California Health Care Improvement Projects (CHIPs)

Monterey Integrated Systems Transformation Initiative

People in Monterey County with complex physical health, behavioral health, and social needs often experience fragmented and ineffective care, leading to poor outcomes and high service use and cost. In response to improving health outcomes for our Monterey County residents, Monterey County Behavioral Health launched the Monterey Integrated System Transformation Initiative. This countywide initiative is designed to help all services become aligned with our most important values for the people who need our help the most.

Optimizing Safety-Net Primary Care Access in the Era of COVID-19

Primary care practices in the safety-net face increasing demands for services as the COVID-19 pandemic has elevated health awareness and state initiatives continue to expand Medi-Cal coverage. At Los Angeles General Medical Center (LA General), the largest primary care site within the Los Angeles County Department of Health Services (DHS), we noted that the years of deferred care, rapid primary care panel growth, and marked workforce attrition pushed our clinics to the breaking point. Primary care provider visits were backlogged, wait times for appointments were months long, and clinical outcomes and patient experience metrics were stagnant or worsening.

As the stewards of primary care access for nearly 58,000 patients across 9 unique medical homes, we heeded the call to disrupt the status-quo and began our journey to design and implement an alternative model of access to meet the competing needs of our patient population. Our vision was to use human-centered design methodology and understand the needs and experiences of all end-users. Our objective focused on developing an innovative solution that integrated medical home team-based care concepts and virtual health tools and technology to improve primary care visit capacity utilization (reduced % monthly visits not utilized, reduce % visit no-show, reduce third next available appointments [TNAA]) and balance clinical quality outcomes in our Quality Incentive Pool (QIP) Program and reported patient experience scores in the Press Ganey Medical Practice Survey (PG-MPS).

Improving Access to Mental Health Services in L.A. County Schools

The crisis in adolescent mental health was highlighted in 2021 bulletins from the Surgeons General of California and the United States. Even before COVID, the incidence of adolescent major depression, suicidal ideation, and emergency room visits was on the rise. The profound death toll, sense of fear, economic disruption, and social isolation exacerbated the unprecedented stresses facing American youth. Communities of color were particularly hard hit by the twin pandemics of COVID-19 and systemic racism. Public school systems in Los Angeles struggle daily with mental health crises for individual students and with their cumulative impact on the learning environment. In 2018-19 there were 7,661 incidents of suicidal ideation on campuses in the L.A. Unified School District alone.

The School Behavioral Health Incentive Program (SBHIP) provided the opportunity for Medi-Cal health plans to earn implement programming to help address this crisis. This CHIP project aimed to improve access to mental health services for children and adolescents in school districts across L.A. County. L.A. Care Health Plan collaborated with Health Net and the L.A. County Office of Education to plan, pilot, and implement a $24 million project to bring telehealth services to students in multiple L.A. County school districts.