Casa Grande native and CEO of Sun Life Family Health Center talks about his journey from trading post to the highest post at Sun Life. Along the way, he shares an update on the changing landscape of healthcare and how Sun Life is leading the way.
Interview by Bea Lueck
GC LIVING: Thank you for taking the time out of your busy schedule to join us. Let’s start with your personal history. Tell us about yourself. Are you from Casa Grande?
Travis Robinette: Well, sort of, I was born in Casa Grande, but we actually lived in Stanfield. There are pictures of me wearing two toy six shooters in the front yard at a house in Casa Grande, probably up over by the railroad tracks where the Holiday Inn is now, in that area. But I don’t remember exactly where. I was too young, so my stronger memories are of Stanfield.
And then, of course, you know, our life was somewhat complex. It was maybe a little bit out of the ordinary in that Dad, in 1955, bought a trading post on the Tohono O’Odham reservation, 87 miles south of here. It was about 50 miles southwest of Sells, closer to Ajo and not very far from the border with Mexico. It was probably one of the most remote trading posts on that reservation anyway.
So, I spent much of my youth there. My first exposure to culture was with Native American people. You can’t underestimate the powerful effect of culture on your life. I learned to play with Native American boys and girls.
GC LIVING: Travis, was that Pisinemo?
Travis Robinette: Pisinemo, Yes! That’s the name of the village. And I think Mom said I was born 10 days after they purchased that trading post. It was an interesting adventure, the five years when that was our only home.
More often than not, when we were going down there or coming to town to get supplies, or what have you, we would get stuck, because the last 12 miles was dirt road with lots of washes. And if it was raining we knew we were going to get stuck eventually. Those washes were going to hang the vehicle, because they filled up the sandbars, right? And it was an adventure to us kids. We’d get to walk home. Yippee! Be it dark or not, lots of times, it was at night. We’d get out a flashlight, if we had one, and we were usually barefoot. But that’s kids, right? My parents would say, “Where’s your shoes?”
We’d say, “I don’t know.”
So we would get to walk barefoot.
GC LIVING: Typical kids…
Travis Robinette: Dad later bought another business in Stanfield. He bought a second-hand store. One business wasn’t enough, I guess. I’m kind of that way too. So, he bought a second-hand store in Stanfield and we had a house on the premises in addition to the one in Pisinemo. There I was introduced to school, having been brought up before that point playing with Native American kids. And I distinctly remember thinking of my Caucasian classmates that they were very different. They didn’t behave right. They didn’t act right. Of course, I thought it was them. I didn’t realize it was me. We don’t look at ourselves that way, right? So, I’m like, “You people are different.”
It wasn’t until years later I put together they just don’t act the same way that Native Americans do. You know, that’s what I’m more comfortable with. I think I discovered that when we had a Native American kid join the school — I think I was in seventh grade – of course I fit right in with him. We understood each other. He gravitated to me as a friend right away so I guessed he also felt as I did.
Anyway, I went to high school here in Casa Grande. I rode a bus for a couple years until I was old enough to have a car and got to drive myself. So, yes, I have been around in this area all my life.
GC LIVING: Now, did your family have the Vekol market in on the Ak-Chin reservation as well?
Travis Robinette: No, that is a first cousin, Jimmy. My dad had two other brothers who also had trading posts – one younger brother, one older. Don is a younger brother to dad and he owned and operated Santa Rosa Trading Post for many years and Jimmy is one of his sons. An older brother to dad, Babe, owned Santa Rosa before Don bought it and also started a second store in Sacaton after his Santa Rosa days. Loyd, one of Babe’s sons, still operates the Sacaton Store. And then, I also had an uncle on my mom’s side with somewhere around 10 years of trading post history in Covered Wells. That was definitely an older type of store. I remember going in there. They had a cowbell on the door and which announced your entry. Inside was a small area surrounded by counter with the grocery and other goods all on shelves behind the counter. In the center of that small entry area there was five or six wood barrels of about fifty gallons capacity each. These barrels held various beans, wheat, things like that. Everything else was behind the counter, and you’d just give them a list and then they would retrieve your stuff – just like you see in Western movies. Now, Dad’s store was not set up that way. It was more, you know, more contemporary with what was up here.
GC LIVING: So, does your family have a lot of native art that you collected in trade over the years?
