Traveling across California, you can feel the potholes caused by tough economic and budget times. But the journey also brings you closer to the remarkable people and resilient organizations serving our most vulnerable neighbors everyday.

I remain hopeful because all across the state momentum is gathering toward a brighter future for the Golden State.

To expand access to health care now, our Health Care and Coverage (HCC) program is working with county leaders and community clinics to seize the opportunities presented by health reform and California's Medi-Cal waiver to transform local health systems. With the support of Blue Shield Against Violence (BSAV), domestic violence service providers are building their capacity and strengthening their leadership as they reach out to new allies to address this critical issue.

Please join us on a virtual tour of California to visit some of the communities where we are joining together with local leaders, our grantees, and partners to make a difference.

Peter V. Long, Ph.D.
President and CEO
Blue Shield of California Foundation

the road to real health reform

When national health reform became law on March 23, 2010, much of the responsibility for implementation shifted to state and local officials.

While the national law provides a roadmap to near universal coverage –
one with new directions, milestones, and opportunities – there are many routes to reach the destination. That's why our Health Care and Coverage program has worked to make the journey easier by providing leaders in the safety net and other policymakers with the information and resources they need to move forward.

the future of the safety net

One leg of this journey was hosting a meeting, California's Healthcare Safety Net: Moving Toward the Future, in Sacramento.

Community clinics, public hospitals, local officials, funders, and other safety net
stakeholders participated in a discussion about how to transform the safety
net to meet the demands and achieve the promise of national health reform.

For those who couldn't attend the meeting, the Foundation captured the event's spirit and key takeaways through a live blog, summary report, and short video. President and CEO Peter Long also co-authored an op-ed on the topic with futurist and fellow speaker Ian Morrison for the Sacramento Bee .

video: california's healthcare safety net

expanding coverage now

Well before national health reform became law, Blue Shield of California Foundation was working with state officials on another path for covering more uninsured Californians. A major milestone in that effort was reached last year, when the federal government granted the state a Section 1115 Medi-Cal waiver.

One such grantee was the Fresno County Department of Public Health, which serves a population – nearly 1 million people – where one in 10 live without health insurance. With their grant, Director Edward Moreno, MD, MPH, immediately convened staff, healthcare providers, Health Authority Commissioners, advocates, and other key stakeholders to begin planning.

“California's Medi-Cal waiver provides Fresno County an opportunity to expand medical and mental health services for the County's poorest residents. Support from Blue Shield of California Foundation to develop a Fresno County Low Income Health Program represents a significant commitment by the Foundation to improve the lives of Valley residents.”

Edward Moreno, MD, MPH,
Director of the Fresno County Department of Public Health

Fresno County's work continues today – as do our efforts to assist local officials (governments, community clinics, and other healthcare providers), since implementation work is where the rubber meets the road for reform.

coordinating services, integrating care

Community clinics, already a critical part of the health safety net, will take on new roles, responsibilities, and face new expectations when health reform becomes reality.

If they are to thrive – and appeal to patients who have more options for their care – they will need to change their operations and work as a team with other safety net providers to coordinate patient care to improve health outcomes and reduce costs (i.e., sharing patient information, streamlining referrals, etc.).

“Newly insured Californians will have more and more options for care. Our member clinics will need to appeal to different types of patients and work with different partners. This requires planning and changes now, which is not easy for clinics burdened with the day-to-day task of caring for current patients. That's why CCC is stepping up to provide training and other support to help these clinics evolve.”

Steve O'Kane, CEO of the Council of Community Clinics

developing clinic leaders

While the new healthcare landscape is about changing systems and organizations, the real drivers of improved access and care will be people. And that's what makes leadership development within community clinics so important.

Meet Tracy Mendez. She's worked the past 10 years at La Clínica de La Raza, Inc., a large health clinic in the Fruitvale neighborhood of Oakland. When Tracy moved to the U.S. from Canada years ago, she was struck by how our healthcare system perpetuated social and economic inequalities. She pursued graduate degrees in public health and public policy to “fix” the system – and works to reduce health disparities as La Clínica's Director of Medical Operations.

