Health Care in California: Improving Delivery and Financing Systems Foundation Report 1999–2001 Mission To expand access to affordable, quality health care for underserved individuals and communities and to promote fundamental improvements in the health care status of the people of California. Foundation Report 1999-2001 Contents Message from Board Chairman........................................................................................................... 3 Message from the President............................................................................................................... 4 Health Care in California: Improving Delivery and Financing Systems..................................................... 8 Program Areas................................................................................................................................... 20 Board Grants and Contracts Awarded............................................................................................... 27 President’s Grants and Contracts Awarded........................................................................................ 57 Grant Application Process................................................................................................................. 63 Financial Statements......................................................................................................................... 64 Staff.................................................................................................................................................. 73 Board of Directors............................................................................................................................ 74 1 CALIFORNIA HEALTHCARE FOUNDATION 2 Foundation Report 1999-2001 Message from the Board Chairman N THE SIX YEARS SINCE OUR CREATION, Established in 1996 as a result of the conversion I the California HealthCare Foundation (CHCF) has tried to spark positive changes in California health care policies and prac- tices by supporting and disseminating new of Blue Cross of California to for-profit status and its merger with WellPoint Health Networks, Inc., CHCF has evolved into an organization that focuses on improving delivery and financing research about key trends, business practices, and systems in California health care. Under the con- policy implications; sponsoring innovative version agreements, CHCF received 80 percent demonstration projects; and promoting the wise of WellPoint’s outstanding shares in 1996. Over and innovative use of technology. As a result of the intervening years, as directed by the conver- our work, both alone and in partnership with sion agreements, we have sold our Wellpoint others, we have helped to streamline access to stock and have transferred the bulk of the pro- government health programs, provided con- ceeds (a net $2.5 billion) to our sister founda- sumers with materials to make better informed tion, The California Endowment—the principal choices about their health care, and brought philanthropic product of the conversion. stakeholders with often divergent opinions In our first biennial report, we promised to keep together to talk about improving the way health you posted on our progress. In this, our second care is structured and paid for in California. report from the Foundation, we do just that. But because California’s complex market changes Although our focus has sharpened, expanding rapidly, it is critically important for our organi- access to health care and improving the health sta- zation to remain nimble and to ensure that it tus of the people of California remain our goals. continues to use its resources in the most respon- sible way possible, for the greatest impact. During the past year, our Board and staff have been involved in a “strategic sharpening” effort. William H. Hastie, Esq. We have emerged from this process humbled by Chairman, Board of Directors the magnitude of the work that lies ahead, but with greater clarity about how best to direct our tools and talents. 3 CALIFORNIA HEALTHCARE FOUNDATION Message from the President ALIFORNIA IS A STATE OF MULTIPLE Health care delivery systems must operate in C REALITIES. During the past several years, Silicon Valley and its high tech corporations brought wealth to many Californians, yet nearly 2 million children remain highly populated urban areas, suburban areas, and sparsely populated rural settings, each with unique challenges to providing and financing care. Some of these challenges are more acute in uninsured today. California’s burgeoning biotech- California, but few are unique to us. nology industry is investing in the development To make improvements in the health care system, of genetically based biopharmaceuticals that answers are needed to a wide range of difficult could dramatically improve the lives of those questions. How can we reduce the numbers of with diabetes, asthma, and cancer; yet, nationally, uninsured children and adults? What conditions California ranks in the bottom quarter of states and capabilities must be in place to improve the in immunizing its young children. quality and delivery of health care? How do we California is one of the most demographically rein in rising pharmaceutical costs without dis- diverse states in the nation; with that come couraging new research into drugs that can diverse, and competing, health care needs. improve and sustain lives? What can be done to 4 Message from the President ensure that Medicare patients have a choice of Pharmaceutical Spending per Resident: California vs. United States health plans in their counties? How will we address the shortage of registered nurses and other $500 health care workers to assure our aging population $420 has access to adequate care? How will financially $400 Retail Dollars per Resident per Year $356 troubled hospitals cope with the need to mod- $313 ernize and complete required seismic upgrades? $300 $281 $239 What regulatory and policy changes will lead to $211 $200 greater financial solvency for medical groups? $100 While acknowledging the challenges, we also rec- ognize indicators of positive change. Increasingly, $0 1997 1998 1999 performance data are available to help educated United States California health care purchasers influence care delivery. Technology promises to deliver innovative Source: IMS Health methods for care delivery—from electronic write. Porter and Kramer call on foundations to consultations, to remote monitoring of patients, “create value” through selecting of best grantees, to increasing access to information on quality. improving the performance of grant recipients, These realities and opportunities have helped signaling other funders to worthwhile invest- shape the direction of the California HealthCare ments, and advancing the state of knowledge and Foundation (CHCF), and have influenced the practice in a given area. evolution of our strategic priorities since our As CHCF studied the health issues facing inception in 1996. Also influencing our direction California and the activities of other foundations, is the landscape of philanthropy in California, several trends became clear. Other statewide and the activities of other foundations—national, foundations were already doing excellent work in statewide, and local. public health and community-based health pro- In a 1999 Harvard Business Review article, Michael motion. Some 46 local and regional health-ori- Porter and Mark Kramer make a compelling ented foundations, many with substantial assets, argument that foundations have an obligation to are focusing on health issues within their local add value through a clearly articulated strategy. communities. Meanwhile, a number of large “We look to foundations to achieve a social foundations have shifted their focus away from impact disproportionate to their spending,” they health care entirely. 5 CALIFORNIA HEALTHCARE FOUNDATION In this mix, we tried to identify key issues that Improving Health Care Delivery: CHCF seeks our foundation might have the capacity and to enhance clinical quality, improve the patient expertise to address. CHCF is focusing on system experience of care, and improve the quality and issues—improving health care delivery, advancing accessibility of health care information for con- effective business practices, and contributing to sumers. We try to make an impact through the effective health policy development. These three dissemination of information and through inno- strategic priorities guide our work. Inevitably, vative demonstration projects. We invest in and study new modes of care delivery. Source of Health Insurance Coverage in California, Nonelderly Advancing Effective Business Practices: CHCF Individually Other Public seeks to strengthen and stabilize health care sys- Purchased Insurance tem finances, improve operations and efficiency, 7% 1% and promote innovation in health care markets. Medi-Cal 11% This is a key area of emphasis for us because the need is so great. Public sector or private sector; not-for-profit or for-profit; health plans, doctors, Employment- Uninsured hospitals, or payers—all need to operate organi- 22% Based 58% zations, balance program and financial demands, attract and retain appropriate staff, and have access to objective data to inform their decision- making processes, for our health care system to be Source: Gilmer, T., and R. Kronick. New Data Shows 6.8 Million Uninsured Californians. UCSD Department of Family and Preventive Medicine, successful. Business practices aren’t always about March 22, 2001. money. For example, structuring a successful adhering to a strategy means making tough state health insurance program for low-income, choices—foregoing many worthwhile projects and uninsured people not only depends on financing, leaving some important issues to others who are but also on whether aspects of program design better positioned to address them. Although we such as enrollment and renewal procedures meet have substantial assets, they are small compared the needs of the beneficiary population. We to the health care needs of California’s popula- believe CHCF can make a significant contribu- tion; we believe that our strategic focus ensures tion in this area, through research and analysis, the best stewardship of foundation resources and convening stakeholders, and publishing and dis- adds the most value for the people of California. seminating objective information. 6 Message from the President Contributing to Effective Health Policy: CHCF strives to inform the development of effective health policy, reduce regulatory duplication, and encourage administrative simplicity in public programs. Just as the notion of “evidence-based medicine” is taking hold in the provider commu- nity, we encourage and promote “evidence-based policy.” CHCF has initiated a number of projects aimed at improving the availability and quality of independent, objective, accurate, and timely information on health policy issues. We seek to be a resource for credible information on key health system issues (for example, medical group solvency, quality measurement and reporting, and the financial implications of hospital seismic retrofitting). At the same time, we are trying to develop channels to respond to the information needs of legislative members and staff, executive branch regulators, industry leaders, and others impact of health care quality information on con- making health policy decisions. In partnership sumers; and issues relating to the adoption and use with the National Health Policy Forum in of new information technologies—and describe Washington, D.C., we produce and disseminate CHCF’s responses to these important areas. issue briefs and convene forums on topics of mutual interest. In addition, our online news services, California HealthLine and iHealthBeat, provide objective news summaries and analyses of current trends in health care, in California and Mark D. Smith, M.D., M.B.A. nationwide. President and CEO In the section following, we focus on what we believe are three of the key health care challenges and opportunities in California—the status of the health care financing and delivery system; the 7 CALIFORNIA HEALTHCARE FOUNDATION Health Care in California: Improving Delivery and Financing Systems N ANY GIVEN DAY, CALIFORNIA’S of the abundant health information on the O NEWSPAPERS are likely to include several stories related to California’s health care system. The articles paint a troubling picture. Millions of people in Internet. Physician groups teeter at the edge of solvency, leaving some patients scrambling to find new physicians. Clearly, California’s health care system is in need of change and improvement. California still lack access to health care. Many A thoughtful and proactive response to the chal- end up in the emergency room for life-threaten- lenges and opportunities posed by three key areas ing (and expensive) conditions that could have of health care—quality of care, Internet-based been avoided with preventive care. Others forgo health care, and business practice reform—could needed treatment because they cannot afford the significantly improve California’s health care sys- cost of pharmaceuticals. While Californians have tem. The California HealthCare Foundation has some tools to help evaluate the clinical perform- responded to these critical health care issues ance of disparate providers and hospitals, many through a variety of approaches, described on the lack information to compare the true value of following pages. competing health plans, or to judge the accuracy 8 Health Care in California: Improving Delivery and Financing Systems Quality of Care: Using Information for Empowerment and Change Wide variation in quality of care cuts across all sectors of California’s health care system. The gap between evidence-based recommendations and actual practice has been well documented (see accompanying box, Geography is Destiny). Many Geography is Destiny providers have been slow to embrace voluntary Monitoring of glucose, or blood sugar, levels is efforts to report on performance, and, although considered to be “a cornerstone of diabetes the situation is slowly changing for the better, few care” by the American Diabetes Association. incentives are in place to stimulate investments in Diabetics who are able to maintain normal or near-normal blood glucose levels experience quality measurement and improvement. fewer complications, such as blindness, kidney Quality measurement is in its infancy, with spir- failure, amputation, and heart disease. But wide variation exists in the percentage of patients ited debate over which metrics are the most reli- receiving annual glucose screenings. In a study able indicators of high quality care. Scientifically of Medicare enrollees in California, the range of valid, standardized, and salient measures of per- diabetics receiving annual screenings in California formance are needed, but the processes for ranged from a high of 51.2 percent to a low of 22 percent, depending on the region. The development of such measures are fragmented, Dartmouth Atlas of Health Care uncovered wide under-funded, and cumbersome. Even where variations in preventive care, diagnostic and professional agreement on effective treatment surgical treatment, and care at the end of life. methods exists, developing information systems Based on the Dartmouth work, CHCF issued a and obtaining data from providers to document report highlighting California variations in medical their performance has been arduous. practice, Geography is Destiny. Recommendations included creating incentives to promote best practices and lessen variations in practice: Public Reporting of Performance Data Creates Beneficial Results q Government, health plans, provider organiza- tions, quality measurement organizations, and To bring quality to the forefront in health care, other entities can support, where possible, there has to be public reporting of useful per- the development and dissemination of stan- formance data for hospitals, doctors, medical dardized best practices for specific procedures groups, health plans, and nursing homes, and and treatments; measures need to be created where they are lack- q Purchasers can encourage use of best prac- tices, by contracting with providers that ing. CHCF endorses the concept that regularly participate in measurement activities; issued public reports on quality performance have q Quality measurement organizations can work two beneficial results. First, quality performance together to standardize measures and report reporting can help consumers make better consistent data; informed purchasing decisions on their providers q Consumer organizations can lend their credibility of care. While not all consumers may care yet and their expertise in policy and community organizing to efforts to minimize variation. about why one surgical group’s severity-adjusted cardiovascular surgery mortality rate is three times Geography is Destiny is available at www.chcf.org. higher than the group across town, a growing 9 CALIFORNIA HEALTHCARE FOUNDATION number of consumers are using this type of infor- guide is being widely distributed to California mation to make health care choices. Even more consumer organizations, providers, purchasers, important, as the demand for quality performance and policymakers. In addition, CHCF has fund- data rises, health care professionals may be ed a $2.4 million assessment of the state’s nursing encouraged to disclose such data as another mar- homes, called the California Nursing Home keting point to consumers. Consumer Information System. The assessment will be conducted by the University of California, CHCF seeks to be a part of this groundswell by San Francisco, the University of Wisconsin, improving the supply of and stimulating the RAND, the UCLA/Borun Center for demand for quality performance information, Gerontological Research, and California reducing barriers to quality improvement (such as Advocates for Nursing Home Reform (CANHR). misaligned incentives or unnecessary duplication A comprehensive report on the quality of nursing of audits and oversight), and engaging a wider sec- home care, which will be released late in 2002, tor of the community as advocates for quality. In will evaluate facility appearance and programs; partnership with established organizations known state and federal inspection results; consumer for their objectivity and their analytic measure- complaints; and staffing and financial indicators, ment work, CHCF provides resources and expert- as well as other aspects of nursing home care, ise for dissemination and outreach. The following including behavioral and quality-of-life issues. examples illustrate the approach that CHCF is taking to help improve health care quality for All California Medicare HMOs Californians. Are Not Created Equal About 1.5 million of the 4 million Medicare- Evaluating Hospitals and Nursing Homes eligible seniors and people living with long-term In partnership with the California Institute for disabilities in California are members of a Health Systems Performance, CHCF developed Medicare HMO. Traditional Medicare is a fee- the first consumer guide to California hospitals. for-service system of insurance; enrollees are free Some 113 hospitals voluntarily participated in the to select a doctor, and Medicare pays the doctor project, which surveyed 21,000 patients on vari- directly for services provided. Medicare HMOs ous aspects of medical, surgical, and hospital are a form of managed care offering more bene- obstetrics services. Released in August, 2001, the fits than traditional Medicare, including limited Patient Evaluation of Hospital Experience prescription drug coverage for an additional pre- (PEP-C) mium; however, seniors enrolled in Medicare Patients rated hospital performance in the HMOs have limited choice of care provider and following areas: usually must obtain a referral before receiving q Respect for patient preferences care from a specialist. q Coordination of care q Information and education Until recently, there was little information avail- q Physical comfort able to help seniors choose the Medicare HMO q Emotional support plan best suited to their individual health care q Involvement of family and friends needs. To bridge that information gap, CHCF q Transition out of hospital partnered with Consumers Union to develop the first comprehensive comparative guide to This report is available at http://hospitalguide.chcf.org. 10 Health Care in California: Improving Delivery and Financing Systems California Medicare HMOs, based on overall rable information on preventive services and value. The Guide to California Medicare HMOs: member satisfaction. A six-step guide to lead peo- Medicare HMOs Are NOT Alike helps consumers ple through the choices they have to make to find understand the benefits provided by HMOs in the best HMO plan for their medical condition the 35 California counties where Medicare HMO and financial situation is also included. In con- plans are available. The report revealed that the junction with the release of the guide, CHCF also value of Medicare HMO coverage varies widely launched a broad outreach campaign to educate in California, and paying more for an expensive seniors about their Medicare options and the plan does not guarantee a better value. It also information available in the guide. The full report found that prescription drug benefits may make may be obtained at http://hmoguide.chcf.org Medicare HMOs especially attractive for some or www.consumerreports.org. seniors, but that the value of drug coverage is inconsistent among plans and counties. Some plans offer no drug coverage at all, while the most Six Steps to Choosing a Medicare HMO generous pay about two-thirds of a typical senior’s 1. Select the provider network prescription costs. 