Welcome to the SNI Forward, our quarterly snapshot of the transformation progress at California’s public health care systems and the work of the California Health Care Safety Net Institute (SNI).
SNI, like many of you, is trying to get a foothold in these ever-changing times of COVID. As health care shifts from a state of crisis to a more proactive approach, SNI is evolving its programming to help members inform the development of their ongoing COVID response structures, as well as new care delivery models that have emerged as part of their COVID recovery efforts.
In this newsletter, we feature several key examples of this work including an initiative to address systemic racism and strategies to integrate virtual care into routine clinical care. We also spotlight Kern Medical’s efforts to address the workforce shortage in light of COVID-19 and UCI Health’s remote patient monitoring program initially launched for COVID-19 patients.
Another area of focus that we are developing is workforce wellbeing. Many providers have experienced (and continue to experience) trauma, stress, and exhaustion from serving on the frontlines of the pandemic. This new effort will be shaped and informed by focus groups that SNI is currently conducting with members. Stay tuned for more information on this program.
In the coming months, SNI will remain focused on supporting members through COVID recovery efforts and the ongoing implementation of CalAIM and the Quality Incentive Pool (QIP), which drives clinical and delivery system transformation, building upon the success of PRIME (read about UCLA’s recent evaluation findings here).
Giovanna Giuliani
Executive Director
California Health Care Safety Net Institute
Racial Equity Community of Practice
Earlier this year, SNI launched its Racial Equity Community of Practice, an 18-month learning collaborative that supports public health care systems’ ability to advance racial equity in their organizations. SNI selected the National Equity Project, an Oakland-based leadership and systems change organization with deep expertise in advancing equity, as its partner. We’re excited to share that our cohort includes nearly 70 leaders across 12 public health care systems.
The program includes two key phases: level-setting and learning and action. In January, SNI hosted a successful virtual kick-off meeting to launch the level-setting phase. In this phase, team members built the critical foundation of a shared understanding of the structures of historical racism and the language and courage to openly discuss racism and its impacts. They also developed a sense of connection, openness, and transparency with their peers, all of which strengthens these leaders and organizations as they prepare for change.
As we enter the learning and action phase this month, teams will equip themselves with a set of tools to implement racial equity efforts in their systems. Over the next 14 months, teams will participate in “liberatory design cycles” to design and test solutions that interrupt systems of inequity and improve racial equity. They will meet in-person and online to share successes, failures, and lessons learned with one another to build on their collective wisdom and move towards equity.
We are deepening our understanding of organizational change and confronting racism through this process and will share updates along the way. Learn more about the Racial Equity Community of Practice.
Virtual Care
Building on lessons learned during the pandemic, public health care systems are incorporating virtual care as part of their long-term organizational strategy. To guide this work, SNI conducted an assessment to help members evaluate and prioritize their virtual care efforts. The results revealed four key priority areas: virtual care governance, operations, patient engagement, and health equity.
In response, SNI developed a webinar series, where public health care system participants learned how to select, monitor, and leverage key performance indicators (KPIs). UC San Diego Health also shared their strategy for telehealth decision making, including resource allocation practices. Other webinars included an overview of hybrid virtual and in-person care models with Contra Costa Health Services and tech navigator solutions to help patients with digital literacy barriers connect to video visits.
Next up, SNI will launch a webinar series to address the digital divide through topics like digital literacy, language access, and staff engagement.
Member Spotlight
Pressures from the Pandemic at Kern Medical
A clinical team at Kern Medical tends to a patient. Photo credit: CAPH/Kern Medical.
“There are days when it’s so much easier to just worry about myself,” said Alicia Gaeta, a nurse at Central Valley’s Kern Medical. “And then I see how hard everyone’s working, and that encourages me to keep going.”
As a continuous cascade of patients requires care for everything from car accidents to clinical depression, Kern Medical’s trauma center and inpatient psychiatric unit – the only such specialized facilities in the area – are experiencing a record-breaking volume of cases.
Meanwhile, the number of medical assistants, nurses, and other health care professionals at Kern Medical has thinned, reflecting national trends of medical workers leaving hospitals in large numbers during the pandemic. In our latest blog, learn about how Kern Medical continues to care for patients, support its indomitable workforce, and attract new health care professionals. And read about the hospital system’s opportunistic strategy for recruiting the future generation of Kern Medical staff.
UCI Health’s Innovative Remote Patient Monitoring Program
Susanna Rustad, UCI Health’s chief procurement officer and executive director of virtual care, and Khurram Mir, senior program manager, seen on a computer screen from a remote location. Photo credit: Kyusung Gong.
“The demand for acute care is high, and our hospital has been at capacity and constrained for years,” said Susanna Rustad, chief procurement officer and executive director of virtual care at the University of California Irvine Health (UCI Health).
