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.