2. Get the most value for your money 3. Understand the prescription drug benefit For consumers, the report compares benefits and 4. Note how members view the plan premiums, and explains which plans offer the best 5. Look at preventive care provided coverage for prescription drugs. It also shows how 6. Ask if the plan evaluates members’ functional much a plan will pay for drugs used to treat a abilities number of chronic diseases and provides compa- Guide to California Medicare HMOs, California HealthCare Foundation and Consumers Union, Summer 2001 Available at http://hmoguide.chcf.org. 11 CALIFORNIA HEALTHCARE FOUNDATION iHealth: The following major trends will have a significant The Internet Offers Health Care impact on iHealth over the next several years: Promise and Pitfalls q Implementation of government regulations on The Internet has the capacity to fundamentally data standards, privacy, security, and data enhance patients’ experience with the health care interchange (primarily through provisions of system, as well as to improve the business and the Health Insurance Portability and clinical practices of the health care industry. Web- Accountability Act of 1996); based applications and new information technolo- q Continuing consumer awareness and empower- gies can dramatically improve the delivery of ment to use the Internet to conveniently access health care, as well as accelerate consumers’ access health care products and services, providers, and to needed health information. Yet there are poten- health care information; tial pitfalls that come with “iHealth,” the new moniker of Internet-based health care, such as q Continuing shakeout of iHealth companies to a ensuring the privacy and security of personal smaller, more focused group that offers tech- health information; financing new technology nologies of value to the health care industry; investments; guaranteeing the quality of health q Development and deployment of new informa- care information on the Internet; and encourag- tion technologies, such as peer-to-peer and sen- ing the adoption of new technologies. sors, increased broadband access, and a more robust and secure wireless infrastructure; and q Provider and hospital solvency issues. 12 Health Care in California: Improving Delivery and Financing Systems Health-e-App Success Story Gloria Sardina of the Comprehensive Health Center, San Diego, used the Health-e-App Web-based enrollment application to verify preliminary eligibility for a single mom with two children. “When we finished the application and were able to—real time—say yes, your children qualify for Healthy Families coverage. She burst into tears. She hugged me. It was a very happy moment for both of us.” Because of the promise of iHealth, both for Internet as a tool to further streamline and sim- patients and for the providers who serve them, plify the application process for both consumers CHCF has taken a leadership role in promoting and program administrators. With more than $1 the effective use and adoption of new information million in grants, CHCF sponsored software technologies. These are some examples. development, convened a statewide panel of eligi- bility experts, and worked collaboratively with Health-e-App: Using the Internet to Boost state departments and community-based organi- Enrollment in Public Health Insurance zations to test the concept. As a result of the More than one in five Californians lack health demonstration project, some 21,000 community- insurance. Of the approximately 1.85 million based certified application assistants will be uninsured California children, an estimated two- trained to assist families with the new online ver- thirds may be eligible for Medi-Cal or Healthy sion. Health-e-App, the nation’s first fully-auto- Families, but have not enrolled. CHCF studied mated application, will be implemented statewide the barriers to the enrollment process in public in California during 2001-2002. health insurance programs for low-income chil- dren and pregnant women, and came up with a new approach designed to overcome the obstacles. Called Health-e-App, it uses Web-based technol- Health-e-App Features ogy to streamline the enrollment process. q Faster, more secure, and consumer friendly q Real-time preliminary eligibility determination Using any Web-enabled device, certified applica- q Real-time selection of health plans and tion assistants (who currently provide families providers (by geographic location, specialty, with free assistance in completing the paper gender, language preferences) version of the joint Healthy Families/Medi-Cal q Real-time payment of Healthy Families premiums application) can enroll eligible applicants in q Electronic Healthy Families or Medi-Cal. Information is signatures collected through a series of interview-style ques- q Built-in error tions. Built-in error-checking catches mistakes checking and ensures entry of required information. Applicants receive a preliminary eligibility/ program determination instantly, along with a confirmation that the state has received their application. Health-e-App evolved from a 1998 report by CHCF’s Medi-Cal Policy Institute, which focused on simplifying the original 28-page joint Healthy Families and Medi-Cal application, and stream- lining the enrollment process for both programs. CHCF and the Institute began exploring the 13 CALIFORNIA HEALTHCARE FOUNDATION Proceed With Caution: Spanish-language Web sites and search engines. Evaluating the Quality of Research focused on information about four com- Health Information on the Internet mon medical conditions: breast cancer, childhood Finding answers to important health questions asthma, depression, and obesity. using Internet search engines and simple search terms is difficult at best. And while the informa- Major findings included: tion consumers do find on Web sites is generally q Answers to important health questions are often accurate, it is usually incomplete and difficult for incomplete. many readers to understand, according to a q Consumers may have to wade through irrele- CHCF report featured in the May 23, 2001 issue vant information when using search engines of the Journal of the American Medical Association. and simple search terms. When employing The study, commissioned by CHCF and con- English search engines, Internet users have a ducted by RAND Health, was the first compre- one in five chance of finding relevant informa- hensive evaluation of the quality, accessibility, and tion from the first page of results. Consumers readability of health information on English- and using Spanish-language search engines have a one in nine chance of finding relevant material. q Many users may not be able to read the infor- Online Information Retrieval mation they find. Nearly half of all adults read on the Increase at an eighth grade level or below, but all of the q Nearly 100 million Americans will go online in search of health-related information in 2001. English-language Web sites and 86 percent of q More than 70 percent say online health Spanish-language sites required high school information has influenced a decision about level reading ability or better. their treatment. As a result of coordinated media outreach by q With an estimated 16,000 health-related Web sites, the Internet has become the CHCF, RAND, and JAMA, an audience in excess world’s largest searchable medical library. of 50 million—reached through newspapers, wire services, television, radio, and the Internet— learned of the study’s findings. CHCF also con- ducted a series of briefings. Following the study’s publication, stakeholders have acknowledged its value in establishing consumer confidence and trust. In addition, a focus on the quality of health information on the Internet has been added to the URAC (also known as the American Accreditation HealthCare/Commission) Health Web Site Accreditation Program. 14 Health Care in California: Improving Delivery and Financing Systems Consumer Tips for Internet Health Information Searches q Allow ample time to search for answers. q Visit several sites to get complete information. q Talk with your health care provider before making treatment decisions. To obtain a copy of Proceed with Caution, visit www.chcf.org. The Privacy Policies and Practices ting into the hands of the casual hacker or some- of Health Web Sites one actively seeking to access company databases. Health care Web sites offer a wide range of clini- q Few health sites maintain a chain of trust with cal and diagnostic information; opportunities to third parties. Privacy protections do not follow purchase products and services; interactions the visitor’s data once it leaves the site. among consumers, patients, and health care pro- fessionals; and the capability to build a personal- The sites highlighted in the report represented a ized health record. These Web sites provide access mix of the most heavily used consumer health to an unprecedented amount of personal informa- Web sites. Following the public release of the tion about consumers. A January 2000 report report, most health Web sites improved their pri- entitled Privacy: Report on the Policies and Practices vacy policies and practices and the Federal Trade of Health Web Sites, sponsored by CHCF and con- Commission launched an investigation of the ducted by the Health Privacy Project at practices documented in the report. To obtain a Georgetown University and Richard M. Smith, copy of the report, visit www.chcf.org. profiled the policies and practices of 21 health- Information Dissemination related Web sites. Among the major findings: To improve California’s health care system, partic- q Visitors to health Web sites are often not anony- ipants must be aware of the many innovations and mous, even if they think they are. Through changes that occur on a daily basis. CHCF con- mechanisms such as cookies, profiling, banner tributes to the knowledge base of some 12,000 ads, and clickstreams, sites are collecting infor- industry leaders who read California HealthLine, a mation about individuals, often without their daily online summary of health policy and indus- knowledge or consent. try news from more than 300 sources. CHCF also q Health Web sites have made efforts to establish publishes a continuing series of iHealth Reports on privacy policies, but the policies often fall short topics requiring more in-depth analysis. In late of truly safeguarding consumers. 2001, CHCF is launching iHealth Beat, which will report on the Internet’s impact on health care, q Actual practices of many health Web sites with daily news coverage, commentary, analysis, appear to contradict the sites’ stated privacy and metrics. For more information on these policies. services, or to sign up for a free subscription, visit q Many sites do not have adequate security in www.chcf.org. place to protect consumer information from get- 15 CALIFORNIA HEALTHCARE FOUNDATION Business Practice Reform: provider organizations. These changes in the Helping the Market Work Better financing and delivery of health care have created California’s health care system is a $140 billion a a need to better understand how health care mar- year enterprise, exceeding the GDP of such coun- kets work, where and why they don’t work, and tries as Finland, Ireland, New Zealand, and the appropriate role of regulation to promote Singapore. Yet the business of health care is poor- improvements that will benefit consumers and ly understood. Despite the long history of patients. Examples of CHCF’s initatives in the investor-owned dominance in some parts of area of market reform follow. health care (such as pharmaceuticals, medical Expanding Health Insurance Coverage devices, and health insurance) most of the system In California, those most likely to be uninsured has never fully employed nor been subject to mar- include workers at small firms, low-wage workers, ket mechanisms. The business practices of many the self-employed, and Latinos. CHCF has provider organizations were developed in an envi- invested in improving the way the commercial ronment far less competitive than the one in market for health insurance is structured, with which they currently operate. But the environ- the ultimate goal of increasing coverage. One ment has changed. Even public programs like project under development is a Web-based Small Medicaid and Medicare are shifting from reliance Business Health Insurance Resource Center that on self-contained rules to reliance on market will offer authoritative information relevant to mechanisms and coordination with private sector the small-group market, such as rights and regu- entities such as health plans and risk-bearing lations, and information about tax-deductibility. 16 Health Care in California: Improving Delivery and Financing Systems Facts About California’s Uninsured Population q California has the fourth highest uninsured rate in the nation. q More than eight in 10 of the uninsured are Such information will be useful to small firms workers and their families. when weighing decisions about whether to offer q More than two in three had family incomes health care coverage. The Resource Center will under 250 percent of the federal poverty level also provide a list of health plans, purchasing in 1999, making health insurance coverage unaffordable. alliances, broker organizations, and online health q Latinos are far less likely than non-Latino insurance sites. CHCF has also conducted survey whites to have job-based coverage, regard- research to help identify barriers and information less of how much they work, the size of the gaps in the individual market for insurance. As a employer, or their educational level. result of this research, published in To Buy or Not Data from the UCLA Center for Health Policy Research, The State of to Buy: A Profile of California’s Non-poor Health Insurance in California: Recent Trends, Future Prospects, March 2001. Uninsured, health plans adjusted the marketing messages they use to reach the individual insur- ance market audience. By building a body of market research to identify strategies to encourage objective, publicly available information, CHCF greater physician participation in Medi-Cal and hopes to expand access to health coverage for Healthy Families. To learn more about Medi-Cal, more Californians. To obtain a copy of To Buy or visit www.medi-cal.org. Not to Buy, visit www.chcf.org. Understanding Rising Using Market Research Prescription Drug Costs to Improve Public Programs In recent years, pharmacy costs have been one of In the private sector, few products are launched the fastest growing segments of without extensive advance market research to The High Cost the total cost of health care, both of New Drugs determine whether they meet the needs of the tar- in California and nationally. The Celebrex get customers. CHCF is leading efforts to encour- increased costs are attributed to (for arthritis), age both public and private sector health care enti- the increased availability of new launched in 1999, ties to make decisions based on objective data, $3.30 drugs (often more expensive than including market research. CHCF’s Medi-Cal per day. the drugs they replace), and to the Policy Institute commissioned a private market Generic ibuprofen increased use of drugs (for exam- research firm to interview 2,000 eligible-but-not- (for arthritis), ple, using a combination of drugs $0.68 per day. enrolled families about their awareness and under- to treat a chronic disease). CHCF standing of the Medi-Cal and Healthy Families published four studies to examine pharmaceutical programs. The research, completed in August issues in 2001: 2000, identified positive and negative attributes of both programs, from the perspective of eligible q Prescription Drug Use and Expenditures but not enrolled individuals. The research under- in California: Key Trends and Drivers scored the need to make the application process q Causes and Cures: Stakeholder Perspectives for both programs faster and easier. It also revealed on Rising Prescription Drug Costs that the target audience was not always aware of q Prescription Drug Coverage and Formulary the scope of program benefits or the ability to Use in California enroll in private HMOs as part of Medi-Cal and Healthy Families. CHCF now is exploring using q Innovations in Prescribing 17 CALIFORNIA HEALTHCARE FOUNDATION The first study revealed dramatic increases in uti- research to assess the cur- Physician Group Insolvency lization. In California, for example, per capita rent state of solvency The California consumption of prescription drugs has increased among California’s risk- Department of Managed by 18.8 percent over the past three years. While bearing physician groups, Health Care estimates the increase in California’s per capita consump- estimate the cost of com- that 20 percent of the tion was higher than the national increase of 14.2 plying with SB 260, state’s medical groups have a negative net percent over the same time period, California identify characteristics worth and few tangible started with a lower baseline rate of utilization. associated with better assets. Higher utilization is a result of an increased liquidity, and make rec- emphasis on preventive care, the use of new drugs ommendations for improving the SB 260 solvency to treat previously untreatable conditions, measures to indicate when a group is wandering increased third-party coverage, and the effect of uncomfortably close to the edge of financial fail- direct-to-consumer advertising on consumer ure. In October 2001, the findings from this demand for new, often more expensive, drugs. In research were provided to medical group directors addition, shifts in risk-sharing from physician statewide, health plans throughout California, groups back to health plans and hospitals may and to the state’s solvency board, charged with account for some of the increase in physician pre- overseeing the solvency of medical groups. It is the scribing practices. first of several studies to address ways for improving physician group solvency. For more information, Prescription Drug Coverage and Formulary Use in see Cash Matters along with related articles on California: Different Approaches and Emerging provider group issues at www.chcf.org. Trends looked specifically at formulary use in California. A new national trend is three-tier for- Evaluating Hospital Financial Health mularies (where patients have broad access to pre- California hospitals function in one of the most scription drugs, but pay a higher co-pay for drugs competitive and complex health care markets in not listed on the pharmacy benefit provider’s list the nation. California’s hospital beds generate of preferred drugs). Three-tier formularies more net patient revenue and expense than those respond to consumer desire for greater choice, but of any other state in the nation. In 1999, the study concludes that this option will have a California’s 409 acute slower adoption in California, where many resi- care hospitals employed dents are already accustomed to more restrictive Hospitals More Likely more than 300,000 to Experience Financial closed formularies. To obtain reports in the Focus people, discharged more Difficulties on Pharmaceuticals series, visit www.chcf.org. than 3 million patients, q Small recorded more than 23 q District-owned Improving Physician Group Solvency million adjusted patient q City/County-owned Financially healthy medical groups are vital for a days, had an available q Rural functioning health care system in California, yet bed capacity of more q Disproportionate share many large medical groups have gone bankrupt. hospitals (greater than than 80,000, and gener- Senate Bill 260, signed into law in 1999, set in average population of ated more than $35 bil- medically indigent patients) motion a regulatory process to address the solven- lion in total revenue. q Not members of a health cy of the state’s medical groups. Through a Request While the influence of care system for Proposal (RFP) process, CHCF funded 18 Health Care in California: Improving Delivery ad Financing managed care has resulted in low utilization and a competitive pricing environment, the patients in hospitals in California are more acutely ill, requir- ing more expensive care. And while California wages for hospital employees are higher than other states, a serious nursing shortage is building. The high proportion of uninsured residents contribute to high expenses and reduced operating margins for hospitals; more than half the state’s hospitals lost money from operations in 1999. Potentially aggravating this financial crisis is another, serious problem. The majority of the hos- pital beds in California are in seismically “non- compliant” buildings, as defined by state law. Many hospitals have more than 75 percent of their solicited a Request for Proposals intended to beds in these structures, which could collapse in a enhance public scholarship in the areas of the large earthquake. CHCF commissioned research business of health care, the health care delivery to estimate cost scenarios for hospitals facing leg- system, and California health policy. CHCF Meeting Seismic islatively mandated seismic encouraged the participation of researchers from Standards retrofitting. The study noted diverse backgrounds—sociology, political science, Forty percent of that a significant portion of California’s hospital anthropology, law, and private sector practition- costs for seismic compliance ers—with different theoretical frameworks, in the buildings must be retrofitted, replaced, or can be attributed to the costs of pursuit of new approaches and productive cross- removed from modernizing aging hospitals. fertilization. In recent years, for example, scholars service by 2008 to This presents an opportunity comply with current from economics departments and schools of to reduce oversupply and plan public policy have become more involved in legislative mandates. The California for capacity that matches the health services research and have made substantial Legislature is needs of communities. Given contributions to the body of knowledge. In considering extending the critical challenges facing this deadline to 2013. 2001, 17 projects were funded (71 percent to California’s hospitals, CHCF first-time CHCF grantees). Examples of funded has commissioned additional studies examining projects include studies of public mental health the financial performance of hospitals to better services and the impact on California youth; understand the drivers of financial failure and downstreaming of risk in Medi-Cal managed care; the potential consequences for the state’s health policy issues relating to the non-poor uninsured; care system. and utilization management techniques for phar- maceutical use in California health plans. Looking “Outside the Box” Discovering innovations in the financing and For a complete listing of CHCF grants awarded delivery of health care is critical to making from January 1, 1999, through February 28, 2001, improvements in the system. In early 2001, CHCF please see page 27. 