California Health Care Improvement Projects (CHIPs)

Ako Jacinto presents his CHIP

California Health Care Improvement Projects (CHIPs) are designed by CHCF Health Care Leadership Program participants with the goal of addressing meaningful challenges or opportunities in health care. 

Browse CHIPs to leverage the work of CHCF alumni and find opportunities to collaborate in order to improve health for Californians.

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Pursuing Certification as a Certified Community Behavioral Health Center (CCBHC)

Devanne Hernandez, MA

Due to the aftermath of COVID-19 and the global pandemic, we are experiencing an unprecedented demand for behavioral health (BH) services. As a Federally Qualified Health Center (FQHC), whole-person care has only been available to patients within the mild to moderate level of impairment, resulting in referrals to county and other specialty mental health clinics for patients that are in crisis, require psychiatry and/or a higher level of care. Unfortunately, current wait times for patients seeking psychiatry and a higher level of care are reportedly between 6-8 months. These entities have also experienced a demand for service and staff shortage issues. To better support patients accessing BH services, I researched a solution to help FHQCs, such as ourselves, expand BH services of various levels of care internally. Certification as a Certified Community Behavioral Health Center (CCBHC) would place our organization in a position to qualify for federal funding under the Substance Abuse and Mental Health Administration (SAMHSA). As an FQHC, securing certification as a CCBHC would reduce the need to refer out, support the continuum care for patients, and provide the funding needed to staff our BH Department with psychiatry, care coordination, peer support, and 24/7 crisis response team.

October 18, 2022
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Increasing Employee & Dependent Engagement with Recommended Cancer Screenings

Sohini Stone, MD, MBA

Due to the COVID-19 pandemic, participation in recommended routine screening declined across the country – in the first six months of the pandemic alone there were 10 million missed cancer screenings. As a result of this decline, individuals are not receiving appropriate early screening and diagnosis, resulting in an increase in cancer diagnoses at advanced stages of the disease. Delayed diagnosis is expected to lead to a higher cost of care, loss of productivity, and increased morbidity and mortality that would have been avoided with appropriate screening.

As Google’s Global Employee Health team, my team is responsible for helping Benefits program partners drive high-quality health outcomes for Googlers based on evidence-based clinical guidelines.

This project consists of two phases:

  1. Research Phase: Apply qualitative and quantitative study methods to understand key barriers to employees following preventative cancer screening guidelines, despite these services being free through the health plan [completed]
  2. Intervention Phase: Based on research learnings, develop, test, and launch preventativecare nudges, personalized to an individual’s specific needs [in progress]
October 18, 2022
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Time to ACT: Reducing Mortality and Readmissions for Hospitalized Patients seen by the Addiction Care Team (ACT)

Marlene Martin, MD

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. At SFGH, addiction affects Black and Latinx individuals (50%), people experiencing homelessness (50%), and those with psychiatric conditions (50%). In 2019, with grants/philanthropy funding, I co-founded the SFGH Addiction Care Team (ACT) to improve hospital-based addiction care for patients. ACT provides evidence-based addiction care, harm reduction, and linkage to care for patients while educating the healthcare workforce and reducing addiction inequities.

October 18, 2022
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Five Health Maintenance Screenings as Initial Street Medicine Core Metrics

Camilo Zaks, MD

Street Medicine is the delivery of individually tailored health and social services to people experiencing unsheltered homelessness (PEUH) in their own environment. Because Street Medicine has historically existed on the margins of the medical field – run as part time teams with volunteer staff - and because of that individually tailored approach, the field lacks universally recognized measures of success.

This CHIP developed five Health Maintenance Screenings as initial Street Medicine core metrics to partially answer the question “how do you know when you’re doing a good job?” Interviews of stakeholders at USC, other Street Medicine providers and patients identified Healthcare maintenance screening as a key gap in Street Medicine. Key tasks addressed by the CHIP included: selection of the screening tests, choosing laboratory testing over Point-of-Care testing, exploring the feasibility of non-blood specimens, improving integration of the lab system and electronic medical record, and implementing new Street-based treatment options for the conditions diagnosed by the new screenings. Four of the five screenings (HIV, Hepatitis C, Syphilis and Colorectal Cancer) have been successfully implemented. The fifth screen (Cervical Cancer) is still in the planning stage.