Travis Robinette: We do, yes. I have my prized pieces. And my dad, of course, had his. Dad is deceased, so we kind of spread those among the family. It’s primarily basketry, but some pottery (from the Tohono O’odham people, who used to be called the Papagos). [Editor’s note: The Tohono O’odham have rejected the former name Papago, used by Europeans after being adopted by Spanish conquistadores from hearing other Piman bands call them this. The Pima were competitors and referred to the people as Ba:bawu˘ko’a, meaning “eating tepary beans.” That word was pronounced papago by the Spanish and adopted by later English speakers. Source: Wikipedia]
There were some villages down there that did make pottery, but pretty much it was a reclaimed art to them, because they hadn’t had the need to make pottery for functional purposes for a long time, so it kind of died and then came back more of an artistic kind of activity. Their pottery, rather than being a reddish clay, it’s more of a light sandy color. I don’t know if that would be traditional or not. But we do have some pottery. But by and large, basketry is their real forte. And I have a fair amount of baskets, both old and new.
GC LIVING: Do you speak Tohono O’odham?
Travis Robinette: Some. I speak enough to get by. My dad, of course, was fluent because when he went down there, he kind of had to learn fresh. I mean, there was nobody there who spoke English, so he taught some of the younger men and women English and they taught him Papago, so he was fluent.
GC LIVING: Where did you go after high school?
Travis Robinette: I went one year to Central Arizona College (CAC). I started working on an accounting degree. And then like many 18, 19-year-olds, I had a girlfriend. And I was thinking, “You know, I need to settle down and get married.” So I quit going to school, asked Dad for a job, and I’ll never forget what he told me. He said of the job I asked for, “Those are big shoes to fill. You sure you can fill them?” And before I could answer, he said, “But, before you answer, you should know that I will fire you for much less than I will any of these other people if you’re not doing the right job.” I was like, “Uh, I think so.” So I went to work for Dad.
GC LIVING: Were you ever fired by Dad?
Travis Robinette: No, but I made sure I wasn’t fired by him. No, I listened very good and I mopped the way he wanted me to mop, or whatever he wanted me to do, I did. I tried to excel at it. And then, probably about a year after that, I married Cindy – who’s still my wife. She’s from Coolidge – born and raised there. We met at church, and I think I terrorized her for probably like a year or two before I actually convinced her to let me take her on a date. After we married, I took her down to Pisinemo, and we lived with Mom and Dad for probably about a year – a year too long. Most people would probably tell you that, right?
But, funny. You know, I have to tell this. If Cindy reads it, she’ll be upset at me. She had never seen the store or where it was. I told her where it was, of course, but you really can’t understand unless you go there. For safer driving reasons, I would purposely wait until later at night to drive down there because it’s all open range, and that’s still true today. In winter time, there is a danger (the cattle) may be lying down on that asphalt, because it’s warm. Well, I purposefully waited until about 11 p.m., and as we left, a thunderstorm brewed up. For me, after going many times down there and having many rainstorms, I pretty much knew this one was bad enough that we probably weren’t going to get there in this car. The car was going to get stuck somewhere on that last 12 miles of dirt road.
I was driving a Firebird, hopped up engine and all and I was putting the gas pedal to it. And – I’m still a teenager at that point in time, so I did like to have a little fun – and I thought, “Well if we’re gonna get stuck, I might as well go out in style.” Your only chance in a Firebird – something that low to the ground – when you’re crossing water is high speed, right? Hydroplaning.
GC LIVING: To kind of float across versus drive through?
Travis Robinette: But the car is going to want to turn sideways on me, you know, at 90 or whatever speed you deem necessary to cover the span of water. And the road is muddy and soft.
GC LIVING: That fast?
Travis Robinette: Oh, it’s the honest-to-God truth. You can ask Cindy. And you know, of course the road is muddy, so when you’re in a car with some horsepower, you’re spinning your tires when you enter the water and you keep them spinning so the car can climb the opposite bank of the wash.. Anyway, I made about three washes – and there’s probably 50 … I think we counted them one time – and on the fourth one the car got just a little bit sideways so that when it touched the muddy opposite bank it spun on me and I couldn’t recover it, so we ended up in the desert. We were stuck with about 10 miles to walk.
GC LIVING: And you’re still married after how many years now?
Travis Robinette: A long time – over 40 years. Anyway, this is the introduction part. I shut off the engine, and I said, “Well, we’re gonna have to walk.”
And then she says, “Well, somebody will come along, right, and give us a ride?”
I said, “Look around you,” She’s looking, and I said, “Do you see any lights anywhere?”
I then said, “Well, nobody’s going to come and get us. We’re going to walk.”
“What about the water?” she said.
