GG Welcome to the first edition of SNI Forward, our new 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).

When I joined SNI as Executive Director in May of last year, I had already been aware of and impressed by the improvements being made at our member systems. I knew that these systems were undergoing intensive primary care redesign efforts, expanding services like inpatient palliative care, making incredible progress in harm reduction, and embarking on the Lean management journey, to name just a few examples.


Since joining SNI, I have grown a more profound appreciation for the true depth and breadth of the transformations happening at our member systems, as well as the multiple roles played by SNI in helping those efforts succeed.

California’s public health care systems are performing at a higher level than ever before, delivering top-quality care to more patients, in more appropriate settings, and taking on increasingly ambitious initiatives.

Through the Medi-Cal 2020 waiver’s PRIME program, California’s public health care systems are further transforming primary and specialty care, working on integrating behavioral health, improving care for high risk populations, and addressing resource utilization, while being measured across dozens of clinically-vetted metrics, and helping to create and test several new “innovative” ones.


Of course, our members don’t operate in a vacuum. They’re performing at this high level in the midst of a policy landscape that is shifting rapidly. We don’t know what the future holds, but we do know that for our members to succeed in any landscape, they will need to sustain the improvements they’ve made and keep their forward trajectory, and that emerging policies must be informed by clinical and contextual expertise.

SNI is here to help.


Giovanna Giuliani
Executive Director
California Healthcare Safety Net Institute

The Role of SNI

SNI Roles

SNI plays an instrumental role in the development of CAPH’s policy and advocacy efforts, including the quality component of CAPH’s proposal in response to new Medicaid managed care regulations from CMS.  Given the instability of the current policy landscape, this role will take on even more importance moving forward.

SNI helps members both achieve their goals and report their performance under the Medi-Cal 2020 waiver, providing members with comprehensive performance measurement support, including the publication of a 700-page metric specification manual and an extensive reporting guide for PRIME, and support for tracking non-traditional services for the waiver’s Global Payment Program.

SNI provides members with learning opportunities and guidance from our own expert staff, leaders in the field, and perhaps most importantly, peers. The development of “Waiver Integration Teams” (or WITs) is a great example. SNI regularly convenes the WITs – cross-disciplinary leadership teams from each public health care system – to foster collaborative thinking and peer learning, and to connect the Medi-Cal 2020 waiver to each member’s strategic vision.

Santa Clara: How Reporting Leads to Transformation

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Photo: Santa Clara Valley Health & Hospital System

Last fall, our members ended year one of the PRIME program and have shared that the robust waiver reporting requirements are catalyzing organizational change. “We haven’t just been reporting, we’ve been expanding collaboration, improving standardization, enhancing data integrity, and building our capacity to provide better health for all,” said Jennifer Tong MD, Chief Medical Information Officer at Santa Clara Valley Medical Center.

SCVMC is a 574 bed hospital and part of Santa Clara Valley Health & Hospital System. It has nearly 25,000 inpatient discharges and provides more than 775,000 outpatient visits annually. The system is participating in nine PRIME projects, with 55 associated metrics.

In addition to laying the foundation for data analytics, PRIME is also effecting change in another way. The denominator for PRIME metrics can include patients who are assigned to a health care system, whether they have been seen or not, encouraging a more proactive approach.

Photo summer 2015 4“As physicians, we’re used to taking care of the patients who are sitting in front of us. Improved data and data governance will allow us to identify the patients who aren’t coming in,” said Dr. Tong. “It leads us down the path towards really transforming the system and becoming proactive.”

“It’s exciting for us to start using this data that we’ve collected and these structures we’ve set up to start putting some of our ideas into practice,” said Dr. Tong.

Measuring Trust

The first year of PRIME data has yielded encouraging results, and shows that California’s public health care systems are already performing at high levels on several metrics.  The “Clinician and Group Consumer Assessment of Healthcare Providers and Systems” (CG CAHPS) survey is a standardized measure of patients’ perception of outpatient care.

PRIME measures the percentage of patients who give their clinician the highest possible ratings – a 9 or 10 out of 10. This includes doctors, nurse practitioners, physician’s assistants and clinical nurse specialists.

Nationally, the 90th percentile for performance on this measure is for 70% of patients to rate their clinicians this highly. PRIME baseline data shows that on average, California’s public health care systems are already five points above this high performance goal. Twelve of our seventeen members meet or exceed the 90th percentile, and the rest are within striking distance, indicating the high level of trust that our members have earned from their patients.

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What's Next: SNI Programs in 2017

In addition to the ongoing support SNI provides to members to succeed in transforming care through the waiver programs, SNI is initiating two programs in early 2017.


Supported by Kaiser Permanente Community Benefit Northern California, SNI is strengthening data analytics capacity among public health care systems through its Data for Improvement program.  The program emphasizes four key areas of data analytics capacity (data quality, performance measurement, analysis of data, and acting on results) and provides access to experts, webinars, applied learning activities, and curated resources. CAPH/SNI members can log in to SNI Link to download materials and learn more about each of the program’s modules.


With support from the Blue Shield of California Foundation, SNI is launching ambulatory care redesign activities focused on strengthening empanelment, team-based care and panel management through a combination of workshops, in-person meetings and webinars.  CAPH/SNI members can log in to SNI Link to register for the webinars, access archives, and learn even more.

Learn More

To learn more, browse the rest of our website at www.safetynetinstitute.org. CAPH/SNI members can also access program materials register for upcoming events and webinars through SNI Link – our members’ only program portal.