19 CALIFORNIA HEALTHCARE FOUNDATION Program Areas HE CALIFORNIA HEALTHCARE stakeholders, and funds development of programs T FOUNDATION is an independent philanthropy committed to improv- ing California’s health care delivery and financing systems. Our goal is to ensure that and models aimed at improving the health care delivery and financing systems. Areas of Focus and Funding Our work is organized into six program areas that all Californians have access to affordable, quality health care. sometimes overlap and “cross-fertilize.” q Quality CHCF’s work focuses on informing health policy decisions, advancing efficient business practices, q iHealth and Technology improving the quality and efficiency of care deliv- q Improving Care Delivery ery, and promoting informed decisions about q Health Insurance Markets and the Uninsured health care and coverage. q Provider Systems CHCF commissions research and analysis, pub- q Medi-Cal/Healthy Families lishes and disseminates information, convenes 20 Program Areas measurement and assessment; and accelerate quality improvement, patient safety, and public accountability through involvement of consumers, providers, purchasers, and policymakers. Examples of projects in this program area: q Developing a comparison guide on California Medicare HMOs, produced in partnership with Consumers Union. q Providing technical assistance to California hos- pitals in completing legislatively mandated medication error reduction plans. q Working with the National Committee for Quality Assurance, Pacific Business Group on Health, and the California Department of Managed Health Care to improve and stream- line the processes for collecting quality of care information about managed care organizations and their contracted provider organizations. Quality q Funding eight consumer/patient group projects on quality issues through a competitive Request While the American health care system holds the for Proposals process. promise of excellence, it is spotty in its application of evidence-based practice, vulnerable to medical errors, and often insensitive to the perspective of iHealth and Technology Program the patient. Processes for developing quality meas- ures are fragmented, under-funded, and cumber- Health careand Technology Program iHealth information is more varied and com- some. Until recently, providers and health plans plex than information exchanged by most other Health care information is more varied and com- lacked incentives to invest in quality measurement industries. information exchanged security of per- plex than The confidentiality and by most other and improvement. While some purchasers are sonal health information exchanged online per- industries. The confidentiality and security of has beginning to demand evidence of quality raised healthconsumer concern. While online has sonal valid information exchanged new infor- improvement, the patient/consumer power that mation technologies concern.the potential to raised valid consumer offer While new infor- drove the environmental, auto safety, and nutri- improve both clinical and business processes, that mation technologies offer the potential to tional movements has been largely absent from potential both clinicalrealized. improve is yet to be and business processes, that the health care arena. potential is yet to be realized. The goals of CHCF’s iHealth and Technology CHCF’s Quality Initiative seeks to foster develop- Program are toCHCF’s iHealth and Technology The goals of stimulate the adoption and effec- ment and dissemination of salient, scientifically tive use are to stimulate the adoption and effec- Program of new information technologies to vetted, and standardized quality of care informa- improve clinical and business practices; and to tive use of new information technologies tion; stimulate consumer and purchaser use of increase understandingbusiness practices; and to improve clinical and of the emerging health comparison information; reduce barriers to quality increase understanding of the emerging health 21 CALIFORNIA HEALTHCARE FOUNDATION policy and regulatory issues resulting from tech- Improving Care Delivery nological change. The fragmentation of California’s health care sys- Examples of projects in this program area: tem poses challenges to the delivery of effective, efficient, high-quality care. The complex web of q Developing Health-e-App, a Web-based enroll- providers, funding sources, clinical and social pro- ment system for public health insurance pro- grams is particularly problematic for individuals grams in California. with multiple health care needs and disparate q Publishing iHealth Reports, a series covering sources of coverage. At the same time, proven clin- new technology concepts, applications, and ical and organizational approaches to high quality related policy and regulatory developments. care delivery exist, but for a variety of reasons have q Monitoring and evaluating online consumer not been fully embraced by many providers and health care information and services. health care organizations. q Creating iHealthBeat, an online daily news CHCF’s Improving Care Delivery Program focus- service that reports on the Internet’s impact on es on achieving better health outcomes, making health care. care delivery more effective and efficient, and improving patients’ experience of care. By work- ing across a range of provider groups, settings, and sectors (public and private), this program area promotes increased use of evidence-based clinical guidelines and disease management interventions; greater coordination of services; improved support systems and infrastructure; enhanced participation by better-informed patients; and more effective use of existing health dollars. Of particular con- cern are special populations (people with complex clinical and/or psychosocial problems, such as frail elders in managed care or children with spe- cial health care needs) and specific diseases or health conditions that affect large numbers of Californians and for which there are clear oppor- tunities for better care and outcomes (for example, diabetes and childhood asthma). Examples of projects in this program area: q Implementing and evaluating improved models of care for children with special health care needs and elders in managed care. q Initiating research on mental/behavioral health. 22 Program Areas group, individual, Medi-gap); and fragmented regulatory systems. Related to the issues that emerge in the markets is the problem of the unin- sured: More than one in five non-elderly Californians (22 percent) lack any form of health insurance. These uninsured individuals are less likely to have a usual source of care, less likely to obtain preventive screenings, and more likely to delay or forego needed care than those with health insurance. CHCF’s program area on Health Insurance Markets and the Uninsured seeks to improve the functioning of California’s health insurance mar- kets, particularly the small group and individual markets, and to expand coverage to the uninsured using market-based approaches. As a widely rec- ognized source of unbiased analysis regarding the health insurance market, CHCF can enhance the quality of purchaser decision-making about health insurance, and can inform public policy. q Providing technical assistance to organizations to improve the delivery of health care services. Examples of projects in this program area: q Sponsoring research on uninsured “frequent q Analyzing the individual market for health utilizers” of hospital and emergency services. insurance to gain a better understanding of the factors that affect consumers’ decisions to buy or not to buy. Health Insurance Markets q Developing a Web-based resource for small and the Uninsured firms interested in purchasing health coverage. In California, as in the nation, insurance is the q Evaluating subsidized programs aimed at low- primary vehicle for obtaining access to quality income children and/or families ineligible for medical care and for reimbursing providers who state programs. deliver care. The majority of California’s popula- q Reviewing California’s health insurance regula- tion obtains health insurance through the private tory system to understand the division of market, but that market does not always function responsibilities among California regulatory efficiently. Among the problems that emerge in entities. the health insurance market include overuse of medical services by insured consumers who may q Sponsoring a survey of small California employ- be unaware of the true cost of medical care; lack ers, both those offering health insurance and of incentives for the healthy to participate in the those not offering, to better understand their market; distinct markets (for example, small decisions about offering coverage. 23 CALIFORNIA HEALTHCARE FOUNDATION Provider Systems CHCF’s Provider Systems program area is com- The financing and delivery of health care in mitted to strengthening core provider organiza- California has evolved into a system that is more tions—physician groups (including medical dependent on organizations than in any other groups, independent practice associations, and state in the nation. In recent years, health plans community clinics), hospitals, nursing homes, have acquired and merged with their competitors, and the workforce they employ. Part of this work individual hospitals have formed multi-hospital is achieved through practical research and analysis systems, and physicians have organized themselves on the business performance, capacity, and distri- into groups that share financial risk with health bution of physician groups, hospitals, and nursing plans. Even employers who purchase health care homes, as well as research on pharmaceutical have organized into coalitions that exert increas- issues, such as purchasing and management of ing pressure on health plans and providers to con- pharmaceuticals by public and private purchasers, tain costs and improve quality. Given this system, providers, and consumers. The work in this pro- the health care needs of Californians are best gram area also promotes adoption of more effec- served when the organizations they rely on are tive business practices, governmental policies, and sound and effective. But many health care organ- regulation. Provider Systems also develops and izations currently confront serious financial and implements innovative programs to support organizational challenges, and health care institu- recruitment, training, and retention of an effective tions face a dearth of health care professionals to health care workforce, including more effective meet current and future needs. organizational leaders and managers. Examples of projects in this program area: q Sponsoring studies on the financial status of hospitals and the costs of seismic upgrading of hospital facilities. q Analyzing organizational characteristics and solvency of physician groups. q Supporting reasearch on the supply and training of physicians, nurses, mental health, and allied and auxiliary health care workers. q Funding a program office at the Center for the Health Professions, under the California Workforce Initiative, to develop and manage projects specific to the health care workforce, including the recently developed Health Care Leadership Program. q Sponsoring research on prescription drug trends, drivers, and business practices. 24 Program Areas Medi-Cal/Healthy Families Six million Californians rely on Medi-Cal and Healthy Families for their health insurance cover- age. Yet two out of every three uninsured children and one in seven uninsured adults in California is eligible for, but not enrolled in, these public pro- grams. And once enrolled, many beneficiaries lose coverage for reasons that may be preventable. Medi-Cal beneficiaries, in particular, face difficul- ty finding available and accessible primary care physicians, specialists, and com- Medi-Cal Facts munity-based long term care Medi-Cal provides health care coverage providers. Meanwhile, costs are and services for more rising rapidly for both pro- than 15 percent of grams, driven by double-digit Californians. increases in drug spending and Pays for 64 percent growing enrollment. of nursing home care for seniors and people CHCF’s Medi-Cal Policy with disabilities. Institute seeks to facilitate and Draws more than enhance the development of $13 billion of federal effective policy solutions for funds into the state’s Medi-Cal and Healthy Families health care system. with a particular interest in identifying and understanding options for improving enrollment and retention, access to q Providing technical assistance to health plans care, and the quality of care provided to people and state officials to improve collaboration and served by these public programs. stimulate adoption of effective approaches to Examples of projects in this program area: collecting and reporting data on health plan performance, including quality of care. q Publishing The Guide to Medi-Cal Programs and other descriptive materials about Medi-Cal and q Conducting the first-ever statewide survey of Healthy Families. beneficiaries in Medi-Cal and Healthy Families to understand their experiences with and opin- q Providing county-by-county data and analysis ions of these programs. of the Medi-Cal program to facilitate compar- isons of the program’s effectiveness across For More Information California’s 58 counties. For more information on any of the CHCF q Funding research on provider payment rates, program areas, visit www.chcf.org or call (510) access to physician services, the impact of wel- 238-1040. fare reform, and other relevant policy issues. 25 CALIFORNIA HEALTHCARE FOUNDATION Board Grants and Contracts Awarded January 1, 1999–February 28, 2001...................................................................................... 27–56 President’s Fund Grants and Contracts Awarded January 1, 1999–February 28, 2001...................................................................................... 57–62 Grant Application Process................................................................................................................. 63 Audited Financial Statements Years ended February 28, 2001 and February 29, 2000........................................................... 64–72 26 Foundation Report 1999-2001 Board Grants and Contracts Awarded The following is a list of grants and contracts authorized by the California HealthCare Foundation Board of Directors from January 1, 1999, through February 28, 2001. January 1, 1999 to February 29, 2000 American Accreditation Healthcare Commission/URAC 21st Century Consumer Washington, DC Alamo, CA $46,695 $50,000 PPO Reporting on Quality Consumer-centered Health Care Guidelines To design and conduct market research, to identify To review clinical guidelines for ten medical con- current preferred provider organization (PPO) quality ditions affecting the general population, as well as reporting activity, and to develop recommendations Medi-Cal and Medicare recipients, and to recommend for a core set of standardized PPO performance strategies for creating consumer guidelines for treating measures for routine public reporting. each condition. AMI Data Systems Academy for International Health Studies Berkeley, CA Davis, CA $4,200 $275,000 County Data Book Database Cross-border Health Insurance Initiative To develop a database for county-by-county statistics To bring together key public and private health care on the Medi-Cal program for the Medi-Cal Policy providers, insurers, and government officials from Institute’s county data book. Mexico, California, and other border states to identify issues in health care financing and delivery systems. AMI Data Systems Berkeley, CA Accurate Data Collectors $2,500 Branford, CT Maintenance of County Data Database $10,255 To perform services as needed for the maintenance of Medi-Cal Beneficiary Survey the county data database project. To fund research for a survey of Medi-Cal benefici- aries, which includes telephone interviews of current Armillary, Inc. and recent Medi-Cal recipients. Port Byron, NY $12,000 Actuarial Research Corporation Quality Initiative Portal Resources Project Annandale, VA To identify, gather, review, and describe 300 Web sites $22,080 for possible inclusion in the Quality Initiative’s portal Evaluation of Employer-sponsored Health Plans Web site. To examine the 1998 Mercer/Foster Higgins National Survey of employer-sponsored health plans to better Asian Pacific American Legal Center of understand the differences in the prevalence of small Southern California employers offering insurance to their workers. Los Angeles, CA $150,000 Advisory Board Company Healthy Families Educational Campaign Washington, DC To conduct an outreach and education campaign on $730,800 the Healthy Families and Medi-Cal programs for California HealthLine Renewal low-income Asian and Pacific Islander communities in To continue support for California HealthLine, an Los Angeles, the Bay Area, Santa Clara, Fresno, and electronic news briefing service on California and Orange counties. national health care policy and health industry news, made available free-of-charge to Californians. Association of California Nurse Leaders Sacramento, CA $42,300 California Nursing Outcomes To support an evaluation of the safety and quality of patient care, focusing on nursing care quality and outcomes. 27 CALIFORNIA HEALTHCARE FOUNDATION Auxiliary Services Enterprise, Inc. California Advocates for Nursing Home Reform Los Angeles, CA San Francisco, CA $25,000 $391,271 California Medicare Project Translation Services Dissemination of California Nursing Home To provide advice, consultation, and translation Performance Indicators services for the California Medicare Project to better To develop, jointly with the University of California, provide information on Medicare to non-English- San Francisco, a comprehensive panel of nursing speaking peoples in California. home performance indicators, and to provide publicly available quality performance data on every skilled- Allan Baumgarten nursing facility in California. Minneapolis, MN $12,206 California Association for Adult Services Reducing Regulatory Duplication in Managed Care Sacramento, CA To provide information about managed care regulation $109,502 in other states to inform California’s efforts to establish Levels-of-Care Framework for Adult Day Services core quality standards for managed care. To produce data for the development of a new “levels of care” framework for adult day services for the elderly, Allan Baumgarten enabling programs to match services with clients’ Minneapolis, MN changing needs. $90,000 Report on Health Care in California California Center for Health Improvement To develop and produce a comprehensive analysis Sacramento, CA of the health care marketplace in California, focusing $40,000 on organizations that deliver and finance health care Quality Audits and Managed Care: Phase I in the state. To support an initial scan of the policy environment associated with two new California laws that make Diana Bermudez up part of the state policy on quality audits and Berkeley, CA managed care. $11,000 Stakeholder Perception: The Medi-Cal Policy Institute California Health Advocates To assist the Medi-Cal Policy Institute in analyzing its Santa Ana, CA overall effectiveness by conducting in-depth interviews $41,200 with health policy stakeholders to determine their Health Insurance Counseling and Advocacy Programs awareness of and opinions about MCPI. Immediate Response Initiative To augment the ability of the California Health Insur- Thomas Buchmueller ance Counseling and Advocacy Programs to inform Irvine, CA Medicare recipients about the Medicare program and $15,000 other activities. The Business Case for Employer-provided Health Benefits California Institute for Federal Policy Research To conduct a review of current literature and to help Washington, DC synthesize information on the “business case” for $10,000 offering health benefits through employment. Briefings for California Congressional Delegation To convene a series of health-related briefings for the Cal- ifornia Congressional Delegation in Washington, D.C. 28 Board Grants and Contracts Awarded: January 1, 1999–February 28, 2001 California Institute for Health Systems California State University, Bakersfield Performance Bakersfield, CA Sacramento, CA $5,000,000 $17,300 Valley Fever Vaccine Project: Phase II Developing a Hospital Quality Public To continue research for the development of a candi- Reporting Agenda date vaccine against Coccidioides immitis (a fungal To provide research, administrative, and logistical organism that causes Valley fever), and to bring a support for a voluntary three- to five-year quality candidate vaccine to Phase III clinical trials. reporting agenda for the California hospital industry, CHCF, and other stakeholders. The California Works Foundation San Francisco, CA California Institute for Rural Health $100,127 Management Quality-related Issues for Health Insurance Programs Lompoc, CA To explore the willingness and ability of health insur- $850,000 ance programs to use quality measures in purchasing Lompoc Elders in Managed Care health care. To expand the current system of case management for Lompoc elders enrolled in Pacificare/Secure Horizon’s CareScience, Inc. Medicare managed care program, moving it beyond Philadelphia, PA the acute hospital setting into the ambulatory and $220,000 community-based arenas. Community-wide Health Care Information Demonstration Project: Phase I California Managed Risk Medical To support the first phase of the development of a Insurance Board community-wide health information system and sup- Sacramento, CA porting technologies in Santa Barbara County. $2,000,000 Major Risk Medical Insurance Program CareScience, Inc. To provide subsidized health insurance for Califor- Philadelphia, PA nians who cannot obtain coverage in the individual $250,000 health insurance market. Community-wide Health Care Information Demonstration Project: Phase II California Pan Ethnic Health Network To support the second phase of the development of a Oakland, CA community-wide health information system and sup- $25,683 porting technologies in Santa Barbara County. Cultural Competency Work Group on Quality To convene a series of meetings, outreach, and CareScience, Inc. research to examine the current survey methods for Philadelphia, PA capturing consumer experience with providers and $50,000 health systems. Evaluation of CALINX: Phase II To assist CHCF in evaluating the success of the California Public Employees’ California Information Exchange (CALINX) demon- Retirement System stration projects being conducted by the Pacific Sacramento, CA Business Group on Health and the National $300,000 Independent Physician Association. Risk Adjustment of Health Insurance Premiums To analyze the data systems of major provider systems CareScience, Inc. and health plans in the Sacramento area, and to Philadelphia, PA develop risk profiles of the CalPERS, Pacific Business $4,620,574 Group on Health, and University of California Community-wide Health Information members enrolled in those health plans and provider Demonstration Project systems. To establish a program management office for facili- tating the Santa Barbara Community-wide Health Care Information Demonstration Project. 