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).

Over the past few months, SNI has developed new and expanded collaborations, mirroring the efforts of our members as they build new partnerships with health plans, social services, and community-based organizations. Collaboration is critical to treating the whole person across the continuum of care – and with that collaboration comes the complexity of engaging new stakeholders, building relationships and trust, and sharing data, just to name a few. SNI is bringing together representatives from these new partnerships with our members to strategize, problem solve, and share lessons learned to improve care delivery.

This version of the SNI Forward touches on two examples of collaborative efforts underway to support Whole Person Care (WPC) and improve encounter data exchange for the Quality Incentive Program (QIP) and the Enhanced Payment Program (EPP). We also provide a snapshot of the diversity across our patient population using recent data from the Public Hospital Redesign and Incentives in Medi-Cal (PRIME) program. Lastly, we describe the innovative ways that three public health care systems are providing non-traditional services through the Global Payment Program (GPP).

We hope you enjoy this version of the SNI Forward.

Giovanna Giuliani
Executive Director
California Health Care Safety Net Institute

Program Highlights

Public Hospitals & Health Plans: Improving Data Quality Together

Paul Luu from San Francisco Health Plan and John Winkel from Zuckerberg San Francisco General Hospital

In April 2018, SNI launched a new collaborative effort with the California Association of Health Plans (CAHP), Local Health Plans of California (LHPC), and the Department of Health Care Services (DHCS) to improve the quality and accuracy of patient encounter data and the exchange of this data among public health care systems, health plans, and the State.

SNI, along with CAHP and LHPC, brought together our members, health plan partners, and the State in two different sessions in April and August 2018. Nearly 200 people attended each meeting. The first meeting focused on the impact of the Medicaid Managed Care Rule on plans and members, an overview of the EPP and QIP, and the basics of encounter data flow and reconciliation.

Building on this successful start, SNI held a second session in August to discuss major sources of encounter data errors and meaningful reconciliation processes. While this effort was established to support encounter data exchange requirements in the EPP and QIP, strengthening relationships between providers and plans and building a strong foundation of data has been valuable and impactful across numerous programs.


Whole Person Care: Building Collaborations through Data Sharing

The Whole Person Care (WPC) program aims to improve care coordination for high-risk individuals by addressing physical health, behavioral health, and other social service needs that include housing, food stability, and other critical community services. Across the state, WPC has fostered new collaborations with social service and health care organizations working together to provide improved care for the most vulnerable individuals. With these new efforts, data collection and data sharing has become a challenge for many WPC sites. For example, restrictions on sharing substance use disorder data can complicate care delivery and coordination efforts.

To address the legal, technological, and cultural barriers to data sharing, SNI convened the WPC Data Sharing meeting in May 2018 with nearly 200 participants from all 25 WPC sites. The participants included WPC program and data leads, behavioral health leads, privacy and compliance officers, and legal counsel. Presentations included an overview of applicable laws for data sharing, technological challenges, and clinical care issues such as patient consent management and shared care planning.

SNI continues to support WPC data sharing through work with the state-led WPC Learning Collaborative, in partnership with DHCS, Harbage Consulting, and the Center for Health Care Strategies.

By The Numbers

Non-English Language Diversity in PRIME

For the first time, as part of PRIME, all California public health care systems are collecting uniform, detailed Race, Ethnicity, and Language (REAL) data and using that data to identify and reduce health disparities. By June 2017, public health care systems had collected REAL data for more than 460,000 patients – an increase of nearly 200,000 over the baseline established in year one of the program. By the end of 2017, nearly all public health care systems met their year-end target of collecting REAL data for at least 40% of patients and are currently on track to meet the 2020 goal.

A first look at the data shows the diversity of languages spoken by patients receiving care in public health care systems. Thirty five percent of individuals on average identified a non-English language as their preferred language and 65% identified English as their preferred language. The top five non-English languages across the public health care systems are Spanish, Vietnamese, Tagalog, Chinese, and Arabic. For our analysis, Chinese includes several dialects such as Mandarin and Cantonese, both of which are highly represented in the data.

Collecting REAL data is a crucial first step in being able to identify and understand the specific needs of the patient population, ultimately with the goal of using this data to identify and improve disparities. To learn more, read our brief, Reducing Health Disparities at California’s Public Health Care Systems.

Member Highlights

Global Payment Program: Expanding Non-Traditional Services  

The Global Payment Program (GPP) is the first payment reform effort of its kind for the remaining uninsured and is focused on encouraging primary and preventative care. As part of the GPP, public hospitals are encouraged to provide “non-traditional” patient-centered services, which are often non-reimbursable high value services shown to improve health outcomes. Non-traditional services include technology-assisted services, such as real-time patient-to-provider telehealth visits and provider-to-provider eConsults, and low-tech but high-impact services, such as wellness visits, support groups, and/or health coaching.

Two years into the program, public health systems are implementing a range of innovative programs to better serve the needs of their diverse patient populations. For example, San Mateo Medical Center created an afterhours clinic for farm workers and their colleagues in the Department of Public Health operate a mobile clinic to better provide care for homeless individuals. Kern Medical Center is conducting targeted outreach to rural communities, including preventative health screening and wellness events.

Many public health systems are using non face-to-face visits as a way to provide more timely and appropriate care. At Riverside University Health System, phone visits are provided to uninsured patients to help address acute health issues and triage care needs. To reduce emergency department utilization, nurses at San Mateo Medical Center conduct phone visits within 48 hours of patient discharge from the emergency department. During these phone visits, nurses can address issues with medication, symptom management, and referrals to other providers.

Improving outpatient care coordination is another major area of focus. San Mateo Medical Center launched a new patient connection center using a collaborative team-based model that includes social services and non face-to-face visits. At Kern Medical Center, clinical social workers have been integrated into primary care so patients with behavioral health needs can more easily access care. Riverside University Health System assigned their uninsured patients to primary care providers in the medical home to ensure they are monitored and have access to the full range of services and resources provided to all patients.

Utilization of non-traditional services are increasing year-to-year, either as a new program or expansion of an existing program. We expect this trend will continue as public hospitals continue to focus on care for the uninsured under GPP.

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

PRIME Waiver Integration Team – On October 24, SNI will hold the ninth Waiver Integration Team (WIT) convening in Burbank, where system leaders will review PRIME DY13 Year-End data and exchange lessons from PRIME’s third year of implementation. For more information, contact Amanda Clarke.

Quality Incentive Program – In December, members will submit baseline performance rates on roughly 20 measures for Program Year 1 of the new pay-for-performance Quality Incentive Program (QIP). Members are also working on improvement targets for Program Year 2, which started in July. SNI continues to provide technical assistance and reporting expertise to help health systems succeed in QIP. For more information, contact Dana Pong.

Value-Based Strategies – SNI continues to bring together member health system leaders around strategic planning and the operations needed to successfully expand value-based arrangements at their organizations. A meeting for the fall is being planned. For more information, contact Giovanna Giuliani.

Ambulatory Care Redesign – This fall, SNI will launch technical assistance for QIP starting with a focus on primary care metrics and continue to provide support for PRIME around HCAHPS and care transitions metrics. For more information, contact Amanda Clarke.


Provider and Staff Satisfaction – The California Improvement Network’s latest report, CIN Connections: Healing the Healers, features actionable information to tackle provider burnout and promote well-­being at health care organizations. The report includes seven steps organizations can take to improve provider wellness and a snapshot of how three organizations are tackling provider burnout.