CHCF’s goal is to bring about measurable, sustainable change to California’s complex health care system in service of our mission. To achieve this goal, we deploy not only funds, but also a broad range of other tactics, including convening key stakeholders to build consensus around difficult, pressing issues; identifying the most effective partners to create and spread change; encouraging others to join in solving key health care challenges; and using a range of communications strategies to deliver messages to the audiences who can help improve the health care system.

Collaboration is central to our work. Our program staff, who bring deep content expertise to the work of the foundation, build close relationships with leaders in the field. Together with our external partners, we develop plans and projects to address specific needs and achieve measurable impact.

The Team

CHCF’s Learning and Impact team works with colleagues across CHCF to support the design and implementation of effective strategies to drive improvements in California’s health care delivery system. This work includes building and improving systems that advance organizational learning, developing and monitoring metrics to assess the impact of our work, and pursuing opportunities to share what we learn with others in the field. Our aim is to ensure that every dollar is invested in service of our mission and goals and is in keeping with our strategy.

Learning from Each Other

Our internal peer review approach is core to our grantmaking process and to our organizational learning, and to our learning with our grantee partners. Staff preparation for peer review typically involves informative back-and-forth with the grantee, and the feedback provided by CHCF peers often raises useful questions and suggestions that strengthen the proposed project. Grants between $30,000 and $500,000 go through a CHCF staff peer review process. All grants over $500,000 also go to our board for approval. This graphic outlines CHCF’s internal grant review process:

CHCF’s Internal Grantmaking Process

Different levels of review based on dollar amount.
Updated September 2022.

 

CHCF staff also learn from each other by holding ourselves true to our strategy. When contemplating new bodies of work, we use the following criteria to assess whether a new area of grantmaking is a fit. These criteria guide us in making challenging decisions among many possible and worthy lines of work we could pursue.

Decisionmaking Criteria for New Bodies of Work

Criteria		Key Questions to Ask
Is this opportunity compelling?	Equity and strategic alignment	How will this proposal address the health equity gap for Californians eligible for Medi-Cal and the residual uninsured?
	Scale	How many people would it impact? How deeply would they be affected? How will this opportunity drive cost-effective care? What is the sustainability of the change we are seeking?
	Listening	How does this proposal allow for patient voice and experience to influence the work?
Is this opportunity well suited to CHCF?	Leverages strengths	Does this proposal leverage our reputation and inherent qualities as an independent, self-governing institution? Is it in line with our rigorous, data-driven, and evidence-based approach? Does it allow us to do things that CHCF could best do?
	Risk/reward	Is there sufficient material upside to justify potential risks? What are the opportunity costs?

Assessing Our Impact

At CHCF, we work to improve the transparency and accountability of California’s health care system. We try to hold ourselves to the same standard. Our semiannual dashboard presents our goals, how we operationalize these goals through our focus areas and bodies of work, and whether we are achieving those aims.

See the CHCF Impact Dashboard from March 2023 (PDF).

CHCF also tracks key environmental metrics (PDF). These high-level indicators help CHCF’s board of directors and its staff understand and track the health of the health care system. These metrics align with CHCF’s goals. They represent major domains in health care quality — such as access, patient experience, clinical outcomes, and cost. They also reflect our commitment to improving the health of Californians with low incomes, including a focus on Medi-Cal and reducing racial/ethnic disparities in care.

We recognize that these metrics are bigger than we are. It is not our sole responsibility to address them. They are also not a direct measure of CHCF’s impact. Their main function is to help us keep our eye on the bigger picture.

Sharing What We Learn

CHCF is committed to sharing what we learn, both internally and externally. We engage independent evaluators to help us learn from the work we fund, including documenting both successes and challenges. We may commission an external evaluation when we have made a program-related investment through our Innovation Fund, when we are considering making material changes to an existing portfolio, when we are considering broader rollout of a program, or when we are trying to determine next steps in longstanding bodies of work. These evaluation findings, which we share publicly, are meant to benefit our grantee partners, as well as other philanthropic organizations who may be working in similar areas.

Evaluations we’ve published in recent years include:

Health Systems — Crosscutting

• Evaluation of a Model Comparative Drug Price Resource
• Reflections on a Decade of Funding Public Hospital Systems
• Frequent Users of Health Services Initiative: Final Evaluation Report (PDF)
• Small Practices/Big Changes: Lessons from EHR Adoption in Tulare County (PDF)
• Evaluation of the CHCF Ambulatory Care Redesign Collaborative

People-Centered Care

Opioid Safety

• Tackling an Epidemic: An Assessment of the California Opioid Safety Coalitions Network

Serious Illness and End-of-Life Care

• Finding Focus: Reflections on a Decade of Work in End-of-Life Care
• In It Together: How Palliative Care Spread to All of California’s Public Hospitals

Laying the Foundation

• Health Care Leadership Program — 2010 Evaluation Focus: Social Network Analysis (Part 1) (PDF)
• Health Care Leadership Program — Interim Evaluation Report (PDF)
• Health Care Leadership Program — Program Evaluation Final Report (PDF)

Program-Related Investments

• Effect of Teledermatology on Access to Dermatology Care Among Medicaid Enrollees

Learning & Impact

• Measuring Foundation Performance: Examples from the Field
• Designing for Learning: One Foundation’s Efforts to Institutionalize Organizational Learning

Large Sunsetted Initiatives

• Collecting Patient-Reported Outcomes: Lessons from the California Joint Replacement Registry (PDF)
• Post-Pilot Evaluation of California Joint Replacement Registry Final Report (PDF)

Fast Facts About Our Grantmaking

• CHCF’s annual budget for grants and PRIs: $40–47 million
• Number of grants awarded annually (approximate): 450–500
• Number of PRIs made annually (approximate): 1–3