29 CALIFORNIA HEALTHCARE FOUNDATION Center for Health Care Rights Community Health Partnership Los Angeles, CA of Santa Clara County $48,400 San Jose, CA Consumer Health Group Interventions $20,000 to Improve Quality Women’s Health Care Feasibility Project To fund a manual describing opportunities for To evaluate the feasibility of creating a sustainable consumer leaders to impact health quality policy. system of health care for women aged 40-64, using the analysis of existing data on uninsured women. Center for Health Care Strategies, Inc. Princeton, NJ Consumer Coalition for Quality Health Care $20,000 Washington, DC State Medicaid/CHIP Purchasing Institute $64,185 To fund the participation of six senior officials HICAP Training from California Medi-Cal and Children’s Health To educate and train California Health Insurance Insurance Program (CHIP) in an Advanced Pur- Counseling and Advocacy Programs (HICAP) pro- chasing Workshop. gram managers about quality issues in health care, particularly in Medicare managed care. Edward Coleman San Francisco, CA Contra Costa County Office on Aging $30,000 Martinez, CA STD Prevention and Control Project: Next Steps $75,000 To coordinate the STD Prevention and Control Project. Medicare Managed Care Partnership Program To develop an expanded service delivery system to The Commonwealth Club of California enhance care for the Contra Costa Health Plan’s San Francisco, CA Medicare risk plan members. $203,000 California Health Care Speaker Series County of San Diego, To help develop, coordinate, and implement the Health and Human Services Agency California Health Care Speaker Series as part of San Diego, CA HealthVote 2000. $100,000 Improving Access to Health Care Communication Sciences Group To develop a strategic plan for increasing access to care San Francisco, CA for San Diego County’s uninsured population. $19,415 Quality Initiative Pilot Studies Cyber Dialogue To provide social marketing and evaluation consul- New York, NY tation to the Quality Initiative, including consultation $22,500 on community intervention design and review of the Health Vote 2000: California Healthline Survey consumer survey and focus group report. To develop an online survey of California Healthline subscribers on issues related to health care and the Community Health Group Foundation 2000 California primary and national elections. San Diego, CA $74,100 Cyber Dialogue CareLink New York, NY To develop CareLink, a multifaceted initiative $80,000 designed to prevent or delay the onset or progression eHealth Ethics Consumer Survey of disability, promote independence, and prevent To conduct a survey of the demographic, attitudinal, institutionalization. and behavioral issues surrounding privacy, confiden- tiality, and ethical conduct on health Web sites. 30 Board Grants and Contracts Awarded: January 1, 1999–February 28, 2001 Suzanne Delbanco ECRI Berkeley, CA Plymouth Meeting, PA $5,500 $20,000 Medi-Cal Beneficiary Survey Conference Support: Conflict and Change To provide advice and expertise on the development, To cosponsor ECRI’s national conference examining fielding, and analysis of the Medi-Cal Beneficiary how public and private payers, providers, regulators, Survey. consumers, manufacturers, attorneys, and researchers construct and apply their visions of quality of care and Deloitte & Touche Consulting Group quality of life. Sacramento, CA $350,000 Edelman Public Relations Worldwide Medi-Cal/Healthy Families Application Automation: Washington, DC Pilot Test Phase $75,000 To support field-testing of the Medi-Cal/Healthy Strategic Communications for eHealth Ethics Project Families automated application to refine the appli- To develop and execute a strategic communications cation’s functionality and establish electronic linkages plan for CHCF’s eHealth Ethics Project that includes for submitting data with California state and county materials development, design and coordination of systems. press events, media outreach, scheduling of press inter- views, and policy briefings. Deloitte & Touche Consulting Group Sacramento, CA Jennifer Elias $300,000 San Francisco, CA Medi-Cal/Healthy Families Application Automation: $3,000 Proof of Concept County Data Book: Writing of County Profiles To develop a proof-of-concept system that simplifies To fund the completion of county profiles for each of the enrollment of eligible children and pregnant the 58 California counties based on independent women in the Medi-Cal and Healthy Families qualitative research and data provided by the Medi- Programs. Cal Policy Institute. Desert Medical Group Eric Marder and Associates, Inc. Palm Springs, CA New York, NY $1,194,977 $520,850 The IMPACT Study Medi-Cal and Healthy Families: A Consumer To test the cost-effectiveness of a multifaceted disease Perspective management program designed to improve the care of To conduct a survey in select regions of California of older adults with major depression or mood disorder. 2,000 individuals who are eligible for, but not enrolled in, the Medi-Cal or Healthy Families Programs. DJL & Associates Sacramento, CA Eric Marder Associates, Inc. $75,000 New York, NY Project Management of the GMC Dental Evaluation $15,500 To develop and manage activities for Sacramento’s Medi-Cal & Healthy Families Program Eligibility Geographic Managed Care Model Dental Services Ad- To fund 50 qualitative, in-person interviews of visory Group, to assist William M. Mercer, Inc. staff, members of the Hispanic population who are eligible and to manage communications with all parties. for, but not enrolled in, the Medi-Cal or Healthy Families Program. 31 CALIFORNIA HEALTHCARE FOUNDATION Field Research Corporation George Washington University San Francisco, CA Washington, DC $10,000 $67,541 Preparing Data for Archives and Presentations Welfare Reform Efforts and Medi-Cal To archive survey data from the Field Research To support research that assesses how implementation Corporation’s work on non-poor uninsured and of the California Work Opportunity and Responsi- individually insured Californians, and to present the bility to Kids program is affecting access to Medi-Cal results of the data to the project’s health plan partners. and Transitional Medi-Cal. Field Research Corporation Georgetown University San Francisco, CA Washington, DC $430,000 $8,800 Surveys for HealthVote 2000 Cross-border Health Insurance Initiative To conduct large-scale baseline surveys prior to both To provide consultation to the Cross-border Health the California March 2000 primary election and the Insurance Initiative on issues related to migration, November 2000 general election to provide a detailed NAFTA, and U.S./Mexico relations, and to provide examination of Californians’ concerns about health consultation to CHCF staff on migration policy as it policy issues. relates to eligibility for and access to health services. Foundation for Accountability (FACCT) Georgetown University Portland, OR Washington, DC $46,610 $78,000 National Outreach to Consumer Organizations Ethical Issues Surrounding eHealth To assist CHCF’s Quality Initiative staff in outreach To conduct research on the privacy policies and work to national consumer organizations, including practices of health Web sites. developing activities that engage unions in equality- based health care purchasing in California. Daniel Gitterman Berkeley, CA Foundation for Accountability (FACCT) $3,600 Portland, OR Cost Benefit Mandates $16,250 To provide an overview of health-related cost/benefit Cost, Quality, and Access to Health Care activity across the states, as well as an in-depth review To fund advice on union-related grants, to develop of several states’ experiences in implementing cost/ activities that help engage unions in quality-based benefit mandates. health care purchasing in California, and to facilitate coordination of FACCT and CHCF union-focused Greer, Margolis, Mitchell Burns initiatives. & Associates, Inc Santa Monica, CA Freeman and Associates $940,500 Sacramento, CA Social Marketing Campaign $20,500 To provide strategic communications for the Quality Consultation for the Quality Initiative Initiative’s first year consumer outreach efforts for the To support the consumer outreach efforts of the Campaign for Quality, including delivery of a print CHCF Quality Initiative. primer/video package to inform consumers of the importance of quality of care when making health Freeman and Associates care decisions. Sacramento, CA $60,000 Consumer Outreach Efforts To provide consultation for the Quality Initiative on consumer outreach efforts. 32 Board Grants and Contracts Awarded: January 1, 1999–February 28, 2001 HandsNet Hedrick Smith Productions, Inc. San Jose, CA Bethesda, MD $45,299 $1,200,000 The Web as a Resource for Medicare Counseling Health Care Documentary Series To train staff and volunteer counselors at California’s To produce two 1-hour segments of a four-part PBS 24 Health Insurance Counseling and Advocacy documentary, “How Good Is Our Health Care?,” a Programs (HICAPs) to use the Internet for accessing series exploring issues relating to health care systems, information on Medicare and program-related infor- care for the chronically ill, access to care, and quality mation. of care. The Hansen Network Kathy Herbst Fremont, CA Haddam, CT $20,000 $3,500 Primer on Measuring Health Care Quality Describing Variations in Health Care To develop content for a primer on quality that frames To educate consumers and other opinion leaders about the quality debate and presents common language, variations in health care within California, as well as definitions, and facts to encourage a high-level and variations between care in California and in other productive discussion around quality of care. parts of the country. Harris Interactive Inc. Institute for the Future Rochester, NY Menlo Park, CA $75,000 $100,000 RAND Online Survey on Health Care Quality Ethical Issues Surrounding eHealth To conduct a Harris Poll online to assess Californians’ To produce special reports and provide project awareness, attitudes, and behaviors on health care management to CHCF’s eHealth Ethics Initiative. quality and decision-making, and to assess the effects of weighting techniques on the survey results. Interactive Applications Group Washington, DC Healthcare Business Media, Inc. $50,000 San Francisco, CA Communications Vehicles for the CALINX Project $100,000 To develop a Web site and an e-mail newsletter California Medicine Roundtable and Supplements template as dissemination vehicles for the California To support the convening of a roundtable on medical Information Exchange (CALINX) health care data necessity, and to develop two special supplements to standards project, and to disseminate information on California Medicine, one on medical necessity and the issues of data security and confidentiality. other on health care quality. Internet Healthcare Coalition Health Systems Research, Inc. Newtown, PA Washington, DC $50,000 $8,000 eHealth Ethics Summit Medi-Cal Policy Institute’s Rates Forum To develop eHealth ethics principles and guidelines To facilitate the Medi-Cal Policy Institute’s Rates through sponsorship of the eHealth Ethics Summit. Forum. Kaiser Foundation Health Plan of Colorado Denver, CO $55,000 Costs and Effectiveness of Screening for Chlamydia To create software for use by managed care organiza- tions in evaluating the costs and effectiveness of screening young women for chlamydia. 33 CALIFORNIA HEALTHCARE FOUNDATION L.A. Care Health Plan Lawrence Livermore National Laboratory Los Angeles, CA Livermore, CA $74,848 $129,999 Planning for Chronic Care Connections Feasibility Study of Communicable Disease To develop mechanisms for coordinating the provision Reporting in California of medical care with the provision of the home and To conduct a feasibility analysis of Web-enabled community-based services to which California Public public health reporting in California, including a Employees Retirement System retirees are entitled. review of communicable disease reporting within California and a review of the requirements and Laguna Research Associates technical approaches to developing an Internet-based San Francisco, CA reporting system. $110,000 Examining the Medi-Cal Managed Care Market The Lewin Group To analyze the financial condition of managed care San Francisco, CA organizations participating in the Medi-Cal program $43,730 to anticipate the future directions of the program. Children’s Health Insurance Performance Indicators for Clinical Quality Lake Snell Perry & Associates, Inc. To assess the State Children’s Health Insurance Washington, DC Program quality measurement implementation strate- $285,000 gies in California, Oregon, Washington, and Arizona. Medi-Cal Beneficiary Survey To conduct a survey of current and recent Medi-Cal The Lewin Group beneficiaries to identify areas for improvement in the San Francisco, CA structure and functioning of the Medi-Cal program. $137,160 Continuous and Presumptive Eligibility for Lake Snell Perry & Associates, Inc. Medi-Cal for Children Washington, DC To explore the costs associated with the possible $6,000 implementation in California of continuous and Snapshot of Consumers’ Views on Quality presumptive Medi-Cal eligibility for children. To produce a snapshot of the best thinking currently available on consumers and quality of health care, and The Lewin Group to conduct a daylong briefing for CHCF staff and San Francisco, CA contractors. $144,021 Guaranteed Eligibility and Lock-In for Medi-Cal Laurel Consulting Group To estimate the budget impacts of implementing a Los Angeles, CA guaranteed eligibility program for adults and children $72,805 in Medi-Cal managed care, and to assess the impact First Things First of the “lock-in” provision that seeks to keep benefici- To facilitate the ongoing development and strength- aries enrolled in the same health plan for a set period ening of the First Things First program through local of time. outreach coalitions designed to increase Medi-Cal enrollment. The Lewin Group San Francisco, CA Laurel Consulting Group $176,055 Los Angeles, CA Business Case for a Medi-Cal and Healthy Families $42,668 Automated Enrollment System Medi-Cal Quality Improvement Training To measure the potential savings and other efficiencies To provide planning and support for training on associated with automating the Medi-Cal/Healthy quality measurement for Medi-Cal health plans, Families enrollment process, to assess the readiness of cosponsored by the Medi-Cal Policy Institute and the the target audience to use the application, and to National Committee for Quality Assurance. gauge the diffusion rate over a two-year period follow- ing statewide implementation. 34 Board Grants and Contracts Awarded: January 1, 1999–February 28, 2001 The Lewin Group Los Angeles Times San Francisco, CA Los Angeles, CA $190,900 $31,900 Provider Organization Accreditation in California A Consumer’s Guide to Health Care To conduct a feasibility study for a provider organi- To produce and disseminate a special supplement to zation accreditation program in California. the Los Angeles Times that provides the general public with credible information on health issues. LifeLong Medical Care Berkeley, CA Susan Maloney $75,000 Silver Spring, MD Community-wide Health Plan for $4,500 Low-income Elderly QI Consumer Survey To assess the feasibility of expanding a program that To review proposals in response to the Quality provides integrated medical and community-based Initiative’s Request for Proposals for consumer services on a capitated basis. research, and to work on survey and campaign devel- opment. Donna Lobdell Sacramento, CA Marcus A. Foster Educational Institute $3,750 Oakland, CA GMC Dental Services Project $1,000,000 To fund analysis for a background report on geo- East Bay Health Careers Collaborative graphic managed care (GMC) dental services. To form a collaborative of the existing health academies and related programs in East Bay high Lompoc Valley Community Healthcare schools to help create a viable health careers system for Organization Alameda and Contra Costa counties. Lompoc, CA $239,000 Mexican American Legal Defense and Santa Barbara Health Care Information Educational Fund Demonstration Project Los Angeles, CA To facilitate the development of a business model for $150,000 the cooperative sharing, maintenance, and use of clini- Healthy Families and Medi-Cal Outreach Campaign cally relevant health information for the Santa Barbara To conduct a media outreach campaign in California Health Care Information Demonstration Project. to educate Latino immigrant families on the benefits of enrolling their children in the Healthy Families and Long Term Care Group Medi-Cal programs. El Segundo, CA $1,000,000 Midcoast Medical Care, Inc. Community-based Health Coaching Santa Maria, CA To invite seniors who have purchased California $67,000 Public Employees Retirement System long-term care Santa Barbara Health Care Information insurance, and who have at least one chronic condi- Demonstration Project tion, to participate in a study on preventing disability To facilitate the development of a business model for through community-based health coaching. the cooperative sharing, maintenance, and use of clini- cally relevant health information for the Santa Barbara Los Angeles Alliance for a New Economy Health Care Information Demonstration Project. (LAANE) Los Angeles, CA $25,000 Lessons Learned from Living Wage Ordinances To document the lessons learned from Los Angeles’ experience with the living wage legislation and imple- mentation, focusing on health benefits and the benefit-wage tradeoff. 35 CALIFORNIA HEALTHCARE FOUNDATION Arthur Miller The National Center on Addiction and Cambridge, MA Substance Abuse at Columbia University $10,500 New York, NY Statewide Conference on Medical Privacy $100,000 and Confidentiality Conference Support: To develop and lead an interactive panel discussion Substance Abuse in the 21st Century among key health care stakeholders, held during a one- To provide support for a four-day national conference day conference on Medical Privacy and Confidentiality. on substance abuse to discuss ways of improving efforts to address substance abuse. Milliman & Robertson, Inc. San Francisco, CA National Committee for Quality Assurance $100,000 Washington, DC Actuarial/Analytical Services for Breast Cancer $225,000 Treatment Fund Improving Quality in Medi-Cal Managed Care To conduct financial and actuarial analyses of methods To provide training to Medi-Cal health plans on how for financing breast cancer treatment, and to help to implement the Health Plan Employer Data and inform the analysis of public financing options for Information Set and the Consumer Assessment of long-term support of breast cancer treatment for low- Health Plans Survey, which help measure quality of income women in California. care through publicly funded health services. Leah Morris National Committee for Quality Assurance Sacramento, CA Washington, DC $3,750 $41,453 Background Report on the Evaluation Quality Evaluation for Preferred of GMC Dental Services Provider Organizations To prepare a background report on geographic managed To produce a position paper on the status of quality care (GMC) dental services. measurement and accountability in the preferred pro- vider organization market. Eleanor Murray San Rafael, CA National Committee for Quality Assurance $5,000 Washington, DC Dissemination of the Non-poor $15,451 Uninsured Study Results Performance-based Accreditation of To assist with the public release of the survey of Provider Organizations California’s non-poor uninsured study, and to provide To participate in the development of the CHCF- consulting to the uninsured program related to survey funded Provider Group Consumer Assessment Survey, research issues. and to evaluate the relationship between it and the Consumer Assessment of Health Plans Survey National Academy for State Health Policy endorsed by the National Committee for Quality Portland, ME Assurance. $37,600 State Reporting of Medical Errors and Adverse Events National Conference of State Legislatures To assess states’ medical error reporting systems, and Washington, DC to share lessons learned with providers, state officials, $3,000 and consumer advocates. Managed Care Regulation Analysis To present a briefing for legislative staff in Sacramento National Academy of Sciences on health policy issues identified by Assembly and Washington, DC Senate staff. $25,000 Workshop Support: The Quality of Health Care To convene a one-day Institute of Medicine workshop on public communications about the quality of health care. 36 Board Grants and Contracts Awarded: January 1, 1999–February 28, 2001 National Conference of State Legislatures National IPA Coalition Washington, DC Oakland, CA $355,000 $485,000 California Support Center for State Building a Health Care Information Infrastructure: Legislators and Staff CALINX Phase II To establish a “California Support Center” within the To continue to develop a standard health care infor- National Conference of State Legislatures’ Forum for mation infrastructure in California that enables State Health Policy Leadership, providing California purchasers, health plans, and providers to improve the policymakers with information that enhances their flow of information throughout the health care capacity for informed decision-making on issues delivery system. related to health care financing, organization, and delivery. National PACE Association San Francisco, CA National Conference of State Legislatures $265,122 Washington, DC Consumer Satisfaction Measurement Tool for the Frail $8,250 Elderly Health Policy Across the States To design and test tools for a subset of the elderly who To present a briefing for legislative staff in Sacramento are using health and supportive services but are too on health policy issues identified by Assembly and frail and/or cognitively impaired to respond easily to Senate staff, focusing on major issues in health policy the customary administration and content of satis- for the upcoming session and the experiences of other faction questionnaires. states in these issue areas. Northstar Interactive, Inc. National Forum for Health Care Quality New York, NY Measurement and Reporting $26,775 New York, NY California HealthLine Survey $1,000,000 To design, administer, and analyze a survey of Organizational and Strategic Infrastructure California HealthLine’s readership to assess the value To support, along with the Robert Wood Johnson that the service provided and to develop possible Foundation and the Health Care Financing Admin- enhancements. istration, the “national measurement table,” at which purchasers of health care and consumers can set On Lok national priorities for quality measurement and San Francisco, CA reporting. $770,620 Medical Group Practices and On Lok National IPA Coalition To develop and test a mechanism for integrating Oakland, CA medical group practices into On Lok’s model of care $50,000 for the frail elderly. Communicating the Success of CALINX To develop and implement an outreach effort ON Marketing informing the California health care community Long Beach, CA about the successes of the CALINX (California $16,500 Information Exchange) health care data standards California Medicare Project project, and trying to build support for wider industry To provide communications and public relations assis- adoption of CALINX data standards and business tance for the launch of the California Medicare Project. rules. O’Neil & Associates Fair Oaks, CA $100,000 Y2K Health Care Awareness and Preparation To coordinate the Foundation’s Y2K Awareness and Preparation efforts with other organizations. 