How We Plan to Achieve This Goal

CHCF's Innovations for the Underserved program focuses on encouraging, testing, and promoting lower-cost models of care by using the foundation's resources to catalyze the growth of low-cost, efficient health care products and services that focus on providing accessible and high-quality health care for underserved Californians. We support this goal through grants and program-related investments.

Why We Focus on This Goal

Millions of Californians cannot afford to buy the health care they need or to pay for insurance to protect against the cost of catastrophic illness or injuries. The cost of employer-based health coverage for a family represents more than three-quarters of a minimum-wage earner's paycheck. The result is that one in five Californians have no insurance, including one of every three Latinos. And while the Affordable Care Act of 2010 will insure millions of uninsured Californians in the next several years, there is little in the new law to stop the spiraling costs of care.

For example, new and expensive diagnostic tools and procedures, which raise the cost of care, are often used instead of well-tested and lower-cost approaches to care, even where evidence shows that the lower-cost approaches are efficacious. CHCF focuses its efforts on helping to create new markets and reshaping existing ones to deliver simple, convenient, low-cost care to underserved Californians who struggle to access and afford medical care through the current system.

The foundation believes that investing in more efficient technologies and new models of care — including those that use providers like nurse practitioners and dental hygienists at their highest level of training — can increase the number of Californians who are getting affordable, appropriate care.

"New and exciting ways to deliver care for underserved populations often can't get the same kind of funding and support as high-cost and high-tech medical advances because the traditional funding sources — like venture capitalists and banks — are focused on larger, more profitable investments," says Margaret Laws, MPP, director of CHCF's Innovations for the Underserved program. "We strongly believe that foundations can play a role in funding lower-cost, high-quality care for the underserved."

For details, see a snapshot of statistics (PDF) on health coverage costs, sites of care for the poor, Medicaid rates for periodic oral exams, and more.

The history of American industry shows that these kinds of "disruptive innovations" can work. For example:

• The invention of personal computers replaced more expensive mainframe computers, and now cheaper and more convenient handhelds are replacing PCs for many functions.
• Southwest Airlines revolutionized the airline business when it originally targeted customers who took buses, rather than planes, by pricing their tickets significantly below established airlines.
• The introduction of clinics into retail stores allowed lower-cost nurse practitioners to provide quick and convenient health care for simple medical needs.

The Innovations for the Underserved program looks for similar opportunities for Californians to obtain their medical care in the least restrictive, most appropriate, and most cost-effective way.

This figure conveys the kinds of change that the Innovations for the Underserved program promotes. Based on Clayton Christensen's work on disruptive innovation, we believe high-quality, lower-cost models of care can be created by moving to lower-cost providers in lower-cost settings, often enabled by new technology that lets these providers safely and effectively perform more sophisticated tasks.

The three examples in red show how real CHCF efforts are demonstrating these principles. Kiosks allow individuals to use a validated computer program to diagnose urinary tract infections (UTIs), moving care down the cost continuum from the hospital to the outpatient clinic, using provider time more effectively, and avoiding long delays for patients. This process is also working with retail clinics and diabetic retinopathy screening.

Key Initiatives

Examples of projects the Innovations for the Underserved program is supporting include:

Alternative sites of care. Supported exploration of retail or "express" clinics in the safety net, and launched a pilot using kiosk-based care for diagnosis and screening. Read more about retail clinics and medical kiosks.

As of September 2010, the project had UTI diagnostic kiosks in Bay Area and Central Valley emergency departments, urgent care sites, and Planned Parenthood clinics, and had developed and is testing reproductive health and STD/STI screening modules for the kiosk.

Next steps are to evaluate results of kiosk pilots and explore expansion to other sites and medical conditions.

Stanford Biodesign partnership. Working with a multidisciplinary Stanford University program to encourage innovation in devices and technologies to improve care and lower costs.

In the 2009-10 academic year, Stanford Biodesign teams conducted observations in safety-net settings and identified more than 200 innovation needs; 20 of these ideas were developed in prototype, including five targeting safety-net needs.

Next steps are to expand the Stanford Biodesign partnership to include CHCF leadership fellows and evaluate potential grants and investments for CHCF.

Specialty Care Safety Net Initiative. Working with the Center for Connected Health Policy to link all five University of California medical campuses to clinics and hospitals across California to provide telehealth specialty consults to underserved patients. Read more about the SCSNI.

As of September 2010, the project had initiated consults in eight medical specialties. The program is being expanded to cover 40 sites across California and is evaluating models for sustainability.

Program-Related Investments. CHCF launched a Program-Related Investment fund in fall 2010, providing investment capital for both nonprofit and for-profit companies with innovations that can lower cost and improve access.

What We Are Working Toward

All Californians will have access to providers at convenient times and locations, at a cost they can afford. The system will enable and facilitate use of appropriate, timely, and lower-cost services while optimizing use of costly and scarce services, such as specialists.

Principles That Guide Us

• Focus on affordability and value to low-income, underserved Californians
• Promote innovations that lower the cost of delivering quality services
• Encourage use of technology (with privacy safeguards) as a key enabler
  

For More Information

See highlights of this program's publications and projects and the list of staff.