Stop & Talk

Grant Oliphant 0:00
Hey, Crystal.

Crystal Page 0:11
Hi, Grant. How are you?

Grant Oliphant 0:12
I'm good. I'm actually really good because I just had a great conversation with Sparkle Barnes, who is head of a major organization called Health Quality Partners,

Crystal Page 0:26
so we're talking healthcare today.

Grant Oliphant 0:27
We are talking healthcare, and and the organization is interesting because it encompasses not only healthcare clinics known as FQHCs or federally qualified health clinics, but also a social enterprise that helps serve those organizations and strengthens them, and it's an interesting mix of the things we've been talking about in terms of social enterprises and nonprofits. Yeah. So on that level, really interesting conversation about leadership and all of that, but you know, also sobering about what it's like to be in the health clinic or healthcare space right now.

Crystal Page 1:07
Yeah, and I think given this moment in time with executive orders, cuts at all levels, should be a good conversation. So we should probably dive in. Well,

Grant Oliphant 1:16
let's dive in because one thing Sparkle Barnes is is positive, and I think people will feel good at the end of this conversation, but also have a better understanding of what the challenges are.

Crystal Page 1:27
All right, let's do it.

Grant Oliphant 1:27
Let's do it.

Grant Oliphant 1:32
All right. Well, Sparkle, thank you so much for being here. It is a pleasure to have you with us. You are doing really important work in the health space that we care a lot about, and we're going to talk about that. But before we do, I want to focus a little bit on your personal story and how you came to be interested in mission-driven work. What brought you to do this?

Sparkle Barnes 1:57
Well, I think I've always been interested in mission-driven work. You know, when I was growing up, we always volunteered. You know, service was a big part of my upbringing in a variety of different settings. When I graduated college, I was looking at you know a variety of opportunities as any young individual does coming out of college, and I had actually interviewed for a number of positions here in San Diego, and when I saw Connect, which is a wholly owned subsidiary of Health Center Partners, I thought, "Well, this is really interesting-a social enterprise. It kind of checked both boxes at once, and so you know, I applied. That was in 2001, and the rest is history. I've not been here all of those years. I actually was here through 2003, and then I went on to get my master's and worked for the Department of Defense and the Navy Marine Corps Relief Society and did some other things. But came back home in 2010, and so I've been here ever since.

Grant Oliphant 3:00
Tell us a little bit about that career trajectory because it's fascinating that you went off and did that work. What what inspired you to pursue that path?

Sparkle Barnes 3:11
Well, my husband. So my husband was active duty. He was he's now retired, but he was a pilot in the Navy. And so, along with having a partner in the Navy is that you move frequently, so I knew I was going to be leaving San Diego in 2003, and so I thought that was a good opportunity and probably a good time in the break in my career to go back and and get my master's degree. And so I did. I got a master's in human relations, and then from there I was working for the Navy Marine Corps Relief Society. I was doing that in Japan. I've continued to volunteer with that organization. They work a lot on financial literacy for individual service members in the Navy as well as in the Marine Corps, and so have continued to stay in touch with that organization, and then we moved again. Well, actually, we moved to Italy, we moved to Japan, and then we moved to Hawaii. And when we did the move to Hawaii, I was again looking for employment, as any military spouse will tell you is is kind of a frequent, especially in in career military, so I was a part of a running club and and met a gentleman that had a position open in public private ventures. So ended up applying and and working in PPV for the Department of Defense for a little while there. And when we transferred back to San Diego, came back to Health Center Partners, so

Grant Oliphant 4:42
fantastic, yeah, and very quickly PPV stands for

Sparkle Barnes 4:45
public private venture.

Grant Oliphant 4:46
That's right. Okay, so in in some ways, such a San Diego story because of the military connection, but you can see the through line around service. That's what took you around the world. Was there a distinct leadership philosophy that emerged from your various experiences before you arrived back here and and began to move toward your your new your current role?

Sparkle Barnes 5:15
I think authenticity. I think in any type of leadership role, I feel like being true to the core of who you are, and I think you really hone in on that when you are moving and you're moving into different roles and different cultures, and really establishing yourselves with different groups of people, whether it's personal or professional. And so I think that gives you that self reflection of what's important to me. Who am I? How do I want to lead? And I think it allows you to craft that. Versus when maybe a contrast to that would be if I had been at Health Center Partners for all those years, then you know you're kind of pigeonholed or you're shaped into what that may look like, whereas I think you can refine that a bit as you as you move. You you learn different things about yourself in different environments.

Grant Oliphant 6:08
Was there anything that you learned abroad that has been especially helpful in your current leadership role?

Sparkle Barnes 6:16
I think that humans are amazing, and I've met so many wonderful so many wonderful people, and I think you know it just allows you the opportunity to see things from a different lens, see your own country from a different lens, to participate in a broader global conversation. So I think that's important as well, and I think those are learnings that have helped me in my life and in kind of meeting people where they are, and that's a part of what I think FQHCs do so well. They're born from the community, they serve the community, they do it in a culturally appropriate way, and I think that is unique to health centers in their in the healthcare realm. And I think it's something that resonates with me as well.