“We’re going to cross it,” I answered. Yeah, she was not real happy with me. I think I heard her say something about she was going to tell her father on us, but we made it.
So then, I have to tell this part. Probably 15 years later, we now own the store. Dad had retired for health reasons, and I bought the store from him; we made payments.
We had one day off a week, and for years hadn’t had a vacation. So we had scheduled a one week vacation, my Mom and Dad came down to sort of oversee the store while we took the kids to Disneyland and it started raining early that morning. And by then, Cindy knew a little bit more about what that might mean. The road was paved then, though. But nevertheless, you still had some long quarter-mile runs where the water might be two-and-a-half feet deep. And, because of the water, you can’t see the road. If you know how to follow it, you can, because there’s a little boil on the edge.
Anyway, as we finally get away for our first vacation in years, we rounded a corner and there’s a quarter-mile of water just running like crazy. I looked at Cindy; she looked at me and she said, “Hit it!” So there’s what 15 years of being down there will do to you in desperation.
Yeah, we owned the store, and I actively managed that for about 10 years.
GC LIVING: Okay so you’re married 10 years. How many children did you have then?
Travis Robinette: We had three children.
GC LIVING: How did you make the transition from trading post owner to health care?
Travis Robinette: That’s not a real simple story, just because I had to leave a family business. That was very tough, but I could see that … first of all the tribe was self-evolving. They wanted to have their own businesses and things like that. I was aware of that and you don’t want to stand in the way of that. I had to really look at what is my future and what does it mean for my family. It was a very tough decision to make. I had first offered to Cindy, “Well if you go to school first, and then you can get a job and then we can transition that way.” I was always forward looking. I promised her when we had bought the store; it was a stepping-stone – just a transition. We’d pay our way through college. But usually that stepping stone ends up being maybe a bit longer than you thought it might be. In this case it took about 25 years.
She didn’t want to go to college, so I said I would and she could manage the store and I’d help by phone. I’ll also be Mr. Mom. We had children that needed to be in school, too, and there was still really no public school down there. So, I went to college and helped her by phone when she had questions or things came up. And so I did four years of college. It took me four years because I was working, and also being Mr. Mom.
GC LIVING: Which college?
Travis Robinette: I attended CAC for two years and finished at ASU. When I graduated, I prepared immediately for the CPA exam, because it was an accounting degree. Everybody said, “You should get your CPA.” I really didn’t know what I wanted to do. It’s was an entirely new profession for me. After college, I went to w ork for a CPA firm in Tempe, James Beaton, PC. I worked in their Tempe office for a year and then they purchased the Dixon and Masters CPA firm in Coolidge. By then, they kind of had a feel for my work, so they essentially assigned me that office to be both the head accountant and manager of the office.
I probably was there (Coolidge) for a year-and-a-half, with James Beaton for about three years. But I was missing something…I wasn’t sure what. We were primarily income tax and very busy during that season. We did a lot of accounting write-ups, but that’s a week or so a month for the rest of the year, so I was bored and wasn’t really sure what I was missing. I had a colleague from ASU call me who was working for Picacho School District. She was leaving and so she thought I would be good for that job. And I thought, “Well, why not? I’ll try it.”
And so I took that job at Picacho. I worked there three years and, still I was just trying to find out where I was going to fit into this world. It wasn’t until I was at this school district and got a little bit of exposure to management again…but after three years there I was still not content. I was like, “You know what? I’m missing the business (management) side.” That store had given me exposure to management, because I grew that store. I did everything I could. I applied everything I learned at CAC in that one year, plus what dad taught me, to make that business grow…and I did pretty well at it. I significantly increased the income. It was a tremendous challenge and a tough business environment and there is no boring in that!
Anyway, I realized at Picacho that I was missing the business side. That competitive spirit where we are in this market and this is our share of that market. Do we want to grow it? Can we grow it? If so, what do we need to do to grow it? I wish I had a crystal ball, but of course you don’t have a crystal ball. That was the sort of thrill, or challenge, that I was missing there.
Then I had another colleague call me, who was working at some medical clinic. She actually said, “I think this job is perfect for you.” She apparently knew me better than I knew myself, in terms of what I was missing. She actually encouraged me to apply and that’s how I ended up at Sun Life as the Chief Financial Officer. I actually researched the medical field before I went and applied for that job. It was very daunting what I read because, even then in 1998, there was massive change underway – massive political pressure on that system. The reimbursements were being pushed down. Still, it was considered a field of opportunity, so I thought I’d give it a try. I was a little bit intimidated. I was like, “Well, you’re working with doctors and I’m from a reservation.” I thought they may not like me, or they may find me crude or whatever. But I took that job and hadn’t looked back really. There’s no boredom in health care. As soon as you get to thinking you might have mastered the business model, it changes and you have to start all over again.
