Foster G. McGaw Prize Finalist Cedars-Sinai on Its Commitment to Community Health and Health Equity

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Tom Haederle
Connecting topnotch medical care to medically underserved areas and populations. Equipping children and families with the tools to achieve ongoing health and well-being. Providing mental health and early intervention programs for students, parents and educators who've been affected by traumatic events. If there was a problem, Cedar Sinai Medical Center in Los Angeles probably has a treatment.

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Tom Haederle
Welcome to Advancing Health. I'm Tom Haederle with AHA Communications. AHA's prestigious Foster G. McGaw Prize Honors Health delivery organizations that have demonstrated a strategic approach to community health and health equity. Among this year's three finalists for the prize, Cedars-Sinai Medical Center in Los Angeles, an 886-bed teaching hospital and academic health science center. And joining me now is Jonathan Schreiber, VP of community Engagement.

00;01;07;14 - 00;01;29;25
Tom Haederle
John, thank you so much for coming by this afternoon. 

Jonathan Schreiber
Thank you. It's a pleasure to be here. Appreciate it. 

Tom Haederle
Congratulations, first of all, on your recognition by the Foster McGaw Prize judges. They were clearly impressed by a number of the initiatives that you have underway, and I'd like to talk about some of those in the next few minutes, starting, I think, with a community clinic initiative, which maybe you could talk a little bit about what that's designed to do and what impact it's made on the community.

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Jonathan Schreiber
Absolutely. This is a I don't want to call it a brainchild of the work that we've been doing for really and truly about a decade now. But one of the key issues that comes up in terms of research that we find over and over again in our community health needs assessment is that people struggle with access to care.

00;01;48;01 - 00;02;13;17
Jonathan Schreiber
And what we do know is that the federally qualified health care center system actually serves about 1.7 million Angelinos is on an annual basis. Those are not just people who sign up. That's actual individuals that are served through those community health centers. So our community clinic initiative is really designed to help build the capacity of each of those clinics to better serve their own constituents.

00;02;13;19 - 00;03;00;16
Jonathan Schreiber
It means sometimes that we're focused on quality improvement. Sometimes it means we're going to help them with regard to how they do their screenings and their connections around our social determinants of health. We have financial viability programs. We helped launch telehealth at the beginning of the pandemic for those federally qualified health centers. We also have a very, very renowned program called Managing Cleaning that helps take mid-level managers and helps them build their own ability to be leaders so that they are prepared to carry forward not only the mission but a stronger, different kind of approach to tackling the problems that are facing the health care system and specifically that FQHC world.

00;03;00;18 - 00;03;21;14
Tom Haederle
That's really impressive and sounds very comprehensive in scope. Is there any way to measure the impact it's had so far? 

Jonathan Schreiber
Well, we focus all the time. Whatever our initiative is, we always focus on how we can improve quality. And so we are looking very specifically at quality measures of individual clinics, quality measures across the board when we talk about our financial viability situation.

00;03;21;17 - 00;03;44;11
Jonathan Schreiber
When that program started, there was at least one efficacy that had two days of cash on hand. Wow. As a health care institution, you cannot survive. No business can survive effectively with two days of cash on hand when they're employing hundreds of people. So we look and we always set goals that are realistic. We have individual clinics that set goals.

00;03;44;11 - 00;04;09;05
Jonathan Schreiber
We also look at our broad initiatives. I mean, we're investing between seven and $10 million a year in this space. So the Community Clinic Association of L.A. County is an incredibly close partner. There are a variety of folks that we really work with in order to better understand the needs of that community and what that community is, as it's going to sound a little funny, but this is very much B2B, not B2C.

00;04;09;06 - 00;04;28;02
Jonathan Schreiber
We are working with those clinics so that they can be better at what they do to serve the community. 

The scope of the program is very impressive. 1.7 million people is taking on a lot. 

To be fair, in our local community benefit service area, that's only 800,000 people. But for all of Los Angeles, which is an enormous you know, L.A. County is 10 million people.

00;04;28;03 - 00;04;51;25
Jonathan Schreiber
Yeah, but these are all people that earn below 250% of the federal poverty level. They're all either on Medi-Cal or they are currently not insured, which it's actually code for people who are undocumented. 

Tom Haederle
Cedars-Sinai also seems to really focus, and I think this also caught the judges eyes as they were looking at the applicants this year on the totality of what it means to be healthy.

00;04;51;25 - 00;05;10;09
Tom Haederle
For example, a program called Coach for Kids provides much more than just immediate care. What else does coach for kids do? And well, it's probably a pretty broad answer, but how does it address issues of food insecurity or domestic violence, for example? 

Jonathan Schreiber
So Coach for Kids is a program that we're incredibly proud of, but it's not a new program.

00;05;10;12 - 00;05;31;26
Jonathan Schreiber
This is a program that's been around in the community for over 30 years. And for most of that time period, we served as the primary care destination point for children and their families in the local community. So that extended in a variety of ways. And our model changed. That, I think, was what may have caught the judge's eye.

