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Background | Program Description | Eligibility | Participant Expectations | What Makes a Strong Application?
Background
The COVID-19 pandemic upended the way California delivers health care. Health care systems scrambled to restructure their services to keep both their patients and employees safe. Federal policymakers moved quickly to expand coverage and payment for telehealth. The California Department of Health Care Services dismantled previous barriers to telehealth and began paying providers for telephone and video visits at the same rate as in-person visits.
As a result, many California health care providers pivoted rapidly from in-person visits to telehealth. Despite external pressures such as the pandemic and wildfires, many health care providers made transformational changes, including adopting new technologies, overhauling workflows, and redefining team member roles, resulting in easier access to services. For example, telehealth led to a drop in patient no-show rates at many clinics, and providers were able to reach clients who lacked adequate transportation and lived in rural locations or in homeless encampments rarely visited by physicians. Telehealth is crucial to increasing access to care as well as health equity – fair, just, and inclusive opportunities for people to be healthy – during this ongoing pandemic and beyond.
While many people have benefited from the expansion of telehealth, others who need services the most have experienced barriers to access, including families with low incomes and/or little to no access to smartphones, computers, tablets or broadband as well as people who cannot read or whose primary or sole language is not English. Extensive work is needed to address barriers faced by patients to ensure that telehealth promotes equitable access to care and does not exacerbate existing health disparities.
As health care providers continue to explore different technologies and practices to meet patients’ needs, there are opportunities to use human-centered design to innovate, learn together, and create a sustainable infrastructure and approach to safely care for patients using telehealth. Additional support is needed to ensure disparities aren’t exacerbated by limited literacy, unequal access to internet-enabled devices, limited broadband, and lack of support and practices for patients to fully engage in their health care.
There is no clear playbook and limited evidence for how to make these fundamental changes in safety net health care systems. However, we believe the answers will emerge from our community of providers who are willing to learn from and share with peers and experts, test new processes, expand the work they have already started, and develop equitable approaches to sustain telehealth as an essential component for how care is delivered into the future.
Through the CCA Equity Collaborative, California Health Care Foundation and Cedars-Sinai will provide $75,000 grants and technical assistance to up to 21 safety-net practices where the majority of patients are covered by Medi-Cal or uninsured. 12 will be funded by CHCF throughout the state and 9 by Cedars-Sinai in Los Angeles. This collaborative is designed for organizations that have already implemented both phone and video telehealth approaches in their practices and have a committed team to test, learn, and share best practices to advance equity in access to telehealth.
Program Description
The goal of the CCA Equity Collaborative is to provide a testing ground and support for organizations to rapidly design, test, scale, and share new strategies to improve equity in access to telehealth. The lessons and best practices developed by participants will lay important groundwork for strengthening telehealth and equitable access to care throughout California’s health care safety net.
Over the course of this 13-month learning collaborative (April 2022 – May 2023), participants will work on innovation projects to advance telehealth delivery for populations who face barriers to accessing care. Organizations will each dedicate a small, multidisciplinary team (3-5 people) to define, discover, design, test, and implement strategies that will improve and sustain telehealth delivery for their specified population. The program will guide teams through a process that advances the use of innovation and performance improvement methods to support rapid testing and learning. Teams will have access to virtual resources, including peers, learning events, coaches and subject matter experts, as well as tools and templates to support testing and learning. The expected outcome is that participants demonstrate increased access to telehealth for populations prioritized for telehealth equity interventions.
Participants will use data and methods to identify population groups experiencing disparities in access to telehealth, define aim statements, and design and test new strategies to improve equitable access to telehealth. Participants will be expected to focus their project on addressing at least two of three program objectives listed in the table below.
Program Objectives |
Illustrative Examples |
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Improve the use of video telehealth. |
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Improve access to telehealth for patients with a preferred language other than English. |
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Support patients with digital barriers. |
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Note: The scope of the CCA Equity Collaborative and participant projects will not include Remote Patient Monitoring (RPM).
Eligibility
We’re looking for health care safety net organizations that provide comprehensive primary care services primarily to at least 8,000 unduplicated patients. Medi-Cal and uninsured patients must make up at least 50 percent of the organizations’ total patient population. If your organization does not meet these criteria but serves a traditionally hard-to-reach or marginalized community, you may still apply as an exception. Please review the narrative questions for more details.
Eligible organizations include California-based:
- Federally qualified health centers (FQHC) and FQHC look-alikes
- Community clinics, rural health clinics, and free clinics
- Ambulatory care clinics owned and operated by county health systems or public hospitals
- Indian Health Service (IHS) clinics
Statewide associations and regional clinic consortia are not eligible to apply.