GC LIVING: So now you’re the CEO at Sun Life. How have the changes in health care – both the business practices and patient care – changed since you started at Sun Life?
Travis Robinette: A fair amount. From the business side, since ‘98, there have been continuous, although small, increments of pushing down of the reimbursement side. Whether it’s Medicare … I mean Medicare usually leads the way. Whatever Medicare does, it’s not long until the private insurances follow suit and/or the state medical program.
GC LIVING: At the same time a steady increase in the operating costs?
Travis Robinette: Yes, because costs have been going up. I think for a good portion of those years the medical price index was among the steepest in rate of increase. That index measures the cost side of the medical profession and with costs soaring upward you can increase your patient encounters and still have a net loss in bottom line traction. Add to that mix any reductions in payment structures and you have a recipe for disaster. That’s part of what I’m saying – it’s a very challenging business model. You can’t really rest. You have to constantly stay on guard.
I think that most people working in the healthcare system realize that it was broken…in terms of duplicated labs, X-rays and a general disconnect from one service provider to another. For example, I have personally told my providers, “I recently had that lab taken already; do you want me to have the results sent to you?” They often say, “No, I’ll run it again.” There’s a general reluctance in health care to rely on a lab result that you didn’t order yourself. So even if you had the records that may not solve that problem for you. There’s an established healthcare culture that is determined to remain the same. We’ve been fighting that, because if you’re going to be affordable, efficient and accountable, you can’t take that old culture along.
I’m not saying that healthcare professionals are at fault, rather, they are caught in a healthcare system in which they also struggle with to survive. That’s sort of been the setting and I think that what has emerged out of that is this whole new concept of value-based reimbursement, or outcome-based – the improvement in one’s health outcome score being tied to reimbursement somehow. That’s the current direction which I think was pretty firmly locked in place in the Affordable Care Act. That’s the highway, if you will, for value-based healthcare and to prepare the healthcare system to handle a larger population and provide better health outcomes with an overall lower system cost.
So, at this point there is a lot of focus on changing the healthcare system from an encounter based (reactionary healthcare) to health outcome based (proactive or preventative). No one really knows how that revenue stream is going to be tied. And, what do you do about patient compliance? You may have the best doctor using the best treatment available, but if the patient isn’t compliant, you’re not going to have the desired outcome. And does the healthcare provider then lose the associated revenue? Who takes the hit? That’s what I mean when I say it’s still very vague. I think it’s fair enough to say that they are still in the concept form, but they’re rolling these reimbursement models out now. I guess that’s okay, you have to test it somehow. You have to develop those … it has to go from concept to reality based on trial and error and that’s kind of where healthcare is today. If the Affordable Care Act is repealed we will still be on the road to reform healthcare because system cost is not sustainable without it.
GC LIVING: Is the community health center model different from the typical family practices office in that it has the ability to educate the patient in greater depth, then measure those changes? Things like diet and exercise?
Travis Robinette: That’s one of the keys to better health, but who wants to exercise? Who wants to take that two- mile walk and eat healthier all the time? Yes, education is a critical piece of convincing all of us to eat better and to exercise our bodies. Yes, community health centers are expected to provide patient education and find innovative ways to work with and along-side the patient to make significant progress in terms of chronic disease management. Grant funds help us with the cost of these services temporarily. The long term sustainability will require that funding be part of the outcome based revenue streams.
GC LIVING: Is insurance driving the outcomes versus the clinician driving the patient and outcome?
Travis Robinette: Ultimately, one would hope that it would be a combination, but for right now, the insurance companies are approaching us and saying, “These are the health metrics we want you to work toward and we will incentivize you, because if you achieve these goals, then you’ll receive these bonuses.” I wouldn’t say that they’re not something a physician wouldn’t want, though, because they are. I want to be fair to the health insurance companies. They employ Medical Directors (physicians) that are familiar with local markets, so they know what the three top health issues or chronic conditions are in a given population. It may be diabetes. It may be cardiology-related issues. They may even have some health indicators that are centered on wellness. They’re trying to tackle the biggest problem areas first. An emerging issue for the healthcare system is that you may have twenty different insurance contracts with twenty different health care goals each for your providers to improve upon. On the provider side how do we tackle this many different objectives at once? Reality is that you must pick and choose which are in common and drive those outcomes simply because you will risk losing out completely if your work is greatly diluted.
