Health Policy

Health policy work conducted in the Division of General Internal Medicine is unified by a firm commitment to improve conditions and policies to enhance the health and well-being of vulnerable populations. Listed below are descriptions of some of our faculty members' current policy work.

Soraya Azari
Dr. Azari’s health policy interest relates to the use of opioid medications for treatment of chronic, non-cancer pain. She is part of a working group comprised of San Francisco safety net providers who aim to devise best practices for use of opioids in primary care. Her group has drafted quality standards for participant clinics, and is collaborating with local emergency departments to discuss appropriate use of opioids.

Kirsten Bibbins-Domingo
Dr. Bibbins-Domingo current work focuses on understanding the interaction between social, behavioral, and biological factors that place vulnerable groups at risk for cardiovascular disease early in life and population-wide policy level interventions that may prevent disease in these groups. She has provided recommendations to local, state, federal, and international organizations interested in the impact on food and nutrition policies on cardiovascular disease prevention and health disparities, including the California Department of Public Health, the Centers for Disease Control and Prevention (CDC), and the Pan American Health Organization (PAHO). She has served on several committees of the Institute of Medicine (IOM), advising federal agencies on policies related to adverse effects of vaccines, presumptive disability in veterans, valuing community-based prevention, and evaluating the impact of population-wide sodium reduction. She is a member of the US Preventive Services Task Force that develops national guidelines for clinical prevention.

Andy Bindman
The major focus of Dr. Bindman’s policy work has been on the Medicaid program, which aside from being the largest public insurance program for the poor, is expected to be a major source of coverage expansion as a part of the Affordable Care Act (ACA). During 2009-2010 he was a member of the staff of the Energy and Commerce Committee in the US House of Representatives where he drafted legislative language on Medicaid related provisions that were included in the final passage of the ACA. He remains intimately involved with the implementation of the ACA at the federal and state level. He currently serves as a senior advisor to the Assistant Secretary for Planning and Evaluation within the US Department of Health and Human Services where he has responsibility for developing regulations on a variety of ACA related topics including payment policy, primary care, and graduate medical education. In California, he is the founder and Director of the California Medicaid Research Institute, a multi-campus research partnership between the University of California and the California Department of Health Care Services which has responsibility for the state's Medicaid program (Medi-Cal). At UCSF, he has also developed and teach on an annual basis as a part of the Masters in Clinical Research Program a course to help young investigators better understand how they can more effectively translate research to inform policy. He disseminates his perspectives on health policy as a featured contributing writer within the Journal of the American Medical Association's (JAMA) Health Policy Blog (http://newsatjama.jama.com/tag/the-jama-forum/)

Maria Chao
Dr. Chao’s policy and advocacy efforts focus on improving access to evidence-based complementary and alternative medicine for underserved populations. Her current work includes evaluating the implementation of acupuncture as an adjunctive therapy in safety net settings to improve quality of life among patients with chronic pain. She has published on racial/ethnic differences in reasons for using complementary and alternative medicine, factors that affect disclosure of complementary and alternative medicine use to healthcare providers, and socioeconomic access to acupuncture through group-based, community acupuncture models. Dr. Chao is a member of the steering committee for Integrative Medicine for the Underserved, a partnership between the UCSF Osher Center for Integrative Medicine and Family and Community Medicine at San Francisco General Hospital. She also serves on the Board of Directors for the American College of Traditional Chinese Medicine.

Arpita Chattopadhyay
Arpita Chattopadhyay’s policy work is on aging and long-term care (LTC) policies especially as it relates to the minority aging. She has presented papers at national conferences that document the differences in LTC by racial and ethnic groups among older adults. Currently she is developing a demographic simulation model to determine future long-term care population in California explicitly accounting for the changing racial/ethnic composition. She has written papers on the contribution of Home and Community Based Services (HCBS) in the overall efficiency of state LTC programs and the effectiveness of integrating LTC and medical care for community dwelling disabled elderly. She also conducts research on Medicaid policy with respect to the long-term care, and health care for the poor.

