Kat Mastrangelo, Executive Director of Volunteers in Medicine

In this episode of Bend Don’t Break, host Aaron Switzer sits down with Kat Mastrangelo, Executive Director of Volunteers in Medicine, a free clinic serving uninsured adults across Central Oregon. Kat shares her journey from a career in health policy and hospital administration to leading an organization that provides critical care for those who fall through the cracks of the healthcare system.

Together, they explore the challenges of rising insurance costs, the impact of expiring subsidies, and the growing need for accessible medical services in our community. Kat also highlights the power of volunteerism, the unique role of charitable pharmacies, and how her team is preparing for a surge in demand. Tune in for an insightful conversation about healthcare equity, community resilience, and the importance of local solutions.

Transcript

SPEAKER_00 0:00

Welcome to the Ben Don't Break Podcast. We are powered by the Source, Ben's locally owned media company and weekly newspaper. This podcast is our eddy in the rushing waters of local journalism. We are glad that you are taking some of your time to listen to us chat with the people who shape our local community. Support us through our member program at Bensource.com.

SPEAKER_01 0:23

Thank you to our presenting sponsor, Remax Key Properties, a family-owned, full-service real estate brokerage specializing in residential, luxury, commercial, new construction, and ranch and land properties. Their new state-of-the-art facility at 42 Greenwood Avenue is a modern collaborative space and the new home of the Ben Don't Break Podcast Recording Studio.

SPEAKER_00 0:44

I'm Aaron Sweitzer, publisher of the Source and producer of this Ben Don't Break Podcast, along with Megan Burton, who is off-screen and being blinded by a very bright light today. Today we are joined by Kat Holman, Mr. Angelo. Correct. Executive Director rhymes with Michael Angelo. That does. Executive Director of Volunteers in Medicine, the free clinic serving uninsured adults across Central Oregon. Kat has spent her career working in healthcare, public policy, and community leadership and has guided VIM since 2008 after first starting as a volunteer. Her work has earned national recognition, including the Circle of Caring Award from the National Association of Free and Charitable Clinics. Kat has lived in Benn for 20 years and serves on several local and national boards, including NAFC, CASA of Central Oregon, City Club of Central Oregon, and the Central Oregon Health Council. We're excited to welcome her to the podcast. Thank you. And full disclosure, I also serve with Kat on the programming committee for City Club, now the board. Yes. And um it is fun. It is a ton, we have a lot of fun.

SPEAKER_02 1:52

Put a little pitch out there for City Club.

SPEAKER_00 1:55

Yeah, and uh Kat is a very good programs uh lead. So put that on the in the thing as well. So Kat, uh thanks for joining. And um maybe just start by uh talking, you've been here for 20 years, but where what's the story prior to that? How did you uh where did you start out?

SPEAKER_02 2:16

Where did we end up, huh? Yeah, how'd you end up here? Oh my gosh. Well, like everybody else, I mean it's such a beautiful place, right? Um, I grew up in Mississippi um and met my husband in college on the East Coast. And um after much moving around the Midwest, back to Baltimore for a little while, then to Kentucky, um he got a position here. Yeah and I'll tell you, 20 years ago, when we came out a little over 20 years ago looking for houses, you know, one of the questions you got then was, oh, you're moving here. Do you have a job already? Are you gonna look for one when you get here? And we always found that very puzzling. Like, how could that even be a thing? Um but we're really glad we landed here.

SPEAKER_00 2:57

The um the Mississippi does not come through.

SPEAKER_02 2:59

Yeah.

SPEAKER_00 3:00

And and I'm originally from Atlanta, and so I'm familiar with uh Southerners losing their accent along the way. But Mississippi, that's a that's a heavy syrup.

SPEAKER_02 3:11

Well, yeah. I could go back to it if you want to. But maybe we'll save that for the margaritas later.

SPEAKER_00 3:20

I um I usually can pick that up pretty well, but I did not hear Mississippi. So uh yeah. So what did your um so when you so you followed your husband's career here?

SPEAKER_02 3:30

Yeah.

SPEAKER_00 3:30

What did you been doing? Where were you prior to moving here?

