Clever Care Health Plan, con sede en Huntington Beach, y Alignment Health, con sede en Orange, tienen planes dirigidos a los asiático-americanos, con beneficios adicionales que incluyen cobertura para tratamientos y medicinas orientales tradicionales como la acupuntura y el masaje tui na. Alignment también tiene una oferta dirigida a los latinos, mientras que SCAN Health Plan, con sede en Long Beach, tiene un producto dirigido a la comunidad LGBTQ+. Las tres los han estado lanzando desde 2020.

Si bien muchos proveedores de Medicare Advantage se dirigen a varias comunidades en sus publicidades, este trío de empresas parece ser uno de los primeros en la nación en crear planes con redes de proveedores y beneficios diseñados para cohortes culturales específicas.

Medicare Advantage suele ser más económico que Medicare tradicional, pero generalmente requiere que los pacientes utilicen proveedores dentro de la red.

“Esto se ajusta mejor a mí”, dijo Tam Pham, de 78 años, vietnamita-americano de Westminster, California y miembro de Clever Care. Hablando con KFF Health News a través de un intérprete, dijo que aprecia los beneficios dentales y de suplementos herbales incluidos en su plan, y especialmente el acceso a un médico que habla vietnamita.

“Siempre puedo recibir ayuda cuando llamo, sin necesidad de un intérprete”, afirmó.

Los defensores de estos nuevos planes con foco cultural dicen que pueden ofrecer no solo proveedores de confianza que comprenden el contexto único de sus pacientes y hablan su idioma, sino también productos y servicios especiales diseñados para sus necesidades. Los asiático-americanos pueden querer cobertura para tratamientos orientales tradicionales, mientras que los pacientes LGBTQ+ pueden estar especialmente preocupados por la prevención o el manejo del VIH, por ejemplo.

Los investigadores de políticas de salud señalan que Medicare Advantage tiende a ser lucrativo para las aseguradoras, pero puede ser tener resultados mixtos para los pacientes, que a menudo tienen una elección limitada de proveedores. Dicen piensan que estos planes enfocados no necesariamente resolverían ese problema. De hecho, algunos se preocupan de que este enfoque pueda terminar siendo un nuevo vector de discriminación.

“Es extraño pensar en comercializar y beneficiarse de las identidades raciales y étnicas de las personas”, dijo Naomi Zewde, profesora asistente en la Escuela de Salud Pública de Fielding de la UCLA. “Deberíamos hacerlo con cuidado y proceder con precaución, para no ser explotadores”.

Sin embargo, hay suficiente evidencia de que los pacientes pueden beneficiarse de una atención dirigida a su raza, etnia u orientación sexual.

Un estudio de noviembre de 2020 que incluyó casi 118,000 encuestas de pacientes, publicado en JAMA Network Open, resaltó la necesidad de una conexión entre el médico y el paciente, encontrando que los pacientes con la misma ascendencia racial o étnica que sus médicos tienen más probabilidades de calificar a estos últimos de manera positiva.

Una encuesta de 2022 realizada a 11,500 personas de todo el mundo por la compañía farmacéutica Sanofi mostró una persistente desconfianza en los sistemas de atención médica entre grupos marginados, como las minorías étnicas, las personas LGBTQ+ y las personas que viven con capacidades diferentes.

Clever Care, fundada por el ejecutivo de salud coreano-americano Myong Lee, tenía como objetivo desde el principio crear planes de Medicare Advantage para comunidades asiáticas desatendidas, según Peter Winston, vicepresidente senior y gerente general de desarrollo comunitario y de proveedores de la empresa. “Cuando comenzamos las inscripciones, nos dimos cuenta de que no existe un ‘asiático’ único, sino que hay coreanos, chinos, vietnamitas, filipinos y japoneses”, agregó Winston.

La compañía tiene líneas de atención al cliente por idioma y brinda a los miembros flexibilidad en cómo y dónde gastar sus asignaciones para beneficios, como por ejemplo en programas de acondicionamiento físico.

Winston dijo que el plan comenzó con 500 miembros en enero de 2021 y ahora tiene 14,000 (aún muy pequeño en comparación con los planes convencionales). El beneficio de suplementos herbales varía según el plan, pero se ofrecen más de 200 productos tradicionalmente utilizados por clientes asiáticos, con una cobertura de hasta varios cientos de dólares por trimestre.

Sachin Jain, médico y CEO de SCAN Group, dijo que su plan LGBTQ+ atiende a 600 miembros.

“Este es un grupo de personas que, durante gran parte de sus vidas, vivió en las sombras”, agregó Jain. “Tenemos la oportunidad, como empresa, de ayudarlos, de proporcionarles un conjunto especial de beneficios que aborden necesidades no satisfechas”.

SCAN también ha enfrentado problemas de prejuicio, con algunos de sus empleados posteando comentarios racistas y un proveedor de larga data negándose a participar en el plan, según relató Jain.

Por su parte, Alignment Health ofrece un plan dirigido a asiático-americanos en seis condados de California, con beneficios como servicios tradicionales de bienestar, una asignación de comestibles para tiendas asiáticas, transporte médico no urgente e incluso cuidado de mascotas en caso de que un miembro tenga un procedimiento hospitalario o una emergencia y necesite estar fuera de casa.

Alignment también tiene una oferta dirigida a los latinos, llamada el Único, en partes de Arizona, Nevada, Texas, Florida y California. El producto de California, un HMO que es una marca junto con Rite Aid, está disponible en seis condados. En Florida y Nevada el plan se denomina “de necesidades especiales”, para beneficiarios de Medicare que también califican para Medicaid. Todos ofrecen una red de proveedores que hablan español.

