As I prepared to become president and CEO of the California Health Care Foundation, the image I kept returning to was of diving into the ocean, with high waves and strong, deep currents. The dramatic challenges confronting health care today are, like swimming in the sea, both invigorating and uncharted. Big data, personalized medicine, payment reform, cost transparency, quality care management, health-at-hand technologies, and advances in molecular biology changing the way we view diseases are but a few of the rapids to be navigated.
At the same time, California’s health care system must adapt to the changing laws, rules, and demographics of our state. One only has to look at the formidable implementation challenges of the Affordable Care Act to reach and enroll the young adult and ethnic communities to illuminate this.
As director of public health for the City and County of San Francisco, I saw the power of government and civil society to overcome such challenges; I also came to understand the inherent difficulties for government to regulate, legislate, and execute policies and programs that are in the public interest. As cochair of a team that created Healthy San Francisco, I witnessed the impact of shared responsibility by all stakeholders to design policy that reflects the best of community values.
As our state health care system is entering a period of rapid transformation, I feel like I am returning to my roots. As an AIDS clinician for 30 years, I have experienced heartbreak at the bedside and miracles of our health care system to address seemingly intractable problems. And in my former role as the CEO of The San Francisco Foundation for 16 years, I learned about the unique role and opportunity of philanthropy, which can catalyze new ideas and innovative solutions with grants and investments. CHCF can bring together stakeholders to help craft solutions that advance the health of our communities. And we can bring into focus issues with a nonpartisan lens to help policymakers and the public understand the challenges that lie ahead. So I am excited to lead and support the values of this special institution with our focus on improving quality and access and looking for innovative ways to challenge the ever-increasing and unsustainable costs of care.
I’m sure many of you reading this are wondering what will remain the same at CHCF and what might change under new leadership. CHCF has carved out an important role in many sectors of our state’s health care system, including:
Transparency. Since its founding, CHCF has been committed to promoting transparency through the publication of reports, surveys, data, and analysis. One example of this is the California Health Care Almanac, which provides the public, policymakers, industry leaders, and the media with an objective look at costs, coverage, and quality.
Collaboration. The foundation has always looked for ways to bring leaders together to advance better care. A good example of this effort is the California Improvement Network (CIN), a dedicated statewide community of high-performing organizations — public and private — that evaluate and promote effective approaches to managing high-cost, complex care for patients with chronic diseases.
Innovation. No one denies that the health care system needs a strong dose of healing itself. And change comes from unexpected places. The CHCF Health Innovation Fund invests in start-up companies with the potential to significantly lower the total cost of care and substantially improve access to care for underserved Californians.
Research and analysis. With the Affordable Care Act (ACA), payment for care will be determined, in part, by outcomes, rather than solely by volume. What will these changes mean, and how will they work? Our staff will provide timely, focused analysis and expertise on this and other issues associated with health reform.
Improving care for patients with complex medical and social needs. As one example, CHCF has promoted a long-running effort to help ensure that palliative care services exist at all of California’s public hospitals, and that the Physician Orders for Life-Sustaining Treatment (POLST) form is used in all appropriate care settings.
Just as health care is always changing, CHCF will adapt and evolve as well. We will continue to play to our strengths while we look for opportunities to help catalyze efforts to make health care better for all Californians. Stay tuned.
Dr. Sandra R. Hernández is president and CEO of the California Health Care Foundation. Prior to joining CHCF, Sandra 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. She also co-chaired San Francisco’s Universal Healthcare Council, which designed Healthy San Francisco, an innovative health access program for the uninsured.
Sandra is an assistant clinical professor at the University of California, San Francisco, School of Medicine. She practiced at San Francisco General Hospital in the AIDS clinic from 1984 to 2016. She was appointed by Governor Jerry Brown to the Covered California board of directors in February 2018. She currently serves on the Betty Irene Moore School of Nursing Advisory Council at UC Davis and the UC Regents Committee on Health Services. Sandra served on the External Advisory Committee at the Stanford Center for Population Health Sciences in 2016. Sandra is a graduate of Yale University, the Tufts School of Medicine, and the certificate program for senior executives in state and local government at Harvard University’s John F. Kennedy School of Government.