California Health Care Improvement Projects (CHIPs)

Unionize the Physicians at Alameda Health System (AHS)

Today, 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.

Developing a Physician Leadership Program at AltaMed Health Services, a Federally Qualified Health Center- Impact on Retention

My project has been to create a physician leadership program called Site Medical Director University (SMD-U) at AltaMed Health Services, the largest Independent Federally Qualified Health Center in the nation. With clinics throughout Los Angeles and Orange counties, our current leadership structure consists of a Chief Medical Officer, 3 Regional Medical Directors, and 15 Site Medical Directors (SMDs) that oversee each clinic. Thus, the SMDs are the functional leaders supervising over 250 Providers. I chose to focus on this group based on their crucial role in leadership, my own experiences as a former SMD, and the fact that SMD positions have the highest turnover of all providers in the organization.

In the past six years, 16 SMDs have left this position to either return to a non-leadership role in AltaMed or leave the company altogether. The reasons for leaving were a lack of time, proper training, and support.

SMD-U aims to provide current physician leaders an opportunity to grow in their positions as clinic leaders, build a sense of ownership and camaraderie, and provide practical leadership skills to support the most common daily issues. This CHIP aims to reduce SMD turnover while improving wellness, motivation, and work satisfaction through a sense of ownership, camaraderie, and leadership growth

Affordability Accelerator: Developing a road map to improve Patient Out-of-Pocket Costs and trustworthiness in healthcare

Healthcare prices are hard to understand and navigate for patients and healthcare teams. Health care affordability (out-of-pocket patient costs) is a leading health care concern for Americans and a key voting issue. More than half of Americans worry about the availability and affordability of health care, and more than a quarter have delayed care because of high costs. I am passionate about this work after having a friend lose her life savings due to healthcare costs and my own family has faced large medical bills without guidance to navigate our healthcare system.

As a nation and in California, we have missed the target to reduce out-of-pocket costs to patients, likely because there has been no clear roadmap of how to approach solutions, and key partners have traditionally worked in silos. 70% of patients across the country and 66% of patients in California hold employer-based, non-group, or Medicare insurance coverage. Thus far, among these insurance types, efforts to increase healthcare value have remained focused on reducing the total costs of care with payers and health systems benefiting, with little attention to rising out-of-pocket costs with nearly no accountability or protections for patients.

So I brought together patients, navigators, social workers, care teams, health system leaders, payers from across the country to develop solutions through an Affordability Accelerator. My CHIP aimed to create a roadmap to provide a path to reach these goals from a perspective of building infrastructure to support health system interventions. My team acknowledged that other payer reforms and patient protection legislation will be required to create large improvements. While the new No Surprises Act and Inflation Reduction Act take important steps toward Medicare price caps, price transparency, and balance billing for out-of-network care, efforts to improve affordability must be guided by care teams and supported by health systems to achieve consequential change. Participants identified strategies to better understand and align clinical and financial decisions throughout a patient’s experience prior to, during, and after care is rendered to develop new care pathways. The participants identified key financial friction points for patients and nine key improvement opportunities.