Todd Macaluso, director de desarrollo de Alignment, se negó a compartir números específicos, pero dijo que la membresía en California en Harmony, su plan adaptado para asiático-americanos, y el Único ha crecido un 80% año tras año desde 2021.

Los esfuerzos de marketing de Alignment, que incluyen visitas a lugares donde los posibles miembros pueden comprar o socializar, van más allá de simplemente inscribir clientes, dijo Macaluso.

“Estar presente allí significa que podemos ver lo que funciona, lo que se necesita y desarrollarlo. La población elegible para Medicare en Fresno es muy diferente de la de Ventura”.

“Es importante tener materiales en el mismo idioma, así como identificar al consumidor que llama, y guiarlo adecuadamente”, dijo Macaluso.

Investigaciones recientes de Better Medicare Alliance, una organización sin fines de lucro fundada por aseguradoras de salud, muestran que, en general, afroamericanos, latinos y asiáticos tienen más probabilidades que los beneficiarios blancos no hispanos de elegir planes de Medicare Advantage. (Los latinos pueden ser de cualquier raza o combinación de razas).

Sin embargo, no está claro en qué medida esto se traducirá en el crecimiento de redes enfocadas: los esfuerzos de marketing de las grandes aseguradoras de Medicare Advantage a menudo se dirigen a cohortes raciales o étnicas específicas, pero los planes no suelen incluir beneficios especiales para esos grupos.

Utibe Essien, profesor asistente de medicina en la UCLA, señaló la histórica desatención a la comunidad negra y que la escasez de médicos negros podría dificultar la creación de una oferta dirigida para esa población. Del mismo modo, muchas partes del país no tienen una concentración lo suficientemente alta de grupos específicos como para respaldar una red enfocada.

Sin embargo, las tres empresas son optimistas sobre la expansión entre grupos que no siempre han sido tratados de manera adecuada por el sistema de atención médica. “Si los tratas con respeto y les brindas atención de la manera que esperan, vendrán”, dijo Winston.

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Clever Care Health Plan, based in Huntington Beach, and Alignment Health, based in nearby Orange, both have plans aimed at Asian Americans, with extra benefits including coverage for Eastern medicines and treatments such as cupping and tui na massage. Alignment also has an offering targeting Latinos, while Long Beach-based SCAN Health Plan has a product aimed at the LGBTQ+ community. All of them have launched since 2020.

While many Medicare Advantage providers target various communities with their advertising, this trio of companies appear to be among the first in the nation to create plans with provider networks and benefits designed for specific cultural cohorts. Medicare Advantage is typically cheaper than traditional Medicare but generally requires patients to use in-network providers.

“This fits me better,” said Clever Care member Tam Pham, 78, a Vietnamese American from Westminster, California. Speaking to KFF Health News via an interpreter, she said she appreciates the dental care and herbal supplement benefits included in her plan, and especially the access to a Vietnamese-speaking doctor.

“I can always get help when I call, without an interpreter,” she said.

Proponents of these new culturally targeted plans say they can offer not only trusted providers who understand their patients’ unique context and speak their language, but also special products and services designed for their needs. Asian Americans may want coverage for traditional Eastern treatments, while LGBTQ+ patients might be especially concerned with HIV prevention or management, for example.

Health policy researchers note that Medicare Advantage tends to be lucrative for insurers but can be a mixed bag for patients, who often have a limited choice of providers — and that targeted plans would not necessarily solve that problem. Some also worry that the approach could end up being a new vector for discrimination.

“It’s strange to think about commodifying and profiting off people’s racial and ethnic identities,” said Naomi Zewde, an assistant professor at the UCLA Fielding School of Public Health. “We should do so with care and proceed carefully, so as not to be exploitive.”

Still, there’s plenty of evidence that patients can benefit from care that is targeted to their race, ethnicity, or sexual orientation.

A November 2020 study of almost 118,000 patient surveys, published in JAMA Network Open, underscored the need for a connection between physician and patient, finding that patients with the same racial or ethnic background as their physicians are more likely to rate the latter highly. A 2022 survey of 11,500 people around the world by the pharmaceutical company Sanofi showed a legacy of distrust in health care systems among marginalized groups, such as ethnic minorities, LGBTQ+ people, and people with disabilities.

Clever Care, founded by Korean American health care executive Myong Lee, aimed from the start to create Medicare Advantage plans for underserved Asian communities, said Peter Winston, the senior vice president and general manager of community and provider development at the company. “When we started enrollments, we realized there is no one ‘Asian,’ but there is Korean, Chinese, Vietnamese, Filipino, and Japanese,” Winston added.

The company has separate customer service lines by language and gives members flexibility on how and where to spend their allowances for benefits like fitness programs.

Winston said the plan began with 500 members in January 2021 and is now up to 14,000 (still very small compared with mainstream plans). Herbal supplement benefit dollars vary by plan, but more than 200 products traditionally used by Asian clients are on offer, with coverage of up to several hundred dollars per quarter.

Sachin Jain, a physician and the CEO of SCAN Group, said its LGBTQ+ plan serves 600 members.

“This is a group of people who, for much of their lives, lived in the shadows,” Jain added. “There is an opportunity for us as a company to help affirm them, to provide them with a special set of benefits that address unmet needs.”

SCAN has run into bias issues itself, with some of its employees posting hate speech and one longtime provider refusing to participate in the plan, Jain recounted.

