The California Advancing and Innovating Medi-Cal initiative created a once-in-a-generation opportunity to reform Behavioral Health documentation. As the Chief of Medi-Cal Behavioral Health with the California Department of Health Care Services, my CHIP focused first on removing complex and cumbersome documentation standards that far exceed the standards of other healthcare delivery systems and replacing them with efficient, effective, and impactful policies to improve the lives of those we serve.
We face an escalating addiction epidemic, with more than 100,000 people dying of drug-related overdoses in the US in 2021—the highest number of deaths ever recorded. San Francisco has the highest overdose death rate in California. At SFGH, more than 1/3 of hospitalized patients have a substance use disorder (SUD). Our patients with SUD have longer lengths of stay (3 v 5 days), 1.5x higher 30-day readmission rates, and 5x higher self-discharges than those without SUD.
Yousef "Dr. Yo-Yo" Turshani, witnessed the protests of summer 2020 and sensed an opportunity. He leveraged his role on the Pediatrics Exam committee of the American Board of Pediatrics to make a change that could have national implications. What is on the Board exam directly influences what residencies believe matters; what is taught or valued. That influences the students who learn from the docs and thereby all who work with pediatricians.
After issuing statements on racial justice during Summer 2020, health care institutions’ attention towards health justice has decreased substantially. Meanwhile, health equity work is often (1) uncompensated and (2) undertaken by people from under-represented communities. This combination results in a “minority tax” on these colleagues, causing ongoing professional and psychological harm.
As indicated in the subtext of my CHIP title, I’m sharing a mix of project and leadership journeys. Especially in the pandemic era, it seems (at least for me), the threads of personal and professional experience are increasingly intertwined. For my CHIP, I started with the question of: How might we develop and implement a respectful, comprehensive, and trauma-informed model of care for pregnant and parenting people that better coordinates existing medical, behavioral health and social services and creates continuity across the birth divide?
While it’s clear that racism and not race has been determined the driver for racial healthcare disparities, it can be frustrating and feel merely theoretical for providers to realize impactful mitigating efforts. My plan is to provide Provider Scorecards reflecting individualized performance metrics stratified by race as a reminder of provider onus regarding health disparities and alerting them to disparities they may unintentionally perpetuate. The goal would be to create a tangible monitor for unconscious bias.
People returning from incarceration face a myriad of health inequities, including increased emergency department utilization, hospitalization and death. In the first 2 weeks post release, people are 12 times more likely to die than their community counterparts from health conditions that could be treated in the primary care setting (including SUD, cardiovascular disease, mental illness and cancer).
If voting is a sign of a healthy democracy, we are in need of serious interventions. Voting is a health “thing”. It is the one power citizens have a right to holding democracy accountable. It ensures a right to a healthier life for people and their loved ones. The impact of voting and political decisions touch every part of our daily life, from safety to housing, education, and ultimately, our health. Voting sends a signal of support or dissent for policies that ultimately shape the social determinants of health. Social determinants subsequently influence who votes and who does not.
Governor Gavin Newson issued an Executive order (N-01-19) in 2019 to transition the pharmacy services from Managed Care Plans (MCPs) and Fee for Service to Medi-Cal Rx. It is to be administered by Magellan Medicaid Administration under Department of Health Care Services (DHCS) guidance. MCPs like Central California Alliance for Health (CCAH) provided our historical claims and prior authorization data to facilitate continuation of care for Medi-Cal members.
I wanted to respond to the social climate of our world after the murder of George Floyd resulting in protests globally. In the midst of these protests, the COVID-19 pandemic ravaged the countries around the globe, highlighting health care disparities in its wake, including marginalized populations disproportionately affected by the pandemic. Our students at USC were no exception to the widespread outcry for social justice. They too were protesting and broadened their attention beyond social reform nationally focusing their attention on the social climate at USC demanding change.