Tucked between mountains on three sides, California’s Shasta County boasts 3,000 square miles of immense natural beauty. The rural setting also brings innate challenges, with nearly one in five residents living below the federal poverty line.
A lifeline for the community is Shasta Community Health Center, a nonprofit primary care system and Federally Qualified Health Center (FQHC) with six locations. It provides over 130,000 patient visits a year across various services, from dental care to HIV early intervention.
At the helm is Dean Germano, who has served as CEO since 1992. A prominent advocate for primary care access, Germano is past Board president of the California Primary Care Association and of the California Endowment, a $3+ billion statewide initiative dedicated to improving the health of all Californians.
In 2017, PCDC worked with Germano to finance a $9.8 million project: a new state-of-the-art facility that today accommodates 25,000 annual visits for medical, dental, and behavioral health services. The project also brought much-needed jobs and business investments to Shasta County.
For his commitment to health equity, Germano will be honored at the PCDC Gala Reception on Tuesday, November 19. He recently reflected on challenges, successes, and lessons learned over nearly three decades.
What sparked your interest in primary care?
During high school and college, I worked at a treatment center for emotionally troubled children, run by the Sisters of Mercy. At the time I’d been thinking of business as my focus in college, but was intrigued by health care and social services.
The executive director of that facility, Sister Edna, encouraged me to consider health care administration as great blend of our interest. That’s how I got started.
Sister Edna helped me land a job at a teaching hospital also run by the Sisters. With time, I was able to get into the University of Toronto’s Master of Health Science – Health Administration Program.
You’ve talked about the stress of acute provider shortages.What other concerns are at top of mind today?
A big challenge for any leader in health care right now is how you manage change.
There’s a lot of talk of moving from volume to value. The value proposition and its link to payment is evolving, especially in the FQHC world. You need to get in front of the changing tide, but you can’t get too far ahead — especially if the financial parts of the system are not following as quickly.
It’s a balancing act for a leader but one that you need to stay on top of. In the FQHC space, it means working in concert with your primary care association and your state and federal partners.
What’s a success or memory you’re especially proud of?
There are so many challenges and successes, so it’s hard to pick one. But if I had to, it would be our first capital campaign — raising the $4.5 million that allowed us to move out of the basement of the old county hospital and into our own new space in downtown Redding.
It was the largest capital campaign in our county, and I would suspect a pretty big one by FQHC standards. Those funds allowed us to move into a modern facility and drive our growth in the early 2000s.
For me, having such a beautiful and functional facility sent a message to all — our staff, civic leaders, everyone — that our patients deserved a nice place that mirrors the high quality of personal care we already give.
To see the proud faces of our providers and the impressed faces of our patients at the time was something I will never forget, given our very modest beginnings.
How has expansion of the Anderson Family Health and Dental Center transformed care?
The Anderson facility in many ways is a compilation of the latest trends in facility design and care delivery in outpatient primary care.
Its design, flow, and general efficiency have become the template for how we plan on building/renovating and delivering care in our current and future sites. The design allows primary care providers to work more closely with their teams at almost all stages of the care delivery process.
The new facility allowed us to better facilitate the front- and back-office work, including scribes, nursing, integrated behavioral health, and of course the work of our primary care clinicians.
We’ve employed scribes for almost eight years; even at the start of the EMR era, we felt that such individuals were necessary if we were to free up our clinicians to do what they’re trained and motivated to do — that is, take care of people.
I should add: the physical beauty of the facility has been a big help in our recruitment of providers!
After nearly three decades, what motivates you in your work?
There’s never really a dull day for me — the challenges are real and often changing. I came out of the hospital system early in my career, albeit in Canada, and thought that this is where I wanted to be.
However, once I got to SCHC and the health center movement, the thought of really having impact on my community — particularly as it influences the health and well-being of others — has been so powerful for me.
My health center takes care of about a quarter of the total population of Shasta County. When it comes to population health, our many partners — including the hospitals, public health and social services, law enforcement, and schools — look to us for leadership on many of these stubbornly difficult health and community issues.
I am also fortunate to have an incredible leadership team, many of who have been with me for a decade or two.
While I, with my Board’s help, help point the organization where I think we need to go, it is my team that makes it happen. They’re truly leaders. When you have such a talented team around you, you feel like nothing is impossible. That’s very powerful and motivating for me.
Is there a patient story, anecdote, or experience that stands out to you?
Truth is stranger than fiction; there are so many stories. I tell my staff that they have the challenge and the honor of being close to the lives of our patients, in many ways that I, as the CEO, cannot be.
Health care is a personal business, and I do routinely hear of the good, bad, and sometimes ugly of what life is like for people of limited means and/or with special health/life challenges.
I do remember one specific event that happened in our Board room many years ago.
We were considering moving into the delivery of dental care, which is not an inexpensive service and a somewhat different dimension than the medical care side. As we discussed the pros and cons of making this investment, conversation was leaning towards not moving ahead.
Then one of our consumer board members spoke — a mother of several young children. She said that her children, all on Medicaid, had no access to dental care in our community. She was so very frustrated as a parent that she couldn’t help them.
It was her words, her situation, that changed the direction of our decision making. A year later we opened our first dental clinic.
What’s your favorite place in Shasta County?
Shasta County has so many wonderful things to do and places to see. The natural beauty of the area is unsurpassed, in my judgment. We have mountains to the east, west, and north, volcanoes that frame the skyline, and several lakes.
The largest is Shasta Lake, with over 400 miles of shoreline that my wife and I enjoy on our pontoon boat many weekends. In the winter you can drive to one of the volcanoes, Mount Shasta, for skiing and the drive down to Redding for golf that afternoon!
The other landmark is our community is the Sundial Bridge which crosses over the Sacramento River. From the bridge you can see several people fly fishing for the migrating salmon and steelhead trout.
It was also designed as a work of art. At certain times of the year, its shadow tells the current time! The Sun Dial Bridge is the cultural center of our community.