SPEAKER_02 3:33

Yeah, so um just prior to here, we were in Kentucky. Um, and that's where our youngest child was born. But before that, we were in um Baltimore for a year. Um he did a fellowship there, and then before that, we were in Peoria, Illinois for five years. And so um so before that we were in Indianapolis, and that's where I really start I finished my master's and went into um health policy with it was Blue Cross Blue Blue Cross Blue Shield of Indiana, which has turned into Anthem. So many people have Anthem health insurance now. So I worked on physician um reimbursement pricing there. And then from there, when we moved to Peoria, I first worked in the city manager's office and rotated through all sorts of different departments, including emergency services and public works. Um, and then after that stint ended, I went to work for one of the they had two big hospitals in Peoria. And so I worked at one of those.

SPEAKER_00 4:30

There's nothing in your background though that would say small mountain town on the west coast prior to landing here.

SPEAKER_02 4:39

Well, and you know, with how does Ben show up on your radar? Um, well, when we were when when Mike was finishing residency and we could go anywhere, um, we got a big map out and we just put pins in all the different places we liked. And I've always loved mountain towns. So Asheville, North Carolina was one of the ones. Um and then Sister City. Yeah, and then this was back when you know you didn't there was no online um job posting. So literally in the back of the journals, there would be job postings, and there was one for Bend Oregon, and we looked it up, and I thought, oh my goodness, that place is so isolated. I don't know. Um and my husband convinced me to come out and look at it. And you know, literally we we flew into San Francisco and there was a meeting there, and we drove up, you know, through um, you know, 97 all the way up, saw the the big, you know, guns ammo liquor sign with the bears and the fish. Yeah, right, I think. And I thought, oh my goodness, where are you taking me? But then we rolled into Ben and it was, I mean, within 20 minutes, we were like, oh, this we looked at a lot of places and this was really neat. Oh, that's great. Yeah, so we had some friends out here in Oregon already, you know, kind of over on the coast and up in the valley, but um we love Bend.

SPEAKER_00 5:57

And you've been at Volunteers in Medicine since 2006?

SPEAKER_02 6:01

I start no 2004. I started as a volunteer when the clinic first opened, and I worked at the front desk and I made appointments and I helped people with their um financial screening that we have to do for other patients. Okay. Um so yeah, going back to when it very first opened.

SPEAKER_00 6:16

Yeah, I and maybe I'm not the only one, but I do suffer from the ignorance of thinking, you know, this volunteers in medicine is um doctors without borders.

SPEAKER_02 6:27

A lot of people make yeah, they they ask if we do yeah, international trips. And no, we don't because there are a lot of people who need help right here in our community. And um and it's really neat because a lot of people we're we are not affiliated with any sort of church or anything, but a lot of people do come to us out of that sense of mission, uh-huh. And they are very um grateful and appreciative that there's an opportunity like that here. So in our own backyard, we can take care of people.

SPEAKER_00 6:56

Yeah. So g give me the you know, 101 on volunteers in medicine here locally. What are the services?

SPEAKER_02 7:05

So we are a free clinic, so that means that we do not charge anybody for the services we provide. Um and you know, our main program is obviously primary care, so people just needing a doctor, like a family doctor. But then we also have retired specialists who will volunteer, so we can do a lot of um referrals to specialists within our own clinic. We also have one of only three charitable pharmacy licenses in the state. And so we can get donated medications. So almost anything a patient would need that would be prescribed, we are able to get through our charitable pharmacy at no cost.

SPEAKER_00 7:38

How does donated medications work? Right. Can I clean out my cattle? Like, here's some benzos. I wasn't using that.

SPEAKER_02 7:46

So when we when when we first started this, and that's going back about 12 years now, um, the state did allow us to accept donated medications from individuals. Wow. It still had to be in the original sealed container. Um and so, you know, if you had just gotten a prescription at the at the drugstore and it was in one of those old pill bottles, we couldn't take it. But the ones that were still sealed, we could. And you know, we had some really expensive medications, like some of these um um like rheumatology meds that are, you know, ten thousand dollars a dose, you know, and and grandma would pass away and they would have extra and they would bring it to us. And then probably about five years into that, they had a change of heart and did not allow us to do that anymore. But originally we were getting medications. Um, it was somehow on our website, and so people from all over the country would send us medications. There was a form they had to fill out an affidavit, but I mean, you know, North Carolina, Texas, Massachusetts, we would get boxes every week of meds because it's uh people really want to be able to do that, and we just we can't anymore. So the donated meds now come from the pharmaceutical companies. Okay, or they're two big companies, Americares and direct relief, and they kind of collect a lot of these medications at the manufacturer level if they kind of aren't short label or whatever. And um, then we they will distribute that to the free clinics, and so we participate in those programs.

