Problem: 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.

Dental 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.

Healthcare 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.

My project has been to create a physician leadership program called Site Medical Director University (SMD-U) at AltaMed Health Services, the largest Independent Federally Qualified Health Center in the nation. With clinics throughout Los Angeles and Orange counties, our current leadership structure consists of a Chief Medical Officer, 3 Regional Medical Directors, and 15 Site Medical Directors (SMDs) that oversee each clinic. Thus, the SMDs are the functional leaders supervising over 250 Providers.

Today, nearly 70% of healthcare providers are employed by large corporate entities. While there are benefits to large healthcare systems, providers in these organizations are feeling disengaged and disempowered due to the inability to effectively advocate for their patients or themselves. This lack of voice contributes to provider burnout, directly affecting the quality of care being delivered and physician attrition.

Street Medicine is the delivery of individually tailored health and social services to people experiencing unsheltered homelessness (PEUH) in their own environment. Because Street Medicine has historically existed on the margins of the medical field – run as part time teams with volunteer staff - and because of that individually tailored approach, the field lacks universally recognized measures of success.

Due to the COVID-19 pandemic, participation in recommended routine screening declined across the country – in the first six months of the pandemic alone there were 10 million missed cancer screenings. As a result of this decline, individuals are not receiving appropriate early screening and diagnosis, resulting in an increase in cancer diagnoses at advanced stages of the disease. Delayed diagnosis is expected to lead to a higher cost of care, loss of productivity, and increased morbidity and mortality that would have been avoided with appropriate screening.

Whole Person Integrated Care (WPIC) is a section within SF DPH’s Ambulatory Care that brought together programs serving people experiencing homelessness (PEH)/transitioning out of homelessness to provide coordinated and integrated care. As part of WPIC’s development, our Urgent Care (UC) clinic integrated with Street Medicine’s Open Access clinic. Two-thirds of the patients are PEH, and the program addresses both urgent needs and transitional primary care for individuals who are unconnected to care and not getting their needs met elsewhere in the system.

Care coordination among patients with severe mental healtillnessesss has been a long-standing challenge. Patients seen in mental health clinics oftentimes have inadequate control of diabetes, hypertension, and dyslipidemia. In addition, more than 60% of this population also suffers from co-occurring substance use disorders. Without addressing these chronic medical problems, patients with poorly managed medical conditions often were lost to follow-up.

Background: Substance abuse by pregnant women is a public health crisis. In, 2019, the U.S. was in the grips of an epidemic, with >70,000 opioid drug overdoses. In 2020 ED visits for opioid abuse went up 45% and studies have estimated an almost 30% increase in opioid overdoses. This has resulted in an ever-increasing number of babies struggling with highly traumatic abstinence (NIDA).