Alignment Health offers a plan targeting Asian Americans in six California counties, with benefits such as traditional wellness services, a grocery allowance for Asian stores, nonemergency medical transportation, and even pet care in the event a member has a hospital procedure or emergency and needs to be away from home.

Alignment also has an offering aimed at Latinos, dubbed el Único, in parts of Arizona, Nevada, Texas, Florida, and California. The California product, an HMO co-branded with Rite Aid, is available in six counties, while in Florida and Nevada, it’s a so-called special needs plan for Medicare beneficiaries who also qualify for Medicaid. All offer a Spanish-speaking provider network.

Todd Macaluso, the chief growth officer for Alignment, declined to share specific numbers but said California membership in Harmony — its plan tailored to Asian Americans — and el Único together has grown 80% year over year since 2021.

Alignment’s marketing efforts, which include visiting places where prospective members may shop or socialize, are about more than just signing up customers, Macaluso said.

“Being present there means we can see what works, what’s needed, and build it out. The Medicare-eligible population in Fresno looks very different from one in Ventura.”

“Just having materials in the same language is important, as is identifying the caller and routing them properly,” Macaluso added.

Blacks, Latinos, and Asians overall are significantly more likely than white beneficiaries to choose Medicare Advantage plans, according to recent research conducted for Better Medicare Alliance, a nonprofit funded by health insurers. (Latino people can be of any race or combination of races.) But it’s not clear to what extent that will translate into the growth of targeted networks: Big insurers’ Medicare Advantage marketing efforts often target specific racial or ethnic cohorts, but the plans don’t usually include any special features for those groups.

Utibe Essien, an assistant professor of medicine at UCLA, noted the historical underserving of the Black community, and that the shortage of Black physicians could make it hard to build a targeted offering for that population. Similarly, many parts of the country don’t have a high enough concentration of specific groups to support a dedicated network.

Still, all three companies are optimistic about expansion among groups that haven’t always been treated well by the health care system. “If you treat them with respect, and bring care to them the way they expect it, they will come,” Winston said.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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A veces dudó de sí mismo, pero le da crédito a la determinación que desarrolló como receptor en el equipo de fútbol americano de la Universidad de California-Davis para ayudarlo en sus estudios.

“Ser un atleta universitario me dio confianza para manejar el rigor de la escuela de medicina”, dijo el joven de 25 años, casado y padre de tres hijos. “Fue más difícil porque no tenía ningún médico modelo a seguir”.

Esta primavera, Cummins completará su cuarto año en el campus regional de la Facultad de Medicina de la Universidad de California-San Francisco en Fresno. En marzo, fue designado al programa de residencia en medicina interna de UCSF Fresno, donde completará su formación.

El campus alberga uno de los Programas de Educación Médica de la Universidad de California, o UC PRIME, que anima a los estudiantes de color a obtener títulos médicos para ayudar a diversificar el campo y aliviar la escasez de médicos, particularmente en las comunidades desatendidas.

El sistema universitario público lanzó el primer programa de capacitación en 2004, en su campus de Irvine, y desde entonces lo ha ampliado a sus seis facultades de medicina, muchos de ellos con énfasis en las comunidades médicamente vulnerables.

Investigadores han descubierto que el programa ha logrado diversificar la inscripción, pero no hay suficiente seguimiento a largo plazo para saber si estos graduados ejercen en las regiones donde más se necesitan.

“Poco se sabe sobre los resultados a largo plazo de UC PRIME, como la ubicación de la práctica o la especialidad”, escribieron los investigadores de Mathematica el otoño pasado después de evaluar el programa a través de un beca de la California Health Care Foundation.

Los administradores de la UC dicen que sus datos muestran resultados prometedores. En su informe de marzo para la Legislatura estatal, el sistema universitario encontró que más de la mitad de los que completaron su capacitación están sirviendo a comunidades desatendidas, aunque las escuelas de Los Ángeles y San Francisco no pudieron brindar información completa.

Los estudiantes participantes reciben capacitación en cursos especializados y experiencias clínicas para brindar atención culturalmente competente. Dependiendo de sus circunstancias individuales, pueden recibir ayuda financiera y becas, así como también desarrollo en liderazgo y tutoría.

“Estos resultados demuestran que los programas UC PRIME tienen un impacto sustancial en el aumento de la cantidad de graduados que siguen carreras dedicadas a mejorar la salud de los desatendidos a través de roles de liderazgo como médicos, educadores, investigadores y defensores de políticas sociales comprometidos con la comunidad”, escribió el sistema universitario.

Deena McRae, vicepresidenta asociada interina de ciencias académicas de la salud de la Oficina del Presidente de la UC, dijo que la universidad continuará mejorando el seguimiento de los profesionales.

Hace varios años, la California Future Health Workforce recomendó expandir el programa, y señaló que es probable que los graduados pertenezcan a grupos raciales y étnicos subrepresentados, que ejerzan en California, “y que atiendan a poblaciones desatendidas más que los médicos que no participan de programas similares”.

El programa de formación médica también busca captar estudiantes en edades tempranas. Por ejemplo, la Oficina de Vías Profesionales de la Salud de UCSF Fresno ejecuta programas que alientan a los estudiantes de escuelas media y secundaria a seguir carreras en medicina.

El estado ha seguido aumentando el apoyo. En 2021, asignó casi $13 millones en nuevos fondos para UC PRIME. Esa cantidad permitirá que el programa crezca de 396 estudiantes este año a casi 500 para el año académico 2026-27, predijo la UC.