Grant Oliphant 7:04
Yeah, so FQHCs, federally qualified health centers, are in the eye of the storm in some ways right now in terms of the changes underway in the United States as a result of legislation changing how healthcare gets funded and who gets funded and who qualifies for for care, and I before we get to that, I just want to ask one more question about when you came back to San Diego, and you could have chosen a number of different paths, what was it that brought you back to this particular FQHC Health Center Partners?

Sparkle Barnes 7:47
So, I actually had a position. I transferred with PPV, so I was working for the Department of Defense when I came back. But I think the opportunity to impact individuals, and I I see my own story in a lot of ways, and in what's happening today. But it was certainly relevant even back then, pre ACA, the Accountable Care Act of access, Affordable Care Act. Sorry, access to healthcare and my own experience. So I think the mission has always resonated with me. There's things that have happened along my own life journey that have really solidified that for me. But it was always there. I grew up in a working class family. Both my parents worked very hard. My mother had a pre-existing healthcare condition. She was denied health insurance, which, when you really think about it, is denying the family health insurance. My father was self-employed; we couldn't afford health care, health insurance, and so you know I think the Affordable Care Act it really helped open up access to healthcare. So for me, you know, if I think about all the conversations that were taking place in 2009, in 2010, I think health center partners really resonated with a part of me that knows that you know we can all have hopes and dreams and places that we aspire to be and do for ourselves and our kids, and that's only possible when we have our health. And so, I felt like the impact I could make was really significant in being able to come back to health center partners.

Grant Oliphant 9:32
I I appreciate that you sharing the story about your mom and your own personal connection because this the story lives within you. Then, because you have personally experienced what it's like not to

Sparkle Barnes 9:44
not to have insurance,

Grant Oliphant 9:46
right? What is you know many people are not really familiar with with clinics and FQHCs, and the you know if they have an impression, it's that it's just another door into the health system, which it is, but what do you wish people understood more about the work that you do?

Sparkle Barnes 10:09
So, federally qualified health centers are providing comprehensive primary care, and so it's primary care that's integrated with behavioral health. It's integrated with oral health, we provide a host of wraparound services and enabling services. So while we're in access into healthcare, we're in access into whole person care, and so we're in access into the care that is going to look at the entirety of the person from you know behavioral, oral, and primary care to ensure that they're really receiving optimal outcomes. When we think about barriers to care and what FQHCs do, you know we help reduce the cost barriers to care with implementation of sliding fee scales, so patients that come in, if they are uninsured, they pay based on their ability to pay. We have translation services, so we're thereby, you know, reducing barriers to care that are linguistic in nature, transportation services, so really interconnected with a variety of community-based organizations, we know you know food insecurities are real, housing insecurities are real with our patients, and how do we ensure they're connected into this broader ecosystem that can really help lift up entire communities? All of that, and we have exceptionally wonderful quality outcomes. So, if we look at our own organization, we have a clinically integrated network, integrated health partners, and so we are responsible for the care of about 300,000 individuals here in San Diego County, and so within our clinically integrated network, our outcomes and quality outcomes in particular outperform any other IPA in the state of California for three of our health plans. And so I think a lot of times there is a perception that community health centers only serve a certain individual, well, where in fact we serve a very broad base of individuals, so we do a we serve a

Grant Oliphant 12:27
so there is no typical typical patient.

Sparkle Barnes 12:29
Well, yes and no, Grant. I would say a large portion of who we serve are on Medicaid. We serve uninsured, but we also serve seniors with Medicare. We serve seniors with Medicare that are also eligible for Medicaid for health or for cost reasons. We serve individuals that are covered with Covered California, and we also serve individuals that have really robust health insurance. And so I think you know our healthcare organizations are really a world class way to get receive healthcare. So not just access in, but really access to whole person.

Grant Oliphant 13:09
And you're meeting them where they are, from the the way you described it. And I cut you off in the middle of sharing your results. I mean the outcomes, then the outstanding level of care. So do you want to finish that that thought.

Sparkle Barnes 13:21
Oh, you know, just I, I think, um, you know, we as health centers, you know, we're it's a highly regulated environment. You know, we work on a variety of quality improvement opportunities all year long, every year. Our community health centers have long-established high-quality outcomes in a culturally competent setting.

Grant Oliphant 13:48
Well, and I appreciate you sharing all of that because I think, to the extent that people assume there is one typical profile of your clientele, it's good to know. I mean, 300,000 is a huge population and and huge variety across that population.