37 CALIFORNIA HEALTHCARE FOUNDATION Outlook Associates, Inc. The Pacific Health Policy Group Long Beach, CA Claremont, CA $300,000 $160,000 Medi-Cal Managed Care Data Mapping Project HIPAA Compliance and Safety Net Providers To analyze the flow of encounter and enrollment data To develop educational materials and “how-to guides” that occurs in Medi-Cal managed care systems be- that help provider organizations comply with the tween providers, intermediaries, health plans, and the federal Health Insurance Portability and Account- state government. ability Act of 1996 (HIPAA). Pacific Business Group on Health The Pacific Health Policy Group San Francisco, CA Claremont, CA $19,387 $90,000 Plan vs. Provider Group Effects on Quality of Care Industry Adoption of National Health Data Standards To investigate the relative importance of the health To support a project that addresses health care indus- plan an individual joins, versus the physician group try transition under the federal Health Insurance and that actually provides treatment, in determining Portability Act of 1996 (HIPAA), and that gathers in- quality of care. formation on industry responses to HIPAA provisions. Pacific Business Group on Health PacifiCare of California, Inc. San Francisco, CA Los Angeles, CA $42,340 $1,000,000 Consumer Assessment Survey Secure Horizons Eldercare Program To design an integrated, standardized instrument for To link frail Secure Horizons members from three use in assessing consumers’ evaluation of their medical participating medical groups (Cedars-Sinai, South Bay, group. and Harriman-Jones) to community-based services. Pacific Business Group on Health PCS Healthcare Systems San Francisco, CA Phoenix, AZ $15,000 $600,000 Blue Ribbon Awards Program Prescription Drug Utilization and Cost Trends To develop and disseminate public outreach materials in the California Market for the Pacific Business Group on Health Blue Ribbon To produce a report that educates and informs health Awards Program. care industry stakeholders and public and private decision-makers about prescription drug utilization Pacific Business Group on Health and cost trends and drivers in California. San Francisco, CA $435,000 David Pockell Building a Health Care Information Infrastructure Lafayette, CA To continue to develop a standard health care infor- $50,000 mation infrastructure in California that enables Senior Advisor to the Uninsured Program purchasers, health plans, and providers to improve the To assist CHCF staff with strategic planning, project flow of information throughout the health care development and implementation, proposal review, delivery system. and external communications. The Pacific Health Consulting Group PricewaterhouseCoopers LLP San Anselmo, CA San Francisco, CA $45,000 $90,352 Quality College for Consumer Advocates Medi-Cal Rates Report To provide information and support on quality of To research Medi-Cal rates for the Medi-Cal Policy health care issues so that consumer leaders and others Institute. may begin to play leadership roles on quality issues of importance to consumers. 38 Board Grants and Contracts Awarded: January 1, 1999–February 28, 2001 Project HOPE— RAND Corporation People-to-People Health Foundation Santa Monica, CA Bethesda, MD $550,000 $300,000 Consumer Survey and Research Project Renewal of Health Affairs Partnership To conduct and report survey findings of California To explore areas of health policy research on Califor- consumers’ attitudes and behaviors regarding health nia-specific topics by supporting policy roundtables, care quality. commissioning relevant research, and producing and publishing papers in an issue of Health Affairs. RAND Corporation Santa Monica, CA Project HOPE— $130,805 People-to-People Health Foundation Health Insurance Coverage Among Welfare Recipients Bethesda, MD in California $75,000 To expand the health-related questions on a survey Special Issue of Health Affairs developed by RAND for the California Department To support publication of a thematic issue of Health of Social Services to evaluate the California Work Affairs that includes an in-depth analysis of pre- Opportunity and Responsibility to Kids program. scription drug use and spending among the elderly, strategies employed by private and public payers for RAND Corporation providing and financing pharmaceuticals, and the Santa Monica, CA role of direct-to-consumer advertising in promoting $85,000 demand for drugs. Analysis of Breast Cancer Treatment To analyze the cost-effectiveness and health benefits Project HOPE—People-to-People Health of current breast cancer treatments and to identify Foundation new areas of research to increase the availability of Bethesda, MD high-quality, cost-effective treatment for all women in $188,631 California. Tracking Insurance and Access to Health Care in California RAND Corporation To conduct an evaluation of the statistical validity and Santa Monica, CA relevance of existing national and state data collection $666,362 efforts that could be used for tracking insurance and Consumer Assessment Survey access to health care in California. To design and test an integrated, standardized survey instrument for use in assessing how consumers Protocare Sciences evaluate the performance of the medical group at Santa Monica, CA which they receive care. $910,000 Variation in the Use of Medications RAND Corporation To conduct research on variations in the use of Santa Monica, CA pharmaceuticals to treat selective conditions in $100,000 California, and to identify potential improvements in Technical Support to the Quality Initiative pharmacological management. To provide technical assistance to the staff of CHCF’s Quality Initiative, including quality of health care RAND Corporation assessment methods and results, survey research Santa Monica, CA methods, and general education and advice in the $74,000 area of quality of health care research. Consumer Assessment Survey Translations To translate the Consumer Assessment of Health Plans Survey and related communications materials into Vietnamese, Mandarin, Cambodian (Khmer), and Korean. 39 CALIFORNIA HEALTHCARE FOUNDATION Reden and Anders, Ltd. Jeffrey Rideout San Francisco, CA Danville, CA $20,000 $15,663 Analysis of HIPC Rates Developing a Hospital Quality To assess how 1998 rates for health plans participating Public Reporting Agenda in the Health Insurance Purchasing Coalition (HIPC) To research and assist in the development of a vol- compare to rates for other small group health insur- untary three- to five-year quality reporting agenda for ance plans. the California hospital industry, CHCF, and other stakeholders. Reden and Anders, Ltd. San Francisco, CA Debra Roth $13,530 Sacramento, CA Educational Forum: California Legislative and $11,500 Administration Staff IV-D Kids Health Insurance Pilot Project To conduct a forum that introduces legislators and To evaluate Sacramento County’s IV-D Kids Health staff to the complexity of accurate projections of Insurance pilot project, a public-private partnership private and public sector costs related to legislative designed to provide affordable health care services to proposals. California children in the child support system. Reden and Anders, Ltd. roundpeg San Francisco, CA San Francisco, CA $1,000 $3,000 Actuarial Assessment of Health Costs Web-based Application Development To support the development phase of CHCF’s work To develop detailed specifications for a Web-based with the California State Senate Insurance Committee mailing list builder to improve CHCF’s outreach and in determining how to assess the cost implications of dissemination activities. health bills before the state legislature. Sacramento Healthcare Decisions Resolution Economics, LLC Sacramento, CA Beverly Hills, CA $190,000 $4,000 Cost-effective Decision Making in Managed Care Survey of California Small Firms To develop and encourage implementation of new To provide consulting services for the 2000 CHCF/ processes for making and/or communicating medical Mercer Survey of California Small Firms. treatment decisions that reflect the views and values of local consumers, physicians, and other stakeholders. Resolve, Inc. Washington, DC San Diego State University $15,000 San Diego, CA Business of Health Care Roundtables $100,000 To assist CHCF in designing and facilitating group Multicultural Outreach and Health Care Delivery meetings of health care stakeholders to discuss urgent To pilot-test the concept of using community health matters regarding improvements in the health care advocates to link a managed care plan with high- marketplace, and to find areas of agreement for prac- risk elderly from culturally diverse communities in tical improvements that benefit consumers. San Diego. Richard Rettig Alexandria, VA $10,000 The Industrialization of Clinical Research To produce a manuscript for publication in Health Affairs on “The Industrialization of Clinical Research.” 40 Board Grants and Contracts Awarded: January 1, 1999–February 28, 2001 Santa Barbara Regional Health Authority Sharp HealthCare Foundation Goleta, CA San Diego, CA $252,500 $1,000,000 Santa Barbara Health Care Information Frail Elderly Care Management Project Demonstration Project To test the hypothesis that overall health care costs can To facilitate the development of a business model for be reduced and quality of life increased in a frail the cooperative sharing, maintenance, and use of clini- elderly group receiving enhanced medical and social cally relevant health information for the Santa Barbara care management intervention. Health Care Information Demonstration Project. Shattuck Hammond Partners The Severyn Group San Francisco, CA Ashburn, VA $573,500 $8,000 California Hospital Financing and Long-term Debt Quality Primer To examine the California hospital industry and the To edit the Quality Initiative’s health care quality financial environment of California hospitals, to review primer. the hospital financing system, and to perform in-depth case studies of representative California hospitals. The Severyn Group Ashburn, VA ShawPittman $37,500 Washington, DC Research and Materials for the Quality Initiative $40,000 To develop fact sheets and a series of case studies to be Evaluating Y2K Readiness used in educating and engaging opinion leaders on To counsel CHCF with respect to legal issues arising quality issues. from a proposed project to assist California’s “safety net” providers in evaluating their Y2K readiness. The Severyn Group Ashburn, VA Donald G. Sikora $17,750 Sherman, TX Health Care Quality Retreat 2000 $20,000 To produce a report of the proceedings of the Health Database for the California Medicare Data Book Care Quality Retreat 2000. To identify and process Health Care Financing Administration Medicare data files, and to develop the SGR Health Alliance California Medicare Project’s statewide Medicare Berkeley, CA database. $198,250 Behavioral Health in California: Richard Smith A State-of-the-State Report Brookline, MA To produce a comprehensive “state-of-the-state” $45,000 report on behavioral health care in California, Ethical Issues Surrounding eHealth focusing on the current sources of funds and costs for To gather the information and profiling practices of mental health and substance abuse services, how these selected health Web sites and search engines. services are delivered, and the regulatory systems and structures. STILL Graphic Design, Inc. San Francisco, CA SGR Health Alliance $5,000 Berkeley, CA eHealth Ethics and Privacy Report Covers $2,700 To design graphics for the eHealth report series. External Review of Mental Health Fact Sheet To review the CHCF Mental Health Fact Sheet. 41 CALIFORNIA HEALTHCARE FOUNDATION STILL Graphic Design, Inc. Stoorza, Ziegaus & Metzger, Inc. San Francisco, CA Sacramento, CA $6,240 $120,000 Guide to Medi-Cal Programs Strategic Communications for HealthVote 2000 To design and produce the Guide to Medi-Cal To provide strategic communications for consumer Programs, an overview of aid codes, eligibility, outreach on health and health care issues for the coverage, and expenditures in the Medi-Cal program. November 2000 California election. Stoorza, Ziegaus & Metzger, Inc. Jeff Stryker Sacramento, CA San Francisco, CA $11,000 $12,000 Media Outreach for the STD Prevention Articles for the California Medicare Project and Control Project To fund “ghost writing” of articles on health care To develop a media strategy to promote the topics for CHCF’s California Medicare Project. Chlamydia Action Agenda, ensuring that legislators and stakeholders are aware of the public health impact Laura Tollen of chlamydia, the human and financial costs of Sausalito, CA untreated infections, and new opportunities to reduce $9,000 chlamydia in California. Medi-Cal Rates Resource Binder To develop a resource binder of materials related to Stoorza, Ziegaus & Metzger, Inc. the development of Medicaid managed care and fee- Sacramento, CA for-service rates in general and the development of $15,000 Medi-Cal rates specifically. La Opinión Partnership To coordinate a Sacramento reception to launch the University of California, Los Angeles CHCF/La Opinión media partnership and the Capital Los Angeles, CA Watch column. $349,933 Coordinating Center for the IMPACT Study Stoorza, Ziegaus & Metzger, Inc. To support the addition of two CHCF-funded sites to Sacramento, CA the national IMPACT Study, a study to improve the $25,000 care of older adults with major depression or mood Release of Non-poor Uninsured Report disorders. To provide strategic communications, planning, and implementation services at a special media/legislative University of California, Los Angeles briefing for the release of the CHCF/Field Research Los Angeles, CA Corporation Survey of the Non-poor Uninsured. $416,518 Program Office: Program for Elders in Managed Care Stoorza, Ziegaus & Metzger, Inc. To establish a Southern California program office for Sacramento, CA managing CHCF’s Program for Elders in Managed Care. $42,500 A Day at the Capitol Events University of California, Los Angeles, To fund the preparation and logistics for publication Neuropsychiatric Institute of findings from the Medi-Cal Policy Institute’s Medi- Los Angeles, CA Cal Beneficiary Survey. $1,000,000 San Diego Alzheimer’s Disease Collaborative Stoorza, Ziegaus & Metzger, Inc. Care Initiative Sacramento, CA To demonstrate and evaluate a two-part quality $15,000 improvement process for Alzheimer’s disease (AD) STD Prevention and Control Project: Next Steps patients and caregivers. To develop targeted intervention strategies for syphilis elimination, and to begin implementing the recommendations from Phase I activities regarding chlamydia reduction. 42 Board Grants and Contracts Awarded: January 1, 1999–February 28, 2001 University of California, San Francisco University of California, San Francisco San Francisco, CA San Francisco, CA $103,500 $99,963 STD Prevention and Control Project: Next Steps The California Dental Access Project To develop targeted intervention strategies for syphilis To conduct research on the current state of access to elimination and implementation steps for both the dental care in California. The research includes recom- chlamydia and the syphilis action plans. mendations on new and innovative modes of delivery of dental care for uninsured, low income, and Medi- University of California, San Francisco Cal populations, with particular attention to delivery San Francisco, CA of services to children. $2,924,982 Establishing a CHCF Public Health Program Office University of California, San Francisco To direct and manage CHCF’s Valley Fever Vaccine San Francisco, CA and STD Prevention and Control projects. $2,003,851 California Nursing Home Performance Indicators University of California, San Francisco To develop, jointly with California Advocates for San Francisco, CA Nursing Home Reform, a comprehensive panel of $24,805 nursing home performance indicators, and to provide Universal Health Insurance Coverage Study: Phase I publicly available quality performance data on every To confirm the policymaking relevance and technical skilled-nursing facility in California. feasibility of a large-scale study that compares alter- native strategies for achieving universal health University of Southern California insurance coverage in California. Los Angeles, CA $249,981 University of California, San Francisco Evaluation of Riordan Commission on San Francisco, CA Healthy Kids’ Program $95,447 To assess the effectiveness of outreach and enrollment Primer on Medi-Cal and Long-term Care methods for immigrant children who are eligible for To produce a background paper on Medi-Cal and the Healthy Kids’ Program, and to determine whether long-term care in California, providing detailed infor- the program has affected utilization of care. mation on services, beneficiaries, and utilization. University of Southern California University of California, San Francisco Los Angeles, CA San Francisco, CA $205,004 $3,000,000 Insurance for In-home Supportive Services Workers Sexually Transmitted Disease Prevention To assess health insurance options for in-home sup- and Control Project portive services workers in Los Angeles. To reduce the number of chlamydia cases by 75 percent, to reduce the complications of chlamydia William M. Mercer, Inc. infection, and to eliminate transmission of syphilis in San Francisco, CA California. $400,000 Evaluating Medi-Cal Dental Services University of California, San Francisco To develop and implement a comprehensive evalu- San Francisco, CA ation of Medi-Cal dental care in Sacramento. The $5,000,000 evaluation compares services provided through the California Health Care Workforce Initiative Geographic Managed Care model to those provided To improve understanding of California health care by fee-for-service providers. workforce issues, and to advance the ability of health care workers to improve the health of Californians. Additional funding for this initiative has been provided by The California Endowment. 43 CALIFORNIA HEALTHCARE FOUNDATION William M. Mercer, Inc. Abt Associates Inc. San Francisco, CA Cambridge, MA $42,900 $25,000 Health Care Quality Campaign Pharmacy Study To provide consultation to the Quality Initiative staff To interview health care professionals in hospitals and on advancing quality measurement and reporting medical centers across California to assess their percep- initiatives. tions of the trends and drivers of pharmaceutical costs and usage. William M. Mercer, Inc. San Francisco, CA Advisory Board Company $470,500 Washington, DC California Employers’ Health Survey 2000 $1,125,000 To repeat the 1998 Mercer survey of small California eHealth News Service firms in the year 2000, expanding it to include firms To host and publish a daily eHealth news service that of 50 to 199 workers. educates policymakers and industry leaders on issues resulting from the adoption of new technologies. Lucien Wulsin Santa Monica, CA American Health Lawyers Association $25,000 Washington, DC Uninsured Child Care Workforce $10,000 To identify and evaluate feasible approaches to Conference Support: Privacy of Health Information expanding health insurance among providers of child To support the Public Interest Colloquium on Privacy care services. of Health Information. Susan Anthony San Francisco, CA $58,000 CHCF Online Health Care Journal: Start-up Phase March 1, 2000 to February 28, 2001 To research and develop an online health care journal that provides an in-depth look at health care issues in 415 Productions, Inc. California and fosters discussion. San Francisco, CA $21,216 Aon Consulting, Inc. CHCF Web Site Redesign: Phase I San Francisco, CA To produce two design concepts for the CHCF Web $5,000 site to expand functionality. Tax Deductibility of Health Insurance Premiums To identify and evaluate the federal and California tax 415 Productions, Inc. implications of health insurance purchased by small San Francisco, CA businesses on behalf of their employees. $272,000 eHealth News Service Development Bananas, Inc. To design and develop a Web-based platform for a Oakland, CA new CHCF eHealth news service. $48,519 Health Care Connections Manual 415 Productions, Inc. To fund updates to the Health Care Connections San Francisco, CA manual, including translation into languages other $69,921 than English, and distribution to families of children CHCF Web Redesign: Phase II with special health care needs. To design graphic elements and templates for CHCF’s Web site to expand functionality. 