Sidra Suess, una paquistaní que creció en Modesto, ahora practica medicina interna en Kaiser Permanente en Stockton. Completó su trabajo de pregrado y dos años de la escuela de medicina en UC Davis antes de hacer sus últimos dos años de la escuela de medicina en UCSF Fresno a través de su programa del Valle de San Joaquín.

“Stockton es una mezcla tan diversa y hermosa de culturas e idiomas”, dijo Suess. “Sé que tomé la decisión correcta al estar aquí y PRIME me abrió las puertas para hacerlo. La ayuda para la matrícula, las becas y otro tipo de apoyo que ofrece pueden ser fundamentales para que los estudiantes se involucren”.

El otoño pasado, Mathematica encontró que los estudiantes de medicina subrepresentados en las escuelas de la UC aumentaron más del doble, del 16% en 2000 al 40% en 2021, un aumento que se atribuye en gran parte a UC PRIME. Los investigadores le dieron crédito al programa por “centrar los esfuerzos de reclutamiento en personas comprometidas a servir a las comunidades subrepresentadas”.

Sin embargo, el informe citó la falta de datos a largo plazo como un obstáculo para saber dónde terminan practicando estos graduados. Un estudio de la Facultad de Medicina de UC Davis encontró que hasta el 62% practicaba en un lugar desatendido, pero esa investigación se basó en fuentes secundarias.

“Se necesitan al menos 11 años o más para producir un médico en ejercicio después de la escuela secundaria, según la especialidad”, dijo Kenny Banh, decano asistente de educación médica de pregrado en UCSF Fresno. “Hace falta más tiempo para realizar un seguimiento de los resultados de nuestros graduados”.

Banh, un médico de medicina de emergencia, enfatizó la importancia de los médicos que hablan los mismos idiomas y provienen de las mismas culturas que sus pacientes. Dijo que las áreas rurales necesitadas a menudo importan médicos extranjeros, patrocinando sus visas, pero que esos médicos no están necesariamente comprometidos con la región.

Mientras tanto, más del 80% de sus estudiantes provienen de entornos desfavorecidos y subrepresentados, dijo. “Estudié medicina para abrir puertas a estudiantes como yo”, dijo Banh.

En las regiones desatendidas, tiende a haber menos médicos; los hospitales y los centros de salud probablemente tengan más dificultades para reclutar y retener médicos; y los pacientes pueden tener que conducir largas distancias para acceder a la atención.

Un informe de 2021 del Healthforce Center en UCSF encontró que Inland Empire tenía la proporción más baja de médicos de atención primaria por cada 100,000 personas en California, mientras que el Valle de San Joaquín tenía la proporción más baja de especialistas por cada 100,000 personas.

Diversificar el campo también podría ser bueno para la salud de los pacientes. Por ejemplo, una nueva investigación ha encontrado que las personas negras viven más tiempo en áreas donde hay más médicos negros.

De Selma, luego Kingsburg, los padres de Inderpreet “Inder” Bal trabajaron como granjeros inmigrantes. Eligió estudiar medicina durante su tercer año en Fresno State, aplicó a UCSF y ahora está en la clase PRIME de UCSF San Joaquin Valley de 2024. “Definitivamente estuvo a la altura de todo lo que imaginé”, dijo Bal.

A través de la experiencia de su madre con cáncer terminal, Bal se dio cuenta de que ser médica no significaba que podía curar a todos, pero se esfuerza por dar lo mejor de sí a cada paciente. Dijo que está comprometida a practicar en el Valle Central algún día.

Esta historia fue producida por KFF Health News, que publica  California Healthline, un programa editorialmente independiente de la California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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“Being a collegiate athlete gave me confidence to apply myself and handle the rigorous schoolwork of medical school,” said the 25-year-old husband and father of three. “It was harder because I didn’t have any physician role models.”

This spring, Cummins will complete his fourth year of medical school at the University of California-San Francisco School of Medicine’s regional campus in Fresno. In March, he matched with UCSF Fresno’s internal medicine residency program, where he will complete his training.

The campus is home to one of the University of California’s Programs in Medical Education, or UC PRIME, which encourages students of color to pursue medical degrees to help diversify the field and ease the physician shortage, particularly in underserved communities. The public university system launched the first training program in 2004, at its Irvine campus, and has since expanded it to all six medical schools, many with an emphasis on medically underserved communities.

Researchers have found that the program has succeeded at diversifying enrollment, but there is not enough long-term tracking to know whether these medical school graduates return to practice in regions where they’re most needed. “Little is known about the long-term outcomes of UC PRIME, such as practice location or specialty, in the absence of a longitudinal, summative program evaluation across all UC PRIME programs,” researchers with Mathematica wrote last fall after assessing the program through a grant from the California Health Care Foundation. (KFF Health News publishes California Healthline, an editorially independent service of the California Health Care Foundation.)

UC administrators say their data shows promising results. In its March report to the state legislature, the university system found over half of those who have completed their training are serving underserved communities, although the Los Angeles and San Francisco schools were unable to provide complete information. Participating students are trained in specialized coursework and clinical experiences to deliver culturally competent care. Depending on their individual circumstances, they may receive financial aid and scholarships as well as leadership development and mentoring.

“These outcomes demonstrate that UC PRIME programs have a substantial impact on increasing the number of UC medical school graduates who pursue careers devoted to improving the health of the underserved through leadership roles as community-engaged clinicians, educators, researchers, and social policy advocates,” the university system wrote.

