The board of directors of the California HealthCare Foundation has asked me to communicate our pride in what has been achieved under Dr. Mark Smith’s extraordinarily creative leadership and to reinforce our commitment to the strategy, programs, and initiatives that CHCF has spearheaded over the last 16 years.
We recognize and anticipate that our next leader will bring fresh ideas and energy that will take us in new directions. We are also firm in our belief that the California HealthCare Foundation will continue to play a central role at the intersection of the health care delivery system and the policy world that Dr. Smith carved out during his tenure.
We take great pride in the fact that CHCF is a respected resource for objective research, information, data, and analysis on a broad range of health care issues in California; a trusted convener; and a creative helping hand, spurring on innovation in the market and the policy community to benefit the health of all Californians. In reflecting on Dr. Smith’s extraordinary leadership, the board has identified 10 areas where the foundation has had particular impact.
All of these efforts have been shepherded by the foundation’s most powerful asset: its staff. Each board member will attest to the quality of people who work for CHCF: their energy, enthusiasm, expertise, and professionalism are truly impressive.
The consistently high standards of the foundation’s staff, grantees, and partners have resulted in a remarkable body of work that has made important contributions to improving quality, access, and affordability of health care services in California and the nation. This list samples from the many and various ways CHCF has made a difference. Dr. Smith’s leadership signature is evident in all of them and together they reflect the enduring DNA of this organization that we believe will carry on under his successor.
1. The Fruits of Conversion: The Orderly Creation of Two Important Philanthropic Foundations
CHCF was originally tasked with managing the sale of Wellpoint stock following the conversion of Blue Cross of California to for-profit status and transferring 80% of the proceeds to The California Endowment (TCE), our sister foundation. The founding CHCF board and staff under Dr. Smith’s leadership managed the process smoothly and created the endowment for TCE, which today has assets of $3.2 billion and annual giving in excess of $165 million. CHCF’s 20% of the proceeds amounted to almost half a billion dollars at the time, and Dr. Smith led the process of developing a complementary strategy and grants program. The result was the creation of two important health care philanthropies in the state: The California Endowment, which focuses on community-level initiatives to improve access and public health, and the California HealthCare Foundation, which focuses on policy and practice change in health care financing and delivery.
2. A Market Savvy, Policy-Relevant, Innovative, and Trusted Philanthropy
We are proud of our position as a trusted convener of health care stakeholders from the worlds of policy and industry. We value our reputation as an organization that simultaneously understands market dynamics and the intricacies of policy at federal, state, and local levels. Dr. Smith and the staff have built the capacity to navigate through this difficult terrain, but most importantly, to identify creative ways to intervene and play a catalytic role. Our board has strongly supported the identification of unique points of leverage on market-makers and policymakers alike to help improve quality, access, and affordability of health care for all Californians.
3. Support for New Leaders
Early in CHCF’s history, in collaboration with the University of California, San Francisco, CHCF conceived of a professional development program for clinical leaders in the state, particularly those serving in safety-net institutions. The purpose was to provide young clinicians with the leadership skills they would need to head their organizations in the future. The program currently has 355 alumni across the state and the board recently announced the foundation’s support for two new classes. The program has been emulated by other foundations and institutions in California, resulting in a total of more than 2,000 graduates across the state. Any meeting of California health care leaders is likely to include graduates of these programs, and many of them have become important grantees, partners, and champions for constructive change across California’s health care system.
4. The Adoption and Effective Use of Health IT
CHCF has always been known as a pioneer in the promotion of health information technology as an important tool to improve the quality, safety, and efficiency of care delivery. Some may point to our investments in the creation of the Santa Barbara County Care Data Exchange as taking a large risk (as we explored in a self-reflective 2007 Health Affairs special section). But as a board, we have been consistent in our support for investment and improvement in the use of new information technology in health care. And indeed we firmly believe that Santa Barbara was a catalyst for the significant federal HITECH investment that has followed.
