Application for Addressing Anti-Black Racism in California’s Delivery System

Date posted: November 17, 2023

Request for Proposals Application Form

This request for proposals (RFP) solicits applications for grants to support quality improvement projects in health care delivery settings. Projects must address anti-Black racism in a health care system in California, with the goal of improving Black health equity. Award amounts will range from $30K to $150K over two years. The deadline for applications is Wednesday, January 31, 2024.

Proposal Title and Monetary Request

Title:(Required)

Total Amount Requested (Not to Exceed $150,000):(Required)

Organization Information

Organization Name:(Required)

Organization Legal Name (If Different):

Street Address:(Required)

City/State/Zip(Required)

Tax ID Number or EIN:(Required)

Organization Type:(Required)

Tax exempt, charitable (i.e., 501[c]3 or government agency)

For-profit organization or individual consultant

Other

If Organization Type Is "Other," Please Explain:(Required)

Upload W-9 (PDF Only)(Required)

Accepted file types: pdf, Max. file size: 100 MB.

Primary Contact

Primary contact has the primary responsibility of overseeing the activities of the grant or contract. May be referred to as the principal investigator, project director, or project lead.

Full Name:(Required)

Title:(Required)

Street Address:(Required)

City/State/Zip:(Required)

Phone:(Required)

Email:(Required)

Payment Contact (Required If Different from Primary Contact)

Payment contact for the person or department that receives and processes grant or contract payments. Note: CHCF issues payments through bill.com.

Full Name (or Department):

Title:

Street Address:

City/State/Zip:

Phone:

Email:

Authorized Signer Contact (Optional Except for Fiscal Sponsors)

Contact information for an official of the organization (if different from, or in addition to, the primary contact) with the authority to sign the agreement for the award. This information is optional except for fiscal sponsors and is used to help obtain official signatures for the award.

Full Name (or Department):

Title:

Email:

Project Information

Project Description: Please describe the objectives of your proposed project and how it will address equitable clinical quality of care and incorporate at least one other domain of the NCQA Health Equity Quality Measurement Framework, which includes equitable experience of care, structures of care, social interventions, and access.(Required)

How do you propose to advance Black health equity in your proposed project? What parts of your intervention will improve the clinical quality of care for the Black Californians you serve?(Required)

What measurable clinical impact do you hope this project will produce? Note: These may be process measures like increases in colorectal cancer screening rates or outcome measures like increased percentage of patients with hypertension whose blood pressure is in the target range for a specified period. Whichever you choose, the clinical quality measures must be tightly linked to health outcomes.(Required)

How will you measure clinical impact? Note: If you are proposing a process measure, please specify how that measure is related to clinical outcomes (e.g., how increased colorectal cancer screening is linked to colorectal cancer rates).(Required)

What impact will you seek in either equitable patient experience, structures of care, access, or social interventions? For example, for structures of care, you might measure improved time to follow-up appointment after positive finding on a cancer screening.(Required)

How will you assess impact in your chosen nonclinical domain of equitable care?(Required)

Please describe how this project might be integrated into operations if the project proves successful. Although we hope for success, we realize that some good ideas don’t pan out. This work is not easy. But we would like to scale and spread those projects that do succeed at improving outcomes for Black Californians. What steps would you need to take to get approval to integrate a successful program into operations at your institution? In what time frame would it be feasible to make the change (e.g., implement a Black hypertension clinic as a regular part of operations)?(Required)

Your Organization

Please describe your practice, including racial demographics of the patient population, insurance mix, and the setting of your proposed project (e.g., community clinic, hospital emergency room, internal medicine unit of a large medical center, pediatric hospital cancer unit — all medical settings are eligible).(Required)

Your Team

Please name the members of your team and describe their roles on the team and their expertise in equitable care, quality improvement, and other areas pertinent to the proposed project.(Required)

Do you require outside expertise to help you assess your impact, or do you have internal capacity? (Note: While our intent is to fund internal capacity that can be brought to scale and sustained, grant funds can be used for internal staff or external consultants to assess impact of the project.)(Required)

Budget

Guidelines for submitting your budget can be found at www.chcf.org/grants/applicant-resources/submitting-proposal/

What is your overall budget, how much of it is for intervention, and how much of it is for evaluation?(Required)

Please upload your completed budget form.(Required)

Accepted file types: pdf, Max. file size: 100 MB.

Please upload your budget justification. The budget justification should give the rationale for each line item in the budget. It should not exceed four pages.(Required)

Accepted file types: pdf, Max. file size: 100 MB.

Letter of Leadership Support

Please upload the letter for leadership support. This letter should be no more than one page and should be submitted by either the chief medical officer, chief quality officer, chief operating officer, or chief executive officer.(Required)

Accepted file types: pdf, Max. file size: 100 MB.

Demographic Information

The California Health Care Foundation (CHCF) is committed to promoting diversity, equity, and inclusion (DEI) through its grantmaking, culture, and organizational operations. For a full statement about our commitment to DEI, please read CHCF’s DEI vision statement. In support of this commitment, CHCF is collecting grantee demographic information to indicate to us the diversity represented by our grantees.

While we acknowledge that diversity encompasses many facets of identity (including race, ethnicity, gender identity, sexual orientation, physical ability, and religion), we are narrowing the focus of our data collection to race and ethnicity. This decision aligns with other data collected across our work, including data reflected in our widely referenced 2021 Almanac Health Disparities by Race and Ethnicity in California: Pattern of Inequity.

Please answer the questions below. The information you provide for questions 1 and 2 will be pooled with data from other grantees and shared in aggregate on CHCF’s website; information provided for question 3 is used solely for internal learning purposes. Unless informed otherwise, such as through a request for proposals, answers to these questions will not be used in funding decisions, nor will they impact your award.

1. Please provide the race and ethnicity of the project director for this proposed engagement. The project director is the person with the primary responsibility of overseeing the activities of the award and may also be referred to as the principal investigator, primary contact, or project lead. If the grantee is a fiscal sponsor, the project director should be a person from the sponsored organization:

If Other, Please Explain

2. Please list each project team member and the race and ethnicity they self-identify as. Project team members are defined as those who will work closely and directly on the activities of the award and may include subcontractors. Suggested racial and ethnic categories include: American Indian / Alaska Native, Asian / Asian American, Black / African American, Latino/x, Multiracial, Native Hawaiian / Pacific Islander, and White.

3. Optional: Please share any official diversity, equity, and inclusion statement issued by your organization or describe how DEI is reflected within your organization, such as in how or with whom you work.

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