Photo: Health Plan of San Joaquin CEO Amy Shin, right, meets with Chief Information Officer Cheron Vail. Photo: Craig Sanders.

Story source: California Health Care Foundation

Veteran nonprofit health care manager Amy Shin was looking for a leadership position in 2013, and Health Plan of San Joaquin (HPSJ) seemed to offer the right fit. After years of working in senior roles at respected Bay Area managed care organizations, here was a CEO job not too far from her Oakland home. The HPSJ board of directors had deemed the organization’s business plan to be in good shape — it just needed someone to “take it to the next level.” Shin was a shoo-in to head what she expected to be a smoothly run operation.

But right after she took the job, all hell broke loose. It became apparent that the plan was losing $1 million a month. The 53-year-old executive is the first to say the top job at the health plan has been the toughest of her career, and she acknowledges her cut-to-the-chase management style has sometimes rankled coworkers. Yet she can look back on that frantic first year and its painful lessons with a sense of accomplishment.

Shin has brought HPSJ to a higher level of sophistication as a nonprofit managed care plan now with nearly $1 billion in annual revenue. Over time, friends and mentors say, Shin has refined her leadership skills and created a greater sense of teamwork by learning how to be flexible while fostering a performance-driven culture. Learning from the wisdom of others who also want better health and health outcomes for all people is important, she acknowledged. “She is no-nonsense in her directness . . . but there is also a soft side that is part of her,” said Jennie Chin Hansen, a health care consultant and Shin’s former boss at On Lok Senior Health Services in San Francisco.

Her evolution as an effective manager was influenced by a two-year fellowship in the CHCF Health Care Leadership Program. “I really believe in the ‘it takes a village’ mentality,” said Shin. “You have to work with others. Don’t try to go at it yourself.”

A Surge of Growth from the Affordable Care Act

At the beginning of her tenure, the health plan had recently expanded to include the Medi-Cal population of neighboring Stanislaus County — the first local initiative health plan in California to extend beyond its home county. Unbeknownst to the board, however, when Shin was hired in May 2013, the plan was losing money because of unfavorable provider contracts and high use of services. She and her colleagues scrambled to stanch the bleeding.

And when the Affordable Care Act kicked in the following year, HPSJ grew even bigger as childless adults enrolled in Medi-Cal. Membership, which was 120,000 in early 2012, almost tripled to 347,000 by 2017. “Those two things, back to back, were very difficult,” Shin remembers. “I felt pretty confident that I could get us through it . . . but it was an ‘all hands on deck’ type of thing.”

Cheron Vail, the health plan’s chief information officer, remembers that Shin “went into overdrive” and began pulling every lever to reduce medical and administrative costs and expenses. The health plan that netted $53 million in 2013 fell back to $39 million in fiscal year 2014. “All of our internal business processes started breaking right and left,” Vail said.

Before Shin joined HPSJ, protocols allowed employees to essentially work in silos, with no need to coordinate with colleagues in the next office. “Those underlying processes were not robust enough,” Vail said.

Documentation was faulty and financial records weak, she said, and amid the confusion, an employee embezzled $90,000 in plan funds. The employee was sentenced to 2½ years in federal prison.

“We had new people now who didn’t know what other people were doing and did not have solid controls,” Vail said. “It was the classic case of building and flying the plane at the same time while taking in all these new members.”

Rebuilding the Executive Team

Vail, who joined the plan in 2012 under the previous CEO, still marvels at how quickly Shin grasped what was going on and identified strategies to turn it around. “There is nobody else on the team who has quite the background that Amy does and understands firsthand the challenges of the people we serve,” she said.

Shin rebuilt her seven-member executive team and beefed up salaries to attract top talent. In 2017, HPSJ reported a $91.3 million positive margin, according to the California Department of Managed Health Care.

Shin has strong quantitative skills and a quick mind for articulating how data can solve problems, said Chin Hansen. But beyond that, she has an “ambition to do good” — a big reason why she recommended Shin for the 2004 CHCF Health Care Leadership Program. She thought Shin would benefit from being around other health care leaders, comparing their styles and developing softer “people skills.” The program enabled Shin to see problems from multiple, and more nuanced, perspectives.

Shin’s leadership skills developed early. The eldest of three daughters, her Korean parents emigrated to the US in the mid-1970s seeking a better life for the family, settling in Los Angeles when Shin was about 10 years old. Her parents spoke little English and worked at low-paying jobs to make ends meet. But they managed to keep their daughters in a kind of bubble of love, as Shin puts it, shielding the three girls from knowledge of the family’s serious economic challenges.

When she was a teenager, her parents bought a liquor store in Huntington Beach, just south of Long Beach. “It’s a terrible way to live, working 365 days a year, opening at 8 AM and closing at midnight,” said Shin, who translated for her parents.

As the oldest child, Shin was expected to keep an eye out for her sisters. The family often looked to her for guidance, so Shin grew up fast. “I think her work ethic came from being in charge at such a young age,” said Leslie McMillan, one of her best friends.

At school, Shin excelled in science and studied microbiology and immunology at UC Berkeley. She wasn’t sure what she wanted to do, but she remembered that her mother always wanted to be a pharmacist. Shin got her doctor of pharmacy degree at the University of Southern California, followed by a residency at UC Irvine.

During that time, her mom was diagnosed with Stage IV cervical cancer. She survived, but the experience made Shin realize that the family had never had health insurance even though they probably were eligible for Medi-Cal. Shin joined a health care plan on her own.

Getting People Past Cultural Barriers and Out of Poverty

It didn’t take Shin very long after starting her pharmacy career to start finding her public health care roots. “One reason why I work in the medical space and especially in this area is that we are serving members who are not just low-income and need Medi-Cal, but also people who have cultural and language barriers,” she explains. “It’s very personal to me.”

It’s a theme she emphasizes as she mentors young women. “I tell them, ‘Of course you will be judged in a certain way because you are a woman or because you come from a certain place or heritage. You cannot let that distract you,’” said Shin. “I am not a Korean-American woman leader; I am a leader. That means I show authority and strength . . . Consistency in how I behave and lead, along with all other women in leadership, will pave the way for eventual equity.”

Shin has worked hard at HPSJ to address key socioeconomic issues. Initiatives are marked by collaboration and partnerships, including campaigns to promote literacy, provide oral health care, reduce opioid dependency, and launch innovative palliative care options.

The Commonwealth Fund in 2016 cited Stockton and most of the surrounding San Joaquin and Calaveras Counties for improving more performance measures (19 of 33) on the fund’s local health system performance scorecard than any region other than Akron, Ohio. Commonwealth described the local improvement as being helped by “supportive state policy and the market dominance of a locally governed Medicaid managed care plan” — that is, HPSJ.

“With 90% of the market share in San Joaquin County and over 60% in Stanislaus County and longstanding relationships with nearly all local health providers,” the report said, the health plan “has the leverage to promote broad-scale performance improvements.”

As Shin enters her fifth year leading HPSJ, she and her team have created a more efficient plan that she believes “truly serves our members.” But getting people out of poverty and into jobs is key. “Our community will be stronger,” she said, “if everything is stronger around us.”

Tracy Seipel is a freelance writer living in the San Francisco Bay Area. She is a former editor and reporter for the San Jose Mercury News and the Bay Area News Group. Reprinted with permission of the California Health Care Foundation. Copyright 2018. All rights reserved. To stay up-to-date on the CHCF Health Care Leadership Program's application and recruitment process, in addition to other leadership development opportunities for health care leaders, please sign up for Healthforce Center's newsletter.