While CHCF has had a long and important interest in promoting health IT to improve clinical care, we have also made special contributions in the seemingly arcane area of enrollment modernization. Building on Mark Smith’s and Vice President of Programs Sam Karp’s combined belief, interest, and expertise in the area, CHCF created important tools, technologies, and policy processes to help automate and modernize enrollment in public programs such as Medi-Cal and Healthy Families. Health-e-App and One-e-App not only enabled thousands of Californians to secure the coverage they were eligible for, but these pioneering efforts laid critical groundwork and built expertise in online enrollment and user experience design that has informed policy and practice related to implementing the Affordable Care Act in California and nationally.
5. Technical Assistance for the Safety Net
Much of CHCF’s work has involved deep engagement with public hospitals, community health centers, and county-organized health systems to improve quality, access, and affordability, particularly for patients with chronic conditions. Through a wide range of projects and initiatives, CHCF has supported chronic disease registries, electronic health records, telehealth adoption, quality improvement activities, and measuring and improving patient experience in institutions that lack the resources, capacity, or time to invest in delivery system transformation. These programs have helped improve access to care for specialty services for the underserved and the quality of care for patients with chronic illness, as well as improve the efficiency, service level, and throughput of overstretched safety-net providers.
6. The California Health Care Almanac and Information Services
CHCF plays an active role in monitoring the functioning and improving the transparency of health care policy and practice in California. Through a wide range of sponsored studies, custom reports, and news services under the broad rubric of the California Health Care Almanac, California Healthline, and iHealthBeat, the foundation keeps health care leaders informed about what is happening, what is important, and what lies ahead. The consistent quality and timeliness of this work has created a resource base that is relied upon by managers, policymakers, consultants, and academics, in the state and across the country.
7. CHCF Center for Health Reporting
CHCF recognized with concern that the ongoing transformation in media was undermining the economic viability of quality journalism in the health care field. The foundation created the CHCF Center for Health Reporting at the USC Annenberg School for Communication and Journalism to support high-quality reporting in partnership with media outlets in the state. The results can be seen in the number of stories produced in state and local media and their impact on the policy discourse on important topics, including the performance of Denti-Cal plans, the public conversation on end-of-life issues, and variation in the quality of care delivered across the state.
8. CHCF Health Innovation Fund
CHCF has committed $10 million over three years to invest in new ventures that have the potential to reduce the cost of care or improve access for the neediest Californians. The fund is off to an exciting start with several important investments in promising start-ups that we hope will create lasting value and improvement in health care delivery in areas such as telehealth access to specialists, better asthma management, and more efficient pharmacy services for rural and safety-net institutions. The fund is at an early stage, but we are excited by the prospects for this program-related investment (PRI) vehicle to innovate in areas of greatest need that the market might have overlooked without our help.
9. End-of-Life Care
End-of-life care has become a focus of the foundation because of the wide gap between the way Californians say they want to spend their last days and the highly medicalized way that many of them die. The foundation has supported greater clarity in end-of-life wishes through use of POLST (Physician Orders for Life Sustaining Treatment) forms across the state. Major progress has been made in making this a standard of care. Similarly, CHCF grants and initiatives have enabled every public hospital in the state to establish palliative care programs over the last five years. CHCF remains committed to raising awareness of Californians’ wishes for the care they receive at the end of life and in supporting care choices that are consistent with those wishes.
10. Supporting Improvement in the Medi-Cal Program and the Implementation of the ACA
CHCF has joined with other foundations and has worked with policymakers and state agencies and departments to provide instrumental technical support for many dimensions of the Medi-Cal program and the implementation of the Affordable Care Act, including:
- Informing the development of enabling legislation for the state-based health benefits exchange
- Providing technical support on the development of Medi-Cal waivers
- Developing performance standards for Medi-Cal beneficiaries with disabilities and monitoring and evaluating their transition into Medi-Cal managed care
- Informing California’s implementation of coverage expansion and insurance market reform, health IT deployment, and quality improvement initiatives
This important work continues.
Over the course of the next year, there will be many opportunities to toast Mark Smith’s legacy and contributions, and also time to warmly welcome a new leader. As we embark on this journey, the CHCF board of directors is proud of CHCF’s past and confident in its future. With the board’s strong encouragement and support, Mark Smith and his team have created an important institution that will continue to serve Californians in the decades ahead, building on a rich legacy of creativity and innovation, as evidenced in these efforts we highlight today.