So, they’re currently not being driven by the physicians, except from the plan side. However, the plans are trying to spend their money to get better health outcomes which, in return, should save money for the healthcare system, because that and healthier customers is the point. If we get better-controlled diabetes, then over time, that patient is going to cost less in terms of their health care. It may be 15 years or longer before they get into that next step, or that next chronic disease state. With diabetes, If you can prolong that next stage, or stop it entirely, then the person can live their normal lifespan without getting into kidney failure, or any other of the many complication of diabetes. The latter stage of disease care is where the major health care expenditures pile up.
GC LIVING: So how is Sun Life evolving to provide the ancillary services to go with the medical needs of the community, as well as paying attention to the business side of the operation?
Travis Robinette: And always hoping you’re doing that with a good, healthy balance, right? As a community health center, we have, for a long time, gathered patient health-related statistics. It’s a requirement of our 330 grant and it’s called a UDS report, a Uniform Data Set. All community health centers are required to submit this report and the data is aggregated to see where each CHC stands in terms of meeting national health goals as well as other statistical comparisons. Therefore, we have a head start in that area, because we’ve been collecting that kind of statistical information and trying to improve it. I wouldn’t say we had a 10-mile head start, but we certainly have a little exposure. Those are very rudimentary measures, and to achieve what they want the new healthcare system to be, we’re going to have to really greatly enhance those efforts.
So, how have we changed? We have brought in a certified diabetes educator, who meets with patients, both group-basis and one-on-one, and those patients think the world of her. She can truly help them. She teaches you what the ingredient thing on this box means to you and to your diabetes. And how do you manage that? She developed an education series, and she has multiple classes that cover nutrition, exercise, medication management, and helps people not feel discouraged when improved results are not happening fast enough.
GC LIVING: Now, you just mentioned one part, because we do have in our communities that you serve, a high Hispanic population and a high Native American population, whose traditional diets have been pointed to as causes of some of the health issues.
Travis Robinette: Yes. We do serve a few Native Americans. However, they are largely served by Indian Health Services and usually seek their healthcare services through that venue. But when you look at our Hispanic population, it is a different story. Our diabetic educator provides both English and Spanish classes, which is critical for those individuals who are monolingual Spanish and her presentation also adapts to those cultural differences. We have recently integrated our Pharm D staff into her program to enhance the nutritional education, add a more intense medication consultation review process, and expand the program to reach more patients of our community.
That was one of our earlier additions in trying to better manage our UDS outcomes – having to deal with the A1C. [Editor’s note: A1C is a measurement of how well-controlled the blood sugar is in someone with diabetes] You don’t have a chance at improving those A1Cs if you don’t have the educator there; teaching those patients how what they eat affects their diabetes and the importance of exercise and consistent blood sugar monitoring.
Looking down the road then, if in fact we are going to be compensated based on patient outcomes, we know that we have to find ways to help the patient manage the behavioral side of health outcomes. Our behaviors can be a huge health determinant.
So, the integration of behavioral health professionals and treating the whole individual is another service concept that we think critical to success under outcome based compensation. We use licensed social workers, so they are able to talk with people about setting and achieving behavioral goals. In our offices, these services can be obtained as part of the visit to the doctor and in the same exam room. This is important since it de-stigmatizes such services where great benefits can be observed with a patient that may be in denial or expressing some depression over their diagnosis or maybe other things going on in their life that are affecting how they take care of themselves. To be able to tell the patient, “We have someone here who might be able to talk with you a little about this,” and you bring them (the behaviorists) in. Now you’re providing that patient a counselor in the doctor’s office and helping with some life coaching and some behavioral health coaching to improve his or her health outcomes. And, ideally they’ll come back with subsequent visits. If successful, we’ve overcome the stigma of being referred to a counselor’s office, which many people are not willing to do. We introduced that seven years ago, and we have behavioral health in all of our offices.
Finally, in the past two years, we’ve worked to establish and integrate dental hygienists and our PharmD’s into the patient visit. Imagine you’re the patient – you’ve been roomed; you’ve had your vitals done; we’ve gone over your history; the doctor’s going to be here in a few minutes, but we’ve got a dental hygienist who’d like to come in and offer you an educational screening regarding your oral health. They ask, “When was the last time you went to the dentist?” and go from there.
