Taking it to the next PHASE: partnering with California safety net to improve community health

Over the past 30 years we’ve learned about the central role that health care safety net providers (e.g., Federally Qualified Health Centers, free clinics, public hospital systems) play in supporting the health and well-being of people living in underserved communities. As a result, we have committed to partnering with funders and other organizations on initiatives that support safety net improvements and innovations to improve community health.

Our evaluations are designed to assess impact, identify promising practices that support peer learning, provide timely feedback for initiative improvement, and use data to inform future investments. Currently, we’re seeing our safety net partners stretch in new ways as they build capacity and systems for delivering virtual care and build or maintain a strong focus on equity and reducing disparities in access and health outcomes.

For more than 10 years, CCHE has partnered with Kaiser Permanente’s (KP) Community Health Programs to evaluate its safety net initiatives. We recently released a new report on the impact of PHASE (Preventing Heart Attacks and Strokes Everyday). PHASE is a long-term initiative in Northern California that focuses on spreading a KP evidence-based, population management approach for patients most at-risk for heart attacks and strokes. Through PHASE, KP has provided grants and technical assistance to its safety net partners since 2006. PHASE currently engages six health center organizations, four regional clinic consortia representing 32 health center organizations, and four public hospitals from 18 counties across Northern California.

Through our evaluation of PHASE over the past decade, we have learned that:

• Successful implementation of any new practice (e.g., clinical guidelines) is bolstered by a strong foundation of effective primary care practice, including supportive leadership and culture, a quality improvement infrastructure, data reporting and analytic capacity, team-based care, empanelment, and proactive population health management. Without these foundational capacities, teams experience slower progress and report more barriers.
• Using data to drive improvements, including having robust systems for data visibility and transparency, is identified as one of the key drivers for achieving measurable changes in outcomes. Requiring clinics to collect and report on meaningful data regularly can be a catalyst for change, but clinic systems also need to invest time and resources in building data capacity to achieve that goal.
• Sustainability of grant-funded programs in clinical settings is supported by program alignment with organizational priorities and payment mechanisms, leadership buy-in, and staff adoption of standard workflows.
• Improvements on key health outcomes can be accelerated by strategic investments in technical assistance, coaching, and other capacity building activities.

These lessons have guided PHASE in its current pivot to supporting the safety net’s ability to care for patients at risk of heart attacks and strokes while responding to COVID-19.