Inside SFHP

Meet our Executive Team

We are led by an Executive team that brings years of public not-for-profit health care experience and policy development to the City’s award winning, managed care health plan.

 

John F. Grgurina Jr., Chief Executive Officer

As Chief Executive Officer of the San Francisco Health Plan (SFHP), John F. Grgurina Jr. leads the mission driven SFHP staff and Governing Board to ensure that San Francisco is a healthy community for all. The Governing Board, staff and John all focus on a belief that every person living in San Francisco deserves access to quality, affordable health care. And thanks to Medi-Cal, Medicare, Employer Sponsored Insurance, Covered California and San Francisco’s Healthy Kids program, every resident of San Francisco is eligible for either insurance or the City’s Award Winning Access program – Healthy San Francisco. No San Franciscan needs to go without care. As competitive as John is, and he is competitive to all who know him, he believes SFHP’s #1 competition is to find everyone who is not insured living in San Francisco and enroll them into health insurance or if not eligible into Healthy San Francisco.

During his 10-year tenure, SFHP has been the highest ranked public Medi-Cal plan every year based on aggregated quality measures and has won an award for Outstanding Performance in Quality Care from the California Department of Health Care Services (DHCS) for the Medi-Cal program 9 times. SFHP has also achieved “Accredited” status by the National Committee for Quality Assurance (NCQA) for its Medicaid (Medi-Cal) HMO line of business.

All of this has occurred while SFHP has gone through significant growth in membership and revenue. SFHP has quadrupled its Medi-Cal membership over the years, increased its market share in San Francisco to 87%, and grown revenue over 500%. Yet, there is still more to do and John and the staff and Board will continue to improve health outcomes of the diverse San Francisco communities through successful partnerships.

John achieved his Bachelor’s degree from UCLA and achieved a Masters of Public Administration from California State University, Hayward now known as California State University, East Bay.

When John isn’t at SFHP you might be able to find him at an Oakland Athletic’s baseball game with his family at the Oakland Coliseum.

Jim Glauber, MD, MPH, Chief Medical Officer
Dr. Jim Glauber joined San Francisco Health Plan in 2014 as the Chief Medical Officer. He oversees and leads the entire Health Services department including Pharmacy, Clinical Operations, Care Management, and Health Outcomes Improvement.

Under the direction of Jim, one of the ways SFHP has improved member experience was through the implementation of a new telemedicine service for members. This new benefit allows an alternative way for members to get access to care quicker and easier. Jim’s leadership also helped markedly improve the rate with which SFHP used their non-specialty mental health benefit over the course of two years. In terms of measured quality, SFHP remains the highest rated public Medicaid plan in California.

Jim offers over 20 years of advising and consulting in the healthcare industry. He received his MD from University of California, San Francisco – School of Medicine, trained in Pediatrics at University of Pennsylvania, and completed a Pediatric Health Services Research Fellowship and Masters of Public Health at Harvard Medical School.

Karen Andrews, Chief Operating Officer
With over 30 years of health care experience, Karen initially joined San Francisco Health Plan in 2012 as an Executive Consultant. Karen returned to the health plan in early 2017 as the Director of Performance and Process Improvement and it was her exemplary leadership that offered her the position of Chief Operating Officer. As COO, Karen leads our provider contracting and provider network operations, customer service, claims, member eligibility, enterprise project management office, quality assurance, business solutions, business intelligence and marketing teams.

Through Karen’s leadership SFHP has increased its provider network from eight to nine networks, secured contracts with 100% of San Francisco hospitals and implemented an organization-wide process improvement program to improve cross-functional efficiencies.

Karen attended the University of Southern Maine and holds an MBA from Suffolk University – Sawyer School of Management, She has volunteered for numerous causes and holds certifications as an Executive Coach, Change Management, and is a 6 Sigma Green Belt. Karen lives in San Francisco and enjoys exploring the city and attending Art and Culture events.

Nina Maruyama, Officer, Regulatory Affairs & Compliance
Nina has been with San Francisco Health Plan for 10 years and comes with over 25 years of experience in managed care, with a focus on health plan licensing, Medi-Cal, compliance and regulatory affairs. Some of her key responsibilities include: state license filings, regulatory agency audits, HIPAA compliance, breach investigations and reporting, delegate oversight, business continuity, fraud, waste and abuse investigations, auditing and monitoring, strategic planning, and board communications.

Through Nina’s leadership the National Committee for Quality Assurance (NCQA) has awarded the organization a Health Plan Accreditation for SFHP’s Medicaid (Medi-Cal) HMO line of business. Another vital initiative Nina takes on is the organization’s business continuity plan. Under her direction she prepares SFHP staff to successfully manage operations during business interruptions or disaster situations and identifies the necessary SFHP personnel and resources that ensure the timely restoration and continuation of services to SFHP’s members, regulatory agencies and business partners.

Nina lives with her husband and two boys in San Francisco and is an avid Warriors fan.

Kate Gormley, Chief Human Resources Officer
Kate serves as San Francisco Health Plan’s Chief Human Resources Officer, bringing more than 30 years of experience in human resource management. Kate first joined San Francisco Health Plan in 2009 in a consulting capacity and throughout the years she continued to offer her expertise to SFHP until her appointment as Chief Human Resources Officer in 2018.

Prior to her role as CHRO, Kate held the top HR role in many companies while running a successful HR consulting firm for the past 20 years. As such, she brings experience and expertise from a number of industries which will most certainly benefit us as we continue to grow and develop our organization as well as the HR function here at SFHP.

Kate truly understands the importance of SFHP’s culture and values, which she instills upon the organization through her leadership and her team. She is dedicated to the mission of SFHP and understands that our people are the most important resource of the organization to further that mission.

Kate is a member and speaker at the Northern California Human Resources Association and participates in many HR forums. Kate has a BS in Political Science and an MBA with an emphasis in Information Systems.

Skip Bishop, Chief Finance Officer

Sumi Sousa, Officer of Policy Development and Coverage Programs
Sumi Sousa is the Officer of Policy Development and Coverage Programs at San Francisco Health Plan. She oversees the non-Medi-Cal lines of business that SFHP operates on behalf of the City and County of San Francisco, including Healthy San Francisco, Healthy Kids and SF City Option. She also manages the enrollment, eligibility and outreach functions of the San Francisco Health Plan Service Center that help the City and County of San Francisco and SFHP meet their universal coverage goals. Sumi draws on her prior work in state health policy and budgeting to help guide SFHP’s strategy, government relations and work with trade associations.

Sumi joined SFHP in 2011. Prior to SFHP, she served as the principal health policy advisor to four Assembly Speakers where she focused on expanding access to affordable, comprehensive health insurance and the health budget. She staffed legislation implementing the Affordable Care Act in California, including the legislation establishing the CA Health Benefit Exchange, now known as Covered CA.

Sumi serves on the California Health Facilities Financing Authority, a statewide board that provides financial assistance to non-profit health facilities and is the major conduit issuer of tax exempt debt for California’s non-profit hospitals and health systems. From 2013 – 2016, she served on the Little Hoover Commission, a bipartisan, independent state commission advising the Governor and Legislature on opportunities to improve efficiency in state government. She previously served as a board member on the California Children and Families Commission (State First 5) and the Asian Pacific Youth Leadership Project.

Sumi is a member of the San Francisco Bicycle Coalition and can be seen riding her bike around San Francisco, usually between Beale St, the SFHP Service Center, and her residence in the Inner Richmond District.