Deena McRae, interim associate vice president of academic health sciences for the UC Office of the President, said the university will continue to enhance its tracking.

Several years ago, the California Future Health Workforce Commission recommended expanding the program, noting that graduates are likely to be from underrepresented racial and ethnic groups, likely to practice in California, “and more likely to care for underserved populations than physicians who do not participate in similar programs during medical school.” The medical training program also seeks to recruit students at an early age. For example, UCSF Fresno’s Office of Health Career Pathways runs programs that encourage middle and high school students to pursue careers in medicine.

The state has followed through by increasing support. In 2021, the state allocated almost $13 million in new funding for UC PRIME. That amount will allow the program to grow from 396 students this year to nearly 500 by the 2026-27 academic year, UC predicted.

Sidra Suess, a Pakistani who grew up in Modesto, now practices internal medicine at Kaiser Permanente in Stockton. She completed her undergraduate work and two years of medical school at UC Davis before doing her final two years of medical school at UCSF Fresno through its San Joaquin Valley program.

“Stockton is such a diverse mix and beautiful blend of cultures and languages,” Suess said. “I know I made the right choice to be here, and PRIME opened doors for me to do this. The tuition help, scholarships, and other support that PRIME offers can be fundamental to getting students involved and active who can do well.”

Last fall, Mathematica found underrepresented medical students at UC schools more than doubled, from 16% in 2000 to 40% in 2021, an increase largely attributed to UC PRIME. Researchers credited the program for “focusing recruitment efforts on individuals committed to serving underrepresented communities.”

However, the report cited a lack of long-term data as an obstacle to knowing where these graduates end up practicing. One study of the program’s graduates and those from several other community-focused special education tracks from the UC Davis School of Medicine found as many as 62% practiced in an underserved location, but that research relied on secondary sources.

“It takes at least 11 years or more to produce a practicing physician after high school, depending on the specialty,” said Kenny Banh, assistant dean of undergraduate medical education at UCSF Fresno. “More time is needed to track outcomes for our graduates.”

Banh, an emergency medicine physician, stressed the importance of doctors who speak the same languages and come from the same cultures as their patients. He said rural areas in need often import foreign physicians, sponsoring their visas, but that those doctors aren’t necessarily committed to the region. They may accept sign-on bonuses and work for a time then leave.

Meanwhile, more than 80% of his students come from disadvantaged and underrepresented backgrounds, he said. “I went into medicine to open doors for students like myself,” said Banh. “Students don’t just walk through those alone.”

In underserved regions, there tend to be fewer doctors serving patients; hospitals and health facilities likely have a harder time recruiting and retaining clinicians; and patients may have to drive long distances to access care. A 2021 report from the Healthforce Center at UCSF found that the Inland Empire had the lowest ratio of primary care physicians per 100,000 people in California while the San Joaquin Valley had the lowest ratio of specialists per 100,000 people.

Diversifying the field could also be good for patients’ health. For example, new research has found that Black people live longer in areas with more Black doctors.

From Selma, then Kingsburg, Inderpreet “Inder” Bal’s parents worked as immigrant farmers. She chose to pursue medicine during her third year at Fresno State, she applied to UCSF, and she is now in UCSF San Joaquin Valley PRIME’s class of 2024. “It definitely lived up to everything I imagined,” said Bal, who is Punjabi Sikh.

Through her mother’s journey with terminal cancer, Bal realized that being a doctor didn’t mean she could cure everyone, but she strives to give every patient her best. Bal said she’s committed to practicing in the Central Valley one day.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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“She looked so sad and didn’t say anything,” Huang recalled. The girl’s brother explained that they had been separated for a week during their journey. His sister cried every day without him, he said. Now, she wanted to stick close at all times.

“This has been pretty hard,” Huang told KHN later. She knew few details of the siblings’ story, but many of the children at the center had trekked across hundreds of miles of dangerous lands guided by a smuggler.

The siblings, not named for privacy reasons, are among the hundreds of children, mostly from Central America, attempting to cross the U.S. border alone from Mexico each day. After brief detention by the Border Patrol, they are sent to shelters run by the Department of Health and Human Services while officials seek to unite them with relatives or other sponsors in the United States.

Long Beach offered housing at its convention center as part of a Biden administration effort to move children more quickly from the forbidding border housing where they are held initially. Those harsh settings, where at least five children died in 2018 and 2019, provoked a backlash against the Trump administration’s immigration policies.

The Long Beach location is one of more than a dozen temporary homes the federal government has set up for a massive influx of children. On June 14, it housed 115 children — a mix of girls up to age 17 and boys up to 12, out of consideration for their privacy and safety, an HHS official said — and had connected 755 others with relatives or sponsors since the first children arrived on April 22. Federal officials, citing the safety and privacy of the children, have not allowed KHN or other news media to enter the facility currently.

The children arrive at the Long Beach facility by bus, scared and timid but “very well behaved,” said Huang, director of pediatric nursing at Mattel Children’s Hospital of UCLA Health, who is doing temporary duty at the shelter. “They warm up to the staff here and when they get to know you and start talking to you, it melts your heart.”

DRC Emergency Services, a government contractor that typically performs jobs like debris removal after hurricanes, subcontracted with UCLA Health, UCI Health, Children’s Hospital of Orange County and other providers to care for the children.

“We can imagine they have been through a lot,” said Jennie Sierra, nursing director in the neonatal intensive care unit at the Orange County hospital. “They’re very grateful, and they’re an amazing, resilient group.”

