When Dr. William "Bill" Gonzaba, founder of the Gonzaba Medical Group, opened his first practice at age 27, the one-room clinic on Nogalitos Street was so small that patients had to wait outside or in their cars for their appointments.
Business expanded throughout the years, and the practice has grown from its modest beginnings in 1960 to a staff of 625 employees working in seven San Antonio clinics specializing in senior care.
On most days when Gonzaba walks through the main clinic – a Mexican restaurant-turned-medical complex on Pleasanton Road on the city's Southside – he runs into someone he has known for decades. He said that over time, the business naturally gravitated toward care for seniors because many of his first patients remain his patients today.
“They have grown up with me,” he said. “I have delivered their kids, and their kids' kids,” and as the practice has expanded to include specialists and a comprehensive rehabilitation center, patients have had little reason to seek services elsewhere.
The need for comprehensive care is acute in the area served by Gonzaba. Bexar County residents south of Hildebrand Avenue on a City Council district map have a 15 percent to 20 percent lower life expectancy than those who live north of that line, according to the Bexar County Health Collaborative, a nonprofit network of health care providers. Five Gonzaba clinics are located south of Hildebrand, and the Gonzaba's Medical Group's main clinic is located in City Council District 3, which has the highest number of people at risk for health complications, including obesity and Type 2 diabetes, according to the collaborative.
District 3 City Councilwoman Rebecca Viagran praised the medical group's commitment to the Southside, to promoting health and wellness throughout the district, and to encouraging seniors within the community to stay active and engaged.
"They are bringing jobs into the area [and] creating new communities through the different events they they offer," Viagran said, such as educational programs and bimonthly farmers markets at clinics.
The bulk of the patient load at the Gonzaba Medical Group are patients enrolled in Medicare Advantage plans, a managed-care model that pays providers a monthly fixed amount per patient for comprehensive care. The program has evolved since the 1990s, when Bill's wife and medical group co-founder, Chave Gonzaba, taught herself the ins and outs of the coverage model by calling California stakeholders and insurance companies, who explained the program over the phone.
People enrolled in Medicaid Advantage plans are typically of “lesser means,” said Gonzaba Marketing Director Jeff Cowart, and are unable to afford supplemental insurance plans with traditional Medicare.
Chave Gonzaba said that while entering into a new coverage model was financially risky for the business, which had only recently began computerizing and streamlining its billing processes, the medical group has always been about "doing the right thing," which in this case meant growing its practice while gearing services toward low-income residents.
Managed plans provide incentives to doctors who keep their patients healthy. If a patient needs care that exceeds the cost of what Medicare provides per month, the medical group must pay the difference in cost out-of-pocket. This requires closely following patients and monitoring their symptoms to ensure that they are maintaining wellness and not becoming sicker.
Nationally, about one-third of all Medicare patients are enrolled under Medicare Advantage, according to Cowart; Gonzaba serves 13,000 Medicare Advantage patients.
Medicare Advantage plans are "very complicated," said Gretchen Johnson, associate director with the Kaiser Family Foundation's Program on Medicare Policy.
"... There are a lot of regulations [with this plan] and [providers] need to know a lot about how to care for a relatively sick and frail population," Johnson said.
When the Gonzaba group's physicians gather for their monthly clinical meeting, they receive a report stating which patients are the sickest and which are improving. The report is the culmination of an in-house data analysis that uses information from a patient’s electronic medical record to determine overall wellness based on 22 metrics, and flags those at risk for needing higher levels of care. Physicians then prioritize patient appointments based on need – those who are the sickest receive priority.
"We are data-driven," Bill Gonzaba said.
At the same time, the medical group has established its place in the community by adhering to its core principle of treating patients like family – "como familia," said Paco Gonzaba, the Gonzabas' son who is the group's executive director of business operations. That means physicians treat patients holistically, rather than just treating symptoms.
“We don’t overutilize medical services for our patients,” he said. “We practice prevention and quality care. It’s the best thing for the patient and the best thing for us.”
The emphasis on family extends to the practitioners and staff. A Southside native, Gonzaba said he grew up in humble circumstances. His father, a contractor, helped build the second clinic on South Flores Street in the 1960s. Gonzaba told the Rivard Report that he felt “privileged and honored to be accepted into medical school,” but had difficulty charging patients at first.
“I never considered medicine a business,” he said. “Helping people and giving back was how I was raised. It’s not about making money.”
Paco got his start with the medical practice skateboarding up and down the halls of the Pleasanton Road clinic when he was a boy. His older brothers, Tom and Greg, went to medical school and joined the practice in 2000, specializing in internal medicine; other family members serve in various staff roles.
Claire Gallegos, 74, has been a patient since she moved to the Southside 17 years ago; at the time she was just looking for a clinic close to her home. The daughter of a physician, she said what was most important to her when choosing a medical home was the quality of care and that the providers be “sincerely interested in [her] as a patient.”
Gallegos has utilized nearly every service the medical group has to offer: trips to urgent care, a major foot surgery, treatment for arthritis, and general wellness visits, which she pays for through private health insurance. She and her husband recently attended Boo Fest, a Halloween dance hosted by the medical group that featured award-winning Tejano singer Ram Herrera and drew more than 1,200 people.
“I was jumping from table to table and even my husband went and had a ball," Gallegos said. "My husband going to something like that and having a ball – that’s a miracle.”
While a dance may seem to have little to do with health care, such events are aimed at keeping area seniors both physically and socially active – and, hopefully, healthier.
In addition to providing office and in-home visits to patients, as well as transportation to and from appointments, the Gonzaba Medical Group runs an events center where it hosts its educational programs, all organized and paid for by the medical group. Educational offerings include healthy meal preparation and how to manage diabetes and high blood pressure.
Cowart explained that the all-encompassing services aim to keep seniors out of the hospital, which he says could be “the worst thing that could happen” to them, because care is overseen by different doctors who may not be familiar with the patient’s health background.
Because Medicare reimbursements are contingent upon population health management, paying attention to patients' medical files and the social determinants of health that may present themselves in an appointment – food scarcity, transportation difficulties, or inability to pay for medication – is essential to the medical group's business model and its mission.
That mission hinges on Bill Gonzaba's principle of treating patients like members of his own family, and his team's willingness to spend time getting to know patients throughout the practice.
"One day I was walking out at 8 p.m. and I saw a couple, both around 50 years old, and I just sat down to talk to them because I wanted to," Gonzaba said. "I asked where they lived, where they went to church. As he kept talking, I [interrupted and] said, 'I delivered you,' and he smiled and said, 'Yes, you did.'"