SPEAKER_00 9:13

Yeah, I mean, all kidding aside on that kind of thing, I mean it's an incredible boon to be able to take these medications that otherwise would be destroyed and redistribute them to people who obviously aren't going to be able to afford some of these prices.

SPEAKER_02 9:28

Absolutely, and you know, the the value of the medications, I mean it's it's um two to three million dollars a year that our patients receive in donated medications through that program. Now we can't have anything like narcotics, our our pharmacy does not we don't have that type of certification, but um everything else that we are able pretty much to do for our patients.

SPEAKER_00 9:48

Yeah. And at and that the backbone of this is practicing physicians or retired physicians who are donating their time to see the greater community.

SPEAKER_02 9:59

Um yes, uh doctors, um, so we have MDs and DOs, we have nurse practitioners, um, nurses, pharmacists, uh physical therapists, counselors, anybody with a professional license who wants to volunteer, and if we have a need, we can match that up, which is pretty cool.

SPEAKER_00 10:18

Yeah, it's and and how large is the group of uh volunteers of in that field?

SPEAKER_02 10:26

Yeah, we've got about 150 total volunteers, um, and probably uh 40 to 50 of those are doctors, and another 40 to 50 are nurses, and then another third or you know, whatever a lot of interpreters, we need a lot of interpreters, um people that can work at the front desk, people who help us with our um fundraising, all sorts of different jobs.

SPEAKER_00 10:48

So how do you I mean I don't want to use the word screen, but how does someone avail themselves of your services? How do you determine need, yeah, things like that?

SPEAKER_02 10:57

Um that's a really important program for us because we have this charitable pharmacy, those pharmaceutical companies are pretty strict about who they're gonna give medicines to, as you might imagine. Yeah. Um so we have a pretty rigorous screening process, and it involves bringing in um either pay stubs or tax returns, and then we have to certify that you live or work in Deschutes County or Jefferson or Crook Counties, excuse me, and um that you've been here at least 90 days and um let's see what is the other piece of that. Oh, somebody in the household does need to be working. So it's a program for people who are working, and our income guidelines go up to 300 percent of the federal poverty level. So for a family of four, that's uh I think it's about sixty-five thousand dollars. Okay. Um so we're not the people who are really low income are gonna qualify for OHP. Right. So we're kind of the people that make too much for OHP, not enough for being able to afford insurance, and their jobs generally do not provide it.

SPEAKER_00 12:05

Yeah. That is fascinating. How is there do you have waiting lists? How does it are you are you meeting the need?

SPEAKER_02 12:12

Um right now we are meeting the need because in Oregon we expanded OHP. So when they expanded OHP, a lot of our patients were able to qualify. Yeah. Um and so then we kind of we've built it up, we have more people who have found us now. We right now do have room, which is one of the reasons we want to um get the word out, is that with all the I'm sure you're going here with this conversation, but with the subsidies expiring, we are really anticipating a lot of people um are going to realize they cannot afford insurance anymore. Right. And they're gonna be out of luck on what are they gonna do.

SPEAKER_00 12:49

Yeah, I I I in I I don't know uh how media and and understanding of what it means when the um insurance is cut, you know, and the um the cost goes up, but I don't I haven't seen the kind of panic that I expected to see with regard to the numbers that I've seen. I mean, the numbers that I've seen with regard to how much people are gonna pay and how much those costs are going up without um usually there's some kind of I think we're working on it or it it's pretty much just it's happening. So was one of the reasons I wanted to bring you in for the podcast. What what are you experiencing on your end as you anticipate catching some of these folks?

SPEAKER_02 13:34

Yeah, so um the people that answer our phones, um, we have definitely seen an increase in the number of people calling and wanting to know about services. Um a lot of them are uh this is interesting too. A lot of them are actually on Medicare, and the Medicare premiums for the advantage bonds are going up. And so they're really Well, they discontinued the advantage.