Sparkle Barnes 14:05
And Grant, that's just in our clinically integrated network. That isn't the totality of who our health centers serve. You know, I think federally qualified health centers represent the largest primary care network in this country. So there are more than 1500 federally qualified health centers. They operate another 16,000 locations. In fact, they serve 52 million Americans. They serve one in seven Americans. In rural areas that's one in three, and oftentimes in rural areas, they are the only option for care as well. About 20 million of the 52 million are living in poverty, and we have a significant number-about 6 million-that are uninsured. In California, there's 209 federally qualified health centers operating 2300 sites. Here in San Diego, for Health Center Partners, our association, our 17 members, which is really made up of federally qualified health centers. We do have Indian health centers, both urban and sovereign, and then Planned Parenthood of the Pacific Southwest. When we look at the totality of our 17 members, we serve a little more than 780,000 patients. We do that across 3.43 point 4 million visits in 250 locations here in a three county area, which is San Diego, Riverside, and Imperial. In San Diego County specifically, it's about 580,000 patients that we serve.

Grant Oliphant 15:36
Well, and this is this is part of what I was hoping we would get to. I'm interviewing you because you're an outstanding leader, and you're seen as that in the in this space. You're also the organization is emblematic of a sector of care that is hugely important in American healthcare, and your you know your your statistic about 52 million people being served through FQHCs means that one in six Americans are getting their care through an FQHC, and many of those Americans are people who are in need in some way, shape, or form, or in a place where they're not going to get any other care. So, just to underscore the importance of what you're saying, the work is particularly important and feels particularly resonant at this moment when so much is in play in the healthcare arena. You had no clue that was going to happen when you came into your role. You actually had a number of of roles within the organization before you became the CEO, correct? And and you became the CEO in what year?

Sparkle Barnes 16:50
In 2025.

Grant Oliphant 16:52
Yeah. So welcome to the party. It's a it's a it's a hard moment. Yeah. You have you have led a strategic change process for your organization, and I'm just going to read a couple of the well the the what I understand are the four visions that are guiding where you're trying to lead your organization, technology and AI, kind of in in some ways obvious, but not easy workforce challenges. Every healthcare institution that we fund and that we know is struggling with how to build the workforce of the future for healthcare. Data sharing and collaboration, and in a world where data is king, we would imagine that there are systems in place to drive better performance, better outcomes, but they're not there yet. And then health equity and access is sort of the core issue of the FQHC community. What led you to adopt those? First of all, did I get them right, and second of all, is what led you to adopt them.

Sparkle Barnes 18:05
So, so for us, so our organization will be 50 years old next year. So we've been around for a very long time. As we look at this pivotal moment for our member organizations that we support, you know, our mission is their mission, right? So we are here in support of the broader mission of community health centers, and we do that really collaboratively across five distinct organizations that are really unified in accelerating efficient and effective primary care. And we do that in supporting models of care in our health centers as well as the broader FQHC movement, and I think as we're looking at what is it that our members need us to do, technology is key. We don't want our members to be left behind around technology and AI, but we also know we need to be mindful and responsible when it comes to technology and AI, and how can we leverage efficiencies that that can bring while also ensuring that we're staying true to our core and serving our patients in the best capacity. And so, I think technology is a big component of that, you know. So, so I think for us, as we look at what we call the next 50, how do we leverage across all five of these entities subject matter expertise, and how do we really lean in and have that tide rise all boats? So, whether it's participation in our clinically integrated network, and whether that tighter integration and work that we do around technical assistance within the network improves those outcomes, or our collaborative grant-funded programs and research, and and really being able to look at not just what has happened, but what's happening. Now and how can we look at what we're forecasting to do? How can we predict what's happening into the future? Yeah.

Grant Oliphant 20:07
So as you were framing that plan and stepping into this role in 2025, you obviously at that point knew things were changing, right? And and had a sense that FQHCs would need to adapt to a different environment, but adaptation isn't easy. And I've seen, I've seen plenty of debate across American society in response to changes affecting not just healthcare but nonprofits and all manner of services. And one perfectly reasonable, rational response is to say we're going to hunker down and stay the same because the model we have is good, and we'll just see if we can ride out the storm. Another model is we have to change because this isn't going away, and we really need to begin to operate in new and different ways. Did you frame your thinking with that, with those choices in mind, and what led you to believe that you have to adapt rather than just hunker down?

Sparkle Barnes 21:17
Well, I've always believed in continuous improvement. So, regardless of you know what what we're working on, which organization, I think continuous improvement, whether it's of our corporate culture or the services that we're providing, is is paramount to our future. So, to me, it was never a question about do we hunker down. I don't think we ever want to throw the baby out with the bathwater, right? I think we have an amazing model. How do we ensure that that model sustains? And I think that's going to take innovation. I think that's going to take you know new ways of thinking of things. We've got a lot of challenges ahead of us, but I think also an opportunity to really lean in with other partners in new and unique ways that will create something even more beautiful than when we went into this.

