Risk Taker

Fraser eventually became a lawyer instead, following in the footsteps of her father, her grandfather and her older brother. After a year as a trial lawyer for the U.S. Department of Justice in San Francisco, Fraser joined San Francisco's Office of the City Attorney as deputy city attorney. That is where she finally had her first taste of healthcare, leading the Health and Human Services team. She also was appointed to the Health Service Board, which oversees health benefits for 100,000 city employees, retirees and their dependents.

Now she is CEO of San Francisco Health Plan (SFHP), a licensed community health plan catering to low- and moderate-income families in San Francisco.

Fraser's personal mission and that of SFHP coincide: provide healthcare to everyone in the United States and be willing to take risks to accomplish that goal. "It is outrageous in a country as wealthy as the United States to force people to decide between paying the rent or going to the doctor," she says. "Being uninsured in the United States is a silent crisis. It is a shameful position to be in, so no one wants to talk about it, but I do." When representatives from other countries visit Fraser and the health plan, they are floored that not everyone is covered by healthcare insurance.

Risk Assessment

This attitude has propelled Fraser into developing several innovative initiatives for the 50,000-member health plan. For one, membership has grown by 55% since her arrival in 2000. In 2002, Fraser proposed that the city adopt a Healthy Kids program, patterned after one sponsored by Santa Clara, Calif. With the blessing of San Francisco Mayor Gavin Newsom, the program was expanded last year to cover young adults, ages 19 to 24 years, who are too old for Healthy Kids, Medi-Cal or the Healthy Families Program, and who are living on an income below 300% of the federal poverty level.

Young parents are eligible for complete medical, dental and vision care if their children are covered by an existing government-sponsored health insurance program. The annual premium for the Healthy Kids & Young Adults program is $48 with $5 copayments for doctor visits.

"No one knew this population of 19 to 24 year olds or how many healthcare services they were utilizing, so commercial plans were unwilling to take the risk," Fraser says, "but for us, it was the right thing to do. We're here to take risks; if we go broke by providing care that people need, then so be it."

Support of Innovation

This health plan CEO is behind other programs that she expects to make a difference in San Francisco-the Healthy Workers program, the Healthy Parents program, healthcare coverage for local taxi drivers, and a medical savings account (MSA) program for childcare providers. She considers these programs to be layers added onto the basic Medi-Cal structure.