Welcome to this special edition of the SNI Forward, celebrating 20 years of SNI’s accomplishments and commitment to patient-centered, high-quality, and equitable health care.
The heart of SNI’s mission has always been to help public health care systems be the best they can be – providing resources, guidance, expertise, and cross-member sharing opportunities to ensure that all individuals, regardless of insurance status or any other circumstance, have access to high-quality health care. Since SNI’s inception in 1999, this mission has driven our work, resulting in many shared successes with our members, some of which are highlighted in this newsletter.
Public health care systems have long been at work assembling the foundation to support and cultivate these accomplishments. Even in the last three years since I stepped into the role of Executive Director, I am amazed to see the transformation of SNI and public health care systems under the Medi-Cal 2020 waiver, particularly our members’ courage and persistence to take on the challenge of value-based care and more complex system redesign efforts.
During this time, as members intensified their transformation efforts, SNI designed support services to help push them to the forefront of system change. A common thread tying these efforts together is the tireless commitment to health equity. Now, with large-scale system-wide initiatives underway to better address disparities and the social determinants of health, public health care systems are advancing this work further. And as we look ahead, addressing social needs alongside medical care, especially for those most in need, will continue to be a key focus area.
These successes have been achieved in true partnership with members. Without the expertise of our members and their willingness to participate in shared learning, SNI would not be successful. It is our privilege and honor to collaborate with such exceptional leaders, clinicians, and staff.
We hope you enjoy this newsletter and join us at our upcoming CAPH/SNI Annual Conference in December, where we will celebrate SNI’s successes further.
Giovanna Giuliani
Executive Director
California Health Care Safety Net Institute
SNI’s History and Progress
SNI, formerly known as the Public Hospital Institute, was established in 1999 based on the recognition that California’s public health care systems could make significant strides in care delivery and the health of their local communities. Early efforts demonstrate public health care systems’ important role in the community with a child passenger safety initiative to increase appropriate use of child safety seats among low-income children and a tattoo removal program to curb youth gang violence.
Between the years of 2002 to 2008, efforts coalesced around chronic care management, language access, culturally appropriate health care, and palliative care. During this time, SNI partnered with members to establish the Health Care Interpreter Network and roll out several cultural proficiency projects. Other key initiatives include a five-year palliative care initiative focused on reaching diverse communities and a chronic care management program, with a focus on addressing racial/ethnic disparities.
In 2010, the five-year Medi-Cal 1115 waiver, known as the Delivery System Reform Incentive Pool (DSRIP) provided a platform for large-scale delivery system transformation across public health care systems. SNI supported members’ efforts to establish primary care medical homes, reduce hospital acquired infections, and improve operational efficiency and patient experience.
Public health care systems’ achievements were impressive – not only in terms of patient care outcomes, but also the infrastructure developed, including electronic health records and data analytic platforms, which set the stage for more complex, higher stakes pay-for-performance programs.
Today, we are nearing the end of the subsequent 1115 Medicaid waiver, called Medi-Cal 2020. With more aggressive milestones, including incentives for value-based care to advance system transformation, SNI enhanced, refined, and expanded technical assistance for three key waiver programs: 1) Public Hospital Redesign and Incentives in Medi-Cal (PRIME); 2) the Global Payment Program (GPP); and 3) Whole Person Care (WPC). By providing support services in leadership development, data governance and analytics, value-based strategies, and care redesign, SNI has been and will continue to be a critical resource for public health care systems’ advancement in California.
Although we stand at a time of uncertainty, given the expiration of the Medi-Cal 2020 waiver, we know that the great work of public health care systems will continue. With accomplishments in DSRIP and the Medi-Cal 2020 waiver, public health care systems are poised to continue on the path of value-based care, and SNI is thrilled to be their partner on this journey.
Partnership with Members
As we reflect on the past and look to the future, SNI’s continued partnership with its members remains absolutely critical. The clinical and operational expertise of our member system leaders, and their experience delivering services to over 2.85 million individuals annually, is what allows SNI to be successful. With our partner, the California Association of Public Hospitals and Health Systems (CAPH), SNI is able to inform policy development and influence the design of Medi-Cal delivery system reforms.
Our members’ steadfast commitment to the safety net mission extends beyond their own systems. They regularly, without hesitation, jump at the opportunity to share their successes, challenges, and lessons learned from piloting and testing new and innovative approaches to improve care. SNI provides forums and connections to help foster this collaborative learning culture, which ultimately helps inform decision making, not only for SNI, but also for the member systems.
