California Health Care Improvement Projects (CHIPs)
California Health Care Improvement Projects (CHIPs) are designed by CHCF Health Care Leadership Program participants with the goal of addressing meaningful challenges or opportunities in health care.
Browse CHIPs to leverage the work of CHCF alumni and find opportunities to collaborate in order to improve health for Californians.
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Partnerships for School Health Care Requirements
Mithu Tharayil, MDMy initial point of inquiry was to better understand what we mean by “equity” and how to operationalize it. In June 2020, employees throughout San Mateo County Health walked out to collectively grieve the murder of George Floyd by police and publicly commit to dismantling the structural racism within our health care system. But what would this look like? How could we translate broad statements into actual wellbeing for our communities? For me, we needed to start by asking our patients and communities these questions and collaborating to implement solutions. If patients determine our health care system’s improvement priorities and co-create solutions, we ensure that those most impacted drive solutions responsive to their experiences. While laying groundwork for community engagement, an urgent need arose with which we could pilot our efforts to pilot equitable care: nearly 1,000 students, mostly Latinx and uninsured, were being excluded or threatened with school exclusion due to school vaccination status. In a novel partnership, the health department, county medical center, and county office of education collaborated to develop temporizing solutions including pop up vaccine clinics, direct scheduling opportunities, and policy guidance discouraging school exclusion.
These measures mitigated the immediate problem, but the county needed to address structural health care inequities to prevent recurrence. I convened a steering committee representing schools, clinics, the health department, and the health plan. We interviewed families who came to these clinics to understand the barriers that resulted in school exclusions despite their efforts to meet requirements. This led to three arms of work: 1) standardized communications to communities, and between health and schools; 2) health care access with specialized services for newcomer students and families, and new mechanisms for schools to connect students to appointments; and 3) learning communities for school staff to support each other with health-related services. So far, this academic year, we have identified fewer school exclusions, have decreased wait times for health care appointments within the safety net clinics, and continue to push coordinated communication to prevent school exclusion.
October 25, 2023View/Download PDF
A Public Health Response to the Overdose Crisis in Los Angeles County
Brian Hurley, M.D., M.B.A.Los Angeles County (along with California and the remaining United States) is in the worse overdose crisis in our history, driven by fentanyl and methamphetamine. No community is unimpacted by overdose, which spares no racial, ethnic, socioeconomic status, or age group. The historic response to substance-related crisis – to encourage people who use drugs to seek substance use treatment – is a necessary but insufficient response with when not paired with robust prevention and harm reduction initiatives that reach the people most in need. 94% of people with substance use disorders do not obtain substance use treatment, and 96.8% of this group do not seek treatment because they are not interested in participating in treatment as usual. Responding to overdose therefore requires our reaching those who are not currently participating in treatment services.
October 25, 2023View/Download PDF
Developing an Advanced Practitioner Training Academy
Paige Thiermann, MD, FAAFPCalifornia is in a critical primary care shortage. In 2018 an estimated 45% of Californians had insufficient access to a primary care provider. This lack of access leads to increased morbidity, mortality and cost of care. This shortage is reflected in my own organization Neighborhood Health Care, an FQHC in San Diego. To effectively care for all of our assigned patients, we needed to expand our current workforce by 20%.
In 2020 we attempted to recruit clinicians, but numerous positions remained vacant for months, with no physician or experienced advanced practitioner applicants. There were, however, numerous new-graduate advanced practitioner applicants. These candidates were enthusiastic and mission-oriented but lacked experience and suffered disruptions in their training due to COVID.
In my CHIP I developed a training program to prepare recently graduated advanced practitioners to care for our complex patient population. The Advanced Practitioner Training Academy (APTA) focuses on providing high quality, evidence-based primary care, an excellent patient experience and easy access to appointments. Training consisted of precepted continuity clinics, specialty rotations and didactic sessions.
October 25, 2023View/Download PDF
Physician Leadership Development
Carmen Liang, DO, MPHEffective physician leadership at the front lines is critical to our health care system as it grapples with worsening workforce shortages, burnout, and attrition associated with the COVID-19 pandemic. The national workforce deficit is projected to be more than 45,000 for primary care and 87,000 for specialty care physicians (Bhardwaj, 2022), and the annual cost of one physician vacancy per year is up to $1 million or 2-3 times a physician’s annual salary (Shanafelt et al., 2017). Health care organizations are investing more in senior physician leadership development but not in early-career physician, who are appointed leadership positions based on clinical skills and willingness to help but do not feel prepared for these roles (Shanafelt et. al., 2021).
