Welcome to the SNI Forward, our quarterly snapshot of the transformation efforts underway at California’s public health care systems, and the work of the California Health Care Safety Net Institute (SNI).

Recently, SNI and CAPH staff reflected on core competencies we value and nurture internally to deliver work that best supports our members. One competency that stood out as critical is dealing with ambiguity. Developing policy and programs in a shifting political and policy landscape, evolving metric specifications for performance measurement, and awaiting federal approval for programs all keep us on our toes. As a team, we also reflected on how our members, California’s public health care systems, are faced daily with similar tensions of preparing for and acting on changes in the face of incomplete information.

The Value Based Strategies program, described below, exemplifies this challenge. While trends reveal a growing movement toward value-based care, members continue to operate in fee-for-service and capitation at the same time and are strategizing when to explore new payment arrangements and implement changes. There is no one clear answer, but members can learn successful practices in the venues SNI creates.

While we acknowledge the challenges of a world demanding change with imperfect information, SNI continues to be there to help members prepare for and act on new requirements in delivery system transformation.

We hope you enjoy this edition of the SNI Forward.

Giovanna Giuliani
Executive Director
California Healthcare Safety Net Institute

Program Highlight: Value Based Strategies

Catalyzed by the alternate payment methodology (APM) requirement in the Public Hospital Redesign and Incentives in Medi-Cal (PRIME) program and growing interest in value-based payment policies and programs, SNI launched a Value-Based Strategies initiative, bringing together members and experts to learn from one another and improve their organization’s value-based capabilities and arrangements. CAPH/SNI hosted a kickoff meeting on March 13 in Oakland for 40 interdisciplinary leaders representing 15 CAPH member systems, with lively discussion, peer questioning and learning from key partners.

The day began with presentations from Jonathan Freedman (Health Management Associates), Giovanna Giuliani (SNI), and Rich Rubinstein (CAPH), who gave a bird’s-eye view of the national and California market trends, financial and environmental considerations and implications of the current waiver. Then, leaders from health plan partners, Dr. Brad Gilbert from Inland Empire Health Plan, Amy Shin from San Joaquin Health Plan, and Neal Jarecki and Ngoc Bui-Tong from Santa Clara Family Health Plan, shared their perspectives on successful partnerships with public health care systems. All three leaders stressed data as the key to improving collaborations and building organizational capacity for taking on additional risk.

In the afternoon, three systems leaders – Tangerine Brigham from Alameda Health System, Ron Boatman from Arrowhead Regional Medical Center, and Reena Gupta, MD, from San Francisco Health Network – shared lessons learned in implementing the APM requirement and in evolving their systems’ value-based care capabilities over time. The speakers emphasized education for staff on managed care principles and practices, the importance of sharing data and setting up dashboards to track progress, and strengthening population health management.

By the end of the convening, attendees were asked to reflect on the day and rank topics for further exploration. Trends emerged around risk stratification, cost of care data, and developing internal managed care expertise, which SNI will incorporate in building 2018 program activities. For more information, contact Giovanna Giuliani at ggiuliani@caph.org.

By the Numbers: Reducing Health Disparities through PRIME

As part of PRIME, public health care systems have made strides in addressing health disparities. As a first step, systems improved the collection of granular Race, Ethnicity and Language (REAL) data and began collecting sexual orientation and gender identity data for the first time. Using that data as a foundation, systems analyzed REAL data to identify a specific metric (e.g., blood sugar control, comprehensive diabetes care) and target population for which a health disparity existed. Then, systems created a plan to address the disparity and are now actively working to reduce it. The graph shows the number of systems targeting which PRIME metric for improvement.

With PRIME, public health care systems are designing, testing and spreading successful practices to strengthen care delivery for specific populations. This work will directly improve the health of patient populations identified in these disparity reduction plans, and PHS can leverage the investments long into the future, improving the health of entire communities.

Read the CAPH/SNI Reducing Health Disparities Brief for additional information, including themes and summaries of members’ disparity reduction plans.