Grant Oliphant 22:06
Yeah, would you walk us through so that our listeners understand some of the changes that you're you're facing? Yeah, I mean, obviously, new policies affecting who qualifies for Medi-Cal and the work requirement? But if you would share with us some of what you're having to navigate,

Sparkle Barnes 22:27
yeah, sure. I I appreciate that, Grant. I think our our challenges, you know, they're they're big. Our challenges are big. So HR1, which passed in mid 2025, over the next 10 years, that will cut about a trillion dollars out of Medicaid. We anticipate that there's going to be 10 more, 10 million more individuals uninsured by the time we get to 2034. What that means for a health center is if a patient comes in today, and they're insured under Medicaid, and they come in tomorrow and they're not. That health center is still going to see that patient, but now it's uncompensated care. So we're going to see a significant shift in our payer mix of patients coming in that don't have health insurance, so certainly HR1 and the structural changes that are happening, we're going to see significantly more uninsured. But also the subsidies for covered California, those lapsed in January of this year. You know, for San Diego, there's about 150,000 people on Covered California. 125,000 of those were receiving the subsidy to make that an affordable option to be able to afford. So I think we're going to see people making really hard choices when people don't have access to primary care that you know creates significant costs in the system downstream. So we're certainly our our biggest challenge is really looking at this shift in payer mix. You know our uninsured rates had dropped significantly over the last 10 years, and so we're now seeing those climb, and I think we're anticipating a significant climb in those. I believe a recent statistic that came out is we're expecting in California to double our uninsured rates. So those that don't have insurance. So

Grant Oliphant 24:37
how does that not financially wreck you? Right. If you look at the role you play, which is already serving a population which is challenged, how do you how do you put wrap your mind around having to deal with something like that?

Sparkle Barnes 24:56
Well, I mean, I it it is significant. I think you know. Unfortunately, it's possible that we're going to see reduction in hours. We might see reduction in sites, and that's really impactful. Here in San Diego, we serve one in five San Diegans, so you know it's going to limit that door. I believe you said earlier it's an access and a doorway into care, and so I think we could see that you know significant reductions in that access, which means people show up downstream sicker, and in the ER, right? And so it really impacts all of us. So I think looking at that, I mean I think this is just going to be a really big ripple effect for all of us.

Grant Oliphant 25:48
Yeah, I I want to underscore that and not breeze past it because I think a lot of folks believe that this problem won't affect them, but I think we're all vulnerable in that the healthcare system is already financially challenged. Clinics like the the FQHCs play a key role in serving large populations. We've discussed that otherwise might not have access to care. If you struggle financially to be able to deliver that care, well, first of all, there's a question about about your business model in that kind of environment, and then there's a question about where people go if they can't go in those doors. And the answer is, and you said it, in many cases to hospital ERs, which means that that becomes the care source of first, of you know, first resource, and how do it means that those systems fill up, and anybody then needing to go to the ER will struggle to find access there, no matter who they are. So we're all vulnerable, and as a result of what happens, you are uniquely on the front lines of it. And I would just love you to say a little bit more about how you think about the commitment you've made to trying to maintain equity and access when equity and access are under assault.

Sparkle Barnes 27:18
Well, we're always going to see our patients. So whether they come in insured or uninsured, we are going to continue to provide that service. What we do know is that for every dollar spent on primary care, $13 of savings happens in the system. There is no other type of care with those statistical outcomes, and so I wish, yeah, and I wish more people understood that investing in primary care is really investing in the entire system, and so we're making it harder to access more barriers to access primary care, and that will have impacts not just on ER access, but you know individuals' premiums because those that are going to figure out as they're making those tough decisions of you know what they're going to pay for, what they can afford, you know individuals that don't have a choice but to try to figure out how to pay for health insurance are going to be, you know, our sicker patients, right? And so that impacts the patient pool as well. So the basic economics of how insurance and healthcare works will will be impacted by this as well.

Grant Oliphant 28:36
You know, it may not be a fair question, so tell me if it's not. But you know, I am curious. It'll probably be a while before we see a reversal of federal policy on this, if we do. And in the meantime, states are having to figure out their own paths, and obviously, organizations are having to figure out their own paths. What do you wish policymakers in California would keep in mind as they navigate this and try to respond in a way that is helpful to Californians?

Sparkle Barnes 29:13
Well, I think we're we're an answer, right? Federally qualified health centers are the backbone of primary care in our country, and they're the backbone of primary care in California. I think we can be relied on, but we also need to be invested in. I think you know we're a resource. We're embedded in the communities. We know our patients. We know the people, their constituents, and I think it's it's an opportunity. I think they're going to need to lean in as well, and I think community health centers are a really strong partner for that.

Grant Oliphant 29:55
So, good answer, by the way. I think that was a yeah. I I mean, one of the things that we all need to keep in mind is that the system can adapt, but it requires a different set of choices, not just from organizations, but in theory and hopefully from policymakers as well at the local level and the state level. So, and I think it's important for our policymakers to keep that in mind. So when you are, you know, I well, let me ask you this: I, I, I think leadership is a lonely job, often, almost regardless. But it's particularly lonely at a moment like this, where you're having to figure out answers to the questions that you're having to navigate. So, what is what what is your secret to staying grounded as you are navigating this, and how do you try and keep your your team grounded when it must be a scary environment for them.

