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.
Search CHIPs
Affordability Accelerator: Developing a road map to improve Patient Out-of-Pocket Costs and trustworthiness in healthcare
Reshma GuptaHealthcare prices are hard to understand and navigate for patients and healthcare teams. Health care affordability (out-of-pocket patient costs) is a leading health care concern for Americans and a key voting issue. More than half of Americans worry about the availability and affordability of health care, and more than a quarter have delayed care because of high costs. I am passionate about this work after having a friend lose her life savings due to healthcare costs and my own family has faced large medical bills without guidance to navigate our healthcare system.
As a nation and in California, we have missed the target to reduce out-of-pocket costs to patients, likely because there has been no clear roadmap of how to approach solutions, and key partners have traditionally worked in silos. 70% of patients across the country and 66% of patients in California hold employer-based, non-group, or Medicare insurance coverage. Thus far, among these insurance types, efforts to increase healthcare value have remained focused on reducing the total costs of care with payers and health systems benefiting, with little attention to rising out-of-pocket costs with nearly no accountability or protections for patients.
So I brought together patients, navigators, social workers, care teams, health system leaders, payers from across the country to develop solutions through an Affordability Accelerator. My CHIP aimed to create a roadmap to provide a path to reach these goals from a perspective of building infrastructure to support health system interventions. My team acknowledged that other payer reforms and patient protection legislation will be required to create large improvements. While the new No Surprises Act and Inflation Reduction Act take important steps toward Medicare price caps, price transparency, and balance billing for out-of-network care, efforts to improve affordability must be guided by care teams and supported by health systems to achieve consequential change. Participants identified strategies to better understand and align clinical and financial decisions throughout a patient’s experience prior to, during, and after care is rendered to develop new care pathways. The participants identified key financial friction points for patients and nine key improvement opportunities.
October 18, 2022View/Download PDF
Building a One-Stop Low Vision Rehabilitation Center
Sally Dang, OD, MPHPermanent vision loss is prevalent among the aging and will continue to rise. There are gaps and barriers resulting from fragmented care locally and globally. The health inequity among the aging, visually impaired population is also a public health issue with an economic burden on state and federal resources. The CDC reports that 4.5M over age 40 report that they are blind. This number is expected double to 9M by 2050. There are 21M more who reports having “vision problems” not correctable with conventional glasses, contact lenses, or refractive laser surgery. California spends up to $14B for this population alone (one of the highest states), with medical costs totaling $5.7B annually and $3.4B for the 65 and older age group. People with severe vision impairment are more likely to have poor health and comorbidities, and 59% of these individuals reported having a fall in the previous year (CDC, 2022).
Patients with all levels of visual impairment may have difficulties performing activities of daily living, resulting in decreased quality of life. The ideal model has been tested at the Veterans Affairs, where I have spent the past ten years implementing best practices. The training programs are goal-oriented and successfully help individuals reintegrate into daily life activities. The feedback from Veteran patients on the impact on their quality of life and mental health has been overwhelmingly positive. This CHIP is aimed to scale a similar sustainable and holistic model that is not currently available to the broader community.
October 18, 2022View/Download PDF
Decreasing Decay Rate in Children under Three by Introducing Early Oral Health Education in Pregnant Mothers in Safety Net Clinics
Connie Kadera, DDSDental Decay is the most common chronic disease among school aged children. In fact, dental disease is more common than childhood asthma. By the time children go to school, 50% of them have already experienced tooth decay in California. As a result, children miss school, learn less, are in pain, or end up in the emergency room due to oral infections. Research, and reports support this position (California Children’s Report Card gave a C- for Oral Health Care in 2020). Treating decay in very young children is very challenging. The good news is that decay is a totally preventable disease. Using a multi-disciplinary approach for early education and intervention with expecting parents, I expect children to have a reduced rate of dental decay by the time their children are 3 years old.
Several efforts to decrease dental decay have already been implemented. Safety net clinics, such as Marin Community Clinics have treated children from the moment, they have their first tooth. Expecting parents are referred early on for dental care. Despite all these efforts, we are still seeing dental decay as a chronic disease in very young children. Our population is not completely aware of the etiology of this disease and the lack of understanding and knowledge is producing little effect in preventing tooth decay.
