Project

California Improvement Network

Despite the availability of information about best practices in chronic disease care, many patients still do not receive the care and support they need to most effectively manage their conditions. The California HealthCare Foundation (CHCF) seeks to measurably improve chronic disease care in California by expanding the number of primary care providers (clinicians and systems) who use clinical data to drive improvements in care.

The California Improvement Network (CIN) was established as a social network to share ideas about improving care delivery. Since 2005, it has sponsored training for more than 600 health care professionals in specific quality improvement skills and has evolved into an organization of partners (see list below) who care for some 20 million Californians and actively work with more than 1 million patients with one or more chronic conditions. The CIN partner organizations work with clinicians from a broad range of outpatient settings in California. They include statewide organizations as well as regional groups, and represent private commercial medical groups, private community clinics, public hospital clinics, a county health department, and two Medi-Cal managed care health plans.

CIN partners are committed to measurement, accountability, and active collaboration as they focus on issues including:

• Use of clinical information systems to track and improve care for patients with chronic conditions at the individual and population levels;
• Techniques for diffusion of better models of care (for example, electronic decision support tools or improving clinical work flow); and
• Team care and engaging patients in their care.

Today, the CIN is a formal partnership between CHCF and selected improvement programs that introduce and support changes in multiple clinician practices involving large numbers of providers. To qualify, potential partners must have a mission that includes: improving outpatient chronic disease care for a population of patients across the state or in a geographic region; a senior leader accountable to the organization's executive leaders and/or board for improved outpatient care; a specific and documented plan for spreading elements of better chronic illness care across its clinical sites, with staff assigned to help implement the plan.

Partner organizations include:

• California Quality Collaborative. This organization, co-sponsored by the Pacific Business Group on Health and the California Association of Physician Groups, has engaged 97 medical groups and practice associations (about 14,000 primary care physicians and thousands of additional health care professionals) throughout California that provide care for more than 5.5 million patient lives.
• California Academy of Family Physicians. A statewide organization representing about 7,000 physicians.
• California Primary Care Association. A statewide organization of community clinic consortia representing more than 700 community clinic sites.
• Humboldt-Del Norte Independent Practice Association. This organization includes 27 primary care practices and 5 safety-net clinics in two counties and is recognized for its innovative approach to chronic disease care.
• Los Angeles Department of Health Services. A county safety-net provider that includes hospitals, health centers, clinics, and public-private partnerships with 100 organizations.
• L.A. Care Health Plan. A community-accountable health plan that serves nearly 800,000 residents in Los Angeles County through Medi-Cal, Healthy Families, and L.A. Care's Healthy Kids and Medicare Advantage Special Needs Plans.
• Partnership Health Plan. A Medi-Cal managed care plan that covers care at 130 sites in Napa, Solano, Sonoma, and Yolo Counties.
• Safety Net Institute of the California Association of Public Hospitals. This organization represents 16 public hospitals and 64 associated outpatient clinics across the state.

Over the next three years, the CIN intends to expand to include additional partner organizations. Along with participation in workshops, trainings, and conferences to increase effectiveness in spreading better chronic illness care, each CIN partner will receive customized coaching and support from national experts including the Institute for Healthcare Improvement (IHI) and the MacColl Institute at Group Health Cooperative. The partners have established a common set of metrics by which they can track progress.

Better Ideas for Chronic Care: Regional Conferences in 2006-07

Building on the positive response to the 2005 statewide Better Ideas Conference (see next section), CHCF sponsored nine regional conferences to foster working relationships among California clinicians leading improvement efforts across various sectors such as public hospitals, community clinics, commercial medical groups, small private practices, etc. Conferences were held in these counties and groups of counties: Alameda; Calaveras and Tuolumne; Monterey; Los Angeles; Merced; Napa, Solano, and Yolo; San Diego; San Francisco; and San Joaquin.

Conference — Chronic Disease Care: Better Ideas in Action

CHCF and CIN sponsored conferences in San Francisco in November of 2005 and 2008 designed for networking and sharing breakthroughs — large and small — in providing chronic disease care. The conferences were designed for those who have a stake in practicing better care: clinical staff, administrators, quality improvement staff, health IT staff, payers, and purchasers. Details on the two conferences, as well as the agenda and speaker materials are available through the Related CHCF Pages link below.