The Buffalonian of the Week: Dr. Raul Vazquez, Physician and CEO at GBUAHN/GBUACO/GBUIPA
Leading GBUAHN/GBUACO’s is their CEO, Dr. Raul Vazquez. Originally from the Bronx in New York City, the father of four came to the city in 1985 as a medical student at the University of Buffalo’s School of Medicine and practiced medicine for 26 years. We spoke to him to discuss his work as a doctor, GBUAHN, and the medical issues his organization’s patients face.
The Greater Buffalo United Accountable Healthcare Network (GBUAHN), located on 564 Niagara Street in Buffalo, is the sixth largest Medicaid Health Home in the State of New York and the largest one outside of the New York City area. Since 2013, it has been treating patients with chronic illnesses from Buffalo’s low-income communities, including refugees and immigrants. Its ever-expanding network in its affiliated Accountable Care Organization, the Greater Buffalo United Accountable Care Organization (GBUACO) brings together 500 doctors and works with organizations such as Jericho Road Ministries, Inc., Urban Medical Practice, and Kaleida Health. GBUAHN/GBUACO also employs over 200 people and has been adding 10-15 new employees to its staff every two weeks.
This interview has been edited for length and clarity.
What made you decide to stay in Buffalo?
I love Buffalo. New York City is good, but it’s just congested and I didn’t know if I wanted to raise my kids with all of it. It’s sort of city/country place. It’s a mixture. It’s not a city, it’s not country. It’s a hybrid. I like the combination of the two.
Why did you choose to be a physician?
A lot of my relatives when they came here [from Puerto Rico] didn’t speak English. They spoke Spanish and I was their translator. I’m a first generation Puerto Rican and sometimes got to see that people weren’t getting proper care because they didn’t understand what they were saying. Sometimes they were mistreated or misdiagnosed. My uncle who passed away six years ago had asthma, and I was always trying to help him get his asthma managed. After that, I said, ‘You know, why don’t you become a doctor?’
What is the Greater United Buffalo Accountable Healthcare Network (GBUAHN)?
What they call an ACO, an Accountable Care Organization, is a way to bring physicians together to better managed patients through the whole maze of medicine. You do your piece, she does your piece, and I do my piece, and no one is talking to each other, and the patient sometimes gets lost because of that. If we had access to that information, I think the patient would get better care in terms of figuring out what they have and make sure their meds are filled. It also means making sure we’re treating them in the right places, [such as] not going to the emergency room and getting admitted because that breaks down everything we’re trying to do. The ACO is more of a coordination of care and doctors are responsible for that patient’s care and responsible financially so if we do the wrong thing, it’s going to hurt you. But it’s also making sure patients are satisfied. That tends to be the biggest way of reducing the costs, but also improving the quality of care.
What pushed you to start GBUAHN?
There are two entities. We’re G Health Enterprises, with five companies. We have an IPA (Independent Practice Association), the Greater Buffalo United Practice Independent Practice Association. That’s a bunch of doctors, around 50. There’s an Accountable Care Organization, GBUACO (Greater Buffalo United Accountable Care Organization). It’s more of a group of 500 physicians from hospitals and make contracts to do services. The Health Home, GBUAHNs is a MSO, a Management Services Organization. It’s not medical care, it’s to make sure people make it to their appointments. If they don’t have housing, we work with housing. If they don’t have transportation, we work on it. If they don’t have food, etc. We try and get people well so they can go to the doctor and those are the things that are taken care of. At one point, they get employed and they work and they’re back in the system, not just being in the Medicaid rolls forever.
Why are those entities separate?
That’s the way the structure is set up in this country. We all have lawyers and we have to be careful what you do within those entities because you can create problem if you don’t. An ACO—we’re the first in the State of New York—has a lot of protections. It means doctors can work together, we can negotiate, and do things like that. And IPAs can’t do those things.
That’s a bunch of a doctors. If it looks like we’re forming a union, we could end up in jail and we want to do the right things. An ACO lets you do this though. It’s non-union, but let you generate money, work together, and share dollars back and forth without it being a problem legally. On the care coordination side, it has nothing to do with that. These are individuals, navigators, health care workers out there trying to address issues to make sure people are getting to places in the end and other things unrelated to the medical practice. G-Health Enterprises puts them under one umbrella to work together, but they have to be sectioned off and be separate.
And are based only in Buffalo, or do you have other locations?
Our biggest location right now is in Erie County. The IPA is just in Erie County, but the ACO is looking across the state so we’re looking to go to Syracuse, Rochester, Albany, and all the way down to New York City.