Sparkle Barnes 31:02
You know, it's interesting. You know, keeping the team grounded. You know, we had a leadership exchange meeting earlier today, and it's a cross section of our leaders from across the five organizations. And you know, there's a new interim final rule on what what does medical frailty mean and in HR1? And I think we were disappointed to see what was in there. And refocusing that conversation to okay, we know it now. We're we'll wait for you know the state to finalize things, but how do we support our members? That's our mission. That's what we're here for. Let's focus on what we can do, and I think that you know that progress is what keeps people focused and grounded. How can we support them? What are the codes we need? How do we how do we assist our providers? So I think that's a a piece of it. I also think that it's important to have that cohort that you can lean in with. I'll tell you, over the last year, my colleagues from around the country, within the state, you know, we talk more frequently than I think we ever did before.

Grant Oliphant 32:16
Good conversations.

Sparkle Barnes 32:17
They are. They're they're exceptionally wonderful conversations. You know, I think it's the same lived experience. I think it's a, you know, it can be a stressful time, but I, I think learning from others and really leaning in, and I, I see a greater sense of willingness to share, to be open about trying to lift all boats with the tide right now a lot less competition of you know this is mine stay in your sandbox it's like come let's dig together let's build a sandcastle I think that's one of the beautiful things that's going to come out of this moment you know we're we're working closely with other associations we're working closely with other community-based organizations. That I think for a while there, you know, when we had lots of wind at our sails, it was like, okay, we're all doing our jobs and and focused our work, and all of a sudden we have this really strong headwind, and we're like, well, who else, who else can help us row, right? And so we're coming together again in a way that I think is really beautiful, and I hope we retain long after this challenge is done. But I think we're we're going to be in this for a while.

Grant Oliphant 33:34
Yeah. Well, and one of the I first of all I love I love that the one result of this terrible set of circumstances is a building of community among organizations and leaders who are encountering some similar problems, and that is ideally one of the results that comes from these circumstances. Yeah, I

Sparkle Barnes 33:56
think innovation too, right? I think just like in COVID, right? Like remembers to

Grant Oliphant 34:01
right.

Sparkle Barnes 34:02
You know, we we did things differently. We were forced to overnight, and a lot of that we still do today because it it forced us to accelerate innovation. And I think you're saying that people though

Grant Oliphant 34:12
What would you say to people who who would justify HR one and the cuts that were imposed by saying, "Aha, you're we're we're forcing you to innovate and adapt, and you're proving that you can do it. So we were right to implement this set of policies.

Sparkle Barnes 34:30
I don't. I think we're going to innovate. I think we're going to adapt, and I think preventable cancers that could have been detected early aren't going to be detected. I think we're still going to see lots of uninsured individuals that forego their health care. So I would say while we'll we'll adapt, I think in general in America with 10 million more individuals uninsured by 2034. We're going to see individuals that maybe don't get to experience their hopes and dreams for themselves in this world because they did not have their health to do that. I cannot solve for that.

Grant Oliphant 35:13
Yeah. So fair to say. I mean, I love you just said it, but to repeat it, the system will adapt, and it will learn, and leaders like you will find new and better ways to run your organizations and and deliver services. But we will still have potentially sicker America. Fair to say, yeah, sobering, and and yet, really important to maintain awareness and visibility on what it is that you are doing, and learn from it as you go, so that you focus on the innovation piece. One of the ways you're doing that is through data, and we talked about data a little bit earlier. Can you talk a little bit about the Atlas system that you're that you're working on.

Sparkle Barnes 36:04
So Atlas, and thank you by the way, Prebys is. I'm asking because we're we're providing support for it, but it but

Grant Oliphant 36:11
it you know we are because it because it right because it I think speaks to what you're trying to do in these in these circumstances. Yes,

Sparkle Barnes 36:20
well, I think it's it's information, and it's allowing us information on a system in closer to real time than what we would have in absence of it. So Atlas is looking at access trends across Southern California, really focused in on San Diego County, where we can see in real time what's happening with our patient population. So we're talking about really large statistics. We're talking about 10 million more people becoming uninsured. We're talking about doubling the uninsured rates in California. We're talking about 125,000 people in San Diego County that relied on subsidies and covered California, but I think it's important in the midst of all these statistics that we think about who that individual is. And so, what's really important to me about Atlas is it is going to trend in real time what's happening statistically with our patients. It will layer that from 2025 forward with what's happening in the environment, and it will also tell the patient's story, and so we'll be able to capture real moments with patients, so that we aren't just looking at statistics and numbers. I think it's really easy to discount what's going on, or to feel like it it doesn't impact you, or you can turn away from it. But I think when we start to see real people, that changes the tone, right? But more so than that, it's about using it to advocate. How can we use this in in our advocacy efforts? And then how can we use this to apply interventions where we know, okay, here's what's happening to a specific population. How do we address this? Versus traditionally, in the FQHC world, we would use UDS to collectively look at a region, and that can be significantly in arrears. I do think we have.