Alice Chen
Dr. Chen’s work focuses on creating policies and programs to improve access to and quality of care for underserved communities. Prior to joining UCSF she served as a Health Policy Scholar in Residence at The California Endowment, where she oversaw the foundation’s language access grantmaking program. She was subsequently awarded a Soros Physician Advocacy Fellowship to partner with the Asian & Pacific Islander American Health Forum to promote the financing and provision of language assistance services in California. She has served on national and state expert advisory committees on language access, cultural competency and health disparities, including for Aetna, the American Medical Association, the California Academy of Family Physicians, the California Association of Public Hospitals and the Robert Wood Johnson Foundation. At San Francisco General Hospital, Dr. Chen’s work centers on delivery system redesign and innovation, with a specific interest in improving the primary-specialty care interface. She has also been instrumental in developing the Partnership for Physician Advocacy Skills (PPAS) curriculum, which provides policy and advocacy knowledge and skills development for residents who are focused on the care of the underserved. She previously served on the boards of the California Pan-Ethnic Health Network and the National Council on Interpreting in Health Care and is currently a board member of the National Council of Asian & Pacific Islander Physicians.

Alicia Fernandez
Dr. Fernandez’s policy work has primarily focused on issues affecting US minority and immigrant populations related to chronic disease care. She is particularly interested in language barriers in health care and the associated policy implications regarding physician language ability and professional interpreter use. Her work in this area has included research on: the impact of language barriers on the management of Type 2 diabetes among Latinos; resident physicians’ use of professional interpreters; the accuracy of tools used to assess physicians’ self-reported Spanish language ability; and the need for national training and certification standards for professional health care interpreters. She has served as an advisor to numerous national foundations, the AMA, ABIM, and other stakeholders focused on health disparities and to state and national advisory committees focused on language barriers and cultural competence. Dr. Fernandez served on the Society of General Internal Medicine Council (2006-09). In addition to her research-related policy work, Dr. Fernandez serves on the board of trustees of American Civil Liberties Union-Northern California.

Liz Goldman
Dr. Goldman’s research and policy work focuses on improving the quality of health care for underserved communities and the safety-net in particular. She promotes high quality, cost-conscious, and appropriate care in the safety-net, and evaluates innovations and health delivery approaches to improve care transitions and provider communication across settings and specialties. As part of her work to improve the science of quality measurement, she has served on an expert work group for Agency for Healthcare Research and Quality Present on Admission (POA) Project.

Claire Horton
Dr. Horton's policy and advocacy work centers on primary care re-design in safety net settings, the elimination of racial and ethnic disparities through primary care quality improvement (QI) efforts, and coaching physician leaders to create system-level change. She launched and co-directs (with Dr. Urmimala Sarkar) the "Triple AIM" curriculum for primary care internal medicine residents at SFGH. The curriculum introduces residents to core QI concepts and skills and includes an experiential component in which residents complete clinic-based QI projects. She is part of UCSF/Center for Health Professions' ACTION grant network, which focuses on integration of health disparities data into QI initiatives. She serves on the advisory board for Healthy San Francisco / San Francisco Health Plan's Quality Improvement initiatives, which have been instrumental in helping to create Pay-for-Performance initiatives in the San Francisco safety net. In the past she has also served on California's Medicaid Managed Care advisory board. She is a coach for the UCSF Center for Health Professions' Institute for Physician Leadership, which aims to equip California's physician leaders with leadership skills to lead their organizations and create meaningful change in statewide healthcare systems (http://www.futurehealth.ucsf.edu/Public/Leadership-Programs/Home.aspx?pid=65)

Margot Kushel
Dr. Kushel has focused her work on developing evidenced-based policy responses to homelessness and related concerns, including "frequent users" of high-cost, acute health care, the reintegration of former prisoners into the community, the effects of food insecurity on health care outcomes, the challenges faced by young adults who age out of the child welfare system, and the use and misuse of opioid analgesics by high risk populations. Dr. Kushel has worked at the local, State and Federal levels through developing effective policies (e.g. respite care and supportive housing for chronically homeless individuals), legislative testimony and testimony to Federal agencies to inform policy-makers about salient policy issues, and work with foundations and advocacy organizations. She served on the Board of the "Frequent Users of Health Care Initiative," a five year California state-wide project to develop responses to reduce unnecessary use of the Emergency Department. She was instrumental in developing the expanded respite services offered in San Francisco. She has worked with the Corporation for Supportive Housing, a national non-profit that seeks to increase the supply of supportive housing for chronically homeless individuals to support policy initiatives. She is frequently asked to speak on topics of highly vulnerable populations to non-medical audiences.