00;05;31;26 - 00;05;49;26
Jonathan Schreiber
So I'm not trying to be you know, all the world is a nail and we're a hammer. But the truth is that we realized that the way that our insurance system in the state of California is headed, I don't know if you're aware of this, but if you're under age 26 or if you're over age 49 today, you qualify for Medi-Cal.

00;05;49;26 - 00;06;12;02
Jonathan Schreiber
If you earn below 250% of the federal poverty level. And that does not distinguish between whether you are documented or whether you're undocumented. As of January 1st, 2020, for every person in the state of California who will qualify for medical insurance, who is below 250% of the federal poverty level, as long as they are a resident of California.

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Jonathan Schreiber
So what that means is that we were actually going out as this health care system was changing. We were going out and trying to be the primary care provider for folks, and they would rely on us as a primary care provider. But what we learned through our community clinic initiative is that it started to impact the way that we saw the delivery system of health care in the community.

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Jonathan Schreiber
The thing that they have the hardest time with -FQHCs - is recruiting new people in the door for them. So we use the Coach for Kids mobile medical unit to do is that we now have a model that we call Care and Connect. So we absolutely, unequivocally continue to do that incredible work with nurse practitioners and with nurses and social workers and providers in the field.

00;06;58;09 - 00;07;21;08
Jonathan Schreiber
But when we finish our work with Coach for Kids, we then connect people to a local federally qualified health center and to other community benefit service providers in the community for things like physical care, behavioral health care, dental care, vision care, legal services, food insecurity. We sign people up for Cal Fresh, which is the state's food stamp program.

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Jonathan Schreiber
So there's a whole variety of work that happens through the work that we do out in the field with Coach for Kids. It's a very special program.

Tom Haederle
Very integrated program, too. It sounds like one one feeding into the other the way you've got it set up. 

Jonathan Schreiber
I think less than feeding into. It's that work that you do informs work that you see as possibilities.

00;07;42;26 - 00;08;10;04
Jonathan Schreiber
And so by working with the Community Clinic Association, by working hand in hand with a variety of FQHCs, by working with the Southside Coalition, which is another group of FQHCs, we learned what the challenges were for those FQHCs, we selected high quality partners that we trust that provide incredible care and we based our outreach and our our systems for Coach on those relationships.

00;08;10;06 - 00;08;33;00
Jonathan Schreiber
So it's a matter of one program informing the way that we see the world, how we shouldn't be driving, no pun intended, into a community to say, we're going to serve you. We're going to say we're going to help and we're going to connect you so that you yourself have a greater ability to take care of you and your family's needs in an ongoing fashion.

00;08;33;00 - 00;08;56;21
Jonathan Schreiber
You don't have to wait for an itinerant mobile unit to come out every two weeks, three weeks a month, to show up. We don't want to be the connector of generational care. We want people to get connected on an ongoing basis so that they can take care of their needs. 

Cedars Sinai also seems to me, though, almost have had a crystal ball in a certain way.

00;08;56;21 - 00;09;19;11
Jonathan Schreiber
And what I mean by that is today we're deluged all too frequently with these heartbreaking stories of violent incidences in school and and shootings and all sorts of traumas that are just, it seems to me, a really ugly aspect of our society right now. But all of that feels relatively new. Yet you have a program in a place called Share and Care that goes all the way back to the early 1980s that seems to deal with some of these things.

00;09;19;11 - 00;09;44;22
Tom Haederle
And what was the impetus for that program? What was happening at the time that it seemed necessary to create something like this? And what difference does it made? 

What do you call it: past Is prologue? Is that the best way to describe it? 

Jonathan Schreiber
That's one one expression. So I think what's interesting is we had a very robust psych program at Cedars-Sinai, including outpatient, and we had outpatient services and we had a person who started because there was actually a shooting at a school in Los Angeles.

00;09;44;22 - 00;10;21;20
Jonathan Schreiber
That's the Genesis story. And those kids were traumatized. And as a consequence, her name was Suzanne Silverman - she's still the founding director of the program - went out and actually visited with those kids and tried to help them through that trauma. And that informed the creation of a program because there was a realization even then that there were incredible amounts of trauma that kids were experiencing. Sometimes that was parents who were incarcerated and that on a serious level or a loss of a family member or a close family member, maybe even a parent, and on a very basic level, bullying.

00;10;21;22 - 00;10;42;02
Jonathan Schreiber
And so what's happened over the years as we've expanded the program, we're now in 30 schools. We have a parents program as well, so that parents and faculty at schools are able to have better tools on how to deal with their own students. But this is a 12 week program. We have multiple curricula depending on the need of what's happening with those groups. 

0;10;42;02 - 00;11;07;14
Jonathan Schreiber
We use art therapy is the primary modality. And we evaluate the program so we can actually tell you that there is a consequence, a positive consequence of kids who have gone through this program and how they behave: A) In the classroom, B) with their peers and C) in their own homes. So it's a very profound and evaluated difference that we know we're making with this program.

