Silver lining during COVID: Health access improving in Valley despite lagging incomes

The San Joaquin Valley has experienced both sides of COVID-19: The essential agriculture and food processing industries that dominate the region’s economy have held up well — with regional unemployment climbing only slightly compared to joblessness numbers that have more than doubled statewide.

But after dodging the first wave of the virus, the Valley has weathered a difficult winter, with workers with low incomes at especially high risk of contracting the virus.

The Valley’s health system reflects these same stark contrasts, and a newly released report from the California Health Care Foundation highlights where the region’s health system has performed well — before and during the pandemic — and where gaps and opportunities for improvement remain.

The new report is a part of a series of regional CHCF studies examining health care markets across California. One salient fact continues to dominate the region’s health landscape: More than half of San Joaquin Valley residents are either covered by Medi-Cal (44%), the state’s health program Californians with lower incomes, or remain uninsured (8%). As a result, despite recent growth in the number of federally qualified health centers and rural health clinics, Valley residents continue to face problems accessing care, especially for behavioral health services. Many of the region’s health-care systems, hospitals and clinics struggle to recruit physicians and other health-care professionals.

While the region’s robust network of hospitals and health providers have responded admirably to COVID-19, the pandemic has only compounded some of these challenges.

Shortages of physicians and other health professionals remain a particularly acute issue across the region, even with a recent wave of state incentive programs aimed at enticing health workers through scholarships, loan repayments, and other recruitment tools. Of the seven markets studied by CHCF, the San Joaquin Valley has the second-lowest ratio of physicians, at 130 per 100,000 people, compared with 191 per 100,000 people statewide. More than 90% of people across the region’s five counties live in federally designated health professional shortage areas, which by definition means the supply of primary-care physicians in the area is inadequate.

For Medi-Cal enrollees, these shortages are even more acute: Of all managed care plans statewide, CalViva, the local plan for Fresno, Kings, and Madera counties, has the fewest primary-care doctors, at just two per 2,000 enrollees.

Once again, however, there is another side to this coin: Experts believe COVID-19 has brought with it some silver linings for lasting improvements in care delivery — including the widespread adoption of telehealth services, which have greatly expanded access to care across the San Joaquin Valley during the pandemic. Within just a few weeks of the first shelter-in-place orders, some local providers reported a 2,000% increase in the use of telehealth, including a 250% increase in remote treatment for behavioral health patients. Patients have largely favored this flexibility, with cancellations and no-shows declining.

Homegrown efforts to expand the medical professional pipeline have also continued during the pandemic: The UC San Francisco School of Medicine’s Fresno campus is training more than 600 residents and rotating third- and fourth-year medical students each year at clinical sites across the region — and more than 50% of residents and fellows remain in the San Joaquin Valley following their training.

Access to mental health and substance use disorder services for Medi-Cal enrollees has also been improving, though gaps in care remain. While the region has only a small number of psychiatric beds, this shortage may be offset by a new 128-bed inpatient psychiatric facility slated to open in Madera County in 2023.

The San Joaquin Valley’s health and income disparities — and its disproportionately high levels of obesity and asthma — have made the region uniquely vulnerable to COVID-19. But the region’s health system is clearly responding, while taking the steps needed to close gaps between patients and providers.