Happy New Year!


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).

The New Year is a natural reflection point for all of us, and we at SNI are able to look back on a very successful 2017. We helped inform the policy and advocacy work of CAPH in this unsteady time. We provided extensive assistance to our member systems around performance measurement and reporting – especially around the core programs of the Medi-Cal 2020 waiver. And we worked to support and accelerate public health care systems’ learning and decision-making by convening leaders and facilitating conversations and connections, aimed at helping our members achieve high performance and deliver top quality care.

All told, in 2017 SNI held eight major in-person convenings where more than 500 attendees gathered together to learn, strategize, tackle tough questions and present on their successes. We conducted nearly 70 webinars with more than 2,000 participants, on topics ranging from the nuts and bolts of waiver program implementation, to successful practices for patient segmentation for care coordination, to nurse co-visits, to data visualization. Pages within SNI Link, our members-only online portal, were accessed more than 9,000 times by our 400 registered users.

In the last quarter of 2017, we held two events focused on PRIME. Our PRIME Data Summit brought together PRIME program leads and analysts for a collaborative session highlighting lessons learned from year two of the program, and sharing tactics for reporting success in the current (third) year. This was followed by a Waiver Integration Team (WIT) convening on trends in PRIME performance across systems and the application of a sustainability framework to hold those gains in the years ahead. A second WIT convening in December focused on the policy efforts underway to bring key supplemental payments into compliance with the Medicaid Managed Care rule, and the work ahead for public health care systems in this area.

Each of these examples tells the story of how SNI’s work reaches public health system leaders, providers, and ultimately, patients. Each also represents an opportunity for SNI to learn and improve. We take in every piece of feedback we receive, hold regular calls with our advisory committees, and check in with members to learn what our members have more questions about and what they’ve got down cold. Just like our members, we’re using the data we’ve collected in the last year to develop and refine our work moving forward, so that we can sustain and improve upon our own successes in 2018.

We hope you enjoy this edition of the SNI Forward.


Giovanna Giuliani
Executive Director
California Healthcare Safety Net Institute

By the Numbers: PRIME Performance

This fall, PRIME entities submitted data* for year two of the program, and the results were impressive, showing widespread improvement as well as sustained results where our members were already high-performing.

Of the 371 metrics for which payment was contingent on performance, our members hit their targets on 89% of them. Across the entire program in year two, including “pay-for-reporting” metrics such as innovative metrics and others that had not yet been established as pay-for-performance, public health care systems achieved 96% of their targets.

(*Data has not yet been finalized by DHCS)


Many of these “pay for reporting” targets have converted to “pay for performance” in this measurement year, with even more following in years four and five. For more on our members’ performance on individual metrics, see the data in our December public PRIME webinar.

These improvements translate into real results for patients. In the second year of PRIME, across our membership, an additional 25,000 patients were screened for tobacco use, and 16,000 more patients were screened for colorectal cancer.


In optional project 1.6 (Cancer Screening and Follow-Up), which just five members are participating in, an additional 4,700 women were screened for breast cancer in PRIME’s second year.

You can read the story of one of these women in our PRIME brief.

Members reported on several initiatives that were key to their success.
  •        Investing in IT and data analytics
  •        Strengthening and standardizing performance improvement
  •        Developing the workforce
  •        Implementing new processes and workflows
  •        Improving coordination and partnerships
  •        Enhancing patient engagement
The work California’s public health care systems did to improve in all of these areas led to improved population health management, success in PRIME, and better care for patients. You can learn more about each of these themes and see great examples from across our membership in our most recent public PRIME webinar.

Member Profiles: Quality Leaders Awards

Trauma Recovery Center
The Trauma Recovery Center uses a new model of care for survivors that combines outreach, clinical case management, and trauma-informed evidence-based mental health and substance abuse services, and will be the pilot and model on which others similar centers around the state will be based.
Targeting Patient Outreach to Increase Cancer Screenings in Primary Care
UCSF utilizes an automated telephonic outreach program and a workflow optimization dashboard to help ensure timely follow-up and care management. The program was rolled out at a pilot clinic site and helped lead to an 8-fold increase in the number of patients at that clinic screened for cancer.
Optimizing Technology for Reporting, Analysis, and Improved Outcomes
SCVMC made improvements to its EHR to enable features like adding patient care scores to patient schedules, allowing clinicians to better prepare for treating complex patients, streamlining patient flow, and incorporating the eConsult specialty referral platform to improve access to specialty appointments.
Telephone Visits
The RUHS telephone visit program allows established RUHS patients and their doctors to discuss test results, conduct medication management, or address certain chronic or acute conditions, without a physical clinic visit. Telephone visits account for about 7% of all RUHS primary care clinic encounters, nearly 8,000 annually.

What's next: SNI Programs in the upcoming quarter

Ambulatory Care Redesign: SNI will host an Ambulatory Care Leaders roundtable on March 1 on the topic of behavioral health integration, as well as a webinar on training staff to collect patient information regarding sexual orientation and gender identity (SO/GI).

Value Based Strategies: In 2018 SNI will launch a new program developed with support from the California Health Care Foundation to advance the capacity of California’s public health care systems to implement value-based strategies, where payment is more closely tied to performance. A kickoff meeting will be held in March.

System Transformation Spotlight: This quarterly webinar series will highlight innovative and impactful member initiatives that support success in all three of Medi-Cal 2020’s major programs. Our January 31 webinar will feature leaders from San Francisco Health Network presenting on the success of their call center.

Waiver Technical Assistance: SNI’s work helping public health care systems implement the Medi-Cal 2020 waiver continues, with regular webinars, and meetings, as well as resources and reporting guides. All of these resources are available to members on SNI Link.