California Improvement Network partners include a broad group of medical providers, health plans, local governments, and institutes. Below you can learn about their roles and resources in promoting better chronic disease care, as well as key quality improvement (QI) initiatives.

1. California Health Care Safety Net Institute (SNI)
2. California Primary Care Association (CPCA)
3. California Quality Collaborative (CQC)
4. Community Clinics Health Network (CCHN)
5. Community Health Center Network (CHCN)
6. HealthCare Partners Medical Group (HCP)
7. Humboldt-Del Norte IPA (HDNIPA)
8. LA Care Health Plan
9. Los Angeles County Department of Health Services, Clinical Resource Management (LAC-DHS)
10. Monarch HealthCare IPA
11. Partnership HealthPlan of California (PHC)
12. Redwood Community Health Coalition (RCHC)
13. San Francisco Health Plan (SFHP)
14. Sharp Rees-Stealy Medical Group (SRSMG)

 

California Health Care Safety Net Institute (SNI)

This is the quality improvement arm of the California Association of Public Hospitals, the trade association for public hospitals, representing 19 public hospitals, academic medical centers, and comprehensive health care systems, including 137 associated primary care clinics and multiple specialty care clinics across the state. Public hospital systems serve an estimated 2.4 million primarily low-income, uninsured, or publicly insured patients. (www.safetynetinstitute.org)

Key quality improvement initiatives include:

• Leading several collaboratives to improve diabetes care, patient access to care, and visit efficiency in outpatient public hospital clinics
• Supporting chronic disease registry and EHR implementations
• Spreading palliative care
• Infusing lean approach to operational efficiency in four public hospital systems
• Working closely with five hospitals and affiliated clinics to develop their infrastructure to better support ongoing QI
• Managing the Seamless Care Center Initiative, a two-year program launched in the fall of 2009, to further the quality goals of public hospital primary care clinics

California Primary Care Association (CPCA)

This statewide trade association represents 807 community clinics and health centers (CCHCs). Its mission is to strengthen member CCHCs and networks through advocacy, education, and services to improve the health status of their communities. (www.cpca.org)

Key quality improvement initiatives are represented under its Aligning Quality Improvement in California Clinics for Meaningful Use (AQICC-MU) project and include:

• Helping prepare California clinics for "meaningful use" of electronic health records (EHRs) to improve clinical outcomes and operational efficiency through four regional training and learning communities
• Building upon the past two years of the statewide Accelerating Quality Improvement through Collaboration (AQIC) project

California Quality Collaborative (CQC)

This statewide health care improvement organization works with commercial medical groups and independent practice associations (IPAs). It is dedicated to advancing the quality and efficiency of patient care in California and transforming outpatient practice by leveraging the relationships physicians already have with medical groups, IPAs, and health plans; together, they contract with 35,000 practices. (www.calquality.org)

Key quality improvement initiative goals for 2011-2014 include:

• Improving care for patients by testing and spreading systematic approaches to care for predicted high-risk individuals
• Reducing avoidable readmissions and emergency department visits by strengthening care coordination on behalf of the patient
• Equipping provider organizations to better engage patients as partners in their care; identifying and spreading models of patient self-management support
• Improving outpatient service delivery
• Programs in support of these goals are:
  - Inland Quality Collaborative
  - Complex Care Management Action Community
  - Avoid Readmissions through Collaboration
  - The Chronic Care Collaborative

Community Clinics Health Network (CCHN)

This consortium supports CCHCs in San Diego and Imperial Counties, including 16 clinic organizations with over 100 sites of care, serving over 650,000 patients annually. It collaborates with CCHCs and other community partners throughout Southern California to support high-quality care through a centralized QI program. (www.cchealthnetwork.com) 

Key quality improvement initiatives include:

• Working with clinic leadership to cross-walk and evaluate current measures with new and evolving measures such as meaningful use of electronic health records, patient centered medical home recognition, pay for performance initiatives, health care coverage initiatives, health information exchange initiatives, quality improvement initiatives, and clinic reporting requirements at the local, regional, state, and national levels
• Working with clinic leadership to assist clinics in transitioning from manual to electronic data collection
• Working with clinic leadership to prepare clinics for change and assisting clinic leadership teams in responding to health reform and other changes