Laurence Peiperl
Dr. Peiperl's policy interests involve the multiple, interacting systems that have evolved to provide care for urban patients with complex medical, psychosocial, and substance abuse issues. He is active in clinical practice, CQI, and teaching in the ED Case Management Program (in collaboration with the SFGH Dept of Psychiatry), Glide Health Services (through a joint appointment in the UCSF School of Nursing Dept of Community Health Services), and SFGH General Medicine Clinic. His work focuses on: 1) improving access to appropriate medical care among frequent users of emergency services 2) optimizing interactions between clinics and case management services, and among case management services of different levels of intensity 3) defining the role of the generalist physician in interprofessional teams and 4) improving the processes of collaboration and consultation between nurse practitioners and physicians.

Neda Ratanawongsa
Dr. Ratanawongsa's advocacy work has focused on system redesign to support safety net clinicians in developing meaningful therapeutic alliances with their patients. Specifically, she is interested in assuring that quality measures, incentives, and health system policies promote relationship-centered communication, support clinician well-being, and improve the recruitment and retention of diverse clinicians in the safety net workforce. Dr. Ratanawongsa's current focus is on tailoring electronic health record system implementation metrics to meet the needs of clinicians caring for linguistically and culturally diverse populations. As Associate Member to the Society of General Internal Medicine Council, Dr. Ratanawongsa helped advocate for fair and equitable Medicare reimbursement policies, adequate funding for health professions training, and support for health services research.

Urmimala Sarkar
Dr. Sarkar’s policy and advocacy work focus on the areas of patient safety, specifically for vulnerable populations with chronic conditions, and health information technology. She serves as an advisor to the National Patient Safety Foundation on outpatient issues and recently served on a Technical Expert Panel on ambulatory safety for the U.S. Department of Health and Human Services. In addition, Dr. Sarkar is passionate about harnessing the health information technology revolution to reduce racial/ethnic, economic, and literacy-related disparities in health care by innovating to address the unmet need for appropriate patient-facing technologies for vulnerable populations.

Dean Schillinger
Dean Schillinger MD has focused his policy efforts for vulnerable populations in two domains: health communication and diabetes. With respect to health communication, in 2000, he completed an Open Society Institute Advocacy Fellowship working with California Literacy, Inc., a non-profit educational organization that helps people gain literacy skills, to advance the California Health Literacy Initiative. Dr. Schillinger also contributed to the 2004 Institute of Medicine Report on Health Literacy and authored a 2012 IOM commissioned paper defining the attributes of health literate healthcare organizations. His communication research also influenced the development of communication standards and performance measures created by the National Quality Forum and the Joint Commission. With respect to diabetes, he was a co-founder for the National Association of Public Health and Hospital Institute’s Diabetes Quality Improvement Consortium. In his capacity as Chief Medical Officer for the Diabetes Prevention and Control Program for the California Department of Public Health, he has been expanding the program’s work in health communications, social and environmental determinants of diabetes, and health disparities. In this capacity, he has partnered with Youth Speaks, a youth empowerment organization that harnesses social media, to advance a California youth-led diabetes prevention and policy initiative known as The Bigger Picture (http://youthspeaks.org/thebiggerpicture/).

Hilary Seligman
Dr. Seligman’s policy and advocacy expertise focus on federal nutrition programs (such as the Supplemental Nutrition Assistance Program), food affordability and access, and income-related drivers of food choice. She serves on numerous committees for Feeding America (the nation’s leading domestic hunger-relief charity), including the Nutrition Advisory Board and the Survey Instrument Redesign Committee. She has had recent speaking engagements on policy and advocacy at the Institute of Medicine (Adequacy of Food Resources and SNAP Allotments), National Anti-Hunger Policy Conference and CACFP Leadership Conference 2012, Feeding America Summit 2012, and the Urban Institute (Role of SNAP During the Great Recession and Beyond). She serves on the Board of Directors for the California Food Policy Advocates and the San Francisco Food Bank/Marin Food Bank.