Innovation Learning Collaborative Track
Made possible by the California Health Care Foundation, with additional funding from the Blue Shield of California Foundation.
As health care providers shift from addressing coronavirus-related emergency care to the whole spectrum of patients’ needs, there are a number of opportunities to innovate and learn together. Health care providers caring for the most vulnerable populations in our communities need to design a sustainable infrastructure and approach to safely care for all patients using telehealth and digital tools.
Patients accessing primary care and behavioral health services in safety net systems may experience additional digital barriers and challenges to accessing care. Population health approaches, team structures, and internal operations must to be adapted to ensure that patients served by safety net health systems aren’t left behind; additional support is needed to ensure disparities aren’t exacerbated by limited literacy skills, the availability of internet-enabled devices, limited broadband, and lack of support for patients to fully engage in their health care.
There is no clear playbook and a limited evidence base for how to make these fundamental changes in safety net health care systems. However, with any new challenge, we believe the answers will emerge from our community of providers who are willing to innovate, test, and learn from each other.
Structure and Core Content
The goal of the Innovation Learning Collaborative is to provide a testing ground and support for organizations to rapidly design, test, and share solutions to effectively care for patients using virtual care strategies. The lessons and best practices developed by participants will lay important groundwork for strengthening telehealth throughout California’s health care safety net. Over the course of this 12-month learning collaborative, participants will join one of three learning cohorts, each aimed at strengthening and sustainably integrating virtual care into the standard of care.
The objectives of the learning collaborative are to:
- Identify the biggest challenges and opportunities to strengthen population health management, build virtual care teams, and engage patients who face digital barriers to care.
- Identify and test virtual care delivery changes to better understand the infrastructure, data, staff, and skills necessary to support these changes.
- Uncover and document the best practices to effectively remotely manage patient populations.
- Share best practices and bring successful changes to scale.
We will select up to 20 health care safety net organizations in California to participate in a virtual innovation learning collaborative. We will provide an array of support and technical assistance including:
- Virtual peer learning convenings,
- Monthly webinars featuring experts in the field,
- Monthly virtual “office hours” with experts,
- Site visits to exemplar organizations, which are likely to be virtual, and
- Educational resources and tools.
An external evaluator will support the collection of data and stories to ensure we assess the overall impact of the learning collaborative and advocate for long-term policy changes to sustain virtual care.
Each organization selected for the Innovation Learning Collaborative should expect to make the following commitments:
- Identify a core project team that will be responsible for leading the testing, implementation, and learning for the organization. At minimum, this team should consist of at least four members including clinical, administrative, and operational leads.
- Ensure that the selected team will participate in all of the core activities (i.e., virtual meetings, testing and implementation of solutions, and evaluation activities).
- Actively participate in at least one of the three cohorts, described below.
- Commit to testing changes and sharing learnings with peers and the safety net community.
- Submit quarterly reports on metrics your organization will collect throughout the program.
- Participate in qualitative interviews with the evaluation team, as needed.
- Be willing to share your experiences and learning with others in the safety net.
Participating organizations will select at least one of the following cohorts. The descriptions below outline the type of issues the teams will tackle in these breakout groups. However, the specific activities and focus areas will be co-designed with accepted applicants.
Cohort 1: Sustaining Virtual Care Teams
Organizations participating in this cohort will uncover and rethink how virtual care teams:
- Deliver primary care services to vulnerable populations.
- Collaborate and effectively communicate with other members of their care team.
- Effectively and efficiently carry out workflows and protocols (e.g., huddle, chart prep, manage the patient experience, etc.)
- Support patients virtually to effectively use digital and virtual tools.
- Identify and define new roles for care team members.
Cohort 2: Population Management
Organizations participating in this cohort will uncover and rethink ways multidisciplinary care teams:
- Coordinate interventions for patients with chronic conditions (e.g., diabetes, cardiovascular disease, etc.)
- Proactively reach out to patients for preventive services.
- Approach planned care and in-reach.
- Stratify and tailor care to sub-populations (e.g., patients in need of prenatal care, behavioral health services, etc.)
- Leverage remote monitoring devices, as well as approaches to manage data and patient needs.
- Manage care for complex patients, including addressing social needs.
Cohort 3: Engaging Patients with Digital Barriers
Organizations participating in this cohort will focus on ways to engage patients in a virtual setting by creatively testing new ways to provide:
- Interpreter services and culturally responsive care for limited English proficient patients.
- Support to patients with limited technical abilities or experience.
- Outreach and connection to homeless patients.
- Connectivity to patient populations with limited access to technology, broadband and Wi-Fi.
- Services tailored to older adult populations that may experience additional technological challenges.
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. We’ll select organizations across the state with the goal of achieving geographic diversity and reaching communities most vulnerable to COVID-19.
Qualifying organizations include:
- Federally qualified health centers (FQHC) and FQHC look-alikes
- Community clinics, rural health clinics, and free clinics
- Ambulatory care clinics owned and operated by public hospitals
- Indian Health Service clinics
- Independent provider care practices
Statewide associations and regional clinic consortia are not eligible to apply.
What Makes a Strong Applicant?