Grant Oliphant 38:19
And you were explaining to me right beforehand that before we started our conversation that it can be two years that data can be two years behind

Sparkle Barnes 38:30
we were right if we were looking at January if we wanted to know what happened collectively in January it would be some time before we saw that so if we were looking at 2025 everybody submits their UDS in the first quarter of the calendar year, but by the time we're able to access that information, it's more like August timeframe to see what happens in 2025. I will say we do have some advantages at our association because we do have a clinically integrated network for a subset of our patient population. We have a much greater real-time look, but that's our primarily our Medicaid-insured population. So, in order for us to look at what's happening holistically with the patients that are coming in, or maybe have stopped coming in, that's really going to require Atlas. That's going to take us looking at a broader view, and to get that that data in, I was at one of our our member organizations in January, and we were just talking about the impact potentially of the subsidies expiring. And the day that I was in this health center, a woman had come in earlier that day, and she had with her her premium, her covered California premium without the subsidy. Right, so she had her bill from covered California without the subsidy, and she came in to a healthcare organization to. Ask an enrollment counselor to unenroll her. She was so afraid of having to pay that bill that she was asking a healthcare organization to make her uninsured. That's the environment that we're in,

Grant Oliphant 40:18
and those are the stories you're going to try and capture through this system, and are you hearing a lot of that? Would you say?

Sparkle Barnes 40:27
Yeah, we're you know absolutely.

Grant Oliphant 40:30
Well, that is horrifying.

Sparkle Barnes 40:31
And you can have the back grant when we have the access data, right, right, right, and and we'll be able to look in real time. We certainly know our uninsured rates are increasing. We know just county statistics of who's covered under Medi-Cal is going down. So we know it's starting. The infrastructure components of HR one really aren't taking place until 2027. So that's when we'll see more of the tsunami of what's going to take place with the structural changes to HR1. So we're just tipping the iceberg right now. I think there's you know some general fear for our our patients right now. I think there's a fear of access. I think there's fear of, you know, if they're covered, California. How my we're already seeing people make decisions about, you know, do I pay for gas? Do I cover my, you know, healthcare premium? So that that is happening, but we'll we'll see more.

Grant Oliphant 41:40
Yeah,

Sparkle Barnes 41:41
we'll see much more.

Grant Oliphant 41:41
Well, I, you know, I appreciate you sharing the story about the woman coming in to essentially disenroll herself because of a fear of having to pay the premium. That's very real, from what I'm hearing elsewhere. That it is the the numbers in terms of the dollar increase that people are facing, is it's a choice they can't make. Tell us a little bit about you know the work requirement that how how you see that playing because the one of the one of the arguments made by proponents of HR1 has been well, you know, we need to get people working again, and there's an assumption that they're not. Have you encountered anything around that?

Sparkle Barnes 42:31
Well, I'm glad you said assumption.

Grant Oliphant 42:33
Yeah,

Sparkle Barnes 42:33
because I think many of our patients are working two to three jobs, and they're still in poverty, and they haven't, they don't have employer-sponsored health insurance, so I, I do think there's a lot of assumptions about who a Medicaid recipient is. Work requirements, we don't have all the answers yet. We know work requirements will begin in January, but we are still waiting for the state to determine exactly how that's going to operationally be done. So we're we there's still some missing puzzle pieces that I think are are quickly going to get filled in. You know, we just saw two days ago the interim final rule on what how medical frailty that policy is going to be enacted from a CMS perspective. So we have to dive in there as to what you know that's going to mean. It was a little bit disappointing to see what's in the interim final rule. We'll certainly make public comment on that. But yeah, there's there are still a lot of unknowns. Even though HR1 was passed in July of 2025, we are still waiting for a few. That was the federal piece. We're still waiting for a few of the state pieces on that.

Grant Oliphant 43:56
Yeah, the reason I asked that question is I think again it's I think it's part of the mythology around this that it's no big deal to change the work requirement. And in fact, to your point, the data shows that most of the recipients of support are actually working, but they're working multiple jobs, and it's in a non-traditional way that makes it hard to prove for the purposes of this new policy.

Sparkle Barnes 44:26
Well, I think also you know there's more frequent redeterminations. So instead of redetermining to qualify for Medi-Cal once a year, you now have to do it twice a year, you know. I always think about it like you know the real ID. That was a lot of work, right? There was a lot of back and forth. I went to the DMV twice

Grant Oliphant 44:52
theoretically one time, right? Right. But a

Sparkle Barnes 44:54
lot can go wrong, right? And you have to.

Grant Oliphant 44:57
I love that example because yeah, it's a lot of work.