What is the biggest challenge you’re facing in healthcare in Buffalo?
You can do a lot of stuff inside an office, but if that patience doesn’t have transportation or a place to live, they’re really not coming back for medical care. We’re dealing with a lot of different individuals, not only the community. We have immigrants that come in and we do immigrant care to make sure they get their exams, they get vaccinations, and showing them how to get into the system in terms of getting the Medicaid so they continue to receive care and also get connected to the different systems in the area that they may need access to. And what does the Health Home does is that we speak 16 languages so it becomes easier for Somali, Congolese [speakers]. Our teams in the system speak [including] Arabic and Spanish.
Language could be a big challenge for immigrants and refugees receiving your services. How do you do handle this barrier?
We have patient navigators that work with the office and we have them in different languages. If someone comes in and [they speak] Arabic, we have a nurse or navigator [who speaks the language] that’s there who will take information that will guide them through the system, and they create a sort of a team. After a while they know who to call when they’re running into problems. They call them rather than a doctor because it’s easier.
Refugees and immigrants are often affected socially and economically. What can you provide to people arriving in Buffalo to deal with these issues?
There are also mental issues. We screen and look for things like that in terms of depression and things like that. We also partner with Jewish Family Services that [operates] the Western New York Center for Survivors of Torture that has a lot patients who have lost relatives, [saw] people who were murdered in front of them, and have a lot of trauma. They help to develop treatment plans and get them the support they need.
What’s the most common medical issue you treat?
In this area, high blood pressure, hypertension is the biggest thing. Once you get here and start eating all the food, you start to notice they have a lot of salt content and often that affects how we do. We get a little heavier, don’t move as much, or exercise. All those things lead to high blood pressure, which is the number one problem that this office runs into. Here, we’re doing things a little bit different. The bottom floor of this facility is all focused on wellness. We have a nutritionist/dietician teaching people how to cook the right way. We process food every time we can and that often has too much salt content. We teach how to substitute and how to eat correctly so you’re not gaining the calories and containing your salt content. We also have a gym where they exercise. That’s a better treatment than giving pills all the time. [The second] is diabetes. There’s a lot of diabetes. Again, all related to diets and eating the wrong food. The third we run into a lot is respiratory diseases like asthma and COPD. There’s also a lot of depression that we see in this area.
You’re running this as a business or as a non-profit organization?
We’re for-profit and we’re a business. [Our patients] have insurance and it covers the cost. They see you, look for a doctor, and come in, in terms of the medical side. With the ACO, once we have a panel that’s big enough, we actually lock contracts with the insurer to manage those patients within the system. If it’s on the Health Home side, we get paid on those members for managing their care.
How do you work with government?
These are services that the part of health care. Erie County has so many dollars that they allocate for different services like transportation. Medical care is where some of those dollars are spent. Most people have insurance, but a few people don’t. But the majority does have some time insurance, and it’s often government insurance.
How do you sign up?
It depends. If it’s GBUAHN, to join you have to have Medicaid and have two chronic diseases. Those chronic disease could be hypertension and diabetes, like we talked about. It can also be depression and obesity. There are all those factors that qualify you. We screen you and go through a whole intake and we assign you with a personal health navigator that will follow your care. We always try to bucket people and put them into groups such as by language. If you speak Arabic for example, we’re more inclined to have an Arabic speaker follow that client. If it’s on the medical side, Urban Family Practice, if you have any type of insurance and even if you don’t have insurance we just make sure that people get into the door.
How has GBUAHN benefited the community?
It’s been phenomenal. Not only do you create jobs, but a couple other things have happened. Because of the impact, it has cut emergency room and inpatient care. The savings has saved the government money because we’re directing and managing people that were lost and getting admitted for the wrong reasons. We’ve actually cut that. One of the things we’ve done is that we’ve taken members that come in GBUAHN and they get all the stuff done. They get their medical care and all those things, and then they work, we get them a job. We’ve hired some individuals and they now work for us.
What are the biggest challenges you are facing as GBUAHN?
The biggest challenge is not having enough people to hire right now. We have to train our own because it’s a different type of job. We want to grow in terms of market, but we need have the right employees in place in order for us to grow.
Finally, what are you planning to do in the future? What are you planning to do in the next five or ten years?
Expand the ACO and Health Home across the state to Syracuse, Rochester, Albany and having a network of physicians across that area and managing half a million people all within our network. Then become an insurance provider in about three years.