Dr. Armen Arshakyan’s office is only a few minutes drive from the Sunset Strip, two premier shopping malls, and Quentin Tarantino’s movie theatre.
But the trilingual, University of Southern California, UCLA, and Cedars-Sinai-trained infectious disease specialist is not a typical hot-shot L.A. doctor. Arshakyan leads the medical team at the Saban Community Clinic, a Federally Qualified Health Center which, in line with the United States’s Health Center Program, offers care to patients regardless of their ability to pay.
The National Association of Community Health Care Centers reported that over 27 million patients — 1 in 12 people in the U.S. — were treated at U.S. health centers last year, saving the nation’s health care system $24 billion.
This mission spoke to Arshakyan, who also practices at Cedars-Sinai Medical Center a few times per month, but he was driven to at the community clinic Saban for another, more practice-based reason.
“It offers you the opportunity to see the broad spectrum of pathology, cultural backgrounds. You’re seeing patients who can’t afford food all the way to the patient who can pay for the services here with private insurance. Very few facilities can give you this patient population,” Arshakyan said to Direct Relief during an interview at the Saban Clinic.
The doctor was originally inspired to work in the emergency room, as a result of watching the television show “ER,” but soon realized that such work would not allow him to continue caring for patients after he treated them.
Hoping to find more of a connection during his multi-location residency, he found himself switching shifts from upscale hospitals to work in the county hospital. Despite the implicit challenges, such as months-long delays on medical imaging exams, he recalled, residents were able to spend more time with patients.
During those lean first years as a doctor, a friend suggested moonlighting at Saban to make some extra cash.
“When I came here, I realized this is exactly the same population I’m interested in,” he said, referring to the satisfaction he gets from treating patients who would’ve been turned away at other facilities to due lack of means.
Beyond offering physicians a more representative population, and rookie doctors more patient time, the model at Saban and other community health centers relies on comprehensive care that keeps a patients’ care under one roof, literally. Saban offers a full range of medical care including an on-site laboratory, pharmacy, dental care, family planning, behavioral health care, showers, and even yoga education.
Getting The Whole Story
Last year, Saban saw 111,753 total patient visits. At least a few of them were by film producer Franco Sama, 61, who was assigned a primary care physician there by his insurance company.
“So far it has been pretty awesome,” he said during a visit to the clinic.
His experience wasn’t what he originally expected.
“I always thought this is the place you go when you don’t have insurance,” he said, and noted that even when he was uninsured, he didn’t visit because of the stigma surrounding community clinics, opting instead to not seek treatment at all.
While under the clinic’s care, he received a serious diagnosis: type 2 diabetes.
“The follow up has been great on their end. I feel like they’re taking care of me, that they have a plan for me. I like that. It was not my experience elsewhere,” Sama said.
It was this level of integration, and the ability to offer more to his patients, that attracted pharmacist Raed Ahmed, who is also trilingual, to the Clinic, and away from a promising management career trajectory at a major national retail pharmacy chain.
“At the end of the day. I want to feel like I did something really valuable,” Ahmed said.
He said he faced many situations at his previous job where he had to turn patients away because they could not afford the cost of medications.
“There, I couldn’t do anything about it, here I can. That’s why I’m here,” he said, adding, “There, you don’t know the patient’s story.”
He felt hamstrung by not being able to learn more about his patients from their doctors or their charts, especially information that would not be easily ascertainable, such as whether or not a patient is food insecure.
Many healthcare institutions offer this level of integration as well, but breakdowns occur when patients receive care across institutions and companies. A 2017 report by Health Affairs showed less than 30% of hospitals are able to share medical records with other healthcare providers, be they at other hospitals and clinics, or at a retail pharmacy.
Ahmed said he learned that one of his patients at Saban had issues with food insecurity and was not able to eat a meal every time he took his medication, as was required. The Clinic was able to offer the patient meal replacement shakes and protein bars, which were donated by Direct Relief.
Similarly, Arshakyan was able to give one of his patients nutritional supplements, even though they were not covered by his insurance plan. He did this without mentioning the lack of coverage to the patient, since Arshakyan believed he would’ve refused, as the patient didn’t want special treatment or to feel as if he was, “taking advantage of the system,” according to Arshakyan.
“This is a much better place for a pharmacist to practice at the level of their license,” Ahmed said.
Filling the Gaps
In addition to its three physical locations in L.A., Saban started meeting some of their patients where they are. Increasingly, that means treating people impacted by homelessness. Saban Clinic healthcare providers are part of an effort, called the E6 Program, which has treated over 1,200 people experiencing homelessness on the streets since 2017.
They also supplemented this care with specially-made kits, which include a mix of food, clothing, and hygiene products, plus handwritten notes of encouragement from local schoolkids, who also help pack them.
For pharmaceuticals, the clinic relies on the federal 340B Drug Discount Program. But sometimes additional help is needed. Ahmed recalled an instance when a patient needed a Hepatitis C treatment. Direct Relief was able to donate the medicine as a result of a partnership with AbbVie, which manufactures the drug.
While receiving federal and state reimbursements, as well as private insurance reimbursements and benefiting from discount programs, Saban reports that the clinic still has to cover a $7 million gap created by treating people without insurance, who account for 45% of all their patients. These are a mix of undocumented individuals and people who make too much for no-cost and low-cost care, but not enough to be able to afford private health insurance.
It’s surprising, given its location, that Saban gets help in picking up this tab from the entertainment industry, as has been the case dating back its early days, when, in 1970, Elvis marched in with a check. The namesakes of the clinic are Haim and Cheryl Saban, of Power Rangers fame, and today the clinic is supported by just about all of the major film and TV studios, TV networks, and Hollywood talent agencies, as well as several of the industry’s most successful creators, such as Chuck Lorre (BIG BANG THEORY), Dick Wolf (LAW & ORDER), and Judd Apatow (THE FORTY-YEAR-OLD VIRGIN).
Perhaps unexpectedly, the Clinic also serves Hollywood. Given the volatility of the industry, many known actors often find themselves without roles, and then without health insurance.
“You can’t judge based on how they’re dressed up,” Arshakan said, referring to the clinic’s patients.
“You’d be surprised… [some] dressed up patients here, they have challenges with food access,” he said.
Though he treats a diverse range of patients, Arshakyan said that one element of the doctor-patient relationship pervades all other distinctions.
“The most important thing in the relationship with your patient is trust. If a patient trusts you, they’ll do it.”