a vision for the future

It’s 2015, and one California town reveals how its individuals, institutions, and systems are stronger and more effective as a result of the investments that Blue Shield of California Foundation (BSCF) is making now. These investments – and strong relationships with local partners – help us to achieve our goals for California: high-quality, affordable care for all, and an end to domestic violence. While the images, names, and scenarios in this report are imagined, the vision and promise of these outcomes is real – and already underway. We invite you to learn more.

8:50 a.m. / JUNE 29, 2015

Gloria leaves her house and walks down Elm Street to her appointment, staring at the abandoned auto parts plant as she passes it. To think, this was once the city’s largest employer – and her own. All that changed in 2010 when the company closed down. Gloria and everyone else lost their jobs, health insurance, and their sense of stability. Now they’re turning it into an apartment complex of all things, she thinks, shaking her head.

But Gloria has more important things to think about. She’s eight-months pregnant and excited for her latest ultrasound today.

9:10 a.m. / JUNE 29, 2015

Gloria enters the community health center where she has received care for the past four years. After losing her job, it was the only place she could go without insurance. Fortunately, in 2011, she enrolled in her county’s Low Income Health Program (LIHP), one of the first in the state to cover its neediest, uninsured residents before they were able to transition to Medi-Cal in 2014. Read more about LIHP.

more about LIHP

California’s Section 1115 Medicaid waiver allows counties to develop Low Income Health Programs to provide coverage for childless adults not otherwise eligible for Medi-Cal. BSCF has provided 24 planning grants to counties to date and issued a report in April 2011 about those counties’ work to date.

Once the California Health Benefit Exchange began in 2014, Gloria secured new coverage and assumed she’d find a doctor elsewhere. But she’s been impressed with changes at the health center, from renovations and better customer service to a telehealth program with specialty care. They even coordinate records – in real time – with other providers: Gloria’s nurse practitioner goes over the reassuring results Gloria received after a recent visit to the endocrinologist. This more coordinated, integrated system of care was a key goal of BSCF’s Health Care and Coverage (HCC) program in 2011. Read more.

more about HCC

To achieve better coordination of care within the safety net – and better outcomes for patients – BSCF supported community health centers in 2011 as they developed electronic systems that transfer to or receive patient information from local hospitals. For example, BSCF granted $500,000 to the Health Plan of San Joaquin to support the implementation of health information exchanges between the public hospital, county health centers, county behavioral health centers, and the Community Medical Centers. Another $500,000 grant helped the Los Angeles County Department of Health Services develop clinical guidelines for an eConsult system between public hospitals and community health centers that will allow doctors and specialists to converse online about a patient’s needs.

For patients like Gloria, the health center has become a true provider of choice, not necessity. It all started in 2011, when BSCF shared eye-opening research about patient perceptions of community health centers and what low-income Californians will look for in a provider as health reform offers new options. Read more about these studies.

more about BSCF’s research

In June 2011, BSCF released results of a statewide survey it commissioned Langer Research Associates to conduct of poor and-near poor Californians ages 19 to 64. Respondents’ perspectives were designed to help safety net providers prepare for full implementation of the federal health reform law – and how it would affect patient choices and behavior. In July 2011, BSCF released a report by Viewpoint Learning that explores patients’ perceptions of and experiences at clinics, including why the Internet is an important tool for clinics.

The center also benefited from the flexible funding provided by BSCF’s Clinic Core Support Initiative. In 2011, an unrestricted grant helped the health center better adapt to the ever-changing healthcare marketplace by investing in more staff and updated equipment. Read more.

more about the Clinic Core Support Initiative

In 2011, BSCF’s Clinic Core Support Initiative provided more than $5 million to the state’s community health centers – reaching a total of more than $50 million in such funding over the past six years to more than 200 community health centers, free clinics, tribal clinics, and clinic consortia.

10:53 a.m. / JUNE 29, 2015

Six blocks away, the health center’s newly promoted executive director, Victor, runs up the steps of the county administration building. After working at the health center for six years as a program manager – often feeling burnt out – Victor found new motivation through the Clinic Leadership Institute’s (CLI) Emerging Leaders program. CLI helps strengthen the entire healthcare safety net by cultivating and empowering the next generation of leaders from California’s community health centers. Read more.

more about CLI

In June 2011, 21 community health center leaders from across California graduated as the third CLI cohort. They participated in interactive and instructive activities focused on strategic thinking, financial management, health policy, and other leadership skills. The Center for the Health Professions at the University of California, San Francisco is the administrator for CLI.