Sparkle Barnes 45:00
And and gather it, and now it's twice a year. And I think what we might see is for individuals that don't have a chronic condition or or don't immediately need it, they may forego it, and then they become another component of the uninsured. So there's a lot to work through. It's very complicated, and you know, our job at Health Center Partners is really assisting our members to navigate this, and then to advocate on their behalf at you know local, state, and and federal level on the impacts on this.

Grant Oliphant 45:37
So, so you know, observation I have about you having sat with you and spoken for the last 45 minutes or so.

Sparkle Barnes 45:44
Oh, has it already been 45 minutes?

Grant Oliphant 45:47
It's I know it's flown by, but you know you're obviously a determined and upbeat person, even though you're very clear-eyed about the challenges that your industry is facing, and that the people you serve are facing, and yet you're up against really significant challenges. And I, I kind of hate the "what gives you hope" question, but I am curious. You know what what is keeping you hopeful right now, and allowing you to remain upbeat despite these challenges.

Sparkle Barnes 46:24
Despite what's happening, we can still be impactful, and we can still help progress our members and uplift the communities that they serve. And I think that's our focus, and that's what we're going to continue. So, so it's

Grant Oliphant 46:45
back to mission. It is

Sparkle Barnes 46:46
100% I think it's it's the mission. We focus to the mission, and I think that you know continues to create that resiliency that's so important right now. But you know, we can still see progress.

Grant Oliphant 47:03
I I appreciate that answer. It's a, what do you wish the rest of the community would do to support you in that?

Sparkle Barnes 47:12
Oh, advocate for community health centers. You know, be an advocate. I think being the largest primary care organization in the country, many people don't realize that they're getting their care at a federally qualified health center, and so ensuring that we are seen as top of mind, as a resource, as a partner, I think that's very important. But yes, I would love for every listener to be an advocate of federally qualified health centers, there's a lot of resources and opportunities to support community health centers and the work that they do.

Grant Oliphant 47:53
Well, Sparkle, you live up to your name. You you manage to, as I said, be positive in a in a challenging time. So I just want to say thank you for sitting down and talking with me, and more importantly, thank you for the work that you're doing and with the positive outlook that you are.

Sparkle Barnes 48:13
Oh, thank you, Grant. This was wonderful. I appreciate it. Thanks for the opportunity.

Grant Oliphant 48:17
Enjoyed it. Alright.

Crystal Page 48:23
I love that conversation. It's it's kind of gloomy and doomy, to be honest.

Grant Oliphant 48:28
Well, there were moments. Yeah, you know, I think I would I I I would say she was as just surprisingly upbeat for somebody who's dealing with really deep challenges. Yeah, but yeah, I mean the you know the challenges that American healthcare is face is are facing is facing as a result of policy changes stemming from HR1 they are they are daunting and they do give you pause and I think for somebody working in that space, you know, you you could easily imagine them feeling depressed, but she's not.

Crystal Page 49:08
Well, but I also think the preventative message was in there, right? When she talked about $1 in primary care saves $13 in the other forms of medical care, and if we could work towards that framework, I I do think I not to say it was gloomy and doomy that you know it's a bummer, but there's also hope, right? You're right.

Grant Oliphant 49:27
Well, one of the things that I love about and we I think discover this over and over again on on this program, mission driven leaders are almost by nature hopeful even in the most challenging of times. So you know they're they're facing really difficult circumstances. Other people might be tempted to give up, but they're still out there finding. It's not the silver lining. They're finding the path forward. Yeah, and. You know when I when I asked Sparkle that very specific question at the end about what gives you hope, you know she went right at mission again, and what gives her hope is the fact that they're doing important work. And to your point, they know they're good. You know they're if $1 invested in that space saves 13 later, and if it makes people healthier, and if 52 million Americans are served through this vehicle of American healthcare, then they know they have to do it well and do it right, even if they're facing difficult challenges.

Crystal Page 50:38
Yeah, well, and I think to go to that mission point when she discussed her mom and their experience of when you do or don't have health care, I think it's clear it's like mission, but it's also purpose driven for her in a way that grounds her. Is what I took away from that. What about you?

Grant Oliphant 50:55
Absolutely. You know, one of my favorite moments in this in this conversation was was when I pressed her on her her point around innovation. You know, she she said, you know, after acknowledging the personal perspective she has on the challenges that many of her clients or and the patient population face. She she also was saying, hey, you know, one of the outgrowths of of facing these difficult circumstances as a sector is the leaders are getting together. We're comparing notes. We're learning from each other. We're supporting each other, and we're innovating. And when I pushed her on, well, wouldn't the people behind these reforms, the policies that are forcing you into that position, say that's exactly why they did this? And and I thought her answer was really good, which was, you know, she didn't phrase it this way, but they don't get to take credit for the good that comes from people trying to adapt to a bad policy. Exactly, it can still be a bad policy, and so you know the policy that willy nilly is forcing people to make really difficult decisions about what they're going to pay for in their personal lives and whether they can continue to pay for their care, whether they can continue to pay for their insurance, that shouldn't be happening.