Tracy's passion, experience, and skills are just what community clinics need, both to handle day-to-day pressures and to help her organization evolve in the new healthcare environment. That's why she was chosen as one of 25 participants of the Clinic Leadership Institute (CLI).

A signature project of the Foundation, managed by the Center for the Health Professions at the University of California, San Francisco, CLI prepares emerging leaders of California community clinics and health centers to be effective, passionate agents of change. Over 18 months, participants hone their skills in finance management, strategy development, and health policy. They also develop and complete a specific project to improve their clinic. Read more about the completed projects of 2010 CLI graduates and an evaluation of CLI.

For Tracy, CLI was a chance to elevate her own abilities – and those of her clinic. Recognizing how critical coordination among care providers will be as reform becomes reality, Tracy is working to incorporate data-collection and dashboards into her agency operations – and across 12 primary care sites.

keeping lights on, doors open, and innovation moving

The Foundation also has a long history of providing core support to community clinics, which can use these flexible funds for whatever's needed most. Sometimes that's paying salaries and bills, often it's covering the costs of care for uninsured patients.

However, core support also empowers clinics to focus on innovation and the changes necessary to improve their services – in tough times and with health reform on the horizon.

Women's Clinic and Family Counseling Center in Los Angeles is a case in point. Founded in 1972 to focus specifically on women's health needs, the clinic now provides medical and mental health services to more than 10,000 men and women each year. In 2010, unemployment remained high in the clinic's neighborhood, and they experienced a 28-percent increase in patients.

They wanted to continue providing high-quality services without losing momentum in their efforts to move to the concept of the “patient-centered medical home,” where partnerships between patients, their families, and various providers help to provide more centralized, comprehensive primary care.

A core support grant from the Foundation helped Women's Clinic cover day-to-day costs and still focus on planning efforts for their medical home approach. In 2010, they were one of 191 grantees who qualified for millions in unrestricted support from the Foundation. Clinics often find that core support grants have a ripple effect in their fundraising. Women's Clinic, for example, used their 2010 grant to attract additional dollars from two other local foundations.

“We're not going to stop caring for the people who come through our doors – or stop working on ways to better serve patients in the future. It is not always easy to do both at the same time. We greatly need and appreciate core support in order to innovate, improve, invest in staff, and raise additional funds.”

Patricia J. Kytlica, Executive Director, Women's Clinic and Family Counseling Center

Over the past six years, we've invested more than $38 million in such support to community, free, and tribal clinics, and clinic consortia. Read an evaluation of the initiative here.

Core support is also a cornerstone of the Foundation’s other program, Blue Shield Against Violence (BSAV). As the state’s largest private funder of domestic violence services and prevention, BSAV is dedicated to ending domestic violence in California.

BSAV announced in 2010 that its Core Support Initiative would distribute $3.2 million over two years to 119 domestic violence shelters and service providers, bringing the Foundation's total support for domestic violence services to more than $33 million since 2002. ( Click here to read an evaluation of our 2008 - 2010 Initiative.)

These grants give domestic violence service providers the flexibility to direct funds wherever they are needed most to fulfill their missions – grantees like Asian Americans for Community Involvement (AACI).

Based in Santa Clara County, AACI, faced similar circumstances as other domestic violence service providers – and some unique ones. For years, the San Jose nonprofit has provided a safe place for domestic violence any survivor with linguistically, culturally competent care for a population that too often experiences barriers when accessing help – or suffers alone in silence. Sometimes survivors do not feel comfortable seeking help, but AACI is recognized in the community as a critical resource for any survivors of domestic violence.

In July 2010, AACI braced for a significant reduction in public funding – nearly the equivalent of their annual emergency shelter budget – forcing them to cut back just as demand for their services escalated. That made any funding, especially flexible dollars, essential.

“Our clients have specific, unique needs. To adequately serve them, especially in tough times, we need a variety of things – from culturally appropriate food staples to immigration fees to repairs to our living facilities. Most grants specify what you can and can't use funds for, which is what makes the flexibility of Blue Shield Against Violence support timely – and invaluable.”