SPEAKER_00 13:56

I mean, my parents were in the situation where they moved from advantage to a different and all the panic that that went in with that.

SPEAKER_02 14:04

Right. And so they're really worried about especially the cost of medications. And part D has gone r up really high. Right. So they are calling to see if we might be a resource for them. And unfortunately, we are we cannot take care of patients who have Medicare or Medicaid. We are only for people without insurance.

SPEAKER_00 14:22

And so that's um it's it's but it seems like that's the population that's gonna be most impacted. Oh that in that in-between group, you know.

SPEAKER_02 14:33

Absolutely. And I think we're not gonna see the full impact of that on January 1 because the subsidies expire December 31st. And so come January one, um, some people are gonna be really worried about it because they're in the middle of something right now, trying to get the care they need. Um, and I think what's gonna happen is a lot of people who, you know, if you're if you're in your 30s or 40s and you don't have a lot going on, you may be like, oh, I really need that, but I'm okay right now. I'm just not even gonna worry about it. Yeah. But come March, April, May, and something does come up and you're like, what is that weird spot on my arm? Or, you know, what's going on with my hip? That's when people I think are going to start to be looking for what am I gonna do now?

SPEAKER_00 15:18

Yeah.

SPEAKER_02 15:19

Yeah.

SPEAKER_00 15:19

Yeah, you bring up a good point that it could be this population that I mean, I remember when I was in my 30s, you're between jobs, you're debating whether you're gonna get your own insurance and you don't qualify for this. And and certainly at those early stages when you're starting your career, your employer probably isn't picking up or or may not be picking up your insurance. Um, but it's not the kind of thing that sparks any kind of urgency until you go in. This just happened to my son, actually, and um the doctor presents him his first bill. And you're like, wait, my wage is never gonna cover this kind of care. Right. You know, and I don't think that a lot of people have that. Um, well, now, like you you've been down the road as much as as you I have. Yeah, you're gonna look back, you you know what's coming, but I I do get the sense because I have had, I kind of mentioned it is I have this, you know, for me, it seems like such a major, you know, problem that I just haven't seen the panic. But now it it does make a little more sense that it's in a population base that um probably thinks they're gonna be okay.

SPEAKER_02 16:29

Or they're just crossing their fingers that they're gonna be okay, right? Right. And they'll just keep playing the lottery and you know, hope it all works out. And and it will for a while, and for a lot of people it will. But that's part of how the ACA was structured was with everybody participating, that meant that it was less expensive for everybody. And if people start to opt out, and especially the healthy people, that leaves the people who are less healthy in the system, which means they have a higher spend on their health insurance, which means that the insurers need to charge more for those premiums. And as a small, you know, we're a small business too. Volunteers in medicine, we're a nonprofit, but we just got our premium um updates for starting in January. And oh wow, um, it was a big shock. I had budgeted a little bit of an increase, but not nearly enough. And we are ending up having to go with a higher deductible on our plan that we offer our own employees just to be able to afford it.

SPEAKER_00 17:29

Yeah, we're going very similar story in our company. It's definitely not a great year for insurance.

SPEAKER_02 17:35

Right. And that will impact people. You know, we talk about like inflation and just the cost of going to get groceries, but down the line, you know, if you're paying $75 for a doctor's visit instead of $50, and you have to pay the first, you know, $5,000 instead of $2,500, you don't feel that immediately. But over the course of the year, that really does add up.

SPEAKER_00 17:57

Yeah. What do you um what do you anticipate is gonna happen with um the insurance companies' roles and responsibilities in this shrinking environment? Because it's one thing when insurance companies do have ACA. And and I remember, I mean, f for those who can remember or followed it, you know, there there were those were big titans fighting as the ACA was going through. And they did, you know, ultimately the promise was to drive all these people in. Um but there were, you know, there's been history of pre pre existing conditions. So these people don't pay these. Now they lapse. Now they've oh they discover they've got a condition, and now they're going in and the premium is much higher. And it was always in their court, in their in their favor. And I I feel like that's another aspect of this that we're not hearing a lot about.

