California HealthCare Foundation
|Key people||Dr. Sandra Hernández, President and CEO|
|Area served||Improving health care in California|
|Focus(es)||Health care delivery, health care financing, chronic disease care, underserved and uninsured, public health, health care reform|
|Method(s)||Grants, program-related investments, and research/analysis|
Based in Oakland, California, the California HealthCare Foundation (CHCF) is a philanthropy that works “as a catalyst to fulfill the promise of better health care for all Californians” by supporting “ideas and innovations that improve quality, increase efficiency, and lower the costs of care.”
The Foundation primarily focuses on health care delivery and finance issues in areas such as enhancing the quality of care for the people with chronic diseases; reducing barriers for affordable health care to the underserved; and promoting transparency and accountability in the health care system.
The California HealthCare Foundation (CHCF) was one of two independent philanthropies created in 1996 as a result of Blue Cross of California’s conversion from a nonprofit health plan to the for-profit corporation WellPoint Health Networks. CHCF’s first responsibility was managing the sale of WellPoint Health Networks stock. Of the $3 billion yielded from this process, four-fifths of the proceeds went to create The California Endowment and the remainder, some $600 million at the time, stayed with CHCF. From its inception, CHCF has looked for opportunities to improve health care in California by supporting higher quality, greater efficiency, and broader access to care.
Dr. Sandra R. Hernández became president and CEO of the California HealthCare Foundation in January 2014. Prior to joining CHCF, Hernández was CEO of The San Francisco Foundation, which she led for 16 years. She previously served as director of public health for the City and County of San Francisco.
Hernández is an assistant clinical professor at the University of California, San Francisco, School of Medicine and maintains a clinical practice at San Francisco General Hospital in the AIDS clinic. She is a graduate of Yale University and the Tufts University School of Medicine.
Hernández is a former board member of Grantmakers In Health, the Council on Foundations, and the California Managed Risk Medical Insurance Board (MRMIB). She co-chaired San Francisco's Universal Healthcare Council, which designed Healthy San Francisco, an innovative health access program for the uninsured.
Previously, the foundation had been led for 18 years by founding president and CEO Mark D. Smith, M.D., M.B.A., a board-certified internist and clinical faculty member at the University of California, San Francisco.
The California HealthCare Foundation focuses its effort in these four areas:
Better Chronic Disease Care: This program works to improve clinical outcomes and quality of life for Californians with chronic conditions. It seeks to expand the number of providers who effectively care for patients with chronic conditions through engagement of patients and families and the use of technology. It also promotes appropriate care toward the end of life that is consistent with patients’ wishes. Projects include efforts to accelerate the use of chronic disease registries and electronic health records to improve care in the safety net; promotion of data-driven quality improvement initiatives; redesign of small practices using health information technology; and development of hospital palliative care programs.
Innovations for the Underserved: This program seeks to reduce barriers to efficient, affordable care for California’s underserved by encouraging, testing, and promoting lower-cost models of care. In addition to grantmaking, the foundation is expanding its use of program-related investment, to spark new innovations in medical and health care devices, technologies, and services.
Market and Policy Monitor: This program encourages greater transparency and accountability in California’s health care system. Through the CHCF California Health Care Almanac and other efforts, the foundation provides data and analysis on policy developments and market trends to inform decision-makers. This program is expanding its efforts to advance public reporting on health care provider and insurer performance, especially in the area of physician-level performance reporting.
Health Reform and Public Programs: The passage of the federal Affordable Care Act in 2010 created an opportunity to extend health coverage to millions of Californians. The Foundation is supporting analytic and technical assistance to California’s health reform implementation team on insurance exchange design and governance issues. CHCF will also work with the State of California to help develop options and recommendations for implementing select provisions of health reform legislation and promoting efficient solutions for determining people’s eligibility for subsidies or public coverage. Since health reform should increase enrollment in Medi-Cal by two to three million, the Foundation supports efforts to streamline eligibility screening, increase access to primary and specialty care, and improve the way Medi-Cal manages the care of its high-cost populations.
Some of CHCF’s initiatives include:
CHCF Health Innovation Fund: In November 2010, CHCF launched this $10 million program-related investment fund aimed at developing “innovative services, devices, and technologies that can significantly reduce costs and improve access to care in California.” CHCF solicited proposals from California businesses and nonprofits for funding in seed rounds from $50,000 to $3 million.
Health-e-App and One-e-App: Enrollment in Healthy Families (California’s Children’s Health Insurance Program [CHIP]) and other public programs used to involve completing a 28-page application to determine eligibility. In 1998, CHCF began an effort to modernize enrollment in public programs with the development of Health-e-App, a web-based application that streamlined the eligibility screening for low-income children. In 2003, working with The California Endowment, an online application called One-e-App was developed to guide low-income families through the process of applying for a range of health and social services programs, including not just Medi-Cal and Healthy Families, but also food stamps, Women, Infants and Children (WIC), and the Earned Income Tax Credit. Now nearly half of the applications for children’s health insurance in California are submitted online, and the nonprofit Social Interest Solutions oversees development and deployment.
CalQualityCare.org: In 2002, CHCF first began publishing ratings of nursing homes online at "California Nursing Home Search" (CalNHS.org). Within a few years, information was added for home health care and hospice services, as well as congregate living health facilities, assisted living, continuing care retirement communities, adult day health care programs, and adult daycare centers. To report on the quality of care in California hospitals, in 2007 CHCF launched CalHospitalCompare.org. In 2009, CHCF launched CalQualityCare.org, upgrading and updating CalNHS.org based on research conducted among key audiences, including consumers and long term care providers. As of 2014, CHCF had added ratings on medical groups and aggregated all these resources at CalQualityCare.org.
