San Francisco's Chinese Community Health Plan Diversifies, Sort Of, Under Obamacare

CCHP enrollment counselor Kristen Chow explains Covered California and federal subsidies to a Chinese-language caller. Currently, more than 90 percent of the HMO's members are ethnically Chinese. (Marcus Teply/KQED)

By Valerie Hamilton

The kitchen at San Francisco's Chinese Hospital is a little different from other hospital cafeterias in the city. The commercial steel kitchen range where you might expect big vats of orange hospital Jell-O to be stewing is here topped with industrial-sized woks. Cooks hired from local Chinatown restaurants are frying Chinese broccoli, onions and noodles.

Larry Loo was born in Chinese Hospital. Now he's the director of business development for Chinese Community Health Plan (CCHP), the HMO affiliated with the hospital and 15 clinics around San Francisco. CCHP has 15,000 members. More than 90 percent of them are Chinese Americans.

The walk-in service center for CCHP members in San Francisco's Chinatown. "We want to make sure the existing community is taken care of," says director of business development Larry Loo. "To the extent that it broadens out, that's great." (Marcus Teply/KQED)

But that may soon change. CCHP is one of 11 insurers statewide -- along with big names like Kaiser and Anthem Blue Cross -- vying for new customers on Covered California, the state's health insurance marketplace.

The hospital and the health plan have made their name providing what's called "culturally competent" care to patients from the city's Chinese community. That goes beyond stir-fried hospital food. Here, people speak Mandarin and Cantonese, the plan covers Eastern medicine, and staff understand Chinese patients' attitudes about health and medical care.

"The reason we're even here is because the Chinese community always had a tough time getting access to care, getting access to doctors that speak their language and understand their needs," Loo explains.

The health plan's roots go back more than 100 years, to a time when widespread racial discrimination meant San Francisco's Chinese were excluded from mainstream health care. The community founded its own medical dispensary in Chinatown to meet the need. That grew into the Chinese Hospital and later, in the 80s, into the Chinese Community Health Plan.

Through it all, they've kept a strongly Chinese identity. When they decided to join Covered California, to make sure their existing members could take advantage of federal subsidies, it was a big step into the multicultural unknown.

Dr. Gustin Ho is a primary care physician in CCHP's network. He says it's time for CCHP to become more diverse.

"Diversity is the way to go, because that's how the society is," Ho says. "I'm not saying it's good or it's bad, but you have to adapt to it. … Are we ready for this change? I think so. The time has come."

Cooks in the Chinese Hospital kitchen stir-fry Chinese broccoli. The hospital and its CCHP health plan focus on "culturally competent" care for Chinese-American patients; that includes Mandarin- and Cantonese-speaking doctors, coverage for some Eastern medicine, and Chinese hospital food. (Marcus Teply/KQED)

Across the city from the Chinatown neighborhood, Mari Duarte is juggling walk-ins and calls at a CCHP enrollment center in San Francisco's ethnically diverse Mission district. CCHP opened the center this fall, to try reach out to people who might not know the plan is open to all people.

"Our focus is more here to the Latinos," Duarte says. "because they're not aware that anyone can come here and sign up, not just the Chinese community."

But in practice, most of CCHP's own marketing efforts have been directed at the Chinese community. The Spanish-language section of its website is mostly in English, and the people in the website photos are still Asian. The health plan has just two Spanish-speaking enrollers. And for customer service in languages other than English, Mandarin and Cantonese, they rely on phone interpreters.

Brenda Yee is the CEO of both the health plan and the hospital. She says she'd like the HMO to remain majority Asian, and that caring for a more diverse population through Covered California won't change who they are.

"Our primary goal is to serve the Asian community," Yee says. "We know where … everything started. So we won't lose our identity. You know people question, 'Why don't we change our name?' and I said, 'Why? No, we are the Chinese Community Health Plan.' It's just that we're serving a lot more other people other than the Chinese now."

Not as many, though, as they might, in a diverse region like the San Francisco Bay Area.

As of mid-December, Chinese Community Health Plan had enrolled more than 2600 new members through Covered California. Of those, almost three-quarters identified themselves as ethnically Chinese.

Chinese Community Health Plan CEO Brenda Yee shows visitors a model of the new Chinese Hospital building. "We know where our culture, we know where our foundation, where everything started," she says. "We won't lose our identity." (Marcus Teply/KQED)

A woman waits to see Dr. Gustin Ho at his office in San Francisco's Chinatown. Ho says 99 percent of his current patients are ethnically Chinese, but that for CCHP, "diversity is the way to go." (Marcus Teply/KQED)

CCHP's motto, "caring for generations," in action at the entrance to Dr. Gustin Ho's medical practice in Chinatown. (Marcus Teply/KQED)

A man reads a Chinese-language newspaper in San Francisco's Chinatown. In the 19th century, the Chinese community was often excluded from mainstream healthcare, and in response, it founded its own Tung Wah medical dispensary. That grew into Chinese Hospital, and later, into CCHP. (Marcus Teply/KQED)

Chinese Community Health Plan's main office, in San Francisco's Chinatown. The historically Chinese-American HMO joined Covered California this year. (Marcus Teply/KQED)