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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Racial Equity in the Workplace
Kimberlee PittersI was working on a A3 to address racial equity in the workplace. Through the A3 process it was ascertained that 35% of staff did not feel comfortable discussing race and racism in the workplace, resulting in an organizational culture and environment unable to advance racial equity. The goal of the project was to continue the A3 process to advance racial equity by increasing staff awareness and comfortability (staff feeling safe) in discussing and addressing racism in the workplace. The target was 100% of staff would have comfort discussing racism in the workplace by December 2021.
June 1, 2022View/Download PDF
Improving the Quality of Applied Behavior Analysis Service with a Pay For Value Program
Edwin PoonApplied Behavior Analysis (ABA) is a type of behavioral therapy commonly used to treat children diagnosed with Autism Spectrum Disorder (ASD). The treatment is long-term, intensive, and highly individualized. If the service is poorly designed or implemented, it may lead to behavioral regression and the need to restart treatment. The goal of my CHIP is to improve the quality of ABA service with a PayFor-Value (P4V) program. Two metrics were used as lead indicators: 1) percentage of supervision conducted by board certified clinicians and 2) utilization rate of approved treatment hours. Providers will have the opportunity the earn up to 4% of their annual total claims amount if they meet preset quality benchmarks.
June 1, 2022View/Download PDF
Implicit Bias Training, Just the Beginning
Lisa RichardsonI 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. I reflected upon this unique time in history. I did not want to create any further harm to our students. I felt compelled to address not only our students’ concerns but also address how our employees can make better decisions personally and professionally in response to the change our students yearned for and demanded. So, I quickly pivoted my CHIP to work on Implicit Bias Training for the Student Health Clinic at the University of Southern California. My goal was simple, to implement the first implicit bias training at the Student Health Center at USC.
June 1, 2022View/Download PDF
Standardizing of “5150” Training Across Counties
Lucero RoblesI wanted to leverage resources to support standardization for county behavioral health plans. County behavioral health plans are responsible for the provision of behavioral health services to person with severe and persistent mental illness and services for substance use disorders to Medi-Cal beneficiaries in their counties. There are 58 counties in California ranging in size from smallrural to extra-large with much variation in how services are delivered. For my project, I focused on training for individuals whom the county designates “writing authority” which authorizes a person the professional responsibility to place a person on an involuntary hold when the person’s mental disorder makes them a danger to themselves, and/or others and/or gravely disabled. I will refer to this as “5150/5585” which are the regulatory sections of the Welfare and Institutions Code (“5150” for adults and “5585” for minors). The regulation defines persons who are designated to perform the activity of involuntary detainment, including the role of the county in the designation of this authority. To receive this designation, an individual must complete training on professional and legal responsibilities of performing this activity. Each of the 58 counties in California develops and delivers this training to persons who may be granted 5150/5585 “writing authority”. The training content and hours in training varies from county to county. There is no standard statewide training.
June 1, 2022View/Download PDF
CHIP: Building New Pathways to Address GI Procedure Critical Backlogs after COVID-19
Gina RossettiLos Angeles County Department of Health Services (LAC-DHS) is a huge organization comprised of multiple large complex facilities with their own unique culture, leadership, policies, and procedures. It can be extremely difficult to implement a system-wide operational approach within the organization due to this landscape, especially in a time limited capacity. Early in the pandemic, LAC-DHS shut down all outpatient GI procedures for six months. This created a huge GI procedure backlog and delay in diagnostic care. Due to COVID-19 budget restrictions, there were no new available resources to solve the problem. Therefore, we needed a multi-pronged innovative strategy to address the backlog and deliver much needed diagnostic and therapeutic services to our patients. Before starting this project, the GI services at LAC-DHS had no standardized electronic data tracking system, no GI specific nursing protocols, and no standard procedure delivery workflows across the system. Our goal was to decrease the GI procedure backlog from 6,000 procedures to 1,500 procedures from August 2020 to March 2021. We accomplished this goal by developing and implementing an electronic procedure queue with triage capabilities, multiple nursing/pharmacy standardized protocols, cross-facility scheduling throughput, and standard policies and procedures across LAC-DHS GI departments.
June 1, 2022View/Download PDF
Advocacy for Pharmacoequity in Medi-Cal Rx
Navneet SachdevaGovernor 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. After several delays in Medi-Cal Rx implementation, the pharmacy benefit was finally transitioned from CCAH and other managed care plans to Medi-Cal Rx on January 1, 2022. There were several issues surfaced at go-live. For our plan, we encountered: • 86 Separate operational issues impacting several thousand members. • 7 drug class specific policy issues impacting several thousand members. • 6 operational policy issues regarding appeals/grievances/complaints process, missing peer-topeer review option, others. • Comparing DHCS policies with CCAH’s practices, it was clearly visible that the members don’t have the same rights and have access to similar medications as they would under a MCP. DHCS didn’t hold themselves to the same standards as they would a MCP to. For example, despite having 180 transitional policy in place by DHCS, the claims were still rejecting at point of sale because of DHCS having manufacturer specific rebate contracts in place. Member has been on the medication, but can’t get it because it is not from a manufacturer that have rebate associate. This practice is quite bothersome to me. It would never be tolerated for a commercial plan or a MCP. Medi-Cal members should have the same rights regardless who is responsible for managing their pharmacy benefit. That is the right thing to do!
June 1, 2022View/Download PDF
Leveraging the Lessons of the Pandemic to Advance Population Health
Carolyn SengerThe SARS-CoV-2 pandemic has shone a bright light on the need to screen for and address preventive and population health needs in a systematic manner. During the pandemic, declines nationally of up to 80- 90% in submitted claims were seen for most preventive services. Patients experienced increased barriers to engaging in care, which often resulted in significant care gaps due to delayed or unmet care needs. The pandemic provided both the challenge and the opportunity to not only expand the ways we provide care, but also change the conversation with our patients and our clients about how they think about and see the value and importance of prevention and population health. The goal of the project was to develop, implement, and iteratively improve an enterprise-wide systematic approach to consistently being aware of, screening for, intervening on, and closing care gaps for our primary-care engaged patients.
June 1, 2022View/Download PDF