Michele Lew, President and CEO of AACI

The power of core support is multiplied when grantees participate in the Foundation's other capacity-building efforts aimed at strengthening organizations and the broader domestic violence field in California. For example, AACI also received coaching on how to form successful partnerships, as well as customized “tough times” financial advice – both steps served to strengthen their long-term ability to serve clients.

strengthening the domestic violence field

The Lake Family Resource Center in Kelseyville, California (pop. 3,353), may be off the beaten path, but it too has an important story to tell.

In 2010, the Center was one of California's domestic violence service providers that faced cutbacks in state and local funding while also experiencing increased demand for services. The center struggled to balance the need to deliver immediate services with the need to strengthen its organization – and its leadership – for longer-term success.

The Center and its Interim Executive Director, Lisa Fronsman, are part of the Foundation's Strong Field Project, a four-year effort started in 2010 aimed at building a stronger, more coordinated network of domestic violence service providers in California. An initiative of our Blue Shield Against Violence program, the Strong Field Project develops individual leadership skills, stronger organizations, and expanded networking and knowledge-sharing opportunities to strengthen the field.

Lisa is one of the Project's 20 Leadership Development participants announced in 2010, and the Lake Family Resource Center also received one the Project's 15 Organizational Strength Grants.

“I – and my organization – want to provide the best possible services to our clients. We don't always have the time to explore our new ideas, so the beauty of the Strong Field Project is that it gives us the space and skills to take our work to the next level.”

Lisa Fronsman, Strong Field Project participant and Interim Executive Director of the Lake Family Resource Center

partners on our journey

A key partner for the network-building aspect of the Strong Field Project is the California Partnership to End Domestic Violence.

This short video clip from the Partnership's Executive Director, Tara Shabazz, reinforces how this leader and frequent partner within the state's domestic violence field values and facilitates greater interaction among key players.

video: the Partnership's Tara Shabazz

spurring innovation

Domestic violence knows no boundaries. But some are at more risks than others, which is why the Foundation supports innovative solutions to prevent violence among the most vulnerable Californians.

Today in California, this includes military families. The current wars and multiple deployments are placing unprecedented demands on California's brave soldiers. Some studies have found that one in five combat veterans returning from Iraq and Afghanistan suffers from post traumatic stress disorder (PTSD) or major depression, which may create a heightened risk for family violence. We're supporting organizations that are helping service members leave behind the violence they experienced in combat.

In Riverside, Alternatives to Domestic Violence (ADV), which serves civilian survivors of domestic violence, forged an innovative partnership with the military to expand ADV's shelter and counseling services to the 27,000 military personnel and family members that call nearby March Air Reserve Base home.

“Domestic violence organizations must think differently – creatively – about how to better reach out to and serve those who may not normally ask for help, know how, or know where to go. The Foundation funds allow us to turn innovative ideas into working solutions for Riverside families.”

Eliza Daniely-Woolfolk,
CEO of Alternatives to Domestic Violence

This is just one area in which BSAV supports of innovative approaches to preventing violence in California. For more information on BSAV's innovations work, click here.

the destination ahead

The journey to reach our goals won't be easy or fast. The road ahead will have ups and downs, but we're honored to share this journey with our grantees, partners, and you.

Following this quick virtual tour, we invite you to meet our stewards and to explore the interactive map at the end to learn what we’re doing in your community. For regular updates, follow me on Twitter: @PeterLongBSCF, or visit us online at www.blueshieldcafoundation.org.

stewards of our journey

The stewards of our journey – our board of trustees – are an experienced, diverse mix of Californians dedicated to our mission of making health care accessible, effective, and affordable for all Californians – and ending domestic violence.

under the hood – where and how we fund

The work and voices of our grantees and partners tells part of the story of where and how the Foundation is trying to make in an impact. Another part of that story is our financials.

We are committed not just to having a broad, effective reach throughout California but also in being transparent about where and how we give.

• grant locations
• program awards
• financial position
• activities and changes