Crystal Page 52:34
Oh yeah, even the story she shared about the woman coming in and asking to be made uninsured because the bill was that scary. I don't think we factor in those things a lot of times in our policy making. So the the fact that she's able to capture a story like that and hopefully use it, like she told all of us to advocate, right? I think that those things really matter because we're just thinking about is someone insured or not. But even being insured has a cost, right? And so she's speaking to all those things.

Grant Oliphant 53:03
Yeah, and although her data is it's early yet in terms of her organization collecting data that would really get at how this is playing out for for her organization, you know, we do know that based on enrollment in the ACA, that the decision she's describing for that woman is playing out across millions of Americans. You know, the thing I wonder about, and I'm still sitting with after the interview, is there is a financial model that sustains everything, right? So, I loved her value statement, which was we are going to continue to see patients whether they can pay or not.

Crystal Page 53:48
Yes,

Grant Oliphant 53:50
bravo and hats off, and I think that is part of what sets FQHCs apart, and we should all be grateful for that, and we should not take it for granted because although that's the values commitment, you know what we really didn't get too far into because we couldn't in the time we had was how that how the financial model for that will be sustained when fewer and fewer people are able to pay for it, and more and more uncompensated care is being provided. You know what we know is that there is a certain point at which systems break when there isn't enough money coming into the system, and I, you know, I think she is on the front lines of fighting the good fight to make sure the care is provided and to make sure that her member organizations have what they need, but there is a you know what what I what I sense is we should not pretend that there isn't a day of reckoning potentially out there for the system and therefore the for everyone who depends on the American healthcare system.

Crystal Page 55:01
Well, and hopefully that reckoning can be offset by the fact that if this data comes in sooner, they're able to make better decisions faster, or just good decisions in a more timely fashion that allows for better healthcare decisions. It allows for maybe them to just, hey, everyone's having this issue, so how do we support that? And so, I hope the debt, the data that they're using, will inform them. It'll inform legislators, but I still am really concerned about this fear of the system breaking. Yeah. When you think about that, and and the grants that we've made, and and leaders like her, does anything else come to your mind?

Grant Oliphant 55:39
Well, you know, I think just that we have to continue to support certainly clinics and FQHCs because they are an important entry entry point into the care system, and we have to keep that robust as long as we possibly can, but I think I think you know she she talked about advocacy. So as we go up the ladder here of influence, you know we need state policy that adapts to these federal changes that are not good changes. You know there, and I want to be clear. In any in any set of policy changes, there there certainly likely to be some policies that maybe are worth keeping. I I think at some point we'll all have to revisit that. But the state for right now has to adapt to a bad set of policies, and I think one place that that all of anybody watching this or listening can weigh in on is, hey Sacramento, let's be paying attention to the importance of FQHCs and access in our medical system, and then you know, at some point, get the federal system to revisit these policies based on data that is coming back. You know, I think we need we need to go back to an era of decisions being made based on science and data.

Crystal Page 57:16
Right. Well, and even the notion that people may not know that they're going to a federally qualified healthcare center was interesting. Is is this FQ? You know, you may not know. You may just think you're in a full corporate sector. Yeah. So we probably should all stop and then check, just so we know. Oh wait, we're benefiting from this system. Right. How do we continue to advocate that it's made whole?

Grant Oliphant 57:39
Well, yeah. I mean, I that that I had exactly the same reaction. It's like, wow, that, yeah, a lot of people probably don't even stop to think about it or know. And and again, there is no one profile. You know, this was an important point she made. There is no one profile of of a patient walking into a clinic. There there are people who are there because they're older. There are people who are there because they're financially in need. But whatever the case, helping helping society understand the role of those facilities, I think, is on all of us because we all benefit from them being there.

Crystal Page 58:18
Agreed. I think that's a perfect stopping point, Grant. What do you say?

Grant Oliphant 58:21
I really enjoyed debriefing with you on this. Me too. Thank you. I really enjoyed talking to Sparkle. I think she's going to be a leader to watch in this space, and we'll probably talk to her again.

Crystal Page 58:32
Yes. Thanks, everyone. Thanks for stopping and talking.

Grant Oliphant 58:39
This is a production of the Prebys Foundation,

Crystal Page 58:43
hosted by Grant Oliphant,

Grant Oliphant 58:45
co-hosted by Crystal Page,

Crystal Page 58:48
produced by Adam Greenfield, Tess Karesky, Edgar Ontiveros Medina, and Crystal Page,

Grant Oliphant 58:55
engineered by Adam Greenfield,

Crystal Page 58:58
production coordination by Tess Karesky.

Grant Oliphant 59:02
Video production by Edgar Ontiveros Medina.

Crystal Page 59:06
Special thanks to the Prebys Foundation team.

Grant Oliphant 59:08
The Stop and Talk theme song was created by San Diego's own mr. Lyrical Groove.

Crystal Page 59:14
Download episodes at your favorite podcatcher or visit us at prebysfdn.org.