- Prior Experience and Desire to Expand Virtual Care Capabilities: Successful applicants should currently provide telehealth via phone and video to patients at the time of applying. Organizations must possess a strong understanding of innovation and performance improvement methods, and they must be ready to measure and test changes throughout this learning collaborative. Grant funds should be used to enhance ability to provide virtual care.
- Clear Vision of How to Sustain the Efforts in This Program: Successful applicants will demonstrate keen understanding of existing challenges and articulate how they intend to further spread or enhance virtual care capabilities 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. Data reporting for this program will build upon existing standard data collection reports.
This learning collaborative is intended to be flexible and responsive to the needs of participants, so we ask each organization to act as a partner in shaping the program by committing to the following:
- Leadership Buy-In: Successful organizations will require leadership that is committed to testing and implementing innovative virtual care delivery approaches. 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 the letter of leadership support.
- Patient and Community Involvement: Successful organizations will involve patients’ and community members’ perspectives and experiences in their plans to implement telehealth services, taking into account disparities in telehealth access across certain patient populations.
- Continuity and a Dedicated Team: At least four individuals are required to commit to the core program team to promote continuity and participate in core activities (i.e., webinars and evaluation activities). The team should include:
- At least one senior leader who can ensure protected time for team members to participate in learning collaborative activities, as well as lead change within their organizations. This individual should also have decision-making authority to move telehealth efforts forward;
- A clinical champion that has a significant role in your organization’s telehealth efforts;
- At least one frontline staff or provider who can inform and lead the operational and clinical implementation within the organization; and
- A data or IT staff that can help to manage data and metrics collection and reporting.
- Participation in Program Activities: Team members are expected to fully participate in program activities including all virtual learning sessions, site visits, one in-person convening in 2021, and monthly calls with faculty and experts. Teams will be asked to complete defined pre-work assignments for virtual and in-person sessions and will be asked to work on multiple changes in the organization to advance team-based care, population health management, and/or engaging patients. Participants will also share lessons learned by presenting examples of their project successes and challenges.
- Data Reporting and Evaluation Activities: Teams are expected to work closely with an external evaluator to collect and submit data at the beginning, mid-point and end of the program on a standardized set of measures, as well as progress reports to share stories about the impact of the work. This program will ensure essential data is collected to advocate for more permanent policy changes to sustain telehealth and virtual care into the future.
(See Appendix A for a current draft description of the measures.) The finalized definitions of program measures, including detailed specifications, will be shared during the program’s kickoff webinar. The evaluation team will work with individual organizations about how best to pull and report data.
How to Apply
Step 1: Watch THE Informational Webinar (Optional)
Register for our Informational Webinar on Tuesday, June 9th at 1:00 pm to hear a more detailed description of the program and listen to some questions and answers.
Step 2: Apply Online
Your proposal and budget must be submitted online by Friday, June 19, 2020 by 5:00 pm.
Applications should include the following:
- Application Submission Form
- Application Narrative: Includes responses to the seven questions listed below.
- Budget Template
- Tax Status Documentation
- Letter of Leadership Support: This letter should demonstrate organizational commitment to implement or expand upon virtual care capabilities and collect data as needed. This includes dedicated time for the core team to fully participate in program activities and implement changes at the clinical and organizational level. The letter should be submitted by either the Chief Medical Officer, Chief Operating Officer, or Chief Executive Officer.
Application Narrative Questions
Please limit your entire response to a maximum of five pages, using at least 11-point font and 1-inch margins.
- Overall Goals: Why is your organization interested in participating in this learning collaborative? What do you want to learn through this collaborative?
- Cohort Preference: Which of the three cohorts (sustaining virtual care teams, population management, engaging patients with digital barriers) is/are most relevant to your goals? Please describe why this is critical for your organization’s success. What are the biggest challenges you hope to address?
- Virtual Care Experience: Please describe your experience with virtual care including modalities of care, whether you are using other virtual tools (portals, texting, phone apps), and what you have learned about the challenges and opportunities for implementing telehealth and virtual care in your organization. If you have successful virtual shifts in care, please share an example.
- QI Experience: Please describe a clinical or operational improvement project you implemented in your organization. What data (outcome measure, processes measures, qualitative measures) did you collect and how often? What is an example of one change you made based on what you learned from the tests and/or data?
- Data Reporting Capabilities: Please describe your current ability to collect and report on patient-level data regarding visit modality (i.e., in-person, phone, video). Please describe what tools or instruments you utilize to collect patient and provider experience and whether you have included any questions about virtual care. Please describe how you would collect data quarterly by visit type and if you could report this data by race/ethnicity?
- Site Selection: What site will you test virtual care practices and why did you select this particular site? What are key characteristics about that site (e.g., patient demographics, number of providers, and prior virtual care capabilities) that fit the program goals?
- Budget Narrative: Please describe how you would use the $100,000 grant to advance your virtual care program. For example, will the funding be used to train staff, purchase equipment, or support patients?
Connected Care Accelerator: Innovation Learning Collaborative Application Submission Form
CCI and CHCF will review applications. Our intent is to select a group of up to 30 safety net health care organizations interested in building their infrastructure for telehealth and virtual care. The accelerator acceptances will be announced via email by Wednesday, July 15, 2020.