As we near the end of the year, we have been reflecting on our growth and achievements in 2022. SNI, like many organizations, has embarked on a journey to look deeper within ourselves, both as an organization and as individuals, to reflect on the impacts of structural racism and to discern our role in addressing them. As part of this effort, SNI defined its commitment to health equity and is pleased to share our proclamation statement below.
On a related note, SNI and our members continue to make progress in our Racial Equity Community of Practice (CoP), which helps strengthen members’ commitment to anti-racism and their capacity to develop strategies that embed equity throughout the organization. Systems are taking advantage of one-on-one coaching with consultants, continuing to learn from peers in structured sessions, and are learning more about successful leadership practices. Below, we highlight Alameda Health System’s equity journey in our latest CoP blog series.
Another key area of focus is our workforce wellbeing programming. Since launching in August, SNI hosted three webinars on the current state of workforce burnout, evidence-based solutions, and measurement approaches. Next up, SNI will host an in-person workshop on leadership approaches to foster a culture of wellbeing.
In a week’s time, we will be heading to Napa for our annual conference. We have a great lineup of nationally known speakers, health care policy experts, and social justice champions who will discuss health equity, health care affordability, midterm election results, climate action, and more. Hope to see you there!
Giovanna Giuliani
Executive Director
California Health Care Safety Net Institute
SNI’s Commitment to Advancing Health Equity
SNI, along with our partner organization the California Association of Public Hospitals and Health systems (CAPH), has been on a journey of contemplation and reflection with a commitment to acknowledge the implications of structural racism and historical marginalization. As part of this effort, CAPH and SNI developed a proclamation statement to demonstrate our pledge to foster equitable health and create an inclusive and equitable workplace. This statement will be posted on our new website launching in early January 2023.
CAPH and SNI are dedicated to cultivating an inclusive culture. We commit to this practice within our organization and within our community.
Our Mission:
Our mission is rooted in the belief that achieving equity is accomplished by addressing systemic inequities and treating every Californian justly. We welcome that every person brings a unique perspective and experience to advance this mission. We recognize the historical footprint of oppression that has led to structural racism, discriminatory barriers, racist policies, and unjust practices and outcomes that disproportionately and negatively impact communities of color. We are dedicated to advancing equitable distribution of opportunities, resources, and health outcomes for the individuals and communities served by our members, California’s public health care systems.
Our Actions:
We take our role and responsibility in shaping the world and driving equitable health care delivery seriously. As an influencer and voice of California’s public health care systems, CAPH/SNI will:
• Integrate diversity, equity, inclusion, and justice into our mission and daily work.
• Prioritize advancing equity and countering structural racism in the development of policies, practices, and programs to strengthen and improve the health care safety net.
Our Vision:
Our vision is to be a leader and thought partner in the creation of more equitable health outcomes. We are aware of the oppressive and inherited systems within health care, but truly believe that through our voice and influence in health policy, advocacy, and program development, we can increase access to patient-centered, high quality and equitable health care and work towards addressing patients’ social needs to improve the health status of our communities.
New Blog Highlights SNI’s Community of Practice and Alameda Health System
As part of a new blog series focused on SNI’s Racial and Equity CoP program, we highlight Alameda Health System’s equity journey and the role of peer support in the CoP. “We provide equal care but not equitable care across the board. And that’s the challenge we are tackling,” said Mark Fratzke, chief operating officer, Alameda Health System (AHS).
Fratzke and his AHS colleagues are grappling with this complex challenge alongside 70 safety net peer members from 12 California public health care systems as part of the CoP. In this blog, you will read about how AHS is designing and delivering robust equity programs, and how the CoP is helping to shape their work. Not only is AHS sharing their successes with their peers, but they are also learning from other systems, including UCLA Health and San Mateo Medical Center.
Photo Credit: Katherine Haynes, senior program officer at the California Health Care Foundation, and Dr. Mini Swift, vice president of population health at Alameda Health System, attend a Community of Practice meeting in Oakland.
Ambulatory Care Workshop: Back to Basics in a COVID-endemic World
Earlier this month, SNI hosted an in-person workshop on Rebuilding Ambulatory Care: “Back to Basics” in a COVID-endemic World.”
Over 60 ambulatory care directors, chief medical officers, and other public health care system leaders gathered in Oakland to discuss how they are rebuilding their ambulatory care delivery systems in the context of pandemic-driven workforce issues, delayed care, and hybrid in-person and virtual care. Prior to the workshop, SNI surveyed systems on care teams and staffing ratios, empanelment processes, and scheduling practices, and how they have evolved as a result of COVID-19. SNI used the results to design the meeting and highlight themes and bright spots.
Riverside University Health System shared how they leveraged Rapid Improvement Events from their multiyear Lean journey to redistribute tasks to other care team members and maximize providers’ time. UCSF Health presented their data-driven approach to determining the right panel size using an algorithm that balances the demand and supply of care. Finally, Los Angeles County Department of Health Services shared how they simplified their scheduling templates from 450 unique appointment types to a standardized set.
Attendees also participated in roundtable discussions to strategize with their peers and identify key takeaways and intentions to strengthen and rebuild their ambulatory care departments.
“Members walked away with pearls of wisdom, large-scale ideas for how to redesign their systems, and everything in between. We’re glad to be able to bring leaders together in-person again, as we all face this new stage of COVID-endemic health system operations,” said Giovanna Giuliani, executive director of SNI.
Photo Credit: Serena Sy, executive director of primary care, and Angela Suarez, primary care medical director, from Santa Clara Valley Medical Center Hospital and Clinics attend the recent ambulatory care workshop.
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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.
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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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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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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.
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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.
PHARMACY QUALITY ALLIANCE COPYRIGHT STATEMENT
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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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.
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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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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.
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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.
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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
As part of a new blog series focused on SNI’s Racial and Equity CoP program, we highlight Alameda Health System’s equity journey and the role of peer support in the CoP. “We provide equal care but not equitable care across the board. And that’s the challenge we are tackling,” said Mark Fratzke, chief operating officer, Alameda Health System (AHS).
Riverside University Health System shared how they leveraged Rapid Improvement Events from their multiyear Lean journey to redistribute tasks to other care team members and maximize providers’ time. UCSF Health presented their data-driven approach to determining the right panel size using an algorithm that balances the demand and supply of care. Finally, Los Angeles County Department of Health Services shared how they simplified their scheduling templates from 450 unique appointment types to a standardized set.