Community Health Center Network (CHCN)

This consortium and MSO represents all FQHCs in Alameda County. It is owned and run by eight network organizations, which have more than 50 delivery sites in Alameda, Contra Costa, and Solano Counties. It serves a provider population of more than 250 primary care providers located in eight community health centers. (www.chcnetwork.org)

Key quality improvement initiatives:

• Population health and panel management
• PHASE program to prevent strokes
• i2iTracks Super User Group
• P4P program: measuring member clinic performance across ten indicators, including patient satisfaction, diabetic care, hypertension control, childhood immunizations, and breast cancer screening
• Collaborative EHR/PMS implementation of NextGen with goal of achieving improvements in quality, efficiency, and patient experience

HealthCare Partners Medical Group (HCP)

This medical group in Los Angeles County provides health care in California, Florida, and Nevada to over 800,000 patients. Some 140,000 patients are Medicare Advantage beneficiaries and another 450,000 members are commercially insured. Its network includes 500 full-time physicians under staff/group model, over 1,300 PCPs, and over 1,500 specialists in IPA model. (www.healthcarepartners.com)

Key quality improvement initiatives include:

• An overarching effort to identify and care for patients with the most complex conditions
• Implemented a "high-risk program" to provide the care needed by those patients
• To identify high-risk patients, a risk stratification system is used that collects the following data:
  - Hospital admissions and readmissions
  - ER utilization
  - Total cost of care
  - Death in the hospital
  - Patient satisfaction
  - Provider satisfaction
  - Completion of advanced directives
  - HEDIS measurements
  - P4P outcomes
  - CMS Five-Star Quality Rating System outcomes

 

Humboldt-Del Norte IPA (HDNIPA)

This IPA in Humboldt and Del Norte Counties represents 7,000 managed care lives. Its network includes 210 physicians, 80 mid-level practitioners, and 97 mental health professionals, including safety-net community clinic providers. (www.hdnipa.com)

Key quality improvement initiatives include:

• Transforming independent primary care practices into Patient-Centered Medical Home-ready practices via Primary Care Renewal 2.0 collaborative, "Red Carpet Care" for PERS PPO patients with complex needs, public reporting of performance data, and supporting improvement in clinician communication with patients and families
• Administering a robust P4P program
• Providing leadership in Humboldt's Aligning Forces for Quality Initiative

LA Care Health Plan

This Los Angeles entity is the largest public agency health plan in the nation, with over 800,000 members in Medi-Cal, Healthy Families, Healthy Kids, and LA Care Health Plan Medicare Advantage HMO. Its network includes over 10,000 physicians. (www.lacare.org)

Key quality improvement initiatives include:

• Diabetes Incentive Pilot: Eligible PCPs can earn up to $125 for optimal screening of members and control of diabetes symptoms 
• Diabetes Improvement Project: Facilitated pay for participation project
• Collaborating with vision care provider by piloting reminder calls to diabetic members due for annual eye exam
• Upcoming group-level incentive program aligned with the California P4P program to improve clinical quality, use of HIT, member satisfaction, and efficiency

Los Angeles County Department of Health Services, Clinical Resource Management (LAC-DHS)

This publicly supported Integrated Delivery Network (IDN) is governed by the LA County Board of Supervisors. It operates a network of three acute care hospitals, one rehabilitation hospital, two multi-service ambulatory care clinics, six comprehensive health centers, ten owned and operated health centers, 80 public-private partnerships, and over 4,000 physicians or practices. Membership of 700,000 patients is 67% uninsured and 26% Medi-Cal. (www.lapublichealth.org) 

Key quality improvement initiatives include:

• Clinical Resource Management (CRM) is one of several countywide and facility-specific performance improvement efforts
• Disease Management Registry (DMR) provides foundation for CRM's systematic approach to chronic disease care
• Electronic tools are used at the point of care to increase care quality for patients through decision support utilizing vital signs, clinical indicators, and pertinent medical history

