“I’m thinking of maybe eating one day, maybe not eating the next two days, so I can stretch my food.”
A patient once said this to a San Mateo Medical Center provider before the system began screening every patient for food insecurity and connecting them to resources.
That moment reminds me of how often California’s public health care systems dig deeper to ask what their patients need. Even as challenges mount and circumstances change, they keep finding innovative ways to deliver services that keep patients healthy and foster overall wellness.
But between asking and delivering lies a critical step: learning. Below, you will hear about SNI’s new “Advancing Maternal and Child Health Quality Improvement” learning series and our in-person convening next month focused on how to improve hospital discharges. For the latter, SNI is partnering with the Local Health Plans of California Institute to bring together systems and their local Medi-Cal managed care plans to strengthen coordination.
This cycle of asking, learning, and delivering is what creates better days for patients and moves California’s safety net forward. It is the through line connecting everyday improvements to the broader progress we’ll celebrate at our CAPH/SNI Annual Conference on December 3-5 in San Diego. Below, we reflect on past Quality Leaders Award winners and offer a glimpse of one of our keynote speakers. We hope to see you there!
Giovanna Giuliani
Executive Director
California Health Care Safety Net Institute
Edonte Hicks, Erica Rios, and Medhin Bihon of the Health Outreach Outcomes Team at Alameda Health System.
SNI launches new learning series on maternal and child health
In interviews with SNI over the summer, California’s public health care system leaders said they are intensifying their focus on improving maternal and pediatric health-related Quality Incentive Pool (QIP) measures, which remain an ongoing challenge.
To support those efforts, SNI launched its learning series – “Advancing Maternal and Child Health Quality Improvement” – this month, drawing dozens of virtual participants. Highlights:
Laurel Bernstein, CNM, Lead Midwife at Alameda Health System (AHS), walked through how the system “flipped the whole model of how we funnel patients into pregnancy care” with its midwife-run Pregnancy Assessment Clinic (PAC). Operating across four AHS clinics since 2023, the PAC aims to see patients within two weeks of seeking pregnancy care, a significant shift from within the first trimester.
“Patients are so much more satisfied,” she said. The system’s performance on the QIP timeliness of prenatal care measure also improved from the bottom quarter to above the national median.
AHS has also improved postpartum visit rates through its Health Outcomes Outreach Team (HOOT). HOOT reached 89% of the patients it contacted primarily by phone, an unusually high outreach rate. And 60% of those went on to complete a postpartum visit.
Natividad Medical Center’s clinicians and a medical assistant and community health worker discussed several factors that contribute to their consistently strong performance on pediatric QIP measures. Working closely with the Monterey County Health Department, the Natividad team attributes its success to several factors, including daily vaccine walk-in clinics, a pro-vaccination culture, and a supportive partnership with the county’s Medi-Cal managed care plan.
What’s next: On January 14, 2026, in Burbank, systems will continue sharing strategies and learning together about how to support expectant parents and families earlier and more effectively in care. This SNI-hosted event will be the first in-person convening of the series. Member systems can register in November.
Collaborating to improve hospital discharges
When patients are discharged from the hospital, they face an increased risk of complications and readmissions. Close coordination between public health care systems and Medi-Cal managed care plans is essential to ensure these patients are safely transitioned home or to other care settings and receive the right follow-up care and support.
On November 5, system and plan leaders from across California will meet in Oakland to explore how they can work together more effectively to improve hospital discharge processes.
Hosted jointly by SNI and the Local Health Plans of California Institute, the convening will examine staffing models for coordinating transitions, related clinical workflows and data exchange processes, and promising strategies for discharging patients with complex health and social needs. Systems and plans can register here.
“The People’s Hospital,” by CAPH/SNI Annual Conference speaker Ricardo Nuila, MD
Conference speaker spotlight
“The antidote to hopelessness in health care.” That’s how one author described “The People’s Hospital” by Ricardo Nuila, MD — a book widely praised by the New York Times, the Los Angeles Times, and the Washington Post.
At the CAPH/SNI Annual Conference on December 3–5 in San Diego, Nuila will draw from his book to share indelible stories of patients and those who deliver their world-class care, and what those successes reveal about public health care systems.
Nuila is Associate Professor of Medicine, Medical Ethics, and Health Policy at Baylor College of Medicine and an internal medicine doctor and hospitalist at Houston’s largest public hospital.
Register now for our conference to hear Dr. Nuila and other exceptional speakers while connecting with others seeking to improve patient care.
Beyond the awards, patients keep winning
When public health care system winners take the stage for the Quality Leaders Awards (QLA) at our CAPH/SNI Annual Conference, it might appear to be a jubilant wrap on their innovative work.
But each QLA win celebrates a milestone in efforts that keep advancing as programs reach further and more patients benefit from better care and services.
Here are two examples:
Providing care in encampments[Ventura County Health Care Agency (VCHCA), 2021]. Since 2021, more people experiencing homelessness in Ventura County are receiving medical care and supportive services where they live. VCHCA leads a growing multidisciplinary encampment outreach program that includes the Ventura County Medical Center’s Backpack Medicine team and community and civic partners. They deliver care directly into encampments, increasing access.
Last year, Ventura County adopted its Homelessness Plan, which calls for more staff, funding, and a broader geographic reach for this cross-sector, coordinated model.
Meeting food needs[San Mateo Medical Center (SMMC), 2022]. At SMMC, every patient is screened for food insecurity, revealing needs that might otherwise remain hidden. Since 2022, that process has expanded and been fully integrated across more clinics and clinician roles. Patients identified with food needs are connected in real time to Second Harvest of Silicon Valley, giving them access to 900 grocery and ready-made meal sites and delivery services.
Join us in San Diego this December to glimpse the next wave of innovations and partnerships shaping a brighter future for patients across California.
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“I’m thinking of maybe eating one day, maybe not eating the next two days, so I can stretch my food.”