SPEAKER_02 18:54

And that was one of the most popular pieces of ACA. There are two pieces that were really popular. Number one, you could keep your kids on your own plan until 26.

SPEAKER_00 19:01

Right.

SPEAKER_02 19:02

Huge. Um, but the other one was the pre-existing condition. So you weren't stuck with the plan. You could move jobs, you could get a new plan if you needed to during open enrollment, and your pre-existing condition would not be excluded. Right. Because that's how those policies used to be written. Um and that's that's huge. That that is so huge for somebody who is dealing with something, and especially chronic disease, diabetes or high blood pressure or uh lupus, you know, all these different diagnoses you can get, which is why you want to take care of yourself.

SPEAKER_00 19:34

Right.

SPEAKER_02 19:36

If that is not covered under care, then that boy, that is really hard.

SPEAKER_00 19:42

Yeah, and because I mean it's something that they're paying on a regular basis, and also have paid into the system up to that point. And by system I mean the insurance company, not the social safety net or any of that, but you paid this company quite a lot of money.

SPEAKER_01 19:56

Yeah.

SPEAKER_00 19:56

And now, due to you know, uh because these premiums are going up and whatever the machinations are behind their their bottom line, um, you've been dropped. Now you gotta go, maybe you let it lapse for a year and you realize I gotta get it. And now you're going in and they're they're bringing up your old medical records.

SPEAKER_02 20:15

Right. Well, and you know, the way it's insane. The way insurance companies are set up and some of the legalities around it, you know, they they expect to be able to have a 20 percent um they they expect that the cost of care that they are paying for is 80 percent of what they get in premiums. Okay. Um and so then there's 20 percent for the admin and all the other pieces. Um, they have to spend at least that much. Now, some of them end up spending more than that, 85 percent, sometimes even ninety percent. When you start to get much lower than that, then all of this infrastructure that the insurance companies had, they can't make the the dollars work. And so that's part of what we're seeing in Oregon is several of these companies that are CCOs now are re they're they're beyond those um those margins that they're expecting to get. And so they are actually losing money on caring for people. And part of that goes into, you know, it it it's utilization in part, and a big piece of that is the pharmaceutical companies who are still making a lot of money. Yeah. And if we, you know, we can either not let people have access to treatments or we could look at different ways to um how do people get reimbursed for their care.

SPEAKER_00 21:33

Yeah. I mean, I I think it's fair to say I was a fan of a the ACA. I would have liked to see that trend continue. I just in the vacuum, it does not seem to me right now that there is going to be some way. To me, there have always been like negotiating government entities, which for a journalist is the only way I could really wrap my head around it, but they're not at the table. They're all they not they've they're all siloed at the point and I don't see how that's gonna benefit um that's gonna benefit the general population because you gotta have an arbitrator.

SPEAKER_02 22:09

Trevor Burrus Yes you do and you need to have be able to buy in volume right so you know one of the concepts that's floating out there is let's just give people the money and then they can go get their own health care. Well if you don't have any purchasing power and you're just going as an individual who's under some duress because you're sick, um you're just gonna pay whatever they ask or you're just gonna say I can't afford it. Instead of you know what here's somebody who does this for a living and we know we're gonna have X number of of hips we need to fix and X number of, you know, whatever diabetic patients and we need to work to get that volume pricing down. You know somebody compared it today that I heard you know you go to Costco, you buy a membership up front to be able to shop at Costco. But when you go to Costco, the people who run Costco have done the work for you. Right. They have gotten the lower prices within the warehouse so that when you go in and shop there you take you you get that benefit.

SPEAKER_00 23:09

Yeah are there do you see for volunteers in medicine in particular um you know where are the bright spots?