To help decompress its in-patient units, reduce the lengths of hospital stay, and deliver a better patient experience, UCI Health started caring for 70 COVID-19 patients in January 2021 with the launch of its innovative remote patient monitoring program.
In our interview with Rustad and Khurram Mir, senior program manager at UCI Health, you will read about how this expanding program works, how patients have responded, and practical advice on what hospital systems should consider when embarking on remote patient monitoring. You’ll also learn about UCI Health’s plans for a full-fledged hospital-at-home program.
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You, your employees and agents are authorized to use CPT only as contained in the QIP PY7 Reporting Manual solely for your own personal use and only for participating in state governmental healthcare related programs supported by and/or administered by California Health Care Safety Net Institute (SNI). You acknowledge that the “AMA” holds all copyright, trademark and other rights in CPT.
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LICENSE FOR USE OF PHYSICIANS' CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION (CPT)
End User Point and Click Agreement:
CPT codes, descriptions and other data only are copyright 2021 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.
You, your employees, and agents are authorized to use CPT only as contained in the following authorized materials of Centers for Medicare and Medicaid Services (CMS) internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid or other programs administered by CMS. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.
Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza, 330 Wabash Ave., Suite 39300, Chicago, IL 60654. Applications are available at the AMA website, http://www.ama-assn.org/go/cpt.
Applicable FARS\DFARS Restrictions Apply to Government Use. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the AMA, AMA Plaza, 330 Wabash Ave., Suite 39300, Chicago, IL, 60611- 5885. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Defense Department procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non- Department of Defense Federal procurements.
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CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.
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LICENSE FOR NATIONAL UNIFORM BILLING COMMITTEE (NUBC)
These materials contain the NUBC Official UB-04 Specifications Manual and data codes (UB-04 Data), which are copyrighted 2022 by the American Hospital Association (AHA), Chicago, IL. Reproduced with permission. No portion of the AHA copyrighted materials may be copied without express written consent of the AHA. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816.
Making copies or utilizing the content of the UB-04 Manual, including codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of the UB-04 Manual or any portion thereof, including the codes and/or descriptions is only authorized with an express license from the AHA.
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1. Subject to the terms and conditions contained in this agreement, you, your employees, and agents are authorized to use UB-04 Data only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of UB-04 Data is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the AHA holds all copyright, trademark, and other rights in UB-04 Data. You shall not remove, alter, or obscure any AHA copyright notices or other proprietary rights notices included in the materials.
2. Any use not authorized herein is prohibited, including, by way of illustration and not by way of limitation, making copies of UB-04 Data for resale and/or license, transferring copies of UB-04 Data to any party not bound by this agreement, creating any modified or derivative work of UB-04 Data, or making any commercial use of UB-04 Data. License to use UB-04 Data for any use not authorized herein must be obtained through the AHA, 155 N. Wacker Drive, Suite 400, Chicago, IL, 60606. Applications are available at the NUBC website, http://www.nubc.org/.
3. The UB-04 Data included in this product is commercial technical data and/or computer databases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the AHA, 155 N. Wacker Drive, Suite 400, Chicago, IL, 60606. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (December 2007) and FAR 52.227-19 (December 2007), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.
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Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled “I agree”.
QIP PY7 Reporting Manual User Agreement AMA PQA CMS v20231211
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Please review this agreement and click “Accept” at the end of this agreement if you agree to the terms of this agreement. If you do not agree, please click “Cancel”; in this case, you will not be able to access the Reporting Manual.
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION (“CPT®”)
End User Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2022 American Medical Association (AMA). All Rights Reserved. CPT is a trademark of the AMA.
You, your employees and agents are authorized to use CPT only as contained in the QIP PY7 Reporting Manual solely for your own personal use and only for participating in state governmental healthcare related programs supported by and/or administered by California Health Care Safety Net Institute (SNI). You acknowledge that the “AMA” holds all copyright, trademark and other rights in CPT.
Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza, 330 Wabash Ave, Suite 39300, Chicago, IL 60611-5885. Applications are available at the AMA Web site (http://www.ama-assn.org/go/cpt.).
U.S. GOVERNMENT RIGHTS
This product includes CPT which is commercial technical data, which was developed exclusively at private expense by the AMA, 330 Wabash Avenue, Chicago, IL 60611. The AMA does not agree to license CPT to the Federal Government based on the license in FAR 52.227-14 (Data Rights - General) and DFARS 252.227-7015 (Technical Data - Commercial Items) or any other license provision. The AMA reserves all rights to approve any license with any Federal agency.
DISCLAIMER OF WARRANTIES AND LIABILITIES
CPT is provided “as is” without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with SNI, and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.
This agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this agreement.
