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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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
Simplifying Access to Behavioral Health Services Through Integrated Care
Jennifer Miyamoto Echeverria, MSW, LCSWIn the United States, 25% of adults are living with a behavioral health concern, yet more than half do not receive treatment. For those seeking out services, their Primary Care Providers deliver about 70% of all behavioral health treatments. Integrated care models provide primary care and behavioral health management in the same setting, making it easier for patients to access and for providers to communicate.
The idea to build an integrated care model in our Blue Shield Promise Primary Care clinics began in early 2020, right before the COVID-19 pandemic hit. My objective is to build an integrated care model with input from clinic leaders, providers, and staff to ensure that clear systems are established, workflows are defined, and seamless communication between medical providers and behavioral health clinicians. The goal is that 100% of the patients who score a ten or more on the PHQ-9 have a conversation with their provider about their referral options for behavioral health services and that referrals follow a clear workflow based on presenting needs to either the clinic LCSW or to the Social Services team.
This project is still progressing, but I will continue to see it through to ensure that the clinic has a clear structure to follow. In addition to the medical providers and the licensed behavioral health clinician, I have a team of community health workers who are also incorporated in the behavioral health referral process. The goal is to create an atmosphere where patients feel as though all of their providers are working together as a team to address all of their needs comprehensively.
October 18, 2022View/Download PDF
Unionize the Physicians at Alameda Health System (AHS)
Lilavati Indulkar, MDToday, nearly 70% of healthcare providers are employed by large corporate entities. While there are benefits to large healthcare systems, providers in these organizations are feeling disengaged and disempowered due to the inability to effectively advocate for their patients or themselves. This lack of voice contributes to provider burnout, directly affecting the quality of care being delivered and physician attrition.
At AHS, we saw an annual 11% attrition rate of quality physicians compared to the national average of 4-6%. The cost of replacing one physician ranges anywhere between $250K to $1M. In addition, we areconcerned about physician shortages, it is predicted that California will have the highest shortage ofhealthcare providers by 2030. After talking to numerous providers, I discovered that the main reasonsfor low morale were the inability to effectively advocate for patients, below market compensation andbenefits, and lack of influence on the workplace environment. My goal was to develop a retention planthat incorporated these factors to retain high quality physicians in a safety net system. Myunconventional but not unprecedented approach was to unionize the physicians at AHS.
October 18, 2022View/Download PDF
Creating A3 (Anyone, Anywhere, at Anytime): A Community-Inspired, Behavioral Health Crisis Response for Contra Costa County
Chad Pierce, PsyDWhen someone experiences a crisis – a fire, crime, or medical emergency – they call 911 with the expectation of getting immediate emergency services. However, when that emergency is a behavioral health crisis, there is currently no timely and clinically appropriate response, which too often results in unnecessary suffering, loss of life, criminalization, or incarceration. A3 addresses this enormous need by making behavioral health part of the emergency response system throughout Contra Costa County.
This project is important to me personally because of Miles Hall and many others who have died due to NOT receiving appropriate behavioral health care. Miles was a 23-year-old African American male who was tragically killed by law enforcement while experiencing a behavioral health emergency in our county.
This project is working to address the unmet behavioral health needs in Contra Costa County through A3. A3 will provide timely and appropriate behavioral health crisis services to Anyone in Contra Costa County Anywhere at any time.
The model is to have a Crisis Call/Dispatch Center to de-escalate crises by phone when possible, mobile response teams to intervene on site (co-responding with law enforcement when necessary), and the build-out of an alternative destination site, the A3 Hub. The A3 Hub will house the A3 Miles Hall Crisis Call Center, Behavioral Health Urgent Care Center, Peer Respite Center, and Recharge (sobering) Center to decrease visits to the Hospital Emergency Department, Psychiatric Emergency Services Department, and Detention Centers.
October 18, 2022View/Download PDF