Monarch HealthCare IPA

The largest IPA in Orange County, it contracts with all major health plans in California and has relationships with most Orange County hospitals. Its network includes over 2,500 physicians who care for more than 170,000 managed care patients. (www.monarchhealthcare.com)

Key quality improvement initiatives include:

• Covering all IHA P4P clinical measures: appropriate resource use, patient experience survey, and CMS Five-Star Quality Rating System
• Working with physician registries, electronic point of care reminder applications, physician progress reports with YTD status and targets, in-office physician and office staff trainings, patient reminder letters, patient direct referrals, patient telephonic interventions, collaboration with specialists, and various educational tools

Partnership HealthPlan of California (PHC)

This County-Organized Health System (COHS) is the Medi-Cal/public health plan for Napa, Solano, Sonoma, and Yolo Counties. It contracts with California to manage the care for over 160,000 Medi-Cal patients with small product lines in Medicare Advantage (6,000 patients), Healthy Kids (less than 1,000), and Healthy Families (less than 1,000). Its network includes over 400 primary care physicians, 1,200 specialists, 142 primary care clinic sites, and over a dozen hospitals including the UC system, CHW, Sutter, Kaiser, Adventist, and community-based hospitals. (www.partnershiphp.org)

Key quality improvement initiatives include:

• Measuring colorectal and breast cancer screening, diabetes care, high blood pressure control, and access to primary care, including P4P incentives and reminder letters
• Participating in Consumer Assessment of Healthcare Providers and Systems Program (CAHPS)
• Providing QI program bonus for PCPs

Redwood Community Health Coalition (RCHC)

This consortium represents 16 CCHCs in Marin, Napa, Sonoma, and Yolo Counties. It is dedicated to improving the health of its communities and assuring access to quality health care among the highest risk populations. It has a patient population of 168,000, with over 90% of patients living in a household earning less than $44,000 a year and with 38% of patients uninsured. (www.rchc.net) 

Key quality improvement initiatives include:

• Finalizing a set of approximately 25 measures to use for benchmarking among its health centers (will include clinical, operational, financial, and regulatory measures)
• Tracking four diabetes measures and two efficiency measures as part of its participation in a statewide community clinic performance improvement initiative (AQICC-MU)
• Tracking a number of clinical measures as part of its UDS reporting
• Working with Partnership HealthPlan's Primary Care Quality Improvement Program on a number of clinical and utilization measures
• Eight member clinics participating in Rapid Dramatic Process Improvement, an intervention program to improve key health center operations
• Holding semi-annual Quality Culture Series sessions for health center leaders; approximately four sessions per year for health center staff

San Francisco Health Plan (SFHP)

This Medi-Cal Managed Care plan also functions as the Third-Party Administrator (TPA) for San Francisco's Healthy San Francisco Program. The plan, which also covers Healthy Kids, Healthy Families, and Healthy Workers, has 61,000 members. Its network consists of six medical groups, six hospital systems, 57 primary care clinics, and 420 primary care providers. (www.sfhp.org)

Key quality improvement initiatives include:

• Providing coordinated patient-centered care for newly enrolled seniors and people with disabilities
• Improving systems of care, with a focus on leadership development and QI infrastructure at the clinic site
• Improving clinical care, with a focus on chronic care management, through technical assistance and incentives
• Improving the patient experience, with a focus on timely access and provider-patient communication

Sharp Rees-Stealy Medical Group (SRSMG)

This San Diego County medical group provides over 1 million patient visits at 19 locations throughout the region, with 1,850 employees and more than 400 physicians representing virtually every medical specialty. (www.sharp.com)

Key quality improvement initiatives are guided by six Pillars of Excellence:

• Quality: Top performing physician organization in California's P4P program for five consecutive years, 2005-2010
• Service: Increase in patient satisfaction rates from 12th to 81st percentile on national Press-Ganey ratings
• People: Employee engagement index in the 99th percentile for health care organizations. Physician satisfaction has improved over 20%
• Finance: 30% decrease in heart failure admissions resulting in over $1.5 million annual savings
• Growth: 11.5% increase in patient visits
• Community: Tens of thousands of community volunteer hours logged by physicians and employees