Member Profile:

Ventura’s Behavioral Health Integration Efforts

Based on member input, SNI has prioritized Behavioral Health Integration (BHI) as a focus area for ambulatory care support in 2018. On March 1, 13 member systems convened for a BHI Leadership Roundtable, where leaders shared approaches to integrate behavioral health services into primary care settings and reach targets for PRIME Project 1.1. Topics covered throughout the day included: models of care integration, behavioral health-primary care team ratios and roles, approaches to financing integration, and strategies to advance a culture of quality improvement among integrated care teams. Dr. Marc Avery, Clinical Professor, University of Washington School of Medicine, and Hunter Gatewood, LCSW, Signal Key Consulting, joined the session to provide content expertise and help facilitate the workshop.

Ventura Health Care Services Agency shared steps that they are taking to strengthen behavioral health-primary care integration. Lucy Marrero, Quality Improvement Manager, discussed Ventura’s “Healthy [Whole] People” approach, which emphasizes universal screenings, early interventions, and brief onsite treatment, as needed. The integrated team uses “hot hand-offs” to quickly refer patients to case management and peer support. Additionally, at registration Ventura electronically administers a survey that includes PHQ-9 and other behavioral health items. The survey can be completed at home via the patient portal or in the clinic waiting room, using tablets and a mobile application.

As a result of these efforts, Ventura saw a 32% increase in screening for clinical depression and follow-up between 2016 and 2017, achieving their target for PRIME Project 1.1. Going forward, the Ventura team will focus on clarifying roles and streamlining the flow of information between integrated care team members.

For more information about the BHI Roundtable or SNI’s ambulatory care offerings, please contact Amanda Clarke at aclarke@caph.org.

What’s Next: Highlights from SNI Programs in the Upcoming Quarter

Public Hospitals & Health Plans: Improving Data Quality Together – SNI is collaborating with the Local Health Plans of California (LHPC) and the California Association of Health Plans (CAHP) to host an in-person meeting on April 18 in Oakland. Health plans and public health care systems will come together and problem solve to identify ways to collectively improve the quality and exchange of encounter and claims data. For more information, contact David Lown at dlown@caph.org.

Data Sharing and Whole Person Care – At the WPC Data Sharing Convening on May 22 in Oakland, attendees will work through the legal, technological, and cultural barriers to sharing information across sectors. CAPH/SNI is co-hosting the convening with the County Health Executives Association of California (CHEAC), and the California State Association of Counties (CSAC), and supported by the California Health Care Foundation (CHCF). For more information, contact Amanda Clarke at aclarke@caph.org.

Quality Incentive Program – The Quality Incentive Program (QIP) is a new pay-for-performance pro­gram for California’s public health care systems that converts funding from previously existing supplemental pay­ments into a value-based structure, designed to bring systems into compliance with the federal Medicaid Managed Care Rule. SNI is collaborating closely with the State, and with NCQA, to develop the reporting infrastructure for QIP and will provide improvement support through its Ambulatory Care Redesign work. For more information, contact Dana Pong at dpong@caph.org.

Ambulatory care redesign: SNI continues PRIME performance improvement support, with spring webinars on Sexual Orientation and Gender Identity data collection and prenatal and postpartum care improvement, as well as supporting foundational capabilities with a webinar on the Collaborative Care model. SNI is also planning an in-person meeting on addressing social determinants of health in summer 2018. For more information, contact Amanda Clarke at aclarke@caph.org.


CHCF Health Care Leadership Program

Applications are open for the CHCF Health Care Leadership Program, administered by Healthforce Center at UCSF. The two-year, part-time program is widely recognized as a transformative experience, helping clinicians of all disciplines better lead change in turbulent times. Alumni of the program are now found among both the CAPH and SNI Boards, the Board’s Clinical Advisory Committee, SNI, and in the leadership and senior management teams across the membership. The part-time program is for clinically trained health care professionals with at least five years of leadership experience who live and work in California. The program seeks diversity across disciplines, organizations, geography and ethnicity. CHCF covers most program costs, but fellows’ home organizations must pay tuition. As with past cohorts, the ability to pay is not a consideration in the selection process.

Applications are due June 8.

For more information and to apply, click here.

Learn More

To learn more, visit our website at www.safetynetinstitute.org. CAPH/SNI members can access program materials through SNI Link– our members’ only program portal.