SPEAKER_02 23:17

Yeah yeah as as we I mean I'm smiling because I you know when we talk about volunteers we're we're like this little island right because everybody who's coming to work there and take care of patients they're there because they want to be there, right? They're volunteers. They get just paid with smiles. And the bright spot I think is that a lot of people who go into healthcare they go into it for the right reasons, which for me is because they want to they want to give back. They have talents and skills and they want to help other people. And they've spent a career in healthcare and they've dealt with terrible schedules and not getting pay raises and not feeling appreciated and everything else and they retire and they come to Vim and they are just doing it because they love being there with other people who are caregivers and the patients are so appreciative. So I would say our volunteers are the number one bright spot that we have. But then also the patients because instead of feeling like you know well you have to do this because you're getting paid for it there's this this is this other piece of it which is you're here and you're doing this out of the goodness of your heart and I want you to know how much I appreciate that. Right. How do people uh find out about Volunteers in medicine other than this great this this podcast yeah this is it you know most of our patients now it's word of mouth honestly and you can imagine if you were going to go to a free clinic you might be a little you might be like oh I I don't know about that. But if you have a friend or a relative who goes there and they're like no actually it's a really great place and I love going there and the doctors are terrific then you have a lot more confidence. And I think a lot of people you know for a long time we had a waiting list and we just were at capacity and so we didn't do a lot of outreach. Now that Oregon has stepped up and really expanded who is eligible for OHP we now do have capacity and you know we're really hoping that in this transition we can be a place for people who are out there who can't afford their premiums anymore who meet our guidelines will be able to find us and at least have a medical home until we can get all this figured out.

SPEAKER_00 25:28

I know you're you can't look in the crystal ball but do you think that OHP is going to hold with all of the funding cuts?

SPEAKER_02 25:37

Yeah. I hear different things. Yeah um so you know depending on you know what happens with the kicker and what happens during the short session I can't imagine if things don't shift at the national level right now our Medicaid waiver is good for another um like year or two. Once that runs out under the current administration I don't think there's any way that that will be right extended. And so I think that will be our real reckoning point is if something hasn't shifted that's when we're gonna really be in a world of hurt. I have heard some talk you know years ago Dr. uh Kitzhaber when he was governor he came up with the whole helps having a doctor yep he had that whole list and we said you know we will fund everything in the state we we we set it up one to like you know 7,653 right number one was prenatal care and deliveries and at the bottom were things like and they would set a line and so everything above this line we will cover and if we don't have enough money everything below the line we're just we don't have money to do it. And so things like an elective hernia might be below the line. It could benefit you there's definitely reasons to do it but you're gonna be okay. And that that's how we used to operate our OHP well in the last year or two um that was determined not to meet the Medicaid standards and so now we are not able to use that list and that line anymore. So to cut benefits we can't just put a a line on the sheet we have to then just say we're not gonna cover whole parts of care that Medicaid would would let us shift.

SPEAKER_00 27:25

So the line isn't moving up and down that any longer.

SPEAKER_02 27:28

Nope it's the whole it's the same thing for the country now.

SPEAKER_00 27:31

Yeah yeah well Kat that is at the end of our time here for the podcast.

SPEAKER_02 27:36

That went fast I know that's that that's I could talk about this stuff forever you know um and I really do hope though I mean if you know if you or somebody you know um does not have insurance or they're one of in this situation where the premiums are going way up you should go to our website. We're getting some information put up so people can easily see if they might be eligible and if so that we we want to be able to help them.

SPEAKER_00 28:02

Yeah I have a feel I mean again uh we'll mention as previously I just have a feeling and maybe it's gonna take two years for the water to really start boiling on this but um it's getting warmer and I do think that you know access to services and groups like yours and it's trying to I mean the philosophy behind it if there is a philosophy is to try to drive more individual individuals to participate in programs like this. It wants people to volunteer I mean that's the only way I can philosophically see the gap is that if it people start putting their time and their charitable resources towards these type of things where there's a gap or um I don't see the two meeting.

SPEAKER_02 28:47

Well and the neat thing about when people donate to Vim because it's also December in the year time what's neat is the dollars that you donate to Vim really get leveraged because of this volunteer piece because of our charitable pharmacy. I that's one thing I really love about when people make investments in our clinic is that it's not just it it's going to direct services but it's also getting multiplied by this volunteer spirit.

unknown 29:12

Great.

SPEAKER_00 29:13

Well Kat thank you for coming in and and rapping with us. All right thanks Alex this has been the Ben Don't Break Podcast uh if you liked what you heard you can go to bensource.com become a member and donate to help us bring more folks in like Kat and also uh do be generous and uh keep the keep them going. Yes all right thank you thank you you've been listening to the Ben Don't Break podcast powered by the Source Weekly to read hear and see more of what we do go to bensource.com