“Most of my nurses here come from immigrant families, and we consider it an honor and privilege to serve in this capacity,” she said.

Before this year’s surge of migrants at the U.S. border, HHS ran about 200 such facilities in 22 states and has announced plans to double capacity by adding about 18,500 emergency beds this year. It has signed $400 million in contracts to provide services for unaccompanied children. The federal government is paying about $35 million to house and care for the children at the Long Beach convention center through Aug. 2.

“Border Patrol stations were never designed to be places for minors to be held for any period of time,” said Border Patrol spokesperson Matthew Dyman. The cells were intended for “single adult males to be quickly turned around — and not for families or children.”

The Border Patrol can legally hold the children 72 hours before putting them in the custody of HHS’ Office of Refugee Resettlement, which looks for relatives or sponsors in the U.S. pending immigration hearings.

On a recent day, June 14, HHS was caring for 15,365 children at facilities around the country and discharged 412 into communities. HHS Secretary Xavier Becerra said in May that the agency had reduced time spent in the emergency shelters to an average of 29 days, down from 40 days in late January.

Within two days of their arrival at Long Beach, the children get a health assessment at a pediatric clinic set up by UCLA Health.

Many come with chronic headaches and stomachaches. Some have rough or broken skin, swollen and infected feet, or rashes caused by filth and clothes rubbing against skin on long marches. Some have colds — or covid; as of Monday, two cases were recorded among children at the convention center. The children stay in isolation and receive appropriate care.

While mental health therapy is limited, visibly sad or anxious children can get counseling and children can take part in weekly group discussions overseen by clinicians, said David Kosub, a federal spokesperson for the Long Beach site. Referrals are provided in the communities to which they are moving, he said.

Caring for the kids “has been very moving and meaningful, even life-changing,” said Dr. Charles Golden, a pediatrician and executive medical director of Children’s Hospital of Orange County’s primary care network.

The doctors and nurses feel loved by their charges, he said. One day, Golden saw a group of children sitting in a circle, playing games. “They came over and gave me a big hug.”

UCLA staffers painted murals for the children, who have access to classrooms, indoor and outdoor play spaces and TVs, soccer nets, hula hoops and ample board games.

They have books, and music from their homelands: punta, marimba, merengue, cumbia and bachata, said UCLA Health child life specialist Tracy Reyes Serrano. Performers have played for the children, too, she said.

“When the kids hear songs they recognize, it lifts their spirits; they’re quick to get up and dance and sing, and we’re happy to join them,” she said.

The Long Beach Community Foundation launched a Migrant Children Support Fund that has raised $200,000, said foundation president and CEO Marcelle Epley. The money has gone to educational programs and toys, as well as gift cards that HHS can distribute once the children are settled with families. Long Beach residents have donated books, toys and personalized notes in Spanish.

Sierra recalled a girl who said she wanted to learn English and become a pediatrician.

“I told her, ‘This is a great country with great opportunities. You’re going to be an amazing doctor,’” Sierra said.

U.S. Rep. Nanette Diaz Barragán (D-Calif.), who represents North Long Beach and the Port of Los Angeles, visited the center May 6 and met children who “seemed to be in a state of hope, smiling and anxious to talk,” including a young boy from Honduras.

“He was very happy until I asked about his home country and he looked like he wanted to cry,” she said. “Someone in our group said, ‘It’s beautiful there,’ and he said ‘No, it’s bad,’ and talked about gangs and violence. He was willing to disagree with an adult.”

The children’s histories are mostly a mystery to their temporary caretakers, said Jennifer Sablan Panopio, a nurse manager in UCI Health’s neonatal intensive care unit who has been the health system’s lead nurse in Long Beach. “We can at least help give them a positive experience here, a good start.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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“She told me, ‘I’m terrified I’m going to get this virus that’s spreading all over the world,'” and worried it would hurt her baby, he said of the March encounter.

Travis, who practices at the Los Angeles County + University of Southern California Medical Center, told the woman he knew she was scared and tried to assure her she was safe and could trust him.

Asking many questions and carefully listening to the answers, Travis was exercising the craft of narrative medicine, a discipline in which clinicians use the principles of art and literature to better understand and incorporate patients’ stories into their practices.

“How do we do that really difficult work during the pandemic without it consuming us so we can come out ‘whole’ on the other end?” Travis said. Narrative medicine, which he studied at Columbia University, has helped him be aware of his own feelings, reflect more before reacting, and view challenging situations calmly, he said.

The first graduate program in narrative medicine was created at Columbia University in 2009 by Dr. Rita Charon, and the practice has gained wide influence since, as evidenced by the dozens of narrative medicine essays published in the Journal of the American Medical Association and its sister journals.

Learning to be storytellers also helps clinicians communicate better with non-professionals, said writer and geriatrician Dr. Louise Aronson, who directs the medical humanities program at the University of California-San Francisco. It may be useful to reassure patients — or to motivate them to follow public health recommendations. “Tell them a story about having to intubate a previously healthy 22-year-old who’s going to die and leave behind his first child and new wife, and then you have their attention.”

“At the same time, telling that story can help the health professional process their own trauma and get the support they need to keep going,” she said.

Teaching Storytelling To Doctors

This fall, Keck School of Medicine of USC will offer the country’s second master’s program in narrative medicine, and the subject also will be part of the curriculum in the new Kaiser Permanente Bernard J. Tyson School of Medicine in Pasadena, which opens its doors July 27 with its first class of 48 students. (KHN, which produces California Healthline, is not affiliated with Kaiser Permanente.)