CLI participants implement individual projects at their health centers, and Victor organized group visits for high school students exposed to violence as a way of providing quality, cost-effective care in partnership with the local high school. This creative approach to strengthening how different health providers serve their community echoes the innovation challenge grants BSCF provided in 2011. Read more.

more about innovation challenge grants

In 2011, BSCF funded the Community Clinics Initiative to issue 13 “innovation challenge grants” to organizations across the state for creative approaches such as: reducing falls among elderly patients; increasing the rates of early care for pregnant Latinas; reducing unnecessary use of emergency departments; establishing a medical home for homeless patients; removing barriers for women seeking mammograms; expanding the use of patient navigators and home healthcare workers; and enhancing the use of call centers, health IT, and mobile medical units.

11:35 a.m. / JUNE 29, 2015

A member of the high school staff who has been instrumental to the success of Victor’s project is Patricia, the school’s coordinator for building healthy relationships among students. She and a local shelter have helped to train staff, students, and parents on the signs of dating abuse – and what to do about it. The program is modeled on a 2011 resolution passed by the Los Angeles Unified School District through the work of Peace Over Violence, a grantee of BSCF’s Blue Shield Against Violence (BSAV) program.

12:30 p.m. / JUNE 29, 2015

At lunchtime, Patricia is joining a quarterly meeting of local leaders – from domestic violence agencies, healthcare providers, and policymakers – to discuss implementation of the citywide violence prevention strategy modeled after a national prevention strategy from the Centers for Disease Control and Prevention.

1:52 p.m. / JUNE 29, 2015

Returning from the quarterly meeting is Meera Raja, the executive director of a nearby domestic violence shelter. She is working with her staff on how to improve their services for immigrant families. Meera identified cultural competency as a key goal for strengthening her organization following her 2011 participation in the Strong Field Project, BSCF’s effort to build a strong, coordinated network of domestic violence service providers in California. Read more.

more about Strong Field Project

The Strong Field Project, a four-year effort started in 2010, aims to build a strong, coordinated network of domestic violence service providers by developing individual leadership skills, stronger organizations, and expanded networking and knowledge-sharing opportunities that strengthen the entire field. Learn about its individual and organizational participants – and highlights – at: http://strongfieldproject.org/

Part of Meera’s work to improve cultural competency is beginning community outreach and prevention education in neighborhoods with immigrant families. She was also able to fund interpretation services through a core support grant from BSCF.

more about BSAV Core Support Initiative

Since 2002, Blue Shield Against Violence has awarded $10.8 million in core support to more than 100 California domestic violence organizations. In 2010, BSCF granted over $3 million through the 2010 − 2012 BSAV Core Support Initiative.

3:02 p.m. / JUNE 29, 2015

The shelter staff person responsible for community outreach is currently on the phone with Frank Chun from the Asian-American Community Center. He’s updating her on Lan, a woman who came to town in 2010 for a job at the auto parts plant. She became a fixture at the Asian-American Community Center, but after losing her job, her family experienced increased stress and, eventually, violence at home. Because the shelter had partnered with the Center on how to spot and address signs of abuse – using a cultural competency grant from BSCF – Frank’s staff was able to talk with Lan about city services available to her, including transitional housing – if that is what she wanted.

more about cultural competency grant

In December 2011, BSCF announced 14 grants to strengthen culturally appropriate domestic violence services for Native American/American Indian, Black and African American, and recent immigrant populations across California.

4:46 p.m. / JUNE 29, 2015

Lan walks down Elm Street with some trepidation – but also hope – as she surveys the new building that will be her temporary home as she works to live a life free of violence. It’s strange, Lan thinks: I’ll now live in this building where I once worked.

As she looks the apartments over, she notices a woman walking toward her, doing the same. She’s pregnant – and glowing from it – and they smile as they pass each other. It’s been a good day.

Thank you for exploring this possible – and attainable – future in California. We truly believe that providing access to high-quality, affordable care for all Californians, and ending domestic violence, is possible. At Blue Shield of California Foundation, we believe this requires thoughtful support of grantees’ short-term needs while also identifying the right strategies, policies, and partners for future change.


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Photos on slides 2, 3, 4, 7, 8, 9, 10, 12, and 15 by Noah Berger. Photo on slide 1 used via Flickr Creative Commons license.
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