California Health Care Improvement Projects (CHIPs)

Increasing Employee & Dependent Engagement with Recommended Cancer Screenings

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]

Five Health Maintenance Screenings as Initial Street Medicine Core Metrics

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.

Unionize the Physicians at Alameda Health System (AHS)

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.