Unfortunately, in 2009, safety net providers faced unprecedented demands for care. As the number of uninsured and underinsured Americans increased, many states and cities across the country responded to historic deficits by cutting assistance to vulnerable populations.

While the impact of the recession has been a national phenomenon, it has been exaggerated in California due to the state’s lower rate of employer-sponsored health coverage and higher proportion of the population that is uninsured, which was 20 percent and rising in 2009. For these reasons, we focused special attention on California’s safety net in 2009, raising these contributions in the state to $37 million.

Grants provided by the American Recovery and Reinvestment Act, also known as the Stimulus Package or ARRA, provided much needed support to the safety net. In response to the relief our economy and neighborhoods badly needed, ARRA provided $275 billion in contracts, grants, and loans. ARRA support to the safety net ensured that health care access would not be compromised for those suffering from job losses, and also provided a temporary financial lifeline to these organizations. But still, many gaps persisted. In all our regions, we stepped in to help fill the unmet needs by increasing our financial, technical, and clinical support. Our help for the year totaled more than $61 million.

Working with the National Patient Safety Foundation and the National Association of Public Hospitals and Health Systems (NAPH), we announced the Patient Safety Initiative at America’s Public Hospitals. This two-year program will ensure safe, high-quality care for people who depend on publicly supported health care institutions.

A few of the goals of the Patient Safety Initiative include:

• Position public hospitals as leaders in patient safety and quality care.
• Deliver measurable results in patient safety by establishing a consistent pool of patient safety knowledge, tool sets, and techniques.
• Develop a community of public hospital clinicians, patient safety and quality leaders, and hospital executives who are committed to this initiative.

Kaiser Permanente invested $718,010 to fund 85 hospitals for the two-year program. Forty-two hospitals were selected in 2009, with the balance to be selected in 2010. This program could potentially be expanded to all 140 NAPH member hospitals.

Our support for vulnerable populations did not stop at our own walls. We provided grants to 378 safety net organizations nationwide.

To ensure that health care professionals working in safety net community clinics and public hospitals serving vulnerable populations have access to the best quality improvement and patient safety training opportunities, Kaiser Permanente began awarding scholarship funding in late 2005 to provide training at the Institute for Healthcare Improvement (IHI), a national leader in quality improvement practices.

During 2009, we awarded a total of 183 scholarships to safety net health care professionals from across the U.S., enabling them to participate in IHI conferences, trainings, and collaborative learning sessions.

In a related effort, Kaiser Permanente is providing $750,000 to sponsor the IHI Open School for Health Professions. The Open School has already registered more than 20,000 students from 41 states and 24 countries. The program gives students in a broad array of health professions access to Web-based quality improvement and patient safety training and enables them to interact with IHI faculty and engage in real-life health care problem-solving. This sponsorship began in 2009 and will be distributed over three years.

Every year, the James A. Vohs Awards for Quality honor Kaiser Permanente projects that advance quality of care. In 2009, the Vohs Multi-regional Award was presented to the Northern and Southern California regions for their ALL/PHASE Community Implementation and Translation Program, which extended an innovative therapeutic practice for diabetics, developed by Kaiser Permanente, to safety net providers. ALL stands for Aspirin, Lisinopril and Lipid-lowering therapy—a bundle of low-cost, generic medications— while PHASE stands for Preventing Heart Attacks and Strokes Everyday, a complementary program for at-risk patients involving a beta blocker and four lifestyle changes.

More than 7,000 diabetic patients who access care through safety net community health centers or public health and hospital systems were put on the ALL/PHASE protocol. Evaluation studies have shown that bringing the program to the safety net community would significantly reduce the number of heart attacks and strokes in medically underserved, vulnerable populations. This program has now been extended to additional safety net clinics in our Georgia, Northwest, and Colorado regions.

Operation Access, a Northern California nonprofit organization, provides and coordinates free outpatient surgeries and surgical consultations to hundreds of uninsured individuals in Northern California every year. In addition to providing financial support, Kaiser Permanente participates by providing operating and procedure rooms, staffed by Kaiser Permanente volunteer physicians and medical staff, in 23 Kaiser Permanente medical centers. Donated procedures include outpatient hernia repair, cyst/lipoma removal, ENT, ophthalmology, orthopedic surgery, and colonoscopies.

Kaiser Permanente funding is supporting a similar program for the uninsured in Orange County. Access OC, which is based on the Operation Access model, identifies, recruits, and coordinates donated outpatient surgeries by Kaiser Permanente medical professionals and medical facilities for the county’s uninsured and working poor. To date, four Kaiser Permanente medical centers in Southern California participate in this program and plans to expand to additional centers are underway.

Our strategic partnerships with safety net providers emphasize quality and patient safety, capacity development, sustainability, workforce and leadership development, and the cultivation of evidence-based practices.

Timely access to specialty care is a growing problem for low-income individuals who depend on safety net providers. For several years, Kaiser Permanente has led a statewide program called the California Specialty Care Access Initiative in partnership with the California Health Care Foundation to study the size and causes of the challenge and to devise solutions. In 2009, our funding focused on support for coalitions that have moved beyond the study and planning phase to actually implement initiatives that increase access and reduce demand for specialty care among uninsured and underinsured populations. In all, 15 lead agencies for coalitions throughout the state are targeting access to many vital specialties, including gastroenterology, orthopedics, neurology, ophthalmology, and cardiology.

Safety net programs targeting elder abuse, support for elder caregivers, and other elder support initiatives were the recipients of 2009 grants provided through a donor- advised fund established by Kaiser Permanente.

In Los Angeles and Orange counties, the South Asian Network’s Elder Caregivers Program received a grant to support the training of 100 South Asian caregivers on aging issues, provide monthly cultural sensitivity workshops, and provide peer support group activities.

We are also helping fund a program by the University of California, Irvine’s Center for Excellence in Elder Abuse and Neglect. The University’s Pharmacy Training Program is developing, piloting, and evaluating an elder abuse curriculum that will train pharmacists and pharmacy staff to act as “gatekeepers” in identifying and reporting elders at risk for abuse, neglect, and self-neglect. The funds will also be used to help establish a statewide Elder Abuse Policy Council, whose duties will include educating policymakers on elder mistreatment issues.

Additional Kaiser Permanente funding was provided to the University of Southern California for the Andrus Gerontology Center’s Fall Prevention Center of Excellence Coalition. The funding will support the development of a sustainable Fall Prevention Coalition and strategic plan to provide services, help reduce injuries from falls, and provide training and advocacy for culturally diverse, underserved communities.

The best safety nets catch people before they fall.

The Health Care Interpreters Network will use a 2009 Kaiser Permanente grant to develop the Statewide Video Network for Public Hospitals to Link with Health Care Interpreters program, which will be implemented in public hospitals throughout California. This program will deliver training and continuing education programs for medical interpreters, and test how this program can be leveraged to provide telemedicine services to patients who have limited English proficiency.