October 18, 2022View/Download PDF
Cultivating Outcomes through Equity in Behavioral Telehealth
Jennifer Clancy, MSWAs behavioral health needs skyrocketed when the COVID-19 pandemic took hold, specialty behavioral health organizations which provide services to people with serious mental illness and/or substance use disorder pivoted to delivering significantly more care via telehealth. While behavioral telehealth access may be a point of pride, racial inequity is also evident in telehealth access. It is disproportionately inaccessible to people of color, in particular those from the Black and Latinx communities, people with limited English proficiency, people facing poverty, and older adults. The key structural barriers often cited are limited access to broadband or technology and lack of digital literacy. However, institutional racism in behavioral health organizations also influences other practices and policies that negatively impact not only telehealth access but also quality. When behavioral telehealth access and quality are both compromised due to racism at structural, personal, and interpersonal levels, inequities in behavioral telehealth outcomes will also persist. As the specialty behavioral health system integrates learning from the dual public health crises of COVID-19 and racism into more permanent telehealth practices, racial equity must be named as a central aim.
This CHIP aims to help organizations address these issues by launching Cultivating Outcomes through Equity in Behavioral Telehealth, a 16-month learning collaborative. I designed the model using feedback gained between January-December 2021 from key informant interviews and Expert Meetings with behavioral health leaders, providers, and clients from underserved communities. I recruited diverse faculty and coaches with expertise in operationalizing strategies to counter structural racism in behavioral health and improve the engagement of people from minoritized communities in telehealth. This collaborative is funded by the California Health Care Foundation. Its goal is to help specialty behavioral health organizations make racial equity in telehealth a strategic priority to improve their behavioral telehealth and hybrid practices. The initiative aims to ensure clients have equitable access to high-quality services that promote meaningful outcomes and flourishing for people from communities with historic behavioral health inequities.
October 18, 2022View/Download PDF
Build a Public Health Infrastructure for Prevention of Oral Health Disease: School-Based Dental Programs
Paula Lee, MPH, RDHAPProblem: Currently, more than half of California kindergartners have experienced tooth decay, and by third grade, this number rises to over 70 percent. If left untreated, tooth decay effects children's overall health, social-emotional development, and academic performance.
Current Status: In California, SB 1433, the kindergarten oral health assessment (KOHA) requirement was signed into law in 2006 and requires children enrolled in public school for the first time (at kindergarten or first grade) have an oral health assessment. AB 1433 was amended in 2017 per SB 379 states that each school or school districts are responsible for reporting KOHA data annually. However, the compliance rate is low for schools distributing, collecting. and uploading KOHA data. Once COVID-19 pandemic, the compliance rate plummeted.
Solution: This CHIP project was aimed to conduct an environmental scan of key issues and barriers, identify collaborative partners, and build public health infrastructure for school-based screening programs aimed to create access to oral health screening for families, link them to a dental home, and increase compliance rate of KOHA requirement.
October 18, 2022View/Download PDF
Healing the Streets: Integrated, Person-centered, Street-based Care for People Experiencing Homelessness and Severe Mental Illness in Santa Cruz County
Shelly BarkerCalAIM and recent Whole Person Care pilot programs are redesigning how care is offered to people with complex needs in the MediCal system. Housing First models have demonstrated the importance of housing for client well-being, stability, and health outcomes, yet most communities lack adequate temporary and permanent housing options. Efforts thus far have failed to demonstrate compelling outcomes due to a combination of the small sample size and the complexity inherent in interventions for people who are unhoused and often have severe mental illness with co-occurring substance use disorder. The Healing the Streets Program (HTS) set out to test an integrated, person-centered, street-based care model that is not based on offering housing. As a society, we tend to “treasure what we measure;” HTS designed the program uniquely focused on articulating and addressing clients’ goals.
The HTS team of Case Managers, Peers, and a Nurse Practitioner began targeted street-based outreach with an existing physical health street medicine team in February 2022 and started enrolling clients in April. HTS staff utilize motivational interviewing and a “circle chart” depicting potential areas of need (hygiene, food assistance, housing navigation, mental health, etc.) to elicit the client’s goals and begin prioritizing them.
October 18, 2022View/Download PDF
It takes a village – promoting health equity domestically and globally
Takudzwa Shumba, MD, MPHIn recent years, there has been increased focus on health equity, galvanized by events such as Black Lives Matter, and increased awareness of the porosity of borders during the COVID19 pandemic. In my role as faculty lead for DEI efforts within Stanford’s Division of Primary Care and Population Health (PCPH) as well as faculty lead for the division’s global health partnership in western Kenya, I realized that many of the challenges to health equity globally are at play domestically. Our division’s overarching goal is to create a culture of medicine that embraces belonging and mutual respect. My main curricular tasks were to create a DEI curriculum for faculty and staff in our division; as well as to create a curriculum for rotating Kenyan students to Stanford that ensured reciprocal change. I will present the Kenyan student elective curriculum creation to illustrate the complexities and challenges in creating this shared culture, and to highlight the numerous stakeholders involved.
October 18, 2022View/Download PDF