If you have questions, please contact:
Illari Alvarez
Program Coordinator, Center for Care Innovations
[email protected]
Participant Expectations
This learning collaborative is intended to be flexible and responsive to the needs of participants, so we ask each organization selected for the CCA Equity Collaborative to act as a partner in shaping the program by making the following commitments:
1. Leadership Support: Successful organizations will require leadership that is committed to testing and implementing innovative approaches to advance telehealth equity and to sharing experiences and learning with others in the safety net. It will also require leaders to understand the importance of using innovation and performance improvement to spread telehealth practices across the organization and willingness to leverage organizational resources to operationalize such changes. We expect strong leadership support from the Chief Medical Officer and Chief Operating Officer at a minimum, as demonstrated through a letter of leadership support.
2. Dedicated Team: Establish a core project team that commits to testing, implementation, and learning for the organization and sharing with peers and the broader safety net community. This core team should consist of three to five clinical, administrative, and operational leads. Please note that we have seen that some teams need to add additional team members as they go through the program, define their project, and uncover learnings in the discovery and testing phases. To begin, the core team should include:
- A clinical champion who has a significant role in the organization’s telehealth efforts;
- At least one operational and/or frontline staff member who can inform and lead the operational and clinical implementation within the organization; and
- A quality improvement, data, or IT staff member that can help to manage data and metrics collection and reporting.
There must be a senior leader to serve as a sponsor for the project team. This senior leader can ensure protected time for team members to participate in learning collaborative activities, as well as lead change and spread successful strategies within their organizations. This individual should also have decision-making authority to move telehealth efforts forward. It should be clear how the participating team will keep the senior leader engaged in the progress of the work.
3. Program Activities: Teams will be expected to complete defined assignments designed to advance their telehealth equity work and to share lessons learned by presenting examples of their project successes and challenges. All project team members are invited and encouraged to participate in all program activities, but we realize that not every member will join all virtual events. Teams are expected to ensure that at least one member from the selected team participates in each of the core activities (i.e., virtual sessions, coaching sessions, and evaluation activities). We have found that when multiple team members are engaged in program activities, their team is more effective and successful. The approximate time commitment is 3-6 hours per team member and per month for program meetings and activities.
4. Patient and Community Involvement: With guidance provided during the program, successful organizations will actively involve patients’ and community members in their plans and efforts to advance telehealth equity.
5. Data Reporting and Evaluation Activities: An external evaluator will support the collection of data and stories to assess the overall impact of the learning collaborative and collect data that can be used to advocate for long-term policy changes to sustain equitable access to care. Teams are expected to work closely with the evaluator to collect and submit data at the beginning, midpoint, and end of the program on a standardized set of measures; participate in two interviews and two program feedback surveys (program midpoint and end), and complete progress reports to share stories about the impact of the work. The evaluation team will support individual organizations to pull and report data. See the appendix for more information about the evaluation approach, including methods and data reporting requirements.
What Makes a Strong Application?
High number and proportion of Medi-Cal or uninsured patients: Successful applicants will meet the eligibility requirements; preference will be given to organizations that serve an even higher proportion than the minimum number of patients and demographic percentages described above.
Organization serves a unique population or need in their community: Preference will be given to organizations that provide needed care for a greater share of patients of color and/or patients with a preferred language other than English.
Prior experience and desire to expand telehealth capabilities: Successful applicants should currently provide telehealth via phone and video to patients at the time of applying. Organizations must possess an understanding of innovation and performance improvement methods, and they must be ready to measure and test changes throughout this learning collaborative. Preference will be given to organizations that clearly articulate how they plan to advance equity in access to telehealth.
Clear vision of how to sustain the efforts in this program: Successful applicants will demonstrate a keen understanding of existing challenges and articulate how they intend to further spread or enhance telehealth equity within their organization beyond this grant funding opportunity.
Data, IT, and QI Systems in Place: Successful applicants will have data, IT, and QI systems in place with the ability to track patient-level data and make improvements to telehealth approaches based upon the data. To the extent possible, data reporting for this program will build upon existing standard data collection reports.
Other preferences: Organizations that have never participated in CCI programs or only one program by CCI will be given preference. Some preference may also be given to applicants with existing practices that are important for other organizations to learn from. Nine out of the twenty-one organizations will be located in Cedars-Sinai service areas I Los Angeles so some preference may be given to organizations there. (Service Planning Areas 2, 3, 4, 5, 6 and 8.) Some preference may also be given to organizations that expand the geographical presence of the program in California.