44 Board Grants and Contracts Awarded: January 1, 1999–February 28, 2001 California Black Health Network, Inc. The California Works Foundation San Diego, CA San Francisco, CA $295,000 $321,253 Quality Improvement Project Improving Health Care Quality Accountability To inform and educate African-American consumers To develop a statewide health care quality purchasing about quality-of-care issues, to establish baseline campaign with California Labor Federation affiliates, definitions for health care quality, and to enhance the to participate in public discussions on quality issues, effectiveness of the community’s role in addressing and to disseminate report card information and health care quality issues. quality data. California Center for Health Improvement CaliforniaKids Healthcare Foundation Sacramento, CA Encino, CA $10,000 $1,500,000 The Health Care Quality & Prevention Project Filling the Gaps in Children’s Health Coverage To summarize findings from six Health Care Quality in California and Prevention Project meetings, and prepare a To provide subsidized coverage for preventive and background paper. primary health care services to uninsured children in California, ages 2 to 18. California Managed Risk Medical Insurance Board CapMetrics, LLC Sacramento, CA Berkeley, CA $26,795 $299,829 Asian Language Oversampling for Health Plan Survey Developing Measures of Provider Solvency To fund oversampling of the Consumer Assessment of and Monitoring Mechanisms Health Plans Survey among Healthy Families Program To test the adequacy of the provider group solvency families who speak one of three Asian languages (Kor- standards described in California Senate Bill 260, to ean, Vietnamese, Cantonese). propose alternative solvency standards, and to estimate the cost of compliance with the existing and proposed California Managed Risk Medical standards. Insurance Board Sacramento, CA The Commonwealth Club of California $500,000 San Francisco, CA Statewide Health-e-App Implementation $498,200 To assist the State of California and its vendor, California Health Policy Speaker Series Electronic Data Systems, in preparing for statewide To renew the California Health Policy Speaker Series, implementation of the Health-e-App automated bringing nationally prominent speakers to California application for the Medi-Cal and Healthy Families for public discussions of critical health policy programs. issues. California Managed Risk Medical Community Health Councils, Inc. Insurance Board Los Angeles, CA Sacramento, CA $150,000 $2,500,000 Improving Quality of Care Information Increasing Access to California’s High-risk Pool To improve information available to consumers in To support subsidized health insurance for Califor- Los Angeles County on the quality of care delivered by nians who cannot obtain coverage in the individual the Medi-Cal program. health insurance market through the state’s Managed Risk Medical Insurance Program. 45 CALIFORNIA HEALTHCARE FOUNDATION Consumers Union DJL & Associates Yonkers, NY Sacramento, CA $260,798 $59,200 Guide to California Medicare HMOs National Committee for Quality Assurance To develop a comparative guide to California Medi- Medi-Cal Liaison Project care HMOs in the 36 counties where plans are To provide overall management and support for the available. The guide includes five quality-of-care design and development of two 1-day educational measures and a “Value Index” that provides compar- “best practices” workshops for the National Commit- ative analyses of premium costs and services provided tee for Quality Assurance Medi-Cal Liaison Project. by plans. DNA Interactive, Inc. County Welfare Directors Association Eustis, FL Sacramento, CA $9,000 $10,000 CHCF Web Site Redesign: Phase I Conference Support: To develop Web site designs for pages of the CHCF County Welfare Directors Association Web site to expand functionality. To support travel and lodging costs for speakers, as well as general conference expenses for the annual Donna Bender Consulting conference. Tarzana, CA $18,468 Carol Cronin Insurance Information Materials for Small Business Annapolis, MD To develop information materials for dissemination to $10,100 small businesses. CalMedicare.org Web Site To provide technical advice in the development of R. Adams Dudley a Web site tool for seniors seeking information San Francisco, CA on Medicare. $30,000 Assuring and Improving California Hospital Quality Deloitte Consulting LLC To identify strategies for increasing the supply of Sacramento, CA hospital quality performance information in Cali- $4,000 fornia, and for improving and assuring hospital Health-e-App Compliance quality overall. To fund compliance of the code in the Health-e-App Internet-enabled application with the level 1 require- Edelman Public Relations Worldwide ments of the Americans for Disabilities Act, as Sacramento, CA requested by the California Governor’s Office. $64,000 Online Healthy Families/Medi-Cal Enrollment Deloitte Consulting LLC Application Process Sacramento, CA To provide public affairs counsel to promote awareness $625,000 and acceptance of online enrollment for the California Health-e-App Implementation Healthy Families and Medi-Cal programs. To work with state agencies and contractors in prepar- ing Health-e-App for transition and licensing to the Edelman Public Relations Worldwide State of California, and to develop enhancements to Sacramento, CA the online enrollment system. $89,100 Online Healthy Families/Medi-Cal Enrollment Devillier Communications Inc. Application Process Washington, DC To provide public affairs counsel to educate key legis- $35,000 lators, staff, and stakeholders throughout the state Screening of Critical Condition about the benefits of online enrollment for the To coordinate and manage a reception and preview California Healthy Families and Medi-Cal programs. screening of the PBS Special Critical Condition with Hedrick Smith. 46 Board Grants and Contracts Awarded: January 1, 1999–February 28, 2001 Edelman Public Relations Worldwide First Consulting Group Sacramento, CA Lexington, MA $84,270 $103,900 Quality of Health Information on the Internet: Application Service Provider Report Series Proceed with Caution Report To develop a series of reports on Application Service To provide consultation and implementation services Providers (ASPs) to help health care organizations to CHCF for the release of a report on the quality of better understand ASPs’ potential role in future infor- health information on the Internet. mation systems planning. Electronic Data Systems First Consulting Group Rancho Cordova, CA Lexington, MA $158,881 $220,000 Health-e-App Interface Development eHealth Reports Series To field-test the Medi-Cal/Healthy Families auto- To prepare reports for CHCF’s eHealth Reports series mated application (Health-e-App) in one California on topics of emerging Internet-based technologies county, including testing the data linkages with state intended to improve health care delivery. point-of-entry for applications, county eligibility systems, and state payment systems. Foundation for Accountability (FACCT) Portland, OR Jennifer Elias $23,000 San Francisco, CA HIV/AIDS Quality Measures Field Testing $6,000 To expand ongoing HIV/AIDS quality measures field CalMedicare.org Web Site testing. To update a Web site to present Medicare/Medigap information to consumers in an accessible format. Foundation for Health Care Quality Stillwater, MN The ETV Endowment of South Carolina, Inc. $35,000 Spartanburg, SC Conference Support: Informing Consumers About $165,000 Health Care Quality Promotion and Outreach for Critical Condition To support planning and management activities To oversee the outreach and promotion of the PBS for the conference on “Informing Consumers About special Critical Condition with Hedrick Smith on Health Care Quality: New Directions for Research public television stations in California. The special, and Action.” cosponsored by CHCF, contains segments on quality of care and the uninsured. The Frabotta Company Mill Valley, CA Maureen Finan $4,500 Chatsworth, CA CHCF Collateral $5,000 To write collateral materials describing CHCF’s new Presentation Materials for the Quality Initiative strategic direction in grantmaking. To develop a series of educational presentation materials for constituents, modeled on the Quality Freeman and Associates Initiative primer. Sacramento, CA $36,000 First Consulting Group Consulting Services for Quality Initiative Lexington, MA To provide consultation to the Quality Initiative in the $15,000 areas of cultural competence and quality of care. Computerized Physician Order Entry Systems To produce a primer for hospital executives on com- puterized physician order entry. 47 CALIFORNIA HEALTHCARE FOUNDATION GeoAccess, Inc. Health Systems Research, Inc. Lenexa, KS Washington, DC $40,000 $238,059 Physician/Health Plan Database Access National eHealth Policy Symposium To provide online access to a database of health plans To provide overall project management for CHCF’s and providers for the pilot testing of Health-e-App in eHealth Policy Symposium, including planning and one California county. logistical support. George Washington University Steve Heimoff Washington, DC Oakland, CA $275,000 $3,500 National Health Policy Forum Partnership The California Delegated Model To establish a partnership that conducts activities To prepare an article on the theoretical underpinnings highlighting the link between national and California of California’s delegated model and its incentives, health policy issues. including why and how this configuration is supposed to work. Georgetown University Washington, DC InMotion Media, Inc. $7,800 Oakland, CA Evaluation of Quotesmith Web Site $36,000 To evaluate Quotesmith’s Web site and privacy policy, Maintenance and Enhancements and to conduct an assessment of the extent to which to CHCF Web Products the site addresses fair information principles. To provide ongoing maintenance and enhancements to the existing CHCF Web site. Georgetown University Washington, DC Institute for Health Policy Solutions $160,000 Washington, DC Health Privacy Implementation Guide $28,000 To develop a companion guide to CHCF’s Privacy Expanding Healthy Families to Cover Parents Primer that helps health care stakeholders in imple- To present and explain findings of the report menting the new federal health privacy regulations. Expanding Healthy Families to Cover Parents to policymakers and other interested constituencies in Georgetown University California. Washington, DC $270,000 Institute for Medical Quality Privacy and eHealth Initiatives San Francisco, CA To produce a series of reports on current issues in $193,000 health privacy, including gaps in privacy protections Impact of Legislation on External Review resulting from the passage of the new federal privacy To conduct a study of the impact of components of law, a review of industry self-regulatory efforts, and California’s Friedman-Knowles external review statute emerging issues in genetic privacy. on patient satisfaction and outcomes. Health Policy Alternatives, Inc. Institute for the Future Washington, DC Menlo Park, CA $3,250 $60,000 ABCs of Medicare in California Technology Diffusion in Health Care Report To provide editorial assistance on the ABCs of Medi- To familiarize clinicians and health care stakeholders care in California primer. with technology diffusion processes, and to explore the rationale for the pace of adoption of some innova- tions over others. 48 Board Grants and Contracts Awarded: January 1, 1999–February 28, 2001 Integral Systems Kaiser Foundation Research Institute Carlsbad, CA Downey, CA $5,000 $277,372 Health-e-App Pilot Project Support Direct-to-Consumer Advertising of Prescription Drugs To respond to calls from designated staff at each site To examine the impact of direct-to-consumer advertis- regarding problems with Internet connection and ing on the use of a new class of non-steroidal anti- hardware. inflammatory drugs that have been heavily marketed to consumers. Integral Systems Carlsbad, CA Susannah Kirsch $51,882 San Francisco, CA Health-e-App Pilot Implementation $6,200 To conduct audits and provide equipment and tech- Privacy Self-Regulation in Online Health Services nical support to pilot test sites for the Health-e-App To evaluate the effectiveness of industry self-regulation project. in maintaining confidentiality of health information online, and to propose appropriate policy options to Interactive Applications Group (IAPPS) ensure confidentiality. Washington, DC $28,000 KVIE Sacramento Assessment of CHCF Web Platform Sacramento, CA To review CHCF’s current and long-term Web plat- $125,000 form and Web site redesign efforts to assure a better Health Counts 2000 product for users. To produce, as part of the CHCF HealthVote 2000 project, special segments of the California Capitol- Judith Jenna Week television program on California health issues, Santa Rosa, CA and to develop other activities to encourage discussion $8,000 of health care issues. Focus on Pharmaceuticals Series To edit studies on prescription drug issues in California. La Opinión Los Angeles, CA Johns Hopkins University $1,250,000 Baltimore, MD Partnership for Health $49,620 To continue the media Partnership for Health with Variations in Medicare Payments for Graduate La Opinión. The Partnership provides health care Medical Education information to California’s Latino population through To document the magnitude of and trends in the the development and dissemination of special health variation of graduate medical education payments care supplements. from Medicare across states and teaching hospitals. Laurel Consulting Group Andrea Johnston Los Angeles, CA San Francisco, CA $78,082 $7,500 Medi-Cal Quality Improvement Training Medi-Cal/Healthy Families Enrollment Strategy Study To provide logistical planning and support for four To synthesize the findings of the Medi-Cal/Healthy 1-day training workshops on quality improvement for Families Enrollment Strategy Study conducted by Medi-Cal health plans. Eric Marder and Associates and the Medi-Cal Policy Institute. 49 CALIFORNIA HEALTHCARE FOUNDATION Laurel Consulting Group Local Health Plans of California Los Angeles, CA Sacramento, CA $34,130 $60,000 Medi-Cal Quality Improvement Training Medi-Cal Health Plans To provide planning and support for training of Medi- To facilitate a daylong strategic visioning session for Cal health plans cosponsored by the Medi-Cal Policy senior leadership of California local health plans Institute and the National Committee for Quality participating in Medi-Cal managed care, bringing Assurance. together industry experts to share best practices. Laurel Consulting Group Amy Markowitz Los Angeles, CA San Francisco, CA $13,510 $31,500 Convening on Medi-Cal Rates Quality Grand Rounds Project To provide planning and logistical support for the To develop and produce a continuing series of confer- Medi-Cal Rates Roundtable. ences and companion articles on quality improvement and medical errors for publication in a scholarly journal. Laurel Consulting Group Los Angeles, CA Albert R. Martin $50,000 San Rafael, CA Health-e-App Pilot Test Coordinator $267,369 To coordinate and provide logistical support for the Future Health Leaders Program Medi-Cal Policy Institute, CHCF staff, and individual To create a CHCF-sponsored fellowship program that test sites for the Health-e-App pilot test in San Diego inspires and prepares California physicians and health County. care professionals to become agents of change in the health care system. Lucian L. Leape Cambridge, MA Milliman & Robertson, Inc. $1,500 Seattle, WA Medication Error Reduction $51,300 To provide consultation for the Quality Initiative in Costs of Coverage for Gynecological Cancers developing requests for proposals for medication error To produce a report on actuarial cost models for reduction projects. gynecological cancers. The cost models show an estimate of the level of funding required to provide The Lewin Group health care benefits to a defined population of cancer San Francisco, CA patients. $27,580 Balanced Budget Act Analyses Eleanor Murray To write a report summarizing Balanced Budget Act San Rafael, CA options, analyses of the issues, and findings for the $5,000 four coverage expansion options for the Medi-Cal Survey of California Small Businesses program. To review results of a pretest of the CHCF/Mercer Survey of California Small Businesses instruments, The Lewin Group and to provide consultation and technical advice on San Francisco, CA survey methodology. $110,035 Medi-Cal Fee-for-service Rates: A National Context To conduct research comparing Medi-Cal fee-for- service rates to rates paid by other Medicaid programs nationally. 50 Board Grants and Contracts Awarded: January 1, 1999–February 28, 2001 National Academy of Sciences Northern California Grantmakers Washington, DC San Francisco, CA $50,000 $60,000 Federal Health Care Quality Oversight HIV/AIDS Issues and Trends To provide supplemental support for a project com- To support technical assistance and education to missioned by the U.S. Department of Health and California foundations and corporate funders on Human Services designed to produce an overview of HIV/AIDS issues and trends. existing federal health care quality oversight, improve- ment, and research programs. Outlook Associates, Inc. Long Beach, CA National Academy of Social Insurance $13,100 Washington, DC Data Mapping Report $70,228 To revise the Medi-Cal Managed Care Data Mapping Medicare and HIV/AIDS in California report, and to present the findings to stakeholders. To conduct qualitative research, in collaboration with the National Association of People with AIDS, on the Douglas J. Porter experiences of California Medicare beneficiaries with Davis, CA HIV/AIDS with payer and provider systems, and to $1,500 analyze the costs and utilization of health care for this White Paper on Medi-Cal Fraud population. To produce a background paper on Medi-Cal fraud focusing on provider versus beneficiary fraud, policy National Committee for Quality Assurance issues of fraud, and recommendations of next steps to Washington, DC reduce fraud. $218,656 Medi-Cal Liaison Project: Year 2 PricewaterhouseCoopers LLP To provide training to Medi-Cal managed care plans San Francisco, CA to improve their ability to effectively measure and $49,410 monitor the quality of care provided to Medi-Cal Resource-based Relative Value Scale (RBRVS) beneficiaries. and Its Applicability to Medi-Cal To conduct research on the costs, benefits, and policy National Committee for Quality Assurance considerations of converting the Medi-Cal fee-for- Washington, DC service payment structure to RBRVS by examining the $499,338 experiences of other states that have implemented Improving Efficiency in Evaluating California RBRVS for their Medicaid programs. Physician Organizations To improve processes for collecting quality of care PricewaterhouseCoopers LLP information about managed care organizations and San Francisco, CA their contracted provider organizations in California. $90,352 Medi-Cal Rates Report National Health Foundation To research Medi-Cal rates for the Medi-Cal Policy Los Angeles, CA Institute. $199,928 Simplifying Medicare+Choice Program Operations PricewaterhouseCoopers LLP To develop Web-based communication tools and data- San Francisco, CA bases designed to assist physicians and other health $51,776 care providers in providing more effective health care Fee-for-service Rates in California: services to California’s Medicare+Choice beneficiaries. Medi-Cal vs. Other Payers To research a comparison of Medi-Cal fee-for-service rates to rates paid in California by Medicare, Medi-Cal managed care health plans, Healthy Families health plans, and commercial payers. 51 CALIFORNIA HEALTHCARE FOUNDATION PricewaterhouseCoopers LLP Public Health Foundation Enterprises, Inc. San Francisco, CA City of Industry, CA $150,000 $1,500 Reducing the Incidence of Chlamydia in California Conference Support: African-American To support a collaboration between the California Women’s Health Health Department and the state’s managed care To produce a conference on African-American women’s plans to improve screening and treatment health issues. of chlamydia. Public Health Institute Progress Foundation Berkeley, CA San Francisco, CA $300,000 $40,000 Women’s Health Leadership, Women’s Choices Mental Health and Substance Abuse Models To train women health leaders in California to become To support a series of expert stakeholder meetings and health quality champions, educate consumers in their case studies designed to identify factors that impede or community about health care quality issues, and facilitate innovations and improvements in California’s develop recommendations for culturally appropriate publicly funded behavioral health service system. quality indicators. Project HOPE—People-to-People Health RAND Corporation Foundation Santa Monica, CA Bethesda, MD $38,038 $258,856 Medi-Cal Coverage Among Former Welfare Recipients Thematic Issue of Health Affairs on the Internet To create a county-by-county chartbook and issue and Health Care brief that provide a comprehensive picture of Medi- To publish a special issue of Health Affairs devoted to Cal take-up rates among former welfare recipients. the Internet and related health care policy issues. RAND Corporation Project HOPE—People-to-People Health Santa Monica, CA Foundation $50,000 Bethesda, MD A Comparative Analysis of the $231,268 Random Digital Dial Survey vs. Internet Survey Who Falls Through California’s Health Care To conduct a comparative analysis designed to deter- Safety Net? mine the relative merits of survey methodology, using To examine the nature and scope of inpatient charity a survey sampling Californians on their attitudes about care services provided by short-term acute care hospi- health care quality. tals in California. RAND Corporation Protocare Sciences Santa Monica, CA Santa Monica, CA $439,141 $227,600 Evaluation of Health Information on the Internet Innovative Approaches to Improve To evaluate the quality of health information on Physician Prescribing English- and Spanish-language Web sites. The study To analyze innovative approaches to physician pre- assesses the ease of using search engines to obtain scribing that indicate possible improvement in health information, analyzes four medical conditions clinical, financial, and patient safety outcomes. on selected health Web sites, and assesses the level of health literacy of the sites. Protocare Sciences Santa Monica, CA $270,000 Addressing Medication Errors: A Practical Toolkit To provide hospital executives with a practical framework for applying technological solutions for reducing medication errors. 