Narrative medicine trains physicians to care about patients’ singular, lived experiences — how illness is really affecting them, said Dr. Deepthiman Gowda, assistant dean for medical education at the new Kaiser Permanente school. The training may entail a close group reading of creative works such as poetry or literature, or watching dance or a film, or listening to music.

He said there’s also “real, intrinsic value” for patients because a doctor isn’t only being trained to care about the body and medications.

“Literature in its nature is a dive into the experience of living — the triumphs, the joys, the suffering, the anxieties, the tragedies, the confusions, the guilt, the ecstasies of being human, of being alive,” Gowda said. “This is the training our students need if they wish to care for persons and not diseases.”

Dr. Andre Lijoi, a geriatrician at WellSpan York Hospital in Pennsylvania, recently led a virtual session for 20 front-line nurse practitioners who work in nursing homes. Two volunteers recited Mary Oliver’s 1986 poem “Wild Geese,” which reads, “Tell me about despair, yours, and I will tell you mine. Meanwhile the world goes on.”

Sharing the poet’s words helped the nurses relieve their pent-up tensions, enabling them to express their feelings about life and work under COVID-19, Lijoi said.

One participant wrote, “As the world goes on around me I mourn seeing my aging parents, planning my daughter’s wedding, and missing my great niece’s baptism. I wonder, when will life be ‘normal’ again?”

Processing Fear To Provide Better Care

Dr. Naomi Rosenberg, an emergency room physician at Temple University Hospital in Philadelphia, studied narrative medicine at Columbia and teaches it at Temple’s Lewis Katz School of Medicine. The discipline helps her “metabolize” what she takes in while caring for COVID-19 patients, including the fear that comes with having to enter patients’ rooms alone in protective gear, she said.

The training helped her counsel a worried woman who couldn’t visit her sister because the hospital, like others around the country, wasn’t allowing relatives to visit COVID-19-infected patients.

“I’d read stories of Baldwin, Hemingway and Steinbeck about what it feels like to be afraid for someone you love, and recalling those helped me communicate with her with more clarity and compassion,” Rosenberg said. (After a four-day crisis, the sister recovered.)

Close readings can also help students understand the various ways metaphor is used in the medical profession, for good or ill, said Dr. Pamela Schaff, who directs the Keck School’s new master’s program in narrative medicine.

Recently, Schaff led third-year medical students through a critical examination of a journal article that described medicine as a battlefield. The analysis helped student Andrew Tran understand that describing physicians as “warriors” could “promote unrealistic expectations and even depersonalization of us as human beings,” he said.

Something similar happens in the militarized language used to describe cancer, he added: “We say, ‘You’ve got to fight,’ which implies that if you die, you’re somehow a failure.”

In the real world, doctors are often focused narrowly, devoting most of their attention to a patient’s chief complaint. They listen to patients on average for only 11 seconds before interrupting them, according to a 2018 study in the Journal of General Internal Medicine. Narrative medicine seeks to change that.

While listening more carefully may add one more item to a physician’s lengthy “to-do” list, it could also save time in the end, Schaff said.

“If we train physicians to listen well, for metaphor, subtext and more, they can absorb and act on their patients’ stories even if they have limited time,” she said. “Also, we physicians must harness our narrative competence to demand changes in the health care system. Health systems should not mandate 10-minute encounters.”

Telling The Patient’s Whole Story

In practice, narrative medicine has diverse applications. Modern electronic health records, with their templates and prefilled sections, can hamper a doctor’s ability to create meaningful notes, Gowda said. But doctors can counter that by writing notes in language that makes the patient’s struggles come alive, he said.

The school’s curriculum will incorporate a different patient story each week to frame students’ learning. “Instead of, ‘This week, you will learn about stomach cancer,’ we say, ‘This week, we want you to meet Mr. Cardenas,'” Gowda said. “We learn about who he is, his family, his situation, his symptoms, his concerns. We want students to connect medical knowledge with the complexity and sometimes messiness of people’s stories and contexts.”

In preparation for the school’s opening, Gowda and a colleague have been running Friday lunchtime mindfulness and narrative medicine sessions for faculty and staff.

The meetings might include a collective, silent examination of a piece of art, followed by a discussion and shared feelings, said Dr. Marla Law Abrolat, a Permanente Medicine pediatrician in San Bernardino, California, and a faculty director at the new school.

“Young people come to medicine with bright eyes and want to help, then a traditional medical education beats that out of them,” Abrolat said. “We want them to remember patients’ stories that will always be a part of who they are when they leave here.”

This story was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This story can be republished for free (details).

“It was a wonderful call,” said Massie, now 38 and a mental health advocate. “I was laughing by the end, and I got in the holiday spirit.”

Massie, a San Francisco resident, later used the line multiple times when she needed additional support, then began to volunteer there.

Now anyone in California who needs a little help — or even a referral to a professional therapist — can receive it by phone or instant message. In October, the San Francisco-based warmline expanded beyond Northern California to cover the whole state through a state budget allocation of $10.8 million for three years.

Unlike a hotline for those in immediate crisis, warmlines provide early intervention with emotional support that can prevent a crisis — and a more costly 911 call or ER visit. The lines are typically free, confidential peer-support services staffed by volunteers or paid employees who have experienced mental health conditions themselves.

“People pay attention when the biggest state in the union decides to say mental health services are not just for crisis,” said Mark Salazar, the San Francisco association’s executive director.