00;11;07;21 - 00;11;24;15
Jonathan Schreiber
And the intervention has only become stronger since its inception in 1981. 

Tom Haederle
Wow. That's really something that to have been so far ahead of the curve has to be a, you know, sometimes satisfaction to. 

Jonathan Schreiber
By the way, I don't know that I would give Cedars-Sinai full credit. I think that for many years this was an independent program that grew.

00;11;24;15 - 00;11;46;08
Jonathan Schreiber
And then we were fortunate enough about 20 years ago or so to be able to bring it in-house. 

Tom Haederle
I see. Let's switch gears a little bit here and talk about health equity, if we could. That's something I think that was measured for this particular prize this year, but something that affects caregivers nationwide. Everybody's thinking about it, talking about it, finding ways to integrate it into their operations and their core missions.

00;11;46;11 - 00;12;07;00
Tom Haederle
What strides would you say Cedars-Sinai has made on the equity front and what remains to be done? 

Jonathan Schreiber
Oh, my gosh, there's so much to do. Complicated question. Yeah, you're asking. You know, we just appointed our second chief health equity officer. We worked very closely. Dr. Christina Harris is responsible for all the health equity work that we're doing, but there's partnerships.

00;12;07;02 - 00;12;36;09
Jonathan Schreiber
None of that is carried on her own. She's a very, very small team of two people. Soon to be slightly more, but it's because it's everyone's work to do health equity. So she focuses both internally and externally. But we play in our community benefit work a very, very key role in health equity. One, we've started a screening program actually, it's been in place now for two years where we screen all patients that come in.

00;12;36;11 - 00;13;01;01
Jonathan Schreiber
This is a common thing that's starting to happen amongst hospitals. We not only screen them for social determinants of health in 11 categories, but we also then connect them to resources that are available to them, either through community based organizations or through the government services. And for those who have very intense needs, we have community health workers that work specifically with them. On a grant-making basis, 

00;13;01;02 - 00;13;31;25
Jonathan Schreiber
we're also now and I see this actually kind of tragically, we're the largest funder of black birth equity programs in the state of California. The leader was and still is on many levels in terms of thinking the California Health Care Foundation. But now we have done just this year, we did $3 million in grant-making to 12 organizations that would focus on black birth equity because of the dramatic differences between black and brown births and non and particularly white births.

00;13;31;25 - 00;13;53;25
UJonathan Schreiber
And so I think that there are dramatic changes there. And we're also one of the first large funders in the state of California. And we, of course, only focus on the L.A. area. But to have done a health equity RFP, the grants in that space where we tried to help bring organizations along so that they could do DEI work in their own organizations.

00;13;53;28 - 00;14;17;06
Jonathan Schreiber
And it's very odd because we're doing renewals for that grant right now. This year we'll do $20 million total in grant-making. And if you really look at it, almost all of it is focused on health equity in one way or another, whether it's access to care or whether it's about housing and homelessness or any of the other spaces where we do funding.

Tom Haederle
That really doesn't seem like a box that anybody can ever check as "done" right now.

00;14;17;08 - 00;14;40;17
Jonathan Schreiber
Yeah, we're far away. Always part of it, too. Yeah. 

Tom Haederle
Well, wrapping up John, Cedars-Sinai has been an innovator in many fronts and I'm sure learned some lessons along the way, as everybody does. What advice would you share with peers, maybe organizations of your own size, that you've learned about building community partnerships and the difference that can make? 

Jonathan Schreiber
I think something that has changed pretty dramatically.

00;14;40;21 - 00;15;04;13
Jonathan Schreiber
It's a callback to something that we talked about earlier in our discussion today, and it's that we cannot do this work without the partnership of organizations and the willingness of individuals in the community to actually do the work alongside us. We can no longer go into a community and say, we're here to solve your problems. No, no, no, no, no.

00;15;04;15 - 00;15;34;00
Jonathan Schreiber
The community itself has to step forward. Organizations have to step forward. Individuals have to step forward so that they are better able to care for A) themselves and, B) their community members. So when we talk and when we talk with our peers in the space, we really specifically say, hey, our our focus is on capacity building, how to make organizations stronger, how to help them with the data that they're dealing with their deep knowledge of the community.

00;15;34;03 - 00;16;03;02
Jonathan Schreiber
How can we make it so that they deliver the services that are required by the community that they serve? And that is a very, very different emphasis than we had in the past. And I mean no disrespect to the work that we used to do, it's simply that we've added this new layer on and I think that that is an evolution in the way that hospitals in their delivery of community benefit have evolved and are continuing to evolve in how we serve our local community.

00;16;03;04 - 00;16;41;22
Tom Haederle
Great final thought. Thank you so much. You've been listening to Jonathan Schreiber, who's vice president of Community Engagement for Cedars-Sinai Medical Center in Los Angeles, talking about why Cedars-Sinai was a finalist for this year's Foster G. McGraw Prize from the American Hospital Association. John, thank you so much for being on Advancing Health. 

Jonathan Schreiber
Thank you. 

Tom Haederle
Appreciate your time. And thank you for listening.