October 18, 2022
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Simplifying Access to Behavioral Health Services Through Integrated Care

Jennifer Miyamoto Echeverria, MSW, LCSW

In the United States, 25% of adults are living with a behavioral health concern, yet more than half do not receive treatment. For those seeking out services, their Primary Care Providers deliver about 70% of all behavioral health treatments. Integrated care models provide primary care and behavioral health management in the same setting, making it easier for patients to access and for providers to communicate.

The idea to build an integrated care model in our Blue Shield Promise Primary Care clinics began in early 2020, right before the COVID-19 pandemic hit. My objective is to build an integrated care model with input from clinic leaders, providers, and staff to ensure that clear systems are established, workflows are defined, and seamless communication between medical providers and behavioral health clinicians. The goal is that 100% of the patients who score a ten or more on the PHQ-9 have a conversation with their provider about their referral options for behavioral health services and that referrals follow a clear workflow based on presenting needs to either the clinic LCSW or to the Social Services team.

This project is still progressing, but I will continue to see it through to ensure that the clinic has a clear structure to follow. In addition to the medical providers and the licensed behavioral health clinician, I have a team of community health workers who are also incorporated in the behavioral health referral process. The goal is to create an atmosphere where patients feel as though all of their providers are working together as a team to address all of their needs comprehensively.

October 18, 2022
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Unionize the Physicians at Alameda Health System (AHS)

Lilavati Indulkar, MD

Today, nearly 70% of healthcare providers are employed by large corporate entities. While there are benefits to large healthcare systems, providers in these organizations are feeling disengaged and disempowered due to the inability to effectively advocate for their patients or themselves. This lack of voice contributes to provider burnout, directly affecting the quality of care being delivered and physician attrition.

At AHS, we saw an annual 11% attrition rate of quality physicians compared to the national average of 4-6%. The cost of replacing one physician ranges anywhere between $250K to $1M. In addition, we areconcerned about physician shortages, it is predicted that California will have the highest shortage ofhealthcare providers by 2030. After talking to numerous providers, I discovered that the main reasonsfor low morale were the inability to effectively advocate for patients, below market compensation andbenefits, and lack of influence on the workplace environment. My goal was to develop a retention planthat incorporated these factors to retain high quality physicians in a safety net system. Myunconventional but not unprecedented approach was to unionize the physicians at AHS.

October 18, 2022
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Developing a Physician Leadership Program at AltaMed Health Services, a Federally Qualified Health Center- Impact on Retention

Marco Angulo, MD

My project has been to create a physician leadership program called Site Medical Director University (SMD-U) at AltaMed Health Services, the largest Independent Federally Qualified Health Center in the nation. With clinics throughout Los Angeles and Orange counties, our current leadership structure consists of a Chief Medical Officer, 3 Regional Medical Directors, and 15 Site Medical Directors (SMDs) that oversee each clinic. Thus, the SMDs are the functional leaders supervising over 250 Providers. I chose to focus on this group based on their crucial role in leadership, my own experiences as a former SMD, and the fact that SMD positions have the highest turnover of all providers in the organization.

In the past six years, 16 SMDs have left this position to either return to a non-leadership role in AltaMed or leave the company altogether. The reasons for leaving were a lack of time, proper training, and support.

SMD-U aims to provide current physician leaders an opportunity to grow in their positions as clinic leaders, build a sense of ownership and camaraderie, and provide practical leadership skills to support the most common daily issues. This CHIP aims to reduce SMD turnover while improving wellness, motivation, and work satisfaction through a sense of ownership, camaraderie, and leadership growth

October 18, 2022
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