Such help lines aren’t limited to California, though. About 30 states have some form of a warmline within their borders, including in Salt Lake City and Omaha, Neb. Still, the loose network of call lines faces no regulation or standardization. They’re relatively new, so they haven’t been extensively studied. And their advocates admit quantifying results can be difficult.

Better known are the suicide crisis lines for those who need help immediately. This summer, the Federal Communications Commission proposed a 988 national hotline number for those considering suicide or having a mental health crisis. Yet mental health advocates say warmlines help fill another important health care gap.

“Warmlines help people who think, ‘I don’t know why I’m not feeling great, or who to turn to, or where to get care, and I don’t know for sure if I even need care,'” said Sarah Flinspach, a project coordinator for the National Council for Behavioral Health, which advocates for mental health care services. “It might be the call that helps someone go back to work that day.”

Filling Gaps, Saving Money

Since the San Francisco Peer-Run Warm Line began in 2014, it has answered more than 100,000 calls and served more than 5,000 people. Approximately 85% of callers were repeat users, said Salazar, and that’s just fine.

“Many people are housed, have jobs and function in society, but they’re struggling,” said California state Sen. Scott Wiener, a Democrat from San Francisco who backed the statewide expansion of the line. “They don’t necessarily need full intervention — they just need support. In the peer-to-peer situation, they can take from someone’s firsthand experience and learn how to navigate these problems.”

People often struggle to access basic mental health services without such help, according to Wiener. “They have the choice between nothing, a friend or going to the ER,” he said.

Warmlines can fill a need in rural communities where access to care is limited or provide after-hours support in urban areas, said Rebecca Spirito Dalgin, who has studied warmlines and directs rehabilitation counseling at the University of Scranton in Pennsylvania.

Advocates say they also can save public money by preventing simmering teapots from boiling over.

Angel Prater, a peer support expert, co-authored a federally funded report in 2015 of Oregon’s Community Counseling Solutions warmline that found the average cost of a single call to the line was about $10 over a five-year period, far less than the estimated $100 cost of a 911 call or a trip to the ER, around $700. By giving callers direct referrals to health care providers and helping them avoid higher levels of care, she added, the warmline saved approximately $1.2 million per quarter by 2016.

In addition, the warmline reduced crisis line calls and psychiatric hospitalizations, she said. It also gave police a resource if they encountered people undergoing a mental health challenge who didn’t require a higher level of services.

“We gave local law enforcement a little warmline card with our phone number,” Prater said. “They could pass it along if they felt someone needed no further intervention at that time.”

The Salt Lake County Warmline, begun in 2012, is part of an effective larger crisis intervention and diversion services program “that saves millions of dollars a year,” according to Barry Rose, crisis clinical manager at the University Neuropsychiatric Institute at the University of Utah. The line receives approximately 2,500 calls monthly, which includes repeat users.

“We’re making relationships as we get to know people and they get to know us,” said Rose, who is also a licensed clinical social worker. “Emotional support keeps us all healthy and establishes the kinds of connections we need in our lives.”

In Omaha, 9 in 10 people who contact Safe Harbor Peer Crisis Services reported its warmline prevented their hospitalization, said Aileen Brady, executive vice president and chief operating officer of Community Alliance, a mental health agency that operates the program.

Safe Harbor’s state-funded warmline also began in 2012 and fields roughly 1,000 calls a month. An annual budget of $670,000 funds the line and a complementary on-site program for people to resolve their distress in person.

Calls Change A Day And A Life

A 2018 survey from the National Council and nonprofit philanthropy Cohen Veterans Network cited knowledge gaps as one of the primary barriers that prevent Americans from getting mental health care. It said 46% of those who have never sought treatment would not know where to go if they needed mental health services for themselves, a family member or a friend.

“It’s unimaginable, hard to conceptualize, for those who don’t work in this field, what the level of need really is,” said Quinn Anderson, who manages the National Alliance on Mental Illness HelpLine, which offers referrals to all sorts of mental health support.

Mental health advocates and users admit the warmline system isn’t perfect. Even people who are aware they exist may not get through immediately depending on the volume of calls.

Unlike some crisis lines, the network of warmlines doesn’t blanket the whole country, and many warmlines won’t take out-of-state calls. A caller out of geographic range may be directed to a line with closer resources. The quality of service offered by those who answer calls can be uneven, and few warmlines offer services in another language.

It can also be difficult to assess how effective the help is, said Spirito Dalgin, who authored studies about warmlines in 2011 and 2018.

“If services are funded on outcomes, how do we measure the outcome of these calls?” she said. “You need access to be able to follow a group of people using the warmline, and they need to self-report.”

Even then, quantifying results is tough. Brady said, “It’s hard to measure what doesn’t happen.”

The lack of tangible proof of success could jeopardize the widespread adoption of warmlines, even while basic and affordable mental health care remains hard to access. Still, some warmline operators are optimistic.

“We could see a national network for warmlines in about five years,” said Salazar. “That’s really needed since, day-to-day, no one really focuses on people who are not yet in crisis.”

How To Find A Warmline Near You 

• An unofficial list by state location is available at warmline.org. The site notes which lines are nationally accessible and welcome calls from anywhere. Every line varies by hours, geographic coverage and training of the person answering the call.
• The National Alliance on Mental Illness also can refer callers to a list of warmlines through its HelpLine at 800-950-NAMI (6264), Monday through Friday, 10 a.m. to 6 p.m. ET.
• Someone in immediate danger can call 911 and declare a psychiatric emergency or call the National Suicide Prevention Lifeline: 800-273-TALK (8255).

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This story can be republished for free (details).