And children, they’re notoriously afraid of dentists, just because it’s somebody working in your mouth. Having the hygienists in this exam room is a much more comfortable way for you to get introduced to dentistry. They may put a sealant on if it’s a child and Mom or Dad agrees. This prevents cavities. All of this is done while you’re in the exam room waiting for your doctor or your nurse practitioner to come around. And there’s no revenue stream, by the way, except for a little bit of grant funding for the sealant program. If it’s not a child of sealant age, we’re paying for this service and our hope is that we get more patients in to see the dentist, so they’ll try to encourage them to schedule a visit if there are cavities, or what have you, because it’s about their overall health.
Finally, there’s one other service that’s our newest integration model, Clinical Pharmacy, which is to have a PharmD in the exam room. [Editor’s Note: A PharmD is a pharmacist with a doctorate, which is more education than is required to become a registered pharmacist.] Of course, the patient is asked if these people can come in. The PharmD will sit down and talk to the patient about their medications. They’ll update their medication list. These are your real experts in pharmaceuticals, drug interactions, drug efficacy. How well it’s working? They know the side effects. They can talk to the patient and ask them, “Are you having any symptoms of this?” For example, there may be a better drug that doesn’t have the same side effects, or a drug which may be a better option to patient outcomes, or may be more cost-effective for the patient.
We have moved to hiring only PharmD’s so we can integrate them in and get them interfaced with the patient. Most PharmDs are trained in patient assessment and are capable of assessing lab values. They truly focus on the whole patient and the effect that the patient’s treatment is having on them. Most people are reluctant to talk to them in the pharmacy. You’ll get some that want to be counseled in the retail setting but not many.
These are integrated models that we are supporting ourselves, but at the end of the day, it’s trying to learn how to better manage those health outcomes for the patient for more than one reason. First and foremost, we’re there to make people better, and if you’re not pushing toward patient outcomes then you’re really not seriously approaching that, I would argue. And then secondly, we know that down the road, health care almost has to go that way to achieve significant cost reduction.
Accountable care, fix or repeal, will not alter this course in my opinion. The healthcare system, as it was prior to ACA, needed to be moved into a sustainable model. Consider the universally accepted mandate for the healthcare system to see more patients, with higher quality outcomes, for less compensation. Consider the healthcare cost as a percent of the Federal budget and you can see why this mandate exists.
I don’t see this issue going away anytime soon. You can see today that it’s very controversial and it should be, our health is important to each and every one of us!
GC LIVING: How do you feel Sun Life is important to the communities you serve here in Pinal County?
Travis Robinette: Unquestionably, the most important factor is that we are a community health center. We are also an FQHC, which is a federally qualified health center, and all FQHCs have the same critical mandate. That is that we cannot refuse care based on the ability to pay. We all have a sliding fee scale for charges based upon income and family size which makes healthcare services affordable to your situation. This has been a great relief to many individuals in our communities and has made the difference between getting well and getting a job or a better job, than being too sick to even get out and look for a job or being healthy enough to go to work and keep your job.
GC LIVING: Now, is that for all of the services that you offer?
Travis Robinette: Yes. Anything that is in our scope of service and at Sun Life and everything that we offer is so the sliding fee scale applies. We also have about 26 percent of our patients that our privately insured. This is important because these are patients that can go to any health provider they choose to, in general, and they choose Sun Life. We strive to be the healthcare provider of choice.
We offer a lot of different services. Having the benefit of a sliding fee isn’t very effective if you only get the discount on the visit itself. If you go to the pharmacy and the medication is $200.00, the sliding fee applies to that too. That’s why we try to bring in ancillary services like X-ray, lab and pharmaceuticals…when it makes sense and we are able to. This is a huge convenience factor to all and an absolute necessity to the family using the sliding fee program.
Another thing about health centers like Sun Life is we open up in places that are in rural locations and may have small populations. You are more likely in these locations to have more uninsured individuals and, equally important communities that don’t have access to healthcare, insured or not.
GC LIVING: What are the top three challenges you face?
Travis Robinette: Top three challenges are patient wait time, prescription refill turnaround time and timely patient reporting on lab and x-ray results. On patient feedback issues we have been working towards finding that good reliable and timely process. I think that having to wait four or five days and sometimes longer is ridiculous. However, there are lots of systemic issues to work through to make sure patient privacy is held securely and that patients sensitivity issues are respected. Wait time is difficult and always have been for several reasons. You have patients that wait and in effect “save up” health issues to stretch their health care dollars further. In addition, many patients have multiple chronic issues and the healthcare provider is, in good faith, going to address all of them and that puts them behind for the day.
