California Health Care Improvement Projects (CHIPs)
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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Physician Leadership Development
Carmen Liang, DO, MPHEffective physician leadership at the front lines is critical to our health care system as it grapples with worsening workforce shortages, burnout, and attrition associated with the COVID-19 pandemic. The national workforce deficit is projected to be more than 45,000 for primary care and 87,000 for specialty care physicians (Bhardwaj, 2022), and the annual cost of one physician vacancy per year is up to $1 million or 2-3 times a physician’s annual salary (Shanafelt et al., 2017). Health care organizations are investing more in senior physician leadership development but not in early-career physician, who are appointed leadership positions based on clinical skills and willingness to help but do not feel prepared for these roles (Shanafelt et. al., 2021).
I interviewed 27 physicians to understand what they needed to feel prepared for their clinical leadership roles. When asked about desired leadership development opportunities, 80% of their responses referred to training programs; opportunities to gain experience from others; and coaching, mentorship, and sponsorship (Liang et. al., 2023). My landscape analysis of leadership programs for UCSF physicians early in their administrative leadership careers revealed a lack of viable options based on scope, cost, and effect on retention.
To address this gap, I decided to work towards building a leadership development program at UCSF for early-
October 25, 2023View/Download PDF
Addressing the Sexually Transmitted Diseases (STDs) Epidemic in Yuba County
Phuong Luu, MD, MHSSexually transmitted diseases (STDs) have increased exponentially in the past several years nationally and statewide. Yuba County as a small rural county in northern California has one of the highest rates of congenital syphilis with a crude rate of greater than 112.9 congenital syphilis cases per 100,000 live births. From 2017 to 2022, the rate of syphilis increased from 17 to 84.1 cases per 100,000.
In California, incarcerated individuals are among the individuals most impacted by STDs. This CHIP project aimed to implement an STDs opt-out testing program for all inmates coming into the Yuba County Jail – a facility with an average jail population in the 180s during the COVID-19 pandemic but is now back to its pre-pandemic level of mid-300s to low 400s. The STDs opt-out testing program was paired with public health staffing of part-time social workers and a nurse to provide social services linkages and medical/behavioral health linkages, respectively.
The planning and implementation of this CHIP project as a public health officer during the height of the COVID-19 pandemic was extremely difficult. This was made more challenging when the proposal to contract with WellPath as the jail medical provider to provide the STDs opt-out testing and treatment was denied by the CA Department of Public Health (CDPH) because WellPath is a for-profit company. Through the project lead’s persistence in providing justification for why WellPath was chosen, CDPH ultimately approved the contract with WellPath and the project successfully started in September 2022.
October 25, 2023View/Download PDF
Health Care at Home Model
Cynthia Lin, MDAt the height of the COVID-19 surges, hospitals were overwhelmed as the number of patients seeking care surpassed bed capacity. A significant bottleneck to hospital discharges in San Francisco was the delay in transferring to post-acute facilities due to the required 10 to 20-day quarantine period and lack of SNF bed availability.
There is a severe shortage of licensed SNF beds even as demand for SNF beds is increasing. Since 2001, the number of licensed SNF beds has decreased by 43% in San Francisco.
• Age 65 and older comprises 14% of city population (113,000). By 2030, population projections of 65 and older to comprise 20% of city population (192,000).
• 38% of San Francisco seniors 65 and older and 7% adults aged 18-64 report disabilities (80,000).
• By 2030, San Francisco would need 4,287 licensed SNF beds–an increase nearly 70% over current supply of 2,542 beds.
This CHIP project aimed to develop a SNF program at Chinese Hospital to address the increased demand for SNF beds in San Francisco and to further expand services by creating a SNF-at-Home program by utilizing the latest technology in remote patient monitoring, telehealth and wearables.
October 25, 2023View/Download PDF
Leading a Payor with a Clinician-Led, Value Driven Lens to Address Health Care Affordability
Ravi Kavasery, MDIn California, high health care costs have created widespread access and health problems for millions of Californians, particularly those with low incomes. 36% of Californians report having medical debt, and 1 in 10 Californians report having trouble paying medical bills.
