.

CHAS was among the first to implement fully electronic health records.

Why is this important?
Currently, almost all the information we have about the health of the American populace comes from two sources: 1) billing information, which is incredibly flawed and money-driven, and 2) studies which need to be extrapolated and expanded and the results of which take 14 years to be implemented in the medical system.

So we really have no database of the health of the populace. Your doctor won’t release the information as long as people think of health care as a commodity, and insurance companies don’t want to share data they have because they are all competing.

A big piece of reform has to be an electronic database because then you can figure out what works and what doesn’t, and we can save a lot of money.

What else is missing?
We are missing leadership. We are missing real vision.

What about complaints about socialized medicine?
We already have socialized medicine. The two highest-quality delivery systems are run by the government — Medicare/Medicaid and the VA. We’re already in the business. To me, [critics of reform] are using wedge words to scare people.

How is CHAS more like infrastructure?
It really is regardless of a patient’s ability to pay, so that first barrier about proving you qualify for care is removed. Everybody qualifies for care. Is that socialized medicine? I guess maybe it is. We also want to have a lifelong relationship with patients. We want to be their medical home.

We have 300 employees and six clinics and some patients who have been with us for 15 years. We are doing it.

We are seeing a rise in the uninsured side of the house. People feel as if they have failed somehow. The stigma that comes with being uninsured probably means that you are unemployed and people take that to mean they have failed. We wrestle with that with our patients. Sometimes it takes a while for patients to get comfortable with us … to know we want to be their health care home.

What factors are holding back reform?
A lot of institutions are not going to change until they are coerced into change. The pharmaceutical industry and insurance companies and the durable-goods providers — a lot of businesses are built up around the fee-for-service model [of health care].

One major hurdle is: How do we help them change? How do we help them figure out a way they can still stay in business?