There are probably many practices in the county who have those same three top complaints. There are systemic issues. There are software issues. There are complexities with e-prescribe where multiple processors introduce time lag. They’re not easy to conquer, but still, they have to be.
GC LIVING: Do you see any challenges in attracting providers?
Travis Robinette: Yes, it is definitely a challenge. The providers tend to like the urban areas. So yes, most of them choose to live there. We’ve tried to make it a condition of employment and we just can’t make that stick. We do have a few that chose to join our community. So yes, it is definitely a handicap.
GC LIVING: Where do you see the vision of Sun Life going in the next decade?
Travis Robinette: In the next decade, assuming we don’t encounter some gigantic stumbling block which trips us up, we would need to talk about our vision for Sun Life. I believe that there is nothing stopping Sun Life from being the premier health care provider in Pinal County, and maybe outside of Pinal County, except ourselves. Now, that’s saying a lot for a kid from Stanfield (he smiles). However, we’re well-positioned. We do have a broad spectrum of coverage, and really, if we hit every ball as best as we can and apply ourselves to continue to drive the organization toward high quality care that is affordable, there is literally nothing stopping us.
GC LIVING: What do you like about leading the organization? And also, let me ask one question that I neglected earlier, when did you take over as CEO of Sun Life?
Travis Robinette: I became CEO in 2006.
So what do I like about leading Sun Life? First, I need to tell you a little about myself. I am a dreamer as my wife would say. I routinely set goals for myself. I’ll push myself pretty hard to try to reach those goals and sometimes it’s some pretty big leaps. What I like is the ability to actually drive a direction, to lead, to get other people ignited, to get them to believe that they can do something greater than they are individually.
GC LIVING: Do you lead by example at Sun Life?
Travis Robinette: Most of the time, I do have my faults. Generally, why should people follow someone who can give good advice, but can’t follow it them self? Otherwise the advice you are touting is untested. I’ll quite often say filter the advice, my habits, my traits, my management style, pick the best, and where you’re better than me, keep that. Don’t take my weak areas; take the strengths, build on those and then if you add your own strengths where I don’t have them, then I have assisted in producing a better leader than I am and that makes a better team.
GC LIVING: Sun Life is a charitable organization that utilizes fundraising, in addition to the grants and government reimbursements and insurance reimbursements, so fundraisers are part of your financial future. You’ve recently increased your community awareness and fundraising efforts.
Travis Robinette: Yes, we have.
GC LIVING: So tell me about some of the things like the recent chocolate run coming. How did things like this come to be?
Travis Robinette: The credit for these events goes to a team of people, a small but mighty team! We have a fundraising committee that tries to do things a little differently because there are a lot of other fundraising events that happen in our county. Sun Life wanted to put together a health related event where people would have fun for a good cause. The run, “For the Love of Chocolate,” is fun, health related (there is running and walking)…and who doesn’t love chocolate? And the goal with the gala was, again, to create something different, to organize a great fundraising event where people could dine, dance, have fun and maybe even make a staycation out of it.
GC LIVING: Does Sun Life have volunteer opportunities?
Travis Robinette: Yes, we do. We bring volunteers in. First, we find out what their interests and skills are. We have people who are greeters. We can find a place for our volunteers. They can become an advocate; they can knit blankets for our new born Sun Life babies; they can become involved in many ways.
Let me touch base on the fundraising, and how it ties into the integrated services we touched on earlier. There are only a few insurance plans that will pay for these types of services. There really isn’t even a billing code for most of these services. Behavioral health services are paid on a limited basis by the state Medicaid plan or AHCCCS. Diabetes care is similar. The rest of the services are in the pioneering stage and are funded through operations as we can afford to do so. That will hopefully change as awareness increases based on success stories on improved patient outcomes. Back to the point, fundraising activities then help support our efforts to find ways to improve the patient outcome, whether it be through education or by hosting a cross functional team of professionals to interface as the patient’s healthcare team.
GC LIVING: You’re not following what others are doing. You’re leading the path for them to follow.
Travis Robinette: That’s right. Sometimes that puts a financial strain on us. If your cold and flu season isn’t quite as big, like it was this year, it may strain us financially. But we’re going to hold that course anyway because we believe that there is value to be found in terms of an improved outcome for the patient. So fundraising is something that we are looking at in more of a long-term basis to building that up to support some of those programs that aren’t reimbursed today. But then there’s a whole education element that we know we have to pick up. Somebody has to educate the patients about their condition, and not just the surface of the condition, but educate the patient so that he or she has a fighting chance to keep the chronic condition in the earlier stages for a much greater time period.
