| Founded | 1996 |
|---|---|
| Location | Oakland, California |
| Key people | Mark D. Smith, M.D., M.B.A., President and CEO |
| Area served | Improving health care in California |
| Focus | Health care delivery, health care financing, chronic disease care, underserved and uninsured, public health, health care reform |
| Method | Grants, program-related investments, and research/analysis |
| Employees | 50 |
| Website | www.chcf.org |
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.”[1]
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.
Established in 1996, CHCF has more than $750 million in assets and has paid out more than $500 million to support its programmatic work.[2][3]
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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.[2]
Since its creation in 1996, the foundation has been led by Mark D. Smith, M.D., M.B.A., a board-certified internist and clinical faculty member at the University of California, San Francisco. Smith also serves as an attending physician at the Positive Health Program for AIDS care at San Francisco General Hospital. He is a member of the Institute of Medicine and serves on the board of the National Business Group on Health. Smith was appointed to chair the IOM committee on "The Learning Health Care System in America," a two-stage consensus study that began in January 2011.[4] He has served on the editorial board of the Annals of Internal Medicine and has participated on the Performance Measurement Committee of the National Committee for Quality Assurance.[5]
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.[6]
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.[7][8]
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.[9][10]
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.[2]
CalHospitalCompare.org: In 2004, CHCF began working with a diverse group of California hospitals and health plans to develop a standardized report card on hospital quality of care. That group, known as the California Hospital Assessment and Reporting Taskforce (CHART), together with the University of California, San Francisco, collected data and in 2007, CHCF launched CalHospitalCompare.org. The website tracks dozens of hospital performance measures and combines quality information from many sources. As of March 2010, more than 240 California hospitals – representing 86% of acute hospital admissions statewide – have participated in the voluntary reporting program. The website is a free service, developed with input from consumer focus groups, and available in English and Spanish. Hospitals are rated on patient satisfaction measures and specific conditions, such as heart bypass surgery, maternity care, and pneumonia treatment.[11]
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.[12]
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.[13] 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.[14]
CHCF commissions and publishes dozens of reports each year. A selection includes:
In addition to the publications and resources offered at its main site, CHCF.org, the Foundation offers these other services:
In a 2010 article for Grantmakers in Health, CHCF CEO Mark Smith described the foundation’s philosophy of programmatic risk – whether the foundation is prepared to make a grant with a significant chance of not achieving its main objectives. In the case of CHCF, he noted that the founding board of directors encouraged staff to take on at least some grants “that were riskier than we might have liked had we been operating alone. This fact – that the organization has grown up along with, and in the shadow of, The California Endowment – has continued to play an important role in the consideration of our appetite for risk.”[18]
Smith discussed the foundation’s methodology for assessing risk in advance of grantmaking, as well as ways to make failures more productive, with lessons for staff, lessons for the board, and the dissemination of lessons to the field. While dissemination of lessons to the field can be humbling, Smith wrote that this effort can make failures productive. He cited CHCF’s response to its unsuccessful multimillion dollar investment in the Santa Barbara County Care Data Exchange, an early attempt to build technology that allowed local health care providers to share patient information across care settings. While the project did not ultimately succeed, it provided a number of lessons on the political, business, and operational challenges of exchanging patient data. CHCF commissioned several research papers, which it distributed widely, and supported a special section in the journal Health Affairs, which reviewed the history of the project and included an independent evaluation, commentaries by participants and experts in the field, and a foundation perspective on the experience.[19] “By assessing the risk of a grant or initiative, mitigating them where possible, and sharing misfires with the wider community, the public is best served,” wrote Smith. “In this way the failure of one philanthropic effort contributes a building block for future success.”