52 Board Grants and Contracts Awarded: January 1, 1999–February 28, 2001 RAND Corporation James C. Robinson Santa Monica, CA Berkeley, CA $698,917 $10,000 Impact of New Prescription Drug Benefit and CHCF Online Journal Formulary Designs To act as guest editor of the first issue of the CHCF To assess how recent innovations in drug benefit online journal, and to write an article on physician design have affected use and costs of both drug and group solvency issues in California. non-drug medical services in California. Stephen Robitaille RAND Corporation Oakland, CA Santa Monica, CA $12,000 $200,000 California HealthLine Features Columns California SB 1953 To develop weekly feature columns for publication on To support a study of California hospital seismic safety California HealthLine. issues to assist the California Legislature, other policy- makers, and the hospital industry in assessing the costs Stephen Robitaille and impact of SB 1953, the state-mandated seismic Oakland, CA compliance standards for California hospitals. $14,000 CHCF Online Journal RAND Corporation To produce articles for the CHCF online journal. Santa Monica, CA $230,000 Ruderman & Roth Testing Pharmacies’ Compliance with Sacramento, CA California SB 393 $4,000 To research whether pharmacies in California that Rights of Employers In Small-group participate in the Medi-Cal program comply with SB Health Insurance Market 393, enacted to facilitate access to prescription drugs To prepare a summary of AB 1672 (Margolin) for Medicare beneficiaries. (Chapter 1128, Statutes of 1992) and subsequent amendments, which affect the rights of small em- RAND Corporation ployers eligible for buying health insurance coverage. Santa Monica, CA $178,791 Ruderman & Roth Estimating the Uninsured in California Sacramento, CA To compare data from two national surveys, and to $3,000 develop statistical probability models designed to Consumer Group in Quality Issues explore the accuracy of the surveys in estimating To provide consultation on the design and structure of health insurance coverage. a proposed Support Center for Consumer/Patient Groups on Quality. Resolve, Inc. Washington, DC Ruderman & Roth $80,000 Sacramento, CA Health Care Collaborative Dialogue $6,250 To explore the feasibility and potential design of a Enhancing Involvement in Health Care Quality Issues structured health care industry stakeholder dialogue as To review proposals submitted in response to the a forum for discussion of California health care issues. Quality Initiative’s Request for Proposals, “Enhancing Involvement in Health Care Quality Issues.” 53 CALIFORNIA HEALTHCARE FOUNDATION Sansum-Santa Barbara Medical Foundation Shoshanna Sofaer Clinic New York, NY Santa Barbara, CA $10,000 $210,000 Evaluation of CalMedigap.org Web Site Santa Barbara Health Care Information To assist CHCF staff in evaluating and launching a Demonstration Project Web site. To facilitate the development of a business model for the cooperative sharing, maintenance, and use of clini- The SPHERE Institute cally relevant health information for the Santa Barbara Burlingame, CA Health Care Information Demonstration Project. $299,838 Tradeoffs Between Health Benefits and Other Forms of Jacob H. Schweitzer Compensation Berkeley, CA To measure tradeoffs workers make between health $3,500 insurance and other forms of compensation through a California Medicare Project’s Data Mapping survey of employees of companies that provide flexible To provide training and assistance to CHCF staff to benefit plans. identify the optimal software for data mapping. Stanford University The Severyn Group Palo Alto, CA Ashburn, VA $80,000 $7,500 Improving the Value of Evidence Assessing Cultural Competence Through Consumer on Plan and Provider Quality Surveys To demonstrate the effectiveness of a new measure- To edit the California Pan Ethnic Health Network ment technique in producing more valid and precise report on Assessing Cultural Competence Through information on the quality of care provided by medi- Consumer Surveys. cal groups in California. SHARP Health Plan STILL Graphic Design, Inc San Diego, CA San Francisco, CA $1,000,000 $3,825 Extending and Expanding Enrollment in FOCUS Design of Counties Count Report To support subsidized health insurance coverage for To design the Medi-Cal Policy Institute’s Counties low-wage workers of small firms in San Diego through Count Report. the Sharp Health Plan’s FOCUS (Financially Obtainable Coverage for Uninsured San Diegans) Support for Families of Children program. with Disabilities San Francisco, CA Sickle Cell Disease Foundation of California $50,000 Los Angeles, CA Family-friendly Materials for California $144,500 Children Services Managing My Pain: Practical Guidelines for To review and revise existing California Children Individuals with Sickle Cell Disease Services program and application materials to ensure To increase the ability of persons with Sickle Cell that they are family-centered and easy to understand for Disease to demand quality care for pain management, families with children with special health care needs. and to improve communications between these patients and their providers. 54 Board Grants and Contracts Awarded: January 1, 1999–February 28, 2001 University of California, Berkeley University of California, Riverside Berkeley, CA Riverside, CA $192,271 $300,000 Financing Care for the Poor Improving Quality of Health Care for Latinos To study two approaches to financing care for the poor To improve the quality of care received by Latinos in in California: Medi-Cal selective contracting for California by supporting Community Health Worker hospital inpatient services, and disproportionate-share promotora programs. hospital subsidies to hospital safety net providers. University of California, San Diego University of California, Irvine La Jolla, CA Irvine, CA $198,240 $297,977 Employer-based Health Insurance Coverage Adverse Selection in Medicaid Care To determine why California workers are less likely To examine the determinants and consequences of in- than other American workers to have health insurance, dividual health insurance decisions within an Orange and to gain a better understanding of the dynamics of County Medicaid managed competition program. the labor and employment markets in California. University of California, Los Angeles University of California, San Francisco Los Angeles, CA San Francisco, CA $222,768 $120,404 Health Insurance Coverage and Welfare-to-work Quality Grand Rounds To study the impact of welfare-to-work on health To educate a broad medical audience on the process of issues. medical error analysis, and to promote quality-of-care improvement. University of California, Los Angeles Los Angeles, CA University of California, San Francisco $497,292 San Francisco, CA Program Office: Program for Elders in Managed Care $224,830 To support the Program Office for CHCF’s Program Effects of Insurance Expansion on Health Care for Elders in Managed Care. To evaluate programs designed to expand health insurance coverage to the uninsured. University of California, Los Angeles Los Angeles, CA University of California, San Francisco $199,967 San Francisco, CA Status of Trauma Centers in California $3,482,631 To conduct a study that describes patterns of use and CHCF Health Care Leadership Program delivery of care in California’s trauma centers. To create a CHCF-sponsored fellowship program that employs interactive and experiential learning methods University of California, Los Angeles and new technologies to prepare California physicians Los Angeles, CA and other health care professionals to become agents $284,992 of change in the California health care system. Evaluation of California’s Emergency Medicine To describe the state of California’s emergency depart- University of California, San Francisco ments, and to assess possible reasons for inadequate Sacramento, CA capacity. $300,000 California Diabetes Control Program To establish 24 community-based consumer action groups throughout California that educate local communities about existing evidence-based guidelines on diabetes and about how to use the guidelines to encourage high-quality diabetes care. 55 CALIFORNIA HEALTHCARE FOUNDATION University of Michigan William M. Mercer, Inc. Ann Arbor, MI San Francisco, CA $237,425 $230,000 Evaluation of Alameda County’s Overview of New Prescription Drug Benefit Communities in Charge Program and Formulary Designs To conduct an in-depth financial analysis, baseline To provide an overview of current and future trends in survey, and follow-up survey of program participants pharmacy benefits and formulary designs in California. in English and Spanish. William M. Mercer, Inc. University of Southern California San Francisco, CA Sacramento, CA $240,000 $299,999 Pharmaceutical Manufacturers, PBM Providers, Plan Health Insurance Among Employed Sponsors, and Pharmacies Latino Californians To conduct research that serves as a primer on the To improve understanding of the forces responsible for financial arrangements among pharmaceutical manu- lack of health insurance among employed Latinos in facturers, retail pharmacies, and PBM providers. California. William M. Mercer, Inc. The Urban Institute San Francisco, CA Washington, DC $75,000 $77,445 Technical Support for Quality Initiative Expansion of Healthy Families: Marginal Tax Rates To provide technical assistance to the staff of CHCF’s To investigate and compare the impact of various Quality Initiative. Healthy Families expansion options on the marginal tax rates and work incentives facing eligible Californians. Women’s Information Network Against Breast Cancer Western Center on Law and Poverty, Inc. Covina, CA Los Angeles, CA $299,862 $7,000 Breast Buddy Peer Support Breast Care Program Conference Support: To provide newly diagnosed breast cancer patients at Consumer Organizations and Quality Martin Luther King University and Harbor/UCLA To provide funding for a summit on enhancing Medical Centers with information and training on consumer organizations’ involvement in health care how to demand quality breast care. quality, and to facilitate an exchange of information among local advocates, statewide advocates, and legislative health care policy staff. Western University of Health Sciences Pomona, CA $287,469 Quality Care for Californians with Disabilities To improve the quality of care obtained by individuals with disabilities by developing disabled- accessible education materials and workshops. William M. Mercer, Inc. San Francisco, CA $16,000 Prescription Drug Information To provide data for a CHCF HealthVote 2000- sponsored Capital Watch PBS television program. 56 Foundation Report 1999-2001 President’s Fund Grants and Contracts Awarded The President’s Fund is a discretionary fund primarily used for planning grants and contracts that lead to larger grants, time-sensitive grants and contracts, or grants and contracts that fall outside CHCF’s main program areas. The following is a list of grants and contracts authorized through the President’s Fund from January 1, 1999, through February 28, 2001. January 1, 1999 to February 29, 2000 Bay Area Black Health Consortium Oakland, CA Advisory Board Company $8,000 Washington, DC Conference Support: Statewide Black Health $15,000 Conference Health Care Industry Committee Delivery System Research Bay Area Blacks in Philanthropy Oakland, CA The African-American AIDS Policy $10,000 and Training Institute Conference Support: National Conference on Los Angeles, CA Black Philanthropy $20,000 National Plan to Stop HIV/AIDS in African- California Association of Homes and American Communities Services for the Aging Sacramento, CA AIDS HealthCare Foundation $30,000 Los Angeles, CA Summit on Managed Care and Seniors $25,000 Sponsorship of THRIVE Magazine The California Health Care Safety-Net Institute Berkeley, CA AIDS Project of the East Bay $7,100 Oakland, CA The Uninsured Debate: Health Care vs. $60,000 Health Insurance HIV/AIDS Policy Program California Healthcare Association AIDS Project of the East Bay Sacramento, CA Oakland, CA $35,000 $60,000 Conference Support: Y2K and Safety Net Providers HIV/AIDS Policy Program California Medical Association Foundation The Alameda County Health Care Foundation Sacramento, CA Oakland, CA $25,000 $25,000 Statewide Forum: Training Local Leaders on Capital Campaign for Highland Hospital Public Health Needs Alliance for Health Care Reform California Primary Care Association Washington, DC Sacramento, CA $25,000 $10,000 Capitol Hill Briefing on the Future of Managed Care Conference Support: The Changing Face of Health Care Association of American Medical Colleges Washington, DC Coe & Associates $30,000 San Francisco, CA Herbert W. Nickens Memorial Fund $50,000 Business of Health Care in California Initiative Association of Health Care Journalists Minneapolis, MN $30,000 Conference Support: Association of Health Care Journalists 57 CALIFORNIA HEALTHCARE FOUNDATION Community Clinic Association of Health Care Conference Administrators, LLC Los Angeles County Bellevue, WA Los Angeles, CA $30,000 $29,808 Scholarships for California Healthcare Financial Management and Private Public 2000 Symposium Partnership Rate Analysis Insight Analysis Cyber Dialogue San Francisco, CA New York, NY $2,500 $16,500 Small Businesses and Health Care Coverage Demographic Oversampling of eHealth Ethics Consumer Survey Institute for Health Policy Solutions Washington, DC Imee DuBose $44,904 San Mateo, CA Feasibility Study: Creating Purchasing Groups $15,000 Using Taft-Hartley Trusts Engaging Independent Health Funders in California Institute for the Future Richard Frank Menlo Park, CA Boston, MA $5,000 $10,000 Survey Instrument for CHCF’s eHealth Project Current Issues in Pharmaceutical Policy and Economics Integrated Healthcare Association Walnut Creek, CA Georgetown University $35,000 Washington, DC The Future of the Delegated Model $10,000 California Congressional Delegation Briefing on Interactive Applications Group Health Privacy and Confidentiality Washington, DC $25,000 Georgetown University Guide to California Health Data Sources Washington, DC $30,000 Los Angeles Times Legislative Monitoring Project Los Angeles, CA $30,000 Daniel Gitterman Conference Sponsor: Festival of Health Berkeley, CA $6,400 Minority Health Institute, Inc. Managed Care Benefit Mandate Proposals Beverly Hills, CA $5,000 Grantmakers in Health Conference Support: Washington, DC HIV/AIDS Prevention for Communities of Color $15,000 Conference Support: Eleanor Murray Annual Meeting on Health Philanthropy San Rafael, CA $10,000 Grantmakers in Health Analysis of Small Business Insurance Practices Washington, DC $27,750 Workshop for New Health Foundations 58 President’s Fund Grants and Contracts Awarded: January 1, 1999–February 28, 2001 The National Hispanic Medical Association Research Foundation of State University Washington, DC of New York $10,000 Albany, NY Conference Support: $25,000 Eliminating Disparities in Health for Hispanics Conference Support: Health Care for Culturally Diverse Populations National Public Health and Hospital Institute Washington, DC Stuart Schweitzer $20,000 Los Angeles, CA Managing Pharmacy Costs $10,000 Concept Paper on Pharmaceutical Policy Issues Robert Nordyke Topanga, CA Southern California Association for $3,600 Philanthropy Managed Care Benefit Mandate Proposals Los Angeles, CA $50,000 Northern California Grantmakers Host Committee: Council on Foundations San Francisco, CA 2000 Annual Conference $60,000 AIDS Task Force 2000 Stratton Publishing & Marketing, Inc. Springfield, VA PricewaterhouseCoopers LLP $20,000 San Francisco, CA Feasibility Study: California Medicine Magazine $40,000 Analysis of Benefit Mandates Before the California UHP Healthcare Senate Insurance Committee Inglewood, CA $5,000 Public Advocates, Inc. Conference Support: Academy of Managed Care San Francisco, CA $20,000 University of California, Berkeley Conference Support: Latino Coalition for a Berkeley, CA Healthy California 2000 $2,500 Conference Support: Building Better Health Systems Public Health Foundation Enterprises, Inc. City of Industry, CA University of Southern California $5,000 Los Angeles, CA Conference Support: 1999 Southern California Public $5,000 Health Association Annual Conference Conference Support: 15th Annual Chicano-Latino Medical Student Association Public Health Institute Berkeley, CA Ventura County AIDS Partnership $5,000 Camarillo, CA California Multi-Cultural Health $25,000 Information Institute Strategic Planning for the Ventura County AIDS Partnership Public Health Institute Berkeley, CA Washington Business Group on Health $32,875 Washington, DC Policy Retreat on Pharmaceuticals and Indigent $34,000 Care in California Leadership Forum on Universal Health Care Access 59 CALIFORNIA HEALTHCARE FOUNDATION Westat California Black Women’s Health Project Rockville, MD Inglewood, CA $27,779 $10,000 Leading Health Indicators Project Conference Support: The Health of Black Women Katherine B. Wilson California Hispanic Health Care Association Berkeley, CA Sacramento, CA $10,000 $25,000 Analysis of Online Health Insurance Sites Doctors from Mexico Project Women & Philanthropy California Primary Care Association Washington, DC Sacramento, CA $5,000 $10,000 Conference Support: Women with Disabilities Conference Support: Opening the Door to Health Care 2000 Women’s Funding Network St. Paul, MN California Public Health Association, Northern $10,000 Division Conference Support: The Future of Philanthropy Berkeley, CA and the Paradox of Wealth $10,000 Conference Support: California’s State Affiliates of the American Public Health Association March 1, 2000 to February 28, 2001 Cattaneo & Stroud, Inc. Welmar, CA $20,000 Academy for Health Services Research Statewide HMO Enrollment Database and Health Policy Washington, DC $7,500 Center for Health Care Rights Conference Support: Los Angeles, CA $30,000 Critical Issues for a New Administration Advocacy for Access to Quality Health Care Advisory Board Company Chicana/Latina Foundation Washington, DC $15,600 Burlingame, CA $10,000 Health Care Industry Committee Research Symposium to Create a Latina Agenda Services 2000/01 for the New Millennium Advisory Board Company The Communications Network Washington, DC $10,000 Washington, DC $10,000 eHealth News Prototype Development Conference Support: Communications Network Fall Conference Association of Health Care Journalists Minneapolis, MN $25,000 Cyber Dialogue Conference Support: National Conference of the New York, NY $70,500 Association of Health Care Journalists Physicians and the Internet: National Survey and California Over-Sample 60 President’s Fund Grants and Contracts Awarded: January 1, 1999–February 28, 2001 Cyber Dialogue Dana C. Hughes New York, NY Berkeley, CA $7,500 $1,800 White Paper on the Quality of Health Information Alameda County Family Care Project Evaluation on the Internet Institute for Health Policy Solutions Debbie Greiff Consulting Washington, DC San Francisco, CA $44,500 $33,000 Roundtable Meeting: Academy for Consumer Feasibility Study: Improving Care for Chronically Choice Health Purchasing Groups Ill Uninsured Institute for Health Policy Solutions Dental Health Foundation Washington, DC Oakland, CA $44,500 $45,000 Options for Expanding Healthy Families Eligibility Oral Health Access Initiative to Working Parents Imee DuBose King, Brown & Partners San Mateo, CA $50,000 $16,582 Sausalito, CA Engaging Independent Health Funders in California Small Business Health Insurance Qualitative Research Education & Research Fund of Employee King, Brown & Partners Benefit Research Institute Sausalito, CA Washington, DC $10,100 $25,000 CHCF Constituents’ Attitudes and Awareness Study Health Insurance Coverage and the Job Market in California Los Angeles County Martin Luther King, Jr./ Charles R. Drew Medical Center Families USA Foundation Los Angeles, CA Washington, DC $9,500 $51,234 Conference Support: Summit on Self-Sufficiency Insurance Status and Access to Care Los Angeles Times Georgetown University Los Angeles, CA Washington, DC $30,000 $14,000 Festival of Health 2000 Assessing the Privacy Policies of Internet Health Insurance Sites Marcy Kates Communications Piedmont, CA Grantmakers in Health $10,000 Washington, DC Summary of Nursing Reports for the California $20,000 HealthCare Workforce Initiative Annual Meeting on Health Philanthropy Albert R. Martin Health Officers Association of California San Francisco, CA Sacramento, CA $26,000 $5,000 Development of a Physician Executive Conference Support: Seeking Solutions—Public Training Program Health Infrastructure 61 CALIFORNIA HEALTHCARE FOUNDATION Caroline McCall Emily Shepard El Cerrito, CA Oakland, CA $25,000 $4,500 Feasibility Study: “Learning Services” for the California Health Care 101 Workshop California Health Care Industry Richard A. Smith Media Metrix Brookline, MA New York, NY $4,500 $60,000 Investigating the Privacy Practices of Web Sites Audience Measurement Report Joanne Spetz The National Hispanic Medical Association San Mateo, CA Washington, DC $11,700 $10,000 Minimum Staffing Ratios in California: Conference Support: Acute Care Hospitals Building Healthy Hispanic Families STILL Graphic Design, Inc. Physicians for a Violence-Free Society San Francisco, CA San Francisco, CA $4,450 $15,000 CHCF’s Issue Brief Series Design and Production Statewide Physician Network for Reducing Violence University of California, San Francisco Protocare Sciences San Francisco, CA Santa Monica, CA $29,999 $65,000 Residential Care in California Variation Utilization of Surgical and Medical Procedures in California University of Southern California Los Angeles, CA Public Health Institute $5,000 Berkeley, CA Conference Support: Healthcare Leadership $36,921 in the 21st Century Impact of Federal Drug Pricing Laws and Policies on State Activities Carol Vorhaus Los Altos, CA RAND Corporation $5,000 Santa Monica, CA California Health Care 101 $30,000 Quality of Health Information on the Internet: Katherine B. Wilson Planning Phase Berkeley, CA $2,700 Resolve, Inc. Update of eHealth Insurance Report Washington, DC $2,880 Enhancing Access to Health Insurance for High-Risk Individuals James C. Robinson Berkeley, CA $18,000 Emerging Internet-Enabled Insurance Sector: Phase 1 62 Foundation Report 1999-2001 Grant Application Process The California HealthCare Foundation carries out its philanthropic activities in three ways: • Foundation Initiated Projects. CHCF will design and manage special initiatives within some program areas. • Requests for Proposals. From time to time CHCF will issue Requests for Proposals (RFPs) in specific program areas. The RFP will define the nature, scope, and duration of the project, and specific application procedures. • Unsolicited Proposals. CHCF welcomes unsolicited proposals for work within our porgram areas in the form of a Letter of Inquiry. Letters should be no more than three pages in length, briefly describing the proposed project, along with an estimated timeline, and tax status information (IRS determination letter or W9 form). Program staff may request a full proposal or further information upon review. Letters of Inquiry are reviewed continuously. Limitations. CHCF does not generally support the cost of direct clinical care, ongoing general oper- ating expenses, capital campaigns, annual appeals or other fundraising events, construction, purchase or renovation of facilities, or purchase of equipment. Address Letters of Inquiry to: Grants Administrator California HealthCare Foundation 476 Ninth Street Oakland, CA 94607 Program Updates. To be added to the mailing list or to receive CHCF updates and RFPs, visit us at www.chcf.org, send an e-mail to info@chcf.org, or call (510) 587-3199. 