Sutter Gould Medical Foundation is a not-for-profit health care organization dedicated to providing the highest level of care for our patients.
Over 280 physicians in both primary and specialty practices provide outpatient services for residents in Stanislaus, San Joaquin and Merced county communities.
With care centers in Modesto, Stockton and six other communities in the Central Valley, Sutter Gould is able to offer high quality medical care close to you and your family.
SGMF provides a full range of outpatient medical services, including:
- A clinical laboratory
- Audiology and hearing aid center
- EKG/Treadmill Labs
- Radiology and Mammography
- Nuclear medicine/ultrasound unit
- Gastrointestinal endoscopy units
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Physician services are primarily provided by Gould Medical Group, Inc., in the Central Valley for over 50 years. We also offer access to additional independent physicians in the Central Valley via our Community Provider Network.
Primary Care and specialists from Allergy to Oncology to Urology are available.
To locate a Sutter Gould affiliated physician, click here.
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Close Ties to the Community
Because we’ve been part of the Central Valley community for years, we take great pride in supporting health-related activities in our area. We maintain close ties with community organizations, and offer support in many ways.
Some of the groups and organizations we have worked with include:
The American Diabetes Association, the American Heart Association, the American Cancer Society, Community Hospice, The Salvation Army, Community CanTree, United Way, the West Side Schools,Community-Based School Instruction, Stanislaus Elder Abuse Prevention Alliance and many others.
For more information about our Community Benefit activities, click here.
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We continually strive to improve the services and care that we provide. Your opinions count and ultimately provide us with the direction in which we need to go to make improvements. We gather your opinions and suggestions in many ways, including:
- Conducting the Sutter system-wide Press Ganey Patient Satisfaction Survey. This survey, mailed to patients after an appointment with one of our providers, addresses all areas of our operations.
- We collect, trend, and report patient complaints and grievances, in order to identify and rectify recurring problems.
- We track and report patient access issues, to identify ways to improve scheduling and physician access.
- We have Patient Representatives, trained and experienced to help resolve all patient complaints.
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Coordinating Your Care
Sutter Gould Medical Foundation's Utilization Management Program
Sutter Gould Medical Foundation's Utilization Management (UM) program is designed to ensure that managed care members receive timely, medically necessary, and cost-effective care services.
Services that we provide to our patients as part of the program:
- Prior authorization/concurrent review
- Discharge planning
- Case Management
- Retrospective review
Our UM staff, including RNs, LVNs and trained representatives, work closely with our medical staff to help coordinate with external specialists. Our goal is to meet the needs of our patients as well as the program.
The managed care plans include Health Net, United Health Care, Secure Horizons, Blue Shield, Blue Cross, California Care, Cigna, and Aetna.
Utilization Management Policies and Procedures
Sutter Gould Medical Foundation uses approved guidelines from the health plans medical management policies and MCG Health, LLC (formerly Milliman Care Guidelines) criteria (approved by the health plans) to review referral requests submitted by contracted providers and primary care physicians. These guidelines are reviewed and updated by these organizations periodically to remain current with new treatment and trends. The criteria provide a guideline only to approve, modify or deny care for persons with similar conditions. Specific care and treatment may vary depending on individual need a benefit covered under the individual’s plan. The criteria are available on request for a specific treatment.
Sutter Gould Medical Foundation ensures that decisions are made only on appropriateness of care, service and existence of coverage. Sutter Gould Medical Foundation managed care staff or providers do not receive any compensation, direct or indirect or financial incentives based on review decisions. Providers are ensured independence and impartiality in making referral decisions that will not influence hiring, compensation, termination, promotion, or any other similar matters.
Sutter Gould Medical Foundation encourages appropriate utilization and discourages inappropriate under-utilization by providers and staff.
Any questions regarding this notice may be directed to Sutter Gould Medical Foundation's Utilization Management Department at 209-550-4712, Monday through Friday from 8 a.m. to 5 p.m. Collect calls will be accepted from out of area callers. Non-Urgent referral requests received after 4:30 PM will be stamped and processed the following business day. Urgent referral requests received after 4 P.M. will be stamped and processed the following business day.
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Our Clinical Quality Committee is devoted to designing, implementing and evaluating programs to improve the health of our patients. Past achievements include:
- The implementation of a Breast Health Program. Patients are being notified of test results sooner, and care is improved by increased coordination between our Radiology, Surgery and Oncology departments.
- Development of an Asthma Program for Pediatric and Adult patients.
- Review of the procedures for our Diabetes Treatment programs at all of our Care Centers.
- Participation in the National Committee of Quality Assurance's
Pay For Performance program -- to improve screening rates for preventative health and conducting appropriate testing and monitoring for chronic diseases.
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Sutter Gould Medical Foundation received a three-year accreditation from the Institute of Medical Quality, a subsidiary of the California Medical Association. The IMQ's standards cover essential quality of care domains and were developed to accommodate the needs of California Ambulatory Facilities. Sutter Gould is the first Foundation in the Sutter system to complete this process.
Sutter Gould was previously accredited by AAAHC and The Medical Quality Commission in 1997.
The achievement of consistent, high-quality healthcare is a goal of the Sutter Gould Medical Foundation, and we will continue to pursue accreditation based on this goal.
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Providing Help for the Uninsured
Sutter Gould Medical Foundation is committed to to the health and well-being of the residents of our community.
We have a financial assistance policy for low-income uninsured patients who may not be able to pay their bill.
Upon application and review, patients may be eligible for full or partial charity care write-off of charges.
Click here to learn more about our charity care policy.
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An Affiliate of Sutter Health
As the seventh largest non-profit health care network in the U.S., Sutter Health is one of the nation's leading systems of community health care services. Each year, Sutter Health serves hundreds of Northern California communities, from the Oregon border to the San Joaquin Valley, and from the Pacific coast to the Sierra foothills.
The Sutter Health system consists of:
- Physicians, hospitals and outpatient care centers in more than 100 communities in Northern California, Southern Oregon and Hawaii.
- Relationships with more than 5,000 physicians.
- Twenty-seven acute care hospitals.
- Long-term care centers.
- Home health and hospice services.
- Occupational health services.
- Medical research institutes.
- More than 35,000 employees
Why affiliate with Sutter Health?
We all started out as independent entities, but forces such as increased competition, higher costs and lower payment for services have made it difficult for us to continue operating on our own. In fact, more than 40 Northern California hospitals have had to close their doors in the last decade or so.
In order to help preserve and strengthen our local health care missions, a number of physicians, hospitals and other health care services in Northern California began coming together. The network we created is Sutter Health.
For some, linking with the Sutter system was literally the key to survival. Formerly struggling hospitals and care centers that once needed help from the system are now strong and healthy. Programs and services have been added, access to care has been improved for local residents, and many new jobs have been created. Sutter Health affiliates also save millions of dollars every year by purchasing supplies, equipment and services together.
Local governance is of vital importance within Sutter Health. Each Sutter affiliate maintains their own local volunteer board of trustees helping to ensure the affiliate is meeting their community needs.