Physician Orders for Life-Sustaining Treatment (POLST): This standardized medical order form is printed on brightly colored paper and indicates which types of treatment a seriously ill patient wants or doesn't want if his or her condition worsens. Too often, conversations about end-of-life care, including medical interventions and intensity of care, don't occur. The POLST form, signed by both the physician and the patient, is a tool to capture these discussions, and it travels with the patient. CHCF has committed more than $2 million to promote use of POLST in California. The Coalition for Compassionate Care of California is working with a statewide taskforce and local community coalitions to implement POLST.
Retail Clinics: Typically staffed with nurse practitioners who provide diagnoses and prescriptions for a limited menu of medical services on a walk-in basis, retail-based health clinics have spread rapidly, expanding from 62 at the beginning of 2006 to approximately 1,000 in 2008. Retail clinics report high levels of customer satisfaction and are drawing patients from all socioeconomic groups. Recent data indicate they are able to provide care for a limited menu of services at 32% to 47% of the cost of a primary care office. CHCF has supported several studies on the retail-based clinic model – both nationally and in California – and its viability. CHCF has also published a guide and toolkit for adapting the retail clinic model to community health centers.
CHCF Health Care Leadership Program: This part-time, two-year fellowship offers clinically trained health care professionals the experiences, competencies, and skills necessary for effective vision and leadership of our health care system. Fellows attend six seminars and participate in ongoing learning activities. Participants broaden management and sharpen leadership skills, and gain unique insight into the trends and challenges facing health care leaders in California.
CHCF commissions and publishes dozens of reports each year. A selection includes:
- Health Care Costs 101, published as part of CHCF's California Health Care Almanac, provides general background on U.S. medical spending. It details how much Americans spend, on which services, and what proportion is paid directly by consumers.
- The recent adoption and use of smartphones by both consumers and providers of health care are the focus of the report, How Smartphones Are Changing Health Care for Consumers and Providers. The uptake of this technology is rapid; two-thirds of physicians and 42% of the public used smartphones as of late 2009, despite the recession that began a year earlier.
- Price Check: The Mystery of Hospital Pricing reports on consumer difficulties in obtaining health care prices for elective procedures at California hospitals. This communication gap poses challenges for anyone who must pay all or part of their medical bills, including the uninsured and people with consumer-directed health plans that typically include high deductibles.
In addition to the publications and resources offered at its main site, CHCF.org, the foundation offers these services:
- CalQualityCare.org: Information and quality ratings for hospitals, medical groups, and long-term care.
- CaliforniaHealthline.org: Daily digest of news, policy, and opinion.
- iHealthBeat.org: Online publication reporting technology’s impact on health care.
- Nationwide Health Information Network
- Venice Family Clinic
- Health care prices
- Health care in the United States
- Convenient care clinic
- List of hospitals in California
- List of California Health Districts
- Electronic Health Record
- California HealthCare Foundation, http://www.chcf.org.
- Susan Dentzer and Mark D. Smith, “Laying the Foundation for Catalytic Change,” Health Affairs February 2010, vol. 29 no. 2 318-323, http://content.healthaffairs.org/content/29/2/318.extract
- Bloomberg Businessweek Snapshot, http://investing.businessweek.com/research/stocks/private/snapshot.asp?privcapId=8206789
- Program-Related Investments, California HealthCare Foundation, http://www.chcf.org/grants/programrelated-investments
- "California HealthCare Foundation Launches Initiatives to Help State Implement Healthcare Legislation," Philanthropy News Digest, September 15, 2010, http://foundationcenter.org/pnd/news/story.jhtml?id=308100006
- Chris Rauber, “California HealthCare Foundation announces $10M ‘innovation fund,’” San Francisco Business Times, November 8, 2010, http://www.bizjournals.com/sanfrancisco/news/2010/11/08/california-healthcare-foundation.html
- Lee-Lee Prina, “California HealthCare Foundation Announces It Will Provide $10 Million in PRI Capital through New Fund; Proposals Sought,” HealthAffairs GrantWatch Blog, November 12, 2010, http://healthaffairs.org/blog/2010/11/12/california-healthcare-foundation-announces-it-will-provide-10-million-in-pri-capital-through-new-fund-proposals-sought-2/?cat=grantwatch
- CalQualityCare.org — About, http://www.calqualitycare.org/about
- "Physician Orders for Life-Sustaining Treatment (POLST)," California HealthCare Foundation, http://www.chcf.org/projects/2008/physician-orders-for-lifesustaining-treatment-polst
- Adapting the Retail Clinic Model to Community Health Centers: A Guide and Toolkit, California HealthCare Foundation, http://www.chcf.org/publications/2008/10/adapting-the-retail-clinic-model-to-community-health-centers-a-guide-and-toolkit
- "CHCF Health Care Leadership Program," Center for the Health Professions at the University of California, San Francisco, http://futurehealth.ucsf.edu/Public/Leadership-Programs/Home.aspx?pid=145
- Katherine B. Wilson, Health Care Costs 101, April 2010, California HealthCare Foundation, http://www.chcf.org/publications/2010/04/health-care-costs-101
- Jane Sarasohn-Kahn, How Smartphones Are Changing Health Care for Consumers and Providers, April 2010, California HealthCare Foundation, http://www.chcf.org/publications/2010/04/how-smartphones-are-changing-health-care-for-consumers-and-providers
- Devon Hill Associates, Price Check: The Mystery of Hospital Pricing, December 2005, California HealthCare Foundation, http://www.chcf.org/publications/2005/12/price-check-the-mystery-of-hospital-pricing