We know that there are more areas that we have to pick up to get at effectively helping our patients in a more affordable way.
GC LIVING: What’s your greatest achievement?
Travis Robinette: Oh, I struggled with that one. I don’t know, I think my greatest achievement was in 2006 when the board asked me if I had an interest in the CEO’s position. And of course I did, but I was also full of the normal fears. People would ask me, “Are you considering maybe someday being the CEO?” And I’d say, “Well yeah, sure, I guess at this age and phase of my career path I either have it or I don’t”. In a sense, I was weighing whether or not I really wanted to know the answer to that question. The dreamer won out! I have a great management team and at eleven years tenure, I’m past the average tenure of a CEO at an organization and not burned out. I’ve still got a little bit of game left in me, so I think that’s probably my major accomplishment.
GC LIVING: Now we’re going finish with two questions I skipped earlier. What’s the craziest thing you’ve ever done?
Travis Robinette: I’ve got a lot of those moments, but I think the craziest thing was when a bunch of guys from Casa Grande decided we were capable dirt bike racers. We raced each other all the time with, of course, a few accidents…nothing serious. We were into racing and were fairly certain of our good riding capabilities. We heard there was a big cross country race in Gila Bend and there were going to be 400-500 riders there, including big name professionals. It was a 100 mile three lap cross country race through mountains, washes, and every other impossible terrain there is around Gila Bend. There were about five or six of us Casa Grande guys entering this race – all beginners. So there we were. Oh my gosh, I had no idea you could make a motorcycle run that fast with zero visibility and stay upright on it. I mean, I had ridden bikes fast, but not quite like that. They started the professionals off first. The beginners were last. So, by the time we got to start out on the first lap, these professionals were coming around on their second lap.
GC LIVING: Yeah, I was going to say they’re coming up behind you.
Travis Robinette: Yeah, or over your head, and hitting the ground with the knobby tires throwing big rocks. They had all this gear on, these plastic leg shields and everything, and chest plates, and we Casa Grande guys were out there with a helmet, and that’s it. And we’re catching rocks in the face, on the shin bone, and when you’re going as fast as you can go and this pro rider on a Maico 500 comes over your head, hits the ground, and his tire shoots rocks into your shin bone, I was thinking, “Oh my gosh, I am going to be killed.” I can’t even get off the trail. There were bikes everywhere. There were so many motorcycles that literally you were surrounded and had them coming over and around you. We were riding way beyond our skill, which we were so sure we had, being from Casa Grande and all. That’s probably the stupidest thing I ever did.
GC LIVING: Did you finish?
Travis Robinette: I did not. I was hit in the head by one of those (bikes) that … actually I was turning and he came on down the hill air born and lightly landed on my helmet. He used my motorcycle and body to affect his turn and was gone. He hit me with the bottom of his engine frame, busted my helmet, knocked me out and gave me a concussion. So I limped in. My guys had to come out and get me because I couldn’t recognize anyone or where I was. One of my friends was hit about the same way I was, except it was his bike that took the brunt of the hit and it busted a hole in his engine – his prize bike. So that was our introduction to racing. That was the first and only motorcycle race I ever participated in.
GC LIVING: So was that your dream profession?
Travis Robinette: A professional motor racer, until I saw what that meant.
GC LIVING: What do you do in your spare time?
Travis Robinette: I’m an avid outdoors man. I love to hunt. I like to fish, but primarily hunt, camping, hiking…anything that gets me out into the wilderness.
GC LIVING: What is the most exotic outdoor locale you’ve been?
Travis Robinette: Northwestern Montana, I think would have to win that. There are big rivers, not Arizona rivers, but real rivers a mile wide. They flow all year long and have big fish in them. There are lots of grizzly bear, brown bear, moose, elk, deer, turkey and other wildlife. It’s awesome just to see those animals, maybe less so to actually harvest one. I do hunt for the meat. I’m not a trophy hunter. I’m satisfied just to see them so if I don’t end up getting one, that’s ok too.
When I am successful in harvesting game animals I know that it was a fair hunt on both sides and that I have put in the years and study to learn the animal and its habitat. If I don’t get something, it’s because I just wasn’t sharp enough to outsmart that animal or did not do my homework before hunting the particular area. I have never used a guide that puts you right on the animal. To me that is not hunting; that’s not the way. You might guess from that, I don’t very often get an animal. They usually outsmart me –except for turkeys, I’ve got that down pretty good now.