When it comes to data analytics, SNI assists our members with their own internal capacity to understand and stratify data for system-wide improvement. SNI identifies and shares successful best practices across public health care systems so that members can develop accurate and timely data analytics to support their front-line teams, which drives local improvement and system redesign to improve patient care.
SNI’s Board of Directors is another driving force of success for SNI. Their engagement and leadership sets the priorities of our organization and ensures that we are working towards shared goals representing the diverse needs of our member systems.
Thank You to Our Funders
Lastly, the work of SNI would not be possible without philanthropic support from our funders. With deep gratitude we thank our current and past sponsors for their commitment to ensuring high-quality health care for all.
Kaiser Permanente
California Health Care Foundation
Blue Shield of California Foundation
The California Endowment
The California Wellness Foundation
America’s Essential Hospitals
What’s Next
Highlights from SNI Programs in the Upcoming Quarter
SNI/CAPH’s Annual 2019 Conference, December 4 – 6 in San Diego, CA. Registration and more information available here.
Transforming Care Delivery and Improving Quality through PRIME (Webinar), Monday, December 16 (1-2 PST). Speakers include representatives from Los Angeles County Department of Health Services and University of California San Diego. Register here.
Save the Date! Whole Person Care: The Essential Role of Community Health Workers & Peers, February 13, 2020. This convening will help pilots further strengthen their community health worker/peer workforce to prepare for sustainability. Registration forthcoming.
QIP PY4Reporting Manual User Agreement AMAPQA CMS v20210125
End User Agreement
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION (“CPT®”)
CPT only copyright 2019 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
You, your employees and agents are authorized to use CPT only as contained in QIP PY4 Reporting Manual solely for your own personal use and only for participating in state governmental healthcare related programs supported by and/or administered by SNI. You acknowledge that the American Medical Association (“AMA”) holds all copyright, trademark and other rights in CPT.
Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this Agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, AMA Plaza, 330 North Wabash Avenue, Suite 39300, Chicago, Illinois 60611-5885. Applications are available at the American Medical Association Web site (http://info.commerce.ama-assn.org/ama-data-file-request-0).
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION (“CPT®”)
CPT only copyright 2019 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
You, your employees and agents are authorized to use CPT only as contained in QIP PY4 Reporting Manual solely for your own personal use and only for participating in state governmental healthcare related programs supported by and/or administered by SNI. You acknowledge that the American Medical Association (“AMA”) holds all copyright, trademark and other rights in CPT.
Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this Agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, AMA Plaza, 330 North Wabash Avenue, Suite 39300, Chicago, Illinois 60611-5885. Applications are available at the American Medical Association Web site (http://info.commerce.ama-assn.org/ama-data-file-request-0).
U.S. Government Rights
This product includes CPT which is commercial technical data, which was developed exclusively at private expense by the American Medical Association (AMA), 330 North Wabash Avenue, Chicago, Illinois 60611. The AMA does not agree to license CPT to the Federal Government based on the license in FAR 52.227-14 (Data Rights - General) and DFARS 252.227-7015 (Technical Data - Commercial Items) or any other license provision. The AMA reserves all rights to approve any license with any Federal agency.
Disclaimer of Warranties and Liabilities.
CPT is provided “as is” without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with SNI, and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.
This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.
Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled “I agree”.
Pharmacy Quality Alliance Copyright Statement
By agreeing to this policy, user accepts the following limitations of the QIP use of the Pharmacy Quality Alliance (PQA) Opioid measures and code sets: To accurately calculate the measure rates, the PQA NDC files are required. User acknowledges that the PQA measures and NDC files will only be used for the sole purpose of evaluating and improving opioid use for populations being served by Public Health Care Systems (PHS) and by District and Municipal Hospitals (DMPH) and will not be used for other purposes within user. Except for the purpose indicated above, the measures and NDC file will not be used in any other commercial product, service or value-added benefit. User also acknowledges that the information and lists will not be forwarded or provided to anyone outside of SNI, the California Department of Health Care Services DHCS, the PHS or the DMPH.
CMS MEDICAID ADULT AND CHILD CORE SET
License Agreements
Please review the licensing information below and indicate your agreement and acceptance.
LICENSE FOR USE OF PHYSICIANS' CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION (CPT)
End User Point and Click Agreement:
CPT codes, descriptions and other data only are copyright 2019 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).