Blue Shield of California is a non-profit health plan serving approximately 4.8 million members and with approximately $24 billion dollars in annual revenue. The organization’s core mission is to ensure all Californians have access to high-quality health care at an affordable price.
My CHIP project was to define a programmatic approach for Blue Shield of California to materially improve our management of health care costs, with the goal of lowering our insurance premiums for our members, improving health outcomes, and member experience. My approach to this CHIP project was to focus on three key actions: (1) developing a robust discipline of data-driven analytics and benchmarking of our health care costs and drivers, (2) leading through a clinician lens focused on quality and value, not cost reduction, and (3) scaling innovative payment models tying quality and cost together.
October 25, 2023View/Download PDF
COVID-19 Data to Action: From Bean-Counting to Beanstalk-Climbing
Darpun Sachdev, MDThe COVID-19 pandemic illuminated longstanding vulnerabilities in public health disease response, lab reporting, technology, and our workforce capacity to address a surge in a novel respiratory virus. Prior to COVID, I had gained extensive experience leading data-driven HIV and STD programs in San Francisco and collaborating across siloes improve population health outcomes. Stepping up to lead San Francisco’s COVID-19 contact tracing program, I witnessed the ability of public health to rapidly improvise new structures, remove red-tape, cultivate a new workforce and transform data systems.
San Francisco implemented one of the nation’s most intensive, comprehensive, and multipronged COVID-19 pandemic responses. As COVID-19 response priorities shifted during the past two years, I utilized the CHIP to understand public health lessons learned during the pandemic, identify opportunities to improve and ensure limited resources are used to build systems that drive meaningful public health action.
October 25, 2023View/Download PDF
Providing Mental Health Services to High School Students in a Mental Health Dessert
Romana Crespo-Belarde, MSW, LCSWMental health needs in our communities are soaring, especially in our high school students. Adolescence is a time when young people are struggling to fit in, socially and emotionally. They are especially vulnerable to bullying, family dysfunction, problems in school, and trauma. Any of these situations may trigger a mental health issue. Mental health problems can affect a student's energy level, concentration, dependability, mental ability, and optimism. Research suggests that depression is associated with lower grade point averages, and that co-occurring depression and anxiety can increase this association.
Families served by White Memorial Community Health Center, a FQHC Look-Alike in Boyle Heights, have communicated the need for culturally and linguistically sensitive, in-person mental health services for their children. Adolescent patients at our clinic have shared their concerns related to increased symptoms of anxiety, depression, trauma, and suicidal ideation.
This CHIP project aims to develop and coordinate a partnership to provide in-person mental health services to students at an underserved high school in Boyle Heights.
October 25, 2023View/Download PDF
Beyond the X-waiver: Normalizing MAT Prescribing in Primary Care
Dawnell Moody, DO, MPHIn January 2023 the DEA and SAMSHA announced elimination of the X-waiver as a requirement to prescribe Suboxone (buprenorphine/ naloxone) for opioid use disorder which presented an opportunity to reduce one barrier to treatment, access to X-waivered providers, among patients at a suburban community health center. This project looked at the willingness of primary care providers not previously X-waivered to begin prescribing Suboxone for patients on a stable dose before and after a peer-led training. It further assessed if there was a difference in willingness to prescribe buprenorphine for chronic pain vs opioid use disorder. Prior to the training, 60% of providers indicated they were likely to prescribe buprenorphine for an indication of chronic pain or opioid use disorder and 40% of providers responded they were not likely to prescribe for either indication. After a one-hour peer training and the creation of a reference guide the number of providers likely to prescribe for an indication of chronic pain was 71% while the percentage likely to prescribe for opioid use disorder was 57%. Those not likely to prescribe for chronic pain dropped to 28%, but the number not likely to prescribe for opioid use disorder remained nearly the same at 43%. During the three months between the peer training and data collection one provider began sending Suboxone prescriptions for a patient with opioid use disorder. In the post-training survey, a question was asked about the new DEA license renewal requirement to complete 8 hours of education on substance use disorders which started in June 2023. Out of the two providers who completed the new requirement one felt it increased their willingness to prescribe MAT and one reported it had no effect.
October 25, 2023View/Download PDF