In California, high health care costs have created widespread access and health problems for millions of Californians, particularly those with low incomes. 36% of Californians report having medical debt, and 1 in 10 Californians report having trouble paying medical bills.

Blue Shield of California is a non-profit health plan serving approximately 4.8 million members and with approximately $24 billion dollars in annual revenue. The organization’s core mission is to ensure all Californians have access to high-quality health care at an affordable price.

Sexually transmitted diseases (STDs) have increased exponentially in the past several years nationally and statewide. Yuba County as a small rural county in northern California has one of the highest rates of congenital syphilis with a crude rate of greater than 112.9 congenital syphilis cases per 100,000 live births. From 2017 to 2022, the rate of syphilis increased from 17 to 84.1 cases per 100,000.

California is in a critical primary care shortage. In 2018 an estimated 45% of Californians had insufficient access to a primary care provider. This lack of access leads to increased morbidity, mortality and cost of care. This shortage is reflected in my own organization Neighborhood Health Care, an FQHC in San Diego. To effectively care for all of our assigned patients, we needed to expand our current workforce by 20%.

My initial point of inquiry was to better understand what we mean by “equity” and how to operationalize it. In June 2020, employees throughout San Mateo County Health walked out to collectively grieve the murder of George Floyd by police and publicly commit to dismantling the structural racism within our health care system. But what would this look like? How could we translate broad statements into actual wellbeing for our communities? For me, we needed to start by asking our patients and communities these questions and collaborating to implement solutions.

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.

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.

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.

When thinking about organizational excellence within a health care organization, clinical efficiency and quality patient care immediately come to mind. Physicians and nurses who provide direct patient care take center stage. What about the radiology and lab staff whose images and test results ensure appropriate diagnoses? What about the schedulers that support patient access, the housekeepers that keep the environment clean for safe patient care, and the facilities management tradesmen who work to keep the lights on?

Contingency management (CM), which involves paying people to use less meth or engage in treatment, is the most effective treatment tool for methamphetamine use disorder. Compared to CM, other treatments (like medications, counseling, detox, and rehab) do not work well for meth use.

The overall purpose of this CHIP was to implement a measurement-based care (MBC) program, utilizing four validated assessment tools: the PHQ-9 (depression), GAD-7 (anxiety), ACEs (trauma), and BAM-7 (addiction and social determinants of health). This program had two phases: (1) establishing a common data collection platform across a diverse range of (largely rural) behavioral health providers, and (2) providing targeted clinical summaries and connection to educational opportunities for clinicians participating in this program.