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).

It is often said that it takes seventeen years for a research finding to evolve into standard clinical practice. At SNI, through ambitious programs like PRIME, our members are challenged to accelerate their pace of change and transformation, implementing improvements and impacting patients’ lives along the way. It’s demanding enough to maintain these gains on a daily basis, but our members are also challenged to ramp-up efforts and performance year-over-year, creating infrastructure to support longstanding quality improvement. In just four years, our members’ successes in the Global Payment Program, PRIME, and Whole Person Care are remarkable. Taken together, what’s even more remarkable is their progress moving their systems forward in value-based care arrangements, as outlined in our recent CAPH/SNI publication.

Of course, making system changes, from improving patient screening to switching enterprise electronic health records (EHRs), is both easier and faster when you’re able to learn from others who have lessons to share. SNI continues to play an important role in creating opportunities for our members to exchange learnings and accelerate their transformation progress. Read on to learn more about SNI’s activities over the last quarter.

We hope you enjoy this edition of the SNI Forward.

Giovanna Giuliani
Executive Director
California Health Care Safety Net Institute

Program Highlight

Member Collaboration: Data for Improvement Meeting

As public health care systems move toward value-based care and population health, data reporting and analytics continues to be essential for success. Clinical and financial data must be complete, validated, and easily accessible. This is no easy task. In addition to the technology infrastructure itself, other critical components for success include effective governing processes, workforce training, and streamlined workflows.

Michael Rothman, Center for Care Innovations, leads breakout session on optimizing primary care panel size

To support public health care systems as they optimize their investments, SNI, in February 2019, brought together over eighty data and strategic leaders from across our member systems to exchange successful practices that support people, processes, and technology for system-wide improvements. Ten organizations presented on their learnings and expertise in using data to further population health and value-based care goals. Discussion topics included reducing care gaps, creating social health information exchanges, and population health registries ‘tips and tricks.’

Three member systems, UC Irvine, Riverside University Health System and Ventura County Health Care Agency, offered advice from their own EHR transitions, including preparation and planning for workflow and staff training, and being realistic about what staff and clinicians have the bandwidth to take on during the switch. Continuing with the theme of balancing demand against constrained resources, Leslie Safier, Director of Performance Improvement at Zuckerberg San Francisco General Hospital (ZSFGH), shared their data governance journey. When it comes to managing too many data and reporting requests, Ms. Safier shared, ZSFGH is “getting better at saying no [and] understanding resources are limited. This allows us to prioritize our analytic resources so we can have the greatest system-wide impact.”

Public health care system leaders took home applicable on-the-ground experience, new peer connections, and some renewed inspiration to improve their data analytics locally. As one attendee shared, “thanks so much for providing thoughtful and unique opportunities for us to grow and expand our capabilities.”

By the Numbers

California’s Public Health Care Systems’ Journey to Value-Based Care

This March, CAPH/SNI released a publication chronicling the public health care systems’ journey to value-based care arrangements. Beginning with coverage expansion and an emphasis on process improvement and infrastructure development, the value-based approach has intensified over the past 10 years to improve health outcomes and increase financial risk.

Since 2005, California implemented three 1115 Medicaid waivers, each challenging public health care systems to tie a greater amount of funding to value-based care.

In 2009, public health care systems in California had zero dollars tied to performance; today that figure is approximately $2.8 billion annually. The magnitude of these payments reflects public health care systems’ willingness to test new and innovative care delivery models to improve care and patient experience.

Learn more about the progress, impact, and future of public health systems’ work toward value-based care with our recent publication, California’s Public Health Care Systems’ Journey to Value Based Care.

Member Profile

Los Angeles Whole Person Care

LA’s Whole Person Care pilot (WPC-LA) is a large and complex initiative that serves six high-needs populations, including homeless and justice-involved individuals, and spans nine service planning areas across LA County. A central feature of the program is a growing workforce of hundreds of Community Health Workers (CHW) – many with lived experience who have the unique insight to engage WPC patients and get them the care they need.

In April, the Department of Health Care Services’ (DHCS) hosted a Learning Collaborative for WPC pilots, which included a site visit to WPC-LA. During the site visit, WPC pilots learned about WPC-LA’s CHW model and other aspects of their work. Front line staff from LA-WPC shared their experiences launching and operating various WPC programs, including CHW-driven complex care management, housing for health, re-entry support, and substance use disorder and mental health.

Participants left the event with new, actionable ideas to improve their own WPC pilots. Based on such positive feedback, the Learning Collaborative is exploring the possibility of organizing another site visit to one or more Bay Area WPC pilots this fall.

For more information on WPC’s core services and member systems’ pilot programs, check out our latest blog or WPC: Going Beyond Medical Services to Help Vulnerable Californians Lead Healthy Lives

What’s Next

Highlights from SNI Programs in the Upcoming Quarter

Care Delivery – On May 2, SNI will host ambulatory care leaders at a “Better Screening for Improved Health” workshop focusing on improving screening processes and interventions, from medical and behavioral health to social care. For more information, contact Kristina Mody.

Value-Based Care – On May 20, SNI will bring together clinical, operational, and financial leaders to discuss cost savings opportunities. This meeting will focus on strategies to identify cost drivers related to utilization, volume, administration, and operations, as well as opportunities to address those costs. For more information, contact Amanda Clarke

Learn More