California Health Care Improvement Projects (CHIPs)

Envisioning a post-pandemic Digital Behavioral Health Department

Rather than seeing COVID-19 as an insurmountable obstacle, I, along with my team at Community Health Centers of the Central Coast (CHCCC), Inc., viewed it as an opportunity to accelerate the pace of innovation. To better meet the needs of the community, the CHC Behavioral Health and Psychiatry Departments are committed to moving beyond brick-and-mortar clinics to a ‘click and mortar’ clinic in the sky, the Cielo Center for Integrated Health. Like many health centers CHCCC quickly shifted to virtual care not long after the pandemic emerged. However, not until the Omicron wave of Covid-19 in January 2021 did I commit to transitioning the behavioral health department to a fully digital service model. The entire landscape of healthcare changed in 2020. I realized I had to pivot our strategy and re-design our clinical structure. I began to design a CHIP in late January with the project aim of increasing access to behavioral health services by creating an organized, fully digital continuity-of-care system for our patients. This system includes a network of remote behavioral health clinicians to ensure patients are provided with outreach and engagement, wellness coaching, counseling, and psychiatry services. An integrated team of physicians, nurses, counselors, health educators, psychiatrists, and care coordinators collaboratively engages, triages and coordinates care through a cloud-based EHR system. This model creates a digital doorway for patients, allowing them to access services anywhere in the community. Moreover, this hybrid model of in-person and remote services bridges the digital divide and promotes health equity by ensuring patients have choices along the continuum of care.

access to “Nutrition super-powers” in the era of obesity and chronic diseases

Chronic diseases (eg: heart disease, stroke, DM, kidney disease, cancer) account for 5 of the top 10 causes of death in our country. Obesity is a well-known risk factor for all these chronic diseases, and we have almost 40% of US adults and 20% of children obese in the US, and the COVID pandemic has only worsened these trends. We currently have outstanding innovations in the field of medicine that focus on medications, delivery methods, and surgeries, yet our communities continue to struggle with chronic disease management and increasing rates of obesity.

It couldn’t be emphasized enough that nutrition plays a major role in the prevention, risk reduction, and management of obesity and chronic diseases. Yet, healthcare models lack focus on it. My work is to highlight the power of nutrition in obesity and chronic disease prevention, risk reduction, and management in a model of integrated care.

The challenge was to create the nutrition-focused model in an FQHC (Federally Qualified Health Clinic) setting, with communities that are uninsured or underinsured, lack access to transportation, have limited means and income, rely on community health clinics for their comprehensive care, and all these barriers further muddled with insurance payment models failing to focus on prevention. The interviews with the stakeholders - patients and their caregivers, clinicians, leads from other departments, and healthcare leaders from other organizations to understand the needs of the community and the success/failures of previous efforts in this arena and community-based organizations - proved to be extremely vital in shaping the direction of this project.

A Medical Group to Serve California’s Federally Qualified Health Centers (FQHCs)

The two largest patient groups in California are Kaiser members (9 million) and patients served by California’s FQHCs (7 million), but you could not find two more dissimilar health systems. Kaiser and nearly all other health systems organize their providers in medical groups; FQHCs are private non-profits that employ and support their providers independently. The separation between individual FQHCs results in inconsistent access and quality, an inability to retain talent and resources, and diminished voice in the broader health care system.

An FQHC Medical Group combines the best of the medical group model - shared quality standards, multi-site, primary care, and specialty provider network, clinician leadership and ownership, career stability, and high retention - with the best of FQHCs - integrated medical and mental health care, mission-driven with a focus on access and equity, nimble and responsive to the communities they serve. An FQHC Medical Group ensures consistent access to diverse providers, and high-quality care across all FQHCs, and fosters a joyful, sustainable career in community health.

An FQHC Medical Group fundamentally changes individual FQHCs’ relationships with providers. The Medical Group directly employs medical and mental health providers and deploys them, under contract, to FQHCs thereby ensuring consistent staffing, provider diversity, and clinical scope where needed. Best practices are applied, and quality standards are monitored across the entire Medical Group. Providers are supported by clinical leadership on all levels and are connected to a provider community that spans many FQHCs. Staff and resources duplicated across several FQHCs would be unified under the Medical Group, reducing costs and improving outcomes for individual FQHCs.