63 CALIFORNIA HEALTHCARE FOUNDATION Report of Independent Auditors The Board of Directors California HealthCare Foundation We have audited the accompanying statements of financial position of California HealthCare Foundation as of February 28, 2001 and February 29, 2000, and the related statements of activities and cash flows for the years then ended. These financial statements are the responsibility of the Foundation’s management. Our responsibility is to express an opinion on these financial statements based on our audits. We conducted our audits in accordance with auditing standards generally accepted in the United States. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements. An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audits provide a rea- sonable basis for our opinion. In our opinion, the financial statements referred to above present fairly, in all material respects, the financial position of California HealthCare Foundation as of February 28, 2001 and February 29, 2000, and the changes in its net assets and its cash flows for the years then ended in conformity with account- ing principles generally accepted in the United States. April 20, 2001 Ernst & Young LLP Quezada & Company 64 Financial Statements Statements of Financial Position February 28 February 29 2001 2000 Assets Cash and cash equivalents $ 54,543,217 $ 76,167,656 Marketable securities 839,627,850 1,002,188,027 Investment income receivable and prepaid expenses 5,751,213 3,357,701 Fixed assets (net) 1,192,050 945,377 Total assets $ 901,114,330 $1,082,658,761 Liabilities and net assets Accounts payable and accrued expenses $ 609,348 $ 920,211 Grants payable 29,965,076 33,067,965 Due to The California Endowment (TCE) 87,948,976 238,140,000 Total liabilities 118,523,400 272,128,176 Commitments and contingencies Net assets: Unrestricted 782,590,930 810,530,585 Total net assets 782,590,930 810,530,585 Total liabilities and net assets $ 901,114,330 $1,082,658,761 See accompanying notes. 65 CALIFORNIA HEALTHCARE FOUNDATION Statements of Activities Year ended February 28 February 29 2001 2000 Revenue: Investment income: Net realized gain on sale of investments $ 93,239,359 $ 129,917,154 Dividends and interest 32,036,104 50,101,001 Rental income, net of related operating expenses of $0 in 2001 and $657,799 in 2000 – 91,445 Less other investment costs (897,746) (1,656,221) 124,377,717 178,453,379 Net unrealized loss on investments (109,415,483) (87,308,427) Total revenue 14,962,234 91,144,952 Expenses: Grants and donations 35,313,223 53,778,837 Program services 6,025,234 4,847,993 Supporting services 1,563,432 1,302,238 Total expenses 42,901,889 59,929,068 Change in net assets (27,939,655) 31,215,884 Net assets at beginning of year 810,530,585 779,314,701 Net assets at end of year $ 782,590,930 $ 810,530,585 See accompanying notes. 66 Financial Statements Statements of Cash Flows Year ended February 28 February 29 2001 2000 Operating activities Change in net assets $ (27,939,655) $ 31,215,884 Adjustments to reconcile the change in net assets to net cash (used in) provided by operating activities: Depreciation expense 393,503 274,641 Net realized gain on investments (93,239,359) (129,917,154) Net unrealized loss on investments 109,415,483 87,308,427 (11,370,028) (11,118,202) Changes in operating assets and liabilities: Prepaid expenses and other assets (2,393,512) (1,392,630) Accounts payable and accrued expenses (310,863) 395,836 Grants payable (3,102,889) 20,717,325 (5,807,264) 19,720,531 Net cash (used in) provided by operating activities (17,177,292) 8,602,329 Investing activities Net proceeds from the sale of Wellpoint Health Networks, Inc. common stock 438,335,008 1,072,541,250 Less proceeds allocated to The California Endowment (350,668,006) (858,033,000) 87,667,002 214,508,250 Net purchase of marketable securities (91,473,973) (244,624,687) Decrease in investment in real estate – 11,000,000 Purchase of furniture and equipment (640,176) (125,803) Net cash used in investing activities (4,447,147) (19,242,240) Net decrease in cash (21,624,439) (10,639,911) Cash and cash equivalents at beginning of year 76,167,656 86,807,567 Cash and cash equivalents at end of year $ 54,543,217 $ 76,167,656 See accompanying notes. 67 CALIFORNIA HEALTHCARE FOUNDATION Financial Statements Notes to Financial Statements 1. Description of Foundation California HealthCare Foundation (the Foundation) is a philanthropic organization established as a tax-exempt, nonprofit cor- poration. The Foundation was inactive until May 20, 1996. The Foundation is exempt from federal income taxes under Section 501(a) of the Internal Revenue Code (IRC) of 1986 as an organization described in Section 501(c)(4). The Foundation’s primary purpose is to promote the availability of, and access to, quality and affordable health care and related services to the people of the state of California, including, without limitation, (i) to improve the availability and access to such care and services to the uninsured, underinsured, and other underserved populations and to improve the health status of all Californians; (ii) to develop and maintain initiatives to address short-term and long-term health care needs and concerns; (iii) to provide grants and establish programs to carry out such purposes; and (iv) otherwise to serve the health-related social wel- fare needs of the people of the state of California. 2. Summary of Significant Accounting Policies Basis of Presentation The accompanying financial statements have been prepared on the accrual basis of accounting in accordance with accounting principles generally accepted in the United States. Net assets and revenues, expenses, gains, and losses are classified based on the existence or absence of donor-imposed restrictions. Since no donor-imposed restrictions exist on the Foundation’s net assets other than described in Note 6, which are accounted for as agency transactions, all of the Foundation’s net assets are classified as unrestricted in the accompanying statement of financial position. Accounting Pronouncements The Foundation’s financial statements are prepared in accordance with SFAS No. 116, “Accounting for Contributions Received and Contributions Made”; SFAS No. 117, “Financial Statements of Not-for-Profit Organizations”; and SFAS No. 124, “Accounting for Certain Investments Held by Not-for-Profit Organizations.” Derivatives The Foundation utilizes futures contracts to reduce interest rate risk on its fixed-income investments. Open positions of futures are accounted for as hedges with gains or losses recorded in the statements of activities. Impact of Recently Issued Accounting Standards In June 1998, Statement of Financial Accounting Standards No. 133 (SFAS 133), “Accounting for Derivative Instruments and Hedging Activities,” was issued. SFAS 133 establishes accounting and reporting standards for derivative instruments, includ- ing certain derivative instruments embedded in other contracts, and for hedging activities. It requires that an entity recognize all derivatives as their assets or liabilities in the statement of financial position and measure these instruments at fair value. The accounting for changes in the fair value of a derivative, that is, gains and losses, depends on the intended use of the derivative and its resulting designation. SFAS 133 will be adopted by the Company during the year ending February 28, 2002. Management does not believe that SFAS 133 will have a significant impact on the Foundation’s financial statements. Cash and Cash Equivalents Cash equivalents consist of highly liquid investments, with maturities of three months or less. Grants Grants awarded with an unconditional promise to give are charged against the operations when authorized by the Foundation’s board of directors. The board’s authorization may not necessarily occur in the same fiscal year in which payment is made. Investments Investments are recorded at market value. Market values for marketable securities are based upon quoted market value. Market values for real estate are based upon periodic appraisals. 68 Financial Statements Due to the California Endowment As more fully described in Note 6, and in accordance with Statement of Financial Accounting Standards No. 136, “Transfers of Assets to a Not-for-Profit Organization or Charitable Trust That Raises or Holds Contributions for Others” (SFAS 136), the Foundation accounts for eighty percent (80%) of its investment in WellPoint Health Networks, Inc. (WLP) common stock as an agent. Fixed Assets Fixed assets are stated at cost. Depreciation and amortization are computed on the straight-line method over the estimated use- ful lives of the respective assets, ranging from three to 10 years. Fixed assets consist of the following: February 28 February 29 2001 2000 Furniture and fixtures $ 653,141 $ 490,496 Office equipment 883,566 680,449 Leasehold improvements 794,293 519,879 2,331,000 1,690,824 Less accumulated depreciation (1,138,950) (745,447) $ 1,192,050 $ 945,377 Estimates The preparation of financial statements in conformity with accounting principles generally accepted in the United States requires management to make estimates and assumptions that affect certain reported amounts and disclosures. Accordingly, actual results could differ from those estimates. Concentration of Credit Risk Financial instruments that potentially subject the Foundation to concentration of credit risk consist of cash and investments. The Foundation invests excess cash with a financial institution. These deposits exceed FDIC insurance limits. 3. Investments Investments are summarized as follows: Unrealized Cost Market Value Gain (Loss) At February 28, 2001: Marketable securities: U.S. Treasury notes and bonds $ 113,833,748 $ 119,983,827 $ 6,150,079 Domestic equities 409,299,893 364,748,937 (44,550,956) Domestic bonds 247,550,248 249,938,361 2,388,113 Foreign equities and bonds 118,880,568 104,956,725 (13,923,843) $ 889,564,457 $ 839,627,850 $ (49,936,607) 69 CALIFORNIA HEALTHCARE FOUNDATION Unrealized Cost Market Value Gain (Loss) At February 29, 2000: Marketable securities: WellPoint Health Networks Inc. common stock $ 171,438,750 $ 297,675,000 $ 126,236,250 U.S. Treasury notes and bonds 74,059,079 72,134,627 (1,924,452) Domestic equities 382,989,715 420,257,145 37,267,430 Domestic bonds 137,845,098 134,172,186 (3,672,912) Foreign equities and bonds 75,387,921 77,949,069 2,561,148 $ 841,720,563 $1,002,188,027 160,467,464 Less allocation of unrealized gain to TCE (100,988,588) Cumulative net unrealized gain on marketable securities $ 59,478,876 Realized gains and losses on sales of marketable securities are computed on a first-in first-out basis. Included in net gains and losses during 2001 and 2000 are approximately $0 and $4.2 million, respectively, in underwriting fees related to the sale of WLP common stock. Other investment costs are comprised of external investment management fees of $789,333 and $1,474,539 for 2001 and 2000, respectively, as well as $108,413 and $181,682 for 2001 and 2000, respectively, representing internal costs incurred in portfolio management. The Foundation uses bond and note payable future derivative contracts to manage exposures to interest rate fluctuations. For every derivative contract used, there is an offsetting financial position in the investment portfolio, minimizing the risk of the use of such instruments. At February 28, 2001 and February 29, 2000, the notional amount of these contracts was $45.5 mil- lion and $22 million, respectively, the majority of which expired in March 2001. The impact of the use of these contracts is not significant to the Foundation’s statements of activities. 4. Employee Benefit Plans Cash Balance Pension Plan The Foundation maintains a Cash Balance Plan (CBP) to cover all employees who would complete 1,000 hours of employ- ment with the Foundation. The CBP is a defined benefit plan and is insured by the Pension Benefit Guaranty Corporation. The Foundation pays the entire cost of the CBP. The benefits are based upon an employee’s age and salary. The Foundation’s funding policy is to make the timely contributions required by applicable regulations. The following represents selected infor- mation related to the CBP: February 28 February 29 2001 2000 Benefit obligation at year-end $ 979,495 $ 460,963 Plan assets at fair value at year-end 765,753 300,224 Funded status of the plan (underfunded) $ (213,742) $ (160,739) Prepaid (accrued) pension cost included $ 34,299 $ (67,251) in other assets (liabilities) Benefit cost $ 400,450 $ 301,861 Employer contributions 502,000 240,000 Benefits paid 14,726 – Weighted-average assumptions: Expected long-term return 9% 9% Discount rate 8% 8% Expected rate of increase in compensation levels 5% 5% 70 Financial Statements Retirement Savings 401(k) Plan and After-Tax Savings Plan The Foundation also maintains a 401(k) plan (the Plan). Participation in the Plan is voluntary and all full-time and part-time employees who work at least 1,000 hours during a 12-month period and complete six months of service are eligible to partic- ipate. Eligible employees may complete a salary deferral agreement and contribute between 1% and 15% of their salary to the Plan subject to IRS limitations. The Foundation will make matching contributions equal to 75% of the first 6% of employ- ees’ salary deferral contributions. The total expense for the Plan for the years ended February 28, 2001 and February 29, 2000 was $91,684 and $64,022, respectively. 5. Federal and California Taxes As a Section 501(c)(4) corporation, the Foundation is exempt from any excise or income taxes on its net investment income. 6. Commitments and Contingencies Commitments Due to The California Endowment The Foundation is obligated to transfer eighty percent (80%) of the net cash proceeds of the sale of WLP common stock to The California Endowment (TCE). Since the Foundation is directed to distribute the proceeds of such sale(s) to TCE, the Foundation accounts for 80% of its investment in WLP common stock as an agent, and has recorded a corresponding liabil- ity to TCE. Accordingly, related agency activity does not appear in the Foundation’s statement of activities, in accordance with SFAS 136. The amount of the liability to TCE is adjusted to reflect changes in the market value of the WLP common stock. The Foundation is required to make qualifying distributions of distributable amounts, as defined in Section 4942 of the IRC, as if the Foundation were an entity subject to the distribution requirements under, but not the taxes imposed by, Section 4942. Transfers of assets to TCE (including transfers of eighty percent (80%) of the net cash proceeds of the sale or disposition of WLP stock, or certain other securities or property) on certain conditions may be designated by the Foundation as qualifying distributions. During fiscal years 2001 and 2000, the Foundation sold 4.4 million and 13.5 million shares, respectively, of WLP common stock and received net cash proceeds of approximately $438 million and $1,072 million, respectively. At February 28, 2001, the liability of $87,948,976 to TCE represents 80% of cash proceeds from 2001 WLP stock sales not yet remitted to TCE. Contingencies Indemnification Agreement The Foundation has agreed to indemnify WLP for certain federal income tax liabilities in accordance with an indemnification agreement between the Foundation, WLP and a subsidiary of WLP. The Foundation has agreed to indemnify WLP for any federal income taxes and related penalties and interest incurred by WLP as a result of (i) a revocation or modification of the Internal Revenue Service (IRS) private letter ruling dated August 16, 1995 (IRS Ruling) that, among other things, (i) the Conversion qualifies as a tax-free transaction and that no gain or loss will be recognized by WLP from the Conversion for fed- eral income tax purposes, or (ii) a determination by the IRS that the Conversion constitutes a taxable transaction for federal income tax purposes under Section 337(d) of the Code. However, the Foundation shall have no liability under this indemni- fication agreement if the revocation or modification, in whole or in part, of the IRS Ruling or disposition of tax liability under Section 337(d) of the Code, is a result of (i) actions taken by WLP without the consent of the Foundation, or (ii) the Conversion not being consummated in accordance with the terms set forth in the request for the IRS Ruling. The indemnification agreement includes a requirement that the Foundation’s net worth not drop below $400,000,000 for a period of six years from the date of the indemnification agreement. The Foundation believes that the basis of the determi- nation of its net worth for this purpose may be different than that used in the determination of its total net assets in the accompanying financial statements. 71 CALIFORNIA HEALTHCARE FOUNDATION Notes to Financial Statements Leases At February 28, 2001, the Foundation was committed under operating leases, principally for rental of office space. The main lease expires in 2009 and the Foundation has the option to extend the lease for an additional five-year period at that time. Rent expense was $389,000 and $307,000 in 2001 and 2000, respectively. As of February 28, 2001, future minimum base rents under terms of noncancelable operating leases are as follows: 2002 $ 644,748 2003 577,052 2004 554,558 2005 490,743 2006 and thereafter 1,454,058 $ 3,721,159 7. Related Party Transactions A member of the Foundation’s board of directors is the executive vice president of a company that provides investment and custodial services to the Foundation. The fees paid to such company for these services aggregated approximately $196,000 and $332,000 for the years ended February 28, 2001 and February 29, 2000, respectively. 72 Foundation Report 1999-2001 Staff Office of the President Kathy T. Hajopoulos, M.P.H. Katharine Miller Mark D. Smith, M.D., M.B.A. Senior Policy Analyst California HealthFunders Extranet President and Chief Executive Ingrid Aguirre Happoldt Manager Officer Policy Analyst Melissa A. Lucas David G. Pockell Cecilia Echeverría, M.P.H., M.P.P. Production Coordinator Chief Program Officer Policy Analyst Terry Rillera, M.A. Margaret A. Laws, M.P.P. Nalini K. Pande, J.D. Administrative Assistant Director of Policy and Planning Policy Analyst Soncedrá Walker Synthia J. Graham, M.B.A. Lucy Streett, M.P.H. Administrative Assistant Assistant to the President Policy Analyst Maisha Nkhume Finance & Administration Jennifer Kaufer Craig C. Ziegler, M.B.A. Board Liaison Administrative Assistant Chief Financial Officer iHealth and Technology Joanne Marzan Damon Dean Sam Karp Administrative Assistant Internet Services Director Chief Information Officer Royah Thomas Doris Velasquez Thomas H. Lee, M.D. Administrative Assistant Director of Human Resources Senior Program Officer The Quality Initiative Beverly Wright Claudia Page Ann F. Monroe, M.A. Director of Grants Administration Program Officer Director Winston Hom, C.P.A. Marla Bailey Lisa Payne Simon, M.P.H. Controller Administrative Assistant Deputy Director Lisa Arnold Improving Care Delivery Jennifer Eames Grants Manager Jan Eldred, M.S. Program Officer Doug Hampson, M.B.A., C.N.E., Vice President Merry Wood M.C.S.E. Soren Green Project Manager Network Manager Administrative Assistant Amanda Anderson Vincent James Administrative Assistant Internet Systems Manager Insurance Markets and the Ned Newcomer Renée Grimani-Kardener, M.A. Uninsured Information Technology Associate Administrative Assistant Jill M. Yegian, Ph.D. Stacy McConnen Angela J. Hernandez, M.A. Senior Program Officer Administrative Assistant Contacts Database Coordinator Marian R. Mulkey, M.P.H., M.P.P. Olivia Johnson Program Officer Communications & Publishing Staff Accountant Stefanie Brynen Karen Hunt, M.A. Tracy Colbert Administrative Assistant Director of Communications & Help Desk Specialist Publishing Provider Systems Rosa Lee Pratt Margaret Lyons Elaine Batchlor, M.D., M.P.H. Administrative Assistant Director of Special Media Projects Vice President Melva J. Washington, M.P.A. Sally Mudd Marianne Laouri, Ph.D. Administrative Assistant Communications Officer, Senior Program Officer Publications Shirley Wu Christina L. Carter Human Resources Assistant Elizabeth Ottinger Administrative Assistant Communications Officer, Operations Medi-Cal Policy Institute Charles Stewart Crystal Hayling Communications Officer, Director Media Relations Christopher V. Perrone, M.P.P. Deputy Director 73 CALIFORNIA HEALTHCARE FOUNDATION Board of Directors Thomas M. Priselac William H. Hastie, Esq. Board Vice-Chairman Board Chairman President, Cedars-Sinai Attorney-at-Law Health System Napoleon Brandford III Harlan H. Edmonds Chairman, Siebert, President, Brandford, Shank & Co. Standfast Services, Inc. Enrique Hernandez, Jr. President and CEO, Monica C. Lozano Inter-Con Security President and COO, Systems, Inc. La Opinión Mark D. Smith, Sheryl K. Pressler M.D., M.B.A. Former Chief Investment President and CEO, Officer, Lend Lease California HealthCare Realestate Investments Foundation A. Eugene Washington, M.D., M.Sc. Professor & Chair, OBGyn Alison A. Winter & Reproductive Sciences, Executive Vice President, UC San Francisco Northern Trust Company 74 Produced by the California HealthCare Foundation Communications and Publishing Department Writer: Marcy Kates Design: Dennis Johnson Design Board photos: ©Donna M. Scholl 476 Ninth Street Oakland, California 94607 Tel: 510.238.1040 Fax: 510.238.1388 www.chcf.org