You, your employees and agents are authorized to use CPT only as contained in the following authorized materials of Centers for Medicare and Medicaid Services (CMS) internally within your organization within the United States for the sole use by yourself, employees and agents. Use is limited to use in Medicare, Medicaid or other programs administered by CMS. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.
Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60654. Applications are available at the AMA Web site, http://www.ama-assn.org/go/cpt.
Applicable FARS\DFARS Restrictions Apply to Government Use. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60654. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.
AMA Disclaimer of Warranties and Liabilities.
CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this agreement.
CMS Disclaimer
The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT should be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.
Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "Accept".
LICENSE FOR USE OF CURRENT DENTAL TERMINOLOGY (CDT™)
THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED “ACCEPT”, YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.
IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED “DO NOT ACCEPT” AND EXIT FROM THIS COMPUTER SCREEN.
IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, “YOU” AND “YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.
1. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association web site, http://www.ADA.org/ .
3. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of restrictions apply to Government Use. Please click here to see all U.S. Government Rights Provisions.
4. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT IS PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESSED OR IMPLIED, INCLUDING BUT NOT LIMITED TO, THE IMPLIED WARRANTIES O F MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE. NO FEE SCHEDULES, BASIC UNIT, RELATIVE VALUES OR RELATED LISTINGS ARE INCLUDED IN CDT. THE ADA DOES NOT DIRECTLY OR INDIRECTLY PRACTICE MEDICINE OR DISPENSE DENTAL SERVICES. THE SOLE RESPONSIBILITY FOR THE SOFTWARE, INCLUDING ANY CDT AND OTHER CONTENT CONTAINED THEREIN, IS WITH (INSERT NAME OF APPLICABLE ENTITY) OR THE CMS; AND NO ENDORSEMENT BY THE ADA IS INTENDED OR IMPLIED. THE ADA EXPRESSLY DISCLAIMS RESPONSIBILITY FOR ANY CONSEQUENCES OR LIABILITY ATTRIBUTABLE TO OR RELATED TO ANY USE, NON-USE, OR INTERPRETATION OF INFORMATION CONTAINED OR NOT CONTAINED IN THIS FILE/PRODUCT. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third party beneficiary to this Agreement.
5. CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. IN NO EVENT SHALL CMS BE LIABLE FOR DIRECT, INDIRECT, SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES ARISING OUT OF THE USE OF SUCH INFORMATION OR MATERIAL.
LICENSE FOR NATIONAL UNIFORM BILLING COMMITTEE (NUBC)
These materials contain NUBC Official UB-04 Specifications (UB-04 Data), which is copyrighted by the American Hospital Association (AHA).
THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.
IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.
IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.
Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use UB-04 Data only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of UB-04 Data is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this Agreement. You acknowledge that the AHA holds all copyright, trademark and other rights in UB-04 Data. You shall not remove, alter, or obscure any AHA copyright notices or other proprietary rights notices included in the materials.
Any use not authorized herein is prohibited, including, by way of illustration and not by way of limitation, making copies of UB-04 Data for resale and/or license, transferring copies of UB-04 Data to any party not bound by this agreement, creating any modified or derivative work of UB-04 Data, or making any commercial use of UB-04 Data. License to use UB-04 Data for any use not authorized herein must be obtained through the American Hospital Association, 155 N. Wacker Drive, Suite 400, Chicago, Illinois, 60606. Applications are available at the NUBC website, http://www.nubc.org/.
The UB-04 Data included in this product is commercial technical data and/or computer databases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Hospital Association, 155 N. Wacker Drive, Suite 400, Chicago, Illinois 60606. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (December 2007) and FAR 52.227-19 (December 2007), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.
AHA DISCLAIMER OF WARRANTIES AND LIABILITIES. UB-04 Data is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. The sole responsibility for the software, including any UB-04 Data and other content contained therein, is with the Medicare/Medicaid Contractor or the CMS; and no endorsement by the AHA is intended or implied. The AHA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The AHA is a third-party beneficiary to this Agreement.
CMS DISCLAIMER. The scope of this license is determined by the AHA, the copyright holder. Any questions pertaining to the license or use of the UB-04 Data should be addressed to the AHA. End users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE UB-04 DATA. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.
In 2010, the five-year Medi-Cal 1115 waiver, known as the Delivery System Reform Incentive Pool (DSRIP) provided a platform for large-scale delivery system transformation across public health care systems. SNI supported members’ efforts to establish primary care medical homes, reduce hospital acquired infections, and improve operational efficiency and patient experience.