I interviewed 27 physicians to understand what they needed to feel prepared for their clinical leadership roles. When asked about desired leadership development opportunities, 80% of their responses referred to training programs; opportunities to gain experience from others; and coaching, mentorship, and sponsorship (Liang et. al., 2023). My landscape analysis of leadership programs for UCSF physicians early in their administrative leadership careers revealed a lack of viable options based on scope, cost, and effect on retention.
To address this gap, I decided to work towards building a leadership development program at UCSF for early-
October 25, 2023View/Download PDF
Addressing the Sexually Transmitted Diseases (STDs) Epidemic in Yuba County
Phuong Luu, MD, MHSSexually transmitted diseases (STDs) have increased exponentially in the past several years nationally and statewide. Yuba County as a small rural county in northern California has one of the highest rates of congenital syphilis with a crude rate of greater than 112.9 congenital syphilis cases per 100,000 live births. From 2017 to 2022, the rate of syphilis increased from 17 to 84.1 cases per 100,000.
In California, incarcerated individuals are among the individuals most impacted by STDs. This CHIP project aimed to implement an STDs opt-out testing program for all inmates coming into the Yuba County Jail – a facility with an average jail population in the 180s during the COVID-19 pandemic but is now back to its pre-pandemic level of mid-300s to low 400s. The STDs opt-out testing program was paired with public health staffing of part-time social workers and a nurse to provide social services linkages and medical/behavioral health linkages, respectively.
The planning and implementation of this CHIP project as a public health officer during the height of the COVID-19 pandemic was extremely difficult. This was made more challenging when the proposal to contract with WellPath as the jail medical provider to provide the STDs opt-out testing and treatment was denied by the CA Department of Public Health (CDPH) because WellPath is a for-profit company. Through the project lead’s persistence in providing justification for why WellPath was chosen, CDPH ultimately approved the contract with WellPath and the project successfully started in September 2022.
October 25, 2023View/Download PDF
Health Care at Home Model
Cynthia Lin, MDAt the height of the COVID-19 surges, hospitals were overwhelmed as the number of patients seeking care surpassed bed capacity. A significant bottleneck to hospital discharges in San Francisco was the delay in transferring to post-acute facilities due to the required 10 to 20-day quarantine period and lack of SNF bed availability.
There is a severe shortage of licensed SNF beds even as demand for SNF beds is increasing. Since 2001, the number of licensed SNF beds has decreased by 43% in San Francisco.
• Age 65 and older comprises 14% of city population (113,000). By 2030, population projections of 65 and older to comprise 20% of city population (192,000).
• 38% of San Francisco seniors 65 and older and 7% adults aged 18-64 report disabilities (80,000).
• By 2030, San Francisco would need 4,287 licensed SNF beds–an increase nearly 70% over current supply of 2,542 beds.
This CHIP project aimed to develop a SNF program at Chinese Hospital to address the increased demand for SNF beds in San Francisco and to further expand services by creating a SNF-at-Home program by utilizing the latest technology in remote patient monitoring, telehealth and wearables.
October 25, 2023View/Download PDF
Leading a Payor with a Clinician-Led, Value Driven Lens to Address Health Care Affordability
Ravi Kavasery, MDIn California, high health care costs have created widespread access and health problems for millions of Californians, particularly those with low incomes. 36% of Californians report having medical debt, and 1 in 10 Californians report having trouble paying medical bills.
Blue Shield of California is a non-profit health plan serving approximately 4.8 million members and with approximately $24 billion dollars in annual revenue. The organization’s core mission is to ensure all Californians have access to high-quality health care at an affordable price.
My CHIP project was to define a programmatic approach for Blue Shield of California to materially improve our management of health care costs, with the goal of lowering our insurance premiums for our members, improving health outcomes, and member experience. My approach to this CHIP project was to focus on three key actions: (1) developing a robust discipline of data-driven analytics and benchmarking of our health care costs and drivers, (2) leading through a clinician lens focused on quality and value, not cost reduction, and (3) scaling innovative payment models tying quality and cost together.
October 25, 2023View/Download PDF