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By agreeing to this policy, user accepts the following limitations of the QIP’s use of the Pharmacy Quality Alliance (PQA) Opioid measures and code sets: To accurately calculate the measure rates, the PQA value sets are required. User acknowledges that the PQA measures and value sets will only be used for the sole purpose of evaluating and improving opioid use for populations served by Public Health Care Systems (PHS) and District and Municipal Hospitals (DMPH) and will not be used for other purposes. Except for the purpose indicated above, the PQA measures and value sets will not be used for any other commercial product, service or value-added benefit. User also acknowledges that the information and PQA value sets will not be forwarded or provided to anyone outside of SNI, the California Department of Health Care Services (DHCS), the PHS or the DMPH.
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License Agreements
Please review the licensing information below and indicate your agreement and acceptance.
LICENSE FOR USE OF PHYSICIANS' CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION (CPT)
End User Point and Click Agreement:
CPT codes, descriptions and other data only are copyright 2021 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.
You, your employees, and agents are authorized to use CPT only as contained in the following authorized materials of Centers for Medicare and Medicaid Services (CMS) internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid or other programs administered by CMS. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.
Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza, 330 Wabash Ave., Suite 39300, Chicago, IL 60654. Applications are available at the AMA website, http://www.ama-assn.org/go/cpt.
Applicable FARS\DFARS Restrictions Apply to Government Use. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the AMA, AMA Plaza, 330 Wabash Ave., Suite 39300, Chicago, IL, 60611- 5885. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Defense Department procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non- Department of Defense Federal procurements.
AMA DISCLAIMER OF WARRANTIES AND LIABILITIES
CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.
CMS DISCLAIMER
The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT should be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.
LICENSE FOR NATIONAL UNIFORM BILLING COMMITTEE (NUBC)
These materials contain the NUBC Official UB-04 Specifications Manual and data codes (UB-04 Data), which are copyrighted 2022 by the American Hospital Association (AHA), Chicago, IL. Reproduced with permission. No portion of the AHA copyrighted materials may be copied without express written consent of the AHA. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816.
Making copies or utilizing the content of the UB-04 Manual, including codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of the UB-04 Manual or any portion thereof, including the codes and/or descriptions is only authorized with an express license from the AHA.
The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in the agreement. By clicking below on the button labeled “Accept” you hereby acknowledge that you have read, understood, and agreed to all terms and conditions set forth in this agreement.
If you do not agree with all terms and conditions set forth herein, click below on the button labeled “Do Not Accept” and exit from this computer screen.
If you are acting on behalf on an organization, you represent that you are authorized to act on behalf of such an organization and that your acceptance of the terms of this agreement creates a legally enforceable obligation of the organization. As used herein, “you” and “your” refer to you and any organization on behalf of which you are acting.
1. Subject to the terms and conditions contained in this agreement, you, your employees, and agents are authorized to use UB-04 Data only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of UB-04 Data is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the AHA holds all copyright, trademark, and other rights in UB-04 Data. You shall not remove, alter, or obscure any AHA copyright notices or other proprietary rights notices included in the materials.
2. Any use not authorized herein is prohibited, including, by way of illustration and not by way of limitation, making copies of UB-04 Data for resale and/or license, transferring copies of UB-04 Data to any party not bound by this agreement, creating any modified or derivative work of UB-04 Data, or making any commercial use of UB-04 Data. License to use UB-04 Data for any use not authorized herein must be obtained through the AHA, 155 N. Wacker Drive, Suite 400, Chicago, IL, 60606. Applications are available at the NUBC website, http://www.nubc.org/.
3. The UB-04 Data included in this product is commercial technical data and/or computer databases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the AHA, 155 N. Wacker Drive, Suite 400, Chicago, IL, 60606. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (December 2007) and FAR 52.227-19 (December 2007), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.
AHA DISCLAIMER
The AHA hasn’t reviewed and isn’t responsible for the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessary represent the views of the AHA. CMS and its products and services aren’t endorsed by the AHA or any of its affiliates.
AHA DISCLAIMER OF WARRANTIES AND LIABILITIES
UB-04 Data is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. The sole responsibility for the software, including any UB-04 Data and other content contained therein, is with the Medicare/Medicaid Contractor or the CMS; and no endorsement by the AHA is intended or implied. The AHA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This agreement will terminate upon notice to you if you violate the terms of this agreement. The AHA is a third-party beneficiary to this agreement.
CMS DISCLAIMER
The scope of this license is determined by the AHA, the copyright holder. Any questions pertaining to the license or use of the UB-04 Data should be addressed to the AHA. End users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USE OF THE UB-04 DATA. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMMISSIONS OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.
Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled “I agree”.
Welcome to the SNI Forward, our quarterly snapshot of the transformation